[Comparison of four evaluation systems used for ankle injuries]

Unlike the knee and shoulder, no widely accepted scoring system exists for the ankle joint. The aim of this study was to compare the results of diverse scoring systems used in ankle injuries.

We compared the results of four evaluation systems used for the ankle including those proposed by (i) Meislin et al. (ME), (ii) Martin et al. (MA), (iii) Kaikkonen and Kannus (KK) and (iv) a modified Bray's system (B). With the use of these evaluation systems we assessed the results of (i) 21 patients who underwent arthroscopic treatment for anterolateral impingement of the ankle, (ii) 17 patients who underwent surgical treatment for bimalleolar ankle fractures, and (iii) 22 patients receiving conservative treatment for grade 2-3 lateral ankle sprains. Statistical analyses were made using the chi-square test.

The four scoring systems yielded similar results ranging from 23% to 33% in three groups, whereas conflicting results were obtained in the remaining cases (67% to 77%). The scores indicating poor outcomes were the highest with the ME and MA systems which included more subjective criteria. Similarly, the number of excellent results were significantly lower in these two systems than those of B and KK (p<0.001).

Due to the high incidence of conflicting results between the scoring systems used, any particular patient may be rated as fair with one system and excellent with another. A standard ankle scoring system requires the inclusion of objective, subjective, and functional criteria, with each patient being evaluated according to individual activity levels as well.