Sports Medicine ( IF 9.3 ) Pub Date : 2023-05-08 , DOI: 10.1007/s40279-023-01834-z Alexandre Maricot 1 , Emilie Dick 1 , Annemiek Walravens 1 , Bert Pluym 1 , Elke Lathouwers 1 , Kevin De Pauw 1, 2 , Jo Verschueren 1 , Bart Roelands 1 , Romain Meeusen 1, 2 , Bruno Tassignon 1
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Background
Lateral ankle sprains are the most common ankle injuries in sports and have the highest recurrence rates. Almost half of the patients experiencing lateral ankle sprains develop chronic ankle instability. Patients with chronic ankle instability experience persistent ankle dysfunctions and detrimental long-term sequelae. Changes at the brain level are put forward to explain these undesirable consequences and high recurrence rates partially. However, an overview of possible brain adaptations related to lateral ankle sprains and chronic ankle instability is currently lacking.
Objective
The primary purpose of this systematic review is to provide a comprehensive overview of the literature on structural and functional brain adaptations related to lateral ankle sprains and in patients with chronic ankle instability.
Methods
PubMed, Web of Science, Scopus, Embase, EBSCO—SPORTDiscus and Cochrane Central Register of Controlled Trials were systematically searched until 14 December, 2022. Meta-analyses, systematic reviews and narrative reviews were excluded. Included studies investigated functional or structural brain adaptations in patients who experienced a lateral ankle sprain or with chronic ankle instability and who were at least 18 years of age. Lateral ankle sprains and chronic ankle instability were defined following the recommendation of the International Ankle Consortium. Three authors independently extracted the data. They extracted the authors’ name, publication year, study design, inclusion criteria, participant characteristics, the sample size of the intervention and control groups, methods of neuroplasticity testing, as well as all means and standard deviations of primary and secondary neuroplasticity outcomes from each study. Data reported on copers were considered as part of the control group. The quality assessment tool for observational and cross-sectional studies was used for the risk of bias assessment. This study is registered on PROSPERO, number CRD42021281956.
Results
Twenty articles were included, of which only one investigated individuals who experienced a lateral ankle sprain. In all studies combined, 356 patients with chronic ankle instability, 10 who experienced a lateral ankle sprain and 46 copers were included. White matter microstructure changes in the cerebellum have been related to lateral ankle sprains. Fifteen studies reported functional brain adaptations in patients with chronic ankle instability, and five articles found structural brain outcomes. Alterations in the sensorimotor network (precentral gyrus and supplementary motor area, postcentral gyrus and middle frontal gyrus) and dorsal anterior cingulate cortex were mainly found in patients with chronic ankle instability.
Discussion
The included studies demonstrated structural and functional brain adaptations related to lateral ankle sprains and chronic ankle instability compared to healthy individuals or copers. These adaptations correlate with clinical outcomes (e.g. patients’ self-reported function and different clinical assessments) and might contribute to the persisting dysfunctions, increased re-injury risk and long-term sequelae seen in these patients. Thus, rehabilitation programmes should integrate sensorimotor and motor control strategies to cope with neuroplasticity related to ligamentous ankle injuries.
中文翻译：
与踝关节外侧韧带损伤相关的大脑神经可塑性：系统评价
背景
踝关节外侧扭伤是运动中最常见的踝关节损伤，并且复发率最高。几乎一半的踝关节外侧扭伤患者会出现慢性踝关节不稳定。患有慢性踝关节不稳定的患者会经历持续的踝关节功能障碍和有害的长期后遗症。大脑水平的变化被提出来部分解释这些不良后果和高复发率。然而，目前缺乏与踝关节外侧扭伤和慢性踝关节不稳定相关的可能的大脑适应的概述。
客观的
本系统综述的主要目的是全面概述与外侧踝关节扭伤和慢性踝关节不稳患者相关的结构和功能性大脑适应的文献。
方法
截至 2022 年 12 月 14 日，系统检索了 PubMed、Web of Science、Scopus、Embase、EBSCO—SPORTDiscus 和 Cochrane 对照试验中央注册库。荟萃分析、系统评价和叙述性评价被排除在外。纳入的研究调查了年满 18 岁、经历过外侧踝关节扭伤或慢性踝关节不稳定的患者的功能或结构性大脑适应情况。外侧踝关节扭伤和慢性踝关节不稳定是根据国际踝关节协会的建议定义的。三位作者独立提取数据。他们提取了作者姓名、发表年份、研究设计、纳入标准、参与者特征、干预组和对照组的样本量、神经可塑性测试方法，以及每项研究中初级和次级神经可塑性结果的所有平均值和标准差。学习。报告的应对者数据被视为对照组的一部分。观察性和横断面研究的质量评估工具用于评估偏倚风险。本研究已在 PROSPERO 上注册，编号 CRD42021281956。
结果
纳入了二十篇文章，其中只有一篇调查了经历过踝关节外侧扭伤的个体。在所有研究中，共有 356 名患有慢性踝关节不稳的患者、10 名经历过踝关节外侧扭伤的患者以及 46 名治疗者被纳入其中。小脑白质微观结构的变化与踝关节外侧扭伤有关。十五项研究报告了慢性踝关节不稳定患者的大脑功能适应情况，五篇文章发现了大脑结构的结果。感觉运动网络（中央前回和辅助运动区、中央后回和额中回）和背侧前扣带皮层的改变主要见于慢性踝关节不稳患者。
讨论
纳入的研究表明，与健康个体或应对者相比，与外侧踝关节扭伤和慢性踝关节不稳定相关的大脑结构和功能适应。这些适应与临床结果（例如患者自我报告的功能和不同的临床评估）相关，并可能导致这些患者出现持续的功能障碍、增加再次受伤的风险和长期后遗症。因此，康复计划应整合感觉运动和运动控制策略，以应对与踝关节韧带损伤相关的神经可塑性。
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