title: Minor or occult ankle instability as a cause of anterolateral pain after ankle sprain.
abstract: OBJECTIVE
  The aim of this study was to determine which intra-articular injuries are associated with chronic anterolateral pain and functional instability after an ankle sprain.
  
  
  METHODS
  From 2008 to 2010, records of all patients who underwent ankle joint arthroscopy with anterolateral pain and functional instability after an ankle sprain were reviewed. A systematic arthroscopic examination of the intra-articular structures of the ankle joint was performed. Location and characteristics of the injuries were identified and recorded.
  
  
  RESULTS
  A total of 36 ankle arthroscopic procedures were reviewed. A soft-tissue occupying mass over the lateral recess was present in 18 patients (50%). A partial injury of the anterior talofibular ligament (ATFL) was observed in 24 patients (66.6%). Cartilage abrasion due to the distal fascicle of the anteroinferior tibiofibular ligament coming into contact with the talus was seen in 21 patients (58.3%), but no thickening of the ligament was observed. Injury to the intra-articular posterior structures, including the transverse ligament in 19 patients (52.7%) and the posterior surface of the distal tibia in 21 patients (58.3%), was observed.
  
  
  CONCLUSIONS
  Intra-articular pathological findings have been observed in patients affected by anterolateral pain after an ankle sprain. Despite no demonstrable abnormal lateral laxity, morphologic ATFL abnormality has been observed on arthroscopic evaluation. An injury of the ATFL is present in patients with chronic anterolateral pain and functional instability after an ankle sprain. A degree of microinstability due to a deficiency of the ATFL could explain the intra-articular pathological findings and the patients' complaints.
  
  
  METHODS
  IV.
authors.affiliation: Foot and Ankle Unit, Hospital Quirón Barcelona, Plaza Alfonso Comín 5, 08023, Barcelona, Spain. jordivega@hotmail.com.
authors.forename: Jordi
authors.initials: J
authors.lastname: Vega
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Peña
authors.affiliation: Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain.|Department of Orthopaedic Surgery, Medical School, University of Pittsburgh, Pisttsburgh, PA, USA.
authors.forename: Pau
authors.initials: P
authors.lastname: Golanó
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000150:complications* / Q000601:surgery; D000843:Ankle Joint; D018771:Arthralgia / Q000209:etiology*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology*; D008023:Ligaments, Articular / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013180:Sprains and Strains / Q000150:complications* / Q000601:surgery; D055815:Young Adult
keywords: Ankle instability; Ankle sprain; Anterolateral pain; Arthroscopy; Ligaments; Microinstability