Unsatisfactory Outcomes After Conservative Treatment for Proximal Migration of Acute Calcaneal- Side Calcaneofibular Ligament Rupture in Athletes: A Preliminary Report

Abstract

Category: Ankle; Sports Introduction/Purpose: Acute ankle ligament rupture is usually treated conservatively. However, it sometimes progresses to chronic ankle instability. We suspected that there is a tendency for calcaneal-side calcaneofibular ligament (CFL) ruptures to progress to chronic ankle instability. Methods: Fourteen athletes with calcaneal-side CFL ruptures who were treated conservatively and followed for a mean period of 35.2 months were included in the study. Proximal migration of the stump of CFL (mm) was evaluated using magnetic resonance imaging at a 45° oblique coronal plane. A Stener lesion was defined as severe migration outside the peroneal tendon. The results of manual anterior drawer, varus stress tests, and stress radiographs at the initial and final follow-up visits were compared. The time to return to running, team training, and sporting competitions were recorded. At the final follow-up, patient satisfaction and Cumberland Ankle Instability Tool (CAIT) were used to assess ankle function. Results: The mean proximal migration of CFL was 11.2 mm. Four Stener lesions were found. However, neither proximal migration nor Stener lesions were significantly related to CAIT scores (rho = 0.288 and rho = 0.082, respectively) instability significantly decreased after conservative treatment from a mean grade of 2.0 to 1.4 in the anterior drawer test (P = 0.032). The varus stress test results showed a decrease from grade 2.2 to 1.8 (P = 0.053) without significance. Radiologically, decreases in anterior translation from 6.1 mm to 5.4 mm (P = 0.205) and talar tilt angles from 7.2° to 6.5° (P = 0.500) were observed without significance. It took 12.2, 14.7, and 18.0 weeks to return to running, team training, and sporting competitions. Seven athletes (50%) reported unsatisfactory results. Conclusion: Conservative treatment for CFL rupture with proximal migration was associated with poor outcomes in athletes.