• AGREE II
• Acute
• Ankle
• Clinical practice
• Evidence-based
• Guideline
• Injury

• Humans
• Ankle Injuries/therapy
• Ankle Injuries/diagnosis
• Practice Guidelines as Topic/standards
• Evidence-Based Medicine/standards

Lateral ankle sprains are the most common traumatic musculoskeletal injuries of the lower extremity, with an incidence rate of 15%-20%. The high incidence and prevalence highlights the economic impact of this injury. Ankle sprains lead to a high socioeconomic burden due to the combination of the high injury incidence and high medical expenses. Up to 40% of patients who suffer from an ankle sprain develop chronic ankle instability. Chronic instability can lead to prolonged periods of pain, immobility and injury recurrence. Identification of factors that influence return to work (RTW) and return to sports (RTS) after a lateral ankle sprain (LAS) may help seriously reduce healthcare costs.

To explore which factors may potentially affect RTW and RTS after sustaining an LAS.

EMBASE and PubMed were systematically searched for relevant studies published until June 2023. Inclusion criteria were as follows: (1) Injury including LAS or chronic ankle instability; (2) Described any form of treatment; (3) Assessment of RTW or RTS; (4) Studies published in English; and (5) Study designs including randomized controlled clinical trials, clinical trials or cohort studies. Exclusion criteria were: (1) Studies involving children (age < 16 year); or (2) Patients with concomitant ankle injury besides lateral ankle ligament damage. A quality assessment was performed for each of the included studies using established risk of bias tools. Additionally quality of evidence was assessed using the GRADEpro tool in cases where outcomes were included in the quantitative analysis. A best evidence synthesis was performed in cases of qualitative outcome analysis. For all studied outcomes suitable for quantitative analysis a forest plot was created to calculate the effect on RTW and RTS.

A total of 8904 patients were included in 21 studies, 10 randomized controlled trials, 7 retrospective cohort studies and 4 prospective cohort studies. Fifteen studies were eligible for meta-analysis. The overall RTS rate ranged were 80% and 83% in the all treatments pool and surgical treatments pool, respectively. The pooled mean days to RTS ranged from 23-93 d. The overall RTW rate was 89%. The pooled mean time to RTW ranged from 5.8-8.1 d. For patients with chronic ankle instability, higher preoperative motivation was the sole factor significantly and independently (P = 0.001) associated with the rate of and time to RTS following ligament repair or reconstruction. Higher body mass index was identified as a significant factor (P = 0.04) linked to not resuming sports or returning at a lower level (median 24, range 20-37), compared to those who resumed at the same or higher level (median 23, range 17-38). Patients with a history of psychological illness or brain injury, experienced a delay in their rehabilitation process for sprains with fractures and unspecified sprains. The extent of the delayed rehabilitation was directly proportional to the increased likelihood of experiencing a recurrence of the ankle sprain and the number of ankle-related medical visits. We also observed that 10% of athletes who did return to sport after lateral ankle sprain without fractures described non-ankle-related reasons for not returning.

All treatments yielded comparable results, with each treatment potentially offering unique advantages or benefits. Preoperative motivation may influence rehabilitation after LAS. Grading which factor had a greater impact was not possible due to the lack of comparability among the included patients.

• Ankle sprain
• Prognostic factors
• Bias
• Return to work
• Return to sport
• Preoperative motivation

• Fatigue
• Knee
• Proprioception
• Sense of position

• acute ankle sprain
• atfl
• cfl
• conservative management
• functional management
• lateral ligaments of ankle
• ptfl
• return to activity

• Ankle sprain
• autologous semitendinosus graft
• lateral instability of the ankle

• Ankle joint
• ankle sprain
• athletes
• rang of motion
• stability

• ankle
• classification criteria
• grading system
• ligament
• sprain

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.

• Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca

Ankle diastasis injuries, or ankle syndesmotic injuries, are common among athletes who usually experience a traumatic injury to the ankle. Long‐term complications are avoidable when these injuries are diagnosed promptly and accurately treated. Whilst ankle arthroscopy remains the gold standard diagnostic modality for ankle diastasis injuries, imaging modalities are still widely utilised due to the treatment having greater accessibility, being less invasive and the most cost effective. There are various imaging modalities used to diagnose diastasis injuries, varying in levels of specificity and sensitivity. These observation methods include; X‐ray, computed tomography (CT), magnetic resonance imaging (MRI) and ankle arthroscopy. This article uncovers common criteria and parameters to diagnose diastasis injuries through the implementation of different imaging modalities. The conclusions addressed within this article are deduced from a total of 338 articles being screened with only 43 articles being selected for the purposes of this examination. Across most articles, it was concluded that that plain X‐ray should be used in the first instance due to its wide availability, quick processing time, and low cost. CT is the next recommended investigation due to its increased sensitivity and specificity, ability to show the positional relationship of the distal tibiofibular syndesmosis, and reliability in detecting minor diastasis injuries. MRI is recommended when ankle diastasis injuries are suspected, but not diagnosed on previous imaging modalities. It has the highest sensitivity and specificity compared to X‐ray and CT.

• Ankle arthroscopy
• CT
• MRI
• X-ray
• ankle diastasis injury
• computed tomography
• imaging modality
• magnetic resonance imaging

• foot
• physical therapy
• physiotherapy
• return to sport

• Ankle Injuries
• Ankle Joint
• Athletes
• Humans
• Randomized Controlled Trials as Topic
• Sports
• Sprains and Strains

• Dorsi-flexion
• VAS
• joint inflammation
• plantar-flexion

Syndesmotic ankle sprains are common and challenging injuries for athletes. The management of such injuries is controversial, with a paucity of evidence on treatment protocols with unpredictability regarding the time lost to participate in sports following injury. The present study seeks to review and report the return to play (RTP) time and examine the outcomes and complications of ankle syndesmotic sprains in the athletic population.

PubMed, Cochrane Library, and Google Scholar were queried in August 2021 for case series, cohorts, and randomized controlled trials that evaluated return to play time after ankle syndesmotic sprains. The primary outcomes were the rate and time to return to play after syndesmotic ankle sprains for both surgical and nonsurgical treatment. Secondary outcomes included short-term complications and recurrence.

Eighteen articles were eligible for meta-analysis with a total of 1133 syndesmotic sprains. The overall RTP was 99% (95% CI 0.96, 1.00), the overall mean RTP was 52.32 days (95% CI 39.01, 65.63). Pooled RTP for surgically treated patients was 70.94 days (95% CI 47.04, 94.85), whereas it was 39.33 days (95% CI 28.78, 49.88) for nonsurgically treated cases. A low incidence of recurrence and complications were reported.

This article reports a high rate of RTP after syndesmotic sprains. Grade of injury and surgical vs conservative management can affect the time to RTP in high-level athletes.

Level of Evidence: Level IV, systematic review and meta-analysis.

• Ankle injuries
• Bone marrow
• Edema
• Magnetic resonance imaging
• Talus

• ankle injury
• immobilization
• ligament rupture
• orthosis
• rehabilitation
• treatment
• weight bearing

• Ankle Injuries/rehabilitation
• Ankle Injuries/therapy
• Collateral Ligaments/injuries
• Collateral Ligaments/physiopathology
• Humans
• Orthotic Devices
• Physical Therapy Modalities
• Range of Motion, Articular
• Weight-Bearing

• MRI accuracy
• acute ATFL injury
• diagnostic accuracy
• lateral ankle trauma
• meta-analysis
• systematic review

The lateral ankle sprain (LAS) is one of the most common injuries in everyday and sports activities. Approximately 20–40 % of patients with LAS develop a chronic ankle instability (CAI). The underlying mechanisms for CAI have not yet been clearly clarified. An inadequate rehabilitation after LAS can be speculated, since the LAS is often handled as a minor injury demanding less treatment. Therefore, the aims of this retrospective study were to determine the CAI rate depending on age and sex and to identify possible determinants for developing CAI.

Between 2015 and 2018 we applied the diagnostic code “sprain of ankle” (ICD S93.4) to identify relevant cases from the database of the BG Klinikum Duisburg, Germany. Patients received a questionnaire containing the Tegner-Score, the Cumberland Ankle Instability Tool (CAIT) and the Foot and Ankle Disability Index. Additionally, there were questions about the modality and beginning of therapy following LAS and the number of recurrent sprains. There was a total of 647 completed datasets. These were divided into a CAI and non-CAI group according to a CAIT cut-off-score with CAI ≤ 24 and non-CAI > 24 points, representing one out of three criteria for having CAI based on international consensus.

The overall CAI rate was 17.3 %. We identified a higher CAI rate in females and within the age segment of 41 to 55 years. A later start of therapy (> 4 weeks) after acute LAS significantly increases ankle instability in CAIT (p < .05). There was a significantly higher CAIT score in patients having no recurrent sprain compared to patients having 1–3 recurrent sprains or 4–5 recurrent sprains (p < .001).

Females over 41 years show a higher CAI rate which implies to perform specific prevention programs improving ankle function following acute LAS. A delayed start of therapy seems to be an important determinant associated with the development of CAI. Another contributing factor may be a frequent number of recurrent sprains that are also linked to greater levels of subjective ankle instability. Therefore, we would recommend an early start of functional therapy after acute LAS in the future to minimize the development of CAI.

• Ankle injury
• Ankle instability
• Epidemiology
• FADI
• Functional rehabilitation

Ankle fractures are common injuries that can result in substantial morbidity in the population. This review discusses the management of closed ankle fractures and outlines the recent evidence and guidelines on perioperative management. In general, a detailed history should be undertaken, followed by examination and imaging of the affected limb. Fixation is based on the AO principles of fracture management that aims towards restoring stability of the joint and reducing the risk of long-term complications. A multidisciplinary approach towards perioperative management is recommended in view of the increasing proportion of aging patients with significant comorbidities.

• Ankle fracture
• Complications
• Older
• Perioperative management
• Trauma and orthopaedic surgery

• ankle sprain
• balance
• limits of stability
• movement system
• subacute
• whole body vibration

Ankle injuries are commonplace in the athletic population, with lateral ligament sprains accounting for the majority of them. The medial ligament complex, the distal tibiofibular syndesmosis as well as any of the bones that constitute the ankle joint can also be injured. Typical mechanisms of injury include inversion-plantarflexion and external rotation on a supinated, dorsiflexed or pronated foot. Lesions of the ankle present with similar symptoms of pain, swelling and tenderness. Therefore, a thorough history and physical examination must be obtained to make the correct diagnosis. This is especially critical for athletes as certain injuries can lead to termination of their career if not treated accurately on time. Imaging may be useful in some cases to confirm or rule out differential diagnoses. Most injuries can be managed conservatively using the Protection, Rest, Ice, Compression and Elevation protocol followed by a comprehensive rehabilitation programme. Surgery is reserved for grade III ligament tears that are refractory to initial non-operative treatment and displaced fractures that are unlikely to unite without surgical intervention. The objective of this review is to discuss the common ankle injuries encountered in the athletic population and the approaches to their diagnosis and management.

• Ankle sprain
• Athlete
• Deltoid ligament
• Lateral ligament
• Syndesmosis
• Fracture

A prominent feature of ankle sprains is their variable clinical course. The difficulty of providing a reliable early prognosis may be responsible for the substantial rate of poor outcomes after an ankle sprain. The aim of the present study was to evaluate the prognostic value of objective clinical measures, pain, and functional scores for ankle sprain recovery. Fifty-two participants suffering from lateral ankle sprain were included. Sprain status was assessed four weeks following injury and included evaluations of ankle range of motion, strength, function, and pain. Seven months following injury, a second assessment classified the patients into recovered and non-recovered groups using ankle ability measures. Following a predictor pre-selection procedure, logistic regressions evaluated the association between the four-week predictors and the seven-month recovery status. Twenty-seven participants (52%) fully recovered and 25 did not (48%). The results of the logistic regressions showed that walking pain was negatively associated with the probability of recovering at seven months (odds ratio: 0.71, 95% CI: 0.53–0.95). Pain four weeks after ankle sprain had relevant predictive value for long-term recovery. Special attention should be paid to patients reporting persistent pain while walking four weeks following sprain to reduce the risk of chronicity.

• ankle injury
• early prognosis
• functional score
• recovery prediction
• sport injury
• walking pain

• Dancing
• Foot
• Foot Diseases
• Humans
• Pain

• App
• Artificial intelligence
• Orthopedics
• Pathologies
• Sport medicine

• Ankle injury
• Instability
• Syndesmosis

• Ankle sprain
• Athlete
• Exercise therapy
• Rehabilitation
• Return to play
• Sport injury

• AUC
• Acute trauma
• Ankle trauma
• Appropriate Use Criteria
• Appropriateness Criteria
• Ligamentous injury
• Osteochondral lesion
• Ottawa Rules
• Syndesmotic injury

• Ankle
• Diagnostic Imaging
• Evidence-Based Medicine
• Humans
• Societies, Medical
• United States

• Adult
• Ankle/physiology
• Ankle Injuries/therapy
• Humans
• Male
• Muscle Stretching Exercises/physiology
• Postural Balance/physiology
• Proprioception/physiology
• Range of Motion, Articular/physiology
• Transcutaneous Electric Nerve Stimulation/methods
• Young Adult

• Ankle sprain
• Anterior talofibular ligament
• Calcaneofibular ligament
• Lateral ligament instability

Despite the evidence on the role of gravity stress test to access the instability of other ankle injuries, there is limited literature regarding gravity stress on the lateral ankle ligament’s insufficiency. The objective of our study was to objectively measure the tibiotalar angular movement under gravity stress after progressive sectioning of the lateral ankle ligaments.

We performed sequential sectioning of the anterior talofibular (ATFL), calcaneofibular (CFL), and posterior talofibular ligaments (PTFL) in twelve ankle specimens. Under gravity stress, we measured the angular movement of the talus in relation to the tibia. The measuring device is based on a three-axis gyroscope and accelerometer.

Comparing to the intact condition, the plantar flexion increased on average 1.78° (95% confidence interval [CI] 1.15;2.42), 5.13° (95%CI 3.10;7.16) and 8.63° (95%CI 6.05;11.22), the rotation increased by 1.00° (95 CI -0.51;2.51), 3.68° (95%CI 1.97;5.40) and 15.62° (95%CI 10.09;21.14), and the varus increased 2.89° (95% CI 1.39, 4.39), 8.12° (95% CI 5.16, 11.07) and 11.68° (95% CI 7.91, 15.46), after sectioning the ATFL, CFL, and PTFL, respectively. The overall changes were statistically significant.

There was a significant tibiotalar laxity after sectioning of lateral ankle ligaments when the foot position is influenced only by gravity. The tibiotalar angular displacement was significant when the CFL and PTFL were cut which suggests that the gravity test could be used to assess combined lateral ankle ligament injury. This evidence might be a step forward in the development of lateral ankle ligaments gravity stress tests.

5 (cadaver study)

• Ankle sprain
• Anterior talofibular ligament
• Diagnosis device
• Instability test
• Lateral ligaments
• Talocrural joint axis

Recent studies in biomechanical modeling suggest a paradigm shift, in which the parameters of biomechanical models would no longer treated as fixed values but as random variables with, often unknown, distributions. In turn, novel and efficient numerical methods will be required to handle such complicated modeling problems. The main aim of this study was to introduce and verify genetic algorithm for analyzing uncertainty in biomechanical modeling. The idea of the method was to encode two adversarial models within one decision variable vector. These structures would then be concurrently optimized with the objective being the maximization of the difference between their outputs. The approach, albeit expensive numerically, offered a general formulation of the uncertainty analysis, which did not constrain the search space. The second aim of the study was to apply the proposed procedure to analyze the uncertainty of an ankle joint model with 43 parameters and flexible links. The bounds on geometrical and material parameters of the model were set to 0.50 mm and 5.00% respectively. The results obtained from the analysis were unexpected. The two obtained adversarial structures were almost visually indistinguishable and differed up to 38.52% in their angular displacements.

• material and geometric parameters
• multibody system
• optimization
• sensitivity
• statics

A select 10-30% of patients with recurrent lateral ankle sprains develop chronic ankle instability (CAI). Patients with chronic ankle instability describe a history of the ankle “giving way” with or without pathological laxity on examination. Evaluation includes history, identification of predisposing risk factors for recurrent sprains, and the combination of clinical tests (eg, laxity tests) with imaging to establish the diagnosis. There are a variety of nonoperative strategies to address chronic ankle instability, which include rehabilitation and taping or bracing to prevent future sprains. Patients who fail conservative treatment are candidates for surgery. The anatomic approaches (eg, modified Broström) are preferred to nonanatomic procedures since they recreate the ankle’s biomechanics and natural course of the attenuated ligaments. There is a growing interest in minimally invasive procedures via ankle arthroscopy that also address the associated intra-articular disorders. This article provides a review of chronic lateral ankle instability consisting of relevant anatomy, associated disorders, evaluation, treatment methods, and complications.

• Ottawa Ankle Rules
• ankle X-ray
• ankle injury
• emergency department
• triage nurse

the ankle joint is a frequently injured joint. It is also affected by inflammatory, infectious and tumoral lesions. Ultrasound is a safe and cost-effective imaging tool when evaluating the ankle joint, as most structures are superficial and accessible. The aim of the study was to determine the pattern of ultrasonographic findings of disorders of the ankle joint complex in patients presenting with ankle pain.

a total of 43 consecutive patients with ankle pain referred for an ankle radiograph or ankle ultrasound were examined. Statistical analysis was done using SPSS version 20.

abnormalities were found in 60% of the examinations performed. The abnormalities were more common in female patients accounting for 61.4% of the abnormalities detected. The most common finding was synovial hypertrophy seen in 26% of the patients.

ankle ultrasound was able to identify a large number of pathologies. This demonstrates the usefulness of ultrasound in the evaluation of a patient with ankle pain.

• Musculoskeletal
• ankle
• pain
• ultrasound

• Ankle injuries
• Arthroscopic surgery
• Arthroscopy
• Joint instability
• Lateral ligament, ankle

• Ankle
• Fat drops
• Flexor tendons
• Intra-articular fracture
• Lipohemarthrosis
• Tendon sheath

• ankle injuries
• clinical prediction rule
• logistic model
• prognosis
• sprains and strains

• Adolescent
• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Ankle Injuries/physiopathology
• Body Mass Index
• Delayed Diagnosis
• Emergency Service, Hospital
• Female
• Humans
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Outcome Assessment, Health Care
• Pain
• Prognosis
• Recurrence
• Reproducibility of Results
• Sprains and Strains/physiopathology
• United Kingdom
• Weight-Bearing
• Young Adult

• HTA/13/19/06 Department of Health
• PDF-2016-09-056 Department of Health
• Health Technology Assessment Programme

• Adolescent
• Adult
• Age Factors
• Aged
• Ankle Injuries/complications
• Ankle Injuries/diagnosis
• Cost-Benefit Analysis
• Female
• Humans
• Logistic Models
• Male
• Middle Aged
• Pain/diagnosis
• Pain/etiology
• Prognosis
• Prospective Studies
• Range of Motion, Articular
• Recovery of Function
• Recurrence
• Reproducibility of Results
• Risk Factors
• Sex Factors
• United Kingdom
• Young Adult

• HTA/13/19/06 Department of Health
• PDF-2016-09-056 Department of Health

• ankle sprain
• bone contusion
• fracture
• osteochondral lesion
• peroneal tendon
• syndesmosis

• Arthrosis
• Concomitant injuries
• Diagnostic imaging
• Fracture dislocation
• Talus fracture

• Ankle Fractures/classification
• Ankle Fractures/diagnosis
• Ankle Fractures/diagnostic imaging
• Ankle Fractures/therapy
• Athletic Injuries/diagnosis
• Athletic Injuries/diagnostic imaging
• Athletic Injuries/therapy
• Humans
• Skiing/injuries
• Talus/injuries

• Chopart joint
• ankle trauma
• calcaneocuboid joint
• midtarsal sprain
• talonavicular

• ankle
• pediatric
• sprain
• trauma

• Adolescent
• Ankle Injuries/diagnosis
• Ankle Injuries/therapy
• Ankle Joint
• Child
• Child, Preschool
• Diagnostic Errors
• Female
• Humans
• Male
• Retrospective Studies
• Salter-Harris Fractures/diagnosis
• Salter-Harris Fractures/therapy

• ankle sprain
• cost-effectiveness
• guideline
• inversion trauma
• sprain prevention

High ankle “syndesmosis” injuries are common in American football players relative to the general population. At the professional level, syndesmotic sprains represent a challenging and unique injury lacking a standardized rehabilitation protocol during conservative management.

PubMed, Biosis Preview, SPORTDiscus, PEDro, and EMBASE databases were searched using the terms syndesmotic injuries, American football, conservative management, and rehabilitation.

Clinical review.

Level 3.

When compared with lateral ankle sprains, syndesmosis injuries result in significantly prolonged recovery times and games lost. For stable syndesmotic injuries, conservative management features a brief period of immobilization and protected weightbearing followed by progressive strengthening exercises and running, and athletes can expect to return to competition in 2 to 6 weeks. Further research investigating the efficacy of dry needling and blood flow restriction therapy is necessary to evaluate the benefit of these techniques in the rehabilitation process.

Successful conservative management of stable syndesmotic injuries in professional American football athletes requires a thorough understanding of the anatomy, injury mechanisms, diagnosis, and rehabilitation strategies utilized in elite athletes.

• ankle
• football
• high ankle
• rehabilitation
• syndesmosis