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Table 2 Included studies in qualitative synthesis

From: Systematic review of chronic ankle instability in children

Author, year Study type Participants Follow up Sample size Measurement of CAI Epidemiology of CAI- prevalence/distribution
Hiller et al. 2008[17] Prospective cohort Adolescent dancers 14.2 ± 1.8 yrs 13 months 116 Ankle instability (CAIT) 36% of all dancers unstable
71% of sprainers unstable
Ankle joint laxity (mod ant draw) 37% right, 47% left ankles moderate to very lax
Self report 50% of total had history of sprain
22% of total had history of ≥2 sprains
38 sprains were sustained by 33 participants
Incidence of sprains 0.21/1000 hours of dancing
Hollwarth et al. 1985[19] Retrospective Patients with high ankle sprain, severe trauma for inclusion 6 yrs 96 Subjective complaints; rolling over, pain, swelling, meterosensitivity 31.3% subjective complaints
16 (range: 9–21) yrs X-ray (AP and lateral) injured side, talar tilt stress x-ray both sides 17.7% ligament avulsions
Ligament stiffness, pain during supination or palpation of, fibular ligaments or syndesmosis 38.5% “pathologic clinical findings”
Abnormal talar tilt (> 5 deg) 42% abnormal
Marchi et al. 1999[20] Prospective cohort Patients with moderate to severe ankle injury 6–15 yrs. 26 female (48%) 3 yrs 220 Medical report of objective (limited joint mobility, pain on pressure, axial deviations, weakness, or shortening of a limb) and subjective (pain at rest or during exercise, sense of unsteadiness, or paraesthesia) symptoms 42% had objective or subjective symptoms (3 yrs follow up)
12 yrs 54 23% had permanent symptoms (Risk ratio: 1.79, p = 0.10) (12 yrs follow up)
Soderman et al. 2001[21] Prospective cohort Adolescent female soccer players 15.9 ± 2.1 (range: 14–19) yrs 1 season 153 Medical report of re-injuries 56% of sprainers had recurrent sprain
Steffen et al. 2008[22] Prospective cohort Female soccer players 15.4 ± 0.8 (range: 14–16) yrs - 1430 Self report of sprain history Players with previous ankle injury (PI) more likely to sustain new ankle injury than those without (NH) (Rate ratio = 1.2 [1.1; 1.3] p < .001).
FAOS 92.0 ± 11.3 (PI), 97.3 ± 6.0 (NH) mean difference: −5.3 (95% CI = −6.0 to −4.5)
Pain 62.8 ± 11.1 (PI), 68.2 ± 9.7 (NH) mean difference: −5.4 (95% CI = −6.3 to −4.5)
Symptoms 96.3 ± 7.5 (PI), 98.7 ± 4.2 (NH) mean difference: −2.3 (95% CI = −2.9 to −1.8)
Activities of daily living 89.0 ± 16.2 (PI), 96.3 ± 8.4 (NH) mean difference: −7.3 (95%CI = −8.4 to −6.2)
Sport and recreation function 71.3 ± 12.4 (PI), 76.3 ± 10.0 (NH) mean difference: −5.0 (95% CI = −5.9 to −4.0)
Ankle-related quality of life 411.5 ± 46.8 (PI), and 436.7 ± 26.8 (NH) mean difference: −25.2
(95% CI = −28.5 to −21.9)
Swenson et al. 2009[23] Descriptive epidemiology study High school students - 100 high schools 13755 injuries Medical report of re-injury Ankle most frequently diagnosed site for recurrent injury in basketball (boys: 58.4%, girls: 43.6%), volleyball (42.7%), soccer (boys: 34.8%, girls: 37.2%), football (29.8%), softball (26.3%), and wrestling (20.1%)
28% of all recurrent injuries were ankle injuries
More recurrent (28%) than new ankle injuries (19%) (Injury Proportion Ratio = 1.47; 95% CI, 1.31-1.65)
Timm et al. 2005[24] Prospective cohort Emergency department patients with ankle injury 6 weeks 199 Medical report of:
Pain with activity 24 (34%) OW, 14 (15%) NW, RR = 2.25 (95% CI = 1.25-4.02)
Range: 8–18 yrs Persistent swelling and/or weakness 22 (31%) OW, 12 (13%) NW, RR = 2.40 (95% CI = 1.28-4.52)
Re-injury 17 (24%) OW, 14 (15%) NW, RR = 1.60 (95% CI = 0.84-3.01)
OW mean age = 13.9 yrs 6 months 171 Pain with activity 19 (41%) OW, 19 (16%) NW, RR = 2.57 (95% CI = 1.50-4.39)
NW mean age = 13.5 years. Persistent swelling and/or weakness 16 (34%) OW, 18 (15%) NW, RR = 2.28 (95% CI = 1.28-4.08)
Re-injury 12 (26%) OW, 19 (16%) NW, RR = 1.62 (95% CI = 0.86-3.06)
31 (44%) of OW had persistent ankle symptoms at 6 months compared with 24 (26%) NW (RR, 1.70; 95% CI, 1.10-2.61)
Tyler et al. 2006[25] Cohort study Male high school football players 3 seasons 152 Medical report of sprain history 50 (33%) had history of previous ankle sprain 15 non-contact ankle sprains were incurred. Of the 11 players who had a previous ankle sprain and sustained a noncontact sprain in this study, 9 (82%) injured the same ankle (incidence 2.1)
Weir & Watson 1996[26] Prospective cohort Physical education students 1 yr 266 Self report of injuries 230 injuries were incurred. The most common injuries were ankle sprains.
Males (56%): 14.3 ± 0.85 (range: 12–15) yrs 7 overuse injuries of the ankle were incurred. 100% of overuse injuries of the ankle were re-injuries.
   Females: 14.1 ± 0.90 (range: 12–15) yrs     
  1. KEY: CAI = Chronic Ankle Instability, CAIT = Cumberland Ankle Instability Tool, FAOS = Foot and Ankle Outcome Score, Mod ant drawer = modified anterior drawer test, OW = Children who are Overweight (≥85th BMI percentile), NW = children who are of Normal Weight (<BMI 85th percentile).