Background
Methods
Inclusion criteria
Exclusion criteria
Search strategy
#1: Terms combined with ‘OR’ | #2: Terms combined with ‘OR’ | #3: Terms combined with ‘OR’ | ||
---|---|---|---|---|
The ankle | Instability | Injury | Diagnosis and measurement | Children |
Ankle | Ankle instability | Sprains and strains | Instability measurement | Child |
Ankle joint | Chronic instability | Inversion sprain | Measurement | Paediatric |
Talocrural | Inversion injury | Instability diagnosis | Pediatric | |
Talocalcaneal | Chronic | Repeated sprain | Diagnosis | Boy |
Tibiotalar | Joint instability | Repeated injury | Laxity | Girl |
Talofibular | Mechanical instability | Recurrent sprain | Adolescent | |
High ankle | Functional instability | Recurrent injury | Teen | |
Perceived instability | Wounds and injury | Teenager | ||
Unstable | Syndesmosis | Youth | ||
Lateral ligament, ankle | Young | |||
Collateral ligament | ||||
Talofibular ligament | ||||
Calcaneofibular ligament | ||||
Combined search: [#1 AND #2] AND #3
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Assessment for study inclusion
Methodological quality assessment
Results
Author, year | Study type | Participants | Follow up | Sample size | Measurement of CAI | Epidemiology of CAI- prevalence/distribution |
---|---|---|---|---|---|---|
Prospective cohort | Adolescent dancers 14.2 ± 1.8 yrs | 13 months | 116 | Ankle instability (CAIT) | 36% of all dancers unstable | |
71% of sprainers unstable | ||||||
Ankle joint laxity (mod ant draw) | 37% right, 47% left ankles moderate to very lax | |||||
Self report | 50% of total had history of sprain | |||||
22% of total had history of ≥2 sprains | ||||||
38 sprains were sustained by 33 participants | ||||||
Incidence of sprains 0.21/1000 hours of dancing | ||||||
Retrospective | Patients with high ankle sprain, severe trauma for inclusion | 6 yrs | 96 | Subjective complaints; rolling over, pain, swelling, meterosensitivity | 31.3% subjective complaints | |
16 (range: 9–21) yrs | X-ray (AP and lateral) injured side, talar tilt stress x-ray both sides | 17.7% ligament avulsions | ||||
Ligament stiffness, pain during supination or palpation of, fibular ligaments or syndesmosis | 38.5% “pathologic clinical findings” | |||||
Abnormal talar tilt (> 5 deg) | 42% abnormal | |||||
Prospective cohort | Patients with moderate to severe ankle injury 6–15 yrs. 26 female (48%) | 3 yrs | 220 | Medical report of objective (limited joint mobility, pain on pressure, axial deviations, weakness, or shortening of a limb) and subjective (pain at rest or during exercise, sense of unsteadiness, or paraesthesia) symptoms | 42% had objective or subjective symptoms (3 yrs follow up) | |
12 yrs | 54 | 23% had permanent symptoms (Risk ratio: 1.79, p = 0.10) (12 yrs follow up) | ||||
Prospective cohort | Adolescent female soccer players 15.9 ± 2.1 (range: 14–19) yrs | 1 season | 153 | Medical report of re-injuries | 56% of sprainers had recurrent sprain | |
Prospective cohort | Female soccer players 15.4 ± 0.8 (range: 14–16) yrs | - | 1430 | Self report of sprain history | Players with previous ankle injury (PI) more likely to sustain new ankle injury than those without (NH) (Rate ratio = 1.2 [1.1; 1.3] p < .001). | |
FAOS | 92.0 ± 11.3 (PI), 97.3 ± 6.0 (NH) mean difference: −5.3 (95% CI = −6.0 to −4.5) | |||||
Pain | 62.8 ± 11.1 (PI), 68.2 ± 9.7 (NH) mean difference: −5.4 (95% CI = −6.3 to −4.5) | |||||
Symptoms | 96.3 ± 7.5 (PI), 98.7 ± 4.2 (NH) mean difference: −2.3 (95% CI = −2.9 to −1.8) | |||||
Activities of daily living | 89.0 ± 16.2 (PI), 96.3 ± 8.4 (NH) mean difference: −7.3 (95%CI = −8.4 to −6.2) | |||||
Sport and recreation function | 71.3 ± 12.4 (PI), 76.3 ± 10.0 (NH) mean difference: −5.0 (95% CI = −5.9 to −4.0) | |||||
Ankle-related quality of life | 411.5 ± 46.8 (PI), and 436.7 ± 26.8 (NH) mean difference: −25.2 | |||||
(95% CI = −28.5 to −21.9) | ||||||
Descriptive epidemiology study | High school students | - | 100 high schools 13755 injuries | Medical report of re-injury | Ankle most frequently diagnosed site for recurrent injury in basketball (boys: 58.4%, girls: 43.6%), volleyball (42.7%), soccer (boys: 34.8%, girls: 37.2%), football (29.8%), softball (26.3%), and wrestling (20.1%) | |
28% of all recurrent injuries were ankle injuries | ||||||
More recurrent (28%) than new ankle injuries (19%) (Injury Proportion Ratio = 1.47; 95% CI, 1.31-1.65) | ||||||
Prospective cohort | Emergency department patients with ankle injury | 6 weeks | 199 | Medical report of: | ||
Pain with activity | 24 (34%) OW, 14 (15%) NW, RR = 2.25 (95% CI = 1.25-4.02) | |||||
Range: 8–18 yrs | Persistent swelling and/or weakness | 22 (31%) OW, 12 (13%) NW, RR = 2.40 (95% CI = 1.28-4.52) | ||||
Re-injury | 17 (24%) OW, 14 (15%) NW, RR = 1.60 (95% CI = 0.84-3.01) | |||||
OW mean age = 13.9 yrs | 6 months | 171 | Pain with activity | 19 (41%) OW, 19 (16%) NW, RR = 2.57 (95% CI = 1.50-4.39) | ||
NW mean age = 13.5 years. | Persistent swelling and/or weakness | 16 (34%) OW, 18 (15%) NW, RR = 2.28 (95% CI = 1.28-4.08) | ||||
Re-injury | 12 (26%) OW, 19 (16%) NW, RR = 1.62 (95% CI = 0.86-3.06) | |||||
31 (44%) of OW had persistent ankle symptoms at 6 months compared with 24 (26%) NW (RR, 1.70; 95% CI, 1.10-2.61) | ||||||
Cohort study | Male high school football players | 3 seasons | 152 | Medical report of sprain history | 50 (33%) had history of previous ankle sprain 15 non-contact ankle sprains were incurred. Of the 11 players who had a previous ankle sprain and sustained a noncontact sprain in this study, 9 (82%) injured the same ankle (incidence 2.1) | |
Weir & Watson 1996[26] | Prospective cohort | Physical education students | 1 yr | 266 | Self report of injuries | 230 injuries were incurred. The most common injuries were ankle sprains. |
Males (56%): 14.3 ± 0.85 (range: 12–15) yrs | 7 overuse injuries of the ankle were incurred. 100% of overuse injuries of the ankle were re-injuries. | |||||
Females: 14.1 ± 0.90 (range: 12–15) yrs |
Component of CAI investigated | Author | Participant number | Participant characteristics | Measurement | Outcome |
---|---|---|---|---|---|
Perceived instability | Hiller et al.[17] | 116 | Adolescent dancers | CAIT | 71% of sprainers unstable |
Hollwarth et al.[19] | 96 | Severe ankle trauma | Self report | 31% had complaints | |
Marchi et al.[20] | 220 | Moderate-severe ankle injury | Medical report | 42% had complaints 3 yrs post injury | |
54 | 23% had complaints 12 yrs post injury | ||||
Steffen et al.[22] | 1430 | Adolescent soccer players | FAOS | Lower function in previously injured than with no previous injury at baseline (mean diff = −25 (95% CI = −28.5 to -21.9) | |
Timm et al.[24] | 99 | Patients with ankle injury | Medical report | 34% had complaints | |
44% of overweight children (BMI > 85th percentile) | |||||
Mechanical instability | Hiller et al.[17] | 116 | Adolescent dancers | Mod ant drawer | 37% Right, 47% Left of all ankles moderate to very lax |
Hollwarth et al.[19] | 96 | Severe ankle trauma | X-ray | 18% had ligament avulsion | |
Clinical tests | 39% had pathologic clinical findings (as defined by authors) | ||||
Talar tilt >5° | 42% of total had abnormal talar tilt | ||||
Recurrent sprain | Hiller et al.[17] | 116 | Adolescent dancers | Self report | 22% had ≥2 sprains |
Soderman et al.[21] | 153 | Adolescent soccer players | Medical report | 56% of sprainers had recurrent sprain | |
Swenson et al.[23] | 13755 injuries | High school students | Medical report | 25% of all recurrent injuries were ankle injuries | |
Timm et al.[24] | 199 | Patients with ankle injury | Self report | 26% of overweight (BMI > 85th percentile) and16% normal weight reinjured | |
Tyler et al.[25] | 152 | High school footballers | Medical report | 15 non-contact ankle sprains incurred and 9 (60%) were re-sprains of the same ankle | |
Weir & Watson [26] | 266 | Physical education students | Self report | 100% overuse ankle injuries were re-injuries |
Quality
Study | Criteria | ||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Author | Year | 1 Hypotheses/objectives | 2 Outcomes | 3 Participants | 4 Findings | 5 Data distribution | 6 p value | 7 Participant Selection | 8 Represent-activeness | 9 Blinding | 10 Statistics | 11 Outcome measures | 12 Intervention groups | 13 Time period | 14 Follow up | Total | Percentage (%) |
Hiller et al.
| 2008 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | N/A | N/A | 1 | 12/12 | 100 |
Hollwarth et al.
| 1985 | 1 | 0 | 0 | 1 | 1 | 0 | 0* | 0* | 0* | 0* | 0* | 1 | 1 | N/A | 5/13 | 38 |
Marchi et al.
| 1999 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | N/A | N/A | 1 | 10/12 | 83 |
Soderman et al.
| 2001 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | N/A | N/A | 1 | 11/12 | 92 |
Steffen et al.
| 2008 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | N/A | N/A | 0* | 10/12 | 83 |
Swenson et al.
| 2009 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | N/A | N/A | N/A | 9/11 | 82 |
Timm et al.
| 2005 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 14/14 | 100 |
Tyler et al.
| 2006 | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 0* | 10/14 | 71 |
Weir & Watson | 1996 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | N/A | N/A | 0* | 9/12 | 75 |