Foot and ankle injuries in sport

ACL-specific consensus defining return to sport as a criteria-based continuum rather than a time point, and setting out testing and shared decision-making for clearance after ACL injury.

• Return to sport is a criteria-based continuum, return to participation, then return to sport, then return to performance, not a single date.
• Clearance should rest on objective testing (strength, hop, movement quality, psychological readiness), not time since surgery alone.
• The decision is shared between clinician and athlete, accounting for the sport's demands and the athlete's risk tolerance.

Our appraisal: Consensus via modified Delphi, so it sets the decision framework rather than validating any single test battery or cut-off. It is most useful as a reminder that a passed clock is not a passed knee; the specific thresholds still lack strong prospective validation.

Updated multidisciplinary evidence-based guideline on diagnosing, treating and preventing lateral ankle sprains.

• Recommends functional treatment (early mobilisation, bracing or taping and exercise) over immobilisation for acute lateral ankle sprain.
• Advises the Ottawa Ankle Rules to select who needs radiography, and delayed physical examination when swelling obscures the acute assessment.
• Supports exercise-based prevention, especially neuromuscular and balance training and bracing, to reduce recurrence in those with a previous sprain.

Our appraisal: One of the few genuinely evidence-graded guidelines in this space, drawing on systematic reviews, though many recommendations still rest on low-certainty evidence. Its functional-treatment and neuromuscular-prevention messages are among the better supported in sports medicine and translate directly to clinic.

Defines and operationalises 'return to sport' as a continuum (return to participation, return to sport, return to performance), with a shared decision-making framework (StARRT).

• Operationalises return to sport as a three-stage continuum applicable across injuries, not just ACL.
• Introduces the StARRT framework (Strategic Assessment of Risk and Risk Tolerance) for the return decision.
• Frames clearance as shared decision-making under uncertainty rather than a purely biological milestone.

Our appraisal: A foundational framework paper rather than an evidence synthesis. Its strength is a shared language for the return-to-sport decision: it tells you how to structure the decision, not what the pass criteria are, so pair it with injury-specific testing evidence.

Position statement on the prevalence, burden and long-term consequences of lateral ankle sprains and their progression to chronic ankle instability.

• Frames lateral ankle sprain as a high-recurrence injury that commonly leads to chronic ankle instability, not a trivial self-limiting event.
• Links chronic ankle instability to reduced physical activity and to early post-traumatic ankle osteoarthritis.
• Calls for better prevention and early management of first sprains to cut the downstream burden.

Our appraisal: A consensus position paper making the case that ankle sprains are undertreated; its epidemiological claims are the strongest part, while the prevention and management implications are directional rather than prescriptive. Useful for justifying active rehabilitation and follow-up of an injury clinicians too often wave through.