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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I would definently monitor ankle sprain outcomes among youth athletes because they are not fully developed yet, putting them at more of a risk for injuries like ankle sprains. With this being said, youth sport programs could easily implement a simple outcome measure to keep track of these recurring ankle sprains. As a student in a clinical site, I have seen many ankle rehabilitation programs used but only a few prevention programs. I feel prevention programs are only implemented when multiple ankle sprains occur around the same time. Prevention programs should be implemented more regularly to then reduce the amount of rehabilitation programs needed
Hi Emily,
Thanks for your thoughtful response to this post! I certainly agree that patient-reported outcome measures to track long-term ankle sprain outcomes would be important, and portable technology such as work phones or iPads would definitely help make this more accessible and feasible to track outcomes as opposed to paper-based approaches. I also agree that prevention programs should become more integral into the sports medicine care approach, and even combining injury prevention exercises into warm-ups may help with coach and athlete buy-in and save additional time and resources on the Athletic Trainer’s end.