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             \author[1]{Amanda Gomes  Quiroga}

             \author[2]{Jose Pereira da Silva  Filho}

             \author[3]{Joaquim Lucas Silva  Cardoso}

             \author[4]{Valter Oliveira da  Silva}

             \author[5]{Ana Beatriz de Matos Berg  Abrantes}

             \author[6]{Rebeca Mendes  Peres}

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\date{\small \em Received: 1 January 1970 Accepted: 1 January 1970 Published: 1 January 1970}

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\begin{abstract}
        


Introduction: It's important to comprehend the key concepts of chronic ligament injuries to the ankle, which occur when there is deterioration or weakening and can result from recurrent or untreated trauma (AMODIO, 2013). Chronic ligament damage typically results from frequent ankle sprains. Ligaments are fibrous tissues that connect bones and provide stability for joints. In the ankle, the ligaments most commonly affected are the anterior talofibular ligament and the calcaneofibular ligament.

\end{abstract}


\keywords{ligament injury; ankle; chronic injury.}

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\section[{Chronic Ankle Ligament Injury and its Clinical}]{Chronic Ankle Ligament Injury and its Clinical}\par
Management, A Literature Review Abstract-Introduction: It's important to comprehend the key concepts of chronic ligament injuries to the ankle, which occur when there is deterioration or weakening and can result from recurrent or untreated trauma (AMODIO, 2013). Chronic ligament damage typically results from frequent ankle sprains.\par
Ligaments are fibrous tissues that connect bones and provide stability for joints. In the ankle, the ligaments most commonly affected are the anterior talofibular ligament and the calcaneofibular ligament.\par
Methodology: This is a literature review whose bases were taken from the SciELO and PubMed data platforms. The research period was July 2023, meeting the inclusion criteria, which were articles from the years 2000 to 2023, in Portuguese and English, online texts, and full texts. The following health descriptors (DeCS) were employed as evaluation techniques for the texts: "ligamentous injury," "ankle," and "chronic."\par
Results: An ankle sprain, which is particularly prevalent in athletes and in those who lead active lives, is an injury that is produced, in most cases, by the eversion or inversion of the foot as a result of fast and forceful movements, with or without tearing of the ligaments (BARONI, 2010). An ankle sprain can occur with or without tearing of the ligaments. Acute ankle ligament injuries are common, with injuries to the lateral ligament complex being the most prevalent. The bone structure of the ankle joint provides stability in a neutral state. Compressive pressures applied in the weight-bearing posture increase the stability of the bone. The majority of ankle lateral ligament injuries heal on their own with conservative care, and in many instances, this type of care results in mechanical stability of the joint (LYNCH, 1999). On the other hand, persistent problems after ankle ligament injuries are not uncommon. After both conservative and surgical treatment, 10\% to 30\% of patients with lateral ligament injuries may experience chronic symptoms (Lynch, 1999).  
\section[{Introduction}]{Introduction} 
\section[{Methodology}]{Methodology}\par
This study is a literature review whose bases were taken from the SciELO and PubMed data platforms. The research period was July 2023, meeting the inclusion criteria of articles from the years 2000 to 2023, in Portuguese and English, online texts, and full texts. As strategies for better evaluation of the texts, the following health descriptors (DeCS) were used: "Ligament injury", "Ankle" and "Chronic". 
\section[{III.}]{III.} 
\section[{Results and Discussion}]{Results and Discussion}\par
Ankle sprains are common injuries among athletes and those who lead busy lives. It typically results from the foot being forced in or out suddenly and violently, and ligaments may or may not be torn (BARONI, 2010).\par
Acute ankle ligament injuries are frequent, with injuries to the lateral ligament complex being the most frequent. The ankle joint's bone structure provides stability in the neutral position. Compressive pressures in the body-loaded position improve bone stability. According to LYNCH (1999), the majority of lateral ankle ligament injuries heal on their own with conservative care, and according to AMODIO (2013), conservative care frequently results in mechanical stability of the joint. However, after ankle ligament injuries, lingering issues are not uncommon. After both conservative and surgical treatment, 10\% to 30\% of patients with lateral ligament injuries may experience chronic symptoms  {\ref (Lynch, 1999)}.\par
Chronic ankle instability brought on by lateral ligament complex injury sequelae is rather uncommon and most frequently seen after an acute ligament injury that was probably not well handled \hyperref[b4]{(CILLO, 1996)}. Other issues, such as stress fractures (especially Jone's fracture), osteochondral fractures, osteochondritis dissecans, midfoot sprains, tendinitis, or subluxation of the peroneus muscles, should be taken into consideration in individuals with persistent issues or unique symptoms (Lynch, 1999).\par
Six months after receiving treatment for acute ligament damage, some individuals may experience discomfort or instability. Chronic instability, osteochondral lesion, impingement with distal tibiofibular inflammatory process, and anterior impingement with exostosis are the various associated ailments that might occur, usually in decreasing order of frequency (GUIDELINES, 2008). Sistent synovitis or tendonitis, ankle stiffness, swelling, pain, muscular weakness, and repeated misalignments are among the typical symptoms. The instability of the ankle is a common factor in many of these issues. It's critical to recognize the difference between mechanical and functional ankle instability. Mechanical instability refers to abnormal laxity of the ligament stabilizers, and functional instability refers to normal but abnormally functioning ligament stabilizers with recurrent episodes of misalignment. Isolated mechanical instability is of minimal clinical importance, but often mechanical and functional instability occur together. It is also important to consider the subtalar joint as part of the cause of instability  {\ref (Lynch, 1999)}. Conflict syndrome is frequently present in people with CTI who have chronic pain, which affects about 60\% of them. Failure to effectively treat may cause an inflammatory process to develop, which will then cause the creation of scar tissue that will occupy the area between the ligaments of the CLL (meniscoid lesion), perhaps causing local pain and inflammation to worsen (MARTINS, 2020).\par
It is challenging to distinguish between lateral ankle ligament instability and subtalar instability, and these issues might coexist. Chronic occurrences of ankle misalignment during physical activity, together with a history of repeated injuries and/or discomfort, edema, and stiffness, are symptoms of both conditions (Lynch, 1999).\par
Misdiagnosis regarding the severity of the injury, as well as patient omission of their injury, can lead to inadequate treatment and consequently chronic instability of the ATPA (CILLO, 1996). Ligament injuries are classified according to severity into grade 1, stretching of the affected ligament, and grade 2, partial injuries, without joint instability. Complete injuries are classified as grade 3, when joint stability is impaired (AMODIO, 2013).\par
The main goal of ankle sprain treatment is to prevent chronic ankle instability, which will later lead to fractures, ligament injuries, or both. In order to treat an ankle sprain, physiotherapeutic resources (conservative treatment) are used to promote an early return to daily activities, preventing the patient from undergoing a more aggressive surgical procedure \hyperref[b6]{(CRISTINA, 2001)}.\par
For the treatment of grade I and II lesions, the prognosis is excellent. Resources are used to reduce edema, such as cryotherapy, bandages, and limb elevation, followed by a period of immobilization with bands or orthoses. Subsequently, with the reduction of pain, flexibility movements begin with progressive load and proprioception \hyperref[b6]{(CRISTINA, 2001)}.\par
In grade III sprains, both conservative and surgical treatment are used, depending on the clinical picture. Conservative treatment is based on the use of cryotherapy, bandaging, positioning, and early mobilization. Surgical treatment consists of ligament sutures or ligament reconstruction, according to the level of rupture and joint instability \hyperref[b6]{(CRISTINA, 2001)}.\par
Although anamnesis and a physical exam are crucial for making a diagnosis, it's also critical to do an imaging scan to describe the lesions that are present and rule out any related illnesses. Given this, and depending on the objective, we can turn to arthroscopy, ultrasound, MRI, and X-rays taken during load and stress (MARTINS, 2020).\par
Conservative treatment involves using the RICE concept (rest, ice, compression, and elevation), followed by a brief (1-2 week) period of immobilization, early joint mobilization, a gradual increase in load, and muscle strengthening activities with proprioception. This approach is usually sufficient for patients to resume their daily and sporting activities once the injury is healed. When conservative treatment does not have the desired results, or in the case of a high-level athlete, surgical treatment should be considered (MARTINS, 2020).\par
The need for and duration of immobilization depend on the degree of injury. A grade I sprain does not require immobilization, so we can only recommend the use of an elastic bandage for a few days. For grade II sprains, more rigid immobilization may be necessary during the first few days until the pain resolves. In cases of fractures or grade III sprains, we must control the range of motion of the joint by applying a plaster cast or immobilizing boot. (MARTINS, 2020).\par
To increase range of motion and lessen the possibility of muscle atrophy, physiotherapy should be started as soon as possible. This should last three to six weeks and consist of proprioception training and rangeof-motion activities (MARTINS, 2020). Although there is a lack of literature concerning clinical trials related to the topic in theory, proprioceptive training's responses to stimuli cover physiological effects and provide evidence of its effectiveness in increasing joint stability and neuromuscular and balance control (ROCHA, 2023). 
\section[{Final Consideration}]{Final Consideration}\par
It is clear from understanding the various treatment modalities that cases involving more extensive injuries over time necessitate different treatment modalities in order to prevent the patient's instability and progression of their ankle ligament injuries, which are chronic in nature and necessitate surgical treatment in severe cases.\begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-2.png}
\caption{\label{figure2}}\end{figure}
 		 		\backmatter  			  				\begin{bibitemlist}{1}
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\end{document}
