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Nuno Corte-Real Department of Orthopaedics, Hospital de Cascais Dr. José de Almeida, Portugal

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João Caetano Department of Orthopaedics, Hospital de Cascais Dr. José de Almeida, Portugal

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Introduction Ankle instability is a clinical condition closely related with the traumatic event commonly known as ankle sprain, usually a supination trauma. This event is extremely frequent, being one of the top causes of Emergency Room visits

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Gema Chamorro-Moriana Department of Physiotherapy, Research Group “Area of Physiotherapy CTS-305”, University of Seville, Seville, Spain

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Veronica Perez-Cabezas Department of Nursing and Physiotherapy, Research Group MOVEIT (eMpOwering health by physical actiVity, Exercise and nutrition) CTS-1038, University of Cadiz, Cadiz, Spain

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Marisa Benitez-Lugo Department of Physiotherapy, Research Group “Area of Physiotherapy CTS-305”, University of Seville, Seville, Spain

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and sports, ankle sprains have the highest incidence ( 4 ). The lateral ligament complex is the most frequently injured ( 2 , 5 , 6 , 7 ), and injury to this complex represents up to 85% of all ankle sprains ( 8 ). Chronic ankle instability (CAI

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Omar A. Al-Mohrej King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia

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Nader S. Al-Kenani King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia

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instability. 4 Epidemiology Among all ankle injuries, ankle sprains are the most common and account for approximately 80%, 5 , 6 of which 77% are lateral sprains. 73% of lateral ankle sprains are due to rupture or tear of the ATFL. 7

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Mario Herrera-Pérez Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain
Department of Surgery, Universidad de La Laguna, Tenerife, Spain

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Victor Valderrabano Foot and Ankle Unit, Orthopaedic Department, Schmerzklinik, Basel, Switzerland
University of Basel, Basel, Switzerland

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Alexandre L Godoy-Santos Orthopaedic Department, Hospital Israelita, Sao Paulo, Brazil

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César de César Netto Director of the UIOWA Orthopedic Functional Imaging Research Laboratory (OFIRL), Iowa, USA
Department of Orthopedic and Rehabilitation, University of Iowa, Iowa, USA

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David González-Martín Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain
Department of Surgery, Universidad de La Laguna, Tenerife, Spain

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Sergio Tejero Foot and Ankle Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
Department of Surgery, Universidad de Sevilla, Sevilla, Spain

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ligament instability, particularly those affecting the lateral collateral ankle ligament (which some authors call ligamentous ankle OA) ( Fig. 2 ) ( 8 , 9 ). Ankle instability increases the peak joint contact stresses of the ankle joint, resulting in

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Kinner Davda Department of Foot & Ankle Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK

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Karan Malhotra Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK

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Paul O’Donnell Department of Foot & Ankle Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK

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Dishan Singh Department of Foot & Ankle Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK

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Nicholas Cullen Department of Foot & Ankle Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK

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pathologies are frequently encountered in patients with chronic lateral ankle instability or cavovarus hindfoot alignment, and usually result from prolonged, repetitive athletic activities or ankle inversion injuries. The management of these conditions is

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Ulrike Wittig Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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Gloria Hohenberger Department of Trauma, LKH Feldbach-Fürstenfeld, Feldbach, Austria

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Martin Ornig Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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Reinhard Schuh Department of Orthopaedics, Protestant Hospital Vienna, Vienna, Austria

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Andreas Leithner Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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Patrick Holweg Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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by immobilization in a brace ( 9 , 10 , 11 ). However, about 10 to 20% develop chronic lateral ankle instability (CLAI) and consequently require surgical ligament repair ( 12 , 13 ). The Broström technique as well as its modifications is considered

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Fabian Krause Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

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Helen Anwander Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

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patients with OLT present ankle ligament laxity and 39% of patients with ankle instability present with an OLT ( 5 , 6 ). Subsequently, acute trauma and repetitive micro-traumata due to ankle instability and/or hindfoot malalignment seem to be a leading

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José Nuno Ferreira Department of Orthopaedics, Hospital Beatriz Ângelo, Portugal

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João Vide Department of Orthopaedics, Hospital Beatriz Ângelo, Portugal

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Daniel Mendes Department of Orthopaedics, Hospital Beatriz Ângelo, Portugal

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João Protásio Department of Orthopaedics, Hospital Beatriz Ângelo, Portugal

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Rui Viegas Department of Orthopaedics, Hospital Beatriz Ângelo, Portugal

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Manuel Resende Sousa Department of Orthopaedics, Hospital da Luz, Portugal

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develop long-lasting symptoms: feeling of ankle instability (‘giving way’), pain, swelling and recurrent sprains, ultimately resulting in functional limitations. 3 The proportion of patients who reported that they still experienced pain at 1-year

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Young Yi Department of Orthopaedic Surgery, Inje University, Seoul Paik Hospital, 85, 2-ga, Jeo-dong, Jung-gu, Seoul, 100-032, Republic of Korea

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Woochun Lee Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, 764-30, Bang bae dong, Seochogu, Seoul, 06554, Republic of Korea.

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Absolute contraindications : • End-stage ankle OA. • Unmanageable hindfoot instability. • Acute osteomyelitis or infection. • Severe vascular and/or neurological deficiency. Relative contraindications : • Advanced age. • Patients with poor general

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Nicola Krähenbühl Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland

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Tamara Horn-Lang Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland

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Beat Hintermann Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland

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Markus Knupp Mein Fusszentrum, Eichenstrasse 31, 4054 Basel, Switzerland

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with failure of the anterior talo-fibular ligament, leads to an unphysiological anterolateral rotation of the talus during gait. 7 As a result, subtalar joint and secondary ankle joint instability may occur. 7 The importance of the calcaneo

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