A 22-year-old basketball player lands awkwardly and sustains a grade III lateral ankle sprain with ATFL and CFL rupture confirmed on stress X-ray (talar tilt >15°). What is the evidence-based management for an acute grade III ankle sprain?
- A Immediate surgical repair of ATFL and CFL
- B Short-leg cast immobilisation for 6 weeks
- C RICE, functional rehabilitation with an air-stirrup brace, and proprioceptive training — surgery reserved for chronic instability ✓
- D Arthroscopic examination and debridement within 48 hours
Explanation
Current evidence (multiple RCTs and meta-analyses) shows functional treatment of acute grade III lateral ankle sprains (RICE, early mobilisation, air-stirrup brace, proprioceptive rehabilitation) produces equivalent or superior long-term outcomes compared to casting or immediate surgical repair. Functional rehabilitation preserves proprioceptive receptor function in the remaining ligament scar tissue. Primary surgical repair is not indicated acutely; it is reserved for patients with proven chronic functional instability after >3–6 months of failed rehabilitation — where the Broström procedure (anatomical repair) ± Gould modification is performed.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.