Evidence for Rehabilitation Interventions After Acute Lateral Ankle Sprains in Athletes: A Scoping Review

Effectiveness of manual techniques, exercise therapy, or combined treatments in the management of ankle sprains or chronic ankle instability in adult athletes: a systematic review protocol

OBJECTIVE

The objective of this review will be to synthesize the evidence on the effectiveness of manual techniques, exercise therapy, or combined treatments in the management of ankle sprains and chronic ankle instability in adult athletes.

INTRODUCTION

Acute ankle sprains and chronic ankle instability are common in athletes. These conditions can result in varying degrees of disability, including reduced athletic performance and time out of competition, which may have adverse psychological effects.

INCLUSION CRITERIA

The review will consider randomized controlled trials evaluating the effectiveness of manual techniques and/or exercise therapy for ankle sprain or chronic ankle instability in adult athletes. The comparators will include sham treatment, no treatment, and other conservative interventions. The outcomes of interest will be pain intensity, functional disability, ankle joint range of motion, ankle muscle strength, postural control, and subjective stability.

METHODS

The review will follow the JBI methodology for systematic reviews of effectiveness. Searches will be conducted to locate published and unpublished studies in the following sources: MEDLINE (Ovid), CENTRAL (Ovid), Embase, SPORTDiscus (EBSCOhost), Physiotherapy Evidence Database (PEDro), Google Scholar, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP). Two independent reviewers will select the study, critically appraise it, and extract data. Then, a narrative synthesis and, if appropriate, a meta-analysis will be performed. The certainty of findings will be determined using the GRADE approach.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42023493687.

A systematic review and meta-analysis of balance training in patients with chronic ankle instability

BACKGROUND

Chronic ankle instability (CAI) is a common yet serious problem for elder patients. This meta-analysis aimed to evaluate the effects of balance training for CAI, to provide evidence for the clinical treatment, and care of CAI patients.

METHODS

Two investigators searched PubMed, EMBASE, Science Direct, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and Weipu Databases up to May 20, 2023, for randomized controlled trials (RCTs) on the effects of balance training for CAI. The mean difference (MD) with 95% confidence intervals (95%CIs) was calculated for each outcome with a fixed or random effect model. Review Manager 5.3 software was used for meta-analysis.

RESULTS

Nine RCTs involving 341 patients were included. Meta-analysis results showed that compared with blank controls, balanced training treatment of CAI could significantly improve the score of CAI [MD = 3.95, 95% CI (3.26, 4.64), P < 0.00001], SEBT-PM [MD = 4.94, 95% CI (1.88, 8.00), P = 0.002], SEBT-PL [MD = 5.19, 95% CI (1.57, 8.81), P = 0.005], and FAAM Sports [MD = 17.74, 95% CI (14.36, 21.11), P < 0.00001]. Compared with strength training, balance training treatment of CAI improved the score of CAIT [MD = 2.36, 95% CI (0.29, 4.44), P = 0.03], FAAM-ADL [MD = 4.06, 95% CI (1.30, 6.83), P = 0.004].

CONCLUSION

The analysis outcomes indicate that balance training enhances daily activity capability, motor function, and dynamic balance to different extents. Additionally, when comparing the results of balance training and strength training, no significant difference was observed between the two methods in improving the dynamic stability of CAI patients. However, it is noteworthy that balance training exhibits a more pronounced impact on enhancing functional scale scores.

Health-seeking behaviors, management practices, and return to play decisions after an ankle sprain in netball: An international cross-sectional survey of 1592 non-elite netballers

OBJECTIVES

Evaluate if non-elite netballers sought health care, treatments received, and return-to-play decisions after an ankle sprain, including intercountry differences.

DESIGN

Cross-sectional survey.

METHODS

Non-elite netballers aged >14 years were recruited from Australia, United Kingdom, and New Zealand. Participants completed an online survey regarding their last ankle sprain and were queried regarding health care sought, health professionals consulted, treatments received, time missed, and return-to-play clearance. Data were described using number (proportion) for the overall cohort and countries. Between-country differences in health care use were compared using chi-square tests. Descriptive statistics were presented for management practices.

RESULTS

We received 1592 responses from Australian (n = 846), United Kingdom (n = 454), and New Zealand (n = 292) netballers. Three in five (n = 951, 60 %) sought health care. Of those, most consulted a physiotherapist (n = 728, 76 %), received strengthening exercises (n = 771, 81 %), balance exercises (N = 665, 70 %) and taping (n = 636, 67 %). Few received return-to-play clearance (n = 362, 23 %). Comparing countries, fewer United Kingdom netballers sought health care than Australian and New Zealand netballers (Australia: 60 % vs United Kingdom: 53 % vs New Zealand: 68 %, p < 0.001), consulted a physiotherapist (Australia: 79 %, United Kingdom: 63 %, New Zealand: 87 %), received strengthening (Australia: 84 %, United Kingdom: 73 %, New Zealand: 84 %) or balance exercises (Australia: 71 %, United Kingdom: 60 %, New Zealand: 80 %) or taping (Australia: 74 %, United Kingdom: 39 %, New Zealand: 82 %). More Australian netballers returned to play within 1-7 days (Australia: 25 %, United Kingdom: 15 %, New Zealand: 21 %) and fewer United Kingdom netballers received return-to-play clearance (Australia: 28 %, United Kingdom: 10 %, New Zealand: 28 %).

CONCLUSIONS

Health-seeking behaviours are adopted by some, but not all netballers after an ankle sprain. For those who sought care, most consulted a physiotherapist and were prescribed exercise-based interventions and external ankle support, but few received return-to-play clearance. Comparing countries, United Kingdom netballers had lower health-seeking behaviours and received less best-practice management than Australian and New Zealand netballers.

Characterization of pain-related behaviors and gene expression profiling of peripheral sensory ganglia in a mouse model of acute ankle sprain

Introduction

Lateral ankle sprain (LAS) is a very common type of joint injury. It occurred with high incidence among general population and especially among individuals participating sports and outdoor activities. A certain proportion of individuals who once developed LAS may suffer persistent ankle pain that affects daily activities. However, the mechanisms underlying LAS-induced pain still remained largely unknown.

Methods

We established a LAS mouse model and systematically evaluated the pain-related behaviors in this mouse model. RNA sequencing (RNA-Seq), combined with bioinformatics analysis, was undertaken to explore gene expression profiles. Immunostaining was used to study glial cell and neuron activation in ipsilateral spinal cord dorsal horn (SCDH) of LAS model mice. Ibuprofen was used to treat LAS model mice.

Results

The LAS model mice developed obvious signs of mechanical and heat hypersensitivities as well as gait impairments in ipsilateral hind paws. Besides, LAS model mice developed signs of pain-related emotional disorder, including pain-induced aversion. By RNA-Seq, we were able to identify certain differentially expressed genes and signaling pathways that might contribute to pain mechanisms of LAS mouse model. In addition, LAS model mice showed increased c-Fos and p-ERK immunoreactivity as well as astrocyte and microglia overactivation in ipsilateral spinal cord dorsal horn, indicating central sensitization might occur. Finally, LAS model mice respond to ibuprofen, a drug clinically used to treat ankle sprain pain.

Conclusion

Our study found LAS model mice may be used as a preclinical animal model for screening novel targets or therapies for ankle sprain. Thus, the study may further help to understand molecular mechanisms contributing to ankle sprain-induced pain.

Current concepts in the surgical management of chronic ankle lateral ligament instability

Background/aims

Ankle sprains are common injuries which can lead to chronic lateral ankle ligament instability (CAI).

Methods

The aim of this review is to provide a comprehensive overview of the epidemiology, pathophysiology, investigation, surgical management and rehabilitation of CAI.

Results

Investigation of CAI is based on history, clinical examination, and imaging. Surgical management of CAI can be defined as anatomic reconstruction, anatomic and non anatomic repair of ATFL and/or CFL. Anatomic repair has been shown to have better functional outcomes and less secondary osteoarthritis when compared to non anatomic repair. Non-anatomic methods do not replicate the normal anatomical course of ATFL/CFL and may lead to stiffness. The most common surgical treatment for CAI is the open modified Broström repair augmented with the Gould modification. There are arthroscopic techniques being developed which have reported promising clinical results. However, there are considerable areas of further research which should be carried out to improve understanding and effectiveness of current treatment options. Standardised validated patient reported outcome measures and evidence-based protocols in the rehabilitation periods are crucial for positive and reproducible outcomes.

Conclusion

Surgical repair has proven to show excellent outcomes for patients suffering from CAI, however larger prospective studies should be carried out to evaluate the use of newer surgical techniques.