%D 1999 %0 ARTICLE %T Treatment of acute lateral ankle ligament rupture in the athlete . Conservative versus surgical treatment . %J %V 27 ( 1 ) %P 61-71 %A Lynch SA %A Renstrm PA %M pub10028133 %X Acute lateral ankle ligament sprains are common in young athletes ( 15 to 35 years of age ) . Diagnostic and treatment protocols vary . Therapies range from cast immobilisation or acute surgical repair to functional rehabilitation . The lateral ligament complex includes 3 capsular ligaments : the anterior tibiofibular ( ATFL ) , calcaneofibular ( CFL ) and posterior talofibular ( PTFL ) ligaments . Injuries typically occur during plantar flexion and inversion ; the ATFL is most commonly torn . The CFL and the PTFL can also be injured and , after severe inversion , subtalar joint ligaments are also affected . Commonly , an athlete with a lateral ankle ligament sprain reports having rolled over the outside of their ankle . The entire ankle and foot must be examined to ensure there are no other injuries . Clinical stability tests for ligamentous disruption include the anterior drawer test of ATFL function and inversion tilt test of both ATFL and CFL function . Radiographs may rule out treatable fractures in severe injuries or when pain or tenderness are not associated with lateral ligaments . Stress radiographs do not affect treatment . Ankle sprains are classified from grades I to III ( mild , moderate or severe ) . Grade I and II injuries recover quickly with nonoperative management . A non-operative functional treatment programme includes immediate use of RICE ( rest , ice , compression , elevation ) , a short period of immobilisation and protection with a tape or bandage , and early range of motion , weight-bearing and neuromuscular training exercises . Proprioceptive training on a tilt board after 3 to 4 weeks helps improve balance and neuromuscular control of the ankle . Treatment for grade III injuries is more controversial A comprehensive literature evaluation and meta-analysis showed that early functional treatment provided the fastest recovery of ankle mobility and earliest return to work and physical activity without affecting late mechanical stability . Functional treatment was complication-free , whereas surgery had serious , though infrequent , complications . Functional treatment produced no more sequelae than casting with or without surgical repair . Secondary surgical repair , even years after an injury , has results comparable to those of primary repair , so even competitive athletes can receive initial conservative treatment . Sequelae of lateral ligament injuries are common . After conservative or surgical treatment , 10 to 30% of patients have chronic symptoms , including persistent synovitis or tendinitis , ankle stiffness , swelling , pain , muscle weakness and giving-way . Well-designed physical therapy programmes usually reduce instability . For individuals with chronic instability refractory to conservative measures , surgery may be needed . Subtalar instability should be carefully evaluated when considering surgery .