Lateral ankle sprain increases subsequent ankle sprain risk: a systematic review.

OBJECTIVE: To evaluate the evidence surrounding the association between lateral ankle sprain (LAS) history and subsequent LAS risk, as well as sex-differences in the observed associations. DATA SOURCES: PubMed, CINAHL, and SPORTDiscus were searched through July 2020 for articles reporting LAS injury history and injury incidence during a study period. STUDY SELECTION: Studies were included if they were prospective in nature, reported the number of participants with and without a history of LAS at study initiation, and reported the number of participants from each group that sustained a LAS during the study period. DATA EXTRACTION: Data included study design parameters as well as the number of participants with and without a LAS history, and the number of subsequent LAS that occurred to both groups. Risk ratios (RR) with 95% confidence intervals (CI) compared the risk of LAS within the study period between those with and without a LAS history for each included investigation. DATA SYNTHESIS: Nineteen studies with a total of 6,567 patients were included. Follow-up periods ranged from 14 weeks to 2 years. Quality assessment scores indicate moderate to high quality studies were included. A significantly higher risk of LAS within the study period was observed among those with a history of LAS in 10 out of 15 studies (RR range=1.29-6.06). Similar associations were seen in four out of six studies that included an all-male sample (RR Range=1.38-8.65), and one out of four studies with an all-female sample (RR=4.28). CONCLUSION: There is strong evidence to support that a previous LAS increases the risk of a subsequent LAS injury. Males but not females with a history of a LAS appear to be at a higher risk of sustaining a subsequent LAS but further data are needed to draw definitive conclusions based on the limited number of sex specific studies.

Four-Week Ankle-Rehabilitation Programs in Adolescent Athletes With Chronic Ankle Instability.

CONTEXT: Researchers have shown that rehabilitation programs incorporating resistance-band and balance-board exercises are effective for improving clinical measures of function and patient-reported outcomes in individuals with chronic ankle instability (CAI). However, whether combining the 2 exercises increases improvement is unknown. OBJECTIVE: To determine the effectiveness of 3 rehabilitation programs on clinical measures of balance and self-reported function in adolescent patients with CAI. DESIGN: Randomized controlled clinical trial (Trail Registration Number: ClinicalTrails.gov: NCT03447652). SETTING: High school athletic training facilities. PATIENTS OR OTHER PARTICIPANTS: Forty-three patients with CAI (age = 16.37 ± 1.00 years, height = 171.75 ± 12.05 cm, mass = 69.38 ± 18.36 kg) were block randomized into 4 rehabilitation groups. INTERVENTION(S): Protocols were completed 3 times per week for 4 weeks. The resistance-band group performed 3 sets of 10 repetitions of ankle plantar flexion, dorsiflexion, inversion, and eversion with a resistance band. The Biomechanical Ankle Platform System group performed 5 trials of clockwise and counterclockwise rotations, changing direction every 10 seconds during each 40-second trial. The combination group completed resistance-band and Biomechanical Ankle Platform System programs during each session. The control group did not perform any exercises. MAIN OUTCOME MEASURE(S): Variables were assessed before and after the intervention: time-in-balance test, foot-lift test, Star Excursion Balance Test, side-hop test, figure-8 hop test, Foot and Ankle Ability Measure, and Cumberland Ankle Instability Tool. We conducted 4 separate multivariate repeated-measures analyses of variance, followed by univariate analyses for any findings that were different. RESULTS: Using the time-in-balance test, foot-lift test, Star Excursion Balance Test (medial, posteromedial, and posterolateral directions), and figure-8 hop test, we detected improvement for each rehabilitation group compared with the control group (P < .05). However, no intervention group was superior. CONCLUSIONS: All 3 rehabilitation groups demonstrated improvement compared with the control group, yet the evidence was too limited to support a superior intervention. Over a 4-week period, either of the single-task interventions or the combination intervention can be used to combat the residual deficits associated with CAI in an adolescent patient population.

Establishing the Minimal Clinical Important Difference and Minimal Detectable Change for the Cumberland Ankle Instability Tool.

OBJECTIVE: To establish the minimal detectable change (MDC) and minimal clinically important difference (MCID) for the Cumberland Ankle Instability Tool (CAIT) in a population with chronic ankle instability (CAI). DESIGN: Experimental cohort. SETTING: Laboratory. PARTICIPANTS: A convenience sample of individuals with CAI (N=50; 12 men; 38 women; episodes of giving way, 5.84±12.54mo). CAI inclusion criteria included a history of an ankle sprain, recurrent episodes of giving way, and a CAIT score ≤25. INTERVENTIONS: Participants completed demographic information, an injury history questionnaire, and the CAIT. Participants then either participated in 4 weeks of wobble board balance training, resistance tubing strength training, or no intervention. After 4 weeks, participants recompleted the CAIT and recorded their global rating of change (GRC). MAIN OUTCOME MEASURES: Dependent variables were pre- and postintervention scores on the CAIT and postintervention GRC. The MDC with 95% confidence interval was calculated. A receiver operating characteristic (ROC) curve identified the optimal CAIT cut point (MCID) between improved and unimproved individuals on the basis of their GRC. The area under the curve was used to identify a significant ROC curve (α=.05). RESULTS: The average CAIT score preintervention was 16.8±5.6, and postintervention, it was 20.0±5.2. Thirty-one participants (62%) rated themselves as improved on the GRC scale, whereas 19 (38%) were not improved. The ROC curve was significant (area under the curve, .797; P=.001), indicating that the CAIT change score significantly predicted clinical status. The MDC was 3.08, and the MCID was ≥3 points. CONCLUSIONS: The CAIT has an MDC and MCID of ≥3 points. When CAIT scores are used to assess patient change over time, these scores should be used as a minimum threshold to indicate detectable and clinically meaningful improvement.