Early mobilization versus immobilization after ankle ligament stabilization

Functional outcome, stability at radiographic investigation and ankle joint torque after anatomical reconstruction of the lateral ankle ligaments were evaluated in patients with early postoperative mobilization versus those w ith cast immobilization. Thirty patients with chronic lateral Ligament inst ability of the ankle underwent anatomical reconstruction of the ligaments. Postoperatively the patients were randomly allocated to two groups: Group A (n=15) were immobilized in a below-knee plaster for 6 weeks and Group B (n =15) underwent early controlled range of motion training using an Air-Cast( R) ankle brace. The funtional results were evaluated using a scoring scale and objective results using standardized stress radiographs. Also eccentric and concentric muscle torque at 60 degrees/5 was measured in plantar flexi on and dorsiflexion, respectively. The functional results were satisfactory in 12/15 ankles in Group A and 14/15 in Group B (n.s.). All the patients w ith satisfactory results regained normal range of motion. Patients with uns atisfactory results had either residual pain or recurrent instability. In G roup B, the strength measurements revealed significantly higher peak torque values after three months in plantar flexion at 60 degrees/s. Six months p ostoperatively, the torque values did not differ significantly between the groups. Also, there was no group difference in the laxity of the ankle join t, including both anterior talar translation test and talar tilt test, at t he two-year follow-up. One patient had a superficial wound infection. We co nclude that after the reconstruction of chronic lateral ligament instabilit y of the ankle the functional and stability results were equally good with early postoperative mobilization and 6-week immobilization. However, using early mobilization plantar flexion strength was regained earlier than with cast immobilization, without any risk of short- or medium-term complication s, such as increased ankle laxity We recommend early mobilization after ana tomical reconstruction of the lateral ankle ligaments.