Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Eur Rev Med Pharmacol Sci. 2022 Mar;26(6):1876-1884. doi: 10.26355/eurrev_202203_28333.
Lateral ankle sprains are very common injuries that can be treated with different strategies. The aim of the present systematic review was to provide a comprehensive analysis on the treatment of acute lateral ankle sprains to clarify the possible differences in outcome between surgical and conservative management, different external supports, and different rehabilitation protocols.
A literature search on three different topics was carried out on PubMed, Scopus, and Web of Science databases on June 25th, 2021. The main objective of the literature search was to identify the randomized trials comparing: (1) surgery to conservative management, (2) different external supports, and (3) different rehabilitation protocols for the treatment of acute lateral ankle sprains. Two investigators extracted independently relevant data from each paper and assessed the quality of the trials using the Cochrane Risk of Bias Assessment.
A total of 12 studies for the first topic, 8 for the second one and 4 for the last one were included in this review. 8 out of 12 RCTs demonstrated a superior outcome and better socio-economic impact of conservative treatment compared to surgical management. In the other two comparisons, due to the wide variety of braces used and the different rehabilitation protocols, inconclusive results were obtained.
Conservative treatment should be the first choice for severe acute lateral ankle sprains, as it provides satisfactory functional outcomes without the risks and costs of surgery. It was not possible to identify the best external support, but a preference toward flexible braces emerged since they allow an earlier return to daily activities. The paucity of studies comparing different rehabilitation protocols precluded the possibility of defining the ideal one.
外踝扭伤是一种非常常见的损伤，可以采用不同的策略进行治疗。本系统评价的目的是对外踝扭伤的治疗进行全面分析，以明确手术与保守治疗、不同的外部固定物和不同的康复方案之间的结果差异。
2021 年 6 月 25 日，在 PubMed、Scopus 和 Web of Science 数据库上进行了三个不同主题的文献检索。文献检索的主要目的是确定比较：（1）手术与保守治疗，（2）不同的外部固定物，（3）急性外踝扭伤治疗的不同康复方案的随机试验。两名调查员分别从每篇论文中提取相关数据，并使用 Cochrane 偏倚风险评估评估试验的质量。
共纳入 12 项关于第一个主题的研究、8 项关于第二个主题的研究和 4 项关于最后一个主题的研究。12 项 RCT 中的 8 项表明，与手术治疗相比，保守治疗具有更好的结局和更好的社会经济效益。在另外两个比较中，由于使用的支具种类繁多，康复方案不同，因此得出的结论不一致。
对于严重的急性外踝扭伤，保守治疗应是首选，因为它可以提供令人满意的功能结果，而没有手术的风险和成本。虽然无法确定最佳的外部固定物，但由于灵活的支具可以更早地恢复日常活动，因此倾向于使用这种固定物。由于比较不同康复方案的研究较少，因此无法确定理想的康复方案。
