Brain neuroplasticity related to lateral ankle ligamentous injuries: a systematic review –insights for injury prevention

ABSTRACT
Background:
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.
Objective:
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.
Design:
Systematic Review
Participants
Included studies investigated functional or structural brain adaptations in patients who experienced a lateral ankle
sprain or chronic ankle instability and were at least 18 years of age. Lateral ankle sprains and chronic ankle instability
were defined following the recommendation of the International Ankle Consortium.
Main Outcome Measurements
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, and 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.
Results:
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, ten 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.
Conclusions
This study highlights evidence regarding structural and functional brain adaptations associated with lateral ankle sprains and chronic ankle instability in athletes. While our primary focus has been on elucidating these neural responses, it's essential to recognise their direct relevance to the broader field of injury prevention and athlete health. The identified neuroplastic changes correlate with clinical outcomes and may contribute to the persisting dysfunctions, increased re-injury risk, and long-term sequelae observed in affected athletes. To bridge this knowledge into practical applications, rehabilitation programs should consider integrating sensorimotor and motor control strategies tailored to address these neuroplastic adaptations. By doing so, we can advance the development of effective injury prevention and rehabilitation strategies, ultimately enhancing the well-being of athletes and minimising the impact of ankle injuries in sports.