Use of the Air-Stirrup brace combined with an elastic wrap promotes a more rapid return to function following first-time grade I and II ankle sprains than do either one alone or other modes of treatment, reported Bruce D. Beynnon, Ph.D., of McClure Musculoskeletal Research Center, Burlington, Vt., and his associates.
For grade III sprains, however, treatment with either the Air-Stirrup brace or casting for 10 days followed by the use of an elastic wrap appears to produce comparable outcomes, according to the investigators (Am. J. Sports Med. 2006;34:1401–12).
In a study supported by Aircast Inc., 212 skeletally-mature patients with first-time ankle sprains were randomized depending on their sprain severity. The 64 with grade I injuries received either an elastic wrap (Ace), an Air-Stirrup ankle brace, or the wrap combined with the brace. The 116 patients with grade II ankle sprains received either an elastic wrap, Air-Stirrup ankle brace, the wrap combined with the brace, or a fiberglass walking cast worn for 10 days followed by the use of an elastic wrap. The 32 patients with grade III sprains were randomized to either Air-Stirrup ankle brace or a fiberglass walking cast worn for 10 days, and then followed by the use of an elastic wrap.
A total of 172 patients (52 grade I, 93 grade II, 27 grade III) completed all the analyses, including keeping a daily log at home. Among those with grade I sprains, it took less than half the time to return to normal walking with the combined treatment than with the individual modalities (4.62 days, compared with 11.16 with the elastic wrap alone and 10.33 with the Air-Stirrup brace alone). Return to normal stair climbing also showed a significant difference—more than twice as rapidly with the wrap plus brace as with the two solo treatments (5.46 vs. 12.05 and 11.43 days, respectively).
The patients with grade II ankle sprains who received the combined Air-Stirrup/elastic wrap required 10.1 days to return to normal walking and 11.72 days for normal stair climbing, compared with 11.67 and 13.38 days for the elastic wrap alone and 13.38/16.38 for the Air-Stirrup ankle brace alone. These differences were significant.
Also significant, function after casting—24.12 and 27.94 days for walking and stair climbing, respectively—was 40% longer than with the combined Air Stirrup/elastic wrap treatment, Dr. Beynnon and his associates reported.
For grade III ankle sprains, there was no difference between treatment with the Air-Stirrup brace and cast immobilization for 10 days followed by the use of elastic wrap until the return of normal walking or stair climbing (18.56 days for the Air-Stirrup versus 19 for casting for walking, 18.31 versus 21.08 for stair-climbing). It's possible that the combined treatment would have benefitted these patients—it wasn't studied because the numbers with grade III sprains were anticipated to be too small for meaningful comparison, the investigators explained.
Secondary outcome measures were less impressive. There was no difference between treatments among those with grade I sprains in time to return to walking with full weight bearing. The time required to regain full capability of normal activities of daily living did not differ among the treatments. Similar trends were seen with grade II sprains, although secondary outcomes were significantly better with the elastic wrap than with casting. No significant differences among the treatments were seen with grade III sprains.
There was no difference between treatments in time to return to walking with full weight bearing. DR. BEYNNON