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Functional treatment versus immobilization for the management of acute ankle sprains: a systematic review and
Félix Vilchez-Cavazos1, Alejandro Quiroga-Garza2, Carlos A Acosta-Olivo1
1Orthopedic Trauma Service, "Dr. José Eleuterio González" University Hospital, School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico.
Background:
Ankle sprains are common among physically active populations. Treatment approaches can be categorized into functional treatment and immobilization. Despite clinical guidelines, controversies exist on which is the better therapeutic option.
Objectives:
We aimed to compare functional treatment with immobilization to determine the most effective treatment strategy for acute ankle sprain in randomized clinical trials (RTCs).
Methods:
A systematic search of databases (MEDLINE, Web of Science, Embase, and Scopus) was performed from inception to December 2023. An assessment of bias in the included studies was performed using the Cochrane Risk of Bias tool. RCTs reporting questionnaires on self-reported pain or function and events related to instability, reinjury, or ability to perform daily activities were extracted. A random effect meta-analysis and forest plot were used to calculate the standardized mean difference (SMD) with a 95 % confidence interval (CI) in the meta-analysis.
Results:
A total of 10 RCTs were included, comprising a study population of 1133 cases, with 577 cases in the functional intervention and 556 cases in the immobilization intervention. The meta-analysis indicated no significant differences between interventions for pain (SMD -0.15, 95 % CI [-0.71, 0.41], I2 = 92 %; p = 0.60) and functional improvement (SMD 0.05, 95 % CI [-0.39, 0.49], I2 = 90 %; p = 0.83).
Conclusions:
Quantitative analysis of RCTs shows no significant difference between functional and immobilization strategies in improving ankle pain or function according to patient reports. Complication rates and return to daily activities also showed no significant variance.
