Gain insights into the application of this new composite score and familiarize yourself with all critical cut-offs.

Keywords: ankle sprain, return to sport, assessment 

Why is this study important?

Lateral ankle sprain is the most prevalent injury in sports, with a high recurrence rate and approximately 40% of patients develop chronic ankle instability. However, around 30% of individuals fully recover from an initial sprain. A crucial factor in achieving full recovery is the management of return to sport (RTS). To date, return to play decisions following lateral ankle sprains remain unclear, as no objective criteria have been established [1,2].

How did the study go about this?

In this paper we evaluated the predictive capacity of the Ankle-GO™ score in identifying future copers and facilitating a safe return to sport, while minimizing the risk of recurrence [3]. Copers are defined as patients who return to their pre-injury sport without functional loss and report no episodes of re-injury or giving way 12 months after a lateral ankle sprain. The Ankle-GO™ is a concise tool comprising four functional tests and two self-reported questionnaires, yielding a maximum score of 25 points. It requires minimal equipment and can be easily administered by physiotherapists. The selection of these components was based on a 2022 narrative review identifying the most relevant functional performance tests and self-reported questionnaires to assist clinicians in making RTS decision following recurrent ankle sprains or surgical ankle stabilization [4]. This approach aligns with the PAASS framework recommended by the International Ankle Consortium [5].

Ankle-GO™ is a composite score that integrates 7 components to provide an objective assessment of the key deficits associated with lateral ankle sprain or chronic ankle instability, both of which contribute to an increased risk of re-injury.  It is derived from 4 functional tests: 

1. the single-leg stance test (SLS) on a firm surface
2. the modified star excursion balance test (mSEBT)
3. the side hop test (SHT)
4. the figure-of-8 test (F8T). 

Additionally, 2 self-reported questionnaires are employed: the Foot and Ankle Ability Measure, which includes subscales for assessing daily activities (FAAMadl) and sports activities (FAAMsport), as well as the Ankle Ligament Reconstruction-Return to Sport after Injury (ALR-RSI). Practitioners can efficiently calculate their patients’ score via the free website https://anklego.com/. Based on our clinical experience, it requires approximately 20-30 minutes to complete the entire assessment on both limbs, with no need for specialized equipment.

What did the study find?

The Ankle-GO™ was initially validated in patients following an ankle sprain, demonstrating good internal consistency with no ceiling or floor effects [6]. Test-retest reliability was excellent, with a minimum detectable change of 1.2 points. It exhibited a good discriminant ability when comparing healthy subjects to patients, and a fair predictive value, with an Ankle-GO™ score at 2 months predicting RTS at 4 months, using a cut-off of 8 points. In a recent study, an Ankle-GO™ score below 8 points at 2 months was associated with a 9 fold increased risk of recurrence after a LAS, with women showing higher re-injury risk [7]. In the study recently published in the BJSM [3], we concluded that patients with an Ankle-GO™ score above 11 points after 2 months of rehabilitation had a 12 -fold greater likelihood of becoming copers one-year post-injury. Female patients, however, were at higher risk of failing to achieve Coper status. None of the 7 components of the Ankle-GO™ score, when considered in isolation, was sufficient to discriminate and identify potential copers.

What are the key take-home points?

• The Ankle-GO™ score serves as a valuable tool for clinicians in guiding return to sport decisions. 
• Patients with an Ankle-GO™ score below 11 points should undergo further rehabilitation to target their specific deficits and mitigate the risk of re-injury or giving-way. 
• Female patients may necessitate more intensive rehabilitation to achieve optimal outcomes.

Authors and affiliations:

Alexandre Hardy1, Ronny Lopes2, Francois Fourchet3, Brice Picot4

1 Clinique du Sport, Paris, France

2 Centre Orthopédique Santy, Lyon, France

3 Hopital de la Tour Geneve Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Switzerland

4 Interuniversity Laboratory of Human Movement Sciences, EA 7424, F-73000, C, University Savoie Mont Blanc, Chambery, France

Competing Interests: None

REFERENCES

1 Tassignon B, Verschueren J, Delahunt E, et al. Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis. Sports Med. 2019;49:601–19. doi: 10.1007/s40279-019-01071-3

2 Wikstrom EA, Mueller C, Cain MS. Lack of Consensus on Return-to-Sport Criteria Following Lateral Ankle Sprain: A Systematic Review of Expert Opinions. J Sport Rehabil. 2020;29:231–7. doi: 10.1123/jsr.2019-0038

3 Picot B, Fourchet F, Rauline G, et al. Ankle-GO score is associated with the probability of becoming coper after lateral ankle sprain: a 1-year prospective cohort study. Br J Sports Med. Published Online First: 9 August 2024. doi: 10.1136/bjsports-2024-108361

4 Picot B, Hardy A, Terrier R, et al. Which Functional Tests and Self-Reported Questionnaires Can Help Clinicians Make Valid Return to Sport Decisions in Patients With Chronic Ankle Instability? A Narrative Review and Expert Opinion. Frontiers in Sports and Active Living. 2022;4.

5 Smith MD, Vicenzino B, Bahr R, et al. Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework-an international multidisciplinary consensus. Br J Sports Med. 2021;bjsports-2021-104087. doi: 10.1136/bjsports-2021-104087

6 Picot B, Lopes R, Rauline G, et al. Development and Validation of the Ankle-GO Score for Discriminating and Predicting Return-to-Sport Outcomes After Lateral Ankle Sprain. Sports Health. 2024;16:47–57. doi: 10.1177/19417381231183647

7 Picot B, Fourchet F, Lopes R, et al. Low Ankle-GO Score While Returning to Sport After Lateral Ankle Sprain Leads to a 9-fold Increased Risk of Recurrence: A Two-year Prospective Cohort Study. Sports Med Open. 2024;10:23. doi: 10.1186/s40798-024-00693-w