Acute Ankle Sprain Management: An Umbrella Review of Systematic Reviews

Abstract

Even though ankle sprains are among the most frequent musculoskeletal injuries seen in emergency departments, management of these injuries continues to lack standardization. Our objective was to carry out an umbrella review of systematic reviews to collect the most effective evidence-based treatments and to point out the state-of-the-art management for this injury. PubMed, Scopus, Web of Science, and the Cochrane library were searched from January 2000 to September 2020. After removing duplicates and applying the eligibility criteria, based on titles and abstracts, 32 studies were screened. At the end of the process, 24 articles were included in this umbrella review with a mean score of 7.7/11 on the AMSTAR quality assessment tool. We found evidence supporting the effectiveness of non-surgical treatment in managing acute ankle sprain; moreover, functional treatment seems to be preferable to immobilization. We also found evidence supporting the use of paracetamol or opioids as effective alternatives to non-steroidal anti-inflammatory drugs to reduce pain. Furthermore, we found evidence supporting the effectiveness of manipulative and supervised exercise therapy to prevent re-injury and restore ankle dorsiflexion.

Characterization of pain-related behaviors and gene expression profiling of peripheral sensory ganglia in a mouse model of acute ankle sprain

“…A prominent feature of ankle sprain patients is the development of ankle pain that affects their life quality (Gonzalez de Vega et al, 2013 ; Gaddi et al, 2022 ). Although the LAS model has been developed to mimic human ankle sprain, it still remains unknown whether the LAS model mice develop similar ankle joint pain as human patients.…”

Cryo plus Ultrasound Therapy, a Novel Rehabilitative Approach for Football Players with Acute Lateral Ankle Injury Sprain: A Pilot Randomized Controlled Trial

“…In fact, Kinkade’s data reported that ice applications and heat packs had matching results [ 34 ]; while Costello et al [ 35 ] established that a whole-body cryotherapy (−110 degrees C) administration provided prompt pain relief and, after 15 min, also reduced muscle tone. Lastly, ice could ensure an analgesic result, which might also facilitate therapeutic exercise in early rehabilitative phase [ 10 ]. In this scenario, it can be stated that cryotherapy, applied by a specific device, has an immediate and profound analgesic effect on severe nociceptive pain and accelerates the tissue healing process by reflex vasodilatation followed by vasoconstriction [ 36 , 37 ].…”

“…In this scenario, a short-term immobilization with functional physiotherapy is preferable to 2/3 weeks conventional therapy with plaster [ 3 ]. Albeit, there is substantial evidence on the management of ankle injuries [ 4 , 5 , 6 , 7 , 8 , 9 ], but there is a disagreement regarding the best therapy management for acute ligament injuries in elite athletes, particularly during COVID-19 era [ 10 , 11 , 12 , 13 ].…”

Topical Treatment Is Effective and Safe for Acute Ankle Sprains: The Multi-Center Double-Blind Randomized Placebo-Controlled TRAUMED Trial

“…Some 40% of ankle sprains are at risk of chronicity. Typical features include pain on weight loading, ankle instability, and mobility issues [4][5][6].…”

“…Guidelines are available. However, there is a general lack of good-quality trial data in support of many current treatments [4,6,7].…”