Outside ligament

Outerband tear: Description

An outer ligament tear (outer ligament rupture) on the upper ankle is one of the most common sports injuries – in addition to damage to the knee. Women are affected more often than men. While in young people, the external ligament tear often occurs isolated, it is often accompanied in older people by a fracture of the outer ankle (the distended lower end of the fibula). In children, they are the injuries, especially in the area of ​​the growth joint of the bone.

The main purpose of the upper ankle is to raise and lower the forefoot. It is stabilized by several bands, including the outer band. This consists of three different band shares:

• Talofibular anterior ligament: connects the anterior border of the lateral malleolus with the talus (one of the tarsal bones)
• Talofibular posterius ligament: connects the inside of the lateral malleolus with the talus
• Ligament calcaneofibulare: connects the outer malleolus with the heel bone

In an external ligament tear most often the weak ligament talofibulare anterius is affected. In about 20 percent of cases, both this ligament and the calcaneofibular ligament rupture. The strongest of the three ligaments, the posterior talofibular ligament, rarely ruptures. Only with strong impact of force tear all three bands.

An outer band tear can be complete or only partial (ligament tear).

Outer ligament tear: symptoms

An outer ligament tear on the upper ankle, the sufferers sometimes perceive as a tangible “crash”. Often the occurrence with the injured foot is no longer possible, but sometimes those affected can still go limp. It develops a strong swelling on the ankle. The area of ​​the torn band is tender.

Outer ligament tear: causes and risk factors

An outer band tear may occur if, for example, the foot buckles out while walking or running. In everyday life, an uneven or slippery floor, stairs or curbs can become traps.

Athletes usually bend over by uncontrolled movements, when they collide with an opponent or when landing after a jump. Particularly high is the risk for an outer band tear in sports with frequent changes of direction, short sprints and fast stop movements, so for example in football, tennis and volleyball.

Risk factors for an external ligament tear are poor training condition, weak muscles, contractures or shortenings of muscles, tendons or the joint capsule. Even nerve damage that leads to a poor perception of the foot and joint position, increase the risk of an external ligament tear. While a lack of experience in the practice of a sport is a risk, even high-performance athletes are particularly at risk. Obesity and high heels can also favor an out-of-band tear.

In rare cases, in addition to torn ligaments, injuries to bones or cartilage may occur.

Outer ligament tear: examinations and diagnosis

If an external ligament tear is suspected, consult an orthopedist, accident surgeon or sports physician. First, the doctor will seek important information in conversation with the patient. For this he asks the following questions:

• How did the injury happen?
• Where is the pain localized?
• Can you still stand on the affected foot?
• Did you have to cancel the activity performed before the injury?
• Did you already have an injury to this foot?

The doctor will then examine the affected foot closely. As with any injury, it must first be checked if blood flow, motor function and sensitivity of the foot are preserved. Already when looking at fall in a torn outer ligament usually a significant swelling and a bruise on the ankle.

A deformity of the foot usually indicates a bony injury. However, deviations of the joint position are also possible with a sole outer ligament tear.

If the patient feels a pressure pain under the outer malleolus when they feel the foot, this indicates an outer ligament tear. A pressure pain on bone points, however, indicates a bone fracture.

Even the combination of pressure pain and bruising make a ligament injury very likely.

Special tests check the function of the outer band. To check the stability of the upper ankle, the so-called drawer test is used. For this purpose, the doctor tries to push the foot forward with the knee flexed and the shin fixed. In the side comparison, such an instability can be determined (Talusvorschub). Another test is the inversion stress test for finding a calcaneofibular torn ligament.

In the event of an external ligament tear, the ankle joint can often be “opened up” laterally (reinforced O position compared to the uninjured ankle on the other foot).

Since there are a variety of muscles, tendons and ligaments on the foot, the out-of-band examination should also consider alternative diagnoses, such as an Achilles tendon tear.

imaging

Not always an imaging is necessary. An X-ray examination can clarify whether in addition to the outer ligament tear bony injuries are still present (such as a bony ligament tear). Sometimes so-called held recordings are made. In doing so, the foot is fixed in a posture in order to examine the “unfoldability” of the upper ankle joint and to indirectly detect an outer ligament tear.

For further diagnostics, computer tomography (CT) or magnetic resonance imaging (MRI) is less frequently performed. Especially in an MRI examination, an outer ligament tear and other connective tissue injuries can usually be recognized well.

Outline tear: treatment

An outer ligament tear usually does not have to be operated on. It has been shown that even with many severe injuries of the outer ligament apparatus, a functionally good result can be achieved without surgery.

immediate measures

The first aid measures for an external ligament tear are based on the PECH rule (break, ice, compression, high camps): If necessary, interrupt the sporting activity, store the ankle joint, cool it (with ice or cold water, for example) and apply a pressure bandage (against the onset of swelling). If necessary, analgesics (such as ibuprofen) can be used against the pain.

Conservative therapy

As a rule, a functional treatment is performed with a special orthosis (ankle splint), which the patient should wear for up to six weeks. It prevents another kinking. In the first week, the foot should be completely relieved (using forearm crutches); This is followed by – in adaptation to the pain – a rapid increase in stress.

Taping is usually not enough at the beginning of the treatment, but can be used in the course of supportive experience by experienced users.

Consistent immobilization is almost only necessary if there is considerable pain. A plaster rail is rarely used and for a few days. Thereafter, usually the described protection against renewed bending over with rails is sufficient.

surgery

Only in a few cases does an external ligament tear have to be treated surgically. An operation is considered in the following situations:

• Outer band tear of all three bands
• additional cartilage / bone damage
• complete instability of the joint
• Axis deviation of the joint
• severe cases of chronic instability
• Failure of conservative therapy
• Outerband tear in professional athletes

The benefits of surgery include a lower rate of osseous tear rupture and a reduction in joint instability. However, even with this seemingly small intervention there is a certain risk of surgery, which must be taken into account.

After surgery, the ankle is usually immobilized in a splint for one to two weeks. This is followed by a functional after-treatment with an orthosis or a so-called stability shoe. The rehabilitation takes a total of about three to four months.

physical therapy

Irrespective of the type of treatment, physiotherapy should be started early after an external ligament tear. The goal is to strengthen the muscles around the ankle to better stabilize the joint. Even a balance training (such as on the wobbly board) makes sense. In the course of training, the load is increased until reaching the pain-free full load. Support bandages can facilitate the training and the later sporty re-entry.

Outer ligament tear: Disease course and prognosis

There are rarely complications after an external ligament tear. The prognosis is usually very good. As a rule, the doctor prescribes a physiotherapy treatment after an outer ligament tear to promote healing. The rehabilitation period is about four to twelve weeks. The natural tissue repair processes can take up to a year.

In about the first two months after the outer ligament tear, those affected should refrain from doing sport, which puts a particular strain on the outer ligaments.

Residual symptoms such as the tendency to swelling can last for several months, but usually disappear completely.

Rarely it comes after an outer ligament tear to a joint stiffening or long-term to the joint wear (arthrosis). If the initial pain does not decrease, an ankle impingement or an (overlooked) shearing fracture must be considered. When impingement comes to the entrapment of soft tissues such as ligaments.

Within one year of the injury there is approximately twice the risk of a renewed outbreak of external ligament in comparison to the average population. The instability can sometimes be compensated by a consistent physiotherapy. In up to 40 percent of the cases remain mechanical instabilities that may require surgery.

prevention

In order to prevent an outer ligament tear, one should warm up sufficiently before the sport. Avoid one-sided stress. Balance gymnastics or a balance sport helps to build supportive muscles (especially in the area of ​​the ankle). Anyone who tends to “kink” and torn ligaments, can support his ankles with sports bandages or tapes. Even shoes with a high shaft protect against one Outside ligament.