Our Clinical Approach to Ankle Sprain

Our Clinical Approach to Ankle Sprain

by | Feb 6, 2026 | dr-chirag-arora, Gurgaon, Health, Orthopedics

Our Clinical Approach to Ankle Sprain

Below is a stepwise orthopedic workflow we use in our clinic.

Mechanism of injury

  • Inversion → ATFL injury (outside sprain) (most common)
  • Eversion → deltoid ligament (inside sprain)
  • External rotation → syndesmotic (high ankle sprain)

Red flags

  • Unable to bear weight immediately 
  • Severe swelling within an hour (fracture)
  • Locking/catching 
  • Medial pain (deltoid injury)

Imaging

X-ray is almost always required, unless clinical decision is otherwise:

  • bone tenderness OR
  • unable to bear weight

MRI indications (never required before 6 weeks)

  • persistent pain > 6 weeks
  • recurrent
  • elite athletes (off season)
  • suspected osteochondral defect

Grading

GRADE 

PATHOLOGY

CLINICAL

I

Stretch

mild swelling, stable

II

Partial Tear

moderate pain, laxity

III

Complete Tear

gross instability

 Management Protocol

Acute phase (0–2 weeks)

PRICE protocol

  • Protection (brace/Cast)
  • Rest 
  • Ice
  • Compression
  • Elevation

Medications

  • Anti-inflammatory medications – short course 5-7 days
  • Early weight bearing as tolerated
  • Physiotherapy (Range of motion)

Walking Cast may be required

  • Severe swelling 
  • Fracture
  • Repeated ankle sprains
  • High grade injury

Return to sport criteria

    • full ROM
    • no swelling
    • 90–95% strength
    • single leg hop pain free
    • good proprioception

       Timelines:

    • Grade I → 1–2 weeks
    • Grade II → 3–6 weeks
    • Grade III → 6–8 weeks

    Surgical indications

    • chronic instability (> 3 months)
    • Recurrent swelling episodes during sports
    • Ankle instability (Exam)
    • syndesmotic diastasis
    • associated osteochondral lesion

    Options

    • Arthroscopic surgery (Brostom-gould repair)

    Our Practical Approach template

    Grade I–II

    • No immobilization required
    • Walking allowed
    • NSAIDs 5 days
    • Supplements
    • physio referral (ROM + strengthening)
    • review 14 days

    Grade III

    • Walking cast 2 weeks
    • Medications
    • supplements
    • structured rehab
    • reassess 6 weeks
    • return to sports > 6 weeks

    IF SYMPTOMS ARE PERSISTENT BEYOND 6 WEEKS, PROGRESS TO MRI.

      Consult Dr. Chirag Arora, Best in Gurgaon, for expert evaluation, personalized rehab, and safe return to sports.

        Preventing Knee Injuries in Weekend Athletes

        Preventing Knee Injuries in Weekend Athletes

        by | Jan 2, 2026 | Gurgaon, Health, Orthopedics

        PREVENTING IN WEEKEND ATHELETES

        Weekend athletes—individuals who engage in sports such as football, badminton, running, cricket, or gym workouts primarily on weekends—are particularly vulnerable to knee injuries. Unlike professional or regular athletes, they often combine high-intensity activity with inadequate preparation and recovery. The knee, being a complex weight-bearing joint, is one of the most commonly affected areas.

        Why Weekend Athletes Are at Higher Risk

        • Sudden bursts of activity after a sedentary workweek
        • Poor muscle conditioning and flexibility
        • Inadequate or cool-down
        • Ignoring early warning signs of injury

        Common injuries include meniscus tears, muscle , ACL , patellofemoral pain syndrome, ligament tears and early cartilage damage.

        PREVENTION TIPS

        1. Importance of a Proper Warm-Up

        A warm-up is not optional—it is injury prevention.

        What a Good Warm-Up Should Include (10–15 minutes)

        a. Light Aerobic Activity (5 minutes)

        • Brisk walking
        • Slow jogging
        • Cycling

        This increases blood flow and prepares muscles and ligaments for load.

        b. Dynamic Stretching (5–7 minutes)
        Focus on controlled movements rather than static holds:

        • Leg swings (front-to-back and side-to-side)
        • Walking lunges
        • High knees
        • Hip openers

        c. Muscle Activation (3–5 minutes)

        • Quadriceps sets
        • Glute bridges
        • Mini squats
        • Resistance band walks

        Why it matters:
        A proper warm-up improves neuromuscular control, joint stability, and reaction time—key factors in preventing ACL and meniscal injuries.

        2. Common Training Errors That Lead to Knee Injuries

        a. Sudden Increase in Intensity or Duration

        Playing an intense match after weeks of inactivity is a common trigger for ligament and cartilage injuries.

        Rule of thumb:
        Increase intensity or duration by no more than 10% per week.

        b. Poor Technique

        • Incorrect landing after jumps
        • Twisting movements with a planted foot
        • Improper squatting or running form

        These place excessive shear forces on the knee, particularly the ACL and meniscus.

        c. Muscle Imbalance

        Weak quadriceps, hamstrings, or hip abductors increase stress on the knee joint.

        Key muscles to strengthen:

        • Quadriceps
        • Hamstrings
        • Gluteal muscles
        • Core muscles

        d. Inadequate Footwear

        Worn-out or inappropriate shoes can alter biomechanics and increase knee load, especially in runners and court-sport players.

        e. Skipping Recovery

        Lack of rest, , and sleep delays tissue recovery and increases injury risk.

        3. RED FLAG SYMPTOMS YOU SHOULD NOT IGNORE

        Continuing to play despite warning signs often converts a minor injury into a surgical problem.

        Seek medical evaluation if you experience:

        • Persistent knee pain lasting more than 3–5 days
        • Swelling during or after activity
        • Knee locking or catching, suggesting meniscus injury
        • Instability or giving way, often linked to ligament injury
        • Inability to fully bend or straighten the knee
        • Pain with twisting movements

        Early assessment can prevent long-term damage and prolonged downtime.

        4. Practical Injury-Prevention Tips for Weekend Athletes

        • Maintain year-round basic fitness, even on weekdays
        • Warm up before and cool down after every session
        • Strength train 2–3 times per week focusing on lower limb and core
        • Learn correct technique from a coach or physiotherapist
        • Use appropriate sport-specific footwear
        • Do not “play through pain”

        TAKE-HOME MESSAGE

        Most knee injuries in weekend athletes are preventable. A structured warm-up, avoidance of common training errors, and early recognition of red-flag symptoms can significantly reduce injury risk. When knee pain persists or affects performance, timely evaluation by an orthopaedic/Sports specialist can prevent progression to serious ligament or cartilage damage.

        Experiencing knee pain, swelling, or instability after weekend sports?
        Consult Dr. Chirag Arora, best , for expert , sports injury care, and advanced orthopedic treatment.

        Common Shoulder and Knee Problems in Middle-Aged Individuals

        Common Shoulder and Knee Problems in Middle-Aged Individuals

        by | Dec 3, 2025 | Gurgaon, Health, Orthopedics

        COMMON SHOULDER AND KNEE PROBLEMS IN MIDDLE-AGED INDIVIDUALS

        As we enter our 30s, 40s, and 50s, many of us start noticing aches and pains that weren’t there before—especially around the shoulders and knees. These joints handle most of our daily movement, and even small changes in strength, flexibility, or activity levels can lead to pain.
        Here’s a clear, simple guide by Dr. Chirag Arora, best in Gurgaon, to the most common shoulder and knee problems seen in middle-aged individuals and how to recognize them.

          1. / Tendinopathy

          This is one of the most frequent causes of shoulder pain. It occurs due to overuse, poor posture, or degeneration of the tendons with age.
          Symptoms: Pain with overhead movements, difficulty sleeping on the affected side, and discomfort while lifting.

          Treatment options: Physiotherapy/Biologic injections (PRP)/ arthroscopic surgery 

          2. Partial/Complete Rotator Cuff Tears

          With age, the rotator cuff tendons weaken, making partial tears more common—even without a major injury. Also one may develop complete tears due to injury or progression of partial tears.
          Symptoms: Sharp pain during movement, reduced strength, and difficulty raising the arm.

          Treatment options: biologic injections/ arthroscopic surgery 

          3. (Adhesive Capsulitis)

          Often seen between ages 40–55, frozen shoulder causes progressive stiffness and pain. It’s more common in individuals with diabetes or thyroid issues.
          Course: Painful phase → Stiffness phase → Gradual recovery (over months to years).

          Treatment options: Steroid Injection shot + PT/ arthroscopic surgery 

          4.

          As the space above the rotator cuff narrows, the tendons get pinched during movement.
          Symptoms: Pain while lifting the arm sideways or overhead, especially between 60–120 degrees of movement. Clinical diagnosis is hallmark.

          Treatment options: Steroid Injection shot + PT/ arthroscopic surgery 

          5.

          The acromioclavicular (AC) joint undergoes wear with age or previous injuries.
          Symptoms: Localized pain on the top of the shoulder and pain when bringing the arm across the body.

          6. Biceps Tendinitis

          Inflammation of the biceps tendon causes pain in the front of the shoulder. Typically symptoms associated with lifting, progression can laed to SLAP tear.
          Symptoms: Pain while lifting, carrying, or doing overhead activities.

          Common Knee Problems

          1. Ligament Injuries

          ACL,MCL and low-grade PCL may occur during twisting injuries or sports.
          Symptoms: Pain, swelling, and a feeling of instability or as an acute presentation of locking episode.

          Much more common in females engaged in contact sports.

          Treatment options: Biologic injections(PRP) + PT (Partial tears)/ arthroscopic surgery (treatment of choice.

          2. Early Knee Osteoarthritis

          One of the most common conditions after 40. The joint cartilage slowly wears down, leading to pain and stiffness.
          Symptoms: Pain during walking or climbing stairs, stiffness after sitting, and creaking sensations.

          Treatment options: Biologic injections(PRP) + PT/ arthroscopic surgery / Joint preservation surgery

          3. Meniscus Tears

          These are age-related/traumatic tears that may occur even during routine activities like squatting or twisting or following a sporting injury.
          Symptoms: Sharp joint-line pain, catching or locking sensations, and swelling.

          Treatment options: Arthroscopic meniscus repair surgery 

          4. /Patellofemoral Pain Syndrome (Runner’s Knee)

          Caused by improper kneecap tracking, muscle imbalance, or overuse.
          Symptoms: Pain in front of the knee while climbing stairs, sitting for long hours, or squatting. 

          This is the softening or wear of the cartilage under the kneecap.
          Symptoms: Grinding sensation, pain with knee bending, discomfort during physical activity.

          Treatment options : medications and PT

          5. Iliotibial (IT) Band Syndrome

          Common in runners or individuals with tight hip muscles.
          Symptoms: Outer knee pain, especially during running or after prolonged activity.

          6. Baker’s Cyst

          A fluid-filled swelling behind the knee, often secondary to arthritis or inflammation.
          Symptoms: Tightness or fullness at the back of the knee, pain during bending.

          Why These Problems Increase in Middle Age

          • Natural wear and tear of tendons and cartilage
          • Reduced flexibility and muscle strength
          • Sedentary work or sudden increases in activity
          • Weight gain increasing joint load
          • Hormonal changes affecting soft tissue

          These factors make the shoulder and knee more vulnerable to strain and degeneration.

          When Should You See a specialist?

          Seek medical attention if you experience:

          • Pain lasting more than 2–3 weeks
          • Swelling post injury
          • Difficulty performing daily activities
          • Increasing stiffness or restricted range of motion
          • Night pain that disrupts sleep
          • Swelling or instability in the joint

          Early diagnosis leads to quicker recovery and prevents long-term damage.

          Majority of cases can be treated with medications and PT, while some conditions such as ligament tears are predominantly treated with arthroscopic surgery.

          Book a consultation with the best , Dr. Chirag Arora, to explore Common Shoulder and Knee Problems in Middle-Aged Individuals.

          Patient Education Guide about Ankle Ligament (ATFL Surgery)

          Patient Education Guide about Ankle Ligament (ATFL Surgery)

          by | Oct 11, 2025 | Health, Gurgaon, Orthopedics

          PATIENT EDUCATION GUIDE ABOUT ANKLE LIGAMENT ()

          What is the ATFL?

          • ATFL is part of the lateral(outside) ankle ligament complex composed of three ligaments  [Anterior Talo-fibular Ligament (ATFL), Calcaneo-fibular Ligament (CFL), Posterior Talo-fibular Ligament (PTFL)]
          • It prevents forward translation & inversion of the talus.
          • Injuries: usually due to an ankle → inadequate treatment or repeated sprains → (unhealed ligament).

          When is ATFL Surgery Needed?

          • Failure of conservative management (physiotherapy, bracing, proprioception training).
          • Chronic ankle instability (giving way, repeated sprains, swelling after exertion).
          • Associated cartilage injury, peroneal tendon issues, or large avulsion.
          • High-level athletes needing reliable ankle stability.

          NOTE : majority (>90%) of ankle sprains (even gd III heal by around 3 months, till then majority are treated by non-surgical treatment)

          Types of ATFL Surgery

          ATFL (anterior talofibular ligament) surgery is broadly of two types: repair (repairing the original torn ligament) and reconstruction (replacing the original ligament). 

          Within repair, there are different techniques.

          1.Anatomic repair (Broström / Broström-Gould procedure)

          • Gold standard.
          • The torn ATFL is repaired and sutured back to the bone.
          • Gould modification → reinforces with extensor retinaculum, to strengthen the repair.

          2.Reconstruction (when native tissue is poor / revision cases)

          • Tendon graft (peroneus brevis, hamstring, allograft) used to recreate ATFL (± CFL).
          • Often reserved for generalized laxity, fail ed Broström, or high-demand athletes.
          • Rarely required in primary cases.

          3. Arthroscopic techniques (Arthrobrostom-gould)

          • Minimally invasive → anchors placed via keyhole incisions.
          • Faster recovery, less stiffness, but technically demanding.
          • Preference in our practice (we routinely do arthroscopic brostom-gould repair procedure)
          • Minimal incisions, early mobilization, minimal blood loss and faster recovery.

          Summary

            • Broström / Broström-Gould (open or arthroscopic) → Gold standard for most isolated ATFL tears.
            • Non-anatomic reconstructions → older, less used.
            • Anatomic reconstruction with grafts → for failed repairs, poor tissue, or very high-demand cases.
            • Arthroscopic repairs/reconstructions → newer, less invasive, increasingly popular.

            Broström Repair (standard arthroscopic ATFL surgery) OUR PRACTICE

            • 0–2 weeks: Full weight bearing in boot (aircast-short)
            • 2–6 weeks: Full weight bearing without boot, start gentle ROM and active exercises (avoid inversion).
            • 6–12 weeks: Progressive strengthening, balance, proprioception.
            • 3–4 months: Light jogging, agility drills.
            • 6 months: Return to pivoting/cutting sports.


            Here’s a step-by-step week-by-week rehab protocol after in our practice  (Broström-Gould).

            Phase 1: Protection & Healing (0–2 weeks)

            • Immobilization in splint or boot (ankle neutral / slight eversion).
            • Weight bearing: Full weight bearing with crutches.
            • ROM: Allowed active
            • Full walking with boot as comfortable
            • Goals: Control pain/swelling, protect repair.

            Phase 2: Early Motion (2–6 weeks)

            • Weight bearing: Full WB without boot by week 4.
            • ROM:
              • Begin gentle dorsiflexion/plantarflexion.
              • Avoid inversion/varus stress.
            • Exercises:
              • Isometrics (quads, glutes, core).
              • Straight leg raises, hip strengthening.
            • Goals: Achieve : 70–80% ROM (without stressing lateral ligaments).

              Phase 3: Strength & Proprioception (6–12 weeks)

              • Without boot 
              • ROM: Gradual full range. Inversion allowed after 6–8 weeks.
              • Strengthening:
                • Theraband resistance (all directions).
                • Calf raises (double → single leg).
                • Balance board / wobble board.
              • Cardio: Stationary bike, pool walking, elliptical.
              • Goals: Normal gait, good single-leg balance.

                Phase 4: Advanced Strength & Running Prep (3–4 months)

                • Strength: Plyometrics (mini hops, box step-ups).
                • Proprioception: Single leg on unstable surface, sport-specific drills (non-contact).
                • Running: Begin straight-line jogging at ~12–14 weeks if pain-free & stable.
                • Goals: ≥80% strength of opposite leg, stable ankle with dynamic movements.

                  Phase 5: Agility & Sport Training (4–6 months)

                  • Agility drills: Side shuffles, cutting drills, carioca, ladder drills.
                  • Jump training: Box jumps, multidirectional hops.
                  • Sport-specific drills: Light practice sessions with brace/taping.
                  • Goals: Explosive strength, reaction training, confidence in ankle.

                    Phase 6: Return to Sport (6 months)

                    • Criteria for clearance:
                      • Strength ≥90–95% of other side.
                      • Hop tests & agility tests symmetric.
                      • No pain, no giving way.
                    • Return: Competitive pivoting sports allowed 6 months.

                      Risks & Complications

                      • Stiffness, wound issues, infection, nerve irritation (superficial peroneal nerve).
                      • Over-tightening → restricted motion.
                      • Failure / recurrence of instability.
                      • Long-term risk: ankle arthritis if instability had been longstanding.

                        Success Rates

                        • Anatomic repair (Broström-Gould): >95–99% success, excellent outcomes in athletes.
                        • Return to same level of sports: 90–95% within 6–9 months (if no major cartilage damage).

                        In short:

                        • Broström repair = gold standard for isolated ATFL tear with good tissue.
                        • Reconstruction = for revisions, poor tissue, or high-demand athletes.
                        • Recovery: 6–9 months for full sports return.

                          Schedule a consultation with Dr. Chirag Arora, the best orthopedic surgeon in Gurgaon, to evaluate your ankle injury and explore the most effective ATFL treatment options today!

                            Graft Options for Ligament Surgeries / ACL

                            Graft Options for Ligament Surgeries / ACL

                            by | Jul 26, 2025 | Health

                            FOR /ACL

                            ACL reconstruction requires a graft to replace the torn ligament. Grafts can be autografts (from the patient’s own body) or allografts (from a cadaver/donor). Below is a breakdown of all major options, including pros, cons, healing characteristics, and indications.

                            AUTOGRAFTS (From the Patient)

                            1. Bone–Patellar Tendon–Bone (BPTB) Autograft
                            • Source: Middle third of the patellar tendon with bone plugs from the kneecap (patella) and tibia.
                            • Fixation: Bone-to-bone (strong and fast healing).
                            • Advantages:
                              • Excellent strength and stability.
                              • Conventional gold standard for high-demand athletes.
                              • Faster graft incorporation due to bone-to-bone healing.
                            • Disadvantages:
                              • (especially when kneeling).
                              • Risk of patellar fracture or tendon rupture.
                              • Longer recovery of quadriceps strength.
                            • Indicated for:
                              • Younger, high-performance athletes.
                              • Contact sport athletes.

                            2. Peroneus longus (PL) Autograft

                             

                            • Source: Peroneus longus(PL) ligament, around the ankle
                            • Fixation: Tendon to bone (strong healing).
                            • Advantages:
                              • Excellent strength and stability.
                              • Becoming the new gold standard for high demand athelets.
                              • Consistent and reproductible graft quality.
                              • Great Healing potential.
                            • Disadvantages:
                              • Mild Risk of Paraesthisia around the ankle.
                            • Indicated for:
                              • Younger, high-performance athletes.
                              • Contact sport athletes.

                            OUR PREFERENCE IN PRACTICE

                            3. Hamstring Tendon Autograft

                            • Source: Semitendinosus (± gracilis) tendon from the inner thigh.
                            • Fixation: Tendon-to-bone (slower than bone-to-bone).
                            • Advantages:
                              • Smaller incision and less pain at donor site.
                              • Lower risk of anterior knee pain.
                              • Good cosmetic outcome.
                            • Disadvantages:
                              • Tendon takes longer to heal into bone tunnel.
                              • Inconsistent graft thickness especially in obese and short height individual.
                              • Possible reduction in hamstring strength.
                              • Slightly higher graft laxity risk in some studies.
                            • Indicated for:
                              • Individuals prone to anterior knee pain.
                              • Cosmetic-sensitive patients.
                              • Recreational athletes.

                            4. Quadriceps Tendon Autograft

                            • Source: Central portion of the quadriceps tendon, with or without a bone plug from the patella.
                            • Fixation: Soft-tissue-to-bone or bone-to-bone (if bone plug used).
                            • Advantages:
                              • Thick, strong graft (larger cross-sectional area).
                              • Less donor site pain than patellar tendon.
                              • Good for revisions or large patients.
                            • Disadvantages:
                              • Risk of quadriceps weakness.
                              • Anterior knee pain
                              • Less widely used, fewer long-term studies.
                            • Indicated for:
                              • Revision surgeries.
                              • Patients with prior patellar or hamstring issues.
                              • High-demand athletes needing strong graft.

                            ALLOGRAFTS (From a Donor)

                            • Sources: Patellar tendon, Achilles tendon, tibialis anterior/posterior, hamstring tendon.
                            • Fixation: Variable; depends on the tissue used.
                            • Advantages:
                              • No donor site morbidity (no extra incision or tissue removal).
                              • Shorter operative time.
                              • Less post-op pain.
                              • Useful for multiligament reconstructions or revisions.
                            • Disadvantages:
                              • Slower biological incorporation.
                              • Higher failure rate in young, active individuals.
                              • Very small risk of disease transmission.
                              • Reduced strength after sterilization (e.g., gamma irradiation).
                            • Indicated for:
                              • Older, less active patients.
                              • Revision surgeries.
                              • Multiligament .

                            Graft Comparison Table

                            Feature BPTB Hamstring Quadriceps PL

                            Healing

                            		 Fast   Moderate      Moderate Fast
                            Strength High High Very High Consistent
                            Donor Site Pain High Low Moderate None
                            Anterior Knee Pain Common Rare Less common None
                            Return to Sport Rate High High

                            High

                             

                            		 High 
                            Graft Failure Risk (young)

                            Low

                             

                            		 Moderate Low

                            Very Low

                             
                            Surgical Time

                            Moderate

                             

                            		 Short Moderate

                            Short

                             

                            KEY CONSIDERATIONS FOR CHOOSING A GRAFT

                            • Age: Younger patients may benefit more from autografts due to lower failure rates.
                            • Activity level: High-level athletes often prefer PL/BPTB grafts.
                            • Occupation: Kneeling professions (e.g., carpenters) may avoid BPTB due to anterior knee pain.
                            • Cosmetic concerns: Hamstring or allograft has better cosmetic appeal.
                            • Revision surgery: PL/Allografts or quadriceps grafts are often favored.
                            • Multiligament injuries: Allografts may reduce surgical morbidity.

                            FINAL VERDICT (IN OUR PRACTICE)

                            OUR CHOICE IS PERONEUS LONGUS (PL) GRAFT IN HIGH DEMAND INDIVIDUALS OR HAMSTRING GRAFT IN LOW DEMAND/RECREATIONAL PLAYERS.

                            WE AVOID QUADRICEPS GRAFT (I/V/O KNEE PAIN POSTOP)