Background: Ruptures of the lateral ankle
ligaments are very common; however, treatment remains controversial.
The aim of the current study was to perform a meta-analysis of randomized,
controlled clinical trials of existing treatment strategies for
acute ruptures of the lateral ankle ligaments.
Methods: Randomized, controlled trials reported
between 1966 and 1998 were included if they involved acute ruptures
of the lateral ankle ligaments. Randomized, controlled trials are
defined as comparative studies with an intervention group and a control
group in which the assignment of participants to a group is determined
by the formal procedure of randomization. Summary measures of effectiveness
were expressed as relative risks with use of random effects modeling.
Results: When analyzing the trials, we searched
for comparable outcome measures in both short and long-term follow-up
studies (studies with six months to 3.8 years of follow-up). This
resulted in the analyses of three outcome measures: time lost from work,
residual pain, and giving-way. This report summarizes the results
of twenty-seven trials. With respect to giving-way, a significant
difference was noted between operative treatment and functional
treatment (relative risk, 0.23; 95 percent confidence interval,
0.17 to 0.31) in favor of operative treatment and a significant
difference was also noted between functional treatment and treatment
with a cast for six weeks (relative risk, 0.69; 95 percent confidence
interval, 0.50 to 0.94) in favor of functional treatment. With respect
to residual pain, no significant difference was found between operative
and functional treatment and a significant difference was found
between functional treatment and treatment with a cast for six weeks
(relative risk, 0.67; 95 percent confidence interval, 0.50 to 0.90).
We found minimal or no treatment to result in more residual pain
(relative risk, 0.53; 95 percent confidence interval, 0.27 to 1.02)
and giving-way (relative risk, 0.34; 95 percent confidence interval,
0.17 to 0.71) than did functional treatment.
Conclusions: We concluded 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 immobilization for six weeks.