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STUDY DESIGN: Single-blind case-control study. OBJECTIVE: To compare functional performance and self-assessed disability scores among individuals with and without chronic ankle instability (CAI) and uninjured controls. BACKGROUND: After an acute lateral ankle sprain, CAI develops in 40% to 75% of all individuals. However, some individuals, copers, maintain high-level activities after an ankle sprain and do not develop CAI. Studying differences between copers and those with CAI is the first step in developing a clinical battery of tests that can accurately determine which individuals are more likely to develop CAI after an acute lateral ankle sprain. METHODS AND MEASURES: Participants were 24 active adults with unilateral CAI (mean +/- SD age, 21.7 +/- 2.8 years), 24 copers (20.8 +/- 1.5 years), and 24 uninjured controls (21.8 +/- 2.6 years). Participants completed 3 questionnaires of self-assessed disability: (1) Foot and Ankle Disability Index, (2) Foot and Ankle Disability Index-Sport, and (3) a questionnaire of ankle function. Four hop tests were also completed: (1) figure-8 hop, (2) side-to-side hop, (3) triple-crossover hop, and (4) single-leg hop for distance. RESULTS: Self-assessed disability was significantly different among groups (P<.001), but hop test scores (P = .259) were not. Those with CAI had greater self-assessed disability than copers and uninjured controls. Copers and uninjured controls did not differ in self-assessed disability or functional performance. CONCLUSIONS: Self-assessed disability is significantly greater in those with CAI than copersand uninjured controls. However, functional performance, measured by hop tests, did not differ among groups.J Orthop Sports Phys Ther 2009;39(6):458-467, Epub 2 February 2009. doi:10.2519/jospt.2009.2989. [ABSTRACT FROM AUTHOR]

Context: Research concerning prophylactic ankle stabilizers (PASs) has focused on healthy subjects, and the results cannot be generalized to the functional ankle instability (FAI) population, a population that has an increased risk of reinjury and is likely to wear PASs. Objective: To determine whether PASs improve dynamic postural stability in FAI subjects as compared with a control (nobrace) condition. Design: A crossover design was used to determine the effects of PASs on dynamic postural stability and vertical ground reaction forces. Setting: Biomechanics laboratory. Patients or Other Participants: Twenty-eight subjects with unilateral FAI, 13 men (age = 21.5 +/- 1.2 years, height = 181.5 cm +/- 10.5 cm, mass = 77.6 kg +/- 17.2 kg) and 15 women (age = 20.5 +/- 1.1 years, height = 169.4 cm +/- 8.2 cm, mass = 67.9 kg +/-8.8 kg). Intervention(s): A jump protocol required subjects to perform a 2-legged jump to a height equivalent to 50% of their maximum vertical leap and land on a single leg. Main Outcome Measure(s): The dynamic postural stability index, the directional components (medial-lateral, anterior-posterior, and vertical), and vertical ground reaction force after a jump landing. Results: Compared with the control condition, only the vertical component score was reduced (improved) with the application of a soft or semirigid PAS (P < .01). Conclusions: Soft and semirigid PASs did not improve dynamic postural stability as measured by the Dynamic Postural Stability Index. However, PASs may help with the attenuation of vertical forces. [ABSTRACT FROM AUTHOR]

Context: New measures of dynamic postural stability are needed to address weaknesses of previous measures. Objective: To assess the feasibility, reliability, and precision of a new measure of dynamic postural stability. Design: A single within-subjects design was used to determine optimal sampling interval as well as intersession reliability. Setting: Biomechanics laboratory. Patients or Other Participants: Eighteen subjects (7 men [age = 22 +/- 3 years, height = 175 +/- 5 cm, mass = 75 +/- 16 kg] and 11 women [age = 23 +/- 2 years, height = 163 +/- 6 cm, mass = 68 +/- 13 kg]) without lower extremity impairment. Intervention(s): A jump protocol that required subjects to perform a 2-legged jump to a height equivalent to 50% of their maximum vertical leap and land on a single leg. Main Outcome Measure(s): The Dynamic Postural Stability Index (DPSI) and the directional components (medial-lateral, anterior-posterior, and vertical) after a jump landing. Results: We observed a significant sampling-interval main effect (F(2,51) = 26.88, P < .01) for the DPSI; the 10-second trial duration produced significantly smaller means than the 5- and 3-second trial durations, whereas the 5-second trial result was also significantly smaller than that of the 3-second trial. The DPSI was highly reliable between test sessions (intraclass correlation coefficient = .96) and very precise (SEM = .03). Conclusions: These results suggest that the DPSI can be used in conjunction with a functional single-leg hop stabilization test and is a reliable and precise measure of dynamic postural stability. We believe the shortest sampling interval (3 seconds) is the best choice for studying and mimicking athletic performance as closely as possible. [ABSTRACT FROM AUTHOR]

PURPOSE: To determine which combination of landing protocol and analysis technique would be the most effective at detecting differences in dynamic stability between healthy subjects and subjects with functional ankle instability (FAI). METHODS: Fifty-eight subjects participated in this investigation: 29 healthy individuals and 29 individuals with FAI. Subjects were assessed during a single test session for time to stabilization (TTS) in the anterior/posterior, medial/lateral, and vertical directions from two protocols: a step down and jump protocol. The step down protocol started with each subject atop a 20-cm-high platform, and the jump protocol started with subjects in a standing position 70 cm from the center of a force plate and required each subject to jump off both legs and touch a designated marker placed at a position equivalent to 50% of the subject's maximum vertical leap. TTS scores in the anterior/posterior, medial/lateral, and vertical direction were compared between group, protocol, and type of analysis. RESULTS: A significant protocol by analysis by group interaction (F(1,56) = 6.9, P = 0.011) was observed for anterior/posterior TTS. Likewise, protocol by group (F(1,56) = 4.4, P = 0.042) and protocol by analysis (F(1,56) = 14.1, P < 0.001) interactions were also noted in anterior/posterior TTS. The jump protocol (2381.7 +/- 36.5 ms) produced significantly greater TTS scores in the vertical direction than the step protocol (1533.5 +/- 71.8 ms), whereas the unbounded third order polynomial (UTOP) method (2554.4 +/- 68.7 ms) produced significant greater TTS scores as compared with the sequential estimation (SE) method (1360.8 +/- 52.1 ms). CONCLUSIONS: The jump protocol and UTOP method of analysis are the most effective TTS combination in detecting differences between healthy and FAI groups. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the effects of an isokinetic fatigue protocol and a functional fatigue protocol on time to stabilization (TTS), ground reaction force (GRF), and joint kinematics during a jump landing. DESIGN AND SETTING: Subjects were assessed on 2 occasions for TTS, GRF, and joint kinematics immediately before and after completing a fatigue protocol. One week separated the 2 sessions, and the order of fatigue protocols was randomly assigned and counterbalanced. SUBJECTS: Twenty healthy male (n = 8, age = 21.8 +/- 1.4 years, height = 180.6 +/- 7.6 cm, and mass = 74.1 +/- 13.0 kg) and female (n = 12, age = 22.2 +/- 2.1 years, height = 169.3 +/- 9.8 cm, and mass = 62.5 +/- 10.1 kg) subjects volunteered to participate. MEASUREMENTS: Subjects performed 2-legged jumps equivalent to 50% of maximum jump height, followed by a single-leg landing onto the center of a forceplate 70 cm from the starting position. Peak vertical GRF and vertical, medial-lateral, and anterior-posterior TTS were obtained from forceplate recordings. Maximum ankle dorsiflexion, knee-flexion, and knee-valgum angles were determined using 3-dimensional motion analysis. RESULTS: A 2-way analysis of variance with repeated measures revealed no significant differences when comparing TTS, GRF, and joint kinematics after isokinetic and functional fatigue protocols. CONCLUSIONS: No difference was noted between isokinetic and functional fatigue protocols relative to dynamic stability when landing from a jump. [ABSTRACT FROM AUTHOR]

Objectives: To develop an internationally agreed-upon core domain set for ankle osteoarthritis (OA)., Methods: In a three-part Delphi process, a group of multidisciplinary health professionals with expertise in ankle OA and people with ankle OA responded to online questionnaires. The questionnaires proposed a list of 29 candidate domains derived from a systematic review of ankle OA research, and interviews with people with ankle OA and health professionals. Consensus was defined a priori as ≥70% agreement in people with ankle OA and health professionals whether a domain should or should not be included in a core domain set. An online consensus meeting was held to discuss and resolve undecided candidate domains., Results: A total of 100 people (75 health professionals and 25 people with ankle OA) from 18 countries (4 continents) participated in this study. Five domains reached consensus for inclusion in a core domain set for ankle OA - pain severity, health-related quality of life, function, disability and ankle range of motion. Twenty-one candidate domains reached agreement not to be included in the core domain set, and three domains remained undecided (ankle instability, physical capacity, and mental health)., Conclusion: This international consensus study, which included people with ankle OA and health professionals, has established a core domain set for ankle OA with five domains that should be measured and reported in all ankle OA trials - pain severity, health-related quality of life, function, disability and ankle range of motion. This core domain set will guide the reporting of outcomes in clinical trials on ankle OA. Future research should determine which outcome measurement instruments should be used to measure each of the core domains., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Chronic ankle instability (CAI) is characterized by persistent neuromechanical impairments following an initial lateral ankle sprain. Ankle joint mobilization and plantar massage have improved the range of motion and static postural control in those with CAI. This study aimed to determine the impact of two-week joint mobilization and plantar massage interventions on gait kinematics and kinetics in individuals with CAI., Methods: A single-blind randomized trial was conducted with 60 participants with CAI, randomized into three groups: joint mobilization ( n  = 20), plantar massage ( n  = 20), and control ( n  = 20). The two treatment groups received six 5-min sessions manual therapy over a 2-week, while the control group received no intervention. Gait biomechanics were assessed on an instrumented treadmill before and after the intervention using 3D kinematics and kinetics analysis. Analyses compared biomechanical outcomes from each treatment group to the control group individually using a 1-dimensional statistical parametric mapping. The alpha level was set at p  < 0.05., Results: Eighteen participants per group were part of the final analysis. No significant main or interactions effects were found for ankle sagittal or frontal plane positions following either intervention ( p  > 0.05 for all comparisons). COP location relative to the lateral border of the foot also did not change ( p  > 0.05)., Conclusion: The findings suggest that two-week joint mobilization and plantar massage interventions do not significantly alter gait biomechanics in individuals with CAI. These results support the need for gait-specific interventions to modify biomechanics in this population.

Context: Individuals with anterior cruciate ligament reconstruction (ACLR) often fail to return to their previous level of sport performance. Although multifaceted, this inability to regain preinjury performance may be influenced by impaired plyometric ability attributable to chronic quadriceps dysfunction. Whole-body vibration (WBV) acutely improves quadriceps function and biomechanics after ACLR, but its effects on jumping performance outcomes such as jump height, the reactive strength index (RSI), and knee work and power are unknown., Objective: To evaluate the acute effects of WBV on measures of jumping performance in those with ACLR., Design: Crossover study design., Setting: Research laboratory., Patients or Other Participants: Thirty-six individuals with primary, unilateral ACLR., Intervention(s): Participants stood on a WBV platform in a mini-squat position while vibration or no vibration (control) was applied during six 60-second bouts with 2 minutes of rest between bouts., Main Outcome Measure(s): Double-leg jumping tasks were completed preintervention and postintervention (WBV or control) and consisted of jumping off a 30-cm box to 2 force plates half the participant's height away. The jumping task required participants to maximally jump vertically upon striking the force plates., Results: Whole-body vibration did not produce significant improvements in any of the study outcomes (ie, jump height, RSI, and knee work and power) in either limb (P = .053-.839)., Conclusions: These results suggest that a single bout of WBV is insufficient for improving jumping performance in individuals with ACLR. As such, using WBV to acutely improve jumping performance post-ACLR is likely not warranted. Future research should evaluate the effects of repeated exposure to WBV in combination with other plyometric interventions on jumping performance., (© by the National Athletic Trainers’ Association, Inc.)

Introduction: Sport and tactical populations are often impacted by musculoskeletal injury. Many publications have highlighted that risk is correlated with multiple variables. There do not appear to be existing studies that have evaluated a predetermined combination of risk factors that provide a pragmatic model for application in tactical and/or sports settings., Purpose: To develop and test the predictive capability of multivariable risk models of lower extremity musculoskeletal injury during cadet basic training at the U.S.Military Academy., Materials and Methods: Cadets from the class of 2022 served as the study population. Sex and injury history were collected by questionnaire. Body Mass Index (BMI) and aerobic fitness were calculated during testing in the first week of training. Movement screening was performed using the Landing Error Scoring System during week 1 and cadence was collected using an accelerometer worn throughout initial training. Kaplan-Meier survival curves estimated group differences in time to the first musculoskeletal injury during training. Cox regression was used to estimate hazard ratios (HRs) and Akaike Information Criterion (AIC) was used to compare model fit., Results: Cox modeling using HRs indicated that the following variables were associated with injury risk : Sex, history of injury, Landing Error Scoring System Score Category, and Physical Fitness Test (PT) Run Score. When controlling for sex and history of injury, amodel including aerobic fitness and BMI outperformed the model including movement screening risk and cadence (AIC: 1068.56 vs. 1074.11) and a model containing all variables that were significant in the univariable analysis was the most precise (AIC: 1063.68)., Conclusions: In addition to variables typically collected in this tactical setting (Injury History, BMI, and aerobic fitness), the inclusion of kinematic testing appears to enhance the precision of the risk identification model and will likely continue to be included in screening cadets at greater risk., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Clinical Scenario: Individuals with chronic ankle instability (CAI) typically complete balance training protocols to improve postural control and reduce recurrent injury risk. However, the presence of CAI persists after traditional balance training protocols suggesting that such programs may be missing elements that could be beneficial to patients. Visual occlusion modalities, such as stroboscopic goggles, may be able to augment balance training exercises to further enhance postural control gains in those with CAI. However, a cumulative review of the existing evidence has yet to be conducted., Focused Clinical Question: Does wearing stroboscopic goggles during balance training result in greater improvements to postural control than balance training alone in those with CAI?, Summary of Key Findings: All 3 studies indicated that the stroboscopic goggles group had statistically significant improvements in either a measure of static or dynamic postural control relative to the standard balance training group. However, significant improvements were not consistent across all postural control outcomes assessed in the included studies., Clinical Bottom Line: Postural control may improve more in those with CAI when stroboscopic goggles were worn while completing balance training exercises relative to completing balance training exercises alone., Strength of Recommendation: Overall, consistent moderate- to high-quality evidence was present in the 3 studies, suggesting grade C evidence for the use of stroboscopic goggles during balance training in those with CAI.

Background: Gait retraining using haptic biofeedback medially shifts the center of pressure (COP) while walking in orthopedic populations. However, the ideal sensor location needed to effectively shift COP medially has not been identified in people with chronic ankle instability (CAI)., Research Questions: Can a heel sensor location feasibly be employed in people with CAI without negatively altering kinematics? Does a heel sensor placement relative to the 5th metatarsal head (5MH) impact COP location while walking in people with CAI?, Methods: In this exploratory crossover study, 10 participants with CAI walked on a treadmill with vibration feedback for 10 minutes with a plantar pressure sensor under the heel and 5MH. Separate 2×2 repeated measures analyses of covariances (rmANCOVAs) were used to compare the averaged COP location and 3-D lower extremity kinematics from the first 10% of stance before and after training and between sensor locations. Baseline measures served as covariates to adjust for baseline differences., Results: Feedback triggered by a heel sensor resulted in 40% of participants avoiding a heel strike. There were no significant main effects or interactions between time and sensor location on COP location when controlling for baseline COP (p>0.05). However, with the 5MH placement, participants displayed less ankle internal rotation(IR) (5MH/Heel: -4.12±0.00º/ -6.43±0.62º), less forefoot abduction (-4.29±0.00º/ -5.14±1.01º), more knee flexion (3.40±0.32º/ 0.14±0.57º), less knee external rotation (-10.95±0.00º/-11.24±1.48º), less hip extension (-0.20±0.00º/-1.42±1.05º), and less hip external rotation (3.12±0.00º/3.75±1.98º)., Significance: A 5MH location may be more feasible based on difficulties maintaining heel strike when the sensor was under the heel. While no sensor location was statistically better at changing the COP, the 5MH location decreased proximal transverse plane motions making participants' gait more like controls. Individual response variations support comprehensive lower extremity assessments and the need to identify responder profiles using sensory feedback in people with CAI., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Kimmery Migel reports financial support was provided by Foundation for Physical Therapy., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Chronic ankle instability is a condition linked to progressive early ankle joint degeneration. Patients with chronic ankle instability exhibit altered biomechanics during gait and jump landings and these alterations are believed to contribute to aberrant joint loading and subsequent joint degeneration. Musculoskeletal modeling has the capacity to estimate joint loads from individual muscle forces. However, the influence of chronic ankle instability on joint contact forces remains largely unknown. The objective of this study was to compare tri-axial (i.e., compressive, anterior-posterior, and medial-lateral) ankle joint contact forces between those with and without chronic ankle instability during the ground contact phase of a drop vertical jump. Fifteen individuals with and 15 individuals without chronic ankle instability completed drop vertical jump maneuvers in a research laboratory. We used those data to drive three-dimensional musculoskeletal simulations and estimate muscle forces and tri-axial joint contact force variables (i.e., peak and impulse). Compared to those without chronic ankle instability, the ankles of patients with chronic ankle instability underwent lower compressive ankle joint contact forces as well as lower anterior-posterior and medial-lateral shearing forces during the weight acceptance phase of landing (p <.05). These findings suggest that patients with chronic ankle instability exhibit lower ankle joint loading patterns than uninjured individuals during a drop vertical jump, which may be considered in rehabilitation to potentially reduce the risk of early onset of ankle joint degeneration., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Context: Limited evidence exists regarding the assessment of single-item patient-reported outcomes when patients are medically cleared to return to sport after a lateral ankle sprain (LAS) injury., Objective: To evaluate self-reports of improvement in health status, pain, function, and disability at return to sport after an LAS., Design: Descriptive study., Setting: Sixty-nine athletic training facilities across 24 states., Patients or Other Participants: A total of 637 patients (males = 53.2%) who were diagnosed with an LAS, restricted from sport after injury, and subsequently medically cleared to return to sport within 60 days were included., Main Outcome Measure(s): Descriptive statistics were used to summarize scores for health status (Global Rating of Change), pain (Numeric Pain Rating Scale), function (Global Rating of Function), and disability (Global Rating of Disability). Mann-Whitney U tests were used to compare score differences between sexes. A Kaplan-Meier analysis was performed to provide a visual depiction of sex differences in the time to return to sport., Results: Most patients sustained an LAS injury while participating in basketball, football, or soccer and were cleared to return to sport 8 days after injury. More than two-thirds of patients reported a meaningful improvement in health status between the time of injury and return to sport. However, many noted deficits related to pain (65.1%), function (86.2%), or disability (35.8%) at return to sport. No differences were seen between males and females for pain (P = .90), function (P = .68), change in health status (P = .45), or disability (P = .21) at return to sport, although males returned to sport slightly sooner than females (P = .025)., Conclusions: Despite self-perceived improvements in health status since the time of injury, patients typically returned to sport with deficits in pain, function, and disability after an LAS. Patients may be returning to unrestricted sport participation before they feel their bodies have fully recovered from the injury., (© by the National Athletic Trainers’ Association, Inc.)

Background: Individuals with chronic ankle instability (CAI) exhibit aberrant gait biomechanics relative to uninjured controls. Altered gait biomechanics likely contribute aberrant joint loading and subsequent early onset ankle joint degeneration. Joint (i.e. cartilage) loading cannot be directly measured without invasive procedures but can be estimated via joint contact forces (JCF) generated from musculoskeletal modeling. However, no investigation has quantified JCF in those with CAI during walking despite the link between ligamentous injury and ankle post-traumatic ankle osteoarthritis., Research Question: Do patients with CAI exhibit altered ankle compressive and shear JCF profiles during the stance phase of walking compared to those without CAI?, Methods: Ten individuals with CAI and 10 individuals without a history of ankle sprain completed a gait assessment at their self-selected speed on an instrumented treadmill. Musculoskeletal modeling was applied to estimate ankle JCF variables within a generic model. Variables included the peak, impulse, and loading rates for compressive, anteroposterior shear, and mediolateral shear JCF., Results: Those with CAI had significantly different JCF forces, relative to uninjured controls, in all directions. More specifically, lower compressive peak and impulse values were noted while higher anteroposterior shearing forces (1 st peak, impulse, loading late) were observed in those with CAI. Those with CAI also demonstrated higher mediolateral shearing forces (1 st peak and impulse)., Significance: Our finding suggests that those with CAI exhibit different ankle joint loading patterns than uninjured controls. Directionality of the identified differences depends on the axis of movement., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Context: Those with chronic ankle instability (CAI) demonstrate deleterious changes in talar cartilage composition, resulting in alterations of talar cartilage loading behavior. Common impairments associated with CAI may play a role in cartilage behavior in response to mechanical loading., Objective: To identify mechanical and sensorimotor outcomes that are linked with the magnitude of talar cartilage deformation after a static loading protocol in patients with and those without CAI., Design: Cross-sectional study., Setting: Laboratory setting., Patients or Other Participants: Thirty individuals with CAI and 30 healthy individuals., Main Outcome Measures(s): After a 60-minute off-loading period, ultrasonographic images of the talar cartilage were acquired immediately before and after a 2-minute static loading protocol (single-legged stance). Talar cartilage images were obtained and manually segmented to enable calculation of medial, lateral, and overall average talar thickness. The percentage change, relative to the average baseline thickness, was used for further analysis. Mechanical (ankle joint laxity) and sensorimotor (static balance and Star Excursion Balance Test) outcomes were captured. Partial correlations were computed to determine associations between cartilage deformation magnitude and the mechanical and sensorimotor outcomes after accounting for body weight., Results: In the CAI group, greater inversion laxity was associated with greater overall (r = -0.42, P = .03) and medial (r = -0.48, P = .01) talar cartilage deformation after a 2-minute static loading protocol. Similarly, poorer medial-lateral static balance was linked with greater overall (r = 0.47, P = .01) and lateral (r = 0.50, P = .01) talar cartilage deformation. In the control group, shorter posterolateral Star Excursion Balance Test reach distance was associated with greater lateral cartilage deformation (r = 0.42, P = .03). No other significant associations were observed., Conclusions: In those with CAI, inversion laxity and poor static postural control were moderately associated with greater talar cartilage deformation after a 2-minute static loading protocol. These results suggest that targeting mechanical instability and poor balance in those with CAI via intervention strategies may improve how the talar cartilage responds to static loading conditions., (© by the National Athletic Trainers' Association, Inc.)

Background: Epidemiological studies of lateral ankle sprains in NCAA sports are important in appraising the burden of this injury and informing prevention efforts., Purpose: To describe the epidemiology of lateral ankle sprains in NCAA sports during the 2014-15 through 2018-19 seasons., Study Design: Descriptive epidemiology study., Methods: Injury and exposure information collected within the NCAA Injury Surveillance Program (ISP) were examined. Counts, rates, and proportions of lateral ankle sprains were used to describe injury incidence by sport, event type (practices, competitions), season segment (preseason, regular season, postseason), injury mechanism (player contact, noncontact, and surface contact, injury history (new, recurrent), and time loss (time loss [≥1 day], non-time loss). Injury rate ratios (IRRs) were used to examine differential injury rates, and injury proportion ratios (IPRs) were used to examine differential distributions., Results: A total of 3910 lateral ankle sprains were reported (4.61 per 10,000 athlete exposures) during the study period, and the overall rate was highest in men's basketball (11.82 per 10,000 athlete exposures). The competition-related injury rate was higher than the practice-related rate (IRR, 3.24; 95% CI, 3.04-3.45), and across season segments, the overall rate was highest in preseason (4.99 per 10,000 athlete exposures). Lateral ankle sprains were most often attributed to player-contact mechanisms in men's (43.2%) and women's sports (35.1%), although injuries were more prevalently attributed to player contact in men's than in women's sports (IPR, 1.23; 95% CI, 1.13-1.34). Overall, 49.7% of all lateral ankle sprains were time loss injuries., Conclusions: The findings of this study are consistent with previous epidemiological investigations of lateral ankle sprains among NCAA athletes. Results offer additional context on differential injury mechanisms between men's and women's sports and on injury risk across the competitive season. Future research may examine the effectiveness of deploying injury prevention programs before the start of a season.

Background: Ankle osteoarthritis (OA) is a debilitating health condition that is increasing in prevalence. Currently, there are no evidence-based guidelines for managing ankle OA. One of the current challenges to establishing guidelines is the lack of a widely agreed-upon set of outcome measures that are consistently used in ankle OA research. Without a set of agreed-upon outcome measures, it is difficult to synthesise clinical trial outcomes through meta-analysis-an essential element of evidence-informed practice. In order to develop an appropriate set of outcome measures for ankle OA, it is important first to develop a core domain set. In this protocol, we describe the methodological approach that we will use to develop such a core domain set for ankle OA., Methods: We established an international steering committee to guide the development of a core domain set for ankle OA. The core domain set development will follow a multi-staged approach consisting of three phases, involving participation by patients and clinicians/healthcare professionals. In phase 1, a list of candidate domains will be gleaned from (a) a scoping review of outcome measures used in ankle OA research, (b) qualitative interviews with individuals with ankle OA, and (c) qualitative interviews with healthcare professionals with expertise in ankle OA. In phase 2, the steering committee will review and generate a list of candidate domains from those gleaned in phase 1. In phase 3, this list of candidate domains will be considered in a Delphi process to reach a consensus on a core domain set. We anticipated this will involve 3 rounds of surveys., Conclusion: This protocol describes the methods that will be used to develop a core domain set of health-related aspects for ankle OA. Importantly, it will include both healthcare professional and patient involvement. This is a prerequisite step to developing a core outcome set for ankle OA that should be reported in all clinical trials for ankle OA. The findings will be widely disseminated across peer-refereed publication(s) and national and international conferences, as well as via relevant professional societies, patient support group organisations, and social media platforms., Project Registration: This project is registered with the Core Outcome Measures in Effectiveness Trials (COMET) database on 17 March 2021. https://www.comet-initiative.org/Studies/Details/1837 ., (© 2022. The Author(s).)