Lateral ankle ligament injury : an experimental and clinical study

Sport has become one of the most popular methods of spending freetime and consequently is of great social importance. fn recent studies concerning sports injuries in the Netherlands (BoersmaSIUtter et al. - 1979, v.Rens 1982) it was estimated that about 20% of all registered sportsmen sustain a sports injury every year, resulting in about 800.000 sports injuries in one year. Ankle sprain was found to be the most frequent injury, accounting for 18-21% of all sports injuries. Accordingly, ankle sprain is diagnosed in about 150.000 sportsmen every jear. The medical consequences of this finding were already clearly recognized in 1975 by Cedell as he stated: 11 Ankle injuries constitute a quantitative therapeutic problem that must be solved in the best way considering the ava-Ilable economic and medical resources. However, the demand for higher quality in the treatment must not be omitted. A reliable diagnostic procedure, providing an accurately specified diagnosis would enable an appropriate therapy for ankle sprains. Consequently, all kinds of sequelae, like chronic sprain, ankle instability, damage to the articular cartilage and osteo-arthrosis, resulting from misdiagnosis and mistreatment, can be prevented (O'Donoghue - 1958, Blain et a!. 1962, Grand 1973, Tenino - 1973, v .Barth - 1975, Fulp - 1975, Kooyman and Ponsen 1976, McCluskey et al. - 1976, Seiler and Holzrichter 1977, Stepanuk -1977, Speeckaert - 1978, Jungmichel - 1978, Tausch - 1978). The study presented in this thesis was set up to evaluate the diagnostic significance of arthrography in diagnosing recent ankle ligament ruptures and to assess the value of early surgical repair of ruptured lateral ankle ligaments as a method of treatment, with the above-mentioned considerations in mind. The two suppositions underlying this study are: 1. The value of the anterior talofibular ligament in stabilizing the ankle joint is generally underestimated. 2. Early surgical repair can improve the process of ligament healing by providing adequate coaptation of ligament ends, thereby leading to early functional recovery. The investigations were prompted by the promising results of surgical repair lateral ankle ligament ruptures, obtained in 63 patients within a pilot study, carried out in the period of May 1977 until April 1979 at the surgical department of the Zeeweg Hospital IJmuiden (Head: F. Schreuder M.D.). The results of a prospective clinical study, carried out at the surgical department of the St. Hippolytus Hospital Delft (Head: W.M. Oosterwijk M.D. Ph.D.) will be compared to the results of other therapeutic modalities as found in literature and will be combined with the findings of an experimental study on the process of ligament healing, carried out at the Laboratory of Experimental Surgery at the Erasmus University Rotterdam, under the supervision of Prof. D.L. Westbroek M.D.

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