Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data
Song Y, Li H, Sun C, Zhang J, Gui J, Guo Q, Song W, Duan X, Wang X, Wang X, Shi Z; Chinese Society of Sports Medicine, Hua Y, Tang K, Chen S. Orthop J Sports Med. 2019 Sep 23;7(9):2325967119873852. doi: 10.1177/2325967119873852. eCollection 2019 Sep.
The Chinese Society of Sports Medicine released a new consensus statement to offer standardized guidelines for indications, surgical techniques, rehabilitation strategies, and assessment measures for people with chronic ankle instability. The document concludes with a clear list of 8 recommendations.
The Chinese Society of Sports Medicine concluded the following eight guidelines for indications, surgical techniques, rehabilitation strategies, and assessment measures for people with chronic ankle instability.
They are :
1. Surgery is suggested when patients continue to have symptoms of CLAI after 3 to 6 months of nonsurgical treatment and have indications of CLAI on physical and imaging examinations (stress radiography or MRI).
2. Simultaneous surgery for CLAI and OCL lesions of the talus or tibia is suggested when both are present.
3. Open and arthroscopic procedures are both recommended in patients with CLAI who undergo anatomic repair or reconstruction.
4. Autograft and allograft are both recommended for anatomic reconstruction in patients with CLAI.
5. When patients with CLAI have subtalar joint instability and both the ATFL and the CFL are ruptured, ATFL and CFL reconstruction is suggested.
6. For patients with CLAI who undergo anatomic repair or reconstruction, ROM (mostly dorsiflexion) and partial weight-bearing with a brace from the second day after surgery are recommended; for those with OCL who undergo anatomic repair or reconstruction and additional microfracture, early ROM and relatively delayed weight-bearing are recommended.
7. Joint stability, muscle strength, and full ROM are recommended prior to returning to sport after surgery.
8. The AOFAS score, Karlsson score, VAS score, FAAM scale, talus tilt test, and anterior drawer stress radiographs are recommended to assess CLAI”. [Song, et al., 2019]
As a graduate student and soon to be practicing clinician in the Athletic training setting, these guidelines will help me have an overview over how I assess, treat, and know when to refer to the team doctor and order imaging. These guidelines also provide a protocol to follow for postsurgical interventions as well as patient education on the topic.