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The present study has two main goals: to conduct a systematic review of musculoskeletal injuries experienced by badminton players, and to examine the management of such injuries. Searches were conducted of the PROSPERO, PubMed, Scopus, and SPORTDiscus databases, from their inception until March 2023. The papers analysed were all based on a study population consisting of individuals aged 18 years or more, diagnosed with badminton-related injuries. The methodological quality assessments was using the Newcastle-Ottawa Scale and REVMAN. A total of 28 studies were included in the systematic review. In total, the analysis included 2435 participants. Of these athletes, 35.6% (1012) were female and 64.4% (1503) were male. By type of injury, sprains were the most commonly studied and the most prevalent, accounting for 36.06% of the sample. These were followed by muscle injuries, representing 23.86% of the total. Injuries to the joints were the least prevalent, accounting for 4.97% of the sample. Lower limb injuries accounted for 52.15% of the total. Of these, ankle injuries were the most common. Despite the generally low quality of the studies considered, the evidence suggests that musculoskeletal injuries, especially to the lower limb, most commonly affect badminton players of all levels.

Objective: Injury to the sternoclavicular joint is a rare phenomenon that has implications for the shoulder complex. Limited literature exists on optimal physical therapy rehabilitation after a sternoclavicular ligament sprain. This case report details the physical therapy management and outcomes of a patient with a posterior sternoclavicular joint sprain., Case Description: The patient was a 34-year-old female who sustained a grade I posteriorly directed sternoclavicular sprain during a motor vehicle accident. She received a combination of acromioclavicular joint mobilizations and therapeutic exercise for her shoulder complex for five sessions over six weeks., Outcomes: At discharge, the patient surpassed the minimally clinically important difference (MCID) and the minimal detectable change (MDC) in her Quick-DASH score. She surpassed the MDC and MCID in her Numerical Pain Rating Scale score. She was able to regain full functional use of her involved upper extremity and returned to her work and original exercise regimen with no further limitations., Conclusion: The outcomes suggest that a combination of acromioclavicular joint mobilizations and therapeutic exercise for the shoulder complex was a suitable option for the conservative management of this patient's grade I sternoclavicular sprain.

Background: Various treatment approaches for individuals with ankle sprains can reduce treatment costs and enhance recovery. This study aimed to compare the efficacy of spring ankle braces with splints and casts in treating ankle sprains., Materials and Methods: This cross-sectional study involved 60 patients diagnosed with ankle sprains at the orthopedic clinic of Imam Khomeini Hospital in Jiroft in 2022. Following diagnosis confirmation through additional examinations and imaging, patients with ankle sprains not requiring surgery were selected and placed in two groups: one treated with spring ankle braces and the other with splints or casts. Both groups underwent a 4-week treatment regimen, comprising 30 individuals each. Data were collected and analyzed using SPSS version 26., Results: The average age of patients was 32.5 ± 13.4 years. Of the ankle sprain patients, 56.7% were male. Patients reported the highest satisfaction levels with the plaster cast treatment method. A statistically significant relationship was found between patient satisfaction and the treatment methods of spring ankle braces and plaster casting (P < 0.05). Patients treated with plaster casts reported the lowest pain levels, with a significant relationship between pain levels and the two treatment methods (P < 0.05). Range of motion results were similar for both treatment methods, while the cast treatment showed the highest incidence of skin complications. A significant relationship was observed between spring ankle braces and plaster casts regarding skin complications (P < 0.05)., Conclusion: Treating ankle sprains with plaster casts leads to higher satisfaction and lower pain levels compared to using spring ankle braces., (© 2024. The Author(s).)

Purpose: A lateral ankle sprain is the most common musculoskeletal injury in the physically active population. However, it is unclear how the clinical condition evolves during the period after the injury and what proportion of patients develops chronic symptoms. Therefore, the purpose of this study is to assess the evolution of patient-reported outcome measures after a first time lateral ankle sprain., Methods: A prospective clinical study assessed the patient-reported outcome measures (PROMs) of a consecutive group of 100 patients during 1 year after a first lateral ankle sprain. The Karlsson score and Foot and Ankle Outcome Score (FAOS) were assessed at 6 weeks, 3 months, 6 months, 9 months and 1 year. The Cumberland Ankle Instability Tool (CAIT)-score was assessed at 6 months, 9 months and 1 year. The difference between the time points of all scores was analysed using the positive change over time (binomial test versus 50%) and the difference in score (signed rank test). The time to sustained excellent level was also assessed overall and in several subgroups: age, gender, degree of injury (2 or 3), avulsion fracture, use of crutches, use of cast. Differences between subgroups were assessed by a generalized log-rank test., Results: All clinical scores demonstrated an improvement up to 12 months after the sprain. The median Karlsson score (interquartile range) improved from 62 (50-80) at 6 weeks to 90 (72-100) at 3 months, to 97 (82-100) at 6 months to 100 (90-100) at 9 months, to 100 (100-100) at 1 year. The analysis of positive change over time demonstrated a significant positive change (P-value <.0005) between all time points except between 6 weeks and 12 weeks when using the FAOS quality score. The difference in score demonstrated a significant change (P-value <.01) between all time points except between 36 weeks and 48 weeks when using the FAOS pain and FAOS sports score. Age and presence of an avulsion fracture were correlated with a slower recovery and worse results. At 1 year, in total 13 patients (13%) had a worse outcome corresponding to a Karlsson score < 81 or CAIT score < 24., Conclusion: The clinical condition after a first ankle sprain demonstrated a significant improvement in PROMs between the different time points in the first year. Twelve months after a first lateral ankle sprain 13% had a fair or poor outcome. Higher age and presence of an avulsion fracture were correlated with a slower recovery and worse results. This information is useful in clinical practice to predict further progression and inform patients. Moreover, it is valuable to improve treatment strategies., Level of Evidence: Level II (prospective cohort study)., Competing Interests: Declaration of Competing Interest None of the authors has a conflict of interest that could inappropriately influence this work., (Copyright © 2024 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Background: Acute lumbar sprain (ALS) is common musculoskeletal disorder characterized by severe low back pain and activity limitation, which significantly impacts the patient's work and life. Immediate relief of pain and restoration of mobility in a short period of time are the main needs of patients when they visit the clinic. This study aims to evaluate the immediate efficacy of this combined treatment for ALS within 10 minutes., Methods: This is a single-center, prospective, randomized clinical trial. 128 eligible patients with ALS will be randomly allocated in a 1:1 ratio to either the auricular acupuncture (AA) group or the sham auricular acupuncture (SAA) group. All patients will receive a single 10-minute treatment. The primary outcome will be the change in pain intensity after 10 minutes of treatment. The secondary outcomes include changes in pain intensity at other time points (2, 5 minutes), changes in lumbar range of motion (ROM) at different time points, blinded assessment, treatment effect expectancy scale evaluation, and treatment satisfaction scale evaluation. All participants will be included in the analysis according to the intention-to-treat principle., Discussion: This is the first randomized controlled trial to assess the immediate efficacy of AA combined with active exercise for ALS. The findings of this study are expected to provide a simple and rapid treatment for ALS in clinical., Trial Registration: Chinese Clinical Trial Registry ChiCTR2400083740. Registered 30 April 2024., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Tang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: High ankle sprains are common athletic injuries and can be associated with long-term sequelae. Regardless of operative or nonoperative treatment, there is a paucity of data in the literature about the long-term outcomes of high ankle sprains., Hypothesis: Nonoperative treatment of high ankle sprains utilizing a standardized protocol will result in good long-term outcomes., Study Design: Case series; Level of evidence, 4., Methods: Patients who experienced a high ankle sprain without radiographic diastasis of the syndesmosis were identified from a previous study database and contacted for long-term follow-up. All patients were high school or National Collegiate Athletic Association Division IA athletes at initial injury and were treated nonoperatively with the same standardized protocol. Patients completed a questionnaire that included documentation of any interim ankle injuries, 2 different patient-reported outcome scores, and ankle radiographs to conduct Kellgren-Lawrence scoring for ankle osteoarthritis., Results: In total, 76 cases in 74 patients were identified in the database. A total of 40 patients were successfully contacted, and 31 patients (24 collegiate and 7 high school athletes) with 33 high ankle sprains completed the survey (31/40; 77.5%). The mean age at follow-up was 45 years (range, 34-50 years), with a mean time from injury to follow-up of 25 years. Overall, 93.5% (n = 29) of the respondents were male, and 42% (n = 13) of the respondents reported an ipsilateral ankle injury since their initial injury, with 16% (n = 5) having ankle or Achilles surgery. The mean Patient-Reported Outcomes Measurement Information System-10 score was 53.4 (SD, 8.3; range, 37.4-67.7), PROMIS median (IQR), 54.1 (39.9, 68.3), and the mean Self-reported Foot and Ankle Score score was 42.7 (SD, 5.86). Follow-up ankle radiographs were obtained in 11 (35%) of the respondents; 27% had Kellgren-Lawrence grade >2 osteoarthritis, and 36% had signs of heterotopic ossification on imaging. The mean tibiofibular clear space was 4.5 mm, and the mean tibiofibular overlap was 7.15 mm, with 27% of patients demonstrating some tibiotalar narrowing., Conclusion: At long-term follow-up, nonoperative management of high ankle sprains without diastasis on imaging was associated with acceptable patient-reported functional outcomes and low rates of subsequent ankle injuries. There was a high incidence of arthritis, but most cases were not clinically significant. This case series shows the natural history of nonoperatively treated high ankle sprains and may serve as a comparison for different management techniques in the future., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This project was partially funded by a grant from the Athletic Trainers’ Society of New Jersey. P.S.B. has received hospitality payments from Smith & Nephew. C.J.G. has received support for education from SeaPearl. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Competing Interests: The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Scenario: Ankle sprains are one of the most common injuries in athletics, and many lead to recurrent sprains, chronic ankle instability, and persistent symptoms. Treatment improvements are needed. Platelet-rich plasma (PRP) involves formulating autologous plasma with higher platelet concentration to be injected in the desired tissue. There is currently high-quality evidence supporting the use of PRP with lateral epicondylitis and knee osteoarthritis to accelerate the healing process and decrease pain., Clinical Question: Does the injection of PRP relieve pain faster and improve function compared with no injection or placebo in patients with a lateral ankle sprain?, Summary of Key Findings: A computerized search yielded 191 studies; of these, 3 studies fit the inclusion and exclusion criteria. PRP injection reduces pain and increases function after lateral ankle sprain 5 to 8 weeks after intervention., Clinical Bottom Line: The use of PRP after lateral ankle sprain to decrease pain and increase function is supported with moderate evidence., Strength of Recommendation: Based on the Strength of Recommendation Taxonomy, evidence from the included studies is considered as level B, reflecting limited quality patient-oriented evidence.

Background: Ankle sprains are one of the most frequent injuries of the musculoskeletal system. The injury pattern determines the treatment and are crucial for the outcome. Nonoperative treatment is commonly recommended for isolated injuries of the lateral ligaments but no standard strategy exists in combined ankle ligament injuries. The goal of this national survey was to achieve an overview about the current diagnostic strategies and common treatment concepts in Germany., Material and Methods: All members of the German Society for Orthopaedics and Trauma Surgery (DGOU) were invited to participate in an anonymous survey about the diagnostic and therapeutic approach in cases of ankle sprains. The online survey consisted of 20 questions. Besides questions about the speciality and scope of activities the participants were ask to depict their diagnostic and therapeutic strategy., Results: A total of 806 participants completed the survey. Most of them were orthopedic trauma surgeons and worked in a hospital. During the first presentation the anterior drawer test (89.5%) and the inversion/eversion test (81.6%) were most commonly used, 88.1% always make an X‑ray examination and 26.5% an ultrasonography examination. Isolated injuries of the anterior fibulotalar ligament (LFTA) were treated nonoperatively by 99.7% of the participants, 78.8% recommend full weight bearing in an orthesis, 78.8% treat the complete rupture of the lateral ligaments without operation whereas 30.1% stated that they would treat a combined lateral ligaments rupture with an injury of the syndesmosis nonoperatively., Discussion: Due to the heterogeneity of injury patterns after ankle sprain no consistent recommendations for diagnostics and treatment exist. The Ottawa ankle rules and ultrasonography were not often utilized despite of the good evidence. The isolated rupture of the LFTA is diagnosed and treated according to the national guidelines by most of the participants. In cases of combined injuries of the lateral and medial ankle ligaments the majority choose a nonoperative treatment strategy which is justified by the guidelines with a low level of evidence. Combined injuries of the syndesmosis and the lateral ankle ligaments were treated operatively, which also correlates with the recommendations in the literature. The standard care of ankle sprain in Germany is in accordance with the recommendations from the current literature., (© 2024. The Author(s).)

Background: Despite the high incidence of ankle sprains, the ideal treatment is controversial and a significant percentage of patients who have suffered an ankle sprain never fully recover. Even professional athletes are affected by this post-traumatic complication. There is strong evidence that permanent impairment after an ankle injury is often due to an inadequate rehabilitation and training program and too early return to sport., Therapy and Rehabilitation: Therefore, athletes should start a criteria-based rehabilitation after ankle sprain and gradually progress through the programmed activities, including e.g. cryotherapy, edema reduction, optimal load management, range of motion exercises to improve ankle dorsiflexion and digital guidance, stretching of the triceps surae with isometric exercises and strengthening of the peroneus muscles, balance and proprioception training, and bracing/taping. The fact that this is professional sport does not exempt it from consistent, stage-appropriate treatment and a cautious increase in load. However, there are a number of measures and tools that can be used in the intensive care of athletes to improve treatment and results., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

BACKGROUND Micro-needle knife (MNK) therapy releases the superficial fascia to alleviate pain and improve joint function in patients with acute ankle sprains (AAS). We aimed to evaluate the efficacy and safety of MNK therapy vs that of acupuncture. MATERIAL AND METHODS This blinded assessor, randomized controlled trial allocated 80 patients with AAS to 2 parallel groups in a 1: 1 ratio. The experimental group received MNK therapy; the control group underwent conventional acupuncture treatment at specified acupoints. Clinical efficacy differences between the 2 groups before (time-point 1 [TP1]) and after treatment (TP2) were evaluated using the visual analogue scale (VAS) and Kofoed ankle score. Safety records and evaluations of adverse events were documented. One-month follow-up after treatment (TP3) was conducted to assess the intervention scheme's reliability. RESULTS VAS and Kofoed ankle scores significantly improved in both groups. No patients dropped due to adverse events. At TP1, there were no significant differences between the 2 groups in terms of VAS and Kofoed scores (P>0.05). However, at TP2, efficacy of MNK therapy in releasing the superficial fascia was significantly superior to that of acupuncture treatment (P<0.001). At TP3, no significant differences in scores existed between the groups (P>0.05). CONCLUSIONS This study demonstrates that 6 sessions of MNK therapy to release the superficial fascia safely and effectively alleviated pain and enhanced ankle joint function in patients with AAS, surpassing the efficacy of conventional acupuncture treatment. Future studies should increase the sample size and introduce additional control groups to further validate the superior clinical efficacy of this intervention.

Objectives: To investigate the epidemiology and management of ankle ligament sprains over seven seasons in a professional ballet company., Design: Descriptive epidemiology study., Methods: Medical attention injury, time-loss injury, and exposure data pertaining to 140 professional ballet dancers were prospectively recorded by Chartered Physiotherapists over seven seasons (2015/16-2021/22); a period including the COVID-19 global pandemic., Results: Sixty-nine ankle sprains (46 time-loss) in 45 dancers (32 %) were recorded: 51 sprains were classified as grade I, 15 were classified as grade II, and three were classified as grade III; 53 sprains affected only one ligament, whilst 16 were multi-ligament sprains. For time-loss injuries, median time-loss durations varied by grading (I - 31 days, II - 54 days, and III - 147 days) and the number of ligaments affected (one - 31 days, two - 54 days, three - 134 days, four - 137 days), with time-loss ranging from 1 to 188 days. Of the 46 time-loss ankle sprains, eight were mild, nine were moderate, and 29 were severe. The incidence rate (injuries·1000 h -1 ) of medical attention ankle sprains was 0.073 (95 % CI: 0.046 to 0.117) in male dancers and 0.101 (95 % CI: 0.069 to 0.148) in female dancers, and the incidence of time-loss ankle sprains was 0.044 (95 % CI: 0.024 to 0.080) in male dancers and 0.064 (95 % CI: 0.040 to 0.103) in female dancers. No significant effect of sex was observed on either medical attention (p = .304) or time-loss (p = .327) ankle sprain incidence rates. Ten percent of dancers sustained multiple sprains across the seven seasons. Fifty and 39 % of ankle sprains in female and male dancers, respectively, were preceded by a history of ankle sprains. Jumping and landing (30 sprains) and non-dance movements (16 sprains) were the most common inciting movements. Bone bruising and synovitis were the most common concurrent pathologies., Conclusions: Ankle sprains placed a considerable burden on the ballet company studied. These time-loss durations specified by number and grade of ligament sprain, injury history, and secondary pathologies can guide return-to-dance rehabilitation pathways., Competing Interests: Declaration of interest statement None., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background and Objective: Ankle sprains, very common injuries occurred especially during sports activities, are mainly caused by indirect trauma, which influences exaggerated stress exceeding the strength of stabilization mechanisms. Up to 85% of such injuries result from a sudden flexion and inversion of the foot. In this study, we analyzed the effectiveness of the platform Pro-kin, an innovative system that has given us the possibility to combine the functionality of the older proprioceptive boards with very accurate software in order to improve and accelerate the recovery after ankle injuries., Methods: 30 patients with moderate ankle sprain outcomes in two groups (A and B) were included in this study. Group A was only treated with proprioceptive exercises for 3 weeks, while the group B was trained with the innovative Pro-kin. In both groups, we evaluated VAS scale, the ratio between the number of circumductions performed by the injured foot and the time spent on doing them and the percentage of load among the injured and the healthy foot in statics and dynamics with electronic baropodometry. Our data has been collected at t0 (beginning of study), t1 (one week later), t2 (two weeks later), t3 (one month later), t4 (two months later), and then analyzed by the two-way analysis of variance (2-way ANOVA) test., Results: At t0 no statistical differences of pain in the 2 groups (3.3 and 3.4); the values were similar, as well as at time t1, t2, t3 and t4. Therefore we deduce that Pro-kin treatment is not painful. The number of circumductions performed was definitely better in B group since the first week; for the A group the values considerably increased only at t3 (one month later). Comparing the load percentages on two feet detected by the electronic baropodometer in statics and in dynamics, we deduced that the patients of A group tend to lean mostly on the healthy foot than B group., Conclusion: This study demonstrates that new technological resources (such as Pro-kin) may be helpful to improve and speed up the recovery of ankle sprain in athletes., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objective: This study investigated the characteristics and trends of children aged 3 to 19 years treated in US emergency departments for dance-related injuries., Methods: Retrospective analysis of data from the National Electronic Injury Surveillance System from 2000 through 2020 was conducted., Results: An estimated 489,119 children received emergency treatment for a dance-related injury, averaging 23,291 children annually, and the rate of injury increased 68.1% during the 21-year study period. Girls accounted for 80.3% and children aged 15 to 19 years accounted for 46.5% of cases. Sprains/strains were the most frequent diagnosis (44.4%), and lower extremities were the most commonly injured body region (56.4%). Compared with other body regions, patients aged 3 to 10 years were more likely to sustain head/neck injuries (odds ratio, 3.94, 95% confidence interval, 3.42-4.52) than 11- to 19-year-olds. Falls and noncontact mechanisms of injury accounted for 35.6% and 32.1% of injuries, respectively. Unstructured dance activity was associated with 30.8% of dance-related injuries overall and 67.0% among children aged 3 to 5 years. Ballet/pointe dancers frequently sustained lower extremity sprains/strains (39.2%). Compared with other dance types, break dancing was more commonly associated with injuries to an upper extremity than other body regions (odds ratio, 4.76, 95% confidence interval, 3.66-6.19)., Conclusions: The rate of pediatric dance-related injuries treated in US emergency departments is increasing. Unstructured dance activity was an important source of dance-related injury, especially among children aged 3 to 5 years. The injury diagnosis and body region injured varied by child age and type of dance. Additional targeted prevention efforts should be implemented that address the injury characteristics of dancer subgroups., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

This case describes a young, healthy woman who developed a grade 1 biceps muscle strain after the use of automatic non-invasive blood pressure monitoring during an elective surgical procedure. She was treated conservatively with simple analgesia, physiotherapy and a sling for comfort. Follow-up conducted 1 week later revealed occasional soreness, but she had almost returned to her baseline activity. The patient made a full recovery without any residual symptoms by the end of 6 weeks. This case highlights the importance of careful monitoring to ensure that routine use of blood pressure cuffs does not cause any pressure injuries., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To conduct a preliminary study on joint injuries of anterior and calcaneal fibular ligaments of the lateral ankle joint, and to analyze mechanism of action of shaking and poking in treating ankle joint and biomechanical properties of ankle during the recovery of joint injuries., Methods: CT scan was performed on a male volunteer with right ankle sprain. Mimics 10.0, Solidworks 2016, Hypermesh 12.0 and Abaqus 6.13 software were used to establish 3D nonlinear finite element analysis model of foot and ankle, and the validity of model was verified. Combined with clinical study, the finite element simulation analysis was carried out on the toe flexion, dorsiflexion, varus and valgus of ankle joint under different treatment periods by adjusting elastic modulus of ligament to simulate ligament injury., Results: With the treatment of shake and prick and recovery of ligament injury, the maximum stress and area with large stress on tibial pitch and fibular joint surface gradually increased under the four working conditions, and the stress value of the maximum stress ligament gradually increased, and the stress of the anterior and calcaneal fibular ligament dispersed and transferred, and the axial force gradually decreased., Conclusion: The finite element method was used to simulate the mechanical condition of the shaking and stamping technique, and the changes of the forces of the ligament and articular surface before and after treatment of anterior and calcaneal ligament combined injury of ankle talus were intuitively observed. The treatment effect was quantified, and could provid objective and scientific basis for clinical promotion and application of this technique.

Context: The medial collateral ligament is the most commonly injured ligament in the knee. The high-speed pivoting and agility movements that are common in the sport of American Football put participants at an increased risk for a valgus force stress from contact or noncontact injuries. Positional release therapy (PRT) also considered strain/counterstrain focuses on releasing the tension in a tissue through unloading the involved body part., Case Presentation: Two male student-athletes participating in football with a mean age of 20.5 years were diagnosed by a physician with medial collateral ligament grade 2 sprain. Both patients sustained their injuries in a regular season game with a contact valgus force from an opposing player., Management and Outcomes: After the initial 72 hours of compression, elevation, and cryotherapy, the patients were both treated with PRT followed by progressive loading exercises. Following 4 treatment sessions of PRT over the next 6 days, the patients started with quadriceps engagement exercises, single-leg squats to 60° knee flexion, side steps, triceps dips, slow controlled lunges, and toe walk. The patients progressed to full body weight squats, single-leg landing, step-up tri-extension, and sidekicks with a leg on table. Then, the patients completed function movements and sports-specific exercises., Conclusions: In this case series, 2 patients competing in intercollege American Football were treated with PRT and progressive loading exercises to facilitate return to unrestricted activities and improve outcome measures. Commonly, a grade 2 medial collateral ligament sprain is conservatively treated with return to sport taking 20 days on average. In this type 2 case series, the clinician found success utilizing PRT early in the recovery process, which in these 2 cases lead to restoration of function, outcome measure improvement, and an expedited return to sport. The expedited return to sport occurred at an average of 18 days for these patients.

Context: Limited evidence exists regarding the assessment of single-item patient-reported outcomes when patients are medically cleared to return to sport after a lateral ankle sprain (LAS) injury., Objective: To evaluate self-reports of improvement in health status, pain, function, and disability at return to sport after an LAS., Design: Descriptive study., Setting: Sixty-nine athletic training facilities across 24 states., Patients or Other Participants: A total of 637 patients (males = 53.2%) who were diagnosed with an LAS, restricted from sport after injury, and subsequently medically cleared to return to sport within 60 days were included., Main Outcome Measure(s): Descriptive statistics were used to summarize scores for health status (Global Rating of Change), pain (Numeric Pain Rating Scale), function (Global Rating of Function), and disability (Global Rating of Disability). Mann-Whitney U tests were used to compare score differences between sexes. A Kaplan-Meier analysis was performed to provide a visual depiction of sex differences in the time to return to sport., Results: Most patients sustained an LAS injury while participating in basketball, football, or soccer and were cleared to return to sport 8 days after injury. More than two-thirds of patients reported a meaningful improvement in health status between the time of injury and return to sport. However, many noted deficits related to pain (65.1%), function (86.2%), or disability (35.8%) at return to sport. No differences were seen between males and females for pain (P = .90), function (P = .68), change in health status (P = .45), or disability (P = .21) at return to sport, although males returned to sport slightly sooner than females (P = .025)., Conclusions: Despite self-perceived improvements in health status since the time of injury, patients typically returned to sport with deficits in pain, function, and disability after an LAS. Patients may be returning to unrestricted sport participation before they feel their bodies have fully recovered from the injury., (© by the National Athletic Trainers’ Association, Inc.)

Purpose: The main objective of this retrospective study was to establish an epidemiological overview of patients admitted to an Emergency department specialized in musculo-skeletal trauma for acute lesions related to Badminton practice in the period from January 1st 2010 to January 1st 2015., Methods: There were 135 patients with 140 admissions and 146 total number of injuries. There were 67 females (48%) and 73 males (52%). The mean age was 28 ± 13.8 years, ranging 10-66 years. 91 patients (65%) could be contacted by telephone to fill a questionnaire aimed at completing the information provided by the medical records., Results: 129 lesions (88.3%) were located to the lower limbs, 16 (11%) to the upper limbs, and one (0.7%) at the head. For the whole series, there were 89 sprains (60.9%), 32 tendino-muscular lesions (21.9%), 13 fractures (8.9%), 5 dislocations (3.4%), 3 painful contusions (2.1%), 3 meniscal injuries (2.1%) and one wound (0.7%). In the lower limbs, lateral ankle sprain was the most frequent diagnosis (43.4%), followed successively by rupture of the Achilles tendon (13.9%), tennis leg (8.5%), and mid-foot sprain (6.9%). Of the 146 lesions, 117 (80.1%) received non-operative treatment, 28 (19.1%) received surgical treatment in the operation room, and one simple wound (0.7%) was sutured in the emergency room., Conclusions: Lateral ankle sprains followed by tendino-muscular lesions of the calf are by far the most frequent lesions of badminton. Modification of the shoes of badminton players should be considered to decrease the high incidence of ankle injuries., (© 2022. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Not all ankle sprains are the same and not all ankles behave the same way after an injury. Although we do not know the mechanisms behind an injury producing an unstable joint, we do know ankle sprains are highly underestimated. While some of the presumed lateral ligament lesions might eventually heal and produce minor symptoms, a substantial number of patients will not have the same outcome. The presence of associated injuries, such as additional medial chronic ankle instability, chronic syndesmotic instability, has been long discussed as a possible reason behind this. To explain multidirectional chronic ankle instability, this article aims to present the literature surrounding the condition and its importance nowadays., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Injuries of the medial ankle ligament complex (MALC; deltoid and spring ligament) are more common following ankle sprains than expected, especially in eversion-external rotation mechanisms. Often these injuries are associated with concomitant osteochondral lesions, syndesmotic lesions, or fractures of the ankle joint. The clinical assessment of the medial ankle instability together with a conventional radiological and MR imaging is the basis for the definition of the diagnosis and therefore the optimal treatment. This review aims to provide an overview as well as a basis to successfully manage MALC sprains., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Sprains are the most frequent injuries of the ankle, especially in sports. Up to 85% of cases affect the lateral ligament complex. Multi-ligament injuries with associated lesions of the external complex, deltoid, syndesmosis, and sinus tarsi ligaments are also common. Most ankle sprains respond to conservative treatment. However, up to 20 to 30% of patients can develop chronic ankle pain and instability.New concepts have been recently developed, based on arthroscopic advances, such as microinstability and rotatory ankle instability. These entities could be precursors of mechanical ankle instability and at the origin of frequently associated ankle injuries, such as peroneus tendon lesions, impingement syndromes, or osteochondral lesions.Imaging methods, especially magnetic resonance (MR) imaging and MR arthrography, are key in precisely diagnosing ligament lesions and associated injuries, facilitating an adequate therapeutic approach., Competing Interests: None declared., (Thieme. All rights reserved.)

The management protocol for each case of ankle sprain should be individualized and optimized in order to reduce the likelihood of development of chronic instability. Initial treatment aims to address pain, swelling, and inflammation and facilitates regaining pain-free joint motion. Short-term joint immobilization is indicated in severe cases. Subsequently, muscle strengthening, balance training, and targeted activities to develop proprioception are added. Gradually, sports-related activities are added with the ultimate goal of bringing the individual back to preinjury level of activity. This protocol of conservative treatment should always be offered before considering any surgical intervention., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Acute ankle sprains are common sports injuries. MRI is the most accurate test for assessing the integrity and severity of ligament injuries in acute ankle sprains. However, MRI may not detect syndesmotic and hindfoot instability, and many ankle sprains are treated conservatively, questioning the value of MRI. In our practice, MRI adds value in confirming the absence or presence of ankle sprain-associated hindfoot and midfoot injuries, especially when clinical examinations are challenging, radiographs are inconclusive, and subtle instability is suspected. This article reviews and illustrates the MRI appearances of the spectrum of ankle sprains and associated hindfoot and midfoot injuries., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Despite the high frequency of ankle sprains, the ideal management is controversial, and a significant percentage of patients sustaining an ankle sprain never fully recover. There is strong evidence that residual disability of ankle joint injury is often caused by an inadequate rehabilitation and training program and early return to sports. Therefore, the athlete should start their criteria-based rehabilitation and gradually progress through the programmed activities, including cryotherapy, edema relief, optimal weight-bearing management, range of motion exercises for ankle dorsiflexion improvement, triceps surae stretching, isometric exercises and peroneus muscles strengthening, balance and proprioception training, and bracing/taping., Competing Interests: Contributions T. Marín Fermín: Conceptualization, Methodology, Validation, Investigation, Resources, Writing–Original Draft, Visualization, Project administration. A.A. Al-Dolaymi: Conceptualization, Validation, Writing–Review and Editing, Supervision. P, D'Hooghe: Conceptualization, Methodology, Validation, Investigation, Writing–Review and Editing, Supervision, Project administration. All authors contributed to the conception and design of the study; acquisition, analysis, and interpretation of the data; drafting the work and revising it critically for important intellectual content; agreed to be accountable for all aspects of the study in ensuring that questions related to the accuracy or integrity of any part of the study were appropriately investigated and resolved. All authors read and approved the final article., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Lateral ankle sprain (LAS) is not as simple as it was believed to be as it has substantial negative impacts on the active sporting population. The negative impact on physical function, quality of life (QoL) and economic burden is significant with increased risk of reinjury, development of chronic lateral ankle instability and posttraumatic ankle osteoarthritis resulting in functional deficits, decreased QoL and chronic disabilities. Economic burden from a societal perspective demonstrated notably higher indirect costs from productivity loss. Preventative interventions with early surgery for a selective cohort of active sporting population may be considered to mitigate morbidities associated with LAS., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To analyze the compatibility regularities of acupoints and the application characteristics of needling-moxibustionmethods in the treatment of ankle sprain by using complex network technology, so as to provide the basis and treatment ideas., Methods: The clinical research articles on acupuncture treatment of ankle joint sprain published from November 2011 to November 2021 were retrieved from databases of CNKI, Wanfang Data knowledge service platform, VIP information Chinese journal service platform and PubMed by using key words of "acupuncture""moxibustion" "acupuncture and moxibustion" "ankle injury" "ankle sprain" "injured ankle" and "syndesmotic injuries". After screening these articles according to our inclusion and exclusion criteria, a database of acupuncture treatment of ankle sprain was established. Then, analysis on the occurrence frequency of acupoints and their related meridians, and methods of needling manipulation, and the association rule analysis (quantitative analysis) about the closeness between acupoints, and the degree of support and confidence coefficient were conducted for acquiring the acupoint combinations with higher correlation in the compatibility using Apriori algorithm after modeling (with IBM SPSS Modeler18.0 software). Gephi 0.9.2 software was used to make complex network analysis, for which "k-core hierarchical analysis" and "community analysis" were used as the methods to analyze the network structure of acupoints, and the confidence value was used as the index to measure the importance of acupoints., Results: A total of 201 articles meeting the criteria were collected, including 196 articles in Chinese and 5 in English. A total of 236 acupuncture prescriptions were extracted, involving 61 acupoints, with a total frequency of occurrence being 846. The top 10 acupoints were Ashi point, Kunlun (BL60), Jiexi (ST41), Qiuxu (GB40), Shenmai (BL62), Yanglingquan (GB34), Taixi (KI3), Zhaohai (KI6), Xuanzhong (GB39) and Shangqiu (SP5), with the occurrence frequency being 109, 79, 70, 68, 63, 59, 53, 52, 37 and 34, respectively. The results of descriptive analysis showed that the top 5 meridians were Gallbladder Meridian of Foot-shaoyang, Bladder Meridian of Foot-taiyang, Kidney Meridian of Foot-shaoyin, Stomach Meridian of Foot-yangming and Spleen Meridian of Foot-taiyin, with the frequency being 181, 153, 116, 105 and 53, respectively. Complex network analysis displayed that after "k-core hierarchical analysis" and "Community division", two communities were reserved, mainly involving 15 core acupoints such as Ahshi point, GB40, ST14, BL62, GB34, KI6, BL60, KI3, GB39, Zusanli (ST36), SP5; Taichong (LR3), Zulinqi (GB41), Sanyinjiao (SP6) and Rangu (KI2). The results of association rule analysis showed that the most relevant acupoint combination is "BL60-ST41" (support degree 34.83％), followed by "BL60-KI3" (support degree 26.37%), reflecting the principle of selection of local acupoint for ankle sprain. The therapeutic methods are filiform needle acupuncture, and the reducing technique and uniform reinforcing and reducing manipulation are the most commonly used approaches, but the reinforcing method is rarely used., Conclusion: In the treatment of ankle sprain, local acupoints and Ashi points are mainly used, in combination with reducing or uniform reinforcing and reducing manipulations, as well as the method of needling and moxibustion, which provides a good reference for clinical practice.

Purpose: This study aimed to investigate the burden of knee, hip, and lumbar spine disorders occurring in the year after an ankle sprain and the influence therapeutic exercise (TE) has on this burden., Methods: A total of 33,361 individuals diagnosed with ankle sprain in the Military Health System between 2010 and 2011 were followed for 1 yr. The prevalence of knee, hip, and lumbar care-seeking injuries sustained after sprain was identified. Relationships between demographic groups, ankle sprain type, and use of TE with rate of proximal injuries were evaluated using Cox proportional hazard models to determine hazard rate effect modification by attribute. The observed effect of TE for ankle sprain on rate of injury to proximal joints was evaluated using Kaplan-Meier survival analyses., Results: Of the total cohort, 20.5% ( n = 6848) of patients sustained a proximal injury. Specifically, 10.1% of the cohort sustained a knee ( n = 3356), 2.9% a hip ( n = 973), and 10.3% a lumbar injury ( n = 3452). Less than half of the cohort received TE after initial sprain. Patients that did were less likely to have subsequent knee (HR = 0.87, 95% confidence interval [CI] = 0.80-0.94), hip (HR = 0.68, 95% CI = 0.58-0.79), or lumbar (HR = 0.82, 95% CI = 0.76-0.89) injuries., Conclusions: One in five individuals that sought care for an ankle sprain experienced a proximal joint injury in the following year. TE for the management of the initial ankle sprain reduced the likelihood of proximal injury diagnosis and should be considered in treatment plans for return to work and sport protocols after ankle sprains., (Copyright © 2023 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

Understanding the types of ankle sprains is essential in determining the most appropriate treatment and preventing substantial missed time from sports. Commonly known and recognized is an acute lateral ankle sprain, however, a differentiation should also be made to understand high (syndesmotic) ankle sprains as the mechanism of injury and recovery periods differ between these two types., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Acute lateral ankle sprain (ALAS) is one of the most frequent musculoskeletal injuries, with a great impact on health and socioeconomic factors. There are few consensuses on this subject and multiple therapeutic options that are difficult to compare due to the lack of a universally adopted classification system. The objective of this study is to is to report the actual knowledge on how ALAS are classified and reported and not to make any therapeutic recommendation. A comprehensive literature review of the literature was carried out through a search in the MEDLINE, Cochrane Library and Google Scholar databases, with identification of articles that describe ways to classify lateral ankle sprains or with relevant content for their classification. Twenty-five different classification systems were identified. The majority of articles referring to ALAS use an unspecific classification. Most classification systems divide sprains into 3 degrees. The most used parameters are the anatomy of the injury, clinical parameters, functional loss and the presence of instability. No articles were found to verify the validity of the systems used, namely regarding their association with therapeutic proposals or prognostic predictions. Based on the available evidence, recommendations cannot be made regarding the most appropriate classification system. The considerable heterogeneity of the existing literature makes it difficult to compare studies and to optimize the treatment and follow-up of these injuries. Future research in this area is necessary to define a practical and rigorous system that can be used universally., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The lateral sprain of the ankle is a very frequent injury in the population in general, appearing in the emergency services frequently. The general objective was to review the current clinical practice guidelines (CPGs) on management and treatment of ankle sprains, assess their quality, analyze the levels of evidence and summarize the grades of recommendation., Methods: A systematic search of the literature in relevant databases with the search terms "ankle," "sprain," "practice guideline," and "guideline" was carried out. There were included those guidelines that had the system of grades of recommendation and level of evidence concerning to management and treatment of ankle sprain. The quality of the guides was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool., Results: Seven clinical practice guides were included in this review. The AGREE II scores ranged from 42% to 100%, with only six CPGs explicitly declaring the use of a systematic methodology. Seventeen recommendations were extracted and summarized., Discussion: Six of the recommendations analyzed present enough evidence to be applied in clinical practice and are highly recommended for ankle sprain management: Ottawa rules, manual therapy, cryotherapy, functional supports, early ambulation, short term NSAIDs and rehabilitation., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: A lateral ankle sprain (LAS) is the most common musculoskeletal injury in the physically active population. It is uncertain what percentage of these patients develop persisting symptoms including pain, recurrent sprains and subjective instability. This systematic review was conducted to assess the presence and duration of persistent symptoms after a first LAS., Methods: A systematic review of the Medline, Web of Sciences, Embase, CINAHL and Pedro databases was performed to identify peer-reviewed articles concerning the occurrence and duration of remaining symptoms after a first LAS. Inclusion criteria focused on selection of patients without previous ankle injuries and study quality. One of the following outcomes had to be described: subjective instability, resprains, remaining symptoms., Results: In total, 15 studies were included. The occurrence of patients with subjective instability decreased from 37.9% (95%CI [6.0-69.7]) at 3 months to 16.1% (95%CI [7.8-24.3]) at 6 months and 8.1% (95%CI [3.3-13.3]) at 12 months. The occurrence of patients with a recurrent LAS was 15.8% (95%CI [6.3-25.3]) at 12 months. The occurrence of patients with residual pain decreased from 48.6% (95%CI [23.6-73.5]) at 3 months, to 21.5% (95%CI [2.8-40.2]) at 6 months and 6.7% (95%CI [3.2-10.1]) at 12 months., Conclusion: This study offers new insights in the presence of remaining symptoms after a first LAS and the development of chronic ankle instability. Twelve months following an initial LAS, a significant number of patients may still have symptoms. The incidence of subjective instability, and pain, continues to decrease until 12 months post-injury. This new information may suggest that a longer period of non-operative treatment may be warranted before recommending surgical intervention in patients with a first LAS., (Copyright © 2021 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Context: Health care utilization and the occurrence of non-time-loss (NTL) lateral ankle sprains is not well documented in collegiate athletes but could provide better estimates of injury burden and inform clinician workload., Design: Descriptive epidemiologic study., Methods: Lateral ankle sprain injury occurrence for Division I collegiate student-athletes in a conference with 32 sports representing 732 team seasons was collected during the 2018-2019 through 2020-2021 academic years. Injuries were designated as acute or overuse, and time-loss (TL) or NTL. Associated health care utilization, including athletic training services (AT services), and physician encounters were reported along with anatomical structures involved and season of occurrence., Results: A total of 1242 lateral ankle sprains were reported over the 3 years from 732 team seasons and 17,431 player seasons, resulting in 12,728 AT services and 370 physician encounters. Most lateral ankle sprains were acute-TL (59.7%), which were associated with the majority of AT services (74.1%) and physician encounters (70.0%). Acute-NTL sprains represented 37.8% of lateral ankle sprains and were associated with 22.3% of AT services and 27.0% of physician encounters. On average, there were 12.7 (5.8) AT services per acute-TL sprain and 6.0 (3.6) per acute-NTL sprain. Most sprains involved "ankle lateral ligaments" (45.6%), and very few were attributed to overuse mechanisms (2.4%)., Conclusions: Lateral ligament sprains are a common injury across many sports and result in substantial health care utilization from ATs and physicians, including NTL lateral ankle sprains. Although TL injuries were the majority of sprains, a substantial proportion of sprains were NTL and accounted for a considerable proportion of health care utilization.

Context: Ankle sprains are common during sport participation and associated with long-term deficits in self-report of function. However, little is known of short-term changes in self-report of function following injury. The authors aimed to assess statistical and clinically meaningful changes in self-report of function, as measured by the Foot and Ankle Ability Measure (FAAM), during the first 2 weeks after an ankle sprain injury., Design: A retrospective analysis of electronic medical records., Methods: Eighty-eight patients, who were diagnosed with an ankle sprain injury by an athletic trainer, received usual care from an athletic trainer, and completed the FAAM during treatment at weeks 1 and 2 postinjury. The authors calculated the percentage of patients who reported clinically meaningful changes and used Wilcoxon signed-rank tests to compare differences in FAAM scores between time points., Results: Between weeks 1 and 2, significant differences were noted for the FAAM Activities of Daily Living (FAAM-ADL) (P < .001) and FAAM Sport (FAAM-Sport) (P < .001). At the patient level, 86.5% (64/74) and 85.2% (69/81) of patients reported changes that exceeded the minimal clinically important difference value for the FAAM-ADL and FAAM-Sport, respectively, between weeks 1 and 2. At week 2, 31.8% (28/88) and 47.7% (42/88) of patients reported a score below 90% on the FAAM-ADL and below 80% on the FAAM-Sport subscale, respectively. Also, 36.4% (32/88) and 25.0% (22/88) of patients reported a score of 100% on the FAAM-ADL and FAAM-Sport subscales, respectively, at week 2., Conclusions: Patients report statistically significant and meaningful improvements in self-report of function during the first 2 weeks following ankle sprain injury. However, almost half of patients still report deficits in sport function at 2 weeks postinjury. Patient-reported outcome measures such as the FAAM, can help capture the patient's perception of function and inform patient care decisions. Research efforts should explore individual response patterns to treatment.

Joint inflammation results from soft-tissue injuries and cartilage damage. PRICE is the standard treatment approach for acute soft tissue injuries like ankle sprain. Electrical stimulation, application of orthotic braces, etc. is also effective for this. In a synergistic device all these components are combined and applied simultaneously. This device was developed for joint inflammation and tested for grade I & II acute ankle joint sprain. To test a synergistic - semirigid device, combining PRICE & electrical stimulation for acute ankle sprains of grades I & II for pain, range of motion and swelling is a case series was the objective. Device was developed using novel concept of synergistic applications of PRICE with electrical stimulation. The joint contour of ankle and specific biomechanical bony surface landmarks were considered. Ethical approval was taken from NTCC committee, AIPT. Recordings were taken from eight patients of acute ankle sprain with - in two days of injury, after getting ethical approval. Elevation to the ankle was provided by keeping the part over the pillow and data was recorded with the help of: 1.VAS scale for pain; 2. Measuring tape; 3. Goniometry. t -test was used to find out the significant difference pre and post the application of device. There was a significant reduction in pain ( p = 0.006), edema ( p  = 0.011), dorsi-flexion ( p  = 0.015), and plantar flexion ( p  =0.008). The synegistic device has been effective for acute ankle inflammation - grade I & II ankle sprains in 5 sessions; sufficient for the return of function.

We aimed to investigate changes in postural stability on a stable surface after the application of dynamic tape for patients with inversion ankle sprains. This study enrolled 30 patients (age 25.5 ± 8.0 years) with grade I and II ankle sprains, which occurred 7−21 days before enrolment. Postural stability (balance, coordination, feedback) was assessed before and after the application of dynamic tape using a stabilographic platform. Three 32-s exercises were performed on the stabilographic platform, one with eyes open, one with eyes closed and one with visual feedback. After the application of dynamic tape, an improvement was observed in terms of the mean radius of sway (4.2 ± 1.3 mm vs. 3.4 ± 0.9 mm; p = 0.012) and coordination (48.8 ± 19.2% vs. 59.3 ± 5.8%; p = 0.021). Selected balance parameters did not improve significantly in the tests with open and closed eyes. Asymmetric load improved for all tests, but significant differences were only observed with eyes closed (34.9 ± 24.4 vs. 41.7 ± 30.5; p < 0.01). We concluded that the use of dynamic tape after an ankle sprain significantly improved balance and coordination on a stable surface. The benefits were shown in terms of a significant improvement in the asymmetric load of the injured limb in comparison to the healthy limb during the test with closed eyes and a considerable improvement in the asymmetric load that was evaluated with visual feedback on a stable surface.

Study Design: Case Series., Background: Syndesmotic ankle sprains can occur in up to 17% of ankle trauma and can lead to long-term disability. This study describes the management of seven patients with subacute, high-grade ankle sprains with concerns of concurrent syndesmotic strain utilizing manual therapy and rigid sports taping., Methods: Seven active duty military members with clinically diagnosed, high-grade ankle sprains and concern for syndesmotic sprain participated in this case series. All patients received multi-modal treatment consisting of manual therapy, rigid sports taping, progressive exercises, and proprioceptive training. Decrease in Numeric Pain Rating Scale (NPRS) following manual therapy and taping treatment, number of sessions before discharge, and the Global Rating of Change (GROC) at discharge were retrospectively reviewed., Results: All patients demonstrated an immediate decrease in NPRS following treatment on average of 5 points (range, 3-8 points) with a functional asterisk sign. The improvement in pain and function was maintained until the next treatment session with a mean GROC score of +3. The mean time until recovery was 5.4 weeks (range, 1-8 weeks)., Discussion: A multimodal approach for patients diagnosed clinically with high-grade ankle sprains and concern for syndesmotic sprain was useful to immediately reduce pain and improve function, and improvements were maintained throughout the duration of care. This study is the first to assess a combination of manual therapy and rigid sports taping for the treatment of suspected syndesmotic ankle sprains, and more stringent research is needed to validate the findings., Level of Evidence: Therapy, 4.

Primary care physicians are often the first to evaluate patients with extremity injuries. Identification of fractures and sprains and their proper management is paramount. After appropriate imaging is obtained, immobilization and determination of definitive management, either nonoperative or operative, is critical. Appropriate immobilization is imperative to injury healing. Nonsurgical management of upper extremity fractures often uses slings, short-term splinting, gutter splints, and/or short or long arm casts. Initial fracture stabilization of the lower extremity is usually accomplished with a posterior splint. Definitive management usually uses controlled ankle movement walker boots, hard-sole shoes, or casting., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: 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., Materials and Methods: 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., Results: 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., Conclusions: 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.

Abstract: The medial collateral ligament (MCL) is the most commonly injured ligament of the knee. Most grade I and II injuries respond to conservative management, but symptoms persist in some patients. In these cases, treatment options are limited. Percutaneous ultrasonic debridement is increasingly being used for tendinopathy and fasciopathy refractory to conservative management, but this has not been reported as a treatment for ligament injury. Here, we present a case of a chronic grade II MCL sprain successfully treated with percutaneous ultrasonic debridement., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose of Review: Acute ankle sprains frequently occur in active children and adolescents but may be the initial clinical presentation of other less common disorders affecting the lower extremities. There are many conditions that may cause one or multiple episodes of ankle injury that are misdiagnosed as an acute ankle sprain. This manuscript highlights diagnoses that should be considered when evaluating and managing a child or adolescent who presents initially and/or repeatedly with an acute ankle sprain., Recent Findings: In recent years, various studies have continued to note the prevalence of misdiagnosed ankle sprains, especially amongst the paediatric population. If ankle radiographs demonstrate no abnormalities during an initial clinical examination, often the patient is diagnosed with an acute ankle sprain. However, this can be a misdiagnosis, especially when the patient has had recurrent episodes of ankle injury and ancillary studies are not performed., Summary: There are many diagnoses that can go unnoticed in the initial evaluation of a paediatric or adolescent ankle sprain. It is important for physicians to be aware of these other conditions to ensure proper treatment plans. This manuscript will analyse five conditions that may be misdiagnosed as an ankle sprain, including juvenile idiopathic arthritis, osteochondritis dissecans of the talus, hereditary sensory motor neuropathy (Charcot-Marie Tooth disease), tarsal coalition and transitional ankle fractures., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Ankle sprains are frequently encountered. They result most of the time in lesions of the lateral ligament complex. Nevertheless, in the context of an ankle sprains, more severe injuries including fracture of the lateral process of the talus, fracture of the base of the 5th metatarsal, tear of the medial ligament complex, lesion of the syndesmosis, sprain of the Chopart joint, and peroneal tendons luxation are potentially overlooked and, if treated inadequately, may be associated with poor functional outcome. The goal of the present paper is to make the emergency practitioner aware of these potential lesions, and to help him making the correct diagnosis in order to initiate the adequate treatment., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Rationale: Complex regional pain syndrome (CRPS) is a painful condition classified as type I or II depending on the absence or presence of nerve injury, respectively. Injury to the lateral dorsal cutaneous nerve (LDCN), a branch of the sural nerve, is a rare occurrence observed after a sprain or procedures conducted on the lateral side of the ankle., Patient Concerns: A 38-year-old female, who had undergone prolotherapy for a sprain in the lateral side of the left ankle 3 months ago, presented with persistent causalgia and dysesthesia around the injection site., Diagnosis: An electrodiagnostic study was conducted, which confirmed that the patient had peripheral neuropathy of the left LDCN. Considering the digital infrared thermal imaging and three-phase bone scan findings and the clinical presentation, the condition was diagnosed as CRPS type II due to iatrogenic LDCN injury according to the Budapest diagnostic criteria for CRPS., Interventions: The patient was treated with steroid pulse therapy, physical therapy, and transcutaneous electrical nerve stimulation, as well as nonsteroidal anti-inflammatory drugs, pregabalin, and tricyclic antidepressants., Outcomes: After 1 month of treatment, allodynia of the left foot persisted, but the pain reduced from 6 points to 3 points on the numeric rating scale. Partial recovery of amplitude and conduction velocity was confirmed in the follow-up electrodiagnostic study., Lessons: LDCN injury should be considered in patients who complain of persistent lateral ankle and foot paresthesia or pain after sprain or procedures performed on the lateral side of the ankle. Early diagnosis and treatment can lead to a good prognosis when the LDCN injury has progressed to CRPS., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

We analysed the effects of an experimental novel protocol of intensive hydrotherapy with hydrogen-rich water (HRW) on injury recovery in athletic men who suffered an acute ankle sprain (AAS) and compared it with a RICE protocol (rest, ice, compression, elevation). Professional athletes (age 23.7 ± 4.0 years; weight 78.6 ± 5.7 kg, height 182.5 ± 4.3 cm; professional experience 5.9 ± 3.9 years) who incurred AAS during a sport-related activity were randomly assigned immediately after the injury to either hydrogen group ( n = 9) or a conventional RICE treatment group ( n = 9). Hydrogen group received six 30-min ankle baths with HRW throughout the first 24 h post-injury, with hydrotherapy administered every 4 hours during the intervention period. RICE group stood off the injured leg, with ice packs administered for 20 min every 3 hours, with the injured ankle compressed with an elastic bandage for 24 hours and elevated at all possible times above the level of the heart. HRW was equivalent to RICE protocol to reduce ankle swelling (2.1 ± 0.9% vs. 1.6 ± 0.8%; P = 0.26), range of motion (2.4 ± 1.3 cm vs. 2.7 ± 0.8 cm; P = 0.60), and single-leg balance with eyes opened (18.4 ± 8.2 sec vs. 10.7 ± 8.0 sec; P = 0.06) and closed (5.6 ± 8.4 sec vs. 3.9 ± 4.2 sec; P = 0.59). This non-inferiority pilot trial supports the use of HRW as an effective choice in AAS management. However, more studies are needed to corroborate these findings in other soft tissue injuries.

Background: Despite being the most commonly incurred sports injury with a high recurrence rate, there are no guidelines to inform return to sport (RTS) decisions following acute lateral ankle sprain injuries. We aimed to develop a list of assessment items to address this gap., Methods: We used a three-round Delphi survey approach to develop consensus of opinion among 155 globally diverse health professionals working in elite field or court sports. This involved surveys that were structured in question format with both closed-response and open-response options. We asked panellists to indicate their agreement about whether or not assessment items should support the RTS decision after an acute lateral ankle sprain injury. The second and third round surveys included quantitative and qualitative feedback from the previous round. We defined a priori consensus being reached at >70% agree or disagree responses., Results: Sixteen assessment items reached consensus to be included in the RTS decision after an acute lateral ankle sprain injury. They were mapped to five domains with 98% panellist agreement-PAASS: P ain (during sport participation and over the last 24 hours), A nkle impairments (range of motion; muscle strength, endurance and power), A thlete perception (perceived ankle confidence/reassurance and stability; psychological readiness), S ensorimotor control (proprioception; dynamic postural control/balance), S port/functional performance (hopping, jumping and agility; sport-specific drills; ability to complete a full training session)., Conclusion: Expert opinion indicated that pain severity, ankle impairments, sensorimotor control, athlete perception/readiness and sport/functional performance should be assessed to inform the RTS decision following an acute lateral ankle sprain injury., Trial Registration Number: ACTRN12619000522112., Competing Interests: Competing interests: KT, TB, OBAO, ED and EV are on the BJSM Editorial Board., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

High-level patellar tendon strain may cause impairments of the tendon's micromorphological integrity in growing athletes and increase the risk for tendinopathy. This study investigated if an evidence-based tendon exercise intervention prevents high-level patellar tendon strain, impairments of micromorphology and pain in adolescent basketball players (male, 13-15 years). At three time points over a season (M1-3), tendon mechanical properties were measured using ultrasound and dynamometry, proximal tendon micromorphology with a spatial frequency analysis and pain and disability using VISA-P scores. The control group (CON, n = 19) followed the usual strength training plan, including sprint and change-of-direction drills. In the intervention group (INT, n = 14), three sessions per week with functional exercises were integrated into the training, providing repetitive high-magnitude tendon loading for at least 3 s per repetition. The frequency of high-level strain (ie, ≥9%) continuously decreased in INT, while tending to increase in CON since tendon force increased in both (p < 0.001), yet tendon stiffness only in INT (p = 0.004). In CON, tendon strain was inversely associated with tendon peak spatial frequency at all time points (p < 0.05), indicating impairments of tendon micromorphological integrity with higher strain, but not at M2 and M3 in INT. Descriptively, the fraction of asymptomatic athletes at baseline was similar in both groups (~70%) and increased to 100% in M3 in INT, while remaining unchanged in CON. We suggest that functional high-load tendon exercises could reduce the prevalence of high-level patellar tendon strain and associated impairments of its micromorphology in adolescent athletes, providing new opportunities for tendinopathy prevention., (© 2021 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Cryotherapy is utilized as a physical intervention in the treatment of injury and exercise recovery. Traditionally, ice is used in the treatment of musculoskeletal injury while cold water immersion or whole-body cryotherapy is used for recovery from exercise. In humans, the primary benefit of traditional cryotherapy is reduced pain following injury or soreness following exercise. Cryotherapy-induced reductions in metabolism, inflammation, and tissue damage have been demonstrated in animal models of muscle injury; however, comparable evidence in humans is lacking. This absence is likely due to the inadequate duration of application of traditional cryotherapy modalities. Traditional cryotherapy application must be repeated to overcome this limitation. Recently, the novel application of cooling with 15 °C phase change material (PCM), has been administered for 3-6 h with success following exercise. Although evidence suggests that chronic use of cryotherapy during resistance training blunts the anabolic training effect, recovery using PCM does not compromise acute adaptation. Therefore, following exercise, cryotherapy is indicated when rapid recovery is required between exercise bouts, as opposed to after routine training. Ultimately, the effectiveness of cryotherapy as a recovery modality is dependent upon its ability to maintain a reduction in muscle temperature and on the timing of treatment with respect to when the injury occurred, or the exercise ceased. Therefore, to limit the proliferation of secondary tissue damage that occurs in the hours after an injury or a strenuous exercise bout, it is imperative that cryotherapy be applied in abundance within the first few hours of structural damage.