Heading into the College Football Playoff National Championship this Monday, all eyes will be on Alabama quarterback Tua Tagovailoa—specifically, on his ankle.
As the number one ranked Crimson Tide goes for its third championship in five years (it won in 2016 and 2018) against number two ranked Clemson, everyone is wondering: Will the Hawaiian sophomore’s ankle hold up for the big game?
Two weeks ago it seemed unthinkable that Tagovailoa would be Alabama’s starter in the National Championship. On December 1, Tagovailoa was taken out of the SEC championship against Georgia with a high ankle sprain, caused when one of his own linemen fell on his foot. But Tagovailoa had a stellar Orange Bowl on December 29 against Oklahoma, when he completed 24 of 27 passes en route to a 45-34 victory against the Sooners.
How did Tagovailoa come back so quickly? One word: TightRope.
What Is a High Ankle Sprain?
“Sprain” is the medical term for an injured ligament, which is a tough, fibrous piece of tissue that connects bones to other bones. A high ankle sprain usually happens in a similar manner as a common ankle sprain: Rolling the ankle. Rolling the ankle means that the inside of the foot turns up and the outside points to the ground. It often happens when running or playing sports.
A high ankle sprain is very similar to a regular (lateral) ankle sprain. The biggest difference is the ligaments involved. In a normal ankle sprain, it is usually one or more of the three ligaments of the lateral ligament complex that are damaged. These ligaments connect the fibula (calf bones) to the talus and the calcaneus (heel bone).
In a high ankle sprain, the ligament that is damaged is called the syndesmosis, which connects the fibula and the tibia (shin bone). For this reason, high ankle sprains are also known as syndesmotic ankle sprains or syndesmosis sprains.
Syndesmotic sprains are notorious for their recovery time. High ankle sprain recovery time is usually about six to seven weeks. So how did Tagovailoa play in the Orange Bowl not even a month after his injury?
“Tua Tagovailoa underwent a TightRope procedure soon after his syndesmotic ankle sprain,” says David Abrutyn, MD, a sports medicine expert with Summit Medical Group Orthopedics. “This greatly reduced his recovery time.”
Add to this Tua’s accelerated physical therapy. “Combined with TightRope, accelerated physical therapy has been shown in rugby players to speed return to play,” says Dr. Abrutyn. “Tua is also taking a risk returning to the field so quickly, but he’s decided that the potential for a big reward—leading his team to another national championship—is worth it.”
What makes a high ankle sprain so difficult to recover from is that the fibula and tibia must be held together and allowed to heal in the correct position. Until recently, this was accomplished using internal fixation. However, this method has various drawbacks.
“Sometimes the screws don’t do a good job of holding the bones in place, and sometimes the screws break,” says Stephanie Adam, DO, one of Summit Medical Group’s foot and ankle orthopedic specialists. “There are even cases where the fibula and tibia drift apart after the screws are inserted.”
Instead of surgical screws, the TightRope procedure fixes the fibula and tibia in place with stainless steel buttons on the bones connected with a flexible polyethylene rope. This method of repair is known as dynamic fixation. A 2015 study suggests dynamic fixation via TightRope produces better clinical outcomes than traditional screws, while a 2012 study suggests faster recovery time.
For lateral ankle sprains, high ankle sprains or any other sports injury, request an appointment with a Summit Medical Group Orthopedics sports medicine or foot and ankle expert. We use advanced diagnostic techniques and state-of-the-art procedures to treat your injury. Our goal is to get you back in the game as soon as possible, as good as or even better than before you were injured.