title: Anterior fibrous bundle: a cause of residual pain and restrictive plantar flexion following ankle sprain.
abstract: OBJECTIVE
  To describe anterior fibrous bundle as an intra-articular residual disorder following ankle sprain.
  
  
  METHODS
  Between January 1998 and January 2009, we performed arthroscopy on 10 patients (7 males, 3 females; median age, 25 years; age range, 17-43 years) who had the uncommon problem of anterior ankle pain accompanied by restriction of plantar flexion following an ankle sprain. Pre-operative magnetic resonance imaging revealed osteochondral lesions (OCLs) of the talar dome in 3 patients, but no other findings that could explain restricted plantar flexion. All patients underwent arthroscopy for investigation and treatment of the cause of symptoms, and the 3 patients with OCL underwent additional arthroscopic drilling. Outcome was measured using the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score, Visual Analogue Scale (VAS) for pain and active plantar flexion angle.
  
  
  RESULTS
  In all patients, an anterior fibrous bundle was confirmed under arthroscopic investigation as the cause of symptoms and was resected arthroscopically. Median AOFAS and VAS scores improved significantly from 65 (range 61-82) and 70 (range 50-85) pre-operatively to 95 (range 84-100) and 4 (range 0-15) at final follow-up, respectively (p < 0.001). In addition, median active plantar flexion angle improved significantly from 40° (range 35-40) pre-operatively to 55° (range 45-55), (p < 0.01).
  
  
  CONCLUSIONS
  An anterior fibrous bundle is one of the intra-articular residual disorders after ankle sprain that can cause restriction of plantar flexion.
authors.affiliation: Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan. miyamoto@med.teikyo-u.ac.jp
authors.forename: Wataru
authors.initials: W
authors.lastname: Miyamoto
authors.forename: Masato
authors.initials: M
authors.lastname: Takao
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsushita
mesh_terms: D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000150:complications / Q000473:pathology* / Q000601:surgery; D001182:Arthroscopy; D059350:Chronic Pain / Q000209:etiology*; D005260:Female; D005355:Fibrosis; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular; D055815:Young Adult