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A Prospective, Randomized Clinical Investigation of the Treatment of First-Time Ankle Sprains

Bruce D. Beynnon, PhD^*,, Per A. Renström, MD, PhD, Larry Haugh, PhD, Benjamin S. Uh, MD and Howard Barker, MD

From the Department of Orthopaedics & Rehabilitation, McClure Musculoskeletal Research Center, University of Vermont, Burlington, Vermont, and the Department of Orthopaedics, Sports Medicine & Arthroscopy, Karolinska Institute, Stockholm, Sweden

^* Address correspondence to Bruce D. Beynnon, PhD, Department of Orthopaedics & Rehabilitation, McClure Musculoskeletal Research Center, University of Vermont, Burlington, VT 05405-0084 (e-mail: bruce.beynnon{at}uvm.edu).

Background: Acute ankle ligament sprains are treated with the use of controlled mobilization with protection provided by external support (eg, functional treatment); however, there is little information regarding the best type of external support to use.

Hypothesis: There is no difference between elastic wrapping, bracing, bracing combined with elastic wrapping, and casting for treatment of acute, first-time ankle ligament sprains in terms of the time a patient requires to return to normal function.

Study Design: Randomized controlled clinical trial; Level of evidence, 1.

Methods: Patients suffering their first ligament injury were stratified by the severity of the sprain (grades I, II, or III) and then randomized to undergo functional treatment with different types of external supports. The patients completed daily logs until they returned to normal function and were followed up at 6 months.

Results: Treatment of grade I sprains with the Air-Stirrup brace combined with an elastic wrap returned subjects to normal walking and stair climbing in half the time required for those treated with the Air-Stirrup brace alone and in half the time required for those treated with an elastic wrap alone. Treatment of grade II sprains with the Air-Stirrup brace combined with the elastic wrap allowed patients to return to normal walking and stair climbing in the shortest time interval. Treatment of grade III sprains with the Air-Stirrup brace or a walking cast for 10 days followed by bracing returned subjects to normal walking and stair climbing in the same time intervals. The 6-month follow-up of each sprain severity group revealed no difference between the treatments for frequency of reinjury, ankle motion, and function.

Conclusion: Treatment of first-time grade I and II ankle ligament sprains with the Air-Stirrup brace combined with an elastic wrap provides earlier return to preinjury function compared to use of the Air-Stirrup brace alone, an elastic wrap alone, or a walking cast for 10 days.

Key Words: ankle injuries • ligament injuries • sprains • rehabilitation

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