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Brain Neuroplasticity Related to Lateral Ankle Ligamentous Injuries: A Systematic Review

  • Systematic Review
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Abstract

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.

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Acknowledgements

We thank our colleagues from the Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science (LIROMS) and the Strategic Research Program Exercise and the Brain in Health & Disease: The Added Value of Human-Centered Robotics (SRP17) who provided insight and expertise that assisted the research. Bart Roelands is a Collen-Francqui research professor.

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  1. Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium

    Alexandre Maricot, Emilie Dick, Annemiek Walravens, Bert Pluym, Elke Lathouwers, Kevin De Pauw, Jo Verschueren, Bart Roelands, Romain Meeusen & Bruno Tassignon

  2. Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium

    Kevin De Pauw & Romain Meeusen

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  1. Alexandre Maricot
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Correspondence to Bruno Tassignon.

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Conflict of Interest

Alexandre Maricot, Emilie Dick, Annemiek Walravens, Bert Pluym, Elke Lathouwers, Kevin De Pauw, Jo Verschueren, Bart Roelands, Romain Meeusen and Bruno Tassignon have no conflicts of interest that are directly relevant to the content of this review.

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Author Contributions

AM substantially contributed to the conception and design of the work, as well as to the acquisition, analysis and interpretation of data for the work. BT, RM, JV, BR, KDP and EL substantially contributed to the conception and design of the work and the interpretation of data for the work. AW, ED and BP substantially contributed to the acquisition and analysis of data for the work. All authors revised the work critically for important intellectual content and gave final approval of the final version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Maricot, A., Dick, E., Walravens, A. et al. Brain Neuroplasticity Related to Lateral Ankle Ligamentous Injuries: A Systematic Review. Sports Med 53, 1423–1443 (2023). https://doi.org/10.1007/s40279-023-01834-z

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