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Archives of Orthopaedic and Trauma Surgery

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Open Access 01-08-2013 | Arthroscopy and Sports Medicine

Treatment of acute ankle ligament injuries: a systematic review

Authors: Wolf Petersen, Ingo Volker Rembitzki, Andreas Gösele Koppenburg, Andre Ellermann, Christian Liebau, Gerd Peter Brüggemann, Raymond Best

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2013

Abstract

Background

Lateral ankle sprains are common musculoskeletal injuries.

Objectives

The objective of this study was to perform a systematic literature review of the last 10 years regarding evidence for the treatment and prevention of lateral ankle sprains.

Data source

Pubmed central, Google scholar.

Study eligibility criteria

Meta-analysis, prospective randomized trials, English language articles.

Interventions

Surgical and non-surgical treatment, immobilization versus functional treatment, different external supports, balance training for rehabilitation, balance training for prevention, braces for prevention.

Methods

A systematic search for articles about the treatment of lateral ankle sprains that were published between January 2002 and December 2012.

Results

Three meta-analysis and 19 articles reporting 16 prospective randomized trials could be identified. The main advantage of surgical ankle ligament repair is that objective instability and recurrence rate is less common when compared with non-operative treatment. Balancing the advantages and disadvantages of surgical and non-surgical treatment, we conclude that the majority of grades I, II and III lateral ankle ligament ruptures can be managed without surgery. For non-surgical treatment, long-term immobilization should be avoided. For grade III injuries, however, a short period of immobilization (max. 10 days) in a below knee cast was shown to be advantageous. After this phase, the ankle is most effectively protected against inversion by a semi-rigid ankle brace. Even grades I and II injuries are most effectively treated with a semi-rigid ankle brace. There is evidence that treatment of acute ankle sprains should be supported by a neuromuscular training. Balance training is also effective for the prevention of ankle sprains in athletes with the previous sprains. There is good evidence from high level randomized trials in the literature that the use of a brace is effective for the prevention of ankle sprains.

Conclusion

Balancing the advantages and disadvantages of surgical and non-surgical treatment, we conclude that the majority of grades I, II and III lateral ankle ligament ruptures can be managed without surgery. The indication for surgical repair should be always made on an individual basis. This systematic review supports a phase adapted non-surgical treatment of acute ankle sprains with a short-term immobilization for grade III injuries followed by a semi-rigid brace. More prospective randomized studies with a longer follow-up are needed to find out what type of non-surgical treatment has the lowest re-sprain rate.

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Title: Treatment of acute ankle ligament injuries: a systematic review
Authors: Wolf Petersen
Ingo Volker Rembitzki
Andreas Gösele Koppenburg
Andre Ellermann
Christian Liebau
Gerd Peter Brüggemann
Raymond Best
Publication date: 01-08-2013
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 8/2013
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-013-1742-5

At a glance: The STEP trials

Springer Medicine

Treatment of acute ankle ligament injuries: a systematic review

Abstract

Background

Objectives

Data source

Study eligibility criteria

Interventions

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objectives

Data source

Study eligibility criteria

Interventions

Methods

Results

Conclusion

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