Ankle supports prevent ankle ligament injury during high-risk sporting activities

Objective. To systematically review the effectiveness of interventions for the prevention of ankle ligament injuries in physically active individuals. Data sources. Studies were identified by searching Medline (1966-1996), Embase (1980-1996), CINAHL (1982-1996) and Current Contents (to March 1997) and by examining the trials database of the Cochrane Musculoskeletal Injuries group. Additionally, relevant organisations and authors of the above papers were contacted. The bibliographies of all located papers were searched. Study selection. Randomised clinical studies of prevention were selected if they included adolescent to middle age individuals at risk of or with a history of prior ankle injury. Trials were excluded if preventive strategies were tested in laboratory conditions or if the outcomes of the trials were not clinically meaningful. The outcome measures included the incidence and severity of injury, complications following injury, self-reported instability and the costs of injury prevention and management. Data extraction. Trials meeting the selection criteria were independently reviewed by four review authors for methodological quality and data on intervention and outcomes were extracted. Five trials with data on 3954 participants met the selection criteria. All five trials evaluated external supports (semi-rigid orthosis, air-cast brace or high top shoe) and one evaluated co-ordination training using a wobble-board. No trials of taping or adapted training programs met the selection criteria. The use of external ankle supports resulted in a significant reduction in the number of ankle sprains (odds ratio 0.49; 95 per cent CI 0.36 to 0.66) with a greater risk reduction for subjects with previous ankle sprains (odds ratio 0.31, 95 per cent CI 0.19 to 0.49). The use of ankle supports did not appear to affect injury severity or the incidence of other leg injuries. Wobble-board training provided a similar protective effect (odds ratio 0.30; 95 per cent CI 0.15 to 0.60) however this intervention was evaluated only in one trial and only for subjects with previous ankle sprain. The protective effect of high top shoes is unclear. Conclusions. There is good evidence that semi-rigid orthoses or air-cast braces prevent ankle ligament injuries during high-risk sporting activities. Participants with a history of previous ankle sprain can be advised that wearing such supports will reduce the risk of future sprain. Weaker evidence exists to suggest that wobble-board training prevents injury recurrence in those with previous ankle sprains. The protective effect of high top shoes is unclear, and there is no evidence available to evaluate the effect of prevention strategies such as taping or adaptive training programs.