The Effect of an External Ankle Brace on Return to Play Following Ankle Sprains in Elite Collegiate Athletes

CATEGORY: Sports; Ankle INTRODUCTION/PURPOSE: Ankle sprains are some of the most common injuries experienced by collegiate athletes. The goal of treatment is to restore function to the ankle allowing the athlete to return to full activity while minimizing lost playing time. There is a paucity of literature on return to play (RTP) for Grade I-IV sprains. There is also no literature regarding the role of external ankle bracing in elite collegiate athletes. The purpose of this study was to determine the return to play in Division I collegiate athletes after being treated in an external ankle brace following Grade I-IV ankle sprain. METHODS: All athletes at an NCAA Division I Institution who sustained ankle sprains (Grade I-IV) between August 2020 and November 2021 and were treated with an external ankle brace were included. Athletes were allowed to gradually RTP using the external ankle brace. Athletes were Graded I-IV by the team's ATC and physician (Malliaropoulos et. al 2009). Grade I sprains were characterized by full weight-bearing capacity (WBC), minimal swelling, isolated tenderness to one ankle ligament, and no instability. Grade II sprains were characterized by partial-to-full WBC, moderate swelling, tenderness to two ankle ligaments, and mild-moderate instability. Grade III sprains were defined by no-to-partial WBC, severe swelling, tenderness to two or more ankle ligaments, and moderate-severe instability. Grade IV sprains were defined as syndesmotic sprains. Athlete RTP was defined as full participation in sports-specific activities with full WBC and clearance for competition. RTP between sprain grades was compared using the Mann-Whitney U test. RESULTS: Thirteen elite collegiate athletes participating in cleated sports were treated: football (n=10), lacrosse, baseball, and track and field (all n=1). Grade I sprains (n=4) averaged RTP of 5.8 +- 1.4 days. Grade II sprains (n=8) averaged RTP of 14.4 +- 2.2 days. No Grade III sprains were observed. The athlete sustaining a Grade IV sprain (n=1) had a RTP of 17 days. A significant difference was found for time for RTP between Grade I and Grade II ankle sprains (p=0.02). Athletes with Grade I and II sprains wore the external brace during sport for 10.8 +- 3.9 days and 10.4 +- 4.7 days, respectively. There were no Grade III sprains observed. The athlete sustaining a Grade IV sprain wore the external brace for 24 days for RTP. There were no secondary complications using the external ankle brace during this study. CONCLUSION: Our results suggest an external ankle brace is a viable alternative to taping and internal bracing for rapid RTP for elite collegiate athletes. There was a significant difference in RTP of 8.6 days for athletes sustaining Grade I and II sprains that were treated with the external ankle brace. There is a lack of literature documenting the time for RTP for ankle sprains. Further investigation is needed to compare external ankle bracing with other ankle sprain treatment modalities regarding RTP.