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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 HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.

 

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