O. Owoeye1, J. Whittaker2, C. Emery3
1Saint Louis University, Physical Therapy and Athletic Training, Saint Louis, United States, 2University of British Columbia, Department of Physical Therapy, Vancouver, Canada, 3University of Calgary, Sport Injury Prevention Research Centre, Calgary, Canada
Background: The risk of ankle post-traumatic osteoarthritis (PTOA) is extraordinarily high compared to other joints. Although the risk of OA substantially increases after a joint injury, research examining PTOA outcomes early in the period between joint injury and disease onset is sparse for the ankle. Improved understanding of the association between history of ankle joint injury in youth sport and health-related outcomes could inform ankle OA prevention strategies.
Purpose: Examine the association between a time-loss and medical attention youth sport-related ankle sprain injury and outcomes related to PTOA, 3–15 years post-injury.
Methods: Participants (n=86) included 50 individuals who experienced a time-loss and medical attention youth sport-related ankle sprain 3–15 years earlier and 36 uninjured controls. The primary outcomes were the five sub-scales of the Foot and Ankle Outcome Score (FAOS): pain, symptoms, activities of daily living, sport/recreation participation and ankle-related quality of life. Secondary outcomes included fat mass index, body mass index, unipedal dynamic balance, star excursion balance, Godin exercise questionnaire score (physical activity), athletic identity, estimated V02max (aerobic capacity), fear of pain, ankle dorsiflexion range of motion, isometric inversion, eversion, plantarflexion and dorsiflexion. Multilevel multivariable linear regression, accounting for sex, age (fixed effects) and clusters of participants (random effects, considering sex and sport), was used to examine the association between previous ankle sprain injury and each outcome. 99% Confidence intervals (99% CI) (adjusted α=0.01 to consider 5 outcomes) were used for primary and 95% CI for secondary outcomes.
Results: Participant median age was 23 years (range, 17–30), and 77% were female. Compared to controls, previously injured participants demonstrated significantly poorer outcomes on all five sub-scales of the FAOS regardless of age or sex with the largest between-group differences in symptoms [-20.9 (99% CI: -29.4 to -12.3)] and ankle-related quality of life [-25.3 (99% CI: -34.7 to -15.9)] subscales. Considering secondary outcomes, previously injured participants had a lower unipedal dynamic balance [-1.9 (95% CI: -3.5 to -0.2)] and higher fear of pain [95% CI: 7.0 (0.8 to 13.3)] compared to controls. No significant differences were found in other secondary outcomes. The post-estimation intra-class correlation from the multilevel multivariable regression models ranged from 0 to 6%.
Conclusion(s): Irrespective of sex and age, youth that experienced a time-loss and medical attention sport-related ankle sprain injury have more pain, symptoms, reduced self-reported function, sport participation and ankle-related quality of life compared to uninjured controls 3–15 year after injury. Further research involving longitudinal designs is needed to fully characterize ankle-related outcomes towards mitigating the risk of PTOA of the ankle.
Implications: This study shows that clinical symptoms, an important feature in the early stages of development of PTOA, is present in young adults with a history of time-loss ankle sprain injury within 3-15 years. This finding contributes to emerging knowledge for early diagnosis and secondary OA prevention interventions; a valuable aspect of health promotion in physical therapy.
Funding, acknowledgements: Funded by the Canadian Musculoskeletal Rehabilitation Research Network. The Sport Injury Prevention Research Centre is supported by the IOC.
Keywords: Ankle, Adolescent, Osteoarthritis
Topic: Health promotion & wellbeing/healthy ageing/physical activity
Did this work require ethics approval? Yes
Institution: University of Calgary, Alberta, Canada
Committee: Conjoint Health Research Ethics Board
Ethics number: REB16-2280
All authors, affiliations and abstracts have been published as submitted.
