Ankle injury due to supination trauma: Potential factors worsening patient outcome

Purpose: Supination trauma is a common sports injury, and often leads to chronic ankle instability. This study analyses whether indications of healing can be detected 2 weeks after supination trauma. Methods: This prospective, monocentric study at a German Medical Center examined patients with acute supination trauma. Only patients with severity levels 2-3 were included in the study, and were advised to wear an orthosis for 5 weeks starting in the emergency room. The follow-up period was two weeks after trauma (followup examination 1/FE1: swelling of the ankle joint, tenderness over the lateral ligament complex and the syndesmosis, questionnaire). Nine months after injury (follow-up examination 2/FE2), these patients were interviewed by telephone using a questionnaire surveying current complaints in everyday life, sports, and work, as well as the general healing process. Results: Forty-one patients aged 35.1 years (+/- 10.5) were included in the study. The presence of hematoma two weeks post-injury (n = 6) correlated significantly with inability to work (p = 0.02). Calcaneofibular ligament (CFL) tenderness was seen in 36 patients, posterior talofibular ligament (PTFL) tenderness in 29 patients, and syndesmosis tenderness in 9 patients. All patients who reported pressure pain at the anterior talofibular ligament (ATFL) at FE1 were significantly more likely to experience feelings of instability at FE2 (p = 0.011). All patients who reported instability at FE1 had significantly greater problems climbing stairs at FE2 (p = 0.003). All patients with hematoma and instability two weeks post-injury had a persistent feeling of instability at FE2. Patients with hematoma and pressure pain at the ATFL at FE1 had persistent pain through FE2. Conclusions: Persistent hematoma, pressure pain at the ATFL or feelings of instability two weeks after ankle sprain increase the likelihood of symptoms persisting for up to nine months post-injury. Physicians and patients should be well informed about the treatment guidelines and not underestimate this injury. In general, further studies are necessary to clarify why acute ankle sprains often lead to persistent complaints.