PERSISTENT DISABILITY ASSOCIATED WITH ANKLE SPRAINS - A PROSPECTIVE EXAMINATION OF AN ATHLETIC POPULATION

The purpose of this study was to examine a young athletic population t o update the data regarding epidemiology and disability associated wit h ankle injuries. At the United States Military Academy, all cadets pr esenting with ankle injuries during a 2-month period were included in this prospective observational study. The initial evaluation included an extensive questionnaire, physical examination, and radiographs, Ank le sprain treatment included a supervised rehabilitation program. Subj ects were reevaluated at 6 weeks and 6 months with subjective assessme nt, physical examination, and functional testing, The mean age for all subjects was 20 years (range, 17-24 years). There were 104 ankle inju ries accounting for 23% of all injuries seen. There were 96 sprains, 7 fractures, and 1 contusion. Of the 96 sprains, 4 were predominately m edial injuries, 76 were lateral, and 16 were syndesmosis sprains. Nine ty-five percent had returned to sports activities by 6 weeks; however, 55% of these subjects reported loss of function or presence of interm ittent pain, and 23% had a decrement of >20% in the lateral hop test w hen compared with the uninjured side. At 6 months, all subjects had re turned to full activity; however, 40% reported residual symptoms and 2 .5% had a decrement of >20% on the lateral hop test. Neither previous injury nor ligament laxity was predictive of chronic symptomatology. F urthermore, chronic dysfunction could not be predicted by the grade of sprain (grade I vs. II). The factor most predictive of residual sympt oms was a syndesmosis sprain, regardless of grade. Syndesmosis sprains were most prevalent in collision sports. This study demonstrates that even though our knowledge and understanding of ankle sprains and reha bilitation of these injuries have progressed in the last 20 years, chr onic ankle dysfunction continues to be a prevalent problem. The early return to sports occurs after almost every ankle sprain; however, dysf unction persists in 40% of patients for as long as 6 months after inju ry. Syndesmosis sprains are more common than previously thought, and t his confirms that syndesmosis sprains are associated with prolonged di sability.