The Sports Docs Pod: Dr. Kenneth Hunt - Modern Management of Ankle Instability (Part II)

This episode of The Sports Docs Podcast is brought to you by BraceLab. Whether you are recovering from an injury, managing everyday discomfort, or just trying to stay active and move confidently, BraceLab has you covered with high-quality, innovative support solutions. We’ll tell you a bit more about how they are changing the game for ankle instability later in the show, but for now, you can learn more at BraceLab.com. For free samples, email samples@bracelab.com and mention The Sports Docs. In Part II of our conversation with Dr. Ken Hunt, orthopaedic foot and ankle surgeon at the University of Colorado, we explore two important diagnoses that can complicate ankle injuries: syndesmotic injuries (high ankle sprains) and osteochondral lesions of the talus (OLTs). We begin with the anatomy and biomechanics of the distal tibiofibular syndesmosis, highlighting how high ankle sprains differ from traditional lateral ankle sprains in their mechanism, clinical presentation, and recovery. Dr. Hunt discusses the importance of distinguishing syndesmotic ligament injury from true mechanical instability, the role of physical examination and advanced imaging, and when surgical stabilization is indicated. We then review the evolution of syndesmotic fixation, including the transition from traditional screw fixation toward dynamic suture-button constructs such as TightRope. We discuss the evidence supporting suture-button fixation, including improved functional outcomes, lower rates of implant removal, and reduced malreduction rates in some comparative studies. Next, we shift our focus to osteochondral lesions of the talus, an important consideration in athletes with persistent deep ankle pain, swelling, or mechanical symptoms following an ankle sprain. Dr. Hunt shares his approach to diagnosis, including the complementary roles of MRI and CT, and explains how lesion stability, size, location, subchondral bone involvement, and prior treatment influence management. We explore the expanding surgical treatment options for talar cartilage injuries, from arthroscopic debridement and bone marrow stimulation to osteochondral grafting and emerging cartilage restoration techniques. Dr. Hunt also discusses how he approaches return-to-play decisions and the importance of evaluating more than symptom resolution alone. Topics covered include: High versus low ankle sprains: anatomy, mechanism, and recovery Diagnosing syndesmotic instability with physical examination, radiographs, MRI, and weight-bearing imaging Indications for operative versus nonoperative management of syndesmotic injuries Syndesmotic screw fixation versus dynamic suture-button stabilization Recognizing osteochondral lesions after ankle sprains MRI and CT findings that guide talar cartilage treatment Nonoperative management of stable osteochondral lesions Arthroscopic versus open approaches to talar cartilage restoration Bone marrow stimulation, osteochondral grafting, and emerging cartilage repair techniques Return-to-play considerations following ankle injury and surgery Clinical takeaway: An ankle sprain is not a single diagnosis. Successful treatment depends on identifying the injured structures, determining whether mechanical instability or cartilage damage is present, and selecting a treatment strategy that addresses the athlete's pathology and functional demands. Join Drs. Ashley Bassett and Catherine Logan for the second half of this evidence-based discussion on modern ankle injury management. Listen to Part I for our discussion of acute lateral ankle sprains, chronic lateral ankle instability, and contemporary ligament treatment strategies. Find the research articles discussed in this episode and more from The Sports Docs Podcast at www.thesportsdocspod.com. https://www.cloganmd.com/ https://orthopedicnj.com/physicians/a...