To determine whether operative treatment is superior to conservative therapy, 60 patients were randomized to surgical suture and cast immobilisation for six weeks (n = 30) or cast immobilisation alone for the same time (n = 30) for acute rupture of the ligaments of the ankle. Variables of well being (ability to work, to do sports, dysesthesia, pain during exercise, swelling, tendency for recurrent distorsion), stability (dislocation and tilting of the talus on x-ray examination) and the radiological evidence of arthrosis were chosen as endpoints. Complete follow-up was obtained one year after the accident. In both groups we did not find any evidence of arthrosis one year after the accident. No significant differences were found between the study groups neither for the parameters of well being nor for objective criteria of stability. No correlation was found between well being and stability of the ankle joint. These results suggest that for the chosen endpoints no treatment modality can be recommended after one year follow-up. Only long-term studies using incidence of arthrosis as the most important endpoint will be able to answer the question whether conservative or operative treatment of rupture of the ankle ligaments is superior.

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