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Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium
  1. Eamonn Delahunt1,2,
  2. Chris M Bleakley3,
  3. Daniela S Bossard1,2,
  4. Brian M Caulfield1,4,
  5. Carrie L Docherty5,
  6. Cailbhe Doherty4,
  7. François Fourchet6,
  8. Daniel T Fong7,
  9. Jay Hertel8,
  10. Claire E Hiller9,
  11. Thomas W Kaminski10,
  12. Patrick O McKeon11,
  13. Kathryn M Refshauge9,
  14. Alexandria Remus4,
  15. Evert Verhagen12,
  16. Bill T Vicenzino13,
  17. Erik A Wikstrom14,
  18. Phillip A Gribble15
  1. 1 School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
  2. 2 Institute for Sport and Health, University College Dublin, Dublin, Ireland
  3. 3 Department of Physical Therapy, High Point University, High Point, North Carolina, USA
  4. 4 Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
  5. 5 School of Public Health, Indiana University, Bloomington, Indiana, USA
  6. 6 Motion Analysis Laboratory, Hôpital De La Tour, Geneva, Switzerland
  7. 7 School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
  8. 8 Department of Kinesiology, Curry School of Education, University of Virginia, Charlottesville, Virginia, USA
  9. 9 School of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
  10. 10 Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
  11. 11 School of Health Sciences and Human Performance, Ithaca College, Ithaca, New York, USA
  12. 12 Amsterdam Collaboration on Health and Safety in Sports and Department of Public and Occupational Health, Amsterdam Movement Science, VU University Medical Center, Amsterdam, The Netherlands
  13. 13 School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
  14. 14 Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  15. 15 Division of Athletic Training, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
  1. Correspondence to Dr Eamonn Delahunt, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland; eamonn.delahunt{at}


Lateral ankle sprain injury is the most common musculoskeletal injury incurred by individuals who participate in sports and recreational physical activities. Following initial injury, a high proportion of individuals develop long-term injury-associated symptoms and chronic ankle instability. The development of chronic ankle instability is consequent on the interaction of mechanical and sensorimotor insufficiencies/impairments that manifest following acute lateral ankle sprain injury. To reduce the propensity for developing chronic ankle instability, clinical assessments should evaluate whether patients in the acute phase following lateral ankle sprain injury exhibit any mechanical and/or sensorimotor impairments. This modified Delphi study was undertaken under the auspices of the executive committee of the International Ankle Consortium. The primary aim was to develop recommendations, based on expert (n=14) consensus, for structured clinical assessment of acute lateral ankle sprain injuries. After two modified Delphi rounds, consensus was achieved on the clinical assessment of acute lateral ankle sprain injuries. Consensus was reached on a minimum standard clinical diagnostic assessment. Key components of this clinical diagnostic assessment include: establishing the mechanism of injury, as well as the assessment of ankle joint bones and ligaments. Through consensus, the expert panel also developed the International Ankle Consortium Rehabilitation-Oriented ASsessmenT (ROAST). The International Ankle Consortium ROAST will help clinicians identify mechanical and/or sensorimotor impairments that are associated with chronic ankle instability. This consensus statement from the International Ankle Consortium aims to be a key resource for clinicians who regularly assess individuals with acute lateral ankle sprain injuries.

  • ankle
  • assessment
  • consensus statement
  • physiotherapy
  • sports medicine

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  • Contributors All authors have made substantial contributions to this manuscript. They have all participated in the concept and design, analysis and interpretation of data and drafting and revising the manuscript. All authors have read the manuscript and agreed to submission for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval University College Dublin Human Research Ethics Committee.

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

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