Cochrane Summaries

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Surgery versus conservative treatment for acute ankle sprains in adults

Kerkhoffs GMMJ, Handoll HHG, de Bie R, Rowe BH, Struijs PAA
Published Online: 
17 February 2010

Ankle sprain is one of the commonest musculoskeletal injuries in active people. It generally involves damage to the lateral or outer ligaments, which connect bones together on the outside of the ankle joint. Treatment is usually either immobilisation of the leg in a plaster cast, or 'functional treatment' where the ankle is kept in use while protected by an external support. After treatment, however, some people still have a weak and sometimes painful ankle. This review aimed to find out if primary surgical repair of the torn ligament(s) gives a better result than either of these two non-surgical or conservative treatments.

Twenty trials were included. These involved a total of 2562 mostly young active adult males. All trials had methodological flaws that could have affected their results. Data for pooling individual outcomes were only available for a maximum of 12 trials. Additionally, there was one low quality and potentially biased trial with very positive results in favour of surgery. When this trial was excluded, the findings of better results for surgery in terms of return to sports, re-injury, persistent pain and ankle instability as judged by the patient were no longer statistically significant. Thus, the trend to a better result from surgery remains unproven. Ankle stability, as judged by the clinician using standard tests, was better after surgery than with conservative treatment. Conversely, there was some limited evidence for longer recovery times, and higher incidences of ankle stiffness, impaired ankle mobility and complications in the surgical treatment group.

We concluded that there was not enough evidence from randomised controlled trials to say whether surgery gives a better result than conservative treatment for acute ankle sprain in adults.