Sports Medicine

, Volume 49, Issue 4, pp 601–619 | Cite as

Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis

  • Bruno Tassignon
  • Jo Verschueren
  • Eamonn Delahunt
  • Michelle Smith
  • Bill Vicenzino
  • Evert Verhagen
  • Romain MeeusenEmail author
Systematic Review



The aim of this systematic review was to identify prospective studies that used a criteria-based return to sport (RTS) decision-making process for patients with lateral ankle sprain (LAS) injury.


Systematic review and narrative synthesis.

Data sources

The PubMed (MEDLINE), Web of Science, PEDro, Cochrane Library, SPORTDiscus (EBSCO), ScienceDirect, and Scopus databases were searched to 23 November 2018.

Eligibility criteria for selecting studies

Studies were included if they prospectively applied a criteria-based RTS decision-making process for patients with LAS injury, but were excluded if they merely gathered outcome measures at the RTS time point. Studies were also excluded if patients were recovering from ankle fracture, high ankle sprain, medial ankle sprain, chronic ankle instability or complex ankle injury.


No studies were identified that used a criteria-based RTS decision-making process for patients with LAS injury. We were unable to conduct a quantitative synthesis or meta-analysis, therefore we provide a narrative synthesis of relevant questionnaires, as well as clinical and functional assessments commonly used in studies retrieved in the search.


There are currently no published evidence-based criteria to inform RTS decisions for patients with an LAS injury. Based on our narrative synthesis, we propose a number of variables that could be used to develop a criteria-based RTS decision paradigm. Future research should aim to reach consensus on these variables and apply them to actual RTS decisions within prospective study designs. Furthermore, we suggest that complex systems theory and the RTS continuum could be used to inform the development of an RTS decision-making paradigm for athletes with LAS injury.



The authors would like to thank the entire Human Physiology Research Group team for its assistance. In particular, thanks are due to Bart Roelands and Jeroen Van Cutsem for their insights into fatigue, Bert Pluym for discussions on the value and feasibility of criteria-based approaches following LAS injury in clinical practice, and Kevin De Pauw for his insights into the CNS. The authors would also like to express their gratitude to Ben Serrien for discussions on complex systems theory in motor control. Finally, the authors would like to thank the physiotherapy students of Vrije Universiteit Brussel, as some insights were able to be further developed while preparing and teaching theoretical and practical courses, as well in debates over the value of criteria-based decision-making frameworks in general and specific rehabilitation.

Compliance with Ethical Standards


No sources of funding were used to assist in the preparation of this article.

Conflicts of interest

Bruno Tassignon, Jo Verschueren, Eamonn Delahunt, Michelle Smith, Bill Vicenzino, Evert Verhagen and Romain Meeusen declare that they have no conflicts of interest relevant to the content of this review.

Supplementary material

40279_2019_1071_MOESM1_ESM.docx (55 kb)
Supplementary material 1 (DOCX 55 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Faculty of Physical Education and Physiotherapy, Human Physiology Research GroupVrije Universiteit BrusselBrusselsBelgium
  2. 2.School of Public Health, Physiotherapy and Sports ScienceUniversity College DublinDublinIreland
  3. 3.Institute for Sport and HealthUniversity College DublinDublinIreland
  4. 4.Division of Physiotherapy, School of Health and Rehabilitation SciencesThe University of QueenslandSt LuciaAustralia
  5. 5.Department of Public and Occupational Health, Amsterdam Movement SciencesAmsterdam Collaboration on Health and Safety in Sports, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands

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