SLR - May 2020 - Lindsey Hjelm

Prevalence and Impact of Chronic Ankle Instability in Adolescent Athletes 

Reference: Luke Donovan, PhD ATC Scott Hetzel, MS, Craig R Laufenber, MD and Timothy A. McGuine, PhD, ATC. Prevalence and Impact of Chronic Ankle Instability in Adolescent Athletes. Orthopedic Journal of Sports Medicine. 2020. Feb 18;8(2) 1-10. 

Scientific Literature Review 

Reviewed By: Lindsey Hjelm, DPM
Residency Program: CHI Franciscan Foot and Ankle Institute – Federal Way, WA

Podiatric Relevance: Lateral ankle sprains are the most common orthopedic injury in the active population. While many patients do not initially seek treatment, chronic ankle instability (CAI) as result of repetitive sprains can be a debilitating condition. CAI can have a life-long negative affects causing post traumatic arthritis and reduced quality of life. Not only does CAI have serious health implications, but also financial burden. A majority of studies focus on the effects to the adult population; however, this research aims to understand the prevalence and impact of the condition within adolescent athletes. 

Methods: This Level three cross-sectional study took place at the University of Wisconsin- Madison. A total of 1036 adolescent athletes, age 14-18, agreed to be part of the study. Participants competed in a wide variety of sports either at club or school-based organizations and were not screened/excluded for history of past injuries.  Participants were educated about signs and symptoms of ankle sprains and instability, allowing them to accurately complete surveys determining presence of CAI, ankle function and physical activity (IdFAI, FAAM-Sport, FAAM- ADL, PedsQL, HRQoL, HSS Pedi-FABS). One thousand and two athletes containing a balanced ratio of male to female high school athletes (50.4 percent females) returned these surveys successfully for statistical analysis to be performed.  

Results: The prevalence of CAI in adolescent athletes within this cohort was 20 percent. The primary sports played by participants included basketball, football and volleyball. Overall, athletes reported high ankle function (FAAM-ADL and FAAM-Sport) with a median score of 100/100. The quality of life (HRQoL) was 100/100 overall. The psychosocial subscore of PedsQL was 96.7 and total subscore was 95.6. Physical activity within the whole group measured a median score of 25/28 (HSS Pedi-FABS). Survey results indicated 26.1 percent of individuals had suffered at least one ankle sprain. Those with positive survey results of CAI, 16.3 percent were unilateral and 3.7 percent bilateral. Ankle function (FAAM-Sport) and quality of life (HRQOL) were lower in participants with unilateral CAI compared to athletes without the condition. Physical activity was not statistically different between patient with or without CAI (HSS Pedi-FABS). Those without CAI reported higher PedsQL emotional, school, physical and psychosocial subscale scores. 

Conclusions: This study demonstrates a relatively high prevalence of CAI in adolescent athletes. In adult populations, the prevalence of CAI is similar, likely correlating to the initiation of symptoms at the time of adolescence. Adolescents with CAI had decreased ankle function in comparison to those without the condition. The impact of CAI on adolescents emotionally, psychosocially and physically can impact individuals into adulthood. The negative effects CAI has on ankle function and quality of life demonstrate necessity for better prevention, treatment and rehabilitation strategies. It has been determined that failure to properly identify and treat this condition can lead to long term negative health effects. Limitations of this study include results taken from a small geographical area, bias towards athletes competing in sports with the highest rate of ankle sprains, and data collected solely from subjective surveys rather than objective findings. 

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