***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND During the recovery period after acute ankle sprain , it is unclear whether conventional treatment should be supported by supervised exercise . AIM To evaluate the short- and long-term effectiveness of conventional treatment combined with supervised exercises compared with conventional treatment alone in patients with an acute ankle sprain . DESIGN R and omised controlled clinical trial . SETTING A total of 32 Dutch general practice s and the hospital emergency department . METHOD Adults with an acute lateral ankle sprain consulting general practice s or the hospital emergency department were allocated to either conventional treatment combined with supervised exercises or conventional treatment alone . Primary outcomes were subjective recovery ( 0 - 10 point scale ) and the occurrence of a resprain . Measurements were carried out at intake , 4 weeks , 8 weeks , 3 months , and 1 year after injury . Data were analysed using intention-to-treat analyses . RESULTS A total of 102 patients were enrolled and r and omised to either conventional treatment alone or conventional treatment combined with supervised exercise . There was no significant difference between treatment groups concerning subjective recovery or occurrence of resprains after 3 months and 1-year of follow-up . CONCLUSION Conventional treatment combined with supervised exercises compared to conventional treatment alone during the first year after an acute lateral ankle sprain does not lead to differences in the occurrence of resprains or in subjective recovery OBJECTIVE To estimate the clinical effectiveness and cost-effectiveness of three methods of ankle support compared with double layer tubular compression b and age . DESIGN A r and omised controlled trial , design ed to reflect practice in UK hospital emergency departments . SETTING Eight emergency departments in Engl and . PARTICIPANTS Aged 16 or over with acute severe ankle sprain , unable to weight bear , no fracture . INTERVENTIONS 584 participants were r and omised to one of four treatment arms : tubular b and age , below knee cast , Aircast ankle brace or Bledsoe boot , all applied 2 - 3 days after presentation to allow swelling to resolve . MAIN OUTCOME MEASURES Response to treatment was assessed using the Foot and Ankle Outcome Score and generic measures ( Functional Limitations Profile , SF-12 and EQ-5D ) . RESULTS When adjusted for age , sex and baseline scores , the below knee cast offered a small but statistically significant benefit at 4 weeks in terms of pain ( FAOS pain difference 5.1 ; 95 % CI 0.4 - 9.8 ) , foot- and ankle-related quality of life ( QoL ) ( FAOS QoL difference 5.9 ; 95 % CI 0.1 - 11.8 ) and the physical component of the SF-12 ( SF-12 score difference 2.2 ; 95 % CI 0.0 - 4.4 ) . Neither the Aircast brace nor the Bledsoe boot was statistically or clinical ly better . At 12 weeks the below knee cast was significantly better than tubular b and age in terms of pain ( FAOS pain difference 5.1 ; 95 % CI 0.3 - 10.0 ) , activities of daily living ( FAOS ADL difference 3.5 ; 95 % CI 0.4 - 6.6 ) , sports ( FAOS sports difference 8.7 ; 95 % CI 1.6 - 15.7 ) and QoL ( FAOS QoL difference 8.7 ; 95 % CI 2.4 - 15.0 ) , and the Aircast brace was better only in terms of ankle-related QoL and mental health . The Bledsoe boot conferred no significant advantage over tubular b and age . By 9 months there were no significant differences . Based on mean direct health-care costs per participant , the Bledsoe boot was the most expensive ( 215 pounds ) and tubular b and age the least so ( 1 pound 44 pence ) . Inclusion of indirect costs ( sick leave ) raised overall costs substantially and removed any significant differences between the therapies . Cost-utility analysis demonstrated that the Aircast brace [ 301 pounds per quality -adjusted life-year ( QALY ) ] and below knee cast ( 339 pounds per QALY ) were more cost-effective than the Bledsoe boot ( 2116 pounds per QALY ) . However , inclusion of indirect costs produced different rank orders , depending on the assumptions made , and results should be treated with caution . CONCLUSIONS The below knee cast and the Aircast brace offered cost-effective alternatives to tubular b and age for acute severe ankle sprain , the former having the advantage in terms of overall recovery at 3 months . As there were no differences in long-term outcome , practitioners should consider likely compliance and acceptability to patients when choosing a brace Background : Lateral ligament ankle sprains are the single most common sports injury . Objective : To determine the functional outcome of the ankle joint after a moderate or severe inversion injury , comparing st and ard treatment with an elastic support b and age against an Aircast ankle brace . Design : Prospect i ve , r and omised controlled trial . Setting : Two accident and emergency departments . Method : Fifty patients presenting consecutively were r and omised into two equal groups : one group was treated with an elastic support b and age and the other with an Aircast ankle brace . All patients were given a st and ardised advice sheet referring to rest , ice , compression , and elevation . Patients were review ed after 48–72 hours , 10 days , and one month . Primary outcome measure : Ankle joint function assessed at 10 days and one month using the modified Karlsson scoring method ( maximum score 90 ) . Secondary outcome measure : The difference in ankle girth ( swelling ) and pain score at 10 days . Results : Seventeen patients in the elastic support b and age group ( six defaulted , two excluded ) and 18 patients in the Aircast ankle brace group ( six defaulted , one excluded ) completed the study . There were no significant differences between the two groups at presentation in terms of age ( mean 35.3 and 32.6 years respectively ) , sex , dominant leg , left or right ankle injured , previous injury , time to presentation ( median three and four hours respectively ) , difference in ankle girth ( mean 14.5 and 14.3 mm respectively ) , and pain scores ( mean 6.2 and 5.8 respectively ) . The Karlsson score was significantly higher in the Aircast ankle cast group than in the elastic b and age group at 10 days ( mean 50 v 35 , p = 0.028 , 95 % confidence interval ( CI ) 1.7 to 27.7 ) and one month ( mean 68 v 55 , p = 0.029 , 95 % CI 1.4 to 24.8 ) ( Student ’s t test ) . There was no difference between the groups in the secondary outcome measures ( swelling , p = 0.09 ; pain , p = 0.07 ) . When hierarchical multiple regression analysis was used to correct for possible baseline confounding factors , the Aircast ankle brace group was significantly associated with higher Karlsson scores at 10 days ( p = 0.009 ) and one month ( p = 0.024 ) . Conclusion : The use of an Aircast ankle brace for the treatment of lateral ligament ankle sprains produces a significant improvement in ankle joint function at both 10 days and one month compared with st and ard management with an elastic support b and age Background The sensorimotor influence of the lateral ankle ligaments in muscle activation is unclear . Hypothesis The lateral ankle ligaments have significant sensorimotor influence on muscle activation . Study Design Controlled laboratory study . Methods Muscle-firing characteristics in response to a high-speed inversion perturbation and during gait were assessed in 13 normal subjects .  Solutions ( 1.5 % lidocaine or a placebo of saline ) were injected bilaterally into the anterior talofibular and calcaneofibular ligaments ( 1.5 ml per ligament ) to alter peripheral afferent influence . Subjects were again tested with the same protocol . Results The protective response of the anterior tibialis and peroneal muscles during inversion perturbation and mean muscle activation amplitude decreased during running after both injections . After injection , no significant differences were seen for muscle reflex latencies , maximum amplitude , time to maximum amplitude during inversion perturbation , or mean amplitude during walking . Conclusion The lateral ankle ligaments have a sensorimotor influence on muscle activation . Clinical Relevance Induced edema from the injected solutions may have altered the sensorimotor influence of the lateral ankle ligaments , thereby inhibiting the dynamic ankle stabilizers . This finding suggests that dynamic stability may be compromised because of swelling after joint injury A study was undertaken to evaluate the effect of a semi rigid ankle orthosis ( Sport-Stirrup ) on the incidence of ankle sprains  in soccer players during 1 playing season . Senior soccer players were divided into 2 groups : play ers with previous ankle sprains ( N = 258 ) and players without such history ( N = 246 ) . The players in these groups were each r and omly allocated to either a semi rigid orthosis or a control group at the start of the playing season . All subsequent injuries during the season and the total number of playing hours were documented . There was a significant reduction in the incidence of ankle sprains ( injuries/1 000 playing hours ) by ankles in the orthosis group with previous sprains ( 0.14 ) com pared with the nonbraced group with previous sprains ( 0.86 ) . The incidence of ankle sprains was significantly higher in the nonbraced group with previous sprains ( 0.86 ) compared with the nonbraced group without pre vious sprains ( 0.46 ) . Thus , in this study , a semirigid or thosis significantly reduced the incidence of recurrent ankle sprains in soccer players with previous history of ankle sprains Objective To compare an accelerated intervention incorporating early therapeutic exercise after acute ankle sprains with a st and ard protection , rest , ice , compression , and elevation intervention . Design R and omised controlled trial with blinded outcome assessor . Setting Accident and emergency department and university based sports injury clinic . Participants 101 patients with an acute grade 1 or 2 ankle sprain . Interventions Participants were r and omised to an accelerated intervention with early therapeutic exercise ( exercise group ) or a st and ard protection , rest , ice , compression , and elevation intervention ( st and ard group ) . Main outcome measures The primary outcome was subjective ankle function ( lower extremity functional scale ) . Secondary outcomes were pain at rest and on activity , swelling , and physical activity at baseline and at one , two , three , and four weeks after injury . Ankle function and rate of reinjury were assessed at 16 weeks . Results An overall treatment effect was in favour of the exercise group ( P=0.0077 ) ; this was significant at both week 1 ( baseline adjusted difference in treatment 5.28 , 98.75 % confidence interval 0.31 to 10.26 ; P=0.008 ) and week 2 ( 4.92 , 0.27 to 9.57 ; P=0.0083 ) . Activity level was significantly higher in the exercise group as measured by time spent walking ( 1.2 hours , 95 % confidence interval 0.9 to 1.4 v 1.6 , 1.3 to 1.9 ) , step count ( 5621 steps , 95 % confidence interval 4399 to 6843 v 7886 , 6357 to 9416 ) , and time spent in light intensity activity ( 53 minutes , 95 % confidence interval 44 to 60 v 76 , 58 to 95 ) . The groups did not differ at any other time point for pain at rest , pain on activity , or swelling . The reinjury rate was 4 % ( two in each group ) . Conclusion An accelerated exercise protocol during the first week after ankle sprain improved ankle function ; the group receiving this intervention was more active during that week than the group receiving st and ard care . Trial registration Current Controlled Trials IS RCT N13903946 The purpose of this study was to examine a young athletic population to up date the data regarding epidemiology and disability associated with ankle injuries . At the United States Military Academy , all cadets presenting with ankle injuries during a 2-month period were included in this prospect i ve observational study . The initial evaluation included an extensive question naire , physical examination , and radiographs . Ankle sprain treatment included a supervised rehabilitation program . Subjects were reevaluated at 6 weeks and 6 months with subjective  assessment , physical  examination  , and functional testing . The mean age for all subjects was 20 years ( range , 17–24 years ) . There were 104 ankle injuries accounting for 23 % of all injuries seen . There were 96 sprains , 7 fractures , and 1 contusion . Of the 96 sprains , 4 were predominately medial injuries , 76 were lateral , and 16 were syndesmosis sprains . Ninety-five percent had returned to sports activities by 6 weeks ; however , 55 % of these subjects reported loss of function or presence of intermittent pain , and 23 % had a decrement of > 20 % in the lateral hop test when compared with the uninjured side . At 6 months , all subjects had returned to full activity ; however , 40 % reported residual symptoms and 2.5 % had a decrement of > 20 % on the lateral hop test . Neither previous injury nor ligament laxity was predictive of chronic symptomatology . Furthermore , chronic dysfunction could not be predicted by the grade of sprain ( grade I vs. II ) . The factor most predictive of residual symptoms was a syndesmosis sprain , regardless of grade . Sy 
    Output:
    
The main advantage of surgical ankle ligament repair is that objective instability and recurrence rate is less common when compared with non-operative treatment .
Balancing the advantages and disadvantages of surgical and non-surgical treatment , we conclude that the majority of grade s I , II and III lateral ankle ligament ruptures can be managed without surgery .
For non-surgical treatment , long-term immobilization should be avoided .
10 days ) in a below knee cast was shown to be advantageous .
After this phase , the ankle is most effectively protected against inversion by a semi-rigid ankle brace .
Even grade s I and II injuries are most effectively treated with a semi-rigid ankle brace .
There is evidence that treatment of acute ankle sprains should be supported by a neuromuscular training .
Balance training is also effective for the prevention of ankle sprains in athletes with the previous sprains .
There is good evidence from high level r and omized trials in the literature that the use of a brace is effective for the prevention of ankle sprains .
Conclusion Balancing the advantages and disadvantages of surgical and non-surgical treatment , we conclude that the majority of grade s I , II and III lateral ankle ligament ruptures can be managed without surgery .
This systematic review supports a phase adapted non-surgical treatment of acute ankle sprains with a short-term immobilization for grade III injuries followed by a semi-rigid brace .