Clinical research study
What Is the Clinical Course of Acute Ankle Sprains? A Systematic Literature Review

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Abstract

Background

Ankle sprains are one of the most common musculoskeletal injuries. In order to evaluate the effectiveness of therapeutic interventions and to guide management decisions, it is important to have clear insight of the course of recovery after an acute lateral ankle injury and to evaluate potential factors for nonrecovery and re-sprains.

Methods

A database search was conducted in MEDLINE, CINAHL, PEDro, EMBASE, and the Cochrane Controlled trial register. Included were observational studies and controlled trials with adult subjects who suffered from an acute lateral ankle sprain that was conventionally treated. One of the following outcomes had to be described: pain, re-sprains, instability, or recovery. Two reviewers independently assessed the methodological quality of each included study. One reviewer extracted relevant data.

Results

In total, 31 studies were included, from which 24 studies were of high quality. There was a rapid decrease in pain reporting within the first 2 weeks. Five percent to 33% of patients still experienced pain after 1 year, while 36% to 85% reported full recovery within a period of 3 years. The risk of re-sprains ranged from 3% to 34% of the patients, and re-sprain was registered in periods ranging from 2 weeks to 96 months postinjury. There was a wide variation in subjective instability, ranging from 0% to 33% in the high-quality studies and from 7% to 53% in the low-quality studies. One study described prognostic factors and indicated that training more than 3 times a week is a prognostic factor for residual symptoms.

Conclusions

After 1 year of follow-up, a high percentage of patients still experienced pain and subjective instability, while within a period of 3 years, as much as 34% of the patients reported at least 1 re-sprain. From 36% up to 85% of the patients reported full recovery within a period of 3 years.

Section snippets

Literature Search

One author (RvR) conducted a database search using MEDLINE (from 1966 to August 2006), CINAHL, PEDro, EMBASE (from 1984 to August 2006) and the Cochrane Controlled Trial Register. The terms “disorder,” “location,” and “design” were linked by the Boolean operator “AND.” For each of the terms, one or more synonyms were used (Table 1).

The selected studies had to fulfill the following criteria for inclusion in the review: the adult subjects had to suffer from an acute lateral ankle sprain; the

Characteristics of Identified Studies

Our search strategy resulted in 1652 potentially relevant articles. From title and abstract, we identified 120 relevant articles. Reviewing the full text, 29 publications met our selection criteria. After screening the reference lists, another 2 studies were included, resulting in 31 relevant articles (Figure 1). Information about these 31 studies is presented in Table 3 (available online).

Four studies were retrospective and 27 were prospective. In these studies, the follow-up period ranged

Discussion

This review summarizes the results on the course of pain, re-sprain, subjective instability, and subjective recovery in patients with an acute lateral ankle sprain. Within 2 weeks, a rapid improvement of pain experience was seen in the majority of patients with acute ankle sprains. Further improvement occurred after these 2 weeks, although more slowly. Re-sprains occurred within periods ranging from 2 weeks to 96 months after the initial injury, and ranges from 3% to 34% of the patients. The

Conclusion

In conclusion, this review presents the clinical course of pain, objective and subjective instability, and subjective recovery of adult patients with conventionally treated ankle sprains. During the first 2 weeks there is a rapid decrease in pain, after which it continues to improve more slowly. After 3 years follow-up, some patients still have residual symptoms of their initial sprain. There is a wide variation in reported subjective instability, re-sprains, and subjective recovery among the

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