Background:High ankle sprains are common athletic injuries and can be associated with long-term sequelae. Regardless of operative or nonoperative treatment, there is a paucity of data in the literature about the long-term outcomes of high ankle sprains.Hypothesis:Nonoperative treatment of high ankle sprains utilizing a standardized protocol will result in good long-term outcomes.Study Design:Case series; Level of evidence, 4.Methods:Patients who experienced a high ankle sprain without radiographic diastasis of the syndesmosis were identified from a previous study database and contacted for long-term follow-up. All patients were high school or National Collegiate Athletic Association Division IA athletes at initial injury and were treated nonoperatively with the same standardized protocol. Patients completed a questionnaire that included documentation of any interim ankle injuries, 2 different patient-reported outcome scores, and ankle radiographs to conduct Kellgren-Lawrence scoring for ankle osteoarthritis.Results:In total, 76 cases in 74 patients were identified in the database. A total of 40 patients were successfully contacted, and 31 patients (24 collegiate and 7 high school athletes) with 33 high ankle sprains completed the survey (31/40; 77.5%). The mean age at follow-up was 45 years (range, 34-50 years), with a mean time from injury to follow-up of 25 years. Overall, 93.5% (n = 29) of the respondents were male, and 42% (n = 13) of the respondents reported an ipsilateral ankle injury since their initial injury, with 16% (n = 5) having ankle or Achilles surgery. The mean Patient-Reported Outcomes Measurement Information System-10 score was 53.4 (SD, 8.3; range, 37.4-67.7), PROMIS median (IQR), 54.1 (39.9, 68.3), and the mean Self-reported Foot and Ankle Score score was 42.7 (SD, 5.86). Follow-up ankle radiographs were obtained in 11 (35%) of the respondents; 27% had Kellgren-Lawrence grade >2 osteoarthritis, and 36% had signs of heterotopic ossification on imaging. The mean tibiofibular clear space was 4.5 mm, and the mean tibiofibular overlap was 7.15 mm, with 27% of patients demonstrating some tibiotalar narrowing.Conclusion:At long-term follow-up, nonoperative management of high ankle sprains without diastasis on imaging was associated with acceptable patient-reported functional outcomes and low rates of subsequent ankle injuries. There was a high incidence of arthritis, but most cases were not clinically significant. This case series shows the natural history of nonoperatively treated high ankle sprains and may serve as a comparison for different management techniques in the future.

中文翻译：

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高位踝关节扭伤的非手术治疗：随访 18 年以上的病例系列


背景：高位踝关节扭伤是常见的运动损伤，可能会导致长期后遗症。无论手术还是非手术治疗，文献中都缺乏关于高位踝关节扭伤的长期结果的数据。假设：采用标准化方案非手术治疗高位踝关节扭伤将产生良好的长期结果。研究设计：案例系列；证据级别，4。方法：从以前的研究数据库中识别出经历过高位踝关节扭伤但未进行韧带联合影像学分离的患者，并联系进行长期随访。所有患者在初次受伤时都是高中或国家大学体育协会 IA 部门的运动员，并采用相同的标准化方案进行非手术治疗。患者完成了一份调查问卷，其中包括任何临时踝关节损伤的记录、2 种不同的患者报告的结果评分以及踝关节 X 光片，以进行踝关节骨关节炎的 Kellgren-Lawrence 评分。 结果：数据库中总共识别出 74 名患者的 76 例。共成功联系到40名患者，31名患者（24名大学运动员和7名高中运动员）完成了调查，共33名高位踝关节扭伤（31/40；77.5%）。随访时的平均年龄为 45 岁（范围为 34-50 岁），从受伤到随访的平均时间为 25 年。总体而言，93.5% (n = 29) 的受访者为男性，42% (n = 13) 的受访者报告自初次受伤以来同侧踝关节受伤，其中 16% (n = 5) 接受过踝关节或跟腱手术。患者报告的结果测量信息系统 10 平均评分为 53.4（SD，8.3；范围，37.4-67.7），PROMIS 中位数（IQR）为 54.1（39.9，68.7）。3)，平均自我报告足部和踝部评分为 42.7 (SD, 5.86)。 11 名受访者（35%）获得了后续踝关节 X 光片； 27% 患有 Kellgren-Lawrence >2 级骨关节炎，36% 的影像学表现有异位骨化迹象。平均下胫腓间隙为 4.5 mm，平均下胫腓重叠为 7.15 mm，27% 的患者表现出一定程度的胫距狭窄。结论：在长期随访中，未进行影像学分离的高位踝关节扭伤的非手术治疗与非手术治疗相关患者报告的功能结果可接受，并且后续踝关节损伤的发生率较低。关节炎的发病率很高，但大多数病例没有临床意义。该病例系列展示了非手术治疗高位踝关节扭伤的自然史，并可作为未来不同治疗技术的比较。