title: A comparative, prospective, and randomized study of two conservative treatment protocols for first-episode lateral ankle ligament injuries.
abstract: BACKGROUND
  The objective of this study was to investigate functional results, the amount of time that patients missed from regular working activities, and the incidence of residual mechanical ankle instability following conservative treatment of a first episode of severe lateral ankle ligament sprain (with articular instability).
  
  
  METHODS
  This prospective and randomized study included 186 patients with severe lateral ankle ligament injuries, who were randomly assigned into 2 conservative treatment groups. In group A, participants were treated with a walking boot with weight-bearing allowed, pain management, ice, and elevation with restricted joint mobilization for 3 weeks. In group B, patients were treated with a functional brace for 3 weeks. After this period, patients from both groups were placed in a short, functional brace for an additional 3 weeks, during which they also started a rehabilitation program.
  
  
  RESULTS
  No statistically significant difference was found in pain intensity score between the 2 groups; however, functional evaluations based on the AOFAS ankle and hindfoot score system showed a statistically significant improvement in the group treated with the functional brace. In addition, the average recovery period necessary for patients of group B to resume their duties was shorter than that for patients in group A. No significant difference was detected in residual mechanical ankle instability between the 2 groups.
  
  
  CONCLUSIONS
  Patients with severe lateral ankle ligament lesions treated with a functional brace were shown to exhibit somewhat better results than those treated with a walking boot, and both methods presented a very low incidence of residual chronic instability. We found adequate conservative treatment was sufficient to reestablish ankle stability and that functional treatment had a marginally better clinical short-term outcome with a shorter average recovery period.
  
  
  METHODS
  Level I, prospective randomized study.
authors.affiliation: Hospital Albert Einstein, São Paulo, Brazil.
authors.forename: Marcelo Pires
authors.initials: MP
authors.lastname: Prado
authors.forename: Alberto Abussamra Moreira
authors.initials: AA
authors.lastname: Mendes
authors.forename: Daniel Tasseto
authors.initials: DT
authors.lastname: Amodio
authors.forename: Gilberto Luis
authors.initials: GL
authors.lastname: Camanho
authors.forename: Niall A
authors.initials: NA
authors.lastname: Smyth
authors.forename: Tulio Diniz
authors.initials: TD
authors.lastname: Fernandes
mesh_terms: D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000628:therapy*; D000843:Ankle Joint / Q000000981:diagnostic imaging; D001915:Braces; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000628:therapy*; D008023:Ligaments, Articular / Q000293:injuries*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D011859:Radiography; D016896:Treatment Outcome; D055815:Young Adult
keywords: acute ankle sprain; conservative treatment; functional treatment; residual instability