Neurocognitive Deficits Related to Ligamentous Ankle Injuries: A Systematic Review

Abstract

Background Lateral ankle sprains (LAS) are among the most common sports injuries, with up to 40% of individuals developing chronic ankle instability (CAI). While altering neurocognitive demands can affect lower limb biomechanics, the underlying mechanisms in CAI patients remain unclear. This systematic review aimed to summarise evidence on the neurocognitive deficits linked with ligamentous ankle injuries and CAI. Methods Following PRISMA guidelines (PROSPERO: CRD42023406395), a comprehensive search of five databases (up to September 24, 2024) identified studies examining neurocognitive performance in adults with LAS or CAI. Inclusion criteria were based on a PICO strategy. Two authors independently selected studies and assessed bias using the QUIPS tool and the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data were extracted using a standardized form detailing study characteristics, patient data, neurocognitive methods, and statistical outcomes. Results This review included 24 studies with 104 LAS and 393 CAI patients, 92 copers, and 317 healthy controls. Eighty-three percent of the included studies showed a high risk of bias. Neurocognitive performance was assessed across nine domains using 27 neurocognitive tasks. CAI patients exhibit deficits in attention, inhibitory control, and visual memory, with mixed results for working memory and processing speed. No deficits were found in language or motor skills. These deficits may contribute to reduced postural stability, particularly under dual-task conditions where cognitive resources are divided. No significant findings were observed for copers. Discussion Methodological variability, cross-sectional designs, and limited focus on LAS underscore the need for further research to examine causality and expand generalizability. Conclusion This review underscores the association between ligamentous ankle injuries, particularly in CAI, and neurocognitive performance, although more research is needed to unravel the causal direction.