I give all people conservative care and a large number never need surgery.  In those who can never get rid of the pain or are recurrent inversion sprains I perform a brostrum ligament repair with gould modification.  If the soft tissues are really thin or absent I augment with a graft or internal brace.  I have all my patients WB in a boot as tolerated immediately after surgery for 1 month then into shoes and a brace after that.  They begin PT at 4 weeks and return to sports at 10-12 weeks.  I personally have had this procedure and like my patients I expect a full recovery back to all previous levels of function

Dear Kamary,

It maybe could help you distinguishing between instability and pain.

Instability as hypermobility does not leads to pain like is well known that all the ankles of professional dancers have hypermobility but not necessary pain.

So again if the problem is the long term pain better treat it.

If not, better to train on prevention of the causes of recurrent sprains

We only know that "The most common mechanism of

injury occurs with forefoot adduction, hindfoot internal rotation,

ankle inversion in plantar flexion, and external rotation

of the leg beyond anatomical constraints" (Robroy L et al.)

At the moment only activities of daily living subscale of the FAAM are predictive of Chronic ankle instability and correctly classify 84.8% of cases of chronic ancke instability (sensitivity, 75%; specificity, 91%; P < .001) in the study of Doherty and colleagues (RG memeber).

Why use surgery if the problem is the trauma and not prevent the trauma with an appropriate rehabilitation?

Hoping it would help you I wish you a wonderful day!

.

Article: Ankle Stability and Movement Coordination Impairments: Ankle Ligament Sprains

Robroy L Martin · Todd E Davenport · Stephen Paulseth · Dane K Wukich · Joseph J Godges

Article: Prevalence and profile of musculoskeletal injuries in ballet dancers: A systematic review and meta-analysis

Toby O Smith · Leigh Davies · Akbar de Medici · Allan Hakim · Fares Haddad · Alex Macgregor

[Show abstract]

Article: Recovery From a First-Time Lateral Ankle Sprain and the Predictors of Chronic Ankle Instability: A Prospective Cohort Analysis

Cailbhe Doherty · Chris Bleakley · Jay Hertel · Brian Caulfield · John Ryan · Eamonn Delahunt

Dear Giacomo and Brian,

Thank you for your answer and for the suggested articles.

Kamary

Hi Kamary,

Except in severe sprains, I would always give conservative therapy a chance.  Based on the literature, I would say that most surgeons would recommend at least 3-6 months worth of therapy before concluding that the therapy has failed for this individual and pursuing surgical options.  As Brian mentioned, the modified Brostrum technique is the gold standard and has good short and long term results.  I have seen a number of elite athletes return to full participation following a lateral ligament repair. 

Determine when therapy has failed can be difficult because it assumes that the therapist has appropriately assessed the full spectrum of impairments and applied appropriate techniques to treat those impairments.  Some of latest research is also showing that there are certain patients characteristics that can predict if a patient will respond to a given treatment.  In other words, we might want to apply joint mobilizations to the ankle if we identify limited dorsiflexion.  Despite the common use of the treatment and the supported research, we have found that it is only effective in select sub-populations.  The other factor to consider is what the patient wants to return to.  Can they modify their activity to remain physically active but avoid recurrent sprains?  For example, they can no longer run because of impingement and giving way but they may be able to swim and/or bike to avoid the surgery if their symptoms present during physical activity but not during activities of daily living.

Hi Erik,

Thank you very much for your answer, it does make complete sense. Your opinion is also influencing on how I will direct our research.

Regards,

Kamary

You may wish to try prolo to the ligamentous insertions to strengthen them and preserve function.  www.getprolo.com.