Skip to main content

The current clinical practice of general orthopaedic surgeons in the treatment of lateral ankle sprain: a questionnaire survey in Miyazaki, Japan

Abstract

Background

Lateral ankle sprain (LAS) is one of the most common musculoskeletal injuries. Numerous studies regarding LAS have been performed. However, there are few studies evaluating the current clinical practice of orthopaedic surgeons regarding LAS. The purpose of this study was to evaluate the current clinical practice of general orthopaedic surgeons in the treatment of LAS.

Methods

A questionnaire survey was conducted from September 2020 to December 2020 in Miyazaki, Japan, to evaluate the clinical practice of general orthopaedic surgeons in the treatment of LAS. The survey was composed of 12 questions that were developed with consideration of the recommendations in the current clinical practice guidelines (CPGs) published by the Dutch orthopaedic society. The questions in this study were focused on the diagnosis, conservative treatment, rehabilitation, and the criteria for return to sports (RTS).

Results

The survey response rate was 82.7% (129/156). Among the respondents, 95.3% did not consider the Ottawa Ankle Rules in the decision to perform plain radiography for patients. Rehabilitation following LAS was performed in 58.9% of patients. Eighty-five (65.9%) of the surgeons used only one factor as the criterion for RTS. The absence of pain was the most frequently used criterion (45.7%). No objective criteria were used for the RTS decision in athletes with LAS.

Conclusions

The present study suggested that most general orthopaedic surgeons do not provide the care for patients with LAS recommended by the current CPGs. No objective criteria for the RTS decision are used for athletes with LAS.

Peer Review reports

Background

Lateral ankle sprain (LAS) is one of the most common musculoskeletal injuries, with an incidence of 2.15 person-years in the United States [1]. Nearly half of ankle sprains were reported to occur during sports activities, with indoor sports, basketball, and soccer reported to be high-risk sports [1, 2]. If LAS is not properly treated, 20–74% of patients will result in chronic lateral ankle instability (CLAI) [3,4,5]. However, even if patients with LAS receive appropriate treatment, they can still develop CLAI [6], indicating the need for better management of LAS. Patients with a history of LAS and CLAI are at risk for the development of posttraumatic osteoarthritis of the ankle [7, 8]. According to the current clinical practice guidelines (CPGs), conservative treatment is the gold standard for LAS [9, 10]. In order to prevent negative results following LAS, a greater advance in the diagnosis, treatment, rehabilitation, and prevention of LAS is still needed.

Especially, the improvement of the clinical practice of emergency physicians and general orthopaedic surgeons may be critical because the majority of individuals who seek medical treatment for LAS visit an emergency department or private orthopaedic clinic [11,12,13,14]. Many previous studies have evaluated issues regarding the management of LAS in the emergency department, such as the validity of the Ottawa ankle rules (OARs) [14,15,16,17]. However, few studies have investigated the clinical practice of general orthopaedic surgeons in the management of LAS [13]. It remains unclear whether or not orthopaedic surgeons are proficient in the management for LAS. Kucera et al. reported that subjects with a history of ankle sprain had an approximately 3.5 times greater risk of recurrent injuries than those who had no history of ankle sprain [18]. Better management by primary physicians, including general orthopaedic surgeons, may prevent recurrent injuries in patients with LAS. We hypothesized that many general orthopaedic surgeons would not provide care for LAS in accordance with the recommendations of the current CPGs. In addition, there is a lack of evidence-based criteria for the return to sports (RTS) following conservative treatment for LAS [19,20,21]. A premature RTS after insufficient assessment may contribute to a high rate of reinjury and the development of CLAI [22, 23]. If evidence-based RTS criteria were applied to athletes with LAS, the high rate of reinjury and development of CLAI may be reduced. Thus, it is worth knowing what criteria are used in the decision-making in relation to the RTS for athletes with LAS in the clinical setting. The purpose of this study is to report the results of a questionnaire survey regarding the current clinical practice of general orthopaedic surgeons in the management of LAS.

Methods

This study was approved by the institutional review board of our hospital. From September 2020 to December 2020, questionnaires were sent by post to the orthopaedic surgeons who worked in Miyazaki prefecture, Japan. Based on a list of orthopaedic surgeons in Miyazaki, those who had retired or did not see patients with LAS were excluded from this study. All questionnaires completed by the orthopaedic surgeons were included in this study. Miyazaki prefecture is a rural area located in the south of Kyushu in Japan; the population is almost 1,060,000. Most orthopaedic surgeons in Miyazaki see a broad spectrum of patients in the clinical settings because there are few specialized hospitals or institutes for specific orthopaedic diseases. Therefore, it was considered suitable for evaluating the clinical practice of general orthopedic surgeons in the management of LAS. In addition, the study population was selected with consideration of the accessibility of information regarding the doctors or their clinics and hospitals, as well as the contact information.

A questionnaire composed of a total of 12 questions, of which 11 were closed-ended questions (single answer), and one was an open-ended question (Table 1). There were 4 questions regarding the diagnosis of LAS, and other questions were about conservative treatment and rehabilitation for LAS. One question was related to athletes with LAS. The respondents were instructed to answer their best managements for patients with LAS who were treated conservatively. The questionnaires were developed by the authors to evaluate clinical practice of general orthopaedic doctors in the diagnosis, treatment, and rehabilitation for LAS. Evidence-based CPGs have been published by the Dutch Orthopaedic Society [9, 10]. The included questions were discussed and selected among the study members based on recommendations of these CPGs. Moreover, there is a lack of evidence-based criteria for a RTS after LAS [19,20,21]. Therefore, an open-ended question was used to investigate the criteria used by general orthopaedic surgeons in decision-making in relation to the RTS after LAS. The Cohen’s Kappa coefficient (κ) was calculated to assess the reliability of closed-ended questions using results from 30 randomly selected respondents. The respondents answered the questionnaire twice with a two-week interval. All values of κ were > 0.80, indicating almost perfect according to Landis’s classifications (slight, 0.0–0.20; fair, 0.21–0.40; moderate, 0.41–0.60; substantial, 0.61–0.80; almost perfect, 0.81–1.00) [24]. All collected questionnaires were tabulated by an author (T.Y.).

Table 1 The Questionnaire used in this study

Results

A total of 156 invitations and questionnaires were sent out for the survey, and 129 completed the questionnaires in the study period. The response rate was 82.7%. Forty-eight private clinics (48 doctors) and 28 hospitals (81 doctors) were included. The experience as an orthopaedic surgeon was > 15 years in 99 (80.6%) (Fig. 1).

Fig. 1
figure1

The experience of the orthopaedic doctors (n = 129). ys, years

The diagnosis of LAS (Question 1–4)

All doctors (100%, 129/129) answered that they performed plain radiography for the diagnosis of LAS (to exclude fractures). Only 4.7% (6/129) considered the OARs in the decision to perform plain radiography. Regarding stress radiography, 58.9% (76/129) answered that they did not perform stress radiography for the diagnosis of LAS. Ultrasonography was used by 46.5% (60/129) of the orthopaedic surgeons.

Conservative treatment and rehabilitation for LAS (Question 5–11)

Regarding immobilization for patients with LAS, 98.4% (127/129) immobilized the injured ankle for the treatment of LAS. A splint was applied for immobilization by 89.1% (115/127), and a cast was used by 6.2% (8/127). The duration of immobilization was reported to be < 1 week by 2.3% (3/129) of orthopaedic surgeons, and > 2 weeks by 64.4% (83/129) (Fig. 2). One hundred six respondents (83.5%) answered that they applied an ankle supporter after immobilization. With respect to whether or not to instruct a patient to avoid weight bearing on the injured foot, 23.3% (30/129) answered that they did not consider the duration of non-weight bearing (NWB) after the diagnosis of LAS. The duration for NWB was < 2 weeks in 52.7% (68/129), and > 2 weeks in 24.1% (31/129).

Fig. 2
figure2

Duration of immobilization for patients with lateral ankle sprain. wk, week

Regarding the rehabilitation for LAS, 58.9% (76/129) of respondents answered that they did not order rehabilitation, while 85.3% (110/129) answered that they considered rehabilitation for < 4 weeks, and 3.1% (4/129) for > 8 weeks (Fig. 3). Twenty-one respondents (16.3%) answered that they did not instruct athletes with LAS to use an ankle supporter or taping during sports activities. Ninety-six of respondents (74.4%) answered that they instructed athletes with LAS to wear an ankle supporter during sports activities. The duration of regular follow-up was reported to be < 4 weeks by 35.8% (46/129), and > 8 weeks by 18.6% (24/129).

Fig. 3
figure3

Prescription of rehabilitation for patients with lateral ankle sprain

The criteria for a RTS after conservative treatment for athletes with LAS (question 12)

As described in the Introduction, the question regarding the criteria for the RTS after conservative treatment for athletes with LAS was open-ended. The top 5 factors for the decision regarding the RTS were the absence of pain, the absence of instability, the time after LAS, no limitation of ankle ROM, and the absence of swelling (Fig. 4). Eighty-five (65.9%) of the respondents used only one of these 5 factors as the criterion for RTS; the absence of pain was the most frequently used criterion (45.7%, 59/129).

Fig. 4
figure4

The top 5 factors used as criteria for a return to sports in athletes with lateral ankle sprain

Discussion

The main findings of the present study were as follows: (1) Only 4.7% of the orthopaedic surgeons considered the OARs in the decision to perform plain radiography for patients with suspected LAS; (2) Approximately 60% of the surgeons did not order rehabilitation for patients with LAS, and 85.3% reported that the duration of rehabilitation was < 4 weeks; (3) The orthopaedic surgeons did not use any objective criteria for the RTS decision after conservative treatment for LAS, and 65.9% used only one factor as a criterion for the RTS. Namely, most general orthopaedic surgeons did not provide the care recommended by the current CPGs to patients with LAS.

Ankle fracture should be excluded in the diagnosis of LAS. The OARs were introduced to rule out a fracture because the majority (> 80%) of individuals with LAS who underwent radiography did not have an ankle fracture [25]. A number of studies have shown the validity and usefulness of the OARs to avoid the unnecessary performance of plain radiography, especially in the emergency department [26,27,28,29]. The current CPG also documented that the OARs should be applied when an ankle fracture is suspected [10]. In this study, < 5% of orthopaedic surgeons considered the OARs in the examination of LAS, indicating that the OARs may not be popular in clinical practice by general orthopaedic surgeons in the management of LAS, and that plain radiography may be unnecessarily performed in some cases. Many studies were conducted in the emergency department setting or investigated treatment by general practitioners [15, 17, 26,27,28]. Therefore, general orthopaedic surgeons may pay limited attention to these studies or discussion on the OARs. However, Pires et al. found that a subjective analysis by orthopaedic surgeons to predict fractures had a higher specificity than the Ottawa ankle rules, suggesting that the clinical significance and usefulness of the Ottawa ankle rules might differ among emergent doctors and orthopaedic surgeons [30]. No studies, as far as we know, have yet resolved these issues. Further studies will be required to assess the difference in the recognition of OARs among emergency doctors, orthopaedic surgeons, and health providers. Papacostas et al. reported that the sensitivity of OARs was 100% when performed by orthopaedic residents or sports medicine doctors [27], suggesting the probability of a reduction in excessive radiation exposure and medical cost when orthopaedic physicians apply the OARs.

In the present study, 46.5% of the respondents reported using ultrasonography (US) to evaluate patients with LAS. Several authors have reported the validity of US in the assessment of LAS [31, 32]. Oae et al. reported that the accuracy of stress radiography and US in the diagnosis of anterior talofibular ligament injury were 67% and 91%, respectively, with the findings of arthroscopy as a reference [33]. Therefore, while the current CPGs do not mention the role of US in the evaluation of LAS [9, 10], the assessment of a fracture using US may result in an additional reduction of unnecessary radiography. More high-quality studies are needed to evaluate the cost-effectiveness of US, as well as the validity of US in the examination of acute LAS.

The current CPGs recommends that a rehabilitation program, including neuromuscular and proprioceptive exercise should be considered after LAS [3, 9, 10]. It has been demonstrated that exercise therapy reduces the rate of recurrence and functional instability [34, 35]. In the present study, < 60% of doctors prescribed rehabilitation for LAS. This rate may not be high, but was somewhat higher than that reported by Feger et al., who found that only 6.8% of patients with LAS received physical therapy within 30 days after the diagnosis of LAS in the US [13]. This may have been due to the fact that, in the present study, we did not evaluate what percentage of patients who were prescribed rehabilitation actually received rehabilitation. Our study population was also limited to orthopaedic surgeons. According to a systematic review, 45% of patients did not completely recover, with 25% complaining of pain and instability at 3 years after LAS [36]. In addition, considering that 74% of patients with LAS had not fully recovered after a mean follow-up period of 29 months [8], increasing the implementation of rehabilitation therapy by orthopedic surgeons will be necessary to improve the quality of care for LAS. Furthermore, the education of patients, their family, and athletic trainers and coaches—in the case of athletes, will be critical because the adherence to rehabilitation is directly related to the effectiveness of rehabilitation [37]. A poor understanding of the injury and the importance of rehabilitation therapy is a main factor in poor adherence [38]. McKay et al. reported that > 50% of athletes who suffered ankle injuries did not seek medical treatment [39]. Furthermore, it was reported that 64% of patients with CLAI did not seek medical treatment following an initial LAS [6]. These findings reflect a poor understanding of the severity of ankle sprain among patients with LAS.

In the present study, > 60% of the orthopaedic surgeons used only one of the 5 factors (absence of pain, absence of instability, time after LAS, no limitation of the ankle ROM, and absence of swelling) in the RTS decision after LAS. This finding suggests that athletes with LAS return to sports without insufficient evaluation in the clinical settings, which would result in a high risk of recurrent LAS and CLAI. A recent systematic review reported that there were no evidence-based criteria for the RTS decisions in athletes with LAS [19, 20]. The current CPGs recommended that early functional rehabilitation focused on muscle strength and response time, proprioception, and coordination be implemented to hasten RTS after LAS [9, 10]. Wikstrom et al. reported that a consensus was reached on the need to evaluate sports-specific movement in the decision of RTS after LAS; however, this statement was obtained by reviewing only low-level retrospective studies [20]. The lack of evidence regarding the criteria for RTS after conservative treatment has also been reported, not only in the LAS but also in knee ligament injuries [40, 41]. However, given the fact that almost half of LASs occur in athletes [1, 2], and that athletes with LAS are at a high-risk of recurrence [6, 39], high-quality studies are mandatory to construct definitive criteria for RTS after LAS.

Medina McKeon et al. reported that there was no difference in the RTS timeline between new and recurrent ankle sprains, and the most high-school athletes returned to sports within 1–3 days [22]. It was also reported that > 50% of athletes with LAS returned to sports in less than 1 week [36]. Considering that the ligament healing time that is at least more than 6 weeks [42], these findings suggest that the RTS after LAS is too early. In the present study, some surgeons used the time from injury as a criterion for the RTS decision; however, the time to RTS was not assessed in this study. It also remains unclear whether the time to RTS should be changed by the severity and a history (first-time or recurrent) of LAS. Malliaropoulos et al. reported that athletes with a low LAS grade (1 or 2) were at a higher risk of reinjury than those with grade 3 [43]. Further studies are needed to evaluate the relationship between the time to RTS and the recurrence rate after LAS.

There are several limitations in this study. First, we did not evaluate all of the issues described in the CPGs, such as the surgical therapy and the prescription of non-steroidal anti-inflammatory drugs. Second, most questions used in this study were close-ended in order to improve the response rate. Therefore, patient specific factors (age, activity level, severity of injury, etc.) were not completely considered. The present study aimed to assess the general clinical practice of orthopaedic surgeons for LAS, therefore, the results should be interpreted with caution. Third, the respondents to the questionnaire survey were all orthopedic surgeons in Miyazaki; therefore, the results in this study may not reflect the current clinical practice in other regions. As mentioned in the Introduction, the survey in the study region would be appropriate for evaluating the clinical practice by general orthopaedic surgeons in the management of LAS. The response rate of a survey of Canadian orthopedic surgeons to investigate the performance of microfracture surgery for knee chondral defects was 24.6% [44]; thus, the response rate of our study (82.7%) was quite high. In spite of these limitations, this study has clinical relevance, both in its emphasis of the need for further studies—especially in relation to evidence-based decision-making for the RTS—and in the suggestion that interventions to bridge the gap between researchers, clinicians and patients should be considered to improve the treatment of LAS.

Conclusions

The present study reported the current management of LAS by general orthopaedic surgeons in Miyazaki, Japan. Most clinicians did not consider the OARs when performing plain radiography. Rehabilitation following LAS was performed for < 60% of patients with LAS, and no objective criteria for the RTS decision were used for athletes with LAS.

Availability of data and materials

All data are available from the corresponding author upon reasonable request.

Abbreviations

LAS:

Lateral ankle sprain

RTS:

Return to sports

CPG:

Clinical practice guideline

CLAI:

Chronic lateral ankle instability

OAR:

Ottawa ankle rule

ROM:

Range of motion

US:

Ultrasonography

References

  1. 1.

    Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont PJ Jr. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010;92:2279–84.

    PubMed  Article  Google Scholar 

  2. 2.

    Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014;44:123–40.

    PubMed  Article  Google Scholar 

  3. 3.

    Gribble PA, Bleakley CM, Caulfield BM, Docherty CL, Fourchet F, Fong DT, et al. 2016 consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med. 2016;50:1493–5.

    PubMed  Article  Google Scholar 

  4. 4.

    Verhagen EA, van Mechelen W, de Vente W. The effect of preventive measures on the incidence of ankle sprains. Clin J Sport Med. 2000;10:291–6.

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    O’Loughlin PF, Murawski CD, Egan C, Kennedy JG. Ankle instability in sports. Phys Sportsmed. 2009;37:93–103.

    PubMed  Article  Google Scholar 

  6. 6.

    Hubbard-Turner T. Lack of medical treatment from a medical professional after an ankle sprain. J Athl Train. 2019;54:671–5.

    PubMed  PubMed Central  Article  Google Scholar 

  7. 7.

    Hintermann B, Boss A, Schäfer D. Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med. 2002;30:402–9.

    PubMed  Article  Google Scholar 

  8. 8.

    Anandacoomarasamy A, Barnsley L. Long term outcomes of inversion ankle injuries. Br J Sports Med. 2005;39:e14.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  9. 9.

    Kerkhoffs GM, van den Bekerom M, Elders LA, van Beek PA, Hullegie WA, Bloemers GM, et al. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. Br J Sports Med. 2012;46:854–60.

    PubMed  Article  Google Scholar 

  10. 10.

    Vuurberg G, Hoorntje A, Wink LM, van der Doelen BFW, van den Bekerom MP, Dekker R, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52:956.

    PubMed  Article  Google Scholar 

  11. 11.

    Lambers K, Ootes D, Ring D. Incidence of patients with lower extremity injuries presenting to US emergency departments by anatomic region, disease category, and age. Clin Orthop Relat Res. 2012;470:284–90.

    PubMed  Article  Google Scholar 

  12. 12.

    Shah S, Thomas AC, Noone JM, Blanchette CM, Wikstrom EA. Incidence and cost of ankle sprains in United States Emergency Departments. Sports Health. 2016;8:547–52.

    PubMed  PubMed Central  Article  Google Scholar 

  13. 13.

    Feger MA, Glaviano NR, Donovan L, Hart JM, Saliba SA, Park JS, et al. Current trends in the management of lateral ankle sprain in the United States. Clin J Sport Med. 2017;27:145–52.

    PubMed  Article  Google Scholar 

  14. 14.

    Kosik KB, Hoch MC, Humphries RL, Tezanos AGV, Gribble PA. Medications used in U.S. Emergency Departments for an ankle sprain: an analysis of the national hospital ambulatory medical care survey. J Emerg Med. 2019;57:662–70.

    PubMed  Article  Google Scholar 

  15. 15.

    Stiell I, Wells G, Laupacis A, Brison R, Verbeek R, Vandemheen K, et al. Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle injuries. Multicentre ankle rule study group. BMJ. 1995;311:594–7.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  16. 16.

    Barelds I, Krijnen WP, van de Leur JP, van der Schans CP, Goddard RJ. Diagnostic accuracy of clinical decision rules to exclude fractures in acute ankle injuries: systematic review and meta-analysis. J Emerg Med. 2017;53:353–68.

    PubMed  Article  Google Scholar 

  17. 17.

    Boutis K, Komar L, Jaramillo D, Babyn P, Alman B, Snyder B, et al. Sensitivity of a clinical examination to predict need for radiography in children with ankle injuries: a prospective study. Lancet. 2001;358:2118–21.

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Kucera KL, Marshall SW, Wolf SH, Padua DA, Cameron KL, Beutler AI. Association of injury history and incident injury in cadet basic military training. Med Sci Sports Exerc. 2016;48:1053–61.

    PubMed  PubMed Central  Article  Google Scholar 

  19. 19.

    Tassignon B, Verschueren J, Delahunt E, Smith M, Vicenzino B, Verhagen E, et al. Criteria-based return to sport decision-making following lateral ankle sprain injury: a systematic review and narrative synthesis. Sports Med. 2019;49:601–19.

    PubMed  Article  Google Scholar 

  20. 20.

    Wikstrom EA, Mueller C, Cain MS. Lack of consensus on return to sport criteria following lateral ankle sprain: a systematic review of expert opinions. J Sport Rehabil. 2019;29:1–20.

    Google Scholar 

  21. 21.

    Al Bimani SA, Gates LS, Warner M, Bowen C. Factors influencing return to play following conservatively treated ankle sprain: a systematic review. Phys Sportsmed. 2019;47:31–46.

    PubMed  Article  Google Scholar 

  22. 22.

    Medina McKeon JM, Bush HM, Reed A, Whittington A, Uhl TL, McKeon PO. Return-to-play probabilities following new versus recurrent ankle sprains in high school athletes. J Sci Med Sport. 2014;17:23–8.

    PubMed  Article  Google Scholar 

  23. 23.

    Nelson AJ, Collins CL, Yard EE, Fields SK, Comstock RD. Ankle injuries among United States high school sports athletes, 2005–2006. J Athl Train. 2007;42:381–7.

    PubMed  PubMed Central  Google Scholar 

  24. 24.

    Landis JR, Koch GG. The measurement of observer agreement for categorial data. Biometrics. 1977;33:159–74.

    CAS  Article  Google Scholar 

  25. 25.

    Bahr R, Lian O, Bahr IA. A twofold reduction in the incidence of acute ankle sprains in volleyball after the introduction of an injury prevention program: a prospective cohort study. Scand J Med Sci Sports. 1997;7:172–7.

    CAS  PubMed  Article  Google Scholar 

  26. 26.

    Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003;326:417.

    PubMed  PubMed Central  Article  Google Scholar 

  27. 27.

    Papacostas E, Malliaropoulos N, Papadopoulos A, Liouliakis C. Validation of Ottawa ankle rules protocol in Greek athletes: study in the emergency departments of a district general hospital and a sports injuries clinic. Br J Sports Med. 2001;35:445–7.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  28. 28.

    Fiesseler F, Szucs P, Kec R, Richman PB. Can nurses appropriately interpret the Ottawa ankle rule? Am J Emerg Med. 2004;22:145–8.

    PubMed  Article  Google Scholar 

  29. 29.

    Derksen RJ, Bakker FC, Geervliet PC, de Lange-de Klerk ES, Heilbron EA, Veenings B, et al. Diagnostic accuracy and reproducibility in the interpretation of Ottawa ankle and foot rules by specialized emergency nurses. Am J Emerg Med. 2005;23:725–9.

    PubMed  Article  Google Scholar 

  30. 30.

    Pires R, Pereira A, Abreu-E-Silva G, Labronici P, Figueiredo L, Godoy-Santos A, Kfuri M. Ottawa ankle rules and subjective surgeon perception to evaluate radiograph necessity following foot and ankle sprain. Ann Med Health Sci Res. 2014;4:432–5.

    PubMed  PubMed Central  Article  Google Scholar 

  31. 31.

    Szczepaniak J, Ciszkowska-Łysoń B, Śmigielski R, Zdanowicz U. Value of ultrasonography in assessment of recent injury of anterior talofibular ligament in children. J Ultrason. 2015;15:259–66.

    PubMed  PubMed Central  Article  Google Scholar 

  32. 32.

    Ekinci S, Polat O, Günalp M, Demirkan A, Koca A. The accuracy of ultrasound evaluation in foot and ankle trauma. Am J Emerg Med. 2013;31:1551–5.

    PubMed  Article  Google Scholar 

  33. 33.

    Oae K, Takao M, Uchio Y, Ochi M. Evaluation of anterior talofibular ligament injury with stress radiography, ultrasonography and MR imaging. Skeletal Radiol. 2010;39:41–7.

    PubMed  Article  Google Scholar 

  34. 34.

    Zech A, Hübscher M, Vogt L, Banzer W, Hänsel F, Pfeifer K. Neuromuscular training for rehabilitation of sports injuries: a systematic review. Med Sci Sports Exerc. 2009;41:1831–41.

    PubMed  Article  Google Scholar 

  35. 35.

    Loudon JK, Santos MJ, Franks L, Liu W. The effectiveness of active exercise as an intervention for functional ankle instability: a systematic review. Sports Med. 2008;38:553–63.

    PubMed  Article  PubMed Central  Google Scholar 

  36. 36.

    van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma-Zeinstra SM. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med. 2008;121:324–31.

    PubMed  Article  PubMed Central  Google Scholar 

  37. 37.

    Brewer BW, Cornelius AE, Van Raalte JL, Petitpas AJ, Sklar JH, Pohlman MH, et al. Age-related differences in predictors of adherence to rehabilitation after anterior cruciate ligament reconstruction. J Athl Train. 2003;38:158–62.

    PubMed  PubMed Central  Google Scholar 

  38. 38.

    Niven A. Rehabilitation adherence in sport injury: sport physiotherapists’ perceptions. J Sport Rehabil. 2007;16:93–110.

    PubMed  Article  PubMed Central  Google Scholar 

  39. 39.

    McKay GD, Goldie PA, Payne WR, Oakes BW. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med. 2001;35:103–8.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  40. 40.

    Kim C, Chasse PM, Taylor DC. Return to play after medial collateral ligament injury. Clin Sports Med. 2016;35:679–96.

    PubMed  Article  PubMed Central  Google Scholar 

  41. 41.

    Wang D, Graziano J, Williams RJ 3rd, Jones KJ. (2018) Nonoperative treatment of PCL injuries: goals of rehabilitation and the natural history of conservative care. Curr Rev Musculoskelet Med. 2018;11:290–7.

    PubMed  PubMed Central  Article  Google Scholar 

  42. 42.

    Hubbard TJ, Hicks-Little CA. Ankle ligament healing after an acute ankle sprain: an evidence-based approach. J Athl Train. 2008;43:523–9.

    PubMed  PubMed Central  Article  Google Scholar 

  43. 43.

    Malliaropoulos N, Ntessalen M, Papacostas E, Longo UG, Maffulli N. Reinjury after acute lateral ankle sprains in elite track and field athletes. Am J Sports Med. 2009;37:1755–61.

    PubMed  Article  Google Scholar 

  44. 44.

    Theodoropoulos J, Dwyer T, Whelan D, Marks P, Hurtig M, Sharma P. Microfracture for knee chondral defects: a survey of surgical practice among Canadian orthopedic surgeons. Knee Surg Sports Traumatol Arthrosc. 2012;20:2430–7.

    PubMed  Article  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Author information

Affiliations

Authors

Contributions

TY collected data. TY mainly drafted the manuscript, and TT, NY, YM and EC supervised it. All authors had complete access to all data used in this study and take responsibility for its accuracy. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Takuji Yokoe.

Ethics declarations

Ethics approval and consent to participate

Ethical approval of this study was obtained from the institutional review board at Miyazaki University Graduate School of Medicine (Approval No. C-0104–1). This study was performed in accordance with the Declaration of Helsinki. Written informed consent was obtained from all subjects.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yokoe, T., Tajima, T., Yamaguchi, N. et al. The current clinical practice of general orthopaedic surgeons in the treatment of lateral ankle sprain: a questionnaire survey in Miyazaki, Japan. BMC Musculoskelet Disord 22, 636 (2021). https://doi.org/10.1186/s12891-021-04527-8

Download citation

Keywords

  • Lateral ankle sprain
  • Clinical practice
  • Orthopaedic surgeons
  • Questionnaire