Objectives To 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.

Design Retrospective cohort study.

Methods Athletes aged ≤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 (≥4 weeks). Multivariable logistic regression was performed to identify factors independently associated with prolonged RTS.

Results A 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.

Conclusions Early 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.

The authors have declared no competing interest.

This study did not receive any funding

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was approved by the Institutional Review Board of Ashiya Central Hospital (Approval No. 7-ACH-11-2).

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All data produced in the present study are available upon reasonable request to the authors