Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis

Tassignon, Bruno; Verschueren, Jo; Delahunt, Eamonn; Smith, Michelle D.; Vicenzino, Bill; Verhagen, Evert; Meeusen, Romain

doi:10.1007/s40279-019-01071-3

Cited by 78 publications

(97 citation statements)

References 208 publications

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“…Consensus was reached regarding the need to assess sport-specific movement (n = 10, 90.9%). [27][28][29][30][31][32][33][35][36][37] Partial agreement was reached regarding the use of a hop test (n = 6, 54.5%), 28,29,31,32,35,36 but there was little consistency as to which hop test should be used. Only 2 papers provided a threshold (ie, the injured leg should perform at ≥80% of the uninjured leg) from which an objective decision could be made for RTS.…”

Section: Rts Criteriamentioning

confidence: 97%

“…After removing duplicates (n = 91), having screened records by title, abstract, and ineligible articles, 11 papers were identified and included in this systematic review (Table 1). [27][28][29][30][31][32][33][34][35][36][37] All of the 11 identified papers focused on RTS with no identified papers making recommendations for report to work or return to duty.…”

Section: Evidence Synthesismentioning

confidence: 99%

“…32,35 Partial agreement was also reached for the need to assess static balance (n = 7, 63.6%). 27,29,31,[34][35][36][37] The use of a single-leg balance test (n = 4, 36.4%) was the most recommended. 29,34,36,37 While some objective thresholds were provided, no consistency was noted among the included papers.…”

Section: Rts Criteriamentioning

confidence: 99%

“…A total of 6 studies (54.5%, partial agreement) recommended pain and swelling as a domain that should be tested during an athlete's RTS assessment. [27][28][29]31,34,37 While specific assessments and thresholds were provided, there was no consistency. Six studies reviewed (54.5%, partial agreement) also recommended that subjective assessments (ie, patient reported outcomes), [29][30][31][32]35,37 range of motion, [29][30][31]33,35,37 and strength 27,[29][30][31]33,37 also be assessed to determine RTS.…”

Section: Rts Criteriamentioning

confidence: 99%

“…However, there was no consistency among the recommended tests or among the included thresholds. A minority of papers recommended dynamic balance (n = 5, 45.5%) 29,30,32,35,37 and running (n = 4, 36.4%) 27,28,33,37 as domains that should be assessed. Within the papers recommending dynamic balance, all 5 29,30,32,35,37 recommended the Star Excursion Balance Test be used.…”

Section: Rts Criteriamentioning

confidence: 99%

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Lack of Consensus on Return-to-Sport Criteria Following Lateral Ankle Sprain: A Systematic Review of Expert Opinions

Wikstrom¹,

Mueller²,

Cain³

2020

Journal of Sport Rehabilitation

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Context: Lateral ankle sprains (LAS) have one of the highest recurrence rates of all musculoskeletal injuries. An emphasis on rapid return to sport (RTS) following LAS likely increases reinjury risk. Unfortunately, no set of objective RTS criteria exist for LAS, forcing practitioners to rely on their own opinion of when a patient is ready to RTS. Purpose: To determine if there was consensus among published expert opinions that could help inform an initial set of RTS criteria for LAS that could be investigated in future research. Evidence Acquisition: PubMed, CINHL, and SPORTDiscus databases were searched from inception until October 2018 using a combination of keywords. Studies were included if they listed specific RTS criteria for LAS. No assessment of methodological quality was conducted because all included papers were expert opinion papers (level 5 evidence). Extracted data included the recommended domains (eg, range of motion, balance, sport-specific movement, etc) to be assessed, specific assessments for each listed domain, and thresholds (eg, 80% of the uninjured limb) to be used to determine RTS. Consensus and partial agreement were defined, a priori, as ≥75% and 50% to 75% agreement, respectively. Evidence Synthesis: Eight domains were identified within 11 included studies. Consensus was reached regarding the need to assess sport-specific movement (n = 9, 90.9%). Partial agreement was reached for the need to assess static balance (n = 7, 63.6%). The domains of pain and swelling, patient reported outcomes, range of motion, and strength were also partially agreed on (n = 6, 54.5%). No agreement was reached on specific assessments of cutoff thresholds. Conclusions: Given consensus and partial agreement results, RTS decisions following LAS should be based on sport-specific movement, static balance, patient reported outcomes, range of motion, and strength. Future research needs to determine assessments and cutoff thresholds within these domains to minimize recurrent LAS risk.

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Section: Rts Criteriamentioning

confidence: 97%

Section: Evidence Synthesismentioning

confidence: 99%

Section: Rts Criteriamentioning

confidence: 99%

Section: Rts Criteriamentioning

confidence: 99%

Section: Rts Criteriamentioning

confidence: 99%

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Lack of Consensus on Return-to-Sport Criteria Following Lateral Ankle Sprain: A Systematic Review of Expert Opinions

Wikstrom¹,

Mueller²,

Cain³

2020

Journal of Sport Rehabilitation

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Ankle ligament reconstruction‐return to sport after injury scale and return to sports after ankle ligament reconstruction or repair—A systematic review

Wang,

Hinz,

Buchalter

et al. 2024

J. exp. orthop.

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PurposeTo systematically review existing literature regarding the ankle ligament reconstruction‐return to sport after injury (ALR‐RSI) scale and to assess its correlation with Return to sport and functional outcomes as well as feasibility, reliability and consistency.MethodsA systematic review of the literature based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) was conducted using PubMed, Embase and Cochrane Library. Studies that evaluated psychological readiness to return to sport after ankle ligament reconstruction or repair for the treatment of chronic lateral ankle instability using the ALR‐RSI scale were included. The results from each study were pooled, and weighted means and overall rates were calculated.ResultsIn total, 157 patients (53.2% male, mean age: 34.2 years) from three articles were included. Overall, 85.0% of patients reported successful return to sport, but only 48.9% of patients returned to the preoperative sporting level. All studies reported a significant difference in psychological scores between patients who returned to sport and those who did not. Pooled mean patient‐reported outcome measures, reported as the American Orthopaedic Foot and Ankle Society Ankle‐Hindfoot (AOFAS, three studies) Score and Karlsson‐Peterson Score (three studies), were 82.7 (range: 29–100) and 81.7 (range: 25–100), respectively. The ALR‐RSI scale demonstrated strong correlations with the AOFAS Score and Karlsson‐Peterson Score.ConclusionPatients who returned to sport after ankle ligament reconstruction or repair exhibited higher psychological readiness compared to those who did not. The ALR‐RSI scale showed strong correlations with ankle function. Evaluation of psychological readiness using the ALR‐RSI scale may provide an additional tool in the assessment of patients who underwent ankle ligament reconstruction or repair.Level of EvidenceLevel III, systematic review.

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Large variation in postoperative rehabilitation protocols following operative treatment of osteochondral lesions of the talus: A systematic review and meta‐analysis on >200 studies

Buck,

Dahmen,

Tak

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeA treatment‐specific rehabilitation protocol and well‐defined return‐to‐play criteria guide clinical decision‐making on return to normal function, activity, sports and performance after surgical treatment for osteochondral lesion of the talus (OLT). The optimal rehabilitation protocols in the current literature remain unclear. The purpose of this study was to explore the existing literature on rehabilitation protocols from the early postoperative phase to return to sport onwards after different types of surgical treatment of OLTs.MethodsPubMed, Embase, CDSR, DARE and Central were searched systematically from inception to February 2023 according to the PRISMA 2020 guidelines. All clinical studies with a description of postoperative rehabilitation criteria after surgical treatment of OLTs were included. The primary outcome of this study is the extent of reportage for each rehabilitation parameter expressed in percentage. The secondary outcome is the reported median time for each parameter in rehabilitation protocols for all different treatment modalities (type of surgery). The median time, expressed as number of weeks, for each parameter was compared between different types of surgery.ResultsA total of 227 articles were included reporting on 255 different rehabilitation protocols from seven different types of surgery. Weight‐bearing instructions were reported in 84%–100% and the use of a cast or walker was prescribed in 27%–100%. Range of motion exercises were described in 54%–100% whereas physical therapy was advised in 21%–67% of the protocols. Any advice on return to sport was described in 0%–67% protocols. A nonparametric analysis of variance showed significant differences between the different surgical treatment modalities for the following parameters between the treatment groups: time to full weight‐bearing (p < 0.0003) and return to high impact level of sports (p < 0.0003). Subjective or objective criteria for progression during rehabilitation were reported in only 24% of the studies.ConclusionAn in‐depth exploration of the current literature showed substantial variation in postoperative rehabilitation guidelines with an associated underreporting of the most important rehabilitation parameters in postoperative protocols after surgical treatment of OLTs. Furthermore, nearly all rehabilitation protocols were constructed according to a time‐based approach. Only one out of four reported either objective or subjective criteria.Level of EvidenceLevel IV, systematic review.

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Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis

Cited by 78 publications

References 208 publications

Lack of Consensus on Return-to-Sport Criteria Following Lateral Ankle Sprain: A Systematic Review of Expert Opinions

Lack of Consensus on Return-to-Sport Criteria Following Lateral Ankle Sprain: A Systematic Review of Expert Opinions

Ankle ligament reconstruction‐return to sport after injury scale and return to sports after ankle ligament reconstruction or repair—A systematic review

Large variation in postoperative rehabilitation protocols following operative treatment of osteochondral lesions of the talus: A systematic review and meta‐analysis on >200 studies

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