Exploring influences and risk of bias of studies on return to sport and work after lateral ankle sprain:A systematic review and metaanalysis

BACKGROUND Lateral ankle sprains are the most common traumatic musculoskeletal injuries of the lower extremity,with an incidence rate of 15%-20%.The high incidence and prevalence highlights the economic impact of this injury.Ankle sprains lead to a high socioeconomic burden due to the combination of the high injury incidence and high medical expenses.Up to 40%of patients who suffer from an ankle sprain develop chronic ankle instability.Chronic instability can lead to prolonged periods of pain,immobility and injury recurrence.Identification of factors that influence return to work(RTW)and return to sports(RTS)after a lateral ankle sprain(LAS)may help seriously reduce healthcare costs.AIM To explore which factors may potentially affect RTW and RTS after sustaining an LAS.METHODS EMBASE and PubMed were systematically searched for relevant studies published until June 2023.Inclusion criteria were as follows:(1)Injury including LAS or chronic ankle instability;(2)Described any form of treatment;(3)Assessment of RTW or RTS;(4)Studies published in English;and(5)Study designs including randomized controlled clinical trials,clinical trials or cohort studies.Exclusion criteria were:(1)Studies involving children(age<16 year);or(2)Patients with concomitant ankle injury besides lateral ankle ligament damage.A quality assessment was performed for each of the included studies using established risk of bias tools.Additionally quality of evidence was assessed using the GRADEpro tool in cases where outcomes were included in the quantitative analysis.A best evidence synthesis was performed in cases of qualitative outcome analysis.For all studied outcomes suitable for quantitative analysis a forest plot was created to calculate the effect on RTW and RTS.RESULTS A total of 8904 patients were included in 21 studies,10 randomized controlled trials,7 retrospective cohort studies and 4 prospective cohort studies.Fifteen studies were eligible for meta-analysis.The overall RTS rate ranged were 80%and 83%in the all treatments pool and surgical treatments pool,respectively.The pooled mean days to RTS ranged from 23-93 d.The overall RTW rate was 89%.The pooled mean time to RTW ranged from 5.8-8.1 d.For patients with chronic ankle instability,higher preoperative motivation was the sole factor significantly and independently(P=0.001)associated with the rate of and time to RTS following ligament repair or reconstruction.Higher body mass index was identified as a significant factor(P=0.04)linked to not resuming sports or returning at a lower level(median 24,range 20-37),compared to those who resumed at the same or higher level(median 23,range 17-38).Patients with a history of psychological illness or brain injury,experienced a delay in their rehabilitation process for sprains with fractures and unspecified sprains.The extent of the delayed rehabilitation was directly proportional to the increased likelihood of experiencing a recurrence of the ankle sprain and the number of ankle-related medical visits.We also observed that 10%of athletes who did return to sport after lateral ankle sprain without fractures described non-ankle-related reasons for not returning.CONCLUSION All treatments yielded comparable results,with each treatment potentially offering unique advantages or benefits.Preoperative motivation may influence rehabilitation after LAS.Grading which factor had a greater impact was not possible due to the lack of comparability among the included patients.

Risk factors for chronic ankle instability after first episode of lateral ankle sprain:A retrospective analysis of 362 cases

Background:Chronic ankle instability(CAI) is a common sequela following an acute lateral ankle sprain(LAS).To treat an acture LAS more effectively and efficiently,it is important to identify patients at substantial risk for developing CAI.This study identifies magnetic resonance imaging(MRI) manifestations for predicting CAI development after a first episode of LAS and explores appropriate clinical indications for ordering MRI scans for these patients.Methods:All patients with a first-episode LAS who received plain radiograph and MRI scanning within the first 2 weeks after LAS from December 1,2017 to December 1,2019 were identified.Data were collected using the Cumberland Ankle Instability Tool at final follow-up.Demographic and other related clinical variables,including age,sex,body mass index,and treatment were also recorded.Univariable and multivariable analyses were performed successively to identify risk factors for CAI after first-episode LAS.Results:A total 131 out of 362 patients with a mean follow-up of 3.0± 0.6 years(mean ± SD;2.0—4.1 years) developed CAI after first-episode LAS.According to multivariable regression,development of CAI after first-episode LAS was associated with 5 prognostic factors:age(odds ratio(OR)=0.96,95% confidence interval(95%CI):0.93-1.00,p=0.032);body mass index(OR=1.09,95%CI:1.02-1.17,p=0.009);posterior talofibular ligament injury(OR=2.17,95%CI:1.05-4.48,p=0.035);large bone marrow lesion of the talus(OR=2.69,95%CI:1.30-5.58,p=0.008),and Grade 2 effusion of the tibiotalar joint(OR=2.61,95%CI:1.39-4.89,p=0.003).When patients had at least 1 positive clinical finding in the 10-m walk test,anterior drawer test,or inversion tilt test,they had a 90.2% sensitivity and 77.4% specificity in terms of detecting at least 1 prognostic factor by MRI.Conclusion:MRI scanning is valuable in predicting CAI after first-episode LAS for those patients with at least 1 positive clinical finding in the10-m walk test,anterior drawer test,and inversion tilt test.Further prospective and large-scale studies are necessary for validation.

Acute ankle sprain in athletes:Clinical aspects and algorithmic approach

Acute ankle sprain is the most common lower limb injury in athletes and accounts for 16%-40%of all sports-related injuries.It is especially common in basketball,American football,and soccer.The majority of sprains affect the lateral ligaments,particularly the anterior talofibular ligament.Despite its high prevalence,a high proportion of patients experience persistent residual symptoms and injury recurrence.A detailed history and proper physical examination are diagnostic cornerstones.Imaging is not indicated for the majority of ankle sprain cases and should be requested according to the Ottawa ankle rules.Several interventions have been recommended in the management of acute ankle sprains including rest,ice,compression,and elevation,analgesic and anti-inflammatory medications,bracing and immobilization,early weight-bearing and walking aids,foot orthoses,manual therapy,exercise therapy,electrophysical modalities and surgery(only in selected refractory cases).Among these interventions,exercise and bracing have been recommended with a higher level of evidence and should be incorporated in the rehabilitation process.An exercise program should be comprehensive and progressive including the range of motion,stretching,strengthening,neuromuscular,proprioceptive,and sport-specific exercises.Decision-making regarding return to the sport in athletes may be challenging and a sports physician should determine this based on the self-reported variables,manual tests for stability,and functional performance testing.There are some common myths and mistakes in the management of ankle sprains,which all clinicians should be aware of and avoid.These include excessive imaging,unwarranted non-weightbearing,unjustified immobilization,delay in functional movements,and inadequate rehabilitation.The application of an evidence-based algorithmic approach considering the individual characteristics is helpful and should be recommended.

OBSERVATION ON THERAPEUTIC EFFECTS OF ACUTE SPRAIN OF SOFT TISSUE TREATED BY ACUPUNCTURE AT PRESSURE PAIN POINTS

In the present paper,70 cases of acute sprain of soft tissue were treated withacupuncture at pressure pain points on the lateral of the second metacarpal bone.Results showedthat the cure rate was 58.6％ and the total effective rate was 94.3％.Also,its mechanisms werestudied preliminarily.The present therapy is simple,convenient,easy to operate and it producesrapidly desired effects with a higher cure rate,so it is suited to be popularized clinically.

FINGER PRESSURE PLUS MOXIBUSTION FOR TREATMENT OF 30 CASES OF ACUTE LUMBAR SPRAIN

In the present paper,30 cases of acute lumbar sprain are treated with finger pressuretherapy and moxibustion therapy.Results show that 21 cases are cured,4 markedly effective and 5effctive.This combined treatment has no sufferings to the patient,is safe,simple and easy to be ac-cepted by patients.

Acupuncture Combined with Plucking Muscle Method for Treatment of 48 Cases of Acute Lumbar Sprain

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Most ankle sprain research is either false or clinically unimportant:A 30-year audit of randomized controlled trials

Background:Lateral ankle sprain is the most common musculoskeletal injury.Although clinical research in this field is growing,there is a broader concern that clinical trial outcomes are often false and fail to translate into patient benefits.Methods:We audited 30 years of experimental research related to lateral ankle sprain management(n=74 randomized controlled trials)to determine if reports of treatment effectiveness could be validated beyond statistical certainty.Results:A total of 77%of trials reported positive treatment effects,but there was a high risk of false discovery.Most trials were unregistered and relied solely on statistical significance,or lack of statistical significance,rather than on interpreting key measures of minimum clinical importance(e.g.,minimal detectable change,minimal clinically important difference).Conclusion:Future clinical trials must adopt higher standards of reporting and data interpretation.This includes consideration of the ethical responsibility to preregister their research and interpretation of clinical outcomes beyond statistical significance.

Patients’perspectives on the conventional synthetic cast vs a newly developed open cast for ankle sprains

BACKGROUND Orthopedic physicians typically apply a cast to immobilize a body part that has been injured.There have been no significant structural changes or advances in synthetic casts since the development of the modern cast.The Opencast®is a recently developed type of cast that allows ventilation and direct visual inspection of the skin to avoid cast-related complications.Although this novel cast appears to have more benefits than the conventional synthetic cast,its clinical efficacy and advantages have not been established.AIM To investigate the clinical efficacy and advantages of the newly developed Opencast®based on patients’perspectives in those with ankle inversion injury.METHODS A specifically designed questionnaire consisting of 19 items was used to compare patients’opinions and concerns of the Opencast®and the conventional synthetic cast.The items were focused on subjective patient satisfaction,discomfort,and adverse effects while wearing the cast.Patients with an ankle inversion injury diagnosed as a high-grade ankle sprain were enrolled.The subjects were randomized and instructed to fill the questionnaire after wearing a synthetic cast or an Opencast®for 2 wk.They were then required to fill the questionnaire again,after switching to the alternative type of cast for 2 more weeks.RESULTS A total of 22 subjects participated in the study.The synthetic cast appeared to be more rigid and stable than the Opencast®,but there was no significant difference in the amount of pain relief.The likelihood of adverse effects when wearing the synthetic cast was significantly higher.Patient satisfaction tended to be rated higher after wearing the Opencast®.Opencast®showed more subjective vulnerability than the synthetic cast,but there was no significant difference in the redo rate.Patients were more anxious about removal of the synthetic cast than of the Opencast®.CONCLUSION The results indicate that the Opencast®could replace the conventional synthetic cast as it offers increased patient satisfaction,which would in turn increase compliance to treatment.

ACUTE WAIST SPRAIN TREATED BY ACUPUNCTURING DONGSHI ACUPOINT

Acute waist sprain is a local injury of themuscle, fascia and ligament in the waist due tosudden overstretch by external force beyond thenormal physiological limit. Acute waist spraincan lead to cicatrix adhesion, loss of normal tis-sue function and chronic waist pathologicalchanges without timely and effecthe treatment.Long time treatment without cure will affectboth work and daily life.

1st degree acromioclavicular sprain, elevated 1st rib, or both? A case study of a rodeo cowboy

Objective: To present a case of a rodeo cowboy who suffered a seemingly routine 1st degree acromioclavicular (AC) sprain. The AC sprain was exacerbated by an elevated 1st rib. Background: Saddle bronc riding is one of three rough stock events in North American rodeo and the least common event for injury relative to bull riding and bareback riding. Shoulder injury in rodeo rough stock events make up 9.3% of all injuries. Approximately 28% of injuries in rodeo are considered minor sprains. The professional cowboy was thrown from his horse landing on the tip of his shoulder. The cowboy presented with a routine 1st degree AC sprain based on the Tossey and Rockwood definitions. Differential Diagnosis: Due to the mechanism of injury and forces produced with the cowboy being thrown to the ground, elimination of serious neck injury was critical. A scanning examination revealed some neck dysfunction. A cervical rotation, lateral flexion special test confirmed the additional elevated 1st rib in addition to the 1st degree AC sprain. Treatment: A chiropractic adjustment of the 1st rib reduced pain in the AC joint from a 6/10 to 1/10 immediately. Subsequently, the patient iced and was treated with one other 1st rib adjustment at a later date. Uniqueness: There were no cases of 1st degree AC sprains with an associated elevated first rib in the literature. It was very unique to relieve to the patient’s shoulder symptoms so dramatically in a short period of time with manual therapy to the first rib. Conclusions: It is important to follow a thorough history and physical examination of patients who suffer from a 1st degree AC sprain. The use of a scanning examination will help identify the primary source of pain (i.e. neck and/or shoulder). Manual therapy of the 1st rib may be useful in the treatment.

THERAPEUTIC EFFECTS OF ELECTROACUPUNCTURE PLUS POINT-PENETRATION FOR CHRONIC ANKLE JOINT SPRAIN

Objective: To observe clinical therapeutic effects of electroacupuncture plus point-penetration for chronic ankle joint sprain. Methods: 76 patients were randomly divided into treatment group (n=43) and control group (n=33).In teatment group, penetration needling from Qiuxu (丘墟 GB 40) to Zhaohai (照海 KI 6) was performed, combined with electrical stimulation for 30 min. Patients of control group were ordered to take Antinfan (50 mg,b.i.d.),supplemented with local external application of Votalin cream (b.i.d.).After 14 treatments (two courses), the therapeutic effect was assessed. Results: Following two courses of treatment, of the 43 cases and 33 cases in treatment and control groups,33 (76.7%) and 15 (45.5%) were cured, 4 (9.3%) and 7 (21.2%) had marked improvement in their symptoms, 3 (7.0%) and 2 (6.1%) had improvement, and 3 (7.0%) and 9(27.3%) failed, with the effective rates being 93.0% and 72.7% respectively. The therapeutic effect of treatment group was significantly superior to that of control group (P<0.05). Conclusion: Penetrative needling plus EA is significantly superior to medication in relieving chronic ankle spain patient’s clinical symptoms and signs.

Forty-three Cases of Acute Lumbar Sprain Treated by Acupuncture Plus Kinesitherapy

Acute lumbar sprain is commonly encountered among the young and middle-aged. It often occurs at the lower part of the back, which seriously hinders the daily life and work of the patients because of the severe pain. The author has treated 43 cases of acute lumbar sprain by needling Weizhong (BL 40), Houxi (SI 3) and Yaotongdian (EX-UE7) plus kinesitherapy and obtained satisfactory therapeutic results. A report follows.

Thirty Cases of Acute Lumbar Sprain Treated by Acupuncture Combined with Point-Injection at Tianzhu

In recent years, the authors have treated 30 cases of acute lumbar sprain by acupuncture combined with point medicinal injection at Tianzhu (BL 10), and obtained quite good therapeutic results, as is reported in the following.

苏筋通络方结合“行气活血”针刺法治疗急性踝关节扭伤临床观察

目的观察苏筋通络方结合“行气活血”针刺法治疗急性踝关节扭伤临床效果。方法将医院创伤骨科门急诊就诊的102例急性踝关节扭伤患者(2020年5月—2022年7月)纳入研究,以随机数字表法将患者分为两组,每组51例,对照组采取西医常规治疗,观察组采取西医常规治疗同时结合苏筋通络方及“行气活血”针刺法治疗。数据比较:临床治疗效果、中医症状(踝关节疼痛肿胀、皮下瘀斑、关节活动受限等)积分变化、踝关节跖屈活动度与背伸活动度变化、视觉模拟评分(Visual Analogue Scale,VAS)变化、美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分变化、血清疼痛物质(神经生长因子、神经肽、P物质)水平变化、白细胞介素-6(Interleukin-6,IL-6)、白细胞介素-1β(Interleukin-1β,IL-1β)、超敏C反应蛋白(Hypersensitive C-reactive protein,hs-CRP)变化。结果观察组患者与对照组患者治疗总有效率相比[98.04%(50/51)vs86.27%(44/51)],P<0.05;治疗后各组患者中医症状(踝关节疼痛肿胀、皮下瘀斑、关节活动受限等)积分、踝关节跖屈活动度与背伸活动度、VAS评分、AOFAS踝-后足评分、神经生长因子、神经肽、P物质、IL-6、IL-1β、hs-CRP等指标均改善,观察组患者治疗后中医症状(踝关节疼痛肿胀、皮下瘀斑、关节活动受限等)积分、踝关节跖屈活动度与背伸活动度、VAS评分、AOFAS踝-后足评分、神经生长因子、神经肽、P物质、IL-6、IL-1β、hs-CRP等指标均明显优于对照组患者,P均<0.05。结论苏筋通络方结合“行气活血”针刺法治疗急性踝关节扭伤临床效果显著,患者经治疗后临床症状显著改善,疼痛缓解,踝关节功能改善,值得应用。

筋伤凝胶治疗急性踝关节扭伤疗效观察

目的探讨筋伤凝胶治疗急性踝关节扭伤(AAS)的临床疗效。方法选取医院筋伤科、足踝科门诊2022年1月至6月收治的AAS患者60例,按随机数字表法分为对照组和观察组,各30例。对照组及观察组患者分别于患处涂抹依托芬那酯凝胶、筋伤凝胶,均每日3次,连续治疗6 d。结果观察组的总有效率为96.67%,稍高于对照组的93.33%(P>0.05)。与治疗前比较,治疗后第3,6天,两组患者的视觉模拟评分量表(VAS)评分、踝关节肿胀程度均显著降低,美国骨科足踝学会(AOFAS)量表评分均显著升高(P<0.05);且观察组患者上述指标改善更显著(P<0.05)。结论筋伤凝胶治疗AAS,可有效缓解患者的踝关节疼痛,消除肿胀,改善踝关节功能。

早期制动配合外敷消炎止痛软膏治疗急性踝关节扭伤的疗效观察

目的评价早期制动配合外敷消炎止痛软膏治疗急性踝关节扭伤的疗效。方法纳入2019年2月至2021年12月从我院收治的急性踝关节扭伤患者84例进行研究,按照随机分组,每组各42例。对照组接受早期制动措施,观察组接受早期制动联合外敷消炎止痛软膏治疗,对比评价两组患者的治疗效果、踝关节功能评分、中医证候积分、生活质量。结果治疗后,相较于对照组(83.33%),观察组患者的总有效率(97.62%)更高(P<0.05);治疗后观察组患者的疼痛评分、功能评分、对线评分均比对照组高,差异有统计意义(均P<0.05);观察组患者生活质量评分高于对照组,而中医证候积分低于对照组(均P<0.05)。结论临床治疗急性踝关节扭伤尽早实施制动处理联合外敷消炎止痛软膏能有效缓解患者的踝关节疼痛和不适症状,还能显著提高踝关节功能恢复,促进患者尽早恢复。

Chronic Ankle Instability: Therapeutic Exercise and Data Analysis

Background and Objectives: Ankle injuries are the most common type of injury in healthy active individuals. If not treated properly, recurrent sprains can lead to a condition of chronic ankle instability (CAI). The present paper examines some subjects with a previous history of acute inversion ankle sprain who have developed a subsequent condition of instability, grouping them according to inclusion criteria and analyzing them through four field tests considered objective by the scientific literature: SEBT test, BEES test, TIBT test, SHT test. The data obtained were stored in order to compare them following a re-education protocol aimed at improving proprioception, balance, walking and strengthening the extrinsic and intrinsic muscles of the foot. per year. The subjects were then divided into two categories: subjects with CAI > 1 year and subjects with CAI ≤ 1 year. A protocol lasting 6 weeks was administered to both groups, trying to work on improving balance in single stance, improving static and dynamic stability, strengthening the gluteus medius and maximus (pelvis stabilizers) and strengthening of the intrinsic muscles of the foot. At the end of the protocol the subjects were all re-evaluated with the same field tests used previously and the data obtained were compared both with the pre-protocol data and with the data measured by the control subjects.

从五体理论探讨慢性踝关节不稳

慢性踝关节不稳即陈旧性踝关节扭伤,属于“筋伤病”的范畴,多由急性踝关节扭伤疾病失治、误治所致,该病及其所致的并发症通常导致踝关节运动功能严重受限,生活质量大幅下降。五体层次结构是《内经》人体结构理论躯体部分的主体框架,与人体运动机能密切相关,踝关节不稳的发病过程和临床表现涉及中医五体病机的演变,故笔者试从五体理论出发,探讨和阐述慢性踝关节不稳的发病机制、治疗进展,发现在五体理论指导下,无论是传统中医疗法,或是将其与西医治疗手段相结合,均可对CAI产生良好疗效。

中药膏摩联合脉冲超短波治疗慢性踝关节扭伤的临床研究

目的:研究中药膏摩联合脉冲超短波治疗慢性踝关节扭伤的临床效果。方法:选取2020年1月—2022年8月北京市昌平区中西医结合医院门诊慢性踝关节扭伤患者80例,随机分为治疗组和对照组,每组40例。治疗组采用中药膏摩联合脉冲超短波治疗,对照组采用双氯芬酸二乙胺乳剂外用配合脉冲超短波治疗。在治疗前及治疗后第3、7、14、28、42天进行视觉模拟评分量表(VAS)评分、Kofoed踝关节功能评分,并测量患踝软组织周径(四点定位法),对两组临床疗效进行比较。结果:治疗第3、7、14、28、42天,治疗组患者踝关节VAS评分降低值均大于对照组,Kofoed踝关节功能评分升高值均大于对照组,踝关节周径减小值均大于对照组,差异有统计学意义(P<0.05);治疗14d后,治疗组临床疗效优于对照组,差异有统计学意义(P<0.05)。结论:中药膏摩联合脉冲超短波治疗慢性踝关节扭伤,具备较好的疗效,能够有效减轻患者关节疼痛、缓解关节肿胀、改善关节功能。

120例踝关节扭伤的肌骨彩超诊断特征分析

目的:通过对踝关节扭伤患者进行肌骨彩超诊断,分析踝关节扭伤的损伤部位、积液产生部位的分布特点特征及其与患者基础基线相关性的规律,并探讨其规律与相应防控措施。方法:选取2018年1月—2023年12月北京市昌平区中西医结合医院门诊收治的120例踝关节扭伤患者的肌骨彩超检查资料,对其进行整理统计分析。结果:踝关节易损伤部位排在前3位的是距腓前韧带、滑膜和跟腓韧带;患者损伤以单处损伤居多,占比为55.83%;积液产生为多处出现居多,占比为51.67%。结果显示,<35岁的男性踝关节扭伤率为73.02%(46/63),高于女性的52.63%(30/57),≥35岁的女性踝关节扭伤占比为47.37%(27/57),高于男性的26.98%(17/63)。结论:在踝关节损伤后的诊疗过程中,需要考虑损伤的具体位置和积液情况,同时也要根据不同年龄和性别进行个性化的诊疗和健康宣教。