INTRODUCTION: Lateral ankle sprain (LAS) injury is one of the most frequently incurred musculoskeletal injuries and shows high recurrence
rates in individuals participating in sports [1, 2]. This high recurrence rate is hypothesised to be mainly caused by an increased reinjury
risk due to previous LAS injury, the persistence of sensorimotor impairments and premature return to sport (RTS) clearance [3].
Therefore, it is indicated to develop and implement evidence-based criteria to guide RTS decisions for individuals with LAS injury. The aim
of this systematic review was to identify prospective studies that used a criteria-based RTS decision-making process for patients with LAS
injury.
METHODS: The PubMed (MEDLINE), Web of Science, PEDro, Cochrane Library, SPORTDiscus (EBSCO), ScienceDirect, and Scopus databases
were searched till 23 November 2018. Studies were included if they prospectively applied a criteria-based RTS decision-making process
for patients with LAS injury. Studies were excluded if they merely gathered outcome measures at the RTS time-point. Studies were also
excluded if patients were recovering from ankle fracture, high ankle sprain, medial ankle sprain, chronic ankle instability or complex
ankle injury.
RESULTS: No studies were identified that used a criteria-based RTS decision-making process for patients with LAS injury. We were unable
to conduct a quantitative synthesis or meta-analysis, so we provided a narrative synthesis of 47 relevant questionnaires, as well as 45
clinical and functional assessments commonly used in studies retrieved in the search.
CONCLUSION: There are currently no published evidence-based criteria to inform RTS decisions for patients with a LAS injury. It seems that
RTS decisions following LAS injury are still generally time-based. Therefore, we propose the following variables that could be used to
develop a criteria-based RTS decision paradigm: (1) predisposing factors increasing the (re-)injury risk and prognostic factors increasing
the risk of developing CAI, (2) ligament healing, ankle laxity and arthrokinematics, (3) clinical tests and patient reported outcomes, (4)
functional and sport-specific performance tests (a. quantitative performance analysis, b. movement quality assessment, and c. acute
fatigue as a constraint and extra criterion), (5) load monitoring, (6) psychological and psychosocial factors, (7) decision modifying variables.
Future research should aim to reach consensus on these variables and apply them to actual RTS decisions within prospective study
designs. Furthermore, we suggest that complex systems theory and the RTS continuum [4] could be used to inform the development of a
RTS decision-making paradigm for individuals with LAS injury.
REFERENCES:
[1] Doherty et al. Sports Med, 2014.
[2] Gribble et al. Br J Sports Med, 2016
[3] Malliaropoulos et al. Am J Sports Med, 2009.
[4] Ardern et al. Br J Sports Med, 2016.
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