Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline

British Journal of Sports Medicine - Tập 52 Số 15 - Trang 956-956 - 2018
Gwendolyn Vuurberg1, Alexander Hoorntje2,3,4, Lauren M. Wink4,5, Brent F W van der Doelen2,3,4, Michel P.J. van den Bekerom6, Rienk Dekker7, C. Niek van Dijk2,3,4, Rover Krips8, Masja Loogman9, Milan L. Ridderikhof10, Frank F. Smithuis11, Sjoerd A.S. Stufkens4, Evert Verhagen3,12,5, Rob A. de Bie13, Gino M. M. J. Kerkhoffs2,3,4
1Academic Medical Center, Amsterdam 1105 AZ, The Netherlands
2Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
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
4Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
5VU Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
6Department of Orthopaedic Surgery, Onze Lieve Vrouwen Gasthuis, Amsterdam, The Netherlands
7Dutch Society of Rehabilitation, University of Groningen, University Medical Center, Groningen, The Netherlands
8Department of Orthopaedic Surgery, Flevoziekenhuis, Almere, The Netherlands
9Dutch College of General Practitioners, Utrecht, The Netherlands
10Emergency Department, Academic Medical Center, Amsterdam, The Netherlands
11Department of Musculoskeletal Radiology, Academic Medical Center, Amsterdam, The Netherlands
12Department of of Public and Occupational Health VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
13Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands

Tóm tắt

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.

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Tài liệu tham khảo

Hertel, 2002, Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability, J Athl Train, 37, 364

10.2165/00007256-199927010-00005

10.1007/s40279-013-0102-5

10.1097/00042752-200010000-00012

Pijnenburg, 2000, Treatment of ruptures of the lateral ankle ligaments: a meta-analysis, J Bone Joint Surg Am, 82, 761, 10.2106/00004623-200006000-00002

10.1016/j.amjmed.2007.11.018

10.1136/bjsports-2016-096188

10.1249/MSS.0b013e3181de7a8a

10.2519/jospt.2013.0303

10.1136/bjsports-2013-093175

10.4085/1062-6050-49.1.14

10.1136/bjsports-2016-096189

10.2106/JBJS.I.01176

10.1136/bjsports-2011-090490

Ouzzani, 2016, Rayyan-a web and mobile app for systematic reviews, Syst Rev, 5, 210, 10.1186/s13643-016-0384-4

Vernooij, 2017, Reporting Items for Updated Clinical Guidelines: Checklist for the Reporting of Updated Guidelines (CheckUp), PLoS Med, 14, e1002207, 10.1371/journal.pmed.1002207

10.1016/S0004-9514(14)60376-7

10.1136/bjsm.2006.029645

Kobayashi, 2013, Intrinsic Predictive Factors of Noncontact Lateral Ankle Sprain in Collegiate Athletes: A Case-Control Study, Orthop J Sports Med, 1, 232596711351816, 10.1177/2325967113518163

Tropp, 1984, Stabilometry in functional instability of the ankle and its value in predicting injury, Med Sci Sports Exerc, 16, 64, 10.1249/00005768-198401000-00013

10.1177/0363546505284191

de Noronha, 2013, Intrinsic predictive factors for ankle sprain in active university students: a prospective study, Scand J Med Sci Sports, 23, 541, 10.1111/j.1600-0838.2011.01434.x

10.1177/1941738115623775

10.1136/bjsm.2005.024356

10.1177/0363546504268137

10.1055/s-2007-964897

10.1016/j.apmr.2006.02.024

Watson, 1999, Ankle sprains in players of the field-games Gaelic football and hurling, J Sports Med Phys Fitness, 39, 66

10.1177/0363546509350757

10.1016/j.gaitpost.2013.02.001

Onate, 2016, Physical Exam Risk Factors for Lower Extremity Injury in High School Athletes: A Systematic Review, Clin J Sport Med, 26, 435, 10.1097/JSM.0000000000000284

10.1136/bjsm.2006.032672

10.1136/bjsm.2008.048462

10.1177/0363546512449602

Hagen, 2016, The angle-torque-relationship of the subtalar pronators and supinators in male athletes: A comparative study of soccer and handball players, Technol Health Care, 24, 391, 10.3233/THC-161138

10.1097/JSM.0b013e31827d21fe

10.1177/0363546505280427

10.1177/0363546503262177

Engebretsen, 2010, Intrinsic risk factors for acute ankle injuries among male soccer players: a prospective cohort study, Scand J Med Sci Sports, 20, 403, 10.1111/j.1600-0838.2009.00971.x

10.2165/00007256-200737010-00006

10.1136/bjsm.2003.005785

Bahr, 1997, Incidence of acute volleyball injuries: a prospective cohort study of injury mechanisms and risk factors, Scand J Med Sci Sports, 7, 166, 10.1111/j.1600-0838.1997.tb00134.x

10.1136/bjsm.2006.027623

10.1249/01.MSS.0000074563.61975.9B

10.1177/0363546512458888

Kofotolis, 2007, Ankle sprain injuries: a 2-year prospective cohort study in female Greek professional basketball players, J Athl Train, 42, 388

10.1177/0363546506294857

Foster, 2012, The influence of heel height on frontal plane ankle biomechanics: implications for lateral ankle sprains, Foot Ankle Int, 33, 64, 10.3113/FAI.2012.0064

10.1016/j.amjmed.2007.11.018

10.1093/fampra/cmw076

van Middelkoop, 2012, Re-sprains during the first 3 months after initial ankle sprain are related to incomplete recovery: an observational study, J Physiother, 58, 181, 10.1016/S1836-9553(12)70109-1

10.1053/j.jfas.2014.06.001

10.1177/0363546516628870

10.1007/s00167-015-3852-9

10.1016/j.apmr.2009.01.020

10.3113/FAI.2008.0305

Linde, 1986, Early mobilizing treatment in lateral ankle sprains. Course and risk factors for chronic painful or function-limiting ankle, Scand J Rehabil Med, 18, 17, 10.2340/165019771986181721

10.2519/jospt.2015.5653

10.1016/j.pmrj.2014.06.014

10.1016/S0004-9514(09)70040-6

O’Connor, 2013, Predicting functional recovery after acute ankle sprain, PLoS One, 8, 10.1371/journal.pone.0072124

10.2522/ptj.20090420

10.1136/bmj.326.7386.417

Knudsen, 2010, Validation of the Ottawa ankle rules in a Danish emergency department, Dan Med Bull, 57, A4142

Jonckheer, 2016, Evaluating fracture risk in acute ankle sprains: Any news since the Ottawa Ankle Rules? A systematic review, Eur J Gen Pract, 22, 31, 10.3109/13814788.2015.1102881

Meena, 2015, Validation of the Ottawa Ankle Rules in Indian Scenario, Arch Trauma Res, 4, e20969, 10.5812/atr.4(2)2015.20969

Wang, 2013, Clinical value of the Ottawa ankle rules for diagnosis of fractures in acute ankle injuries, PLoS One, 8, 10.1371/journal.pone.0063228

10.1302/0301-620X78B6.1283

10.3109/17453679608997757

10.1016/S0735-6757(98)90219-4

10.1136/adc.2004.066647

10.1016/j.injury.2006.07.028

10.1067/mem.2002.121397

Derksen, 2015, Diagnostic performance of the Bernese versus Ottawa ankle rules: Results of a randomised controlled trial, Injury, 46, 1645, 10.1016/j.injury.2015.03.038

Konradsen, 1991, Early mobilizing treatment for grade III ankle ligament injuries, Foot Ankle, 12, 69, 10.1177/107110079101200202

10.1136/bjsports-2012-090319

Lin, 2013, Quantitative evaluation of the viscoelastic properties of the ankle joint complex in patients suffering from ankle sprain by the anterior drawer test, Knee Surg Sports Traumatol Arthrosc, 21, 1396, 10.1007/s00167-013-2459-2

Polzer, 2012, Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm, Orthop Rev, 4, 5

Yammine, 2011, Ankle "sprains" during sport activities with normal radiographs: Incidence of associated bone and tendon injuries on MRI findings and its clinical impact, Foot, 21, 176, 10.1016/j.foot.2011.05.002

10.1016/j.ejrad.2015.09.028

10.1177/0363546514529643

Margetić, 2012, Comparative assessment of the acute ankle injury by ultrasound and magnetic resonance, Coll Antropol, 36, 605

Margetic, 2009, The Value of Ultrasound in Acute Ankle Injury: Comparison With MR, Eur J Trauma Emerg Surg, 35, 141, 10.1007/s00068-008-7174-1

10.1177/0363546503260757

van den Bekerom, 2012, What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?, J Athl Train, 47, 435, 10.4085/1062-6050-47.4.14

Coté, 1988, Comparison of three treatment procedures for minimizing ankle sprain swelling, Phys Ther, 68, 1072, 10.1093/ptj/68.7.1072

Airaksinen, 1990, Elastic bandages and intermittent pneumatic compression for treatment of acute ankle sprains, Arch Phys Med Rehabil, 71, 380

Rucinkski, 1991, The effects of intermittent compression on edema in postacute ankle sprains, J Orthop Sports Phys Ther, 14, 65, 10.2519/jospt.1991.14.2.65

Tsang, 2003, Volume decreases after elevation and intermittent compression of postacute ankle sprains are negated by gravity-dependent positioning, J Athl Train, 38, 320

10.1136/bjsm.2006.025932

10.1136/bmj.c1964

Hing, 2011, Comparison of multimodal physiotherapy and "R.I.C.E."self- treatment for early management of ankle sprains, New Zealand Journal of Physiotherapy, 39, 13

10.1007/s00167-014-2851-6

10.1136/emj.11.3.178

Predel, 2012, Efficacy and Safety of Diclofenac Diethylamine 2.32% Gel in Acute Ankle Sprain, Medicine & Science in Sports & Exercise, 44, 1629, 10.1249/MSS.0b013e318257ed41

10.1177/0300060513487639

10.1177/1071100716650530

10.1177/030006059001800205

Ekman, 2002, Efficacy of celecoxib versus ibuprofen in the treatment of acute pain: a multicenter, double-blind, randomized controlled trial in acute ankle sprain, Am J Orthop, 31, 445

10.1177/0363546505283261

Morán, 1990, An observer-blind comparison of diclofenac potassium, piroxicam and placebo in the treatment of ankle sprains, Curr Med Res Opin, 12, 268, 10.1185/03007999009111657

10.1177/030006059101900205

10.1097/00042752-200407000-00005

Nadarajah, 2006, Efficacy and tolerability of celecoxib compared with diclofenac slow release in the treatment of acute ankle sprain in an Asian population, Singapore Med J, 47, 534

Cardenas-Estrada, 2009, Efficacy and safety of celecoxib in the treatment of acute pain due to ankle sprain in a Latin American and Middle Eastern population, J Int Med Res, 37, 1937, 10.1177/147323000903700632

Hajimaghsoudi, 2013, Naproxen Twice Daily Versus as Needed (PRN) Dosing: Efficacy and Tolerability for Treatment of Acute Ankle Sprain, a Randomized Clinical Trial, Asian J Sports Med, 4, 249, 10.5812/asjsm.11411

10.1016/j.annemergmed.2006.05.015

Kayali, 2007, The efficacy of paracetamol in the treatment of ankle sprains in comparison with diclofenac sodium, Saudi Med J, 28, 1836

Lyrtzis, 2011, Efficacy of paracetamol versus diclofenac for Grade II ankle sprains, Foot Ankle Int, 32, 571, 10.3113/FAI.2011.0571

Aghababian, 1986, Comparison of diflunisal and acetaminophen with codeine in the management of grade 2 ankle sprain, Clin Ther, 8, 520

Stovitz, 2003, NSAIDs and musculoskeletal treatment: what is the clinical evidence?, Phys Sportsmed, 31, 35, 10.3810/psm.2003.01.160

Fotiadis, 2011, Are venotonic drugs effective for decreasing acute posttraumatic oedema following ankle sprain? A prospective randomized clinical trial, Arch Orthop Trauma Surg, 131, 389, 10.1007/s00402-011-1266-9

10.1016/j.jemermed.2015.03.021

González de Vega, 2013, Traumeel vs. diclofenac for reducing pain and improving ankle mobility after acute ankle sprain: a multicentre, randomised, blinded, controlled and non-inferiority trial, Int J Clin Pract, 67, 979, 10.1111/ijcp.12219

10.1097/JSM.0b013e3180f6169f

10.3810/PSM.2009.04.1684

Kerkhoffs, 2002, Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults, The Cochrane database of systematic reviews, 3, CD003762

Naeem, 2015, Assessment of functional treatment versus plaster of Paris in the treatment of grade 1 and 2 lateral ankle sprains, J Orthop Traumatol, 16, 41, 10.1007/s10195-014-0289-8

Uslu, 2015, Cohesive taping and short-leg casting in acute low-type ankle sprains in physically active patients, J Am Podiatr Med Assoc, 105, 307, 10.7547/13-130.1

10.1016/S0140-6736(09)60206-3

Bilgic, 2015, Comparison of two main treatment modalities for acute ankle sprain, Pak J Med Sci, 31, 1496, 10.12669/pjms.316.8210

10.1177/1071100713519776

10.1016/j.ajem.2014.05.054

Noh, 2010, Outcome of the functional treatment of first-time ankle inversion injury, J Orthop Sci, 15, 524, 10.1007/s00776-010-1481-1

Kerkhoffs, 2002, Different functional treatment strategies for acute lateral ankle ligament injuries in adults, The Cochrane database of systematic reviews, 3, CD002938

van den Bekerom, 2016, Randomized comparison of tape versus semi-rigid and versus lace-up ankle support in the treatment of acute lateral ankle ligament injury, Knee Surg Sports Traumatol Arthrosc, 24, 978, 10.1007/s00167-015-3664-y

10.1186/s13047-015-0069-6

10.2165/11584370-000000000-00000

10.1016/j.jsams.2012.03.008

10.1249/MSS.0b013e3181a3cf0d

10.1016/S0004-9514(06)70059-9

10.1016/S0004-9514(08)70061-8

10.1016/j.math.2012.02.016

10.1136/bmj.c5688

10.3109/14038190903174262

10.3113/FAI.2010.0523

Cleland, 2013, Manual Physical Therapy and Exercise Versus Supervised Home Exercise in the Management of Patients With Inversion Ankle Sprain: A Multicenter Randomized Clinical Trial, Journal of Orthopaedic & Sports Physical Therapy, 43, 443, 10.2519/jospt.2013.4792

10.1016/j.csm.2014.12.001

van Os, 2005, Comparison of Conventional Treatment and Supervised Rehabilitation for Treatment of Acute Lateral Ankle Sprains: A Systematic Review of the Literature, Journal of Orthopaedic & Sports Physical Therapy, 35, 95, 10.2519/jospt.2005.35.2.95

Hing, 2011, Comparison of multimodal physiotherapy and "R.I.C.E." self-treatment for early management of ankle sprains, New Zealand Journal of Physiotherapy, 39, 13

van Rijn, 2007, Supervised exercises for adults with acute lateral ankle sprain: a randomised controlled trial, Br J Gen Pract, 57, 793

Punt, 2016, Wii Fit™ exercise therapy for the rehabilitation of ankle sprains: Its effect compared with physical therapy or no functional exercises at all, Scand J Med Sci Sports, 26, 816, 10.1111/sms.12509

10.1136/bjsports-2013-092763

10.1016/j.jmpt.2008.09.013

Mobarakeh, 2015, Effect of Friction Technique on Ankle Sprain Grade II Treatment, Biomedical & Pharmacology Journal, 8, 523, 10.13005/bpj/794

Truyols-Domínguez, 2013, Efficacy of thrust and nonthrust manipulation and exercise with or without the addition of myofascial therapy for the management of acute inversion ankle sprain: a randomized clinical trial, Journal of Orthopaedic & Sports Physical Therapy, 43, 300, 10.2519/jospt.2013.4467

Cosby, 2011, Immediate effects of anterior to posterior talocrural joint mobilizations following acute lateral ankle sprain, Journal of Manual & Manipulative Therapy, 19, 76, 10.1179/2042618610Y.0000000005

van Ochten, 2014, Chronic Complaints After Ankle Sprains: A Systematic Review on Effectiveness of Treatments, Journal of Orthopaedic & Sports Physical Therapy, 44, 862, 10.2519/jospt.2014.5221

Struijs PA , Kerkhoffs GM . Ankle sprain. BMJ Clin Evid 2010;2010.

Kerkhoffs, 2007, Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults, Cochrane Database Syst Rev, 8, Cd000380

10.1007/s00402-013-1742-5

Han, 2012, A Meta-analysis of treatment methods for acute ankle sprain, Pakistan Journal of Medical Sciences, 28, 895

Van Der Windt, 2002, Ultrasound therapy for acute ankle sprains, The Cochrane database of systematic reviews, 1, CD001250

van den Bekerom, 2012, Therapeutic ultrasound for acute ankle sprains, Eur J Phys Rehabil Med, 48, 325

10.1016/S0003-9993(98)90237-4

Mendel, 2010, Effect of high-voltage pulsed current on recovery after grades i and ii lateral ankle sprains, J Sport Rehabil, 19, 399, 10.1123/jsr.19.4.399

Feger, 2015, Electrical stimulation as a treatment intervention to improve function, edema or pain following acute lateral ankle sprains: A systematic review, Physical Therapy in Sport, 16, 361, 10.1016/j.ptsp.2015.01.001

10.1590/S1413-35552010000300012

Barker, 1985, Porter J. A double-blind clinical trial of lower power pulsed shortwave therapy in the treatment of a soft tissue injury, Physical therapy, 71, 500

Michlovitz, 1988, Ice and high voltage pulsed stimulation in treatment of acute lateral ankle sprains, Journal of Orthopaedic & Sports Physical Therapy, 9, 301, 10.2519/jospt.1988.9.9.301

Pasila, 1978, Pulsating shortwave diathermy: value in treatment of recent ankle and foot sprains, Archives of physical medicine and rehabilitation, 59, 383

Pennington, 1993, Pulsed, non-thermal, high-frequency electromagnetic energy (DIAPULSE) in the treatment of grade I and grade II ankle sprains, Mil Med, 158, 101, 10.1093/milmed/158.2.101

10.1136/bmj.2.5808.269

10.1186/1472-6882-13-55

Kim, 2014, Acupuncture for treating acute ankle sprains in adults, Cochrane Database Syst Rev, 46, CD009065

10.3810/psm.2009.12.1739

Stasinopoulos, 2017, The use of Bioptron light (polarized, polychromatic, non-coherent) therapy for the treatment of acute ankle sprains, Disabil Rehabil, 39, 450, 10.3109/09638288.2016.1146357

NederlandsHuisartsenGenootschap. Informatie-uitwisseling tussen huisarts en specialist bij verwijzingen. Blad voor de huisarts, 2008.

KNGF. Richtlijn acuut lateraal enkelbandletsel, 2011.

Belo J , Buis P , Rv R , et al . NHG-Standaard Enkelbandletsel (tweede herziening). Huisarts Wet 2012;55.

Wilson, 2015, The Effects of Kinesiotape Applied to the Lateral Aspect of the Ankle: Relevance to Ankle Sprains – A Systematic Review, PLoS One, 10, 10.1371/journal.pone.0124214

Handoll, 2001, Interventions for preventing ankle ligament injuries, The Cochrane database of systematic reviews, 3, CD000018

10.1136/bjsm.2010.076406

10.1177/1941738115593441

10.1016/j.jsams.2014.04.005

10.1136/bmj.b2684

10.1177/036354658501300408

10.1097/00005768-200112000-00003

Holme, 1999, The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain, Scand J Med Sci Sports, 9, 104, 10.1111/j.1600-0838.1999.tb00217.x

Wester, 1996, Wobble board training after partial sprains of the lateral ligaments of the ankle: a prospective randomized study, Journal of Orthopaedic & Sports Physical Therapy, 23, 332, 10.2519/jospt.1996.23.5.332

10.1503/cmaj.1040805

Cumps, 2007, Efficacy of a sports specific balance training programme on the incidence of ankle sprains in basketball, J Sports Sci Med, 6, 212

10.4085/1062-6050-43.3.230

Institute WLD. Ankle & Foot (acute & chronic). Corpus Christi (TX: Work Loss Data Institute, National Guideline Clearinghouse, 2008:152.

10.1016/S1083-7515(02)00031-1

10.1016/S1083-7515(02)00030-X

10.1007/s00167-012-2252-7

Karlsson, 1996, Early functional treatment for acute ligament injuries of the ankle joint, Scand J Med Sci Sports, 6, 341, 10.1111/j.1600-0838.1996.tb00104.x

10.1136/bmj.282.6264.607

Anderson KM . Movement control and cortical activation in functional ankle instability: University of Minnesota, 2008.

Bullock-Saxton, 1994, The influence of ankle sprain injury on muscle activation during hip extension, Int J Sports Med, 15, 330, 10.1055/s-2007-1021069

Wilkerson, 1994, Dynamic ankle stability: mechanical and neuromuscular interrelationships, J Sport Rehabil, 3, 43, 10.1123/jsr.3.1.43

10.1177/036354659602400319

Vaes, 2001, Control of acceleration during sudden ankle supination in people with unstable ankles, Journal of Orthopaedic & Sports Physical Therapy, 31, 741, 10.2519/jospt.2001.31.12.741

van Cingel, 2006, Repeated ankle sprains and delayed neuromuscular response: acceleration time parameters, Journal of Orthopaedic & Sports Physical Therapy, 36, 72, 10.2519/jospt.2006.36.2.72

10.1136/bjsm.33.4.255

10.3113/FAI.2007.0343

10.2519/jospt.2008.2524

10.1055/s-2008-1025777

10.2519/jospt.1997.26.2.78

10.1136/bjsm.2003.011031

10.3310/hta13320

Feger, 2017, Current Trends in the Management of Lateral Ankle Sprain in the United States, Clin J Sport Med, 27, 145, 10.1097/JSM.0000000000000321

10.1016/S0196-0644(95)70108-7

10.1186/1471-2474-8-99

10.1148/radiol.2362041130

Audenaert, 2010, Evaluation and economic impact analysis of different treatment options for ankle distortions in occupational accidents, J Eval Clin Pract, 16, 933, 10.1111/j.1365-2753.2009.01231.x

Fatoye, 2016, The cost-effectiveness of semi-rigid ankle brace to facilitate return to work following first-time acute ankle sprains, J Clin Nurs, 25, 1435, 10.1111/jocn.13255

10.1177/0363546514529642

10.1177/0363546510373470

10.1053/j.jfas.2006.09.005

10.1136/bjsports-2016-096178

de Vries, 2008, Arthroscopic capsular shrinkage for chronic ankle instability with thermal radiofrequency: prospective multicenter trial, Orthopedics, 31, 655, 10.3928/01477447-20110505-22

Daş, 2016, Implementation of the Ottawa ankle rules by general practitioners in the emergency department of a Turkish district hospital, Ulus Travma Acil Cerrahi Derg, 22, 361

Kievit J , Verhoeff WWA , Dijkgraaf PB . Rapport AZL-CBO: Sturing van Zorgverlening, Kwaliteit en Informatie. Budgettering op de Afdeling Algemene Heelkunde, Kostenonderzoek en Informatievoorziening. Utrecht: The Netherlands: Nationaal Ziekenhuis Instituut, 1991:19–35.

van Riet, 2000, Minder rontgenfoto’s en toch goede klinische zorg door geprotocolleerde fysische diagnostiek bij enkelletsels, Ned Tijdschr Geneeskd, 144, 224