Classification of Low Ankle Sprains
Ecchymosis and swelling
Pain with weight bearing
stretch without tear
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A 30-year-old high level athlete sustained a low ankle sprain 1 week ago. The treatment options of immobilization and functional management are discussed. Which of the following statements is FALSE?
Functional management is associated with higher rate of return to sports than immobilization.
Functional management is associated with greater range of motion than immobilization.
Functional management is associated with less persistent swelling than immobilization.
Functional management is associated with a greater risk of increased ankle joint laxity than immobilization.
Functional management is associated with higher rate of satisfaction than immobilization.
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An 18-year-old presents with complaints of ankle pain after a fall 10 days ago. He has kept his ankle wrapped and elevated as recommended by his primary care doctor. He is neurovascularly intact on physical exam. The provocative maneuver shown in Figure A is positive. What neuromuscular pathway needs to be rehabilitated to reduce recurrence of the injury?
A 21-year-old collegiate basketball player comes down with a rebound and rolls his ankle. He is able to finish the game, but complains of ankle pain and swelling afterwards. Physical exam is notable for moderate inversion laxity with the ankle held in dorsiflexion. With placement of the ankle in plantarflexion, no inversion laxity is appreciated. Which of the following ligaments has been attenuated?
Anterior talofibular ligament
Anterior tibiofibular ligament
Posterior tibiofibular ligament
An 18-year-old male college student presents with a right ankle injury two weeks after slipping on a soccer ball. The skin is grossly intact and there is no evidence of neurovascular compromise. The provocative test demonstrated in Figure A is positive. Which of the following nonoperative treatment modalities have been shown to minimize recurrence of his injury?
Immobilization in a non weight-bearing cast
Immobilization in a weight-bearing boot
Immobilization in a splint
Functional bracing with early proprioceptive training
Neuromuscular training alone
A 20-year-old male sustains a right ankle injury after landing awkwardly catching a rebound in a basketball game. The next day he has swelling and ecchymosis present about the lateral ankle. There is no effusion in the knee. His area of maximal tenderness is represented by the area at the white arrow in Figure A. The examination demonstrated in Figure B reveals 2mm of ankle translation. The examination demonstrated in Figure C is not provocative for pain. A 3-view radiograph of the ankle is normal. What is the next most appropriate step in management?
Short leg cast for 4 weeks followed by physical therapy
Magnetic resonance imaging (MRI) of the ankle
Brostrom reconstruction with Gould modification
Functional bracing as needed and physical therapy
Magnetic resonance imaging (MRI) of the ankle with intra-articular contrast
In the majority of patients, which of the following treatments leads to a good or excellent one-year prognosis in the care of first time grade-III sprains of the lateral ligaments of the ankle?
Ice, elevation, and early physical therapy
Operative repair of the lateral ligaments
Self-guided early controlled mobilization
Application of a removable brace
All of the above
In dancers, peroneal muscle weakness has been shown to be the cause of which of the following?
Acute cuboid subluxation
A 38-year-old postal carrier complains of recurrent right ankle sprains and lateral ankle pain. A clinical photograph and radiograph are provided in Figures A and B. Coleman block testing demonstrates correction of the deformity. Custom orthotics, bracing, and NSAIDS have failed to provide pain relief or prevent recurrent sprains. Which of the following treatments should be pursued?
Steroid injection of the sinus tarsi and taping of the ankles before activity
Lateral ligament repair and augmentation with inferior extensor retinaculum
Lateral ligament reconstruction with peroneus brevis tendon grafting
First metatarsal osteotomy and lateral ligament reconstruction with peroneus brevis tendon grafting
Triple arthrodesis and split peroneus brevis tendon graft reconstruction of the lateral ligaments
The anterior drawer test with the ankle in 20 degrees of plantarflexion most effectively tests for injury or laxity or which of the following ligaments shown in Figure A?
A 20-year-old female collegiate basketball player has had recurrent ankle sprains of her right ankle. Trials of immobilization and physical therapy have not prevented further injuries. Physical exam reveals significant laxity of the right ankle compared to the left ankle, but otherwise is normal. Radiographs are unremarkable. What is the best surgical treatment for this patient?
Evans tenodesis (peroneus brevis tenodesis)
Modified Broström procedure
Allograft reconstruction with a tendon graft from the fibula to the 5th metatarsal base
Primary ligament repair with lateralizing calcaneal osteotomy
Primary ligament repair with a dorsiflexion osteotomy of the 1st metatarsal