Prediction of Acute and Recurrent Ankle Sprains in Athletes

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DOI: 10.13023/ETD.2017.056

Abstract and keywords

Ankle sprains are not only among the most common sport-related injuries, but also associated with a high rate of recurrence. While prevention is a favorable approach to reducing the incidence of index and recurrent ankle sprains, identifying individuals at greater risk may improve allocation of preventative resources. This dissertation aimed to accomplish the following through three aims: 1) determine the ability of baseline clinical tests to predict acute lateral ankle sprain (LAS) in an understudied athletic population, 2) describe the degree of residual impairments and activity limitations in athletes returning to play from a LAS, and 3) determine the ability of patient- and disease-oriented outcomes to predict recurrent ankle sprains in athletes returning to play in the same competitive season.

In the first aim, baseline anterior star excursion balance test scores (SEBT-ANT) and isometric hip extension strength (HEXT) were not useful predictors of LAS in collegiate women’s soccer players. Participant height produced a prediction model for LAS with excellent sensitivity (0.88) and moderate specificity (0.51). The diagnostic odds ratio (DOR=7.50) and area under the receiver operating characteristic curve (AUROC=0.73) further established the predictive utility of height for injury. Taller collegiate women’s soccer players may be less able to resist external moments exerted on the body, potentially increasing LAS risk.

For the second aim, athletes returning to play from a LAS reported low self-reported function based on scores from the Foot and Ankle Ability Measure activity of daily living (FAAM-ADL) and sport (FAAM-S) subscales. Additionally, participants demonstrated significantly lower ankle dorsiflexion range of motion and SEBT-ANT scores, and significantly greater ankle joint swelling and ligamentous laxity of the involved limb compared to the uninvolved limb. The residual impairments and activity limitations exhibited by athletes returning to play may offer a means of identifying individuals at increased risk for recurrent injury and chronic ankle instability.

In the third aim, athletes that sustained a recurrent ankle sprain in the same competitive sport season exhibited greater height, mass, and body mass index (BMI) compared to those that did not sustain a recurrent injury. ROC curve analyses and DORs further validated the predictive utility of height (AUROC=0.71, DOR=4.93), mass (AUROC=0.75, DOR=12.21) and BMI (AUROC=0.71, DOR=9.48). A clinical evaluation of pain, ankle joint swelling, ligamentous laxity, ankle dorsiflexion range of motion, SEBT-ANT scores, FAAM-ADL scores, and FAAM-S scores at return to play (RTP) failed to predict recurrent injury status. Similar to the first study, athletes with larger stature may have decreased ability to reverse momentum in the presence of injurious forces. Athletic trainers can use information from this dissertation to determine which athletes are at elevated risk for an acute and recurrent ankle sprain, and ultimately facilitate improved allocation of resources for injury prevention.

Keywords: ankle sprain; injury prediction; clinical evaluation; disease-oriented outcomes; patient-oriented outcomes; return to play

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