Risk Factors in the Development of Chronic Ankle Instability: An Overview of Systematic Reviews

Background and/or Objectives: The most widely accepted model of chronic ankle instability (CAI) pathogenesis was proposed by Hertel and colleagues in 2019. Prior to this, Thompson and colleagues published an umbrella review of risk factors for CAI in 2017. This umbrella review was limited in scope, not addressing all aspects of CAI development as proposed by the Hertel model. The purpose of this umbrella review was to systematically summarize and critically appraise current and updated evidence of risk factors associated with the development of CAI utilizing the framework of the recent Hertel model and standardized criteria.

Design: Medline, Embase and Cochrane databases were searched using the following inclusion criteria: (i) systematic reviews and meta-analyses comparing CAI patients versus controls and (ii) articles published during or after 2017.

Setting : Overview of systematic reviews on CAI risk factors

Participants : The database search identified 1550 references. After removal of duplicates, abstract screening, and full-text review, 15 systematic reviews remained, 8 of which were meta-analyses. The following data was extracted: study characteristics, operative definition of CAI, patient characteristics, and significant risk factors for developing CAI. All screening and data extraction was completed by two independent researchers.

Interventions: N/A

Main Outcome Measures: Risk factors for CAI were extracted and regrouped according to the categories presented in Hertel’s model including motor-behavioral, sensory-perceptual, pathomechanical, and personal risk factors.

Results: Postural stability deficits, muscle weakness, decreased neural reflexes, impaired neuromuscular control, altered biomechanics and kinematics, proximal joint compensation, body composition, previous injury history, altered landing mechanics, reduced flexibility and range of motion, and delayed stabilization were identified as risk factors for the development of CAI. Furthermore, these impairments also affect the knee, hip and contralateral limb.

Conclusions: Multiple factors can influence the risk of developing CAI. Future rehabilitation protocols for acute sprains should include bilateral assessments, neuromuscular training and targeted strengthening programs for the ankle, hip and knee.