Letter to the Editor: Acute Treatment of Inversion Ankle Sprains: Immobilization versus Functional Treatment

Reply: We acknowledge the insightful comments of Kerkhoffs and colleagues regarding our systematic review of immobilization versus functional treatment for acute inversion ankle sprains.2 In citing their extensive prior work on the subject, they clarify our findings and expand the scope of our discussion. Rather than to “bring old news as new” or to mislead our readers, our aim in conducting this project was to provide an updated review of high-quality studies addressing our research question, and we sought to achieve this aim by including only English-language articles that represented the highest available level of evidence. Although this method only identified nine articles suitable for review, we believe our carefully chosen inclusion and exclusion criteria helped eliminate bias in the presentation of our results. Systematic reviews are not intended to review the literature on a subject, but rather to ask a very specific question and attempt to answer the question with the best available evidence, not all the papers on a subject. In addition, our review was intended neither to analyze nor compare functional and surgical treatment. The trial by Beynnon et al1 provides an excellent addition to the literature; however, this article was not in print at the time we presented our review. Kerkhoffs and colleagues use their letter as a forum to go beyond the scope of our paper and discuss their prior work comparing surgical with nonsurgical treatment for acute ankle injuries and for comparing various functional treatments. This work confirms the need for more well-designed clinical studies to identify potential methods of improving the treatment of inversion ankle sprains. Morgan H. Jones, MD Department of Orthopaedic Surgery Cleveland Clinic Foundation Cleveland, OH; and Annunziato S. Amendola, MD University of Iowa Hospitals and Clinics Iowa City, IA