Early Versus Delayed Mobilization Post-Operative Protocols for Primary Lateral Ankle Ligament Reconstruction: A Systematic Review and Meta-Analysis

Early Functional Rehabilitation in Foot and Ankle Surgery

The traditional postoperative management of common foot and ankle procedures has involved a prolonged period of immobilization and nonweight bearing. The concern was loss of correction and fixation failure. However, it has been shown that a prolonged period of nonweight bearing can predispose patients possible deep vein thrombosis, disuse osteopenia, cardiovascular complications, and generalized deconditioning. The authors' institution has published studies reviewing the efficacy of early weight bearing after first metatarsophalangeal joint arthrodesis, modified Lapidus bunionectomy, and open reduction and internal fixation of ankle fractures. This article highlights the literature and rationale supporting the safety of early weight-bearing protocols.

Current concepts in the surgical management of chronic ankle lateral ligament instability

Background/aims

Ankle sprains are common injuries which can lead to chronic lateral ankle ligament instability (CAI).

Methods

The aim of this review is to provide a comprehensive overview of the epidemiology, pathophysiology, investigation, surgical management and rehabilitation of CAI.

Results

Investigation of CAI is based on history, clinical examination, and imaging. Surgical management of CAI can be defined as anatomic reconstruction, anatomic and non anatomic repair of ATFL and/or CFL. Anatomic repair has been shown to have better functional outcomes and less secondary osteoarthritis when compared to non anatomic repair. Non-anatomic methods do not replicate the normal anatomical course of ATFL/CFL and may lead to stiffness. The most common surgical treatment for CAI is the open modified Broström repair augmented with the Gould modification. There are arthroscopic techniques being developed which have reported promising clinical results. However, there are considerable areas of further research which should be carried out to improve understanding and effectiveness of current treatment options. Standardised validated patient reported outcome measures and evidence-based protocols in the rehabilitation periods are crucial for positive and reproducible outcomes.

Conclusion

Surgical repair has proven to show excellent outcomes for patients suffering from CAI, however larger prospective studies should be carried out to evaluate the use of newer surgical techniques.