Management of lateral ankle sprains in adolescents

Temos aktualumas A lateral ankle sprain (LAS) is one of the most common injury, which occurs in children. Despite large number of studies, diversity of treatment strategies persists. Over 20 years acronym PRICE (protection, rest, ice, compression, elevation) and anti-inflammatory drugs (NSAIDs) is first option, despite its lack of high quality evidence. Lately acronym PEACE and LOVE (protection, elevation, avoid anti-inflammatory drugs and icing, compression, education, load, optimism, vascularisation, exercise) was announced, which involves immediate care and rehabilitation of soft tissue damage. It is thought that phases of inflammation help tissue to heal and NSAIDs combined with icing interferes it, so new strategy excludes this combination. Darbo tikslas (-ai) To compare PRICE vs PEACE and LOVE for LAS treatment, to evaluate injury severity outcomes and to verify the need of plaster cast immobilization in adolescents. Tyrimo metodai A prospective randomised study of 65 (37 male, 28 female) patients from 12 to 17 years old who admitted LUHS Paediatric emergency department (ED) in year 2022- 2024 after LAS was executed. Inclusion criteria were first time LAS, acute period of 1 to 4 days after injury, exclusion of chronic pain and any fracture, except avulsion. Depending on symptoms immobilization by plaster cast was applied for 30 patients (46,2%) in the ED. At first visit to the policlinics cast was removed for all of them, lace-up splint was prescribed to all 65 patients and they were randomly allocated to two age and gender homogenous groups: classic (A) PRICE (n = 32, male 62,5%, female 37,5%) or new (B) PEACE and LOVE (n = 33, male 51,5%, female 48,5%) treatment method. Patient diagnose was confirmed by x rays and ultrasound system MyLab 9 eXP 20071, Esaote S.p.A., CE 0123. Ankle function was tested by Biodex isokinetic dynamometer to compare range of motion (ROM) and peak torque to body weight (PEAK TQ/BW) of inversion (IN) and eversion (EV), Y balance test composite scores (YBT CS) were counted to evaluate proprioception between involved (I) and uninvolved (U) legs 1 to 2, 5 to 7 and 12 to 15 weeks after injury comparing two methods. Depending on radiologic findings patients were divided into two groups: I – diagnosed with sprains (grade I) or partial tears (grade II) of lateral ankle ligaments; II – diagnosed with complete tears (grade III) and/or avulsions of lateral malleolus. Data analysis was performed by IBM SPSS 22 software. Two independent samples were compared by Mann-Whitney U test, three measurements in each group were compared by Friedman test. Rezultatai Mean patient age in group was A 14,31 (SD 1,67), in group B 14,64 (SD 1,64). Depending on injury severity 30 patients (46.2%) formed group I and 35 patients (53.8%) group II. There was a significant difference measuring YBT CS deficiencies between U and I legs in group I and II after third testing: YBT-3 CS group I -0,47% vs group II 1,43% (U=353, p=0,02). Only first Biodex testing showed higher deficit of IN for I leg: 1 PEAK TQ/BW IN group I 27,43% vs group II 37,77% (U=358, p=0,028) but later testings showed no significant difference depending on injury severity. Group II showed significantly higher ROM deficit at second and third testing: 2 ROM group I 27,83 ° vs 37,43 ° (U=370, p=0,04), 3 ROM group I 26,53 ° vs 38,54 ° (U=331, p=0,011). Immobilization by plaster cast in the ED was applied to total of 30 (46,15%) patients: 12 (40,0%) group I and 18 (51,4%) group II patients (p=0,357). Application of plaster cast had no better outcomes over 3 testings in IN, EV or ROM: : 3 PEAK TQ/BW IN cast group 31,62% vs no cast group 34,19% (U=483,5, p=0,585); 3 PEAK TQ/BW EV cast group 29,8% vs no cast group 35,74% (U=429, p=0,206); 3 ROM cast group 33,40 ° vs no cast group 32,66 ° (U=513, p=0,875). Two different treatment strategies were compared by Friedman test, pairwise comparisons were performed and B treatment method showed significant better results in YBT CS, PEAK TQ/BW IN and ROM deficit scores: group A YBT CS-1 2,28% and YBT CS-3 1,7% vs group B YBT CS-1 2,42% and YBT CS-3 1,61% (p=0,003); group A 1 PEAK TQ/BW IN 2,09 and 3 PEAK TQ/BW IN 1,84 vs group B 1 PEAK TQ/BW IN 2,27 and 3 PEAK TQ/BW IN 1,68 (p=0,049); group A 1 ROM 2,59 ° and 3 ROM 1,45 ° vs group B 1 ROM 2,64 ° and 3 ROM 1,47 ° (p<0,001). Išvados, rekomendacijos Higher grade of lateral ankle ligaments tear has no significant impact on ankle proprioception outcomes, but has impairement of ROM and early post injury inversion force. Immobilization by plaster cast is used too often even for minor injuries because it has no better outcomes for LAS treatment, it should be used as short as possible and only for pain control. PEACE and LOVE treatment method showed better results than PRICE in YBT CS, ROM and inversion force.