Acute ligament injury of the ankle joint

　　1. Etiology

　　Direct violence, indirect violence, and muscle strain can all cause injury.

　　2. Pathogenesis

　　The force causing acute ligament injury of the ankle joint can be roughly divided into three types: direct violence, indirect violence, and muscle pull, among which indirect violence is the main factor. It often occurs when a person trips on uneven ground or stairs, with the ankle in an extreme inverted plantarflexed position, causing excessive stretching of the lateral collateral ligament and resulting in injury. In mild cases, it may cause partial rupture of the tibiofibular inferior ligament, while in severe cases, it can lead to complete ligament rupture and ankle subluxation or dislocation. Or, due to excessive external inversion and external rotation of the distal end of the ankle joint, it can directly cause injury to the medial malleolus and/or the inferior tibiofibular ligament. Such injuries often coexist with fractures of the medial and/or lateral malleoli. Clinically, the most common injuries are the anterior talofibular ligament and the anterior tibiofibular ligament at the lateral malleolus, while the deltoid ligament injury often occurs in conjunction with ankle fractures and dislocations.

　　1. The medial side of the ankle joint is reinforced by a relatively tough medial ligament, while the lateral side has the anterior talofibular ligament, the posterior talofibular ligament, and the calcaneofibular ligament. These three ligaments originate from the lateral malleolus, with the first two ending at the talus and the last one at the calcaneus. Therefore, they are relatively independent and weak. During exercise, they often sustain injuries due to excessive inversion of the foot caused by sudden force, leading to lateral ligament injuries. Additionally, when the ankle joint is plantarflexed, the joint is relatively loose and less stable, making it prone to sprains, especially inversion sprains. Due to the special role this joint plays during exercise, it often takes a long time to heal, so we should pay more attention to protecting it and treat it promptly. Proper initial treatment after an ankle sprain is quite important.

　　2. If early treatment is not appropriate, excessive ligament laxity can lead to instability of the ankle joint, making it prone to recurrent sprains, and even joint cartilage damage, resulting in traumatic arthritis, which severely affects walking function.

　　The sequelae of improper treatment of ankle sprains generally include the following types.

　　Acute ankle ligament injury is caused by traumatic factors, so paying attention to safety in production and life is the key to preventing the disease. In social production activities, through the harmonious operation of people, machines, materials, environment, and methods, various potential accident risks and injury factors in the production process are always kept in an effective control state, and the lives and health of the laborers are protected in an all-round way.

　　First, imaging examination

　　1. When taking the anteroposterior and lateral X-ray films, the lower leg should be internally rotated by 20°, so that the transverse axis of the ankle joint is parallel to the X-ray film box, so that the entire joint gap is equal, and the subchondral bone plates of the tibia and talus are also parallel (A). The continuous alignment relationship between the subchondral bone plate at the distal end of the tibia and the linear shadow under the lateral malleolus can identify the slight shortening of the fibula, and can also observe the outward displacement of the talus and the widening of the lateral gap (B). When the lateral malleolus ligament is injured, only local soft tissue swelling shadows are seen on the routine film. If the diagnosis needs to be further clarified, a stress film can be taken after local anesthesia and compared with the healthy side, the normal tibiotalar inversion angle is 5°～10° (the angle when the tibial articular surface and the talus superior articular surface are inverted), if this angle is more than 1 times that of the healthy side, it indicates that the anterior tibiofibular ligament is ruptured; if it is more than 2～3 times, it is the rupture of the anterior tibiofibular ligament and the calcaneofibular ligament; if it is more than 5 times, it is the complete rupture of the lateral malleolus ligament, at this time, it is often accompanied by the fracture of the distal end of the fibula (C), the talus is not dislocated in the lateral and anteroposterior stress images (D). When the anterior tibiofibular ligament is injured, the talus appears in the anterior semi-dislocation (E).

　　2. When the medial malleolus ligament is ruptured, an ankle joint eversion stress film can be taken under local anesthesia to check, and some can show the separation sign of the tibiofibular inferior joint.

　　3. When the tibiofibular ligament is injured, a double-ankle contrast film should be taken to observe the distance between the tibiofibular inferior joints on both sides; if necessary, take a stress film after local anesthesia, that is, place the ankle joint in the position of external rotation, external rotation, internal rotation, and normal position to take a film, if the tibiofibular separation is shown, regardless of whether the fibula is fractured or not, it indicates that all three bundles of ligaments are completely ruptured; if the distal end of the fibula does not abduct when it is in the abducted position, but only shows rotation, it indicates that the posterior tibiofibular ligament is not ruptured; if the ankle joint is inverted alone, and if the gap between the tibia and fibula is increased by more than 3mm, it indicates that the tibiofibular ligament is injured, showing the semi-dislocation of the ankle joint.

　　Second, special examination

　　Ankle joint puncture angiography: can find the contrast agent entering the site of ligament injury at the ankle joint, magnetic resonance imaging (MRI) examination: MRI has good soft tissue resolution, can determine the range of blood hematoma in the soft tissue of the ankle, and identify ligament tears, rupture injuries, etc.

　　What kind of food should be eaten for the ankle acute ligament strain to be good for the body: reasonable diet and nutrition. The patient's diet should be light and easy to digest, eat more vegetables and fruits, reasonably match the diet, and pay attention to sufficient nutrition. In addition, patients also need to pay attention to avoid spicy, greasy, and cold foods.

　　I. Treatment

　　1. Non-surgical Treatment

　　(1) Incomplete rupture of the lateral malleolar ligament: In addition to general treatment such as early local cold compress, the affected foot should be strictly immobilized to promote ligament repair. ①Incomplete injury of the anterior talofibular ligament: Fixed with a lower leg cast in the inverted and plantar flexed position for 3 to 4 weeks, followed by immobilization with an ankle brace and functional exercise after removing the cast. ②Incomplete rupture of the talocalcaneal ligament: The ankle joint is fixed in functional position (90° to 100°) with an inverted lower leg cast for about 4 weeks, followed by the same subsequent treatment. ③Incomplete injury of the posterior talofibular ligament: The lower leg cast is fixed in the inverted and plantar flexed position for 4 to 5 weeks.

　　(2) Simple incomplete injury of the deltoid ligament in the medial malleolar ligament injury: Generally, the lower leg cast is fixed in an inverted position for 4 to 5 weeks. Mild cases can also be fixed in an inverted position with wide adhesive tape for 3 weeks, followed by physical therapy and the use of an external ankle brace.

　　(3) Simple tibiofibular ligament injury: Use a lower leg cast and shape and apply pressure on both sides above the ankle joint (using the palm of both hands for pressure) to facilitate reduction. After 4 to 6 weeks of fixation, change to an external ankle brace.

　　2. Surgical Treatment

　　(1) Complete rupture of the lateral malleolar ligament: In principle, ligament repair should be performed except for those with poor general condition who cannot undergo surgery. For late-stage cases with difficult repair, partial gastrocnemius, most or all of the damaged ligament can also be reconstructed using the nearby part of the fibular short muscle.

　　(2) Complete rupture of the deltoid ligament with associated fracture: The ruptured ligament is repaired, and for fractures with displacement, open reduction and internal fixation can be performed at the same time (usually tension band or screw fixation). The lower leg cast is immobilized for 4 to 5 weeks after the operation. After removing the cast, functional exercise and the use of an external ankle brace are performed.

　　(3) Rupture of the deltoid ligament with associated tibiofibular joint separation (often accompanied by a fracture of the lateral malleolus): At the same time as the operation, the tibiofibular joint below is fixed with a long screw, and the fixation time is generally not more than 6 weeks.

　　(4) Lesion of the tibiofibular ligament with associated displaced fracture: When performing open reduction and internal fixation of the fracture, long screws are often used for compression fixation and reduction. The postoperative cast is immobilized for 6 to 8 weeks, and the time for removing the cast is determined according to the healing condition of the fracture.

　　II. Prognosis

　　Generally, the prognosis is good.