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Sports docs’ weekly blitz: The dreaded high-ankle sprain

Ankle sprains are some of the most common injuries in sports. When they occur low down by the bony protuberances (“malleoli”) on either the outside or the inside of the ankle, they are generally treated symptomatically until the athlete is able to return to competition. When they sprain occurs higher up between the two leg bones (tibia and fibula), the sprain takes much longer to heal and often requires surgery.

In this instance, the tibia and fibula dissociate from each other and the articular surfaces of the ankle joint are often no longer congruent, setting the stage for post-traumatic arthritis. The goal of surgery is to make the joint surfaces congruent again (or “anatomic”) as they were before the injury so the ankle is stable and the joint surfaces glide on one another perfectly. 

While low ankle sprains generally take anywhere from a few days to a few weeks to recover from, the dreaded “High Ankle Sprain” can sometimes take months to return to competitive sport. 

The surgical treatment for these injuries has evolved along with all of sports medicine, so that now, instead of screws, I routinely use an implantable device called a “tightrope." It holds the two bones together much like the cable a trapeze artist walks on at circuses.

In contrast to traditional screws used to fix high ankle sprains, the tight rope allows for a little bit of physiologic motion between the fibula and tibia that occurs naturally. Research has shown the tightrope construct provides a more anatomic reduction than screws, and I believe the physiologic motion allowed by the tight rope allows more anatomic movement during ankle motion. 

Another advantage of this tightrope system is there is no risk of implant breakage, which often happens with screws once the athlete returns to play. Therefore, hardware removal is unnecessary with the tight rope construct and a second surgery (which is required to remove the screws once the high ankle sprain is healed) is avoided.

See the images below to see what the x-rays look like following ankle tightrope surgery for a high ankle sprain. 

Next week’s Weekly Blitz will be brought to you by my partner, Dr. Tom Greenwald.

That’s all for now, Doc Warme.  


Are you interested in making an appointment with our docs? Click here to learn more about Dr. WarmeDr. Buckand Dr. Greenwald.


Dr. Bryan Warme


Dr. Warme treats all athletic injuries and specializes in arthroscopic reconstruction of the Shoulder, Elbow, Hip, Knee and Ankle. He provides orthopedic coverage for Iowa State's athletes and area high school athletes. Having been an athlete himself who had to work through various injuries and surgeries, he is committed to giving athletes the best care possible with the goal of getting them back on the field competing at the highest levels. His approach is to treat all his patients as if they were members of his own family. Dr Warme Specializes in: Sports Medicine Consultant to ISU Athletic Teams Arthroscopic Reconstruction:shoulder, elbow, hip, knee and ankle

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