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A twist on the athlete's ankle twist: some ankles are more equal than others
  1. Gino MMJ Kerkhoffs1,
  2. Johannes L Tol2
  1. 1Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
  2. 2Department of Sports Medicine, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  1. Correspondence to Dr Gino MMJ Kerkhoffs, Department of Orthopedic Surgery, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands; G.M.Kerkhoffs{at}amc.uva.nl

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Ankle injuries are prolific but not benign. Kerkhoffs et al1 present a consensus statement on the diagnosis and treatment of acute lateral ligament ruptures that will help us to treat the majority of our athletes in an evidence-based way. However, is it reasonable to assume that all these injuries and athletes are equal? Should we necessarily treat high-level athletes in a different way than recreational athletes or is the proposed simple functional treatment sufficient for all?

Historical perspective

Complete cast immobilisation was the treatment of choice until the sixties, when Freeman introduced the concept of using coordination exercises to reduce the proprioceptive deficit and symptoms of the ankle ‘giving way’.2 Primary surgical repair became treatment of choice from 1966, after the PhD research of Broström.3 While Broström reported lower rates of long-term complaints after surgical intervention, he still recommended functional treatment initially due to the quicker return to work and sports.

Quick wins or long-term success

In high-level athletes, goals are often set in the short term and only the upcoming game really counts. From daily clinical practice we know that it …

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