Early mobilization versus immobilization after ankle ligament stabilization.
Functional outcome, stability at radiographic investigation and ankle joint torque after anatomical reconstruction of the lateral ankle ligaments were evaluated in patients with early postoperative mobilization versus those with cast immobilization. Thirty patients with chronic lateral ligament instability of the ankle underwent anatomical reconstruction of the ligaments. Postoperatively the patients were randomly allocated to two groups: Group A (n=15) were immobilized in a below-knee plaster for 6 weeks and Group B (n=15) underwent early controlled range of motion training using an Air-Cast ankle brace. The functional results were evaluated using a scoring scale and objective results using standardized stress radiographs. Also eccentric and concentric muscle torque at 60 degrees/s was measured in plantar flexion and dorsiflexion, respectively. The functional results were satisfactory in 12/15 ankles in Group A and 14/15 in Group B (n.s.). All the patients with satisfactory results regained normal range of motion. Patients with unsatisfactory results had either residual pain or recurrent instability. In Group B, the strength measurements revealed significantly higher peak torque values after three months in plantar flexion at 60 degrees/s. Six months postoperatively, the torque values did not differ significantly between the groups. Also, there was no group difference in the laxity of the ankle joint, including both anterior talar translation test and talar tilt test, at the two-year follow-up. One patient had a superficial wound infection. We conclude that after the reconstruction of chronic lateral ligament instability of the ankle the functional and stability results were equally good with early postoperative mobilization and 6-week immobilization. However, using early mobilization plantar flexion strength was regained earlier than with cast immobilization, without any risk of short- or medium-term complications, such as increased ankle laxity. We recommend early mobilization after anatomical reconstruction of the lateral ankle ligaments.
Karlsson
J
J
Department of Orthopaedics, Sahlgrens University Hospital, Göteborg, Sweden.
Lundin
O
O
Lind
K
K
Styf
J
J
D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000601:surgery*; D002370:Casts, Surgical; D005260:Female; D006801:Humans; D007103:Immobilization; D007593:Joint Instability / Q000601:surgery*; D008023:Ligaments, Articular / Q000293:injuries*; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome