Abstract
CASE HISTORY: A 21-year-old female with hypermobile Ehlers-Danlos Syndrome (hEDS) sustained a right ankle inversion injury while stepping off a curb, resulting in acute pain, swelling, and inability to weightbear. Initial conservative treatment including rest, ice, and traditional physical therapy (PT) was initiated but failed to relieve symptoms. Magnetic Resonance Imaging (MRI) revealed a Grade-II ATFL tear with chronic instability. After three months of unsuccessful conservative management and persistent pain and instability, surgical intervention was pursued. PHYSICAL EXAM: Examination revealed marked tenderness over the anterior talofibular ligament (ATFL), restricted motion in all directions, decreased strength (2+/5) and positive anterior drawer (2+). DIFFERENTIAL DIAGNOSES: At initial evaluation, the patient presented with 3/10 pain at rest and 7/10 “sharp” pain with motion, accompanied by a 3+ ankle effusion. The treating PT considered a differential diagnoses of lateral ankle sprain, peroneal tendon strain, osteochondral lesion of the talus, and syndesmotic injury. TESTS & RESULTS: Radiographs ruled out the presence of a fracture. Special tests revealed a positive anterior drawer test, and negative cotton and External Rotation Squeeze tests. MRI revealed a Grade-II ATFL tear. Stress X-Ray was positive for talar tilt, consistent with chronic instability. FINAL DIAGNOSIS: Final diagnosis was a Grade-II ATFL tear secondary to ligamentous laxity associated with hEDS. DISCUSSION: Although Grade-II ATFL tears typically respond to conservative management, individuals with hEDS exhibit greater instability and delayed healing, warranting earlier surgical consideration. This case highlights the importance of identifying connective tissue disorders when managing ankle injuries, as standard protocols may be insufficient for this patient population. OUTCOME OF THE CASE: The patient underwent right ankle arthroscopy and Modified Broström-Gould repair with internal bracing, achieving significant postoperative improvement. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: At three month follow up, the patient demonstrated full, pain-free range of motion, 5/5 strength and returned to dynamic activities such as running, jumping, and single-leg hopping without instability.
Recommended Citation
Finkelstein, Jake; Hirsch, Jessie; Pottorf, Ofra A.; and Rothstein, Alex
(2025)
"Surgical Management of a Grade-II Anterior Talofibular Ligament Tear with Ehlers-Danlos Syndrome: A Case Report,"
International Journal of Exercise Science: Conference Proceedings: Vol. 15:
Iss.
7, Article 20.
Available at:
https://digitalcommons.wku.edu/ijesab/vol15/iss7/20