A systematic review 1 including 84 studies with a total of 7 819 subjects was abstracted in DARE. 19 studies assessed pharmacological agents, 41 examined surgical and active mobilisation, and 24 analysed physical modalities. NSAIDs tended to offer significant improvement in recovery time and symptomatic relief over placebo. Topical gels provided temporary relief but no signficant improvement in final treatment outcome. Trials comparing surgical repair, plastering, casting and active mobilisation indicated a more rapid recovery through active mobilisation. In general, conservative treatments produced satisfactory results in outcome. Cryotherapy reduced pain, oedema and shortened recovery period, if applied within first 2 days following injury.
Another systematic review 2 including 27 studies with a total of 3 345 subjects was abstracted in DARE.
Strapping, bracing, use of an orthosis (such as an air cast), elastic wrapping, and use of special shoes for at least five weeks were considered to be functional treatment.
There was no difference between operative and functional treatment when residual pain was studied as outcome. Treatment with a cast for six weeks caused more residual pain than functional treatment (RR 0.67; 95% CI: 0.50 to 0.90). With respect to giving-way, operative treatment was better than functional treatment (RR 0.23; 95% CI 0.17 to 0.31) and functional treatment was better than a cast for six weeks (RR 0.69; 95% CI 0.50 to 0.94).
The authors state that a no-treatment strategy for ruptures of the lateral ankle ligaments leads to more residual symptoms. Operative treatment leads to better results than functional treatment, and functional treatment leads to better results than cast immobilisation for six weeks.
Comment: The quality of evidence is downgraded by inconsistency (variability in results, heterogeneity in interventions and outcomes across studies).
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