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Published on: October 28, 2022
Early functional deficits following first-time acute lateral ankle sprain: A multidimensional assessment framework
Janina Tennler1,2, Christian Raeder1,2, Arthur Praetorius1,2
1Department of Arthroscopic Surgery, Sports Traumatology and Sports Medicine BG Klinikum Duisburg Duisburg Germany.
Purpose:
Lateral ankle sprain (LAS) is one of the most common musculoskeletal injuries associated with sensorimotor impairments that increase the risk of reinjury and chronic ankle instability. Early clinical assessment after acute LAS is often symptom-guided rather than based on objective functional testing. This study aimed to identify the most sensitive functional impairments within the first weeks after injury and to determine cut-off values that support structured clinical assessment.
Methods:
In this cross-sectional matched case-control analysis, 36 individuals (14-41 years) with MRI-confirmed first-time acute LAS were compared to 36 matched healthy controls. Patients (recruiting 01/22-09/24) were assessed 2-3 weeks post-injury using patient-reported outcomes, postural control, strength, range of motion (ROM), gait/running kinematics and jump performance. Between-group differences were analysed using t tests or Statistical Parametric Mapping. Receiver operating characteristic analyses were used to determine diagnostic cut-off values. It was hypothesized that individuals with acute first-time LAS would demonstrate clinically relevant deficits across functional domains compared with healthy controls, and that these parameters would allow the derivation of clinically useful cut-off values.
Results:
Individuals with LAS demonstrated substantial impairments across several domains. The most discriminative parameters were Foot and Ankle Ability Measure (FAAM) Sport (effect size [ES] -4.09, cut-off <86) and Cumberland Ankle Instability Tool (CAIT) (ES -3.65; cut-off <26) (psychometry), Star Excursion Balance Test (SEBT) composite score (ES -1.22; cut-off <92.81) (postural control), concentric plantarflexion strength (ES -1.34; cut-off <2.24 Nm/kg) (strength), passive plantarflexion and total ROM (ES -2.29; cut-off <44° and <72°), transverse ankle kinematics during gait (ES 1.14; cut-off <-15°) (gait/running) and drop jump contact time (ES 1.62; cut-off >0.23 s) (jump performance). These measures formed a minimal multidimensional assessment.
Conclusion:
These parameters and cut-off values enable objective, multidimensional assessment in the early phase after acute LAS and may facilitate impairment-based rehabilitation beyond symptom-guided evaluation.
Level Of Evidence:
Level III, cross-sectional matched pair-study.
