{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T20:01:07Z","timestamp":1790539267753,"version":"4.1.0"},"reference-count":59,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2021,5,15]],"date-time":"2021-05-15T00:00:00Z","timestamp":1621036800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,5,15]],"date-time":"2021-05-15T00:00:00Z","timestamp":1621036800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2021,5,15]],"date-time":"2021-05-15T00:00:00Z","timestamp":1621036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Despite being a significant public health problem, ankle sprains\u2019 prognostic factors are largely unknown. This review aimed to systematically analyze the literature on acute ankle sprains to compare the prognosis of a combined anterior talofibular (ATFL) and calcaneofibular (CFL) ligaments rupture with an isolated ATFL rupture in terms of progression to chronic ankle instability and other clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The databases for Pubmed, CENTRAL and Web of Science were searched. Clinical studies reporting the prognostic effect of combined ATFL\u2010CFL rupture versus an isolated ATFL rupture in conservatively treated ankle sprains, with a minimum follow\u2010up of 12\u00a0months, were eligible for inclusion. Only studies with a reliable diagnostic method for anterolateral ankle ligaments evaluation, namely ultrasonography, magnetic resonance imaging, arthrography or stress tenography, were included. The relative risk (RR), along with the 95% confidence interval (CI), was used to quantitatively analyze the main outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nine papers were selected for inclusion, of which five were suitable for quantitative analysis. None of them found a statistically significant correlation between ligament injury severity and progression to chronic instability. Concerning other clinical outcomes, three studies found a statistically significant correlation between a combined ligament injury and a worse clinical prognosis. From the quantitative analysis, the relative risk (RR) of chronic ankle instability in a single versus a combined ligament rupture showed no significant difference.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A significant statistical correlation between a combined ATFL\u2010CFL rupture and chronic ankle instability, compared to an isolated ATFL rupture, was not found. There is, however, fair evidence showing a worse clinical outcome score in the combined ruptures, as well as a decreased return to full sports activities. The use of reliable and accessible diagnostic methods to determine the number of ruptured ligaments might have a role in managing severe ankle sprains.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-021-06610-y","type":"journal-article","created":{"date-parts":[[2021,5,15]],"date-time":"2021-05-15T13:02:36Z","timestamp":1621083756000},"page":"3512-3524","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Chronic ankle instability has no correlation with the number of ruptured ligaments in severe anterolateral sprain: a systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5832-7626","authenticated-orcid":false,"given":"J\u00e1come","family":"Pacheco","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Hospital de Sant\u2019Ana Rua de Benguela, 501 2775\u2010028 Cascais Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Guerra\u2010Pinto","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Hospital de Sant\u2019Ana Rua de Benguela, 501 2775\u2010028 Cascais Portugal"},{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery Hospital da Cruz Vermelha Lisbon Portugal"},{"name":"<!--<label>3<\/label>--> Department d\u2019Anatomia i Embriologia Humana Universitat de Barcelona Barcelona Spain"},{"name":"<!--<label>4<\/label>--> NOVA Medical School Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Ara\u00fajo","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Hospital de Sant\u2019Ana Rua de Benguela, 501 2775\u2010028 Cascais Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Flora","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Hospital de Sant\u2019Ana Rua de Benguela, 501 2775\u2010028 Cascais Portugal"},{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery Hospital da Cruz Vermelha Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Al\u00e7ada","sequence":"additional","affiliation":[{"name":"<!--<label>5<\/label>--> Department of Orthopaedic Surgery Hospital de Cascais Cascais Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Rocha","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Hospital de Sant\u2019Ana Rua de Benguela, 501 2775\u2010028 Cascais Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Diniz","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Hospital de Sant\u2019Ana Rua de Benguela, 501 2775\u2010028 Cascais Portugal"},{"name":"<!--<label>6<\/label>--> Department of Bioengineering and iBB, Institute for Bioengineering and Biosciences, Instituto Superior T\u00e9cnico Universidade de Lisboa Lisbon Portugal"},{"name":"<!--<label>7<\/label>--> Fisiogaspar Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Guimar\u00e3es","family":"Consci\u00eancia","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> NOVA Medical School Lisbon Portugal"},{"name":"<!--<label>8<\/label>--> Department of Orthopaedic Surgery Centro Hospitalar Lisboa Ocidental Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,5,15]]},"reference":[{"key":"e_1_2_8_2_2","first-page":"47","article-title":"Persistent pain after operative treatment for chronic lateral ankle instability","volume":"13","author":"Ahn BH","year":"2021","journal-title":"Orthop Res Rev"},{"key":"e_1_2_8_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100720962803"},{"key":"e_1_2_8_4_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.173.2.2798866"},{"issue":"6","key":"e_1_2_8_5_2","first-page":"560","article-title":"Sprained ankles. III. Clinical observations in recent ligament ruptures","volume":"130","author":"Brostr\u00f6m L","year":"1965","journal-title":"Acta Chir Scand"},{"issue":"5","key":"e_1_2_8_6_2","first-page":"537","article-title":"Sprained ankles. V. Treatment and prognosis in recent ligament ruptures","volume":"132","author":"Brostr\u00f6m L","year":"1966","journal-title":"Acta Chir Scand"},{"key":"e_1_2_8_7_2","first-page":"485","article-title":"Sprained Ankles. II. Arthrographic diagnosis of recent ligament ruptures","volume":"129","author":"Brostr\u00f6m L","year":"1965","journal-title":"Acta Chir Scand"},{"key":"e_1_2_8_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jos.2019.04.012"},{"key":"e_1_2_8_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2010.04.005"},{"key":"e_1_2_8_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00330\u2010019\u201006156\u20101"},{"key":"e_1_2_8_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/159.1.20"},{"key":"e_1_2_8_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12178\u2010020\u201009631\u20101"},{"key":"e_1_2_8_13_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.61B3.113414"},{"key":"e_1_2_8_14_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.66B2.6368563"},{"key":"e_1_2_8_15_2","first-page":"1","article-title":"Understanding acute ankle ligamentous sprain injury in sports","volume":"30","author":"Fong DT","year":"2019","journal-title":"Sports Med Arthrosc Rehabil Ther Technol"},{"key":"e_1_2_8_16_2","doi-asserted-by":"crossref","unstructured":"FagerlandMW(2015) Evidence\u2010based medicine and systematic reviews.Res Med Biol Sci431\u2013461","DOI":"10.1016\/B978-0-12-799943-2.00012-4"},{"key":"e_1_2_8_17_2","doi-asserted-by":"publisher","DOI":"10.1302\/2058\u20105241.5.200019"},{"key":"e_1_2_8_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/00042752\u2010199901000\u201000008"},{"key":"e_1_2_8_19_2","doi-asserted-by":"publisher","DOI":"10.23736\/S0022\u20104707.20.10050\u20101"},{"issue":"3","key":"e_1_2_8_20_2","first-page":"285","article-title":"Comparative study of clinical and ultrasonographic evaluation of lateral collateral ligament sprains of the ankle","volume":"49","author":"Gremeaux V","year":"2009","journal-title":"J Sports Med Phys Fitness"},{"key":"e_1_2_8_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports\u20102016\u2010096189"},{"key":"e_1_2_8_22_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports\u20102013\u2010093175"},{"key":"e_1_2_8_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0020\u20101383(80)80046\u20105"},{"issue":"1","key":"e_1_2_8_24_2","first-page":"37","article-title":"Entorse lateral do tornozelo: capacidade diagn\u00f3stica do exame objectivo e exames imagiol\u00f3gicos","volume":"24","author":"Guerra\u2010Pinto F","year":"2016","journal-title":"Revista Portuguesa Ortopedia Traumatologia"},{"key":"e_1_2_8_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00450229"},{"key":"e_1_2_8_26_2","doi-asserted-by":"publisher","DOI":"10.5312\/wjo.v11.i12.534"},{"key":"e_1_2_8_27_2","doi-asserted-by":"publisher","DOI":"10.4085\/1062\u20106050\u2010447\u201017"},{"key":"e_1_2_8_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"e_1_2_8_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518815160"},{"key":"e_1_2_8_30_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623\u2010199173020\u201000021"},{"issue":"4","key":"e_1_2_8_31_2","first-page":"154","article-title":"Operative oder konservative Behandlung der frischen Aussenbandruptur am oberen Sprunggelenk. Randomisierte klinische Studie [Surgical or conservative treatment of recent rupture of the lateral ligament of the upper ankle joint. Randomized clinical study]","volume":"91","author":"Klein J","year":"1988","journal-title":"Unfallchirurg"},{"key":"e_1_2_8_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00266052"},{"key":"e_1_2_8_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s003300050703"},{"key":"e_1_2_8_34_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00256\u2010010\u20101017\u2010y"},{"key":"e_1_2_8_35_2","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2021.0302"},{"key":"e_1_2_8_36_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.N.01112"},{"key":"e_1_2_8_37_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"e_1_2_8_38_2","doi-asserted-by":"publisher","DOI":"10.3109\/17453678809148786"},{"key":"e_1_2_8_39_2","doi-asserted-by":"publisher","DOI":"10.3109\/17453678108992150"},{"key":"e_1_2_8_40_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13643\u2010016\u20100384\u20104"},{"key":"e_1_2_8_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.crad.2014.12.008"},{"key":"e_1_2_8_42_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005373\u2010196912000\u201000002"},{"key":"e_1_2_8_43_2","volume-title":"Thesis: acute ankle injuries: diagnostic and therapeutic strategies on evidence\u2010based grounds","author":"Pijnenburg ACM","year":"2006"},{"key":"e_1_2_8_44_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsams.2014.01.005"},{"key":"e_1_2_8_45_2","first-page":"3","article-title":"Diagnosis and treatment of injury to the lateral ligament of the ankle. A comparative clinical study","volume":"486","author":"Prins JG","year":"1978","journal-title":"Acta Chir Scand Suppl"},{"key":"e_1_2_8_46_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659302100303"},{"key":"e_1_2_8_47_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659202000102"},{"issue":"2","key":"e_1_2_8_48_2","first-page":"164","article-title":"Effectiveness of ultrasonography in diagnosing chronic lateral ankle instability: a systematic review","volume":"11","author":"Radwan A","year":"2016","journal-title":"Int J Sports Phys Ther"},{"key":"e_1_2_8_49_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k4597"},{"key":"e_1_2_8_50_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00776\u2010006\u20101090\u20101"},{"key":"e_1_2_8_51_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00932312"},{"key":"e_1_2_8_52_2","doi-asserted-by":"publisher","DOI":"10.1177\/0284185119873119"},{"key":"e_1_2_8_53_2","doi-asserted-by":"crossref","unstructured":"SongK PietrosimoneB TennantJN NissmanDB DedererKM ParanjapeC WikstromEATalar and subtalar T1\u03c1 relaxation times in limbs with and without chronic ankle instability.Cartilage(2021)10.1177\/194760352199462634636628","DOI":"10.1177\/1947603521994626"},{"key":"e_1_2_8_54_2","first-page":"15","article-title":"Accuracy of magnetic resonance imaging in diagnosing lateral ankle ligament injuries: a comparative study with surgical findings and timings of scans","volume":"7","author":"Tan DW","year":"2016","journal-title":"Asia Pac J Sports Med Arthrosc Rehabil Technol"},{"key":"e_1_2_8_55_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891\u2010017\u20101777\u20109"},{"key":"e_1_2_8_56_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.78B6.0780958"},{"key":"e_1_2_8_57_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports\u20102016\u2010096733"},{"key":"e_1_2_8_58_2","volume-title":"Diagnostic and therapeutic aspects of inversion trauma of the ankle joint","author":"Moppes FI","year":"1982"},{"key":"e_1_2_8_59_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2007.11.018"},{"key":"e_1_2_8_60_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports\u20102017\u2010098106"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-021-06610-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00167-021-06610-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-021-06610-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00167-021-06610-y","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T12:33:21Z","timestamp":1760877201000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1007\/s00167-021-06610-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,15]]},"references-count":59,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1007\/s00167-021-06610-y"],"URL":"https:\/\/doi.org\/10.1007\/s00167-021-06610-y","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,15]]},"assertion":[{"value":"26 January 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 May 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the Research and Ethical Committees of our Institution. This article does not contain any studies with human participants or animals performed by any of the authors.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}