Prevalence and Impact of Chronic Ankle Instability in Adolescent Athletes

Donovan L, Hetzel S, Laufenberg CR, McGuine TA. Orthop J Sports Med. 2020 Feb 18;8(2):2325967119900962. doi: 10.1177/2325967119900962.

https://www.ncbi.nlm.nih.gov/pubmed/32118082

Take-Home Message

Approximately 1 in 5 adolescent athletes had chronic ankle instability, and they tended to report impaired function and health-related quality of life outcomes compared to other adolescent athletes. These findings support the need for ankle sprain prevention and intervention programs into adolescent sport settings.

Summary

Chronic ankle instability (CAI) is a common condition related to decreased joint health, reduced physical activity, and reduced overall health-related quality of life among adults. However, the impact of CAI on an adolescent population remains unknown. This information would help to justify incorporating injury prevention and intervention programs into adolescent sport settings to reduce the burden associated with repeated ankle sprains. Therefore, the authors performed a cross-sectional study of the prevalence and impact of CAI on ankle function, physical activity, and health-related quality of life among adolescent athletes (ages 14-18 years) at eight different club or high school sports facilities. The athletes completed surveys with parental supervision to assess their ankle sprain history, presence of CAI, ankle function, health-related quality of life, and physical activity (Table). Overall, 1,002 adolescent athletes across a variety of sports completed the surveys (~50% females and males). While about 26% of athletes reported one previous ankle sprain, about 20% of all athletes reported having CAI in at least one ankle (37 bilateral cases; 4%). Adolescent athletes with CAI had worse ankle function and health-related quality of life outcomes compared to athletes without CAI. However, physical activity did not differ between the groups.

Outcome Survey Tool Presence of CAI Identification of Functional Ankle Instability (IdFAI) CAI Present = IdFAI >11 in at least one ankle Ankle Function Foot and Ankle Ability Measure – Activities of Daily Living (FAAM-ADL) Foot and Ankle Ability Measure – Sport (FAAM-Sport) Health-Related Quality of Life Pediatric Quality of Life Inventory 4.0 (PedsQL) Physical Activity Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS)

Viewpoints

Overall, the authors found that CAI was a common condition among adolescent athletes and that having CAI was associated with poor ankle function and quality of life. Although CAI develops over time, long-term deficits following an ankle sprain may occur earlier than previously thought. This study is important because there is now a foundation to justify, including ankle sprain prevention and intervention programs into adolescent athletics to prevent health burdens throughout the lifespan. The fact that 1 in 5 adolescent athletes may have CAI highlights that clinicians, coaches, and parents need to do more to address the fact that only 20% of coaches use injury prevention programs despite recommendations for these programs. It is important to note that although physical activity did not differ between groups, paper-based surveys may not be sensitive enough to detect activity changes following injury. Previous studies among adults have used smartwatches or other sensors as a better approach to track these outcomes, which should be considered in youth populations. Finally, it is worth considering that these outcomes were taken at a single time point in one state, and future research should prospectively track adolescent CAI outcomes. While we wait for these studies, clinicians should consider ankle sprain prevention programs in adolescent sport settings to combat poor health outcomes associated with repeated ankle injuries.

Questions for Discussion

Do you monitor ankle sprain outcomes among youth athletes? Have you incorporated any injury prevention programs for lateral ankle sprains in your clinical setting?

Written by: Alexandra F. DeJong

Reviewed by: Jeffrey Driban

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