The management of acute lateral ankle sprains: a survey of South African surgeons and best evidence available

Abstract

Introduction: Ankle sprains remain the single most frequent injury in modern sports with increasing evidence that it is not as innocuous as previously thought. Conservative treatment options include various forms of immobilisation such as casts, moonboots and stirrup braces, followed by a rehabilitation period involving different modalities. Despite clinical evidence there seems to be a divergence between research and practice with an increase in acute surgical repair especially with regard to professional athletes. The aim of the study was to assess the approach on management of acute ankle sprains by orthopaedic surgeons in South Africa, by means of a descriptive cross-sectional survey analysis. Methods: This was a two-part study. First, a questionnaire was emailed to participating orthopaedic surgeons, consisting of eight treatment options for a grade three lateral ankle sprain in a non-professional athlete. Secondly, a literature review was undertaken to establish the current best practice concerning ankle sprain management. Results: A total of 129 responses was received out of the 719 that were sent out. Surgical repair was offered in 24 (19%). Conservative treatment including either cast or moonboot for a period of six weeks was chosen by 49 (38%) and two to four weeks by 55 (43%) as their preferred treatment. Only 39 (30%) of responding South African Orthopaedic Association members chose a short period of immobilisation followed by functional rehabilitation in accordance with the current best evidence available, based on the literature review done. Conclusion: Despite good clinical evidence, there seems to be a lack of consensus in the management of grade three lateral ankle sprains. Level of evidence: Level 5