Objective: To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes.Background: Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short-and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented.Recommendations: The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available.

This study generated clear clinical guidelines to help decision making regarding the surgical approach to resurface the talar dome with osteochondral techniques. The majority of the talar dome can be accessed without osteotomy.

We have shown through our study that patients who undergo surgical intervention to repair a torn anterior cruciate ligament with the use of autogenous hamstring tendons demonstrate with weaker internal tibial rotation postoperatively at 2 years when compared to the contralateral limb.

Infection following anterior cruciate ligament reconstruction (ACLR) is rare. Previous authors have concluded that diabetes, tobacco use, and previous knee surgery may influence infection rates following ACLR. The purpose of this study was to identify a cohort of patients undergoing ACLR and define (1) the incidence of infection after ACLR from a large multicenter database and (2) the risk factors for infection after ACLR. We identified patients undergoing elective ACLRs in the American College of Surgeons National Surgical Quality Improvement Program database between 2007 and 2013. The primary outcome was any surgical site infection within 30 days of surgery. We performed univariate and multivariate analyses comparing infected and noninfected cases to identify risk factors for infection. In total, 6,398 ACLRs were available for analysis of which 39 (0.61%) were diagnosed with a postoperative infection. Univariate analysis identified preoperative dyspnea, low hematocrit, operative time > 1 hour, and hospital admission following surgery as predictors of postoperative infection. Diabetes, tobacco use, age, and body mass index (BMI) were not associated with infection ( > 0.05). After multivariate analysis, the only independent predictor of postoperative infection was hospital admission following surgery (odds ratio, 2.67; 95% confidence interval, 1.02-6.96; = 0.04). Hospital admission following surgery was associated with an increased incidence of infection in this large, multicenter cohort. Smoking, elevated BMI, and diabetes did not increase the risk infection in the present study. Surgeons should optimize outpatient operating systems and practices to aid in same-day discharges following ACLR.

Postoperative knee stiffness can influence outcomes following operative treatment of multiligament knee injuries (MLKIs). The purpose of this study was to evaluate patient and surgical factors that may potentially contribute to stiffness following surgery for MLKIs. All surgically managed MLKIs involving two or more ligaments over a 10-year period at a single level one trauma center were included in this study. A retrospective review was performed to gather objective data related to the development of knee stiffness after surgery. Patients were classified as "stiff" postoperatively if they (1) had a flexion contracture greater than 10 degrees, (2) failed to reach 120 degrees of flexion at final follow-up, or (3) underwent a manipulation under anesthesia with or without arthroscopic lysis of adhesions to improve range of motion. Patient and surgical factors were evaluated systematically to determine factors associated with stiffness. The mean age of the cohort was 27.6 years at the time of surgery and mean follow-up was 50 weeks. Overall, 26/121 (21.5%) knees were diagnosed with postoperative stiffness. In the acute postoperative phase, 17 patients underwent manipulation under anesthesia. There were no significant differences in age, body mass index, associated injuries, mechanism, external fixation use or surgical timing (acute vs. chronic) between stiff and normal knees. Factors associated with the development of postoperative stiffness included knee dislocation ( = 0.04) and surgical intervention on three or more ligaments ( = 0.04). Careful attention to postoperative rehabilitation regimens should be given to patients with knee dislocations and/or those undergoing reconstruction or repair of three or more injured ligaments. Surgeons may utilize spanning external fixation if necessary without increasing the rate of long-term stiffness. Further, acute surgery does not appear to influence rates of postoperative stiffness or the need for manipulation.