In search of optimal conservative treatment method for lateral ankle sprains in adolescents

Abstract

Introduction 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 NSAID’s combined with icing interferes it, so new strategy excludes this combination. Aims and Objectives To compare PRICE vs PEACE and LOVE for LAS treatment and to evaluate injury severity outcomes in adolescents. Materials and methods A prospective randomised study of 33 (18 male, 15 female) patients from 12 to 17 years old who admitted LUHS Paediatric emergency department in year 2022 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. Patients were randomly allocated to classic (A) PRICE (n = 16, male 61.1 %, female 38.9 %) or new (B) PEACE and LOVE (n = 17, male 50 %, female 50 %) 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 and 5 to 7 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. Results Mean patient age was 15.19 (SD 1.54). Depending on injury severity 15 patients (46.9 %) formed group I and 17 patients (53.1 %) group II. There was no significant difference measuring deficiencies between U and I legs in group I and II in both testing: YBT-1 CS group I 15.46 % vs group II 17.41 % (U = 112, p = 0.558); YBT-2 CS group I 12,30 % vs 15 % (U = 68, p = 0.393); 1 PEAK TQ/BW IN group I 15.17 % vs group II 17.68 % (U = 108, p = 0.450); 1 PEAK TQ/BW EV group I 14.60 % vs group II 18.18 % (U = 99, p = 0,282); 2 PEAK TQ/BW IN group I 15.90 % vs group II 12.88 % (U = 66, p = 0.340); 2 PEAK TQ/BW EV group I 12.85 % vs group II 14.68 % (U = 73.5, 0 = 0,564); 1 ROM group I 13.47° vs group II 19.18° (U = 82, p = 0.086); 2 ROM group I 11.35° vs 15.56° (U = 58.5, p = 0.183). […].