The Epidemiology of Lateral Ligament Complex Ankle Sprains in National Collegiate Athletic Association Sports

Abstract

Background:

Ankle sprains are a common injury in collegiate sports. Few studies have examined the epidemiology of individual ligament injuries, specifically the lateral ligament complex (LLC) of the ankle.

Purpose:

To describe the epidemiology, including the estimated yearly national incidence, of LLC sprains among National Collegiate Athletic Association (NCAA) athletes.

Study Design:

Descriptive epidemiology study.

Methods:

Injury surveillance data for 25 sports from the NCAA Injury Surveillance Program (NCAA-ISP) for the academic years 2009-2010 to 2014-2015 were used for analysis. All injuries included for analysis had a diagnosis of an LLC sprain. LLC sprain rates and rate ratios (RRs) with 95% CIs were calculated. From the sample, national estimates of the annual incidence of LLC sprains across the entire student-athlete body from these 25 sports were also calculated.

Results:

During the 2009-2010 to 2014-2015 academic years, 2429 LLC sprains were reported, for a rate of 4.95 per 10,000 athlete-exposures (AEs). LLC sprains comprised 7.3% of all reported collegiate sports injuries in the NCAA-ISP. Also, an estimated 16,022 LLC sprains occurred annually among the 25 sports. The sports with the highest LLC sprain rates were men’s basketball (11.96/10,000 AEs) and women’s basketball (9.50/10,000 AEs). Most LLC sprains occurred during practices (57.3%); however, the LLC sprain rate was higher in competitions than in practices (RR, 3.29; 95% CI, 3.03-3.56). Also, 11.9% of LLC sprains were identified as recurrent injuries, with the largest proportions of recurrent LLC sprains being found within women’s basketball (21.1%), women’s outdoor track (21.1%), women’s field hockey (20.0%), and men’s basketball (19.1%). In 44.4% of LLC sprains, the athlete returned to play in less than 24 hours; in 3.6%, the athlete required more than 21 days before returning to play (including those who did not return to play at all).

Conclusion:

LLC sprains were the most commonly reported injury diagnosis among United States collegiate student-athletes. Continued examination of interventions that aim to reduce the incidence, severity, and recurrence of LLC sprains, specifically in women, is warranted.

Keywords

ankle sprain college injury

Get full access to this article

View all access options for this article.

References

Agel

Evans

Dick

Putukian

Marshall

. Descriptive epidemiology of collegiate men’s soccer injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2002-2003. J Athl Train. 2007;42(2):270-277.

Agel

Palmieri-Smith

Dick

Wojtys

Marshall

. Descriptive epidemiology of collegiate women’s volleyball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train. 2007;42(2):295-302.

Anandacoomarasamy

Barnsley

. Long term outcomes of inversion ankle injuries. Br J Sports Med. 2005;39(3):e14.

Attenborough

Hiller

Smith

Stuelcken

Greene

Sinclair

. Chronic ankle instability in sporting populations. Sports Med. 2014;44:1545-1556.

Ben Abdelkrim

Castagna

Jabri

Battikh

El Fazaa

El Ati

. Activity profile and physiological requirements of junior elite basketball players in relation to aerobic-anaerobic fitness. J Strength Cond Res. 2010;24:2330-2342.

Ben Abdelkrim

El Fazaa

El Ati

. Time-motion analysis and physiological data of elite under-19-year-old basketball players during competition. Br J Sports Med. 2007;41:69-75.

Beynnon

Vacek

Murphy

Alosa

Paller

. First-time inversion ankle ligament trauma the effects of sex, level of competition, and sport on the incidence of injury. Am J Sports Med. 2005;33:1485-1491.

Cho

Kim

Shon

Park

Cha

. A ligament reattachment technique for high-demand athletes with chronic ankle instability. J Foot Ankle Surg. 2015;54:7-12.

Cross

Worrell

Leslie

Van Veld

. The relationship between self-reported and clinical measures and the number of days to return to sport following acute lateral ankle sprains. J Orthop Sports Phys Ther. 2002;32:16-23.

10.

Cumps

Verhagen

Meeusen

. Efficacy of a sports specific balance training programme on the incidence of ankle sprains in basketball. J Sports Sci Med. 2007;6:212-219.

11.

Denegar

Hertel

Fonseca

. The effect of lateral ankle sprain on dorsiflexion range of motion, posterior talar glide, and joint laxity. J Orthop Sports Phys Ther. 2002;32:166-173.

12.

Dias

. The lateral ankle sprain: an experimental study. J Trauma. 1979:19(4):266-269.

13.

Dick

Ferrara

Agel

. Descriptive epidemiology of collegiate men’s football injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train. 2007;42:221-233.

14.

Evans

Hertel

Sebastianelli

. Bilateral deficits in postural control following lateral ankle sprain. Foot Ankle Int. 2004;25:833-839.

15.

Gribble

Delahunt

Bleakley

. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. Br J Sports Med. 2013;43(8):585-591.

16.

Hootman

Dick

Agel

. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42:311-319.

17.

Hubbard

Hicks-Little

. Ankle ligament healing after an acute ankle sprain: an evidence-based approach. J Athl Train. 2008;43:523.

18.

Janssen

Hendriks

van Mechelen

Verhagen

. The cost effectiveness of measures to prevent recurrent ankle sprains: results of a 3-arm randomized controlled trial. Am J Sports Med. 2014;42(7):1534-1541.

19.

Kerr

Dompier

Snook

. National Collegiate Athletic Association Injury Surveillance System: review of methods for 2004-2005 through 2013-2014 data collection. J Athl Train. 2014;49:552-560.

20.

Kovaleski

Heitman

Gurchiek

Hollis

Liu

Pearsall

4th . Joint stability characteristics of the ankle complex in female athletes with histories of lateral ankle sprain, part II: clinical experience using arthrometric measurement. J Athl Train. 2014;49:198.

21.

Kucera

Marshall

Bell

DiStefano

Goerger

Oyama

. Validity of soccer injury data from the National Collegiate Athletic Association’s Injury Surveillance System. J Athl Train. 2011;46:489-499.

22.

Lam

Snyder Valier

Valovich McLeod

. Injury and treatment characteristics of sport-specific injuries sustained in interscholastic athletics: a report from the athletic training practice-based research network. Sports Health. 2015;7:67-74.

23.

Matthew

Delextrat

. Heart rate, blood lactate concentration, and time-motion analysis of female basketball players during competition. J Sports Sci. 2009;27:813-821.

24.

McGuine

Brooks

Hetzel

. The effect of lace-up ankle braces on injury rates in high school basketball players. Am J Sports Med. 2011;39:1840-1848.

25.

McGuine

Hetzel

Wilson

Brooks

. The effect of lace-up ankle braces on injury rates in high school football players. Am J Sports Med. 2012;40:49-57.

26.

McInnes

Carlson

Jones

McKenna

. The physiological load imposed on basketball players during competition. J Sports Sci. 1995;13:387-397.

27.

Medina McKeon

Bush

Reed

Whittington

Uhl

McKeon

. Return-to-play probabilities following new versus recurrent ankle sprains in high school athletes. J Sci Med Sport. 2014;17:23-28.

28.

National Collegiate Athletic Association. Student-athletes. Available at: http://www.ncaa.org/student-athletes. Accessed November 2, 2015.

29.

Nedelec

McCall

Carling

Legall

Berthoin

Dupont

. The influence of soccer playing actions on the recovery kinetics after a soccer match. J Strength Cond Res. 2014;28:1517-1523.

30.

Riva

Bianchi

Rocca

Mamo

. Proprioceptive training and injury prevention in a professional men’s basketball team: a six-year prospective study. J Strength Cond Res. 2016;30(2):461-475.

31.

Sheppard

Gabbett

Stanganelli

. An analysis of playing positions in elite men’s volleyball: considerations for competition demands and physiologic characteristics. J Strength Cond Res. 2009;23:1858-1866.

32.

Söderman

Adolphson

Lorentzon

Alfredson

. Injuries in adolescent female players in European football: a prospective study over one outdoor soccer season. Scand J Med Sci Sports. 2001;11:299-304.

33.

Swenson

Collins

Fields

Comstock

. Epidemiology of US high school sports-related ligamentous ankle injuries, 2005/06-2010/11. Clin J Sport Med. 2013;23:190-196.

34.

Swenson

Yard

Fields

Comstock

. Patterns of recurrent injuries among US high school athletes, 2005-2008. Am J Sports Med. 2009;37:1586-1593.

35.

Taylor

Ford

Nguyen

Terry

Hegedus

. Prevention of lower extremity injuries in basketball: a systematic review and meta-analysis. Sports Health. 2015;7(5):392-398.

36.

Tyler

McHugh

Mirabella

Mullaney

Nicholas

. Risk factors for noncontact ankle sprains in high school football players: the role of previous ankle sprains and body mass index. Am J Sports Med. 2006;34:471-475.

37.

van den Bekerom

Kerkhoffs

McCollum

Calder

van Dijk

. Management of acute lateral ankle ligament injury in the athlete. Knee Surg Sports Traumatol Arthrosc. 2013;21:1390-1395.

38.

Verhagen

Van Tulder

van der Beek

Bouter

Van Mechelen

. An economic evaluation of a proprioceptive balance board training programme for the prevention of ankle sprains in volleyball. Br J Sports Med. 2005;39:111-115.