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Re-injury versus osteoarthritis for functional or surgery ankle treatments
 
A new trial in Finland has found that functional treatment for ruptures of the lateral ligaments in ankles is just as effective as surgical treatment for recovering a pre-injury activity level, but that the occurrence of re-injury and osteoarthritis significantly differ.

Published online by The Journal of Bone and Joint Surgery  in September 2010, the aim of the Finnish randomised, controlled trial was to establish whether surgery provides better long-term results for ruptures of the lateral ligaments than functional treatment.

While sedentary patients often heal well with non-operative treatments, physically active patients that put more stress on the ankle, such as athletes, are often recommended surgery when presenting a grade-III lateral ligament injury.

But, up until now there has been little conclusive evidence to determine the comparative effectiveness of surgical and non-operative treatment. In addition, little has been done to assess the degree of osteoarthritis at the time of follow-up.

In the Finnish trial, the researchers took 51 physically active Finnish men aged between 18 and 26 all with acute Grade-III lateral ligament ruptures of the ankle. Twenty-five were given surgery, and 26 were given functional treatment, which included a light-weight orthotic ‘Aircast ankle brace’ worn for three weeks.
A long-term follow-up examination, which included stress radiographs and magnetic resonance imaging scans, was performed on 60% of the surgical treatment group, and 69% of the functional treatment group. The mean age at the time of follow-up was 34 years in the surgical group and 33 in the functional.

The researchers concluded that while both groups successfully recovered their pre-injury activity levels, re-injury occurred less frequently in the surgically treated patients.
On the flipside, surgical treatment may increase the risk of subsequent osteoarthritis, with four of the 15 surgical patients displaying Grade-II osteoarthritis, compared to none of the functional patients.

In addition, functional treatment likely results in fewer days of hospitalisation, and is therefore less expensive.

1 Surgical Versus Functional Treatment for Acute Ruptures of the Lateral Ligament Complex of the Ankle in Young Men. A Randomized Controlled Trial. Pihlajamäki H et al. J Bone Joint Surg Am. 2010; 92:1-8. Epub ahead of print. doi:10.2106/JBJS.I.01176

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