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Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline
  1. Gwendolyn Vuurberg1,2,3,
  2. Alexander Hoorntje1,2,3,
  3. Lauren M Wink1,4,
  4. Brent F W van der Doelen1,2,3,
  5. Michel P van den Bekerom5,
  6. Rienk Dekker6,
  7. C Niek van Dijk1,2,3,
  8. Rover Krips7,
  9. Masja C M Loogman8,
  10. Milan L Ridderikhof9,
  11. Frank F Smithuis10,
  12. Sjoerd A S Stufkens1,
  13. Evert A L M Verhagen3,4,11,
  14. Rob A de Bie12,
  15. Gino M M J Kerkhoffs1,2,3
  1. 1Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
  3. 3Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands
  4. 4VU Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
  5. 5Department of Orthopaedic Surgery, Onze Lieve Vrouwen Gasthuis, Amsterdam, The Netherlands
  6. 6Dutch Society of Rehabilitation, University of Groningen, University Medical Center, Groningen, The Netherlands
  7. 7Department of Orthopaedic Surgery, Flevoziekenhuis, Almere, The Netherlands
  8. 8Dutch College of General Practitioners, Utrecht, The Netherlands
  9. 9Emergency Department, Academic Medical Center, Amsterdam, The Netherlands
  10. 10Department of Musculoskeletal Radiology, Academic Medical Center, Amsterdam, The Netherlands
  11. 11Department of of Public and Occupational Health VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
  12. 12Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
  1. Correspondence to Gwendolyn Vuurberg, Academic Medical Center, Amsterdam 1105 AZ, The Netherlands; g.vuurberg{at}


This guideline aimed to advance current understandings regarding the diagnosis, prevention and therapeutic interventions for ankle sprains by updating the existing guideline and incorporate new research. A secondary objective was to provide an update related to the cost-effectiveness of diagnostic procedures, therapeutic interventions and prevention strategies. It was posited that subsequent interaction of clinicians with this guideline could help reduce health impairments and patient burden associated with this prevalent musculoskeletal injury. The previous guideline provided evidence that the severity of ligament damage can be assessed most reliably by delayed physical examination (4–5 days post trauma). After correct diagnosis, it can be stated that even though a short time of immobilisation may be helpful in relieving pain and swelling, the patient with an acute lateral ankle ligament rupture benefits most from use of tape or a brace in combination with an exercise programme.

New in this update: Participation in certain sports is associated with a heightened risk of sustaining a lateral ankle sprain. Care should be taken with non-steroidal anti-inflammatory drugs (NSAIDs) usage after an ankle sprain. They may be used to reduce pain and swelling, but usage is not without complications and NSAIDs may suppress the natural healing process. Concerning treatment, supervised exercise-based programmes preferred over passive modalities as it stimulates the recovery of functional joint stability. Surgery should be reserved for cases that do not respond to thorough and comprehensive exercise-based treatment. For the prevention of recurrent lateral ankle sprains, ankle braces should be considered as an efficacious option.

  • ankle sprain
  • sprain prevention
  • guideline
  • inversion trauma
  • cost-effectiveness

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  • Contributors The search and full-text inclusion was performed by GV, AH and BFWvdD. Meta-analyses were performed by GV and LMW. All authors were members of the guideline committee and contributed to the content of this guideline. This manuscript was read and approved by all authors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data used in this study may be found in the reference list or appendix including the flow chart and meta-analyses.

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