Anterior ankle impingment syndrome is less frequent, but associated with a longer absence and higher re-injury rate compared to posterior syndrome: a prospective cohort study of 6754 male professional soccer players

Abstract

Purpose To study the epidemiology and return to play characteristics of anterior and posterior ankle impingement syndromes (AAIS and PAIS) over 18 consecutive seasons in male professional soccer players. Methods Between the 2001–2002 and 2018–2019 seasons, 120 European soccer teams were followed prospectively for various seasons. Time loss injuries and player exposures were recorded individually in 6754 unique players. Injury incidence and burden were reported as the number of injuries and days absence per 1000 h with 95% confidence intervals (CIs). Injury severity was reported as median absence in days with the interquartile range (IQR). Results Out of 25,462 reported injuries, 93 (0.4%) were diagnosed as AAIS (38%) or PAIS (62%) in 77 players. AAIS and PAIS were similar regarding injury characteristics except for a greater proportion of AAIS having a gradual onset (69% vs.47%; P = 0.03) and being re-injuries (31% vs. 9%; P = 0.01). Impingement syndromes resulted in an overall incidence of 0.03 injuries (95% CI 0.02–0.03) per 1000 h and an injury burden of 0.4 absence days per 1000 h. PAIS incidence was significantly higher than that for AAIS [0.02 (95% CI 0.002–0.03) vs. 0.01 (95% CI 0.005–0.01) injuries per 1000 h (RR = 1.7). The absence was significantly longer in AAIS than in PAIS [10 (22) vs. 6 (11) days; P = 0.023]. Impingement syndromes that presented with a gradual onset had longer absences in comparison to impingement with an acute onset [8 (22) vs. 5 (11) days; P = 0.014]. Match play was associated with a higher incidence and greater injury burden than training: 0.08 vs. 0.02 injuries per 1000 h (RR 4.7), respectively, and 0.9 vs. 0.3 days absence per 1000 h (RR 2.5). Conclusion Ankle injuries are frequent in men’s professional soccer and ankle impingement is increasingly recognized as a common source of pain, limited range of motion, and potential time loss. In our study, ankle impingement was the cause of time loss in less than 0.5% of all injuries. PAIS was more frequently reported than AAIS, but AAIS was associated with more absence days and a higher re-injury rate than PAIS. The findings in this study can assist the physician in best practice management on ankle impingment syndromes in professional football. Level of evidence II.

Clinical significance of the anteromedial talus osteophyte in anteromedial ankle impingement in chronic lateral ankle instability

“…Ankle impingement is becoming more well recognized as a consequence of recurrent ankle sprains, and it is thought to be caused by CLAI. CLAI patients frequently have anterior ankle impingement with soft tissue and/or osseous anomalies [ 14 , 15 ]. Anterolateral ankle impingement (ALAI) syndrome and anteromedial ankle impingement (AMAI) syndrome are currently thought to be two distinct conditions [ 16 ].…”

Relationship between the morphology of osteophytes and cartilage lesions in anterior ankle impingement in athletes: a cross‐sectional study

“…These symptoms are caused by the pathological contact of bone and soft tissue structures in the anterior part of the ankle joint [ 1 ]. It is prevalent in athletes and decreases their athletic performance [ 2 ]. Anterior ankle impingement syndrome was first described by Morris in 1943 [ 3 ], followed by McMurray [ 4 ], and they termed anterior ankle impingement syndrome as athlete’s ankle and footballer’s ankle, respectively.…”

Assessing the Effectiveness of Arthroscopic Capsular Repair in Elite Baseball Players: Letter to the Editor

“…In general, acute lesions of the shoulder caused by sudden sport injuries, such as traumatic luxation, acromioclavicular joint disruption, traumatic tendon ruptures, labral lesions, cartilage defects, and fractures, have to be distinguished from chronic or long-standing abnormalities due to recurrent microtrauma, such as overuse bursitis and tendinitis, as well as secondary forms of impingement along with rotator cuff tears and labral lesions. 1 It would need to be assessed to see if that is a confounding variable that influenced why some players met the excellent criteria, met the good criteria, or were not able to meet either. The authors mentioned age, but it is not enough to draw conclusions about how long the patients have been playing.…”