Combined multi-ligament instability in patients with chronic symptoms following rotational ankle injuries. A prospective cohort study.

PURPOSE: To prospectively quantify isolated versus combined ligamentous instability in symptomatic patients after rotational ankle injuries (RAI) and assess changes in patient-reported outcomes (PROs) after targeted surgical stabilization.

METHODS

Adults with pain and/or subjective instability > 6 months after RAI who failed nonoperative care were enrolled. All underwent diagnostic ankle arthroscopy and open stabilization based on standardized intraoperative criteria for lateral, syndesmotic, and deep deltoid instability; combined patterns were classified. PROs and complications were recorded.

RESULTS

Twenty-nine patients (30 ankles; 36.1 years, BMI 31.2 kg/m2) after RAI were included, mean 45.2-month follow-up. Instability patterns were multidirectional (lateral/deltoid/syndesmotic) in 60%, rotational (lateral/deltoid) in 20%, anterolateral (lateral/syndesmotic) in 13%, and anteromedial (deltoid/syndesmotic) in 3.5%; isolated lateral occurred in 3.5%. Collected PROs showed improvement (ps<0.04) and three complications occurred (10%).

CONCLUSION

In symptomatic patients after RAI, multi-ligament ankle instability predominated, most commonly multidirectional or rotational patterns. Intraoperative-guided comprehensive stabilization yielded PRO improvements with a low complication rate.

STUDY

DESIGN

Level II. Prospective cohort study.