Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium.
Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium.
Sports Med. 2023 Jul;53(7):1423-1443. doi: 10.1007/s40279-023-01834-z. Epub 2023 May 8.
Lateral ankle sprains are the most common ankle injuries in sports and have the highest recurrence rates. Almost half of the patients experiencing lateral ankle sprains develop chronic ankle instability. Patients with chronic ankle instability experience persistent ankle dysfunctions and detrimental long-term sequelae. Changes at the brain level are put forward to explain these undesirable consequences and high recurrence rates partially. However, an overview of possible brain adaptations related to lateral ankle sprains and chronic ankle instability is currently lacking.
The primary purpose of this systematic review is to provide a comprehensive overview of the literature on structural and functional brain adaptations related to lateral ankle sprains and in patients with chronic ankle instability.
PubMed, Web of Science, Scopus, Embase, EBSCO-SPORTDiscus and Cochrane Central Register of Controlled Trials were systematically searched until 14 December, 2022. Meta-analyses, systematic reviews and narrative reviews were excluded. Included studies investigated functional or structural brain adaptations in patients who experienced a lateral ankle sprain or with chronic ankle instability and who were at least 18 years of age. Lateral ankle sprains and chronic ankle instability were defined following the recommendation of the International Ankle Consortium. Three authors independently extracted the data. They extracted the authors' name, publication year, study design, inclusion criteria, participant characteristics, the sample size of the intervention and control groups, methods of neuroplasticity testing, as well as all means and standard deviations of primary and secondary neuroplasticity outcomes from each study. Data reported on copers were considered as part of the control group. The quality assessment tool for observational and cross-sectional studies was used for the risk of bias assessment. This study is registered on PROSPERO, number CRD42021281956.
Twenty articles were included, of which only one investigated individuals who experienced a lateral ankle sprain. In all studies combined, 356 patients with chronic ankle instability, 10 who experienced a lateral ankle sprain and 46 copers were included. White matter microstructure changes in the cerebellum have been related to lateral ankle sprains. Fifteen studies reported functional brain adaptations in patients with chronic ankle instability, and five articles found structural brain outcomes. Alterations in the sensorimotor network (precentral gyrus and supplementary motor area, postcentral gyrus and middle frontal gyrus) and dorsal anterior cingulate cortex were mainly found in patients with chronic ankle instability.
The included studies demonstrated structural and functional brain adaptations related to lateral ankle sprains and chronic ankle instability compared to healthy individuals or copers. These adaptations correlate with clinical outcomes (e.g. patients' self-reported function and different clinical assessments) and might contribute to the persisting dysfunctions, increased re-injury risk and long-term sequelae seen in these patients. Thus, rehabilitation programmes should integrate sensorimotor and motor control strategies to cope with neuroplasticity related to ligamentous ankle injuries.
外侧踝关节扭伤是运动中最常见的踝关节损伤，复发率最高。几乎一半经历过外侧踝关节扭伤的患者会发展为慢性踝关节不稳定。慢性踝关节不稳定的患者会出现持续的踝关节功能障碍和不利的长期后果。从大脑层面的变化来解释这些不良后果和高复发率是有一定道理的。然而，目前还缺乏对与外侧踝关节扭伤和慢性踝关节不稳定相关的大脑适应性变化的全面概述。
本系统综述的主要目的是提供与外侧踝关节扭伤和慢性踝关节不稳定相关的结构和功能大脑适应性的文献全面概述。
系统检索了 PubMed、Web of Science、Scopus、Embase、EBSCO-SPORTDiscus 和 Cochrane 中央对照试验注册库，检索截至 2022 年 12 月 14 日。排除了荟萃分析、系统评价和叙述性综述。纳入的研究调查了经历过外侧踝关节扭伤或慢性踝关节不稳定且年龄至少 18 岁的患者的功能性或结构性大脑适应性。外侧踝关节扭伤和慢性踝关节不稳定是根据国际踝关节联合会的建议定义的。三位作者独立提取数据。他们提取了作者姓名、发表年份、研究设计、纳入标准、参与者特征、干预组和对照组的样本量、神经可塑性测试方法以及每项研究中主要和次要神经可塑性结果的所有均值和标准差。将报告的适应者数据视为对照组的一部分。使用观察性和横断面研究的质量评估工具进行偏倚风险评估。本研究在 PROSPERO 注册，编号为 CRD42021281956。
共纳入 20 篇文章，其中只有一篇研究了经历过外侧踝关节扭伤的患者。在所有综合研究中，共纳入了 356 例慢性踝关节不稳定患者、10 例经历过外侧踝关节扭伤的患者和 46 例适应者。小脑白质微观结构的变化与外侧踝关节扭伤有关。15 项研究报告了慢性踝关节不稳定患者的功能性大脑适应性，5 项研究发现了结构性大脑结果。在慢性踝关节不稳定患者中，主要发现了感觉运动网络（中央前回和辅助运动区、中央后回和额中回）和背侧前扣带皮层的改变。
纳入的研究表明，与健康个体或适应者相比，外侧踝关节扭伤和慢性踝关节不稳定与结构和功能大脑适应性有关。这些适应性与临床结果（例如患者的自我报告功能和不同的临床评估）相关，并可能导致这些患者持续存在功能障碍、增加再次受伤风险和长期后果。因此，康复计划应整合感觉运动和运动控制策略，以应对与韧带踝关节损伤相关的神经可塑性。
