How are ankle sprains graded?

Updated: Jan 14, 2019
  • Author: Craig C Young, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Ankle sprains are classified into the following 3 grades:

  • Grade 1 injuries involve a stretch of the ligament with microscopic tearing but not macroscopic tearing. Generally, little swelling is present, with little or no functional loss and no joint instability. The patient is able to fully or partially bear weight.

  • Grade 2 injuries stretch the ligament with partial tearing, moderate to severe swelling, ecchymosis, moderate functional loss, and mild to moderate joint instability. Patients usually have difficulty bearing weight.

  • Grade 3 injuries involve the complete rupture of the ligament, with immediate and severe swelling; ecchymosis; an inability to bear weight; and moderate to severe instability of the joint. Typically, patients cannot bear weight without experiencing severe pain.

Ankle sprain staging or grading is primarily done clinically. The clinician can determine whether the ankle ligaments are stretched without significant tear (grade 1), are partially torn (grade 2), or are completely torn (grade 3) on the basis of the degree of swelling and ecchymosis and on the clinical stability of the ankle. Arthrograms, stress radiographs, and magnetic resonance imaging (MRI) scans add little to the management of the ordinary ankle sprain. In order to have any significance, stress radiographs should be performed on both ankles.

This grading system fails to characterize ankle injuries involving 2 or more ligamentous structures and excludes consideration of nonligamentous injuries.

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