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Peroneal Reaction Time after Ankle Sprain: A Systematic Review and Meta-analysis


Medicine & Science in Sports & Exercise: March 2014 - Volume 46 - Issue 3 - p 546–556
doi: 10.1249/MSS.0b013e3182a6a93b
Applied Sciences

Background Many studies have examined the temporal response of the peroneal muscles to sudden inversion perturbation in patients with a previous ankle sprain. The purpose of this systematic review with meta-analysis was to synthesize the evidence and determine whether peroneal reaction time (PRT) impairments are present after ankle sprain.

Methods An electronic search was conducted using PubMed Central and EBSCOhost (1965–January 2013). Articles were included if they 1) examined the PRT to sudden inversion perturbation in patients with a history of ankle sprain using a mechanical tilt platform, 2) made comparisons with a control group or contralateral limb with no history of ankle sprain, and 3) provided data for the calculation of effect sizes (ES). In addition to examining the overall effect of sustaining an ankle sprain on PRT, the effects of study design and subject characteristics on PRT were evaluated. Bias-corrected Hedges g ES and 95% confidence intervals (CI) were calculated to make comparisons across studies.

Results A total of 23 studies met the inclusion criteria. The overall ES was 0.67 (95% CI = 0.37–0.95, P < 0.001), indicating that a previous ankle sprain, regardless of study design or subject characteristics, resulted in moderate-to-strong PRT deficits. Further analyses determined studies with patients classified as having chronic ankle instability demonstrated large magnitude PRT deficits in between groups (ES = 0.72, 95% CI = 0.29–1.14, P = 0.001) and side-to-side (ES = 1.24, 95% CI = 0.70–1.79, P < 0.001) comparisons, whereas patients with all other ankle sprain histories demonstrated weak PRT alterations in between groups (ES = −0.21, 95% CI = −1.01 to 0.59, P = 0.61) and side-to-side (ES = 0.21, 95% CI = −0.19 to 0.60, P = 0.31) comparisons.

Conclusions Overall, this meta-analysis determined that individuals with a previous ankle sprain exhibit delayed PRT. Further analyses determined that these deficits are more evident in patients with chronic ankle instability when compared with the contralateral uninvolved limb or a healthy control group.

1School of Physical Therapy and Athletic Training, Old Dominion University, Norfolk, VA; and 2School of Health Sciences and Human Performance, Ithaca College, Ithaca NY

Address for correspondence: Matthew C. Hoch, Ph.D., ATC, School of Physical Therapy and Athletic Training, Old Dominion University, 104A Health Sciences Annex Building, Norfolk, VA 23529; E-mail:

Submitted for publication March 2013.

Accepted for publication July 2013.

© 2014 American College of Sports Medicine