Diagnosis, treatment and prevention of ankle sprains:update of an evidence-based clinical guidelineGwendolyn Vuurberg,1,2,3 Alexander Hoorntje,1,2,3 Lauren M Wink,1,4Brent F W van der Doelen,1,2,3 Michel P van den Bekerom,5 Rienk Dekker,6C Niek van Dijk,1,2,3 Rover Krips,7 Masja C M Loogman,8 Milan L Ridderikhof,9Frank F Smithuis,10 Sjoerd A S Stufkens,1 Evert A L M Verhagen,3,4,11 Rob A de Bie,12 Gino M M J Kerkhoffs1,2,3For numbered affiliations see end of article.Correspondence toGwendolyn Vuurberg, Academic Medical Center, Amsterdam1105 AZ, The Netherlands; g.vuurberg@amc.uva.nlReceived 26 May 2017Revised 11 January 2018 Accepted 2 February 2018To cite: Vuurberg G,Hoorntje A, Wink LM, et al. Br J Sports Med Epub ahead of print: [please include Day Month Year]. doi:10. 1136/ bjsports-2017-098106AbsTRACTThis guideline aimed to advance current understandings regarding the diagnosis, prevention and therapeuticinterventions for ankle sprains by updating the existing guideline and incorporate new research. A secondaryobjective was to provide an update related to thecost-effectiveness of diagnostic procedures, therapeutic interventions and prevention strategies. It was posited that subsequent interaction of clinicians with thisguideline could help reduce health impairmentsand patient burden associated with this prevalentmusculoskeletal injury. The previous guideline provided evidence that the severity of ligament damage can beassessed most reliably by delayed physical examination (4–5 days post trauma). After correct diagnosis, it can be stated that even though a short time of immobilisation may be helpful in relieving pain and swelling, the patient with an acute lateral ankle ligament rupture benefitsmost from use of tape or a brace in combination with an exercise programme.New in this update: Participation in certain sports isassociated with a heightened risk of sustaining a lateral ankle sprain. Care should be taken with non-steroidalanti-inflammatory drugs (NSAIDs) usage after an ankle sprain. They may be used to reduce pain and swelling,but usage is not without complications and NSAIDsmay suppress the natural healing process. Concerningtreatment, supervised exercise-based programmespreferred over passive modalities as it stimulates therecovery of functional joint stability. Surgery shouldbe reserved for cases that do not respond to thoroughand comprehensive exercise-based treatment. For theprevention of recurrent lateral ankle sprains, ankle braces should be considered as an efficacious option.INTRoDuCTIoNA lateral ankle sprain (LAS) is a frequently incurred musculoskeletal injury, with a high prevalence among the general population and individuals who participate in sports.1 2 About 40% of all traumatic ankle injuries occur during sports. For indoor sports, an incidence of 7 LAS per 1000 exposures has been reported.3 Despite the high prevalence and incidence of LAS injuries,...
