Acute Ankle Sprain Management: An Umbrella Review of Systematic Reviews

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2022 Jul 25

PMID 35872766

Authors

Diego Gaddi

Angelo Mosca

Massimiliano Piatti

Daniele Munegato

Marcello Catalano

Giorgia Di Lorenzo

Marco Turati

Nicolo Zanchi

Daniele Piscitelli

Kevin Chui

Giovanni Zatti

Marco Bigoni

Affiliations

Soon will be listed here.

Abstract

Even though ankle sprains are among the most frequent musculoskeletal injuries seen in emergency departments, management of these injuries continues to lack standardization. Our objective was to carry out an umbrella review of systematic reviews to collect the most effective evidence-based treatments and to point out the state-of-the-art management for this injury. PubMed, Scopus, Web of Science, and the Cochrane library were searched from January 2000 to September 2020. After removing duplicates and applying the eligibility criteria, based on titles and abstracts, 32 studies were screened. At the end of the process, 24 articles were included in this umbrella review with a mean score of 7.7/11 on the AMSTAR quality assessment tool. We found evidence supporting the effectiveness of non-surgical treatment in managing acute ankle sprain; moreover, functional treatment seems to be preferable to immobilization. We also found evidence supporting the use of paracetamol or opioids as effective alternatives to non-steroidal anti-inflammatory drugs to reduce pain. Furthermore, we found evidence supporting the effectiveness of manipulative and supervised exercise therapy to prevent re-injury and restore ankle dorsiflexion.

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References

Villafane J, Valdes K, Pedersini P, Berjano P . Osteoarthritis: a call for research on central pain mechanism and personalized prevention strategies. Clin Rheumatol. 2018; 38(2):583-584. DOI: 10.1007/s10067-018-4270-4. View

Green T, Willson G, Martin D, Fallon K . What is the quality of clinical practice guidelines for the treatment of acute lateral ankle ligament sprains in adults? A systematic review. BMC Musculoskelet Disord. 2019; 20(1):394. PMC: 6717337. DOI: 10.1186/s12891-019-2750-6. View

Kim T, Lee M, Kim K, Kang J, Choi T, Ernst E . Acupuncture for treating acute ankle sprains in adults. Cochrane Database Syst Rev. 2014; (6):CD009065. PMC: 10514753. DOI: 10.1002/14651858.CD009065.pub2. View

Wikstrom E, Mueller C, Cain M . Lack of Consensus on Return-to-Sport Criteria Following Lateral Ankle Sprain: A Systematic Review of Expert Opinions. J Sport Rehabil. 2019; 29(2):231-237. DOI: 10.1123/jsr.2019-0038. View

Smith R, Reischl S . Treatment of ankle sprains in young athletes. Am J Sports Med. 1986; 14(6):465-71. DOI: 10.1177/036354658601400606. View

Ferran N, Maffulli N . Epidemiology of sprains of the lateral ankle ligament complex. Foot Ankle Clin. 2006; 11(3):659-62. DOI: 10.1016/j.fcl.2006.07.002. View

Delahunt E, Coughlan G, Caulfield B, Nightingale E, Lin C, Hiller C . Inclusion criteria when investigating insufficiencies in chronic ankle instability. Med Sci Sports Exerc. 2010; 42(11):2106-21. DOI: 10.1249/MSS.0b013e3181de7a8a. View

Meroni R, Piscitelli D, Bonetti F, Zambaldi M, Guccione A, Pillastrini P . Rasch analysis of the Italian version of fear avoidance beliefs questionnaire (FABQ-I). Disabil Rehabil. 2014; 37(2):151-7. DOI: 10.3109/09638288.2014.909890. View

Doherty C, Bleakley C, Delahunt E, Holden S . Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med. 2017; 51(2):113-125. DOI: 10.1136/bjsports-2016-096178. View

10.

Al Bimani S, Gates L, Warner M, Bowen C . Factors influencing return to play following conservatively treated ankle sprain: a systematic review. Phys Sportsmed. 2018; 47(1):31-46. DOI: 10.1080/00913847.2018.1533392. View

11.

Meroni R, Piscitelli D, Bonetti F, Zambaldi M, Cerri C, Guccione A . Rasch Analysis of the Italian version of Pain Catastrophizing Scale (PCS-I). J Back Musculoskelet Rehabil. 2014; 28(4):661-73. DOI: 10.3233/BMR-140564. View

12.

Bleakley C, McDonough S, MacAuley D . The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sports Med. 2004; 32(1):251-61. DOI: 10.1177/0363546503260757. View

13.

Feger M, Goetschius J, Love H, Saliba S, Hertel J . Electrical stimulation as a treatment intervention to improve function, edema or pain following acute lateral ankle sprains: A systematic review. Phys Ther Sport. 2015; 16(4):361-9. DOI: 10.1016/j.ptsp.2015.01.001. View

14.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

15.

van den Bekerom M, Struijs P, Blankevoort L, Welling L, van Dijk C, Kerkhoffs G . What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?. J Athl Train. 2012; 47(4):435-43. PMC: 3396304. DOI: 10.4085/1062-6050-47.4.14. View

16.

van den Bekerom M, Sjer A, Somford M, Bulstra G, Struijs P, Kerkhoffs G . Non-steroidal anti-inflammatory drugs (NSAIDs) for treating acute ankle sprains in adults: benefits outweigh adverse events. Knee Surg Sports Traumatol Arthrosc. 2014; 23(8):2390-2399. DOI: 10.1007/s00167-014-2851-6. View

17.

Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C . The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2013; 44(1):123-40. DOI: 10.1007/s40279-013-0102-5. View

18.

Kazemi K, Arab A, Abdollahi I, Lopez-Lopez D, Calvo-Lobo C . Electromiography comparison of distal and proximal lower limb muscle activity patterns during external perturbation in subjects with and without functional ankle instability. Hum Mov Sci. 2017; 55:211-220. DOI: 10.1016/j.humov.2017.08.013. View

19.

Ortega-Avila A, Cervera-Garvi P, Marchena-Rodriguez A, Chicharro-Luna E, Nester C, Starbuck C . Conservative Treatment for Acute Ankle Sprain: A Systematic Review. J Clin Med. 2020; 9(10). PMC: 7599579. DOI: 10.3390/jcm9103128. View

20.

Brantingham J, Bonnefin D, Perle S, Cassa T, Globe G, Pribicevic M . Manipulative therapy for lower extremity conditions: update of a literature review. J Manipulative Physiol Ther. 2012; 35(2):127-66. DOI: 10.1016/j.jmpt.2012.01.001. View