The presence of persistent symptoms 12 months following a first lateral ankle sprain: A systematic review and meta-analysis

A lateral ankle sprain (LAS) is the most common musculoskeletal injury in the physically active population. It is uncertain what percentage of these patients develop persisting symptoms including pain, recurrent sprains and subjective instability. This systematic review was conducted to assess the presence and duration of persistent symptoms after a first LAS. A systematic review of the Medline, Web of Sciences, Embase, CINAHL and Pedro databases was performed to identify peer-reviewed articles concerning the occurrence and duration of remaining symptoms after a first LAS. Inclusion criteria focused on selection of patients without previous ankle injuries and study quality. One of the following outcomes had to be described: subjective instability, resprains, remaining symptoms. In total, 15 studies were included. The occurrence of patients with subjective instability decreased from 37.9% (95%CI [6.0–69.7]) at 3 months to 16.1% (95%CI [7.8–24.3]) at 6 months and 8.1% (95%CI [3.3–13.3]) at 12 months. The occurrence of patients with a recurrent LAS was 15.8% (95%CI [6.3–25.3]) at 12 months. The occurrence of patients with residual pain decreased from 48.6% (95%CI [23.6–73.5]) at 3 months, to 21.5% (95%CI [2.8–40.2]) at 6 months and 6.7% (95%CI [3.2–10.1]) at 12 months. This study offers new insights in the presence of remaining symptoms after a first LAS and the development of chronic ankle instability. Twelve months following an initial LAS, a significant number of patients may still have symptoms. The incidence of subjective instability, and pain, continues to decrease until 12 months post-injury. This new information may suggest that a longer period of non-operative treatment may be warranted before recommending surgical intervention in patients with a first LAS.