BACKGROUND Syndesmotic and medial ankle sprains constitute up to 15% of all ankle sprains in athletic populations and can result in significant time lost to injury and long-term disability. PURPOSE The objective of this study was to estimate the rate of syndesmotic and medial ankle sprain injuries and identify risk factors associated with these injuries within the physically active cadet population at the United States Military Academy (USMA). STUDY DESIGN Cohort study; Level of evidence, 2. METHODS The Cadet Illness and Injury Tracking System (CIITS) database at USMA was queried for all ankle injuries between 2005 and 2009. Sex, level of competition, and exposure to sport were among risk factors analyzed. RESULTS Among 20 336 person-years, 1206 cadets sustained ankle sprain. Syndesmotic (6.7%) and medial (5.1%) ankle sprains had an incidence rate (IR) of 4.8 and 3.5 per 1000 person-years, respectively. Compared with women, men were 3 times more likely to experience medial ankle sprain (IR ratio [IRR] 3.37; 95% confidence interval [CI]: 1.05, 10.74], but there was no difference in rate of syndesmotic sprains by sex (IRR 1.06; 95% CI: 0.58, 1.95). Athletics accounted for 81% of syndesmotic sprains and 64% of medial sprains. Sprint football (52.3), team handball (men's, 34.7), soccer (men's, 30.5; women's, 6.5), and basketball (men's, 24.8; women's, 6.7) had the highest syndesmotic IR per 100 000 athlete-exposures. Medial sprain IR was highest in men's rugby (16.6) and gymnastics (14.0). When analyzed by athlete-exposure, male intercollegiate athletes had a greater risk of syndesmotic sprain than their female counterparts (3.53; 95% CI: 1.26, 9.83). Furthermore, intercollegiate level of competition had an increased risk of syndesmotic sprain when compared with intramural level (IRR 2.41; 95% CI: 1.03, 5.65). CONCLUSION Male athletes have an over threefold greater risk of medial ankle sprain. Male sex and higher level of competition are risk factors for syndesmotic ankle sprain during athletics.
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