Advertisement

What Is the Clinical Course of Acute Ankle Sprains? A Systematic Literature Review

      Abstract

      Background

      Ankle sprains are one of the most common musculoskeletal injuries. In order to evaluate the effectiveness of therapeutic interventions and to guide management decisions, it is important to have clear insight of the course of recovery after an acute lateral ankle injury and to evaluate potential factors for nonrecovery and re-sprains.

      Methods

      A database search was conducted in MEDLINE, CINAHL, PEDro, EMBASE, and the Cochrane Controlled trial register. Included were observational studies and controlled trials with adult subjects who suffered from an acute lateral ankle sprain that was conventionally treated. One of the following outcomes had to be described: pain, re-sprains, instability, or recovery. Two reviewers independently assessed the methodological quality of each included study. One reviewer extracted relevant data.

      Results

      In total, 31 studies were included, from which 24 studies were of high quality. There was a rapid decrease in pain reporting within the first 2 weeks. Five percent to 33% of patients still experienced pain after 1 year, while 36% to 85% reported full recovery within a period of 3 years. The risk of re-sprains ranged from 3% to 34% of the patients, and re-sprain was registered in periods ranging from 2 weeks to 96 months postinjury. There was a wide variation in subjective instability, ranging from 0% to 33% in the high-quality studies and from 7% to 53% in the low-quality studies. One study described prognostic factors and indicated that training more than 3 times a week is a prognostic factor for residual symptoms.

      Conclusions

      After 1 year of follow-up, a high percentage of patients still experienced pain and subjective instability, while within a period of 3 years, as much as 34% of the patients reported at least 1 re-sprain. From 36% up to 85% of the patients reported full recovery within a period of 3 years.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Goudswaard A.N.
        • Thomas S.
        • van den Bosch W.J.H.M.
        • et al.
        The Dutch College of General Practitioners (NHG) Practice Guideline ’Ankle sprains’.
        (Accessed August 8, 2007)
        • Kannus P.
        • Renstrom P.
        Treatment for acute tears of the lateral ligaments of the ankle.
        J Bone Joint Surg Am. 1991; 73: 305-312
        • Kerkhoffs G.M.
        • Handoll H.H.
        • de Bie R.
        • et al.
        Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults.
        Cochrane Database Syst Rev. 2002; (CD000380)
        • Kerkhoffs G.M.
        • Rowe B.H.
        • Assendelft W.J.
        • et al.
        Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults.
        Cochrane Database Syst Rev. 2002; (CD003762)
        • Kerkhoffs G.M.
        • Struijs P.A.
        • Marti R.K.
        • et al.
        Different functional treatment strategies for acute lateral ankle ligament injuries in adults.
        Cochrane Database Syst Rev. 2002; (CD002938)
        • Lynch S.A.
        • Renstrom P.A.
        Treatment of acute lateral ankle ligament rupture in the athlete.
        Sports Med. 1999; 27: 61-71
        • Pijnenburg A.C.
        • Van Dijk C.N.
        • Bossuyt P.M.
        • Marti R.K.
        Treatment of ruptures of the lateral ankle ligaments: a meta-analysis.
        J Bone Joint Surg Am. 2000; 82: 761-773
        • Fleiss J.L.
        Methods for Rates and Proportions.
        2nd edition. Wiley-Interscience, New York, NY1981
        • Allen M.J.
        • McShane M.
        Inversion injuries to the lateral ligament of the ankle joint.
        Br J Clin Pract. 1985; 39: 282-286
        • Cetti R.
        • Christensen S.E.
        • Corfitzen M.T.
        Ruptured fibular ankle ligament: plaster or Pliton brace?.
        Br J Sports Med. 1984; 18: 104-109
        • de Bie R.A.
        • de Vet H.C.
        • van den Wildenberg F.A.
        • et al.
        The prognosis of ankle sprains.
        Int J Sports Med. 1997; 18: 285-289
        • Els M.
        • Niggli A.
        • Ochsner P.E.
        Functional therapy using a laced ankle brace in supination trauma of the ankle joint with lesions of the capsule-ligament apparatus [German].
        Swiss Surg. 1996; 2: 280-283
        • Green T.
        • Refshauge K.
        • Crosbie J.
        • Adams R.
        A randomized controlled trial of a passive accessory joint mobilization on acute ankle inversion sprains.
        Phys Ther. 2001; 81: 984-994
        • Holme E.
        • Magnusson S.P.
        • Becher K.
        • et al.
        The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain.
        Scand J Med Sci Sports. 1999; 9: 104-109
        • Klein J.
        • Rixen D.
        • Albring T.
        • Tiling T.
        Functional versus plaster cast treatment of acute rupture of the fibular ligament of the upper ankle joint.
        Unfallchirurg. 1991; 94: 99-104
        • Konradsen L.
        • Bech L.
        • Ehrenbjerg M.
        • Nickelsen T.
        Seven years follow-up after ankle inversion trauma.
        Scand J Med Sci Sports. 2002; 12: 129-135
        • Korkala O.
        • Rusanen M.
        • Jokipii P.
        • et al.
        A prospective study of the treatment of severe tears of the lateral ligament of the ankle.
        Int Orthop. 1987; 11: 13-17
        • Leanderson J.
        • Bergqvist M.
        • Rolf C.
        • et al.
        Early influence of an ankle sprain on objective measures of ankle joint function.
        Knee Surg Sports Traumatol Arthrosc. 1999; 7: 51-58
        • Leanderson J.
        • Wredmark T.
        Treatment of acute ankle sprain.
        Acta Orthop Scand. 1995; 66: 529-531
        • Moller-Larsen F.
        • Wethelund J.O.
        • Jurik A.G.
        • et al.
        Comparison of three different treatments for ruptured lateral ankle ligaments.
        Acta Orthop Scand. 1988; 59: 564-566
        • Munk B.
        • Holm-Christensen K.
        • Lind T.
        Long-term outcome after ruptured lateral ankle ligaments.
        Acta Orthop Scand. 1995; 66: 452-454
        • Nilsson S.
        Sprains of the lateral ankle ligaments.
        J Oslo City Hosp. 1983; 33: 13-36
        • Povacz P.
        • Unger S.F.
        • Miller W.K.
        • et al.
        A randomized, prospective study of operative and non-operative treatment of injuries of the fibular collateral ligaments of the ankle.
        J Bone Joint Surg Am. 1998; 80: 345-351
        • Schaap G.R.
        • de Keizer G.
        • Marti K.
        Inversion trauma of the ankle.
        Arch Orthop Trauma Surg. 1989; 108: 273-275
        • Sommer H.M.
        • Arza D.
        Conservative functional treatment of fibular capsule ligament rupture even in the performance athlete [German]?.
        Sportverletz Sportschaden. 1987; 1: 25-29
        • Sommer H.M.
        • Arza D.
        Functional treatment of recent ruptures of the fibular ligament of the ankle.
        Int Orthop. 1989; 13: 157-160
        • Sommer H.M.
        • Schreiber H.
        Early functional conservative therapy of fresh fibular capsular ligament rupture from the socioeconomic viewpoint [German].
        Sportverletz Sportschaden. 1993; 7: 40-46
        • Wester J.U.
        • Jespersen S.M.
        • Nielsen K.D.
        • Neumann L.
        Wobble board training after partial sprains of the lateral ligaments of the ankle: a prospective randomized study.
        J Orthop Sports Phys Ther. 1996; 23: 332-336
        • Anandacoomarasamy A.
        • Barnsley L.
        Long term outcomes of inversion ankle injuries.
        Br J Sports Med. 2005; 39 (discussion e14): e14
        • Boyce S.H.
        • Quigley M.A.
        • Campbell S.
        Management of ankle sprains: a randomised controlled trial of the treatment of inversion injuries using an elastic support bandage or an Aircast ankle brace.
        Br J Sports Med. 2005; 39: 91-96
        • Kerkhoffs G.M.
        • Struijs P.A.
        • de Wit C.
        • et al.
        A double blind, randomised, parallel group study on the efficacy and safety of treating acute lateral ankle sprain with oral hydrolytic enzymes.
        Br J Sports Med. 2004; 38: 431-435
        • Pijnenburg A.C.
        • Bogaard K.
        • Krips R.
        • et al.
        Operative and functional treatment of rupture of the lateral ligament of the ankle.
        J Bone Joint Surg Br. 2003; 85: 525-530
        • Zammit E.
        • Herrington L.
        Ultrasound therapy in the management of acute lateral ligament sprains of the ankle joint.
        Phys Ther Sport. 2005; 6: 116-121
        • Mazieres B.
        • Rouanet S.
        • Velicy J.
        • et al.
        Topical ketoprofen patch (100 mg) for the treatment of ankle sprain: a randomized, double-blind, placebo-controlled study.
        Am J Sports Med. 2005; 33: 515-523
        • O’Hara J.
        • Valle-Jones J.C.
        • Walsh H.
        • et al.
        Controlled trial of an ankle support (Malleotrain) in acute ankle injuries.
        Br J Sports Med. 1992; 26: 139-142
        • Chaiwanichsiri D.
        • Lorprayoon E.
        • Noomanoch L.
        Star excursion balance training: effects on ankle functional stability after ankle sprain.
        J Med Assoc Thai. 2005; 88: S90-S94
        • Pugia M.L.
        • Middel C.J.
        • Seward S.W.
        • et al.
        Comparison of acute swelling and function in subjects with lateral ankle injury.
        J Orthop Sports Phys Ther. 2001; 31: 384-388
        • Grønmark T.
        • Johnsen O.
        • Kogstad O.
        Rupture of the lateral ligaments of the ankle: a controlled clinical trial.
        Injury. 1980; 11: 215-218
        • Linde F.
        • Hvass I.
        • Jurgensen U.
        • Madsen F.
        Early mobilizing treatment in lateral ankle sprains.
        Scand J Rehabil Med. 1986; 18: 17-21
        • Kerkhoffs G.M.
        • Struijs P.A.
        • Marti R.K.
        • et al.
        Functional treatments for acute ruptures of the lateral ankle ligament: a systematic review.
        Acta Orthop Scand. 2003; 74: 69-77