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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-04-2016 | Ankle

Rehabilitation after anatomical ankle ligament repair or reconstruction

Authors: Christopher J. Pearce, Yves Tourné, Jennifer Zellers, Romain Terrier, Pascal Toschi, Karin Grävare Silbernagel, ESKKA-AFAS Ankle Instability Group

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2016

Abstract

The selection, implementation of and adherence to a post-operative regimen are all essential in order to achieve the best outcomes after ankle ligament surgery. The purpose of this paper is to present a best-evidence approach to this, with grounding in basic science and a consensus opinion from the members of the ESSKA-AFAS Ankle Instability Group. Basic science and clinical evidence surrounding tissue healing after surgical repair or reconstruction of the ligaments as well as around the re-establishment of sensorimotor control are reviewed. A consensus opinion based on this evidence as to the recommended rehabilitation protocol after ankle ligament surgery was then obtained from the members of the ESSKA-AFAS Ankle Instability Group. Rehabilitation recommendations are presented for the initial post-operative period, the early recovery phase and a goal-orientated late rehabilitation and return-to-sport phase. This paper presents practical, evidenced-based guidelines for rehabilitation and return to activity after lateral ankle ligament surgery.

Adams D, Logerstedt DS, Hunter-Giordano A, Axe MJ, Snyder-Mackler L (2012) Current concepts for anterior cruciate ligament reconstruction: a criterion-based rehabilitation progression. J Orthop Sports Phys Ther 42(7):601–614CrossRefPubMedPubMedCentral

Bedi A, Kovacevic D, Fox AJ, Imhauser CW, Stasiak M, Packer J, Brophy RH, Deng XH, Rodeo SA (2010) Effect of early and delayed mechanical loading on tendon-to-bone healing after anterior cruciate ligament reconstruction. J Bone Joint Surg Am 92(14):2387–2401CrossRefPubMedPubMedCentral

Benjamin M, Evans EJ, Copp L (1986) The histology of tendon attachments to bone in man. J Anat 149:89–100PubMedPubMedCentral

Bien DP, Dubuque TJ (2015) Considerations for late stage ACL rehabilitation and return to sport to limit re-injury risk and maximize athletic performance. Int J Sports phys Ther 10(2):256–271PubMedPubMedCentral

Brumann M, Baumbach SF, Mutschler W, Polzer H (2014) Accelerated rehabilitation following Achilles tendon repair after acute rupture—development of an evidence-based treatment protocol. Injury 45(11):1782–1790CrossRefPubMed

Collado H, Coudreuse JM, Graziani F, Bensoussan L, Viton JM, Delarque A (2010) Eccentric reinforcement of the ankle evertor muscles after lateral ankle sprain. Scand J Med Sci Sports 20(2):241–246CrossRefPubMed

Costa ML, MacMillan K, Halliday D, Chester R, Shepstone L, Robinson AH, Donell ST (2006) Randomised controlled trials of immediate weight-bearing mobilisation for rupture of the tendo Achillis. T J Bone Joint Surg Br 88(1):69–77CrossRef

Costa ML, Shepstone L, Darrah C, Marshall T, Donell ST (2003) Immediate full-weight-bearing mobilisation for repaired Achilles tendon ruptures: a pilot study. Injury 34(11):874–876CrossRefPubMed

Dagher E, Hays PL, Kawamura S, Godin J, Deng XH, Rodeo SA (2009) Immobilization modulates macrophage accumulation in tendon-bone healing. CORR 467(1):281–287CrossRef

10.

David P, Halimi M, Mora I, Doutrellot PL, Petitjean M (2013) Isokinetic testing of evertor and invertor muscles in patients with chronic ankle instability. J Appl Biomech 29(6):696–704PubMed

11.

de Vries JS, Krips R, Sierevelt IN, Blankevoort L, van Dijk CN (2011) Interventions for treating chronic ankle instability. Cochrane Datab Syst Rev 8:CD004124

12.

Donovan L, Hart JM, Hertel J (2014) Lower-extremity electromyography measures during walking with ankle-destabilization devices. J Sport Rehab 23(2):134–144CrossRef

13.

Eechaute C, Vaes P, Van Aerschot L, Asman S, Duquet W (2007) The clinimetric qualities of patient-assessed instruments for measuring chronic ankle instability: a systematic review. BMC musculoskeletal disorders 8:6CrossRefPubMedPubMedCentral

14.

Fees M, Decker T, Snyder-Mackler L, Axe MJ (1998) Upper extremity weight-training modifications for the injured athlete. A clinical perspective. Am J Sports Med 26(5):732–742PubMed

15.

Forestier N, Terrier R, Teasdale N (2015) Ankle muscular proprioceptive signals’ relevance for balance control on various support surfaces: an exploratory study. Am J Phys Med Rehab 94(1):20–27CrossRef

16.

Forestier N, Toschi P (2005) The effects of an ankle destabilization device on muscular activity while walking. Int J Sports Med 26(6):464–470CrossRefPubMed

17.

Fortuna M, Teixeira S, Machado S, Velasques B, Bittencourt J, Peressutti C, Budde H, Cagy M, Nardi AE, Piedade R, Ribeiro P, Arias-Carrion O (2013) Cortical reorganization after hand immobilization: the beta qEEG spectral coherence evidences. PLoS ONE 8(11):e79912CrossRefPubMedPubMedCentral

18.

Freeman MA (1965) Instability of the foot after injuries to the lateral ligament of the ankle. J Bone Joint Surg Br 47(4):669–677PubMed

19.

Freeman MA, Dean MR, Hanham IW (1965) The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br 47(4):678–685PubMed

20.

Galatz LM, Charlton N, Das R, Kim HM, Havlioglu N, Thomopoulos S (2009) Complete removal of load is detrimental to rotator cuff healing. JSES 18(5):669–675

21.

Galatz LM, Rothermich SY, Zaegel M, Silva MJ, Havlioglu N, Thomopoulos S (2005) Delayed repair of tendon to bone injuries leads to decreased biomechanical properties and bone loss. J Orthop Res 23(6):1441–1447CrossRefPubMed

22.

Galatz LM, Sandell LJ, Rothermich SY, Das R, Mastny A, Havlioglu N, Silva MJ, Thomopoulos S (2006) Characteristics of the rat supraspinatus tendon during tendon-to-bone healing after acute injury. J Orthop Res 24(3):541–550CrossRefPubMed

23.

Gimbel JA, Van Kleunen JP, Williams GR, Thomopoulos S, Soslowsky LJ (2007) Long durations of immobilization in the rat result in enhanced mechanical properties of the healing supraspinatus tendon insertion site. J Biomech Eng 129(3):400–404CrossRefPubMed

24.

Gomez MA, Woo SL, Amiel D, Harwood F, Kitabayashi L, Matyas JR (1991) The effects of increased tension on healing medical collateral ligaments. Am J Sports Med 19(4):347–354CrossRefPubMed

25.

Gribble PA, Hertel J, Plisky P (2012) Using the star excursion balance test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. J Athlet Tran 47(3):339–357

26.

Hartsell HD, Spaulding SJ (1999) Eccentric/concentric ratios at selected velocities for the invertor and evertor muscles of the chronically unstable ankle. Br J Sports Med 33(4):255–258CrossRefPubMedPubMedCentral

27.

Healy B, Beasley R, Weatherall M (2010) Venous thromboembolism following prolonged cast immobilisation for injury to the tendo Achillis. J Bone Joint Surg Br 92(5):646–650CrossRefPubMed

28.

Karlsson J, Lundin O, Lind K, Styf J (1999) Early mobilization versus immobilization after ankle ligament stabilization. Scand J Med Sci Sports 9(5):299–303CrossRefPubMed

29.

Karlsson J, Rudholm O, Bergsten T, Faxen E, Styf J (1995) Early range of motion training after ligament reconstruction of the ankle joint. Knee Surg Sports Traumatol Arthrosc 3(3):173–177CrossRefPubMed

30.

Kelln BM, McKeon PO, Gontkof LM, Hertel J (2008) Hand-held dynamometry: reliability of lower extremity muscle testing in healthy, physically active, young adults. J Sport Rehab 17(2):160–170

31.

Kerkhoffs GM, Struijs PA, Raaymakers EL, Marti RK (2002) Functional treatment after surgical repair of acute Achilles tendon rupture: wrap vs walking cast. Arch Orthop Trauma Surg 122(2):102–105CrossRefPubMed

32.

Kiers H, Brumagne S, van Dieen J, van der Wees P, Vanhees L (2012) Ankle proprioception is not targeted by exercises on an unstable surface. Europ J Appl Physiol 112(4):1577–1585CrossRef

33.

Konradsen L (2002) Sensori-motor control of the uninjured and injured human ankle. J Electromyogr Kinesiolog 12(3):199–203CrossRef

34.

Li X, Killie H, Guerrero P, Busconi BD (2009) Anatomical reconstruction for chronic lateral ankle instability in the high-demand athlete: functional outcomes after the modified Brostrom repair using suture anchors. Am J Sports Med 37(3):488–494CrossRefPubMed

35.

Lu HH, Thomopoulos S (2013) Functional attachment of soft tissues to bone: development, healing, and tissue engineering. Ann Rev Biomed Eng 15:201–226CrossRef

36.

Marker DR, Seyler TM, Bhave A, Zywiel MG, Mont MA (2010) Does commitment to rehabilitation influence clinical outcome of total hip resurfacing arthroplasty? J Orthop Surg 5:20CrossRef

37.

Messer TM, Cummins CA, Ahn J, Kelikian AS (2000) Outcome of the modified Brostrom procedure for chronic lateral ankle instability using suture anchors. Foot Ankle Int 21(12):996–1003PubMed

38.

Miyamoto W, Takao M, Yamada K, Matsushita T (2014) Accelerated versus traditional rehabilitation after anterior talofibular ligament reconstruction for chronic lateral instability of the ankle in athletes. Am J Sports Med 42(6):1441–1447CrossRefPubMed

39.

Munn J, Sullivan SJ, Schneiders AG (2010) Evidence of sensorimotor deficits in functional ankle instability: a systematic review with meta-analysis. J Sci Med Sport 13(1):2–12CrossRefPubMed

40.

Paris DL, Sullivan SJ (1992) Isometric strength of rearfoot inversion and eversion in nonsupported, taped, and braced ankles assessed by a hand-held dynamometer. J Orthop Sports Phys Ther 15(5):229–235CrossRefPubMed

41.

Pearce CJ, Brooks JH, Kemp SP, Calder JD (2011) The epidemiology of foot injuries in professional rugby union players. Foot Ankle Surg 17(3):113–118CrossRefPubMed

42.

Peltz CD, Dourte LM, Kuntz AF, Sarver JJ, Kim SY, Williams GR, Soslowsky LJ (2009) The effect of postoperative passive motion on rotator cuff healing in a rat model. J Bone Joint Surg Am 91(10):2421–2429CrossRefPubMedPubMedCentral

43.

Petersen OF, Nielsen MB, Jensen KH, Solgaard S (2002) Randomized comparison of CAM walker and light-weight plaster cast in the treatment of first-time Achilles tendon rupture. Ugeskr Laeger 164(33):3852–3855PubMed

44.

Petrera M, Dwyer T, Theodoropoulos JS, Ogilvie-Harris DJ (2014) Short- to medium-term outcomes after a modified brostrom repair for lateral ankle instability with immediate postoperative weightbearing. Am J Sports Med 42(7):1542–1548CrossRefPubMed

45.

Postle K, Pak D, Smith TO (2012) Effectiveness of proprioceptive exercises for ankle ligament injury in adults: a systematic literature and meta-analysis. Man Ther 17(4):285–291CrossRefPubMed

46.

Risberg MA, Holm I (2009) The long-term effect of 2 postoperative rehabilitation programs after anterior cruciate ligament reconstruction: a randomized controlled clinical trial with 2 years of follow-up. Am J Sports Med 37(10):1958–1966CrossRefPubMed

47.

Roll R, Kavounoudias A, Albert F, Legre R, Gay A, Fabre B, Roll JP (2012) Illusory movements prevent cortical disruption caused by immobilization. NeuroImage 62(1):510–519CrossRefPubMed

48.

Rozzi SL, Lephart SM, Sterner R, Kuligowski L (1999) Balance training for persons with functionally unstable ankles. J Orthop Sports Phys Ther 29(8):478–486CrossRefPubMed

49.

Sale DG (1988) Neural adaptation to resistance training. Med Sci Sports Excer 20(5 Suppl):S135–S145CrossRef

50.

Saleh M, Marshall PD, Senior R, MacFarlane A (1992) The Sheffield splint for controlled early mobilisation after rupture of the calcaneal tendon. A prospective, randomised comparison with plaster treatment. J Bone Joint Surg Br 74(2):206–209PubMed

51.

Sammarco GJ, Idusuyi OB (1999) Reconstruction of the lateral ankle ligaments using a split peroneus brevis tendon graft. Foot Ankle Int 20(2):97–103CrossRefPubMed

52.

Schilders E, Bismil Q, Metcalf R, Marynissen H (2005) Clinical tip: achilles tendon repair with accelerated rehabilitation program. Foot Ankle Int 26(5):412–415PubMed

53.

Silbernagel KG, Brorsson A, Karlsson J (2014) Rehabilitation following achilles tendon rupture. Achilles Tendon Disord Compr Overv Diagn Treatment DJO Publ 2014:151–163

54.

Speck M, Klaue K (1998) Early full weightbearing and functional treatment after surgical repair of acute achilles tendon rupture. Am J Sports Med 26(6):789–793PubMed

55.

Suda EY, Amorim CF, Sacco Ide C (2009) Influence of ankle functional instability on the ankle electromyography during landing after volleyball blocking. J Electromyography and Kinesiolog 19(2):e84–e93CrossRef

56.

Terrier R, Rose-Dulcina K, Toschi B, Forestier N (2014) Impaired control of weight bearing ankle inversion in subjects with chronic ankle instability. Clin Biomech 29(4):439–443CrossRef

57.

Thepaut-Mathieu C, Van Hoecke J, Maton B (1988) Myoelectrical and mechanical changes linked to length specificity during isometric training. J Appl Physiol 64(4):1500–1505PubMed

58.

Thomopoulos S, Genin GM, Galatz LM (2010) The development and morphogenesis of the tendon-to-bone insertion—what development can teach us about healing. J Musculoskel Neuronal Interact 10(1):35–45

59.

Thomopoulos S, Hattersley G, Rosen V, Mertens M, Galatz L, Williams GR, Soslowsky LJ (2002) The localized expression of extracellular matrix components in healing tendon insertion sites: an in situ hybridization study. J Orthop Res 20(3):454–463CrossRefPubMed

60.

Thomopoulos S, Kim HM, Rothermich SY, Biederstadt C, Das R, Galatz LM (2007) Decreased muscle loading delays maturation of the tendon enthesis during postnatal development. J Orthop Res 25(9):1154–1163CrossRefPubMed

61.

Thomopoulos S, Marquez JP, Weinberger B, Birman V, Genin GM (2006) Collagen fiber orientation at the tendon to bone insertion and its influence on stress concentrations. J Biomech 39(10):1842–1851CrossRefPubMed

62.

Thomopoulos S, Williams GR, Gimbel JA, Favata M, Soslowsky LJ (2003) Variation of biomechanical, structural, and compositional properties along the tendon to bone insertion site. J Orthop Res 21(3):413–419CrossRefPubMed

63.

Thomopoulos S, Williams GR, Soslowsky LJ (2003) Tendon to bone healing: differences in biomechanical, structural, and compositional properties due to a range of activity levels. J Biomech Eng 125(1):106–113CrossRefPubMed

64.

Thomopoulos S, Zampiakis E, Das R, Silva MJ, Gelberman RH (2008) The effect of muscle loading on flexor tendon-to-bone healing in a canine model. J Orthop Res 26(12):1611–1617CrossRefPubMedPubMedCentral

65.

Thonnard JL (1988) La pathogénie de l’entorse du ligament latéral externe de la cheville. Evaluation d’une hypothèse. Thèse en vue de l’obtention du grade de Docteur en réadaptation. Université Catholique de Louvain, Faculté de médecine, Institut d’Éducation physique et de réadaptation

66.

Thorstensson A (1977) Observations on strength training and detraining. Acta Physiol Scand 100(4):491–493CrossRefPubMed

67.

Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A (2010) Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Am 92(17):2767–2775

68.

Woo SL, Gomez MA, Sites TJ, Newton PO, Orlando CA, Akeson WH (1987) The biomechanical and morphological changes in the medial collateral ligament of the rabbit after immobilization and remobilization. J Bone Joint Am 69(8):1200–1211

69.

Wu X, Wang H, Meng C, Yang S, Duan D, Xu W, Liu X, Tang M, Zhao J (2014) Outcomes of arthroscopic arthrolysis for the post-traumatic elbow stiffness. Knee Surg Sports Traumatol Arthrosc 23(9):2715–2720CrossRefPubMed

Title: Rehabilitation after anatomical ankle ligament repair or reconstruction
Authors: Christopher J. Pearce
Yves Tourné
Jennifer Zellers
Romain Terrier
Pascal Toschi
Karin Grävare Silbernagel
ESKKA-AFAS Ankle Instability Group
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-016-4051-z

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