Apoptosis: Progressive Deterioration in Chronically Unstable Ankle

Apoptosis refers to planned cell death and is critical for body homeostasis by eliminating harmful cells. In musculoskeletal medicine, it has been shown that uncontrolled apoptosis can cause irreversible degenerative diseases such as tendon degeneration after rotator cuff tear and degeneration of the human meniscus.

Chronic ankle ligament injury

In an in-vitro biopsy study of chronic lateral ankle instability, Choi et al. (2023) found the apoptotic activity of the ATF ligament was higher in chronic instability than acute ATF injury. This suggests that treatment approaches emphasizing non-operative care in chronic ATF tear do not consider that this is a progressive biologic process and not solely a mechanical issue.

The implication for augmentation

With biological differences in the anterior talofibular ligament between the chronic and acute ankle instability suggest that treatment plans should include ligament augmentation. Further research should focus on apoptotic timing as well as biological augmentation to prevent or reverse apoptosis within anterior talofibular ligament.