Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline

Vuurberg, Gwendolyn; Hoorntje, Alexander; Wink, Lauren M.; Doelen, Brent F W van der; Bekerom, Michel PJ van den; Dekker, Rienk; Dijk, C. Niek van; Krips, Rover; Loogman, Masja; Ridderikhof, Milan L; Smithuis, Frank F; Stufkens, Sjoerd A.S.; Verhagen, Evert; Bie, Rob A. de; Kerkhoffs, Gino M. M. J.

doi:10.1136/bjsports-2017-098106

Cited by 342 publications

(374 citation statements)

References 187 publications

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“…Most patients experiencing a LAS can be successfully treated and regain functional ankle stability with conservative treatment . Despite recommended conservative treatments (e.g., functional support and exercise therapy), up to 40% of the patients continue to suffer from residual complaints and may progress to chronic ankle instability (CAI) . CAI is defined as the instability of the ankle with the feeling of giving‐way, episodes of recurrent ankle sprains, with or without the presence of joint laxity …”

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confidence: 99%

Typical Shape Differences in the Subtalar Joint Bones Between Subjects with Chronic Ankle Instability and Controls

Tümer

Vuurberg

Blankevoort

et al. 2019

Journal Orthopaedic Research

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Bone shapes, particularly those defining the subtalar joint (STJ), have not received much attention yet as a risk factor for developing chronic ankle instability (CAI) after sustaining a lateral ankle sprain (LAS). This study aimed to compare three‐dimensional (3D) shape variations in the STJ bones within individuals with CAI and healthy controls. 3D statistical shape models (SSMs) of the STJ bones were built to describe the bone shape variations observed within a population consisting of 26 individuals with unilateral CAI and 26 healthy controls. Using the SSMs and analysis of covariance test, age‐ and gender‐adjusted shape variations in the bones were compared within individuals with CAI and healthy controls. The mean age of the CAI patients (14 males and 12 females) and healthy controls (12 males and 14 females) was 29 (standard deviation [SD] = 11) and 36 years (SD = 11), respectively. Tali and calcanei did not significantly vary between ipsilateral CAI and their contralateral ankle. Two shape modes, one for the talus (p = 0.015, variations in the curvature of the talar lateral process and the inclination angle of the talar neck relative to the body) and one for the calcaneus (p = 0.003, variations in the medial and lateral tuberosities, and the contour of the anterior articular surface), described significant shape differences between the CAI patients and healthy controls. The CAI patients generally had flatter talar joint surfaces and a flattened calcaneal ground‐contact surface. These findings suggest that specific bone shapes may increase the risk of developing CAI after sustaining a LAS. © 2019 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:1892–1902, 2019

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confidence: 99%

Typical Shape Differences in the Subtalar Joint Bones Between Subjects with Chronic Ankle Instability and Controls

Tümer

Vuurberg

Blankevoort

et al. 2019

Journal Orthopaedic Research

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“…However, it is important to note that (1) the previously mentioned risk factors are for LAS broadly and are not specific to recurrent LAS; (2) few objective thresholds (ie, cutoff scores) were calculated; and (3) additional risk factors, outside of the agreed upon domains (eg, body mass index, reaction time, coordination, running speed, etc), were identified in these investigations as well as in a more comprehensive review. 17 The alignment of known modifiable risk factors provides face validity to the domains agreed upon within published expert opinions. These same domains represent areas of deficiency in those with CAI providing further face validity to the results.…”

Section: Research Team Credentialsmentioning

confidence: 99%

“…The agreed upon domains are consistent with the domains most commonly targeted in rehabilitation protocols for LAS. 17 However, the lack of prospective data related to RTS following LAS makes it impossible to determine if assessing these domains can provide meaningful information about an individual's risk for reinjury following RTS. Furthermore, few objective thresholds against which a RTS decision could be made were provided.…”

Section: Research Team Credentialsmentioning

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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“…As ankle injury/trauma is the major risk factor for the development of OA, programmes to prevent the onset or delay the progression to OA are warranted. This may be achieved by preventing ankle sprains through prophylactic measures (activity appropriate footwear, optimisation of ankle passive restraints, external restraints and bracing as well as postural stability enhancement) 169,[534][535][536] . Likewise, early recognition of ankle injuries by identifying individuals at risk for OA following ankle injury/trauma, avoiding re-injury 537 and targeting potentially modifiable factors such as post-injury treatment approach, joint mechanics, fitness and strength, BMI and behavioral characteristics (i.e.…”

Section: Clinical Implications From This Thesismentioning

confidence: 99%

Understanding the physical and psychological impairments and associated disability characterising individuals with ankle symptoms and osteoarthritis

Mahrouqi¹

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Musculoskeletal conditions are prevalent worldwide and are associated with pain, disability and impaired quality of life (QoL). Osteoarthritis (OA) is a common, costly and disabling musculoskeletal condition. Lower limb OA research has focussed on the hip and knee and, as a consequence, impairments characterising ankle OA are not well understood.This thesis aims to advance our understanding of the physical, functional and psychological impairments and associated disability in individuals with persistent ankle symptoms and in those with radiographic evidence of ankle OA. Study 1: A systematic literature review and meta-analysis was conducted to synthesise and appraise the quality of studies investigating physical impairments in ankle OA. The review identified eight studies, three of which were included in the meta-analyses. Meta-analyses revealed large impairments of ankle sagittal plane range of motion (ROM) on the affected compared to the unaffected side and less sagittal plane torque in ankle OA compared to controls. Evidence from single studies indicated deficits in frontal plane ROM and strength, talar translation and rotation, balance, electromyography of ankle muscles, abnormal bony alignments and greater fatty infiltrate in all calf muscle compartments in individuals with ankle OA. Critical appraisal of the literature revealed limitations surrounding assessor blinding, measurement validity, and lack of generalization. Study 2: A cross-sectional laboratory study of 96 participants compared physical measures of function, strength, ROM and posture and patient-reported outcomes in 1) individuals with symptoms and radiographic evidence of ankle OA to asymptomatic individuals; and 2) asymptomatic individuals with and without radiographic evidence of ankle OA. Those with symptomatic OA reported greater pain, disability, instability, kinesiophobia, lower function and QoL, and exhibited significant deficits in muscle strength, ROM and ambulatory function compared to asymptomatic individuals. Most patient-reported and physical outcomes were similar between asymptomatic individuals with and without radiographic OA. Stair function times were significantly associated with QoL and self-reported function. ii Study 3: A cross-sectional exploratory survey (n=394) was conducted to compare selfreported daily living and sports function, ankle pain and disability, physical activity, ankle instability, and QoL between individuals with and without persistent ankle pain and stiffness, and to explore factors associated with QoL. Individuals with ankle symptoms reported worse scores for all measures, except self-reported physical activity. Daily living function and age explained 66% of the variance in QoL. Study 4: Individuals with and without persistent ankle pain and stiffness (n= 231) participated in an online survey to obtain data about pain severity, pain self-efficacy, anxiety, depression, kinesiophobia, pain catastrophizing, and function. Individuals with persistent ankle pain reported higher pain and depressive symptoms, an...

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Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline

Cited by 342 publications

References 187 publications

Typical Shape Differences in the Subtalar Joint Bones Between Subjects with Chronic Ankle Instability and Controls

Typical Shape Differences in the Subtalar Joint Bones Between Subjects with Chronic Ankle Instability and Controls

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

Understanding the physical and psychological impairments and associated disability characterising individuals with ankle symptoms and osteoarthritis

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