Intrinsic Risk Factors for Ankle Sprain Differ Between Male and Female Athletes: A Systematic Review and Meta-Analysis

Abstract

Background Ankle sprains remain prevalent across most team sports. However, despite divergent ankle sprain injury rates in male and female athletes, little is known about potential sex-specific risk factors for ankle sprain. Objective To systematically investigate the sex-specific risk factors for ankle sprain. Methods Combinations of the key terms were entered into PubMed, Web of Science, Embase and Cochrane Library databases, and prospective studies reporting ankle sprain risk factors in males or females were included for meta-analysis. Results Sixteen studies were eligible for inclusion, for a total of 3636 athletes (735 female) and 576 ankle sprains (117 female). Out of 21 prognostic factors, previous ankle sprain injury (odds ratio = 2.74, P < .001), higher body mass index (SMD = 0.50, P < 0.001), higher weight (SMD = 0.24, P = 0.02), lower isometric hip abduction strength (SMD = − 0.52, P < 0.0001) and lower dynamic balance performance (SMD = − 0.48 to − 0.22, P < 0.001–0.04) were identified as risk factors in male athletes. In female athletes, out of 18 factors eligible for meta-analysis, only lower concentric dorsiflexion strength was identified as a risk factor (SMD = − 0.48, P = 0.005). Conclusion This meta-analysis provides novel evidence for different risk factor profiles for ankle sprain injuries between female and male athletes. Further studies, particularly in female athletes, are needed to strengthen the evidence.

Factors Associated With a Lateral Ankle Sprain in Young Female Soccer Players: A Prospective Cohort Study

“…Once again, systematic reviews found a lack of data for female athletes. 24,36 Given our exclusive focus on female soccer players, our results add considerable evidence supporting the risk for LASs in female athletes with prior LASs.…”

“…36 Another meta-analysis concluded that a previous ankle sprain was a prognostic risk factor only in male athletes. 24 Despite this, several articles, although few in number, have suggested that an LAS was also a risk factor for 25 found that players with a history of LASs were predisposed to LASs in a prospective cohort study of female collegiate soccer players. Once again, systematic reviews found a lack of data for female athletes.…”

“…Importantly, the authors noted the relatively scarcity of data on female athletes. 24 The aim of the current study was to identify intrinsic risk factors for an LAS in a relatively large population of young female soccer players.…”

CORR Insights®: Differences in Cortical Activation During Dorsiflexion and Plantarflexion in Chronic Ankle Instability: A Task-fMRI Study

“…Estimated annual costs to treat these injuries are at least USD 2 billion (in 1984 dollars) [39]. These injuries now occur more frequently in females than males in sports like basketball, soccer, lacrosse, and volleyball [24, 34, 44], so the physical and financial burden of chronic ankle instability is shifting to females.…”

“…Establishing these relationships can provide a holistic neuromechanical understanding of chronic ankle instability that can drive more effective personalized screening programs, injury prevention protocols, rehabilitation techniques, and surgical treatments. As the factors associated with ankle ligament injury can differ between males and females [3,24], injury prevention protocols and treatment algorithms likely need to target sex-specific injury mechanisms.…”