Ignoring a sprained ankle can become a bigger pain later in life

NEW YORK—May 23, 2008 

A sprained ankle: a major inconvenience for active Americans and an injury that is often overlooked by those who experience them.

While one in every 10 visits to the emergency room is for a sprained ankle, most falsely believe that it is a mild injury that needs mild treatment, if any at all. Big mistake, says John G. Kennedy, M.D., foot and ankle orthopedic surgeon at Hospital for Special Surgery in New York City, who warns athletes that improper treatment of an ankle sprain can lead to serious problems down the road.

“Athletes, especially male athletes, have been told by countless coaches and trainers to ‘suck it up’ and put some ice on an ankle sprain,” says Dr. Kennedy. “Those are the types of patients I see 10-15 years down the road in my office, who have formed large cysts, known as osteochondral lesions, in their ankles. Their next stop is typically the operating table to have cartilage restored.”

Case in point – basketball has been a constant in Queens resident Bob Fohngho’s life since he was 8. Throughout his career, the 25-year-old suffered several ankle sprains as a result of awkward landings. Typically, his coaches told him to wrap the ankle in ice and elevate it for a day or so. Trainers cautioned that his injured ankle needed more rest, but Bob did not want to let his team or coaches down and decided it was “good enough” to play on. As years progressed, his passion for basketball never waned. However, he experienced a great deal of pain in his injured ankle when he was not active.

Frustrated, Bob went to several doctors to find out why he was still in pain, but x-ray after x-ray showed no problems with the ankle. He finally turned to Dr. Kennedy, who suggested an MRI to get a better look at the injured ankle. The MRI showed that Bob, in fact, had an osteochondral lesion.

“Nearly 45 percent of the time, osteochondral lesions do not show up on normal x-rays,” said Dr. Kennedy. “To the active male, a negative x-ray result gives them temporary solace and false confidence that they can get ‘back in the game.’ Once the pain comes back, it plays on the psyche of the athlete – they feel the pain, but the x-ray showed no problems. They do not know what to do."

In Bob’s case, Dr. Kennedy presented the best option as a surgical procedure that would remove the cyst and replace it with undamaged cartilage from an area above his knee cap. This procedure, known as Osteochondral Autologous Transfer System (OATS), uses a device that resembles an apple corer to remove the lesion and then bore a hole into the damaged ankle. Dr. Kennedy chose the OATS procedure because of the large size of Bob’s lesion. In instances where the cyst is smaller, doctors would use a less invasive known as microdrilling. This type of procedure is usually recommended for patients under 50 years of age. Dr. Kennedy then removed healthy cartilage from his knee and used it to fill the hole in his ankle. A plate and two screws were put in place to stabilize the ankle.

Immediately following surgery, Bob was put in a below-the-knee cast for two weeks and was then put into a removable boot for roughly five weeks. After the cast was removed, Bob began intensive physical therapy. Dr. Kennedy noted that a patient like Bob, who is an athlete and wants to go back to sports, is motivated and takes rehabilitation with great verve, which results in speedier and stronger recoveries. There is a gradual molding process for the new cartilage in the ankle and exercises focus more on range of motion, rather than the ability to bear weight on the ankle. Once a patient exhibits a more fluid range of motion, the focus then shifts toward weight-bearing exercises.

Fifteen months following his surgery, Bob runs at full speed, experiences no more pain in his ankle, and plays in two competitive basketball leagues. “This experience has not only allowed me to get back on the basketball court but has boosted my confidence at my job as well,” said Bob, who was recently promoted to department supervisor of the GYN unit at Memorial Sloan-Kettering Hospital in New York. One thing is now certain for Bob – he will no longer ignore a sprained ankle.

About Hospital for Special Surgery
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics, No. 3 in rheumatology by U.S. News & World Report (2007), and has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center. In the 2006 edition of HealthGrades' Hospital Quality in America Study, HSS received five-star ratings for clinical excellence in its specialties. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Medical College of Cornell University, HSS provides orthopedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Medical College of Cornell University. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.

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