Fractures and Chronic Recurrence are Commonly Associated with Ankle Sprains: a 5-year Population-level Cohort of Patients Seen in the U.S. Military Health System

Rhon, Daniel I.; Greenlee, Tina A.; Cook, Chad; Westrick, Richard B.; Umlauf, Jon A; Fraser, John J.

doi:10.26603/001c.27912

Cited by 8 publications

(7 citation statements)

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“…This is a salient consideration given the relatively higher prevalence of ankle sprain recurrence reported in large-sample examinations among other, comparably active populations. 31 The prevalence of recurrent lateral ankle sprains was relatively high in men’s basketball, lacrosse, and soccer as well as in women’s field hockey and basketball. Ankle sprain recurrence has been previously shown to be a strong correlate of subsequent physical dysfunction and compromised functional capacity in later life (eg, postcareer chronic ankle instability after lateral ankle sprains).…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Lateral Ligament Complex Tears of the Ankle in National Collegiate Athletic Association (NCAA) Sports: 2014-15 Through 2018-19

et al. 2023

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Background: Epidemiological studies of lateral ankle sprains in NCAA sports are important in appraising the burden of this injury and informing prevention efforts. Purpose: To describe the epidemiology of lateral ankle sprains in NCAA sports during the 2014-15 through 2018-19 seasons. Study Design: Descriptive epidemiology study. Methods: Injury and exposure information collected within the NCAA Injury Surveillance Program (ISP) were examined. Counts, rates, and proportions of lateral ankle sprains were used to describe injury incidence by sport, event type (practices, competitions), season segment (preseason, regular season, postseason), injury mechanism (player contact, noncontact, and surface contact, injury history (new, recurrent), and time loss (time loss [≥1 day], non–time loss). Injury rate ratios (IRRs) were used to examine differential injury rates, and injury proportion ratios (IPRs) were used to examine differential distributions. Results: A total of 3910 lateral ankle sprains were reported (4.61 per 10,000 athlete exposures) during the study period, and the overall rate was highest in men’s basketball (11.82 per 10,000 athlete exposures). The competition-related injury rate was higher than the practice-related rate (IRR, 3.24; 95% CI, 3.04-3.45), and across season segments, the overall rate was highest in preseason (4.99 per 10,000 athlete exposures). Lateral ankle sprains were most often attributed to player-contact mechanisms in men’s (43.2%) and women’s sports (35.1%), although injuries were more prevalently attributed to player contact in men’s than in women’s sports (IPR, 1.23; 95% CI, 1.13-1.34). Overall, 49.7% of all lateral ankle sprains were time loss injuries. Conclusions: The findings of this study are consistent with previous epidemiological investigations of lateral ankle sprains among NCAA athletes. Results offer additional context on differential injury mechanisms between men’s and women’s sports and on injury risk across the competitive season. Future research may examine the effectiveness of deploying injury prevention programs before the start of a season.

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Section: Discussionmentioning

confidence: 99%

Epidemiology of Lateral Ligament Complex Tears of the Ankle in National Collegiate Athletic Association (NCAA) Sports: 2014-15 Through 2018-19

et al. 2023

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“…A critical source for many of the articles was the databases for the United States military. These include the US military Health System Data Repository (MHR) [ 15 - 16 ], the Defense Medical Epidemiology Database (DMED) [ 10 ], and the Department of Defense Trauma Registry (DODTR) [ 13 ]. These convenient databases lend themselves to massive amounts of information within military personnel.…”

Section: Reviewmentioning

confidence: 99%

“…These tests range from asking patients subjectively on a scale of 1-100 (SANE) how the ankle feels to the movement (FMS) to tests that combine pain and movement (AOFAS). The importance of prompt and accurate testing is key to stabilizing the ankle and possibly bringing down the number of first-time ankle sprains to develop chronic ankle instability (40%) [ 16 ]. In addition to inconsistent testing leading to a premature return, delayed rehabilitation caused problems down the line as well.…”

Section: Reviewmentioning

confidence: 99%

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Examination of Ankle Trauma in United States Military Members: A Scoping Review

Sinopoli¹,

Vasauskas²

2022

Cureus

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Military members, along with their injuries and expectations to return to duty, vary significantly from the general population. The purpose of this scoping review is to examine current literature pertaining to ankle injuries in United States military members and identify the research gaps. A scoping review was carried out with the PRISMA-ScR guidelines. A systematic search was utilized on three databases: PubMed, AMED, and Cochrane Library. The papers included were those of ankle injuries in the military. Exclusionary criteria included papers that did not have quantitative data, no full paper availability and non-US military. One hundred and fifty articles were screened, with nine meeting the inclusion criteria. Almost all of these were cohort by design. The focus was on a variety of tests for returning to active duty and the risks associated with individual factors for each service member. The study identified a lack of randomized control trials, underrepresentation of vulnerable subgroups within the US military, and no single test for ankle mobility and strength to return to duty. Prioritizing these deficiencies may help to save time and money within the US military healthcare system.

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“…Perceptions of LAS as a benign and self-limiting condition preclude care-seeking by service members [ 5 ]. Moreover, injury recurrence is common during the first 12 months following injury [ 6 , 7 ] and beyond [ 8 ]. Approximately 40% of individuals with LAS are projected to progress to develop chronic ankle instability (CAI) [ 8 , 9 ]—a complex clinical entity characterized by mechanical and sensorimotor impairments that result in long-term disability and degraded health-related quality of life [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Uneven Treadmill Training for Rehabilitation of Lateral Ankle Sprains and Chronic Ankle Instability: Protocol for a Pragmatic Randomized Controlled Trial

et al. 2022

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Background Lateral ankle sprains (LASs) are common injuries among military service members. Approximately 40% of individuals with an LAS progress to develop chronic ankle instability (CAI), a condition that results in substantial mechanical and neurophysiological impairment and activity limitation. Since proprioceptive and balance training improve functional outcomes and prevent secondary injury following LAS, they are recommended in clinical practice. Uneven treadmills are an innovative modality that challenge the sensorimotor system while performing an ecologically valid task simulating environments frequently encountered by service members with LAS and CAI. Objective The aim of this study is to evaluate whether the inclusion of uneven treadmill training in standard rehabilitation can improve clinical, functional, biomechanical, and patient-reported outcomes compared with the standard of care alone in service members with LAS and CAI. The prophylactic effects of treatment on secondary injury and identification of any contributing or mediating factors that influence outcomes following treatment will also be evaluated. We hypothesize that service members receiving uneven treadmill training will demonstrate greater improvements in clinical and instrumented measures of impairment, patient-reported function, and lower risk of injury recurrence than the control group immediately post and 18 months following treatment. Methods A multisite, parallel randomized clinical trial will be performed among service members aged 18-49 years being treated for LAS and CAI in military treatment facilities in the United States. Participants randomly assigned and allocated to receive the experimental intervention will be provided up to 12 sessions of training on an uneven terrain treadmill over a 6-week treatment course to supplement standard rehabilitation care. Treatment intensity of the rehabilitation exercises and treadmill training will be progressed on the basis of patient-perceived intensity and treatment responses. Outcome measures will include patient-reported outcomes, functional assessments, performance measures, and biomechanical measures. Investigators collecting outcome measures will be blinded to treatment allocation. Reinjury rates and patient-reported outcomes of function will be tracked over 18 months following treatment. Results The project was funded in September 2020. Patient recruitment began in November 2021, with 3 participants enrolled as of February 2022. Dissemination of the main study findings is anticipated in 2024. Conclusions This study will assess the impact of an innovative uneven-terrain treadmill on treatment outcomes in the rehabilitation of service members with LAS and CAI. The results of this study will be used to inform rehabilitation practices and to potentially improve functional outcomes and secondary prevention in this patient population. Trial Registration ClinicalTrials.gov NCT04999904; https://clinicaltrials.gov/ct2/show/NCT04999904?term=NCT04999904 International Registered Report Identifier (IRRID) DERR1-10.2196/38442

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Fractures and Chronic Recurrence are Commonly Associated with Ankle Sprains: a 5-year Population-level Cohort of Patients Seen in the U.S. Military Health System

Cited by 8 publications

References 32 publications

Epidemiology of Lateral Ligament Complex Tears of the Ankle in National Collegiate Athletic Association (NCAA) Sports: 2014-15 Through 2018-19

Epidemiology of Lateral Ligament Complex Tears of the Ankle in National Collegiate Athletic Association (NCAA) Sports: 2014-15 Through 2018-19

Examination of Ankle Trauma in United States Military Members: A Scoping Review

Uneven Treadmill Training for Rehabilitation of Lateral Ankle Sprains and Chronic Ankle Instability: Protocol for a Pragmatic Randomized Controlled Trial

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