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Br J Sports Med. 2018 Aug;52(15):956. doi: 10.1136/bjsports-2017-098106. Epub 2018 Mar 7.

Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline.

Author information

Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.
Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands.
VU Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
Department of Orthopaedic Surgery, Onze Lieve Vrouwen Gasthuis, Amsterdam, The Netherlands.
Dutch Society of Rehabilitation, University of Groningen, University Medical Center, Groningen, The Netherlands.
Department of Orthopaedic Surgery, Flevoziekenhuis, Almere, The Netherlands.
Dutch College of General Practitioners, Utrecht, The Netherlands.
Emergency Department, Academic Medical Center, Amsterdam, The Netherlands.
Department of Musculoskeletal Radiology, Academic Medical Center, Amsterdam, The Netherlands.
Department of of Public and Occupational Health VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands.


This guideline aimed to advance current understandings regarding the diagnosis, prevention and therapeutic interventions for ankle sprains by updating the existing guideline and incorporate new research. A secondary objective was to provide an update related to the cost-effectiveness of diagnostic procedures, therapeutic interventions and prevention strategies. It was posited that subsequent interaction of clinicians with this guideline could help reduce health impairments and patient burden associated with this prevalent musculoskeletal injury. The previous guideline provided evidence that the severity of ligament damage can be assessed most reliably by delayed physical examination (4-5 days post trauma). After correct diagnosis, it can be stated that even though a short time of immobilisation may be helpful in relieving pain and swelling, the patient with an acute lateral ankle ligament rupture benefits most from use of tape or a brace in combination with an exercise programme.New in this update: Participation in certain sports is associated with a heightened risk of sustaining a lateral ankle sprain. Care should be taken with non-steroidal anti-inflammatory drugs (NSAIDs) usage after an ankle sprain. They may be used to reduce pain and swelling, but usage is not without complications and NSAIDs may suppress the natural healing process. Concerning treatment, supervised exercise-based programmes preferred over passive modalities as it stimulates the recovery of functional joint stability. Surgery should be reserved for cases that do not respond to thorough and comprehensive exercise-based treatment. For the prevention of recurrent lateral ankle sprains, ankle braces should be considered as an efficacious option.


ankle sprain; cost-effectiveness; guideline; inversion trauma; sprain prevention

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