Chronic ankle instability has no correlation with the number of ruptured ligaments in severe anterolateral sprain: a systematic review and meta-analysis

Abstract

Purpose Despite being a signiicant public health problem, ankle sprains' prognostic factors are largely unknown. This review aimed to systematically analyze the literature on acute ankle sprains to compare the prognosis of a combined anterior taloibular (ATFL) and calcaneoibular (CFL) ligaments rupture with an isolated ATFL rupture in terms of progression to chronic ankle instability and other clinical outcomes. Methods The databases for Pubmed, CENTRAL and Web of Science were searched. Clinical studies reporting the prognostic efect of combined ATFL-CFL rupture versus an isolated ATFL rupture in conservatively treated ankle sprains, with a minimum follow-up of 12 months, were eligible for inclusion. Only studies with a reliable diagnostic method for anterolateral ankle ligaments evaluation, namely ultrasonography, magnetic resonance imaging, arthrography or stress tenography, were included. The relative risk (RR), along with the 95% conidence interval (CI), was used to quantitatively analyze the main outcomes. Results Nine papers were selected for inclusion, of which ive were suitable for quantitative analysis. None of them found a statistically signiicant correlation between ligament injury severity and progression to chronic instability. Concerning other clinical outcomes, three studies found a statistically signiicant correlation between a combined ligament injury and a worse clinical prognosis. From the quantitative analysis, the relative risk (RR) of chronic ankle instability in a single versus a combined ligament rupture showed no signiicant diference. Conclusion A signiicant statistical correlation between a combined ATFL-CFL rupture and chronic ankle instability, compared to an isolated ATFL rupture, was not found. There is, however, fair evidence showing a worse clinical outcome score in the combined ruptures, as well as a decreased return to full sports activities. The use of reliable and accessible diagnostic methods to determine the number of ruptured ligaments might have a role in managing severe ankle sprains. Level of evidence Level III.

Risk factors for chronic ankle instability after first episode of lateral ankle sprain: A retrospective analysis of 362 cases

“…Previous studies have reported that the development of CAI has no correlation with the severity of ATFL/CFL injuries as assessed by clinical tests after LAS. 39 Thus, the initial severity of injury to proprioceptive nerves within the sprained ligaments might not be a determinant for ankle proprioception deficiency in CAI.…”

Injury severity at the time of sport-related ankle sprain is associated with symptoms and quality of life in young adults after 3–15 years

“…[ 31 ] and Pacheco et al. [ 32 ] regarding prognostic factors associated with poor clinical outcomes in individuals with ankle injuries. Both studies listed injury severity as a clinical indicator for poor prognosis, but also determined that there is insufficient evidence at this point to offer any recommendations about clinical traits that would prognosticate a poor recovery or progressing disability.…”

“…Both studies listed injury severity as a clinical indicator for poor prognosis, but also determined that there is insufficient evidence at this point to offer any recommendations about clinical traits that would prognosticate a poor recovery or progressing disability. Further research is needed to accurately understand the prognosis and potential consequences of ankle sprains [ 32 , 33 ].…”

Chronic lateral ankle instability using anterior tibiofibular ligament distal fascicle transfer augmentation repair: an anatomical, biomechanical, and histological study

“…Ankle sprains are the most common cause of ATFL injuries. If not treated promptly and properly after injury, repeated ATFL damage may result in chronic lateral ankle instability (CLAI) ( Pacheco et al, 2021 ). Therefore, appropriate treatment should be performed promptly to reduce the long-term complications of ATFL injuries.…”