In a recent E-talk thread, we have discussed the management of lateral ankle injuries with numerous responses on the topic of the surgical management of these challenging patients. However, on the topic of conservative management of lateral ankle injuries, I found this interesting article in the British Medical Journal regarding home-based proprioceptive training. This article sought to evaluate the effectiveness of an unsupervised proprioceptive training program on recurrences of ankle sprain after usual care in athletes who had sustained an acute sports related injury to the lateral ankle ligament.
To do so, they prospectively evaluated 522 athletes, aged 12-70, who had sustained a lateral ankle sprain up to two months before inclusion. Study participants were randomly divided into 256 (120 female and 136 male) in the intervention group; 266 (128 female and 138 male) in the control group. Both groups received treatment according to usual care. Athletes allocated to the intervention group additionally received an eight week home based proprioceptive training program, and following these interventions, study participants were asked to self report the recurrence of ankle sprain during the follow-up period.
During the one year follow-up, 145 athletes reported a recurrent ankle sprain: 56 (22%) in the intervention group and 89 (33%) in the control group. Nine athletes needed to be treated to prevent one recurrence (number needed to treat). The intervention program was associated with a 35% reduction in risk of recurrence. No significant differences were found between medically treated athletes in the intervention group and medically treated controls. Athletes in the intervention group who were not medically treated had a significantly lower risk of recurrence than controls who were not medically treated.
What does this suggest? The use of a proprioceptive training program after usual care of an ankle sprain is effective for the prevention of self reported recurrences. This proprioceptive training was specifically beneficial in athletes whose original sprain was not medically treated.
Previous study data has suggested that proprioceptive training can reduce recurrences in ankle sprain by up to 50%, and this new study seems to suggest that home proprioception training can also be of benefit in reducing the recurrence of ankle sprains in athletic patients. However, most authors would agree that despite treatment of an ankle sprain, risk of recurrence remains high.
What is your conservative care paradigm for lateral ankle injuries?
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