Article information
El esguince de tobillo es una de las lesiones más comunes en ortopedia. El mecanismo más habitual de lesión es una entorsis en inversión del pie. Con este mecanismo, el complejo ligamentario lateral del tobillo se lesiona. La mayoría de los pacientes con esguince agudo de tobillo pueden ser manejados con éxito con un tratamiento conservador. Sin embargo, muchos pacientes sufren síntomas residuales que incluyen dolor crónico e inestabilidad.
La artroscopia en el tobillo sigue evolucionando. Se han observado lesiones intraarticulares durante la artroscopia de tobillo en pacientes afectos de dolor anterolateral tras un esguince de tobillo, o en la inestabilidad crónica de tobillo. Estos hallazgos artroscópicos sugieren la presencia de una microinestabilidad o inestabilidad oculta de tobillo en algunos pacientes, o de una inestabilidad rotatoria del tobillo en pacientes con síntomas crónicos de inestabilidad. Recientemente se han descrito técnicas artroscópicas para el tratamiento de la inestabilidad lateral del tobillo con resultados excelentes.
El objetivo de este trabajo es dar a los lectores una revisión completa sobre las novedades relacionadas con la inestabilidad crónica del tobillo.
Palabras clave:
Esguince de tobillo
Dolor anterolateral
Inestabilidad de tobillo
Artroscopia
Microinestabilidad
Inestabilidad rotatoria
Ankle sprain is one of the most common disorders among orthopaedic patients. The most common mechanism of injury is an inversion movement of the foot. With this mechanism, the lateral ligament complex of the ankle is injured. Most patients with acute ankle sprains can be successfully managed with conservative treatment. However, many patients report residual symptoms, including chronic pain and instability.
Arthroscopy in the ankle continues to evolve. Intra-articular pathological findings have been observed during ankle arthroscopy in patients affected by anterolateral pain after an ankle sprain or chronic ankle instability. These findings suggest the presence of a microinstability or occult ankle instability in some patients, or a rotational ankle instability in patients with chronic instability symptoms. Recently, arthroscopic techniques have been described to treat lateral ankle instability with excellent results.
The aim of this paper is to provide the readers a comprehensive review of innovations regarding the chronic ankle instability.
Key words:
Ankle sprain
Anterolateral pain
Ankle instability
Arthroscopy
Microinstability
Rotational instability
Full text is only aviable in PDF
Bibliografía
[1.]
F.C. Balduini, J. Tetzlaff.
Historical perspectives on injuries of the ligaments of the ankle.
Clin Sports Med, 1 (1982), pp. 3-12
[2.]
F.H. Renstrom, S.A. Lynch.
Acute injuries of the ankle.
Foot Ankle Clin, 4 (1999), pp. 697-711
[3.]
J.S. Makhani.
Diagnosis and treatment of acute rupture of the various components of the lateral ligaments of the ankle.
Am J Orthop, 4 (1962), pp. 224-230
[4.]
P.B. McCulloch, P. Holden, D.J. Robson, D.I. Rowley, S.H. Norris.
The value of mobilisation and nonsteroidal anti-inflammatory analgesia in the management of inversion injuries of the ankle.
Br J Clin Pract, 39 (1985), pp. 69-72
[5.]
T. Viljakka, P. Rokkanen.
The treatment of ankle sprain by bandaging and antiphlogistic drugs.
Ann Chir Gynaecol, 72 (1983), pp. 66-70
[6.]
J.G. Garrick.
The frequency of injury, mechanism of injury, and epidemiology of ankle sprains.
Am J Sports Med, 5 (1977), pp. 241-242
[7.]
N.A. Ferran, F. Oliva, N. Maffulli.
Ankle instability.
Sports Med Arthrosc, 17 (2009), pp. 139-145
[8.]
C.N. Van Dijk.
On diagnostic strategies in patient with severe ankle sprain.
Thesis, University of Amsterdam, (1994),
[9.]
L. Broström, V. Sprained ankles.
Treatment and prognosis in recent ligament ruptures.
Acta Chir Scand, 132 (1966), pp. 537-550
[10.]
S.K. Sarrafian.
Anatomy of the foot and ankle. Descriptive, topographic.
functional, 2nd edition., J.B. Lippincott Co, (1993),
[11.]
C.E. Milner, R.W. Soames.
Anatomical variations of the anterior talofibular ligament of the human ankle joint.
J Anat, 191 (1997), pp. 457-458
[12.]
E.M. Delfaut, X. Demondion, N. Boutry, H. Cotten, H. Mestdagh, A. Cotten.
Multi-fasciculated anterior talo-fibular ligament: Reassessment of normal findings.
Eur Radiol, 13 (2003), pp. 1836-1842
[13.]
P. Golanó, J. Vega, L. Pérez-Carro, V. Götzens.
Ankle anatomy for the arthroscopist. Part II: Role of the ankle ligaments in soft tissue impingement.
Clin N Am, 11 (2006), pp. 275-296
[14.]
J. Vega, P. Golanó, F. Pellegrino, E. Rabat, F. Peña.
All-inside arthroscopic lateral collateral ligament repair for ankle instability with a knotless suture anchor technique.
Foot Ankle Int, 34 (2013), pp. 1701-1709
[15.]
T.B. Neuschwander, A.A. Indresano, T.H. Hughes, B.W. Smith.
Footprint of the lateral ligament complex of the ankle.
Foot Ankle Int, 34 (2013), pp. 582-586
[16.]
N.A. Ferran, N. Maffulli.
Epidemiology of sprains of the lateral ankle ligament complex.
Foot Ankle Clin N Am, 11 (2006), pp. 659-662
[17.]
A.M. Rijke, H.T. Goitz, F.C. McCue, P.M. Dee.
Magnetic resonance imaging of injury to the lateral ankle ligaments.
Am J Sports Med, 21 (1993), pp. 528-534
[18.]
G. Lentell, B. Baas, D. Lopez, L. McGuire, M. Sarrels, P. Snyder.
The contributions of proprioceptive deficits, muscle function, and anatomic laxity to functional instability of the ankle.
J Orthop Sports Phys Ther, 21 (1995), pp. 206-215
[19.]
J.P. Gerber, G.N. Williams, C.R. Scoville, R.A. Arciero, D.C. Taylor.
Persistent disability associated with ankle sprains: A prospective examination of an athletic population.
Foot Ankle Int, 19 (1998), pp. 653-660
[20.]
M.A. Freeman.
Instability of the foot after injuries to the lateral ligament of the ankle.
J Bone Joint Surg Br, 47 (1965), pp. 669-677
[21.]
J. Hertel.
Functional instability following lateral ankle sprain.
Sports Med, 29 (2000), pp. 361-371
[22.]
R.D. Ferkel, R.P. Karzel, W. Del Pizzo, M.J. Friedman, S.P. Fischer.
Arthroscopic treatment of anterolateral impingement of the ankle.
Am J Sports Med, 19 (1991), pp. 440-446
[23.]
R.D. Ferkel.
Soft-tissue lesions of the ankle.
Arthroscopic surgery: The foot and ankle, pp. 121-143
[24.]
R.D. Ferkel, S.P. Fisher.
Progress in ankle arthroscopy.
Clin Orthop, 240 (1989), pp. 210-220
[25.]
S.H. Kim, K.I. Ha.
Arthroscopic treatment for impingement of the anterolateral soft tissues of the ankle.
J Bone Joint Surg Br, 82B (2000), pp. 1019-1021
[26.]
M. Takao, K. Innami, T. Matsushita, Y. Uchio, M. Ochi.
Arthroscopic and magnetic resonance image appearance and reconstruction of the anterior talofibular ligament in cases of apparent functional ankle instability.
Am J Sports Med, 36 (2008), pp. 1542-1547
[27.]
I. Taga, K. Shino, M. Inoue, K. Nakata, A. Maeda.
Articular cartilage lesions in ankles with lateral ligament injury: An arthroscopic study.
Am J Sports Med, 21 (1993), pp. 120-127
[28.]
C.N. Van Dijk, P.M.M. Bossuyt, R.K. Marti.
Medial ankle pain after lateral ligament rupture.
J Bone Joint Surg Br, 78B (1996), pp. 562-567
[29.]
W.B. Kibler.
Arthroscopic findings in ankle ligament reconstruction.
Clin Sports Med, 15 (1996), pp. 799-804
[30.]
G.A. Komeda, R.D. Ferkel.
Arthroscopic findings associated with the unstable ankle.
Foot Ankle Int, 20 (1999), pp. 708-713
[31.]
B. Hintermann, A. Boss, D. Schafer.
Arthroscopic findings in patients with chronic ankle instability.
Am J Sports Med, 30 (2002), pp. 402-409
[32.]
R.D. Ferkel, R.N. Chams.
Chronic lateral instability: Arthroscopic findings and long-term results.
Foot Ankle Int, 28 (2007), pp. 24-31
[33.]
R.J. Meislin, D.J. Rose, J.S. Parisien, S. Springer.
Arthroscopic treatment of synovial impingement of the ankle.
Am J Sports Med, 21 (1993), pp. 186-189
[34.]
S.H. Liu, A. Raskin, L. Osti, K. Jacobson, G. Finerman, C. Baber.
Arthroscopic treatment of anterolateral ankle impingement.
Arthroscopy, 10 (1994), pp. 215-218
[35.]
S. Rasmussen, C. Hjorth Jensen.
Arthroscopic treatment of impingement of the ankle reduces pain and enhances function.
Scand J Med Sci Sports, 12 (2002), pp. 69-72
[36.]
H.A. Gulish, R.J. Sullivan, M. Aronow.
Arthroscopic treatment of soft-tissue impingement lesions of the ankle in adolescents.
Foot Ankle Int, 26 (2005), pp. 204-207
[37.]
M. Urgüden, Y. Söyüncü, H. Ozdemir, H. Sekban, F.F. Akyildiz, A.T. Aydin.
Arthroscopic treatment of anterolateral soft tissue impingement of the ankle: evaluation of factors affecting outcome.
Arthroscopy, 21 (2005), pp. 317-322
[38.]
A.H. Hassan.
Treatment of anterolateral impingements of the ankle joint by arthroscopy.
Knee Surg Sports Traumatol Arthrosc, 15 (2007), pp. 1150-1154
[39.]
J.M. Villarreal, R.B. Cerecedo, F.F. Cal y Mayor, I.L. González.
Arthroscopic treatment for anterolateral ankle impingement of athletes.
Acta Ortop Mex, 22 (2008), pp. 103-106
[40.]
A.M. Moustafa El-Sayed.
Arthroscopic treatment of anterolateral impingement of the ankle.
J Foot Ankle Surg, 49 (2010), pp. 219-223
[41.]
R. Franco, J. Vega, M. Pérez, D. Redó, J.R. Ramazzini, A. Dalmau.
Resultados del tratamiento artroscópico del pinzamiento blando de tobillo.
Rev Pie Tobillo, 24 (2010), pp. 24-29
[42.]
L. Alparslan, C.P. Chiodo.
Lateral ankle instability: MR imaging of associated injuries and surgical treatment procedures.
Semin Musculoskelet Radiol, 12 (2008), pp. 346-358
[43.]
B. Hintermann.
Biomechanics of the unstable ankle joint and clinical implications.
Med Sci Sports Exerc, 31 (1999), pp. 459-469
[44.]
J.R. Crim, T.C. Beals, F. Nickisch, A. Schannen, C.L. Saltzman.
Deltoid ligament abnormalities in chronic lateral ankle instability.
Foot Ankle Int, 32 (2011), pp. 873-878
[45.]
V. Valderrabano, M. Wiewiorski, A. Frigg, B. Hintermann, A. Leumann.
Chronic ankle instability.
Unfallchirurg, 110 (2007), pp. 691-699
[46.]
R.M. Van Rijn, A.G. van Os, R.M. Bernsen, P.A. Luijsterburg, B.W. Koes, S.M. Bierma-Zeinstra.
What is the clinical course of acute ankle sprains?. A systematic literature review.
Am J Med, 121 (2008), pp. 324-331
[47.]
T. Buchhorn, P. Ziai.
Ventral impingement syndrome of the ankle joint.
Arthroskopie, 22 (2009), pp. 109-115
[48.]
J. Leanderson, E. Eriksson, C. Nilsson, A. Wykman.
Proprioception in classical ballet dancers. A prospective study of the influence of an ankle sprain on proprioception in the ankle joint.
Am J Sports Med, 24 (1996), pp. 370-374
[49.]
S. Robbins, E. Waked.
Factors associated with ankle injuries preventive measures.
Sports Med, 25 (1998), pp. 63-72
[50.]
G.G. Asimenia, M. Paraskevi, S. Polina, B. Anastasia, T. Kyriakos.
Aquatic training for ankle instability.
Foot Ankle Spec, 6 (2013), pp. 346-350
[51.]
G.B. Wilkerson, J. Pinerola, R.W. Caturano.
Invertor vs evertor peak and power deficiencies associated with lateral ankle ligament injury.
J Orthop Sports Phys Ther, 26 (1997), pp. 78-86
[52.]
C.W. DiGiovanni, A. Brodsky.
Current Concepts: Lateral Ankle Instability.
Foot Ankle Int, 27 (2006), pp. 854-866
[53.]
D. Rosenbaum, E. Eils.
A multistation proprioceptive exercise program in patients with ankle instability.
Med Sci Sports Exer, 33 (2001), pp. 1991-1998
[54.]
I. Miralles, S. Monterde, S. Montull, I. Salvat, J. Fernández- Ballart, J. Beceiro.
Ankle Taping Can Improve Proprioception in Healthy Volunteers.
Foot Ankle Int, 31 (2010), pp. 1099-1106
[55.]
B.F. DiGiovanni, G. Partal, J. Baumhauer.
Acute ankle injury and chronic lateral instability in the athlete.
Clin Sports Med, 23 (2004), pp. 1-19
[56.]
B.F. DiGiovanni, C.J. Fraga, B.E. Cohen, M.J. Shereff.
Associated injuries found in chronic lateral ankle instability.
Foot Ankle Int, 21 (2000), pp. 809-815
[58.]
J.S. De Vries, R. Krips, I.N. Sierevelt, L. Blankevoort, C.N. van Dijk.
Interventions for treating chronic ankle instability.
Cochrane Database Syst Rev, 10 (2011), pp. CD004124
[59.]
A.M. Rijke, H.T. Goitz, F.C. McCue, P.M. Dee.
Magnetic resonance imaging of injury to the lateral ankle ligaments.
Am J Sports Med, 21 (1993), pp. 528-534
[60.]
G. Lentell, B. Baas, D. Lopez, L. McGuire, M. Sarrels, P. Snyder.
The contributions of proprioceptive deficits, muscle function, and anatomic laxity to functional instability of the ankle.
J Orthop Sports Phys Ther, 21 (1995), pp. 206-215
[61.]
J.P. Gerber, G.N. Williams, C.R. Scoville, R.A. Arciero, D.C. Taylor.
Persistent disability associated with ankle sprains: A prospective examination of an athletic population.
Foot Ankle Int, 19 (1998), pp. 653-660
[62.]
G.J. Sammarco, O.B. Idusuyi.
Reconstruction of the lateral ankle ligaments using a split peroneus brevis tendon graft.
Foot Ankle Int, 20 (1999), pp. 97-103
[63.]
T.M. Messer, C.A. Cummins, J. Ahn, A.S. Kelikian.
Outcome of the modified Broström procedure for chronic lateral ankle instability using suture anchors.
Foot Ankle Int, 21 (2000), pp. 996-1003
[64.]
R. Schmidt, S. Benesch, C. Bertsch.
Biomechanical consequences of anatomical reconstruction of the lateral ligaments to the ankle joint complex: An in-vitro investigation.
Deutsche Zeitschrift für Sportmedizin, 54 (2003), pp. 136-141
[65.]
S.H. Liu, C.L. Baker.
Comparison of lateral ankle ligamentous reconstruction procedures.
Am J Sports Med, 22 (1994), pp. 313-317
[66.]
J.M. Hollis, R.D. Blasier, C.M. Flahiff, O.E. Hofmann.
Biomechanical comparison of reconstructive techniques in simulated lateral ankle ligament injury.
Am J Sports Med, 23 (1995), pp. 678-682
[67.]
R. Bahr, F. Pena, J. Shine, W.D. Lew, S. Tyrdal, L. Engebretsen.
Biomechanics of ankle ligament reconstruction: An in vitro comparison of the Brostrom repair. Watson-Jones reconstruction, and a new anatomic reconstruction technique.
Am J Sports Med, 25 (1997), pp. 424-432
[68.]
R. Krips, C.N. van Dijk, P.T. Halasi, H. Lehtonen, C. Corradini, Moyen, J. Karlsson.
Long-term outcome of anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint: A multicenter study.
Foot Ankle Int, 22 (2001), pp. 415-421
[69.]
T. Fujii, H.B. Kitaoka, K. Watanabe, Z.P. Luo, K.N. An.
Comparison of modified Brostrom and Evans procedures in simulated lateral ankle injury.
Med Sci Sports Exerc, 38 (2006), pp. 1025-1031
[70.]
W.G. Hamilton, F.M. Thompson, S.W. Snow.
The modified Brostrom procedure for lateral ankle instability.
Foot Ankle, 14 (1993), pp. 1-7
[71.]
H. Thermann, H. Zwipp, H. Tscherne.
Treatment algorithm of chronic ankle and subtalar instability.
Foot Ankle Int, 18 (1997), pp. 163-169
[72.]
S.J. Bell, T.S. Mologne, D.F. Sitler, J.S. Cox.
Twenty-six-year results after Brostrom procedure for chronic lateral ankle instability.
Am J Sports Med, 34 (2006), pp. 975-978
[73.]
C.N. Van Dijk, D. Scholte.
Arthroscopy of the ankle joint.
Arthroscopy, 13 (1997), pp. 90-96
[74.]
C.N. Van Dijk, P.E. Scholten, R. Krips.
A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology.
Arthroscopy, 16 (2000), pp. 871-876
[75.]
M. Maiotti, C. Massoni, U. Tarantino.
The use of arthroscopic thermal shrinkage to treat chronic lateral ankle instability in young athletes.
Arthroscopy, 21 (2005), pp. 751-757
[76.]
T.H. Lui.
Arthroscopic-assisted lateral ligamentous reconstruction in combined ankle and subtalar instability.
Arthroscopy, 23 (2007), pp. 554
[77.]
N.M. Corte-Real, R.M. Moreira.
Arthroscopic repair of lateral ankle instability.
Foot Ankle Int, 30 (2009), pp. 213-217
[78.]
C. Nery, F. Raduan, A. Del Buono, I.D. Asaumi, M. Cohen, N. Maffulli.
Arthroscopic-assisted Broström-Gould for chronic ankle instability: A long-term follow-up.
Am J Sports Med, 39 (2011), pp. 2381-2388
[79.]
J.I. Acevedo, P.G. Mangone.
Arthroscopic lateral ankle ligament reconstruction.
Tech Foot Ankle, 10 (2011), pp. 111-116
[80.]
E.S. Kim, K.T. Lee, J.S. Park, Y.K. Lee.
Arthroscopic anterior talofibular ligament repair for chronic ankle instability with a suture anchor technique.
Orthopedics, 34 (2011), pp. 1-5
[81.]
L.B. Cannon, H.K. Slater.
The role of ankle arthroscopy and surgical approach in lateral ankle ligament repair.
J Foot Ankle Surg, 11 (2005), pp. 1-4
[82.]
Y. Hua.
Modified Broström procedure plus ankle arthroscopy may be effective for ankle instability.
Arthroscopy, 26 (2010), pp. 524-528
[83.]
W.R. Bosien, O.S. Staples, S.W. Russell.
Residual disability following acute ankle sprains.
J Bone Joint Surg Am, 37 (1955), pp. 1237-1243
Copyright © 2013. SEMCPT. Publicado por Elsevier España, S.L.U.
