Inestabilidad lateral aguda de tobillo. Estudio comparativo entre el tratamiento quirúrgico mínimamente invasivo y el tratamiento funcional
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Published:
Apr 30, 2025
Keywords:
Lateral ankle instability, stress radiography, ankle sprain, functional treatment, surgical treatment
Main Article Content
Abstract
Introduction: Lateral ankle instability is a frequently underdiagnosed condition. The objective of this study was to evaluate two treatment approaches: functional and surgical. We hypothesized that ligament reconstruction using peripheral tissue promotes scar formation, stabilizing the joint and leading to better recovery outcomes compared to functional treatment.
Materials and Methods: Between 2021 and 2023, 48 patients with lateral ankle instability were treated. Stress radiographs were performed by applying a varus force to the hindfoot while stabilizing the distal leg and comparing the affected ankle with the contralateral healthy ankle. Patients were divided into two groups according to the treatment received: Group A (minimally invasive surgical technique) and Group B (functional treatment).
Results: The comparative results were as follows: Visual Analog Scale scores: Group A: 9.6, Group B: 7.26. American Orthopaedic Foot & Ankle Society (AOFAS) scores: Group A: 99.7, Group B: 85.3. Additional outcomes assessed included residual instability, time to return to previous activities, and complications.
Conclusions: This study suggests that minimally invasive surgical treatment for lateral ankle instability is an effective option, providing faster recovery and better clinical outcomes compared to functional treatment, with a low complication rate.
Materials and Methods: Between 2021 and 2023, 48 patients with lateral ankle instability were treated. Stress radiographs were performed by applying a varus force to the hindfoot while stabilizing the distal leg and comparing the affected ankle with the contralateral healthy ankle. Patients were divided into two groups according to the treatment received: Group A (minimally invasive surgical technique) and Group B (functional treatment).
Results: The comparative results were as follows: Visual Analog Scale scores: Group A: 9.6, Group B: 7.26. American Orthopaedic Foot & Ankle Society (AOFAS) scores: Group A: 99.7, Group B: 85.3. Additional outcomes assessed included residual instability, time to return to previous activities, and complications.
Conclusions: This study suggests that minimally invasive surgical treatment for lateral ankle instability is an effective option, providing faster recovery and better clinical outcomes compared to functional treatment, with a low complication rate.
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How to Cite
Arzac Ulla, I. (2025). Inestabilidad lateral aguda de tobillo. Estudio comparativo entre el tratamiento quirúrgico mínimamente invasivo y el tratamiento funcional. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(2), 131-140. https://doi.org/10.15417/issn.1852-7434.2025.90.2.2035
Section
Clinical Research
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References
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microinstability and ankle functional instability. J Clin Orthop Trauma 2024;51:102380. https://doi.org/10.1016/j.jcot.2024.102380
2. Camacho LD, Roward ZT, Deng Y, Latt LD. Surgical management of lateral ankle instability in athletes. J Athl Train 2019;54(6):639-49. https://doi.org/10.4085/1062-6050-348-18
3. Altomare D, Fusco G, Bertolino E, Ranieri R, Sconza C, Lipina M, et al. Evidence-based treatment choices for
acute lateral ankle sprain: a comprehensive systematic review. Eur Rev Med Parmacol Sci 2022;26(6):1876-84.
https://doi.org/10.26355/eurrev_202203_28333
4. Aiyer A, Murali S, Kadakia AR. Advances in diagnosis and management of lateral ankle instability: A review of
current literature. J Am Acad Orthop Surg Glob Res Rev 2023;7(12):e23.00251. https://doi.org/10.5435/JAAOSGlobal-D-23-00251
5. Puri A. Lateral ankle instability – repair/ reconstruct what’s new. J Orthop Surg (Hong Kong) 2023;31(2):
10225536231182348. https://doi.org/10.1177/10225536231182348
6. Hamilton WG. Sprained ankles in ballet dancers. Foot Ankle 1982;3(2):99-102. https://doi.org/10.1177/107110078200300208
7. Freeman MA. Instability of the foot after injuries to the lateral ligament of the ankle. J Bone Joint Surg Br 1965;47(4):669-77. PMID: 5846766
8. Kerkhoffs GM, Handoll HH, de Bie R, Rowe BH, Struijs PA. Surgical versus conservative treatment for acute
injuries of the lateral ligament complex of the ankle in adults. Cochrane Database Syst Rev 2007;(2):CD000380.
https://doi.org/10.1002/14651858.CD000380.pub2
9. Knupp M, Ledermann HP, Magerkurth O, Hintermann B. The surgical tibiotalar angle: a radiological study. Foot
Ankle Int 2005;26(9):713-6. https://doi.org/10.1177/107110070502600909
10. Kato T. The diagnosis and treatment of instability of the subtalar joint. J Bone Joint Surg Br 1995;77(3):400-6.
PMID: 7744924
11. Gould N, Seligson D, Gassman J. Early and late repair of lateral ligament of the ankle. Foot Ankle 1980;1(2):84-9. https://doi.org/10.1177/10711008000100206
12. Bersusky E, Arzac Ulla I, Loterzo LG, Ricciardi G, Zanotti G. Puntajes VI. Rev Asoc Argent Ortop Traumatol 2023;88(1):123-7. https://doi.org/10.15417/issn.1852-7434.2023.88.1.1706
13. Gribble PA. Evaluating and differentiating ankle instability. J Athl Train 2019;54(6):617-27. https://doi.org/10.4085/1062-6050-484-17
14. Kim TY, Hwang YG, Ahn J, Baek JH, Jeong BO. Evaluation of stress radiographs taken before and after spinal
anesthesia in patients with chronic ankle instability. J Foot Ankle Surg 2020;59(1):53-8. https://doi.org/10.1053/j.jfas.2019.01.020
15. Sarcon AK, Heyrani N, Giza E, Kreulen C. Lateral ankle sprain and chronic ankle instability. Foot Ankle Orthop
2019;4(2):2473011419846938. https://doi.org/10.1177/2473011419846938
16. Hao ZT, Ma YX, Hao T, Feng W, Wang JH, Fan DS, et al. Comparison of surgical intervention with functional
treatment for acute ruptures of lateral ankle ligament: a meta-analysis. Asian Pac J Trop Med 2012;5(5):396-401.
https://doi.org/10.1016/S1995-7645(12)60066-2
17. Doherty C, Bleakley C, Hertel J, Caulfield B, Ryan J, Delahunt E. Recovery from a first-time lateral ankle sprain
and the predictors of chronic ankle instability: a prospective cohort analysis. Am J Sports Med 2016;44(4):995-1003. https://doi.org/10.1177/0363546516628870
18. Cao S, Wang C, Wang X, Ma X. Percutaneous inferior extensor retinaculum augmentation technique for chronic ankle instability. Orthop Surg 2022;14(5):977-83. https://doi.org/10.1111/os.13248
19. Matsui K, Burgesson B, Takao M, Stone J, Guillo S, Glazebrook M; ESSKA AFAS Ankle Instability Group. Minimally invasive surgical treatment for chronic ankle instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016;24(4):1040-8. https://doi.org/10.1007/s00167-016-4041-1
microinstability and ankle functional instability. J Clin Orthop Trauma 2024;51:102380. https://doi.org/10.1016/j.jcot.2024.102380
2. Camacho LD, Roward ZT, Deng Y, Latt LD. Surgical management of lateral ankle instability in athletes. J Athl Train 2019;54(6):639-49. https://doi.org/10.4085/1062-6050-348-18
3. Altomare D, Fusco G, Bertolino E, Ranieri R, Sconza C, Lipina M, et al. Evidence-based treatment choices for
acute lateral ankle sprain: a comprehensive systematic review. Eur Rev Med Parmacol Sci 2022;26(6):1876-84.
https://doi.org/10.26355/eurrev_202203_28333
4. Aiyer A, Murali S, Kadakia AR. Advances in diagnosis and management of lateral ankle instability: A review of
current literature. J Am Acad Orthop Surg Glob Res Rev 2023;7(12):e23.00251. https://doi.org/10.5435/JAAOSGlobal-D-23-00251
5. Puri A. Lateral ankle instability – repair/ reconstruct what’s new. J Orthop Surg (Hong Kong) 2023;31(2):
10225536231182348. https://doi.org/10.1177/10225536231182348
6. Hamilton WG. Sprained ankles in ballet dancers. Foot Ankle 1982;3(2):99-102. https://doi.org/10.1177/107110078200300208
7. Freeman MA. Instability of the foot after injuries to the lateral ligament of the ankle. J Bone Joint Surg Br 1965;47(4):669-77. PMID: 5846766
8. Kerkhoffs GM, Handoll HH, de Bie R, Rowe BH, Struijs PA. Surgical versus conservative treatment for acute
injuries of the lateral ligament complex of the ankle in adults. Cochrane Database Syst Rev 2007;(2):CD000380.
https://doi.org/10.1002/14651858.CD000380.pub2
9. Knupp M, Ledermann HP, Magerkurth O, Hintermann B. The surgical tibiotalar angle: a radiological study. Foot
Ankle Int 2005;26(9):713-6. https://doi.org/10.1177/107110070502600909
10. Kato T. The diagnosis and treatment of instability of the subtalar joint. J Bone Joint Surg Br 1995;77(3):400-6.
PMID: 7744924
11. Gould N, Seligson D, Gassman J. Early and late repair of lateral ligament of the ankle. Foot Ankle 1980;1(2):84-9. https://doi.org/10.1177/10711008000100206
12. Bersusky E, Arzac Ulla I, Loterzo LG, Ricciardi G, Zanotti G. Puntajes VI. Rev Asoc Argent Ortop Traumatol 2023;88(1):123-7. https://doi.org/10.15417/issn.1852-7434.2023.88.1.1706
13. Gribble PA. Evaluating and differentiating ankle instability. J Athl Train 2019;54(6):617-27. https://doi.org/10.4085/1062-6050-484-17
14. Kim TY, Hwang YG, Ahn J, Baek JH, Jeong BO. Evaluation of stress radiographs taken before and after spinal
anesthesia in patients with chronic ankle instability. J Foot Ankle Surg 2020;59(1):53-8. https://doi.org/10.1053/j.jfas.2019.01.020
15. Sarcon AK, Heyrani N, Giza E, Kreulen C. Lateral ankle sprain and chronic ankle instability. Foot Ankle Orthop
2019;4(2):2473011419846938. https://doi.org/10.1177/2473011419846938
16. Hao ZT, Ma YX, Hao T, Feng W, Wang JH, Fan DS, et al. Comparison of surgical intervention with functional
treatment for acute ruptures of lateral ankle ligament: a meta-analysis. Asian Pac J Trop Med 2012;5(5):396-401.
https://doi.org/10.1016/S1995-7645(12)60066-2
17. Doherty C, Bleakley C, Hertel J, Caulfield B, Ryan J, Delahunt E. Recovery from a first-time lateral ankle sprain
and the predictors of chronic ankle instability: a prospective cohort analysis. Am J Sports Med 2016;44(4):995-1003. https://doi.org/10.1177/0363546516628870
18. Cao S, Wang C, Wang X, Ma X. Percutaneous inferior extensor retinaculum augmentation technique for chronic ankle instability. Orthop Surg 2022;14(5):977-83. https://doi.org/10.1111/os.13248
19. Matsui K, Burgesson B, Takao M, Stone J, Guillo S, Glazebrook M; ESSKA AFAS Ankle Instability Group. Minimally invasive surgical treatment for chronic ankle instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016;24(4):1040-8. https://doi.org/10.1007/s00167-016-4041-1