Epidemiology of Ankle Ligament Injuries in US High School Athletes

Abstract

Category: Sports; Ankle; Trauma Introduction/Purpose: Foot and ankle injuries account for a large percentage of the over one million injuries sustained by high school level athletes. To date, many studies have examined the epidemiology of lower extremity injuries and ankle sprains, but few studies have classified sprains into subtypes across multiple sports. The purpose of this study was to describe the epidemiology of ankle sprain subtypes across 9 common high school sports. Methods: Athlete exposure and injury specific data from 7 seasons (2014 to 2021) were collected using the internet-based High School Reporting Information Online (High School RIO), a national high school sports injury surveillance system, for athletes participating in 1 of 9 sports (boys' and girls' soccer, girls' volleyball, boys' and girls' basketball, boys' baseball, girls' softball, boys' football, boys' wrestling). Incidence and ligament involvement of foot and ankle injuries were examined, with incidence being calculated as 1 injury per 10,000 athlete exposures (AE). Results: Ankle ligament injuries accounted for 89.0% of the 7,321 foot and ankle injuries across the 9 sports (81-94%). Girls and boys' basketball had the highest incidence of sprains, 3.46 and 3.37 respectively. Ankle ligament injuries accounted for 35.9% of all lower extremity injuries in basketball players. 85.0% of the sprains were classified as lateral ligament, 4.0% medial ligament, 11.5% syndesmosis (8.6% partial and 2.9% complete syndesmosis injuries). Football had the highest percentage of syndesmosis injuries at 11.0%, and the highest incidence of both syndesmosis injuries (0.44) and medial ligament injuries (0.17). Surgical intervention was required in 4.3% of complete syndesmosis injuries and 0.7% of lateral ligament injuries. No differences were found in incidence of ankle ligament injuries comparing pre-COVID-19 seasons (2014-2020) to the 2020-2021 season. Conclusion: Ankle sprains account for a large percentage of foot and ankle injuries sustained by high school level athletes. Syndesmosis injuries occur more commonly in football and are 6 times more likely to require early surgical intervention compared to lateral ligament injuries. Identifying sports commonly involved in these injuries and classifying the sprains is the first step in implementing early identification, rehabilitation, and prevention programs. Future studies should examine the efficacy of injury prevention programs and rates of ankle sprains among high school level athletes.

The effect of thickness and elastic modulus of the anterior talofibular ligament on anterior ankle joint stiffness: A subject-specific finite element study

“…Ankle sprain is one the most common type of sports injuries from the epidemiological data ( Swanson et al, 2022 ), approximately 85% of which are LAS ( Ferran and Maffulli, 2006 ). The injuries of the lateral ankle joint are typically due to sudden excessive inversion, which is combined with a pronounced plantarflexion and internal rotation of the ankle joint complex ( Fong et al, 2012 ).…”

“…Lateral ankle ligaments include the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). ATFL was the most mechanically vulnerable ligament ( Kumai et al, 2002 ), injury of which was involved in 85%–100% of LAS ( Ferran and Maffulli, 2006 ; Swanson et al, 2022 ), while CFL was involved in 35% and PTFL was involved in 10%. Extending from the anterior border of the lateral malleolus of the fibula to the neck of the talus, ATFL was also the structurally weakest in the lateral ankle ligaments ( Khawaji and Soames, 2015 ).…”