Epidemiology and return to play following isolated syndesmotic injuries in professional football players

AimTo determine the epidemiology of isolated syndesmotic injuries in professional football players.
Methods:Data from 15 consecutive seasons of European professional football between 2001 and
2016 contributed to the dataset of this study. Match-play and training data from a total of
3677 players from 61 teams across 17 countries have been included. Team medical staff
recorded player exposure and time loss injuries. Injury incidence was defined as the
number of injuries per 1000 player-hours. Injury burden was defined as number of days
absence per 1000 player-hours. Seasonal trends for isolated syndesmotic injury incidence,
isolated syndesmotic injury proportion of ankle ligament injuries, and isolated
syndesmotic injury burden were analysed via linear regression.
Results
The isolated syndesmotic injury incidence was 0.05 injuries per 1000 hours of exposure (95% CI 0.04 to 0.06) or 1 injury per team every 3 seasons. The injury incidence during match play was 13 times higher compared to during training, 0.21 (95% CI 0.16 to 0.26) and 0.02 (95% CI 0.01 to 0.02) respectively. Out of the 1320 ankle ligament injuries registered during the 15 seasons 94 (7%) were diagnosed as isolated syndesmotic injuries. An annual increase in injury incidence was observed (R276 =0.495,b=0.003, 95% CI 0.001 to 0.004, p=0.003). However, no significant annual change of
injury burden was observed (R278 =0.033, b=0.032, 95% CI -0.073 to 0.138, p=0.520). 74%
of the injuries were contact related and the mean (+/- SD) absence following an isolated
syndesmotic injury was 39 (+/- 28) days.
Conclusions: The incidence of isolated syndesmotic injuries in elite professional European football has increased annually between 2001 and 2016.