Functional Severity Determines Return to Sport After Ankle Sprain in Young Athletes

ObjectivesTo determine whether early functional severity at presentation explains variability in return to sport (RTS) after ankle sprain in young athletes, compared with sprain subtype and injury mechanism. DesignRetrospective cohort study. MethodsAthletes aged [&le;]22 years with acute ankle sprains were identified from a prospectively maintained institutional database. Surgically treated cases were excluded. Functional severity at presentation was classified into three grades based on the ability to continue sports participation and ambulate immediately after injury. Injury mechanisms were categorized as high-energy deceleration (HED) or non-HED. RTS was analyzed as time to return and as prolonged RTS ([&ge;]4 weeks). Multivariable logistic regression was performed to identify factors independently associated with prolonged RTS. ResultsA total of 437 cases were included. Median RTS was 2.0 weeks (interquartile range, 0.0-4.0), and prolonged RTS occurred in 33.0% of cases. RTS duration increased stepwise with greater functional severity (p < 0.001). In multivariable analysis, functional severity was strongly associated with prolonged RTS (Grade 2: adjusted odds ratio [OR], 3.58; 95% confidence interval [CI], 2.07-6.19; Grade 3: adjusted OR, 24.53; 95% CI, 10.67-56.43; p < 0.001), and age was also independently associated (adjusted OR, 1.19 per year; 95% CI, 1.11-1.27; p < 0.001). Sprain subtype and injury mechanism were not independently associated with RTS after adjustment. ConclusionsEarly functional severity at presentation is the primary determinant of RTS after ankle sprain in young athletes. Apparent differences related to sprain subtype and injury mechanism are largely explained by initial functional impairment.