Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Caspar Theyß Strasse 27-31, Grunewald, 14193, Berlin, Germany.
Arch Orthop Trauma Surg. 2013 Aug;133(8):1129-41. doi: 10.1007/s00402-013-1742-5. Epub 2013 May 28.
Lateral ankle sprains are common musculoskeletal injuries.
The objective of this study was to perform a systematic literature review of the last 10 years regarding evidence for the treatment and prevention of lateral ankle sprains.
Pubmed central, Google scholar.
Meta-analysis, prospective randomized trials, English language articles.
Surgical and non-surgical treatment, immobilization versus functional treatment, different external supports, balance training for rehabilitation, balance training for prevention, braces for prevention.
A systematic search for articles about the treatment of lateral ankle sprains that were published between January 2002 and December 2012.
Three meta-analysis and 19 articles reporting 16 prospective randomized trials could be identified. The main advantage of surgical ankle ligament repair is that objective instability and recurrence rate is less common when compared with non-operative treatment. Balancing the advantages and disadvantages of surgical and non-surgical treatment, we conclude that the majority of grades I, II and III lateral ankle ligament ruptures can be managed without surgery. For non-surgical treatment, long-term immobilization should be avoided. For grade III injuries, however, a short period of immobilization (max. 10 days) in a below knee cast was shown to be advantageous. After this phase, the ankle is most effectively protected against inversion by a semi-rigid ankle brace. Even grades I and II injuries are most effectively treated with a semi-rigid ankle brace. There is evidence that treatment of acute ankle sprains should be supported by a neuromuscular training. Balance training is also effective for the prevention of ankle sprains in athletes with the previous sprains. There is good evidence from high level randomized trials in the literature that the use of a brace is effective for the prevention of ankle sprains.
Balancing the advantages and disadvantages of surgical and non-surgical treatment, we conclude that the majority of grades I, II and III lateral ankle ligament ruptures can be managed without surgery. The indication for surgical repair should be always made on an individual basis. This systematic review supports a phase adapted non-surgical treatment of acute ankle sprains with a short-term immobilization for grade III injuries followed by a semi-rigid brace. More prospective randomized studies with a longer follow-up are needed to find out what type of non-surgical treatment has the lowest re-sprain rate.
外踝扭伤是常见的肌肉骨骼损伤。
本研究旨在对过去 10 年有关外侧踝关节扭伤治疗和预防的证据进行系统文献回顾。
PubMed 中心，谷歌学术。
荟萃分析、前瞻性随机试验、英语语言文章。
手术和非手术治疗、固定与功能治疗、不同的外部支撑、康复平衡训练、预防平衡训练、预防支具。
系统检索 2002 年 1 月至 2012 年 12 月期间发表的关于外侧踝关节扭伤治疗的文章。
确定了 3 项荟萃分析和 19 篇报告 16 项前瞻性随机试验的文章。与非手术治疗相比，手术踝关节韧带修复的主要优点是客观不稳定和复发率较低。权衡手术和非手术治疗的利弊，我们得出结论，大多数 I 级、II 级和 III 级外侧踝关节韧带撕裂可以不手术治疗。对于非手术治疗，应避免长期固定。然而，对于 III 级损伤，短时间（最长 10 天）的石膏固定被证明是有利的。在这个阶段之后，半刚性踝关节支具最有效地防止内翻。即使是 I 级和 II 级损伤，也可以用半刚性踝关节支具得到最有效的治疗。有证据表明，急性踝关节扭伤的治疗应辅以神经肌肉训练。平衡训练对于有既往扭伤史的运动员预防踝关节扭伤也有效。文献中有高水平随机试验的良好证据表明，使用支具可有效预防踝关节扭伤。
权衡手术和非手术治疗的利弊，我们得出结论，大多数 I 级、II 级和 III 级外侧踝关节韧带撕裂可以不手术治疗。手术修复的指征应始终根据个体情况而定。本系统综述支持急性踝关节扭伤的阶段性适应非手术治疗，对于 III 级损伤，短期固定后采用半刚性支具。需要更多前瞻性随机研究和更长的随访时间，以确定哪种非手术治疗方法的再扭伤率最低。
