Ankle Injury Prevention Programs for Youth Sports: A Systematic Review and Meta-analysis

Abstract

Context: Previous research has demonstrated that using a multicomponent approach to ankle injury preventions can significantly reduce ankle injuries; however, these studies lack specific intervention recommendations.

Objective: To evaluate the exercise components of prevention programs on ankle injuries specifically in high school athletes. Secondary objectives were to assess the overall effectiveness of prevention programs on ankle injuries in this population and how compliance and education may impact success.

Data sources: A total of 5 databases were searched through September 26, 2022.

Study selection: Study inclusion criteria included randomized control trials (RCTs) investigating exercise interventions in high school athletes aged 13 to 19 years, participation in sports competition, reporting of injury incidence, and specific exercise interventions used.

Study design: Systematic review and meta-analysis.

Level of evidence: Level 1.

Data extraction: Pooled overall ankle injury incidence rate ratio and 95% CIs were calculated using random-effects meta-analysis.

Results: A total of 10 studies were included, of which 9 used multicomponent exercise interventions and 1 used only balance training. Of the 10 studies, 3 demonstrated statistically significant reduction in ankle injuries. When data from all 10 studies were pooled and analyzed, there was a statistically significant overall reduction (incidence rate ratio, 0.74; 95% CI 0.60-0.91) in ankle injuries when comparing intervention groups with controls.

Conclusion: The most effective injury prevention programs included multiple components, emphasized strengthening and agility exercises, and promoted high adherence to the intervention. The importance of coach and player education on how and why to perform an injury prevention program as well as the frequency and duration of programs was also important. Exercise-based injury prevention programs may reduce ankle injury incidence in youth athletes by 26% when pooling data from a multitude of sport types/settings.

Keywords: ankle; exercise; prevention (injury); sports; youth.

Figure 1.

Flowchart of study inclusion and exclusion.

Figure 2.

Meta-analysis describing the injury prevention effect reported by each study. Horizontal lines through the boxes demonstrate data within the 95% CI. The diamond describes the combination of all raw pooled data for injury risk reduction ratio, with its boundaries representing the 95% CI.