Acute Lateral Ankle Injuries In Track & Field Athletes

A NEW CLASSIFICATION

N. Malliaropoulos, M.Desalen, Em. Papacostas

National Track & Field Centre - Sports Injury Clinic

Thessaloniki

ABSTRACT

Key words: ankle sprains, recurrence rate , classification, criteria.

PURPOSE: To introduce our ankle sprains classification method based on objective criteria.

MATERIALS – METHODS:170 acute lateral ankle ligament injuries were examined. These cases were initially classified in the usual clinical way. In addition we estimated the full rehabilitation time and measured the following:

a. active range of motion by goniometry, b. ankle oedema with the figure of 8 (eight) method, c. distance between the posterior articular surface of the tibia to the nearest point of the talus, from the anterior drawer stress x – rays (for 3rd degree cases). We compared all our measurements to the healthy side.

RESULTS:

Results: Twenty five out of the 183 athletes (13,60%) experienced a second ankle injury. First degree injuries, 71 athletes, presented 14,08% recurrence rate. Second degree injuries, 66 athletes, presented 19,69% recurrence rate. Third degree injuries, 40 athletes, presented 5% recurrence rate and none of the fourth degree injured athletes presented the same injury (0% recurrence rate).

74 (43.5%) cases were categorized as first grade, 53 (31.1%) second and 43 (25.4%) as third degree. In those cases that were classified, on clinical grounds, as third degree, we conducted anterior drawer stress x-rays, and reclassified them according to these findings in two subgroups, IIIA & IIIB

GRADEROMOEDEMA (cm)STRESS X-RAYS
I3.65° (±3.96°)0.25 (±0.31) 
II8.45°(±4.78°)1.608 (±0.66) 
IIIA14°(±5.85°)2.19 ±0.47)2.18mm (±0.65mm)
IIIB20.88°(±10.24°)2.32 ±0.27)6mm (±0.78mm)

When oedema is measured there is substantial difference (p<0,05) between grades I, II and IIIA, although there is no statistical difference between IIIA and IIIB. However, when active ROM is measured there is significant statistical difference (SSD) between all grades (I, II, IIIA, IIIB). The above signify the difference between grades IIIA and IIIB.

Most importantly, when the stress x- rays results are analysed, SSD occurs when comparing grades IIIA and IIIB.

CONCLUSIONS: As a conclusion we think that the following criteria can be safely used for more accurate classification of acute ankle lateral injuries, leading in specific treatment and earlier return in sports activities.

GradeDecreased ROMOedemaStress radiographs
Iup to 5°up to 0,5cmNot obtained
II5° to 10°0,5cm to 2cmNot obtained
IIIAmore than 10°more than 2cmNormal
IIIBmore than 10°more than 2cmjoint laxity more than 5mm

Objective: The aim of our study is to establish that therapeutic applications according to the healing process phases and further subdivision of the existing three grade classification into a four grade one is correlated with low recurrence rate.

Design: During the period 1990-2005, 183 elite Track and field athletes were treated for an ankle injury. All cases were classified in four (4) grades (I, II, IIIA, and IIIB) according to our classification criteria. In a grade I injury, there are decreased ROM up to 5 compared with the uninjured side, and EDE up to 0.5 cm. In a grade II injury, there are decreased ROM more than 5 and less than 10 , and EDE greater than 0.5 cm and less than 2.0 cm. In grade IIIA injury, there are decreased ROM greater than 10, EDE greater than 2.0 cm and normal stress radiographs. Finally in a grade IIIB injury, there are decreased ROM greater than 10, EDE greater than 2 cm and difference in distance between the posterior articular surface of the tibia to the nearest point of talus when comparing uninjured and injured ankles greater than 3mm.

Results: Twenty five out of the 183 athletes (13,60%) experienced a second ankle injury. First degree injuries, 71 athletes, presented 14,08% recurrence rate. Second degree injuries, 66 athletes, presented 19,69% recurrence rate. Third degree injuries, 40 athletes, presented 5% recurrence rate and none of the fourth degree injured athletes presented the same injury (0% recurrence rate).

Conclusions: The proposed classification has great value in predicting full return in athletic activities without residual complaints, if the proper rehabilitation programme is executed.

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