Treatment Of Acute Ankle Sprains Research Articles

Conservative Management of Ankle Sprains

Ankle sprains are the most common sports related lower extremity injuries. Lateral ankle sprains are most common in ankle sprains. The staged treatment is recommended for the acute lateral ankle sprain. First treatment for acute ankle sprains focuses on control of pain and swelling: protection, rest, ice, compression, and elevation (PRICE) is a well-established protocol for treatment of acute ankle injury. The second phase of treatment is allowed ankle range of motion (ROM) with stirrup brace and the third phase is the exercises which increase ROM and muscle strength around the ankle joint. Adequate treatment for acute lateral ankle sprain can prevent the occurrence of chronic lateral ankle instability. The chronic lateral ankle instabilities have two categories: function instability and anatomical instability. Functional exercise for improving proprioception and strength of peroneal muscle is the first line treatment for chronic lateral ankle instabilities instead of early surgery. Early functional exercises could improve the ankle function, protect the repeated ankle after acute lateral ankle sprain, and improve the symptoms of chronic lateral ankle instabilities.

Arthroscopic excision of separated ossicles of the lateral malleolus

BackgroundWe have conducted a retrospective review of 19 patients for whom 20 separated ossicles of the lateral malleolus were excised arthroscopically. We examined the operating methods, findings, and overall results. MethodsThe patients’ indications for this procedure were as follows. The main complaints were pain alone; ossicle sizes were small and ankle instability was minimal. There were 12 ankles of 12 males and eight ankles of seven females. The patients’ average age was 17.6years. A 2.7-mm, 30° arthroscope was inserted into the ankle joint through the anterolateral portal. Instruments were inserted through the accessory anterolateral portal, and ossicles were removed piece by piece. Talar tilt angles and anterior displacements were examined and compared before and after surgery by use of stress radiographs. Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scales were assessed pre and postoperatively. ResultsAll patients recovered their original levels of activity. The mean talar tilt angle changed from 6.1°±2.4° preoperatively to 6.0°±1.8° postoperatively (p=0.93), and the mean anterior displacement changed from 5.9±1.7mm preoperatively to 6.1±2.0mm postoperatively (p=0.42). Average JSSF ankle/hindfoot scale improved from 77.6±2.6 points preoperatively to 97.2±5.2 points postoperatively (p<0.01). ConclusionsArthroscopic excision of separated ossicles of the lateral malleolus achieved good results with minimum incisions, and relatively early resumption of daily and sports activity was possible. However, when the ossicles were embedded within the fibers of the anterior talofibular ligament, it was impossible to avoid cutting of ligament fibers. To reduce the possibility of ligament dysfunction, we believe postoperative treatment should conform to the accepted method for treatment of acute ankle sprains.

Naproxen Twice Daily Versus as Needed (PRN) Dosing: Efficacy and Tolerability for Treatment of Acute Ankle Sprain, a Randomized Clinical Trial.

This study was conducted to compare the efficacy and safety of naproxen 500 mg twice daily (BID) versus naproxen 500 mg as needed (PRN) for treatment of ankle sprain. In this seven-day, randomized, parallel group trial, 135 patients with ankle sprain occurring less than 48 hours prior to the first dose of study medication were randomized to receive naproxen 500 mg BID (67 patients) and naproxen 500 mg as needed (PRN) (68 patients). The ankle pain was assessed at rest and on full weight bearing using Numeric Rating Scale (NRS) from 0 (no pain) to 10 (the worst imaginable pain). Ankle swelling was assessed as a 4-point scale ranging from 0 (no swelling) to 3 (severe swelling) rated by the investigator. The primary efficacy end point was the patient's assessment of ankle pain via NRS and the degree of swelling on day seven. Results showed a significant decrease in pain on weight bearing, pain at rest and the extent of swelling (P<0.001) in both groups, but there was no substantial difference between the two groups (P>0.05) after seven days. Assessing the safety profile of the two different dosing, 13.3% of the naproxen BID group and 6.7% of the as needed group had adverse events, showing that the as needed regimen was safer (P<0.001). Results showed that naproxen as needed may reduce the pain and edema of the sprained ankle with no significant difference compared to the BID regimen, while it possesses better safety profile and lower total drug use.

Treatment of acute ankle ligament injuries: a systematic review.

BackgroundLateral ankle sprains are common musculoskeletal injuries.ObjectivesThe objective of this study was to perform a systematic literature review of the last 10 years regarding evidence for the treatment and prevention of lateral ankle sprains.Data sourcePubmed central, Google scholar.Study eligibility criteriaMeta-analysis, prospective randomized trials, English language articles.InterventionsSurgical and non-surgical treatment, immobilization versus functional treatment, different external supports, balance training for rehabilitation, balance training for prevention, braces for prevention.MethodsA systematic search for articles about the treatment of lateral ankle sprains that were published between January 2002 and December 2012.ResultsThree meta-analysis and 19 articles reporting 16 prospective randomized trials could be identified. The main advantage of surgical ankle ligament repair is that objective instability and recurrence rate is less common when compared with non-operative treatment. Balancing the advantages and disadvantages of surgical and non-surgical treatment, we conclude that the majority of grades I, II and III lateral ankle ligament ruptures can be managed without surgery. For non-surgical treatment, long-term immobilization should be avoided. For grade III injuries, however, a short period of immobilization (max. 10 days) in a below knee cast was shown to be advantageous. After this phase, the ankle is most effectively protected against inversion by a semi-rigid ankle brace. Even grades I and II injuries are most effectively treated with a semi-rigid ankle brace. There is evidence that treatment of acute ankle sprains should be supported by a neuromuscular training. Balance training is also effective for the prevention of ankle sprains in athletes with the previous sprains. There is good evidence from high level randomized trials in the literature that the use of a brace is effective for the prevention of ankle sprains.ConclusionBalancing the advantages and disadvantages of surgical and non-surgical treatment, we conclude that the majority of grades I, II and III lateral ankle ligament ruptures can be managed without surgery. The indication for surgical repair should be always made on an individual basis. This systematic review supports a phase adapted non-surgical treatment of acute ankle sprains with a short-term immobilization for grade III injuries followed by a semi-rigid brace. More prospective randomized studies with a longer follow-up are needed to find out what type of non-surgical treatment has the lowest re-sprain rate.

235 A Randomized, Clinical Trial Comparing Ankle Manipulation With Standard Treatment to Standard Treatment Alone for the Treatment of Acute Ankle Sprains

235 A Randomized, Clinical Trial Comparing Ankle Manipulation With Standard Treatment to Standard Treatment Alone for the Treatment of Acute Ankle Sprains

What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?

Ankle sprains are common problems in acute medical care. The variation in treatment observed for the acutely injured lateral ankle ligament complex in the first week after the injury suggests a lack of evidence-based management strategies for this problem. To analyze the effectiveness of applying rest, ice, compression, and elevation (RICE) therapy begun within 72 hours after trauma for patients in the initial period after ankle sprain. Eligible studies were published original randomized or quasi-randomized controlled trials concerning at least 1 of the 4 subtreatments of RICE therapy in the treatment of acute ankle sprains in adults. MEDLINE, Cochrane Clinical Trial Register, CINAHL, and EMBASE. The lists of references of retrieved publications also were checked manually. We extracted relevant data on treatment outcome (pain, swelling, ankle mobility or range of motion, return to sports, return to work, complications, and patient satisfaction) and assessed the quality of included studies. If feasible, the results of comparable studies were pooled using fixed- or random-effects models. After deduction of the overlaps among the different databases, evaluation of the abstracts, and contact with some authors, 24 potentially eligible trials remained. The full texts of these articles were retrieved and thoroughly assessed as described. This resulted in the inclusion of 11 trials involving 868 patients. The main reason for exclusion was that the authors did not describe a well-defined control group without the intervention of interest. Insufficient evidence is available from randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults. Treatment decisions must be made on an individual basis, carefully weighing the relative benefits and risks of each option, and must be based on expert opinions and national guidelines.

The ANKLE TRIAL (ANKLE treatment after injuries of the ankle ligaments): what is the benefit of external support devices in the functional treatment of acute ankle sprain? : a randomised controlled trial

BackgroundAcute lateral ankle ligament injuries are very common problems in present health care. Still there is no hard evidence about which treatment strategy is superior. Current evidence supports the view that a functional treatment strategy is preferable, but insufficient data are present to prove the benefit of external support devices in these types of treatment. The hypothesis of our study is that external ankle support devices will not result in better outcome in the treatment of acute ankle sprains, compared to a purely functional treatment strategy. Overall objective is to compare the results of three different strategies of functional treatment for acute ankle sprain, especially to determine the advantages of external support devices in addition to functional treatment strategy, based on balance and coordination exercises.Methods/designThis study is designed as a randomised controlled multi-centre trial with one-year follow-up. Adult and healthy patients (N = 180) with acute, single sided and first inversion trauma of the lateral ankle ligaments will be included. They will all follow the same schedule of balancing exercises and will be divided into 3 treatment groups, 1. pressure bandage and tape, 2. pressure bandage and brace and 3. no external support. Primary outcome measure is the Karlsson scoring scale; secondary outcomes are FAOS (subscales), number of recurrent ankle injuries, Visual Analogue Scales of pain and satisfaction and adverse events. They will be measured after one week, 6 weeks, 6 months and 1 year.DiscussionThe ANKLE TRIAL is a randomized controlled trial in which a purely functional treated control group, without any external support is investigated. Results of this study could lead to other opinions about usefulness of external support devices in the treatment of acute ankle sprain.Trial registrationNetherlands Trial Register (NTR): NTR2151

Pooled analysis of clinical trial data evaluating the safety and effectiveness of diclofenac epolamine topical patch 1.3% for the treatment of acute ankle sprain

This pooled analysis assessed the efficacy and safety of the diclofenac epolamine topical patch 1.3% (DETP) for the treatment of acute mild-to-moderate ankle sprain. Data from 2 randomized, double-blind, placebo-controlled studies enrolling 274 male and female patients aged 18 to 65 years with acute ankle sprain were pooled and evaluated. The primary end point was pain reduction on movement assessed using a 100 mm visual analog scale (VAS). Safety and tolerability were also assessed. Beginning approximately 3 hours after initial treatment, DETP-treated patients experienced statistically significant and sustained lower mean VAS scores in pain intensity on movement (mean ± SD, 54.1 ± 20.0 mm versus 60.3 ± 16.8 mm) compared with placebo-treated patients, representing a 20% versus 13% reduction in VA S pain scores from baseline (P = 0.012). This statistically significant difference in mean VAS score was maintained through day 7 (9.4 ± 14.4 mm versus 18.4 ± 18.2 mm, P < 0.0001). The DETP and placebo patches were well tolerated. These results further confirm the efficacy and safety of DETP for the treatment of acute pain from ankle sprains.

Therapeutic ultrasound for acute ankle sprains.

Ultrasound is used in the treatment of a wide variety of musculoskeletal disorders, which include acute ankle sprains. This is an update of a Cochrane review first published in 1999, and previously updated in 2004. To evaluate the effects of ultrasound therapy in the treatment of acute ankle sprains. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (September 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 3), MEDLINE (1966 to September 2010), EMBASE (1983 to September 2010), CINAHL (1982 to 2004), and PEDro - the Physiotherapy Evidence Database (accessed 01/06/09). We also searched the Cochrane Rehabilitation and Related Therapies Field database, reference lists of articles, and contacted colleagues.The WHO International Clinical Trials Registry Platform was searched for ongoing trials. Randomised or quasi-randomised trials were included if the following conditions were met: at least one study group was treated with therapeutic ultrasound; participants had acute lateral ankle sprains; and outcome measures included general improvement, pain, swelling, functional disability, or range of motion. Two authors independently performed study selection, and assessed the risk of bias and extracted data. Risk ratios and risk differences together with 95% confidence intervals were calculated for dichotomous outcomes and mean differences together with 95% confidence intervals for continuous outcome measures. Limited pooling of data was undertaken where there was clinical homogeneity in terms of participants, treatments, outcomes, and follow-up time points. Six trials were included, involving 606 participants. Five trials included comparisons of ultrasound therapy with sham ultrasound; and three trials included single comparisons of ultrasound with three other treatments. The assessment of risk of bias was hampered by poor reporting of trial methods and results. None of the five placebo-controlled trials (sham ultrasound) demonstrated statistically significant differences between true and sham ultrasound therapy for any outcome measure at one to four weeks of follow-up. The pooled risk ratio for general improvement at one week was 1.04 (random-effects model, 95% confidence interval 0.92 to 1.17) for active versus sham ultrasound. The differences between intervention groups were generally small, between zero and six per cent, for most dichotomous outcomes. The evidence from the five small placebo-controlled trials included in this review does not support the use of ultrasound in the treatment of acute ankle sprains. The potential treatment effects of ultrasound appear to be generally small and of probably of limited clinical importance, especially in the context of the usually short-term recovery period for these injuries. However, the available evidence is insufficient to rule out the possibility that there is an optimal dosage schedule for ultrasound therapy that may be of benefit.

A Systematic Review on the Treatment of Acute Ankle Sprain

Ankle injuries, especially ankle sprains, are a common problem in sports and medical care. Ankle sprains result in pain and absenteeism from work and/or sports participation, and can lead to physical restrictions such as ankle instability. Nowadays, treatment of ankle injury basically consists of taping the ankle. The purpose of this review is to evaluate the effectiveness of ankle braces as a treatment for acute ankle sprains compared with other types of functional treatments such as ankle tape and elastic bandages. A computerized literature search was conducted using PubMed, EMBASE, CINAHL and the Cochrane Clinical Trial Register. This review includes randomized controlled trials in English, German and Dutch, published between 1990 and April 2009 that compared ankle braces as a treatment for lateral ankle sprains with other functional treatments. The inclusion criteria for this systematic review were (i) individuals (sports participants as well as non-sports participants) with an acute injury of the ankle (acute ankle sprains); (ii) use of an ankle brace as primary treatment for acute ankle sprains; (iii) control interventions including any other type of functional treatment (e.g. Tubigrip™, elastic wrap or ankle tape); and (iv) one of the following reported outcome measures: re-injuries, symptoms (pain, swelling, instability), functional outcomes and/or time to resumption of sports, daily activities and/or work. Eight studies met all inclusion criteria. Differences in outcome measures, intervention types and patient characteristics precluded pooling of the results, so best evidence syntheses were conducted. A few individual studies reported positive outcomes after treatment with an ankle brace compared with other functional methods, but our best evidence syntheses only demonstrated a better treatment result in terms of functional outcome. Other studies have suggested that ankle brace treatment is a more cost-effective method, so the use of braces after acute ankle sprains should be considered. Further research should focus on economic evaluation and on different types of ankle brace, to examine the strengths and weaknesses of ankle braces for the treatment of acute ankle sprains.

A Systematic Review on the Treatment of Acute Ankle Sprain: Brace versus Other Functional Treatment Types

A Systematic Review on the Treatment of Acute Ankle Sprain: Brace versus Other Functional Treatment Types

A Systematic Review on the Treatment of Acute Ankle Sprain: Brace versus Other Functional Treatment Types

A Systematic Review on the Treatment of Acute Ankle Sprain: Brace versus Other Functional Treatment Types

Como o ortopedista brasileiro trata entorse lateral aguda do tornozelo?

OBJETIVO: A entorse lateral aguda do tornozelo (ELAT) é uma afecção frequente cujo tratamento ainda não se encontra totalmente estabelecido. O objetivo do estudo foi verificar a conduta do médico ortopedista brasileiro (incluindo residentes) em relação ao diagnóstico, classificação, tratamento e complicações da entorse lateral aguda do tornozelo (ELAT). MÉTODOS: Um questionário de múltipla escolha foi elaborado com objetivo de abordar os principais aspectos do tratamento da ELAT. O questionário foi veiculado na página eletrônica oficial da Sociedade Brasileira de Ortopedia e Traumatologia, no período de 15 de junho a 1º de agosto de 2004. RESULTADOS: Foram incluídos para análise um total de 444 questionários. Os resultados demonstraram concordância da maioria dos entrevistados em relação aos seguintes aspectos: 90,8% utilizam alguma classificação para nortear o tratamento da entorse; 59% classificam a ELAT com segurança; 63,7% utilizam imobilização rígida nas lesões ligamentares completas; 60,6% utilizam medicação anti-inflamatória na ruptura ligamentar parcial; 75,9% relataram que a dor residual é a complicação mais frequente. Não houve consenso quanto ao método de imobilização da ELAT parcial visto que imobilização e tratamento funcional foram escolhidos com a mesma frequência (47%). Não houve diferenças significativas entre as respostas dos residentes e a dos ortopedistas (p = 0,81). CONCLUSÕES: Os ortopedistas e residentes em ortopedia do Brasil têm dificuldade em classificar a ELAT e não há consenso quanto à melhor opção para a ELAT parcial.

Ankle sprains: from diagnosis to management. the physiatric view

Ankle injuries are the most frequently encountered injuries in clinical practice. They are often managed by general practicians, and not only by orthopaedic or physiatric physicians. This injury is usually non-complicated, but some care should be taken to assure an adequate management and to exclude severe lesions. The stability of the ankle is necessary for functional activity of lower extremity, allowing walking and participation in other high demanding activities like running or jumping. There is a constant concern in adopting the best diagnostic and treatment procedures to enhance the recovery and to prevent the chronic joint instability. According to this, there should be proposed comprehensive strategies focusing the rehabilitation view. The ankle is a complex articular structure with contributions from the talocrural, subtalar, and inferior tibiofibular joints. The full understanding of the functional anatomy and biomechanics is the first step for the evaluation of the etiologic factors. The recognition of the mechanism of injury, and the risk factors, should be carefully addressed to make an accurate diagnosis, proper management and to implement prophylactic measures, knowing that the lateral ligamentous complex is the most commonly injured. As always, diagnosis can be made taking an adequate history, performing a thorough physical examination, and when necessary, requesting complementary studies. The priority in initial assessment it's to clear out some severe complications, like fractures, that can mimic or that can be associated with ankle sprains. Although the conventional radiology is suitable for most cases, that has been greatly improved through the institution of the Ottawa Rules, in selected patients the severity of the damage is best evaluated with other imaging resources. Treatment of acute ankle sprains depends on the severity of the injury. Most acute lateral ligament injuries are best treated nonsurgically and will regain satisfactory ankle stability after functional treatment. The conservative approach has been found to be equally effective in treating grade I and II ankle sprains. Some controversy still exists regarding the appropriate treatment of grade III injuries. General belief is that the majority of these patients may also be treated well with conservative management. Surgical reconstruction may be necessary, in cases that develop chronic functional instability, and especially in athletes with high demands on ankle joint stability. The purpose of this article is to review the biomechanics, clinical examination, diagnosis, management and secondary prevention of ankle sprains. We discuss the use and benefit of different modalities and outline a three-phase intervention program of rehabilitation based on recent guidelines.

Letters to the Editor: Acute Treatment of Inversion Ankle Sprains: Immobilization versus Functional Treatment

To the Editor: This letter is in reference to the article “Acute treatment of inversion ankle sprains: immobilization versus functional treatment” by Jones and Amendola.2 When the diagnosis of an acute lateral ankle ligament rupture has been made, a no-treatment strategy leads to a higher number of residual complaints when compared with an adequate treatment strategy.9 Various treatments for acute lateral ankle ligament injuries can serve this goal. The three main modalities are (1) immobilization with a plaster cast or splint; (2) functional treatment, an early mobilization program that involves the use of an external support; and (3) operative treatment. This variation in treatment practice for lateral ankle ligament injuries suggests a lack of evidence-based management strategies. The title and introduction of the article by Jones and Amendola suggest the effort of the authors to fill at least part of this lack of evidence-based treatment recommendations. However, the remainder of this review is disappointing. After a review of the literature to identify articles that represent the highest level of evidence, the authors came up with only 19 articles fit for review of which 10 were fit for inclusion in their review. Consequently, only limited randomized controlled trials are presented in the results section, which has obvious consequences on the outcome and on the final conclusions. Jones and Amendola did not discuss some of the systematic reviews published in recent years. These reviews covered the issue of optimal treatment for acute lateral ankle ligament injuries quite extensively3,5-10 and stated functional treatment appears to be the favored treatment for acute ankle sprains compared with immobilization. Although many trials were poorly reported and there was variety among the functional treatments evaluated,5,6 Jones and Amendola bring old news as new without mentioning or discussing the already-existing evidence on the subject. Therefore, there is a lack of useful information in their Discussion section. We wonder if they were unaware of current evidence-based literature on the topic. Further, they did not discuss surgery as a treatment option and did not comment on earlier work on the evaluation of different functional treatment options for acute lateral ankle ligament injuries.1,7,8 In our recent update4 of a systematic review published in 2002,3 fixed-effect model analyses showed there were statistically significant differences in favor of surgical treatment (nonreturn to preinjury level of sports, ankle sprain recurrence, long-term pain, and subjective or functional instability); however, these differences were no longer statistically significant when using the more appropriate random-effects model and with the removal of one low-quality (quasirandomized) trial with extreme results. So there is still insufficient evidence available from randomized controlled trials to determine the superiority of either surgical or nonoperative treatment for acute injuries of the lateral ligament complex of the ankle. High-quality randomized controlled trials of primary surgical repair versus the best available nonoperative treatment for well-defined injuries are required. In a systematic evaluation of different functional treatments,7,8 a lace-up ankle support seems to be effective in reducing swelling in the short term when compared with a semirigid ankle support, elastic bandage, and tape. However, the most effective functional treatment, clinically and in terms of cost, remains unclear from available trials.7,8 Systematic reviews of the literature are a modern and popular medium for authors to present a complete and up-to-date survey of the evidence on a topic; however, they should not forget, as with conducting and reporting randomized controlled trials, the process of conducting and reporting a systematic literature search should be done with great care for completeness and accuracy. Inadequately performed systematic reviews can easily mislead the readers of high-quality journals. Gino M. M. J. Kerkhoffs, MD, PhD Department of Orthopedic Surgery Orthopedic Research Center Amsterdam, Academic Medical Center Amsterdam, The Netherlands Department of Orthopedic and Trauma Surgery Kantonsspital St Gallen St Gallen, Switzerland Peter A. A. Struijs, MD, PhD C. Niek van Dijk, MD, PhD Department of Orthopedic Surgery Orthopedic Research Center Amsterdam Academic Medical Center Amsterdam, The Netherlands

Valdecoxib Provides Effective Pain Relief following Acute Ankle Sprain

We sought to determine whether valdecoxib is as effective as diclofenac in treating acute ankle sprain. Patients (n=202) with acute first- and second-degree ankle sprain were randomized to valdecoxib (40 mg twice daily on day 1 followed by 40 mg once daily on days 2-7) or diclofenac (75 mg twice daily). The primary efficacy end-point was the Patient's Assessment of Ankle Pain visual analogue scale (VAS, 0-100 mm) value on day 4. Valdecoxib was as efficacious as diclofenac in treating the signs and symptoms of acute ankle sprain. The mean VAS reduction in ankle pain on day 4 was not different between groups; the two-sided 95% confidence interval for the between-group difference was within the prespecified limit for non-inferiority (10 mm). There were no significant differences between groups for all secondary efficacy end-points. The two treatments were similarly effective and well tolerated for treatment of acute ankle sprain.

Ultrasound therapy for acute ankle sprains.

Ultrasound is used in the treatment of a wide variety of musculoskeletal disorders. To evaluate the effects of ultrasound therapy in the treatment of acute ankle sprains. We searched the Cochrane Musculoskeletal Injuries Group specialised register (November 15th 2001), the Cochrane Controlled Trials Register (The Cochrane Library Issue 3, 2001), MEDLINE (1966 to October 2001), EMBASE (1983 to 2001 week 45), CINAHL (1982 to October week 4 2001), and PEDro - The Physiotherapy Evidence Database (http://ptwww.cchs.usyd.edu.au/pedro/ accessed 15.11.01). We also searched the Cochrane Rehabilitation and Related Therapies Field database, reference lists of articles, and contacted colleagues. Randomised or pseudo-randomised trials were included in the review if the following conditions were met: at least one study group was treated with active ultrasound; the study included patients with acute lateral ankle sprains; and outcome measures included general improvement, pain, swelling, functional disability, or range of motion. Final selection of papers was conducted by two independent reviewers. Two reviewers independently assessed trial quality using a standardised checklist, and extracted data. Whenever possible, the results were analysed on an intention-to-treat basis. Relative risks together with 95 per cent confidence intervals were calculated for dichotomous outcomes, and weighted or, where different scales were used, standardised mean differences together with 95 per cent confidence intervals for continuous outcome measures. Pooling of data was undertaken where there was clinical homogeneity in terms of subjects, treatments, outcomes, and follow-up time points. Five trials were included, involving 572 patients. Four of these trials were only of modest methodological quality and one placebo-controlled trial was considered to be of good quality. None of the four placebo-controlled trials (sham ultrasound) could demonstrate statistically significant differences between true and sham ultrasound therapy for any outcome measure at seven to 14 days of follow-up. The pooled relative risk for general improvement was 1.04 (random effects model, 95% confidence interval 0.92 to 1.17) for the comparison between ultrasound and sham ultrasound. The differences between intervention groups were generally small, between zero and six per cent for most dichotomous outcomes. However, one trial reported relatively large differences for pain free status (20%) and swelling (25%) in favour of ultrasound treatment. The extent and quality of the available evidence for the effects of ultrasound therapy for acute ankle sprains is limited. The results of four placebo-controlled trials do not support the use of ultrasound in the treatment of ankle sprains. The magnitude of most reported treatment effects appeared to be small, and may be of limited clinical importance. As yet, only few trials are available and no conclusions can be made regarding an optimal and adequate dosage schedule for ultrasound therapy, and whether such a schedule would improve on the reported effectiveness of ultrasound for ankle sprains.

Lateral ankle sprains: a comprehensive review part 2: treatment and rehabilitation with an emphasis on the athlete.

This is the second part of a two-part comprehensive review of lateral ankle sprains. In the first part of our review, we discussed the etiology, natural history, pathoanatomy, mechanism of injury, histopathogenesis of healing, and diagnostic approach to acute and chronic lateral ligamentous ankle injuries. Conservative intervention and treatment of grade I-III and chronic, recurrent sprains of the lateral ankle ligaments and appropriate rehabilitation guidelines are the topics of this article. We review the use and benefit of different modalities and external supports and outline our five-phase intervention program of rehabilitation based on the histopathogenesis of ligament healing. We discuss the expected timing of recovery of the acute injury as well as the management of chronic, recurrent ankle sprains. Treatment of acute ankle sprains depends on the severity of the injury. Conservative therapy has been found to be uniformly effective in treating grade I and II ankle sprains. Some controversy exists regarding the appropriate treatment of grade III injuries, particularly in high-level athletes. Our belief is that the majority of these patients may also be treated well with conservative management. Other options for the management of grade III sprains will be briefly discussed at the end of this article.

A Quantitative Comparative Assessment of the Immediate Response to High Frequency Ultrasound and Low Frequency Ultrasound (‘Longwave Therapy’) in the Treatment of Acute Ankle Sprains

Summary This paper describes a prospective randomised trial to compare the relative efficacy of high frequency ultrasound (3 MHz) and low frequency ultrasound (45 kHz) in the treatment of unilateral acute ankle sprains. A placebo group, which received ‘sham’ ultrasound was also included in the trial. Objective, quantified measurements of the patients’ gait were made before treatment and immediately following treatment, using the Gaitway system. The results show that the group treated with longwave showed a much greater improvement immediately following therapy with statistically highly significant improvement in length of stride, symmetry of swing phase duration, cadence and walking velocity. The enhanced response was evident also from follow-up measurements using Gaitway at three days after treatment and by clinical impressions and patients’ commentaries. We consider the difference between these forms of therapy to be significant and consequently suggest that the name ‘longwave therapy’ be used to describe the low frequency treatment modality. This paper describes a prospective randomised trial to compare the relative efficacy of high frequency ultrasound (3 MHz) and low frequency ultrasound (45 kHz) in the treatment of unilateral acute ankle sprains. A placebo group, which received ‘sham’ ultrasound was also included in the trial. Objective, quantified measurements of the patients’ gait were made before treatment and immediately following treatment, using the Gaitway system. The results show that the group treated with longwave showed a much greater improvement immediately following therapy with statistically highly significant improvement in length of stride, symmetry of swing phase duration, cadence and walking velocity. The enhanced response was evident also from follow-up measurements using Gaitway at three days after treatment and by clinical impressions and patients’ commentaries. We consider the difference between these forms of therapy to be significant and consequently suggest that the name ‘longwave therapy’ be used to describe the low frequency treatment modality.

Neuartige funktionelle Untersuchungen zum Stabilisierungsverhalten von Sprunggelenksorthesen

For functional treatment of acute ankle sprain after surgical or nonsurgical management various special shoes and braces are in use. For a comparison under functional conditions we applied controlled inversion movements of 20 and 30 degrees to 13 subjects. The reduction of angular displacement was measured for the following orthosis: Aircast, Adimed Stabil 2, Adipromed Stabil Super, Mikros Ankle Brace, MHH-Splint Caligamed, Puschbrace and Tape. For evaluation of the neuromuscular activation surface EMGs of selected leg muscles were analyzed. A significant reduction of the induced inversion displacement was observed in all devices, although a complete inhibition of this movement was not possible. EMG activation was comparable to physiological conditions and is not correlated to the displacement characteristics. It is concluded that functional evaluation must take into consideration both the optimal reduction of the inversion and the high functional innervation.