Epidemiology of U.S. high school sports-related ligamentous ankle injuries, 2005/06-2010/11

Abstract

Objective: Describe ankle injury epidemiology among US high school athletes in 20 sports.

Design: Descriptive prospective epidemiology study.

Setting: Sports injury data for the 2005/06 to 2010/11 academic years were collected using an Internet-based injury surveillance system, Reporting Information Online.

Participants: A nationwide convenience sample of US high schools.

Assessment of risk factors: Injuries sustained as a function of sport and gender.

Main outcome measures: Ankle sprain rates and patterns, outcomes, and mechanisms.

Results: From 2005/06 to 2010/11, certified athletic trainers reported 5373 ankle sprains in 17,172,376 athlete exposures (AEs), for a rate of 3.13 ankle sprains per 10,000 AEs. Rates were higher for girls than for boys (rate ratio [RR], 1.25; 95% confidence interval [CI], 1.17-1.34) in gender-comparable sports and higher in competition than practice for boys (RR, 3.42; 95% CI, 3.20-3.66) and girls (RR, 2.71; 95% CI, 2.48-2.95). The anterior talofibular ligament was most commonly injured (involved in 85.3% of sprains). Overall, 49.7% of sprains resulted in loss of participation from 1 to 6 days. Although 0.5% of all ankle sprains required surgery, 6.6% of those involving the deltoid ligament also required surgery. The athletes were wearing ankle braces in 10.6% of all the sprains. The most common injury mechanism was contact with another person (42.4% of all ankle sprains).

Conclusions: Ankle sprains are a serious problem in high school sports, with high rates of recurrent injury and loss of participation from sport.

FIGURE 1A

Rates of ankle sprains per 10,000 athlete exposures by sport in 9 sports, High School Sports-Related Injury Surveillance Study, United States, 2005/06–2010/11. ^a,b,c ◆ Total Football ▴ Boys’ Soccer Girls’ Soccer × Girls’ Volleyball • Boys’ Basketball Girls’ Basketball + Wrestling ∎ Baseball Softball aReflects rates for combined original and convenience samples. b“Total,” is the total rate for combined original and convenience sample data for only the original 9 sports. cSignificant trends (see text): Total (p = 0.002), boys’ football (p = 0.006), boys’ soccer (p = 0.028), boys’ wrestling (p = 0.005), and girls’ volleyball (p = 0.015), and boys’ basketball (p = 0.041)

FIGURE 1B

Rates of ankle sprains per 10,000 athlete exposures by sport, High School Sports-Related Injury Surveillance Study, United States, 2005/06–2010/11.^a,b,c ◆ Total ▴ Boys’ Ice Hockey Girls’ Field Hockey × Boys’ Volleyball • Boys’ Lacrosse Girls’ Lacrosse ∎ Boys’ Track and Field Girls’ Track and Field Girls’ Gymnastics + Cheerleading aBoys’ and girls’ swimming and diving not included because only 2 girls’ swimming and diving ankle sprains were recorded. b“Total” is the rate for combined original and convenience sample data for all 20 sports. cNone of these trends were significant at p = 0.05.

FIGURE 2

Specific ligamentous structures involved in ankle sprains among US high school athletes shown in medial (left), posterior (middle) and lateral (right) views, High School Sports-Related Injury Surveillance Study, United States, 2005/06–2010/11.^a,b aPercentages represent the proportion of all ankle sprains involving the indicated ligament. bAnterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), anterior inferior tibiofibular ligament (AITFL), posterior talofibular ligament (PTFL), posterior inferior tibiofibular ligament (PITFL)