Rory McIlroy revealed on Instagram that he ruptured his anterior talofibular ligament, the major ankle stabilizing ligament, while playing soccer with friends over the weekend. His instagram pictures show him in a removable cast boot up to the knee, donning a pair of crutches, and says "Total rupture of left ATFL (ankle ligament) and associate joint capsule damage."
But, what does this mean for the world number one defending champion?
The good news, no surgery. The bad news, a long recovery of 6-8 weeks of casting followed by physical therapy -- about a 3-month recovery in total.
What Is An Ankle Ligament Rupture?
The ankle joint has strong ligaments that hold it together on the inside and outside. The inside is structurally strong, however the outside of the ankle is weaker and more susceptible to injury. There are three ligaments on the outside of the ankle that can be injured -- they are the anterior talofibular ligament, calcaneofibular ligament and the posterior talofibular ligament. The anterior talofibular ligament, abbreviated ATFL, is the most commonly injured ankle ligament and is located on the outside part of the ankle bone, more near the front/side of the ankle.
When the ankle ligaments are overstretched, specifically in a motion known as inversion, they can become injured. Inversion injuries are those where the foot rolls inward on the ankle. These are the same injuries that cause ankle fractures. They are common in sports where there is explosive side-to-side movements such as soccer, basketball and baseball.
There are varying degrees of ankle ligament injuries that can occur from mild to severe. A mild injury is best known as a simple ankle sprain - where the ligaments become overtaxed and inflamed. A more significant sprain is one where the ankle ligaments have tears but are structurally intact. The most severe injury is a complete tear, better termed rupture, where the ligament is no longer incontinuity and essentially not functional
How Are Ankle Ligament Ruptures Treated?
It used to be that ankle ligament ruptures underwent surgery to repair the ruptured ligament. In this case, surgeons would reattached the separated torn ligament together with strong sutures. The post-op care would involve casting and no weight for 6 weeks followed by physical therapy, with a full recovery around 3 months. Nowadays, ankle ligament ruptures are treated without surgery and casting for 6 weeks, also followed by a course of physical therapy. The reason surgery is not necessary is because neutralizing the ankle in a cast in the proper position allows the ligaments to heal so long as there is not motion causing the ligaments to separate.
What Is The Long Term Prognosis After Ankle Ligament Ruptures?
Most people with ankle ligament ruptures, if treated properly and patients follow doctors directions, heal up without any long term sequelae. However, if the ankle ligaments do not heal in the proper position, they may heal in an over-stretched or lengthened position, and ultimately lead to a condition called ankle instability. With ankle instability, people experience "weak ankles" and often recurrent sprains or ankle twisting events. This is problematic for people who walk on uneven/canted surfaces -- such as a roof or a golf course. The most common complaint is patients say their ankles "give way." Longstanding ankle instability can require surgery to rebuild the inefficient ankle ligaments.
Will Rory's Golf Game Ever Be The Same?
If Rory has a standard ankle injury, even with rupture of the ATFL, he will likely get back to normal without any long standing issues. Its just going to take a few months. He just needs to follow instructions and allow his ankle ligaments to heal. Its important not to push the healing process or else he could wind up with chronic ankle instability should the ligaments heal over-stretched. Ankle instability would make maneuvering on the golf course a disaster.
Dr. Neal Blitz
Reconstructive Foot & Ankle Surgery
New York City
To learn more about ankle instability surgery and Dr. Blitz, please visit www.DrNealBlitz.com