The epidemiology of chronic ankle instability with perceived ankle instability- a systematic review

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Abstract

Background

Chronic ankle instability, developing from ankle sprain, is one of the most common sports injuries. Besides it being an ankle issue, chronic ankle instability can also cause additional injuries. Investigating the epidemiology of chronic ankle instability is an essential step to develop an adequate injury prevention strategy. However, the epidemiology of chronic ankle instability remains unknown. Therefore, the purpose of this study was to investigate the epidemiology of chronic ankle instability through valid and reliable self-reported tools in active populations.

Methods

An electronic search was performed on PubMed and Web of Science in July 2020. The inclusion criteria for articles were peer-reviewed, published between 2006 and 2020, using one of the valid and reliable tools to evaluate ankle instability, determining chronic ankle instability based on the criteria of the International Ankle Consortium, and including the outcome of epidemiology of chronic ankle instability. The risk of bias of the included studies was evaluated with an adapted tool for the sports injury review method.

Results

After removing duplicated studies, 593 articles were screened for eligibility. Twenty full-texts were screened and finally nine studies were included, assessing 3804 participants in total. The participants were between 15 and 32 years old and represented soldiers, students, athletes and active individuals with a history of ankle sprain. The prevalence of chronic ankle instability was 25%, ranging between 7 and 53%. The prevalence of chronic ankle instability within participants with a history of ankle sprains was 46%, ranging between 9 and 76%. Five included studies identified chronic ankle instability based on the standard criteria, and four studies applied adapted exclusion criteria to conduct the study. Five out of nine included studies showed a low risk of bias.

Conclusions

The prevalence of chronic ankle instability shows a wide range. This could be due to the different exclusion criteria, age, sports discipline, or other factors among the included studies. For future studies, standardized criteria to investigate the epidemiology of chronic ankle instability are required. The epidemiology of CAI should be prospective. Factors affecting the prevalence of chronic ankle instability should be investigated and clearly described.

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Most cited references 36

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Understanding injury mechanisms: a key component of preventing injuries in sport.

R Bahr, T Krosshaug (2005)

Anterior cruciate ligament (ACL) injuries are a growing cause of concern, as these injuries can have serious consequences for the athlete with a greatly increased risk of early osteoarthrosis. Using specific training programmes, it may be possible to reduce the incidence of knee and ankle injuries. However, it is not known which programme components are the key to preventing knee and ankle injuries or how the exercises work to reduce injury risk. Our ability to design specific prevention programmes, whether through training or other preventive measures, is currently limited by an incomplete understanding of the causes of injuries. A multifactorial approach should be used to account for all the factors involved-that is, the internal and external risk factors as well as the inciting event (the injury mechanism). Although such models have been presented previously, we emphasise the need to use a comprehensive model, which accounts for the events leading to the injury situation (playing situation, player and opponent behaviour), as well as to include a description of whole body and joint biomechanics at the time of injury.

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The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies.

Brian Caulfield, Eamonn Delahunt, Jay Hertel … (2014)

Ankle sprain is one of the most common musculoskeletal injuries, yet a contemporary review and meta-analysis of prospective epidemiological studies investigating ankle sprain does not exist. Our aim is to provide an up-to-date account of the incidence rate and prevalence period of ankle sprain injury unlimited by timeframe or context activity. We conducted a systematic review and meta-analyses of English articles using relevant computerised databases. Search terms included Medical Search Headings for the ankle joint, injury and epidemiology. The following inclusion criteria were used: the study must report epidemiology findings of injuries sustained in an observed sample; the study must report ankle sprain injury with either incidence rate or prevalence period among the surveyed sample, or provide sufficient data from which these figures could be calculated; the study design must be prospective. Independent extraction of articles was performed by two authors using pre-determined data fields. One-hundred and eighty-one prospective epidemiology studies from 144 separate papers were included. The average rating of all the included studies was 6.67/11, based on an adapted version of the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines for rating observational studies. 116 studies were considered high quality and 65 were considered low quality. The main findings of the meta-analysis demonstrated a higher incidence of ankle sprain in females compared with males (13.6 vs 6.94 per 1,000 exposures), in children compared with adolescents (2.85 vs 1.94 per 1,000 exposures) and adolescents compared with adults (1.94 vs 0.72 per 1,000 exposures). The sport category with the highest incidence of ankle sprain was indoor/court sports, with a cumulative incidence rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures and 4.9 per 1,000 h. Low-quality studies tended to underestimate the incidence of ankle sprain when compared with high-quality studies (0.54 vs 11.55 per 1,000 exposures). Ankle sprain prevalence period estimates were similar across sub-groups. Lateral ankle sprain was the most commonly observed type of ankle sprain. Females were at a higher risk of sustaining an ankle sprain compared with males and children compared with adolescents and adults, with indoor and court sports the highest risk activity. Studies at a greater risk of bias were more likely to underestimate the risk of ankle sprain. Participants were at a significantly higher risk of sustaining a lateral ankle sprain compared with syndesmotic and medial ankle sprains.

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What are the Main Running-Related Musculoskeletal Injuries?

Alexandre Lopes, Luiz Carlos Hespanhol Junior, Simon Yeung … (2012)

Background Musculoskeletal injuries occur frequently in runners and despite many studies about running injuries conducted over the past decades it is not clear in the literature what are the main running-related musculoskeletal injuries (RRMIs). Objective The aim of this study is to systematically review studies on the incidence and prevalence of the main specific RRMIs. Methods An electronic database search was conducted using EMBASE (1947 to October 2011), MEDLINE (1966 to October 2011), SPORTDiscus™ (1975 to October 2011), the Latin American and Caribbean Center on Health Sciences Information (LILACS) [1982 to October 2011] and the Scientific Electronic Library Online (SciELO) [1998 to October 2011] with no limits of date or language of publication. Articles that described the incidence or prevalence rates of RRMIs were considered eligible. Studies that reported only the type of injury, anatomical region or incomplete data that precluded interpretation of the incidence or prevalence rates of RRMIs were excluded. We extracted data regarding bibliometric characteristics, study design, description of the population of runners, RRMI definition, how the data of RRMIs were collected and the name of each RRMI with their rates of incidence or prevalence. Separate analysis for ultra-marathoners was performed. Among 2924 potentially eligible titles, eight studies (pooled n = 3500 runners) were considered eligible for the review. In general, the articles had moderate risk of bias and only one fulfilled less than half of the quality criteria established. Results A total of 28 RRMIs were found and the main general RRMIs were medial tibial stress syndrome (incidence ranging from 13.6% to 20.0%; prevalence of 9.5%), Achilles tendinopathy (incidence ranging from 9.1% to 10.9%; prevalence ranging from 6.2% to 9.5%) and plantar fasciitis (incidence ranging from 4.5% to 10.0%; prevalence ranging from 5.2% to 17.5%). The main ultra-marathon RRMIs were Achilles tendinopathy (prevalence ranging from 2.0% to 18.5%) and patellofemoral syndrome (prevalence ranging from 7.4% to 15.6%). Conclusion This systematic review provides evidence that medial tibia stress syndrome, Achilles tendinopathy and plantar fasciitis were the main general RRMIs, while Achilles tendinopathy and patellofemoral syndrome were the most common RRMIs for runners who participated in ultra-marathon races.

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Author and article information

Contributors

Chiao-I Lin:

ORCID: http://orcid.org/0000-0002-1898-172X

chialin@uni-potsdam.de

Sanne Houtenbos: houtenbos@uni-potsdam.de

Yu-Hsien Lu: yu-hsienlu@cuhk.edu.hk

Frank Mayer: fmayer@uni-potsdam.de

Pia-Maria Wippert: wippert@uni-potsdam.de

Journal

Journal ID (nlm-ta): J Foot Ankle Res

Journal ID (iso-abbrev): J Foot Ankle Res

Title: Journal of Foot and Ankle Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1757-1146

Publication date (Electronic): 28 May 2021

Publication date PMC-release: 28 May 2021

Publication date Collection: 2021

Volume: 14

Electronic Location Identifier: 41

Affiliations

[1 ]GRID grid.11348.3f, ISNI 0000 0001 0942 1117, Medical Sociology and Psychobiology, Department of Physical Activity and Health, , University of Potsdam, ; Am Neuen Palais 10, House 12, 14469 Potsdam, Germany

[2 ]GRID grid.11348.3f, ISNI 0000 0001 0942 1117, University Outpatient Clinic, Centre of Sports Medicine, , University of Potsdam, Am Neuen Palais 10, House 12, ; Potsdam, Germany

[3 ]GRID grid.10784.3a, ISNI 0000 0004 1937 0482, JC School of Public Health and Primary Care Faculty of Medicine, , The Chinese University of Hong Kong, Shatin, NT, ; Hong Kong, China

[4 ]Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, the Brandenburg Medical School Theodor Fontane and the Brandenburg University of Technology Cottbus–Senftenberg, Am Neuen Palais 10, House 12, Potsdam, Germany

Author information

Chiao-I Lin http://orcid.org/0000-0002-1898-172X

Article

Publisher ID: 480

DOI: 10.1186/s13047-021-00480-w

PMC ID: 8161930

PubMed ID: 34049565

SO-VID: f2613814-7950-4166-a984-c26781164123

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 3 December 2020

Date accepted : 4 May 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100010002, Ministry of Education;

Funded by: Universität Potsdam (1031)

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: ankle sprain,sports injury,functional ankle instability

Data availability:

ScienceOpen disciplines: Orthopedics

Keywords: ankle sprain, sports injury, functional ankle instability

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The epidemiology of chronic ankle instability with perceived ankle instability- a systematic review

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Abstract

Background

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Orthopedics

Most cited references 36

Understanding injury mechanisms: a key component of preventing injuries in sport.

The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies.

What are the Main Running-Related Musculoskeletal Injuries?

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Cited by 12

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