Different functional treatment strategies for acute lateral ankle ligament injuries in adults

Kerkhoffs GMMJ, Struijs PAA, Marti RK, Assendelft WJJ, Blankevoort L, van Dijk CN

Published Online:

January 21, 2009

When people sprain their ankles, they often injure the ligaments connecting the bones on the side of the ankle (lateral ankle ligaments). The damage might be a mild over-stretching or a complete rupture (break). The three main treatments are plaster casts or splints, surgery or keeping the ankle in use with external support from strapping or other supports (functional treatment). This review of trials looking at functional treatment found that elastic bandages lead to few complications than taping, but recovery might be faster with a semi-rigid ankle or lace-up support. More research is needed.

Abstract (click to read)

Background:

Acute lateral ankle ligament ruptures are common problems in present health care. Early mobilisation and functional treatment are advocated as a preferable treatment strategy. However, functional treatment comprises a broad spectrum of treatment strategies and as of yet no optimal strategy has been identified.

Objectives:

The objective of this review is to assess different functional treatment strategies for acute lateral ankle ligament ruptures in adults.

Search strategy:

We searched the Cochrane Bone, Joint and Muscle Trauma Group specialised register (December 2001), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), MEDLINE (1966 to May 2000), EMBASE (1980 to May 2000), CURRENT CONTENTS (1993 to 1999), BIOSIS (to 1999), reference lists of articles, and contacted organisations and researchers in the field.

Selection criteria:

Randomised clinical trials describing skeletally mature individuals with an acute lateral ankle ligament rupture and comparing different functional treatment strategies were evaluated for inclusion.

Data collection and analysis:

Two reviewers independently assessed the quality of included trials and extracted relevant data on treatment outcome. Where appropriate, results of comparable studies were pooled. Individual and pooled statistics are reported as relative risks (RR) for dichotomous outcome and (weighted) mean differences (WMD) for continuous outcome measures with 95 per cent confidence intervals (95%CI). Heterogeneity between trials was tested using a standard chi-squared test.

Main results:

Nine trials involving 892 participants were included. Lace-up ankle support had significantly better results for persistent swelling at short-term follow up when compared with semi-rigid ankle support (RR 4.19, 95% CI 1.26 to 13.98); elastic bandage (RR 5.48; 95% CI 1.69 to 17.76); and to tape (RR 4.07, 95% CI 1.21 to 13.68). Use of a semi-rigid ankle support resulted in a significantly shorter time to return to work when compared with an elastic bandage (WMD (days) 4.24; 95% CI 2.42 to 6.06); one trial found the use of a semi-rigid ankle support saw a significantly quicker return to sport compared with elastic bandage (RR 9.60; 95% CI 6.34 to 12.86) and another trial found fewer patients reported instability at short-term follow-up when treated with a semi-rigid support than with an elastic bandage (RR 8.00; 95% CI 1.03 to 62.07). Tape treatment resulted in significantly more complications, the majority being skin irritations, when compared with treatment with an elastic bandage (RR 0.11; 95% CI 0.01 to 0.86). No other results showed statistically significant differences.

Authors' conclusions:

The use of an elastic bandage has fewer complications than taping but appears to be associated with a slower return to work and sport, and more reported instability than a semi-rigid ankle support. Lace-up ankle support appears to be effective in reducing swelling in the short-term compared with semi-rigid ankle support, elastic bandage and tape. However, definitive conclusions are hampered by the variety of treatments used, and the inconsistency of reported follow-up times. The most effective treatment, both clinically and in costs, is unclear from currently available randomised trials.

This record should be cited as:

Kerkhoffs GMMJ, Struijs PAA, Marti RK, Assendelft WJJ, Blankevoort L, van Dijk CN. Different functional treatment strategies for acute lateral ankle ligament injuries in adults. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD002938. DOI: 10.1002/14651858.CD002938

Assessed as up to date:

May 23, 2002

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Primary Review Group:

Bone, Joint and Muscle Trauma Group

Health topics:

Orthopaedics & trauma > Soft tissue injuries > Ligament injuries in the ankle

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Different functional treatment strategies for acute lateral ankle ligament injuries in adults

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