Ankle Sprain

Prompt, accurate diagnosis is crucial, and evidence-based, functional rehabilitation regimens have a proven track record in returning active patients to work and sport. When patients fail to improve with physical therapy and external bracing, multiple surgical techniques have been described with reliable results, including both anatomic and non-anatomic reconstructive methods.

Essential Literature

A RANDOMIZED CONTROLLED TRIAL OF A PASSIVE ACCESSORY JOINT MOBILIZATION ON ACUTE ANKLE INVERSION SPRAINS
Green et. al 2015
Conclusion:
Addition of a talocrural mobilization to the RICE protocol in the management of ankle inversion injuries necessitated fewer treatments to achieve pain-free dorsiflexion and to improve stride speed more than RICE alone…

MANAGEMENT AND PREVENTIN OF ACUTE AND CHRONIC LATERAL ANKLE INSTABILITY IN ATHLETIC PATIENTS
McCriskin BJ et. al 2015
Conclusion:
Prompt, accurate diagnosis is crucial, and evidence-based, functional rehabilitation regimens have a proven track record in returning active patients to work and sport. When patients fail to improve with physical therapy and external bracing, multiple surgical techniques have been described with reliable results, including both anatomic and non-anatomic reconstructive methods. Anatomic repair of the lateral ligamentous complex remains the gold standard for recurrent ankle instability, and it effectively restores native ankle anatomy and joint kinematics while preserving physiologic ankle and subtalar motion. Further preventative measures may minimize the risk of ankle instability in athletic cohorts, including prophylactic bracing and combined neuromuscular and proprioceptive training programs. These interventions have demonstrated benefit in patients at heightened risk for lateral ankle sprain and allow active cohorts to return to full activity without adversely affecting athletic performance.

SUPERVISED REHABILITATION VERSUS HOME EXERCISE IN THE TREATMENT OF ACUTE ANKLE SPRAINS: A SYSTEMATIC REVIEW
Feger MA et. al 2015
Conclusion:
In competitive sports medicine, supervised rehabilitation is the standard of care; in the general population, unsupervised home exercise is more common. We systematically reviewed randomized, controlled trials comparing outcomes for supervised rehabilitation versus home exercise programs. Supervised rehabilitation programs resulted in (1) less pain and subjective instability, (2) greater gains in ankle strength and joint position sense, and (3) inconclusive results regarding prevention of recurrent ankle sprains. We recommend supervised rehabilitation over home exercise programs owing to the improved short-term patient-recorded evidence with a strength-of-recommendation taxonomy level of evidence of 2B.

THE EFFICACY OF MANUAL JOINT MOBILISATION/MANIPULATION IN TREATMENT OF LATERAL ANKLE SPRAINS: A SYSTEMATIC REVIEW
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Conclusion:
For acute ankle sprains, manual joint mobilisation diminished pain and increased dorsiflexion range of motion. For treatment of subacute/chronic lateral ankle sprains, these techniques improved ankle range-of-motion, decreased pain and improved function.

CHRONIC COMPLAINTS AFTER ANKLE SPRAINS: A SYSTEMATIC REVIEW OF TREATMENTS
van Ochten JM et. al 2014
Conclusion:
In chronic ankle complaints after an ankle sprain, a training program gives better results for pain and function, and a decrease of recurrent ankle sprains, than a wait-and-see policy. There was insufficient evidence to determine the most effective surgical treatment, but limited evidence suggests that postoperative, early mobilization was more effective than a plaster cast.

COST-EFFECTIVENESS OF MEASURES TO PREVENT RECURRENT ANKLE SPRAINS
Janssen KW et. al 2014
Conclusion:
Bracing was found to be the dominant secondary preventive intervention over both neuromuscular training and the combination of both measures.

EFFICACY OF THRUST AND NONTHRUST MANIPULATION AND EXERCISE WITH OR WITHOUT THE ADDITION OF MYOFASCIAL THERAPY FOR THE MANAGEMENT OF ACUTE INVERSION ANKLE SPRAINS
SEBASTIÁN TRUYOLS-DOMÍNGUEZ et. al. 2013
Conclusion:
This study provides evidence that, in the treatment of individuals post–inversion ankle sprain, the addition of myofascial therapy to a plan of care consisting of thrust and nonthrust manipulation and exercise may further improve outcomes compared to a plan of care solely consisting of thrust and nonthrust manipulation and exercise.

INTERVENTIONS FOR TREATING CHRONIC ANKLE INSTABILITY
de Vries JS1 et. al 2011
Conclusion:
Neuromuscular training alone appears effective in the short term but whether this advantage would persist on longer-term follow-up is not known. While there is insufficient evidence to support any one surgical intervention over another surgical intervention for chronic ankle instability, it is likely that there are limitations to the use of dynamic tenodesis. After surgical reconstruction, early functional rehabilitation appears to be superior to six weeks immobilisation in restoring early function.

ACUTE AND CHRONIC LATER ANKLE INSTABILITY IN THE ATHLETE
Chan KW 2011
Conclusion:
The ATFL followed by the CFL are the most commonly injured ligaments. Eighty percent of acute ankle sprains make a full recovery with conservative management, while 20% of acute ankle sprains develop mechanical or functional instability, resulting in chronic ankle instability. Treatment of acute ankle sprains generally can be successfully managed with a short period of immobilization that is followed by functional rehabilitation. Patients with chronic ankle instability who fail functional rehabilitation are best treated with a Brostrom-Gould anatomic repair or, in those patients with poor tissue quality or undergoing revision surgery, an anatomic reconstruction.