COMBINED MULTI-LIGAMENT INSTABILITY IN PATIENTS WITH CHRONIC SYMPTOMS FOLLOWING ROTATIONAL ANKLE INJURIES. A PROSPECTIVE COHORT STUDY

Cesar de Cesar Netto; Erik Jesus Huanuco Casas; Aly Fayed; Kepler Carvalho; Conor O’Neil; Enrico Pozzessere; Nacime Salomao Barbachan Mansur

doi:10.1016/j.fas.2026.06.019

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COMBINED MULTI-LIGAMENT INSTABILITY IN PATIENTS WITH CHRONIC SYMPTOMS FOLLOWING ROTATIONAL ANKLE INJURIES. A PROSPECTIVE COHORT STUDY

Journal article

Peer reviewed

COMBINED MULTI-LIGAMENT INSTABILITY IN PATIENTS WITH CHRONIC SYMPTOMS FOLLOWING ROTATIONAL ANKLE INJURIES. A PROSPECTIVE COHORT STUDY

Cesar de Cesar Netto, Erik Jesus Huanuco Casas, Aly Fayed, Kepler Carvalho, Conor O’Neil, Enrico Pozzessere and Nacime Salomao Barbachan Mansur

Foot and ankle surgery

07/06/2026

DOI: 10.1016/j.fas.2026.06.019

PMID: 42420113

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Abstract

To prospectively quantify isolated versus combined ligamentous instability in symptomatic patients after rotational ankle injuries (RAI) and assess changes in patient-reported outcomes (PROs) after targeted surgical stabilization. Adults with pain and/or subjective instability >6 months after RAI who failed nonoperative care were enrolled. All underwent diagnostic ankle arthroscopy and open stabilization based on standardized intraoperative criteria for lateral, syndesmotic, and deep deltoid instability; combined patterns were classified. PROs and complications were recorded. Twenty-nine patients (30 ankles; 36.1 years, BMI 31.2kg/m2) after RAI were included, mean 45.2-month follow-up. Instability patterns were multidirectional (lateral/deltoid/syndesmotic) in 60%, rotational (lateral/deltoid) in 20%, anterolateral (lateral/syndesmotic) in 13%, and anteromedial (deltoid/syndesmotic) in 3.5%; isolated lateral occurred in 3.5%. Collected PROs showed improvement (ps<0.04) and three complications occurred (10%). In symptomatic patients after RAI, multi-ligament ankle instability predominated, most commonly multidirectional or rotational patterns. Intraoperative-guided comprehensive stabilization yielded PRO improvements with a low complication rate. Level II. Prospective cohort study.

Ankle Instability

Ankle Sprain

Anterolateral

Anteromedial

ATFL

Combined

Deltoid

Lateral Instability

Medial Instability

Multidirectional

Rotational

Syndesmosis

Syndesmotic Instability

Details

Title: Subtitle: COMBINED MULTI-LIGAMENT INSTABILITY IN PATIENTS WITH CHRONIC SYMPTOMS FOLLOWING ROTATIONAL ANKLE INJURIES. A PROSPECTIVE COHORT STUDY
Creators: Cesar de Cesar Netto - University of Iowa
Erik Jesus Huanuco Casas - Duke Medical Center
Aly Fayed - University of Iowa
Kepler Carvalho - University of Iowa, Orthopedics and Rehabilitation
Conor O’Neil - Duke University
Enrico Pozzessere - Duke Medical Center
Nacime Salomao Barbachan Mansur - University of Iowa, Orthopedics and Rehabilitation
Resource Type: Journal article
Publication Details: Foot and ankle surgery
DOI: 10.1016/j.fas.2026.06.019
PMID: 42420113
ISSN: 1268-7731
eISSN: 1460-9584
Publisher: Elsevier Ltd
Language: English
Electronic publication date: 07/06/2026
Academic Unit: Orthopedics and Rehabilitation
Record Identifier: 9985180976102771

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