SLR - May 2021 - Gagandeep Sandhu

Conservative Treatment for Acute Ankle Sprain: A Systematic Review

Reference: Ortega-Avila, AB, Cervera-Garvi, P, Marchena-Rodriguez, A, Chicharro-Luna, E, Nester, CJ, Starbuck, C, Gijon-Nogueron, G. Conservative Treatment for Acute Ankle Sprain: A Systematic Review. J. Clin. Med. 2020, 9, 3128.

Level of Evidence: Level IV

Scientific Literature Review

Reviewed By: Gagandeep Sandhu, DPM
Residency Program: Roxborough Memorial Hospital – Philadelphia, PA 

Podiatric Relevance: Ankle sprains are the most common musculoskeletal injuries affecting the lower limb in active people. Sprains are defined as stretching, partial or complete tearing of a ligament which is induced by excessive motion at a joint, with inversion being the most common. Conservative modalities for acute ankle sprains is the most common treatment. Determining which conservative treatments to reduce pain, enhance recovery and improve functional stability is paramount. This was a systematic review done with numerous journal search engines and included randomized control trial studies. 

Methods: The study focused on meta-analyses used for systematic review via numerous journal search engines. Eligibility for this review were: acute ankle sprains given conservative treatment as the initial option, and randomized controlled clinical trials where patients were seen within seven days of injury. Each study evaluated pain, functionality/disability. They excluded chronic/recurrent ankle sprains, surgical treatment, and non-randomized control trials, and those that were rated as biased under Cochrane risk bias tool. The review of literature was conducted by two independent researchers, who needed a consensus to use a paper - if there was a disagreement a third researcher was sought out. The patients' age, sex, characteristic of sprain, study design and treatment were extracted from each paper; however, no meta-analysis was conducted due to the differences in population. Each study was assessed for level of bias by both researchers.

Results: A total of 10,556 studies were identified: 9860 studies were duplicated, leaving 696 studies. However, only 20 studies were designated to have met the criteria for the article. A total of 2236 patients were included in the study with mean age of 28 and involving a distribution of 40 percent females and 60 percent males. All patients underwent conservative treatment; however, the location of sprain was usually not specified. Time of injury to treatment was recorded, which was usually less than 48 hours. Average follow up was 162 days. The most common treatment was manual/physiotherapeutic methods, followed by bandages, in that order. Multiple pain and functional scales were utilized.

Conclusions: Overall, low quality studies were utilized. However, these conservative treatments are still effective in reducing pain and returning functionality to the ankle. Interestingly, the article fails to demonstrate which conservative treatments were more effective, therefore additional high-quality research needs to be completed in order to determine the best plan of care for ankle sprains.

Educational Opportunities