Lateral Ankle Sprain and Subsequent Ankle Sprain Risk: A Systematic Review.

OBJECTIVE: To evaluate the evidence regarding the association between lateral ankle sprain (LAS) history and the subsequent LAS risk, as well as sex differences in the observed associations. DATA SOURCES: PubMed, CINAHL, and SPORTDiscus were searched through July 2020 for articles on LAS history and incidence during the study period. STUDY SELECTION: Studies were included if they were prospective in nature and the authors reported the number of participants with and those without a history of LAS at study initiation as well as the number of participants in each group who sustained an LAS during the investigation. DATA EXTRACTION: Data were study design parameters as well as the number of participants with and those without an LAS history and the number of subsequent LASs that occurred in both groups. Risk ratios (RRs) with 95% CIs compared the risk of LAS during the study period between those with and those without an LAS history for each investigation. DATA SYNTHESIS: A total of 19 studies involving 6567 patients were included. The follow-up periods ranged from 14 weeks to 2 years. Assessment scores indicated the studies were of moderate to high quality. A significantly higher risk of LAS during the study period was observed among those with a history of LAS in 10 of 15 studies (RR range = 1.29-6.06). Similar associations were seen in 4 of 6 studies of all-male samples (RR range = 1.38-8.65) and 1 of 4 studies with an all-female sample (RR = 4.28). CONCLUSIONS: Strong evidence indicates that a previous LAS increased the risk of a subsequent LAS injury. Men with a history of LAS appeared to be at a higher risk of sustaining a subsequent LAS, but women were not. However, further data are needed to draw definitive conclusions from the limited number of sex-specific studies.

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

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.

Efficacy of non-surgical interventions on dynamic balance in patients with ankle instability: A network meta-analysis.

OBJECTIVES: To identify non-surgical treatments which were deemed to be more effective in improving dynamic postural control in patients with chronic ankle instability (CAI). DESIGN: Systematic review and random-effects network meta-analysis. METHODS: We searched Scopus, CENTRAL, and PubMed until 26 August 2017. We used data from randomized trials comparing the results of different non-surgical interventions for lateral CAI. We assessed dynamic postural control in terms of the star-excursion balance test in the posteromedial direction. We evaluated this outcome at the end of the rehabilitation protocols (i.e., short term) and 6months after treatment (i.e., medium term). We assessed the quality of the included studies with the Cochrane risk of bias tool and evaluated the quality of evidence from the network of interventions using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS: Nineteen trials were eligible for inclusion in this systematic review. A 4-6-week supervised balance training program and a 4-6-week strengthening rehabilitation protocol provided significant improvements compared to control (8 studies, standardized mean difference [SMD] was -0.75, 95% CIs [-1.28 to -0.23]); and 2 studies, SMD was -1.2, 95% CIs [-2.36 to -0.08], respectively). A 6-week combined intervention that addressed balance and strength had the highest probability of being among the best treatments. However, the latter rehabilitation intervention was included in only one trial. CONCLUSIONS: The network meta-analysis showed that supervised balance training protocols and strengthening programs significantly improved dynamic balance in patients with CAI. A combination of these interventions may further increase the efficacy of non-surgical treatment options for the first-line management of CAI.

Effects of a 4-Week Biomechanical Ankle Platform System Protocol on Balance in High School Athletes With Chronic Ankle Instability.

CONTEXT: Chronic ankle instability (CAI) describes the residual symptoms present after repetitive ankle sprains. Current rehabilitation programs in the high school population focus on a multistation approach or general lower-extremity injury-prevention program. Specific rehabilitation techniques for CAI have not been established. OBJECTIVE: To determine the effectiveness of a 4-wk biomechanical ankle platform system (BAPS) board protocol on the balance of high school athletes with CAI. DESIGN: Randomized control trial. SETTING: Athletic training facility. PATIENTS: Twenty-two high school athletes with "giving way" and a history of ankle sprains (ie, CAI) were randomized into a rehabilitation (REH) (166.23 ± 0.93 cm, 67.0 ± 9.47 kg, 16.45 ± 0.93 y) or control (CON) (173.86 ± 8.88 cm, 84.51 ± 21.28 kg, 16.55 ± 1.29 y) group. INTERVENTIONS: After baseline measures, the REH group completed a progressive BAPS rehabilitation program (3 times/wk for 4 wk), whereas the CON group had no intervention. Each session consisted of 5 trials of clockwise/counterclockwise rotations changing direction every 10 s during each 40-s trial. After 4 wk, baseline measurements were repeated. MAIN OUTCOME MEASURES: Dependent measures included longest time (time-in-balance test), average number of errors (foot lift test), average reach distance (cm) normalized to leg length for each reach direction (Star Excursion Balance Test [SEBT]), and fastest time (side hop test [SHT]). RESULTS: Significant group-by-time interactions were found for TIB (F1,20 = 9.89, P = .005), FLT (F1,20 = 41.18, P < .001), SEBT-anteromedial (F1,20 = 5.34, P = .032), SEBT-medial (F1,20 = 7.51, P = .013), SEBT-posteromedial (F1,20 = 12.84, P = .002), and SHT (F1,20 = 7.50, P = .013). Post hoc testing showed that the REH group improved performance on all measures at posttest, whereas the CON group did not. CONCLUSION: A 4-wk BAPS rehabilitation protocol improved balance in high school athletes suffering from CAI. These results can allow clinicians to rehabilitate in a focused manner by using 1 rehabilitation tool that allows benefits to be accomplished in a shorter time.