From the Guidelines
Surgical therapy is the recommended treatment for a grade 3 ATFL sprain with a CFL tear, as it provides better outcomes in terms of recovery of ankle activity and instability compared to functional treatment. Treatment for a grade 3 ATFL sprain with a CFL tear typically requires comprehensive management, starting with the RICE protocol: rest, ice, compression, and elevation for the first 48-72 hours to reduce swelling and pain 1.
Key Considerations
- Use non-weight bearing with crutches for 1-2 weeks, followed by a walking boot or ankle brace for 4-6 weeks.
- Pain management includes NSAIDs like ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks.
- Physical therapy should begin after the acute phase, focusing on range of motion exercises, progressive strengthening, proprioception training, and balance exercises over 8-12 weeks. However, for severe cases with significant instability, such as a grade 3 ATFL sprain with a CFL tear, surgical repair is necessary, especially for athletes or physically active individuals, as it helps prevent recurrent ankle sprains and decreases the prevalence of chronic instability 1.
Recovery and Rehabilitation
- Recovery typically takes 12-16 weeks, with full return to sports activities possible around 4-6 months.
- A comprehensive approach is necessary because grade 3 sprains represent complete ligament tears, and the combination with a CFL tear creates significant ankle instability that requires proper rehabilitation to prevent chronic instability and recurrent sprains. According to a study published in the British Journal of Sports Medicine, surgical treatment provides better outcomes in terms of recovery of ankle activity and instability compared to functional treatment 1.
From the Research
ATFL Grade 3 Treatment with CFL Tear
- The treatment for ATFL grade 3 injuries with CFL tear is more controversial, and the approach may vary depending on the severity of the injury and the individual's specific needs 2.
- A non-operative 'functional treatment' programme is often recommended, which 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 2.
- Proprioceptive training on a tilt board after 3 to 4 weeks can help improve balance and neuromuscular control of the ankle 2.
- For individuals with chronic instability refractory to conservative measures, surgery may be needed, and subtalar instability should be carefully evaluated when considering surgery 2.
- Arthroscopic anatomical repair or anatomical reconstruction surgery is commonly used in clinical practice for treating acute injury to the ATFL, and modified arthroscopic Broström surgery has many advantages, such as less trauma, rapid pain relief, and fewer complications 3.
- Conservative management of acute lateral ligaments of the ankle injuries, including ATFL and CFL injuries, can be effective, and early and effective initial treatment involving pain management, prompt resumption of weight-bearing activities, limited immobilisation, and targeted physical therapy yields favorable outcomes 4.
Treatment Approaches
- Non-surgical treatment is the first choice for acute injury of the ATFL, and the standard treatment strategy involves the "peace and love" principle, followed by personalized rehabilitation training programs 3.
- Surgical treatment is feasible if non-surgical treatment is not ideal or fails, and the choice of surgical approach depends on the specific injury scenario and individual needs 3.
- Prophylactic bracing or taping can be considered to lower the risk of re-injury and enhance functionality in athletes who experience regular ankle sprains 4.