Original research
Epidemiological study of post-traumatic ankle osteoarthritis after ankle sprain in 195,393 individuals over middle age using the National Health Insurance Database: A retrospective design

https://doi.org/10.1016/j.jsams.2021.08.018Get rights and content

Abstract

Objectives

This study aimed to determine the risk of ankle OA onset after an incidence of sprain, relative to the risk of onset in healthy population, and to investigate the effect of gender, age, BMI, and exercise on the development of ankle OA after sprain.

Design

Retrospective cohort study.

Methods

Using a sample cohort dataset from 2002 to 2013 provided by the Korean National Health Insurance Sharing Service, we calculated the mean survival time and cumulative incidence rate in sprained and healthy populations using Kaplan-Meier analysis. A Cox proportional hazards model was used to analyze the adjusted hazard ratio (HR) of sprain for the development of OA with 95% confidence intervals (CIs). Adjusted HRs of gender, age, BMI, and exercise (yes/no) were analyzed in the sprained group.

Results

Among the selected population of 195,393 individuals, 40,876 (20.9%) were diagnosed with an ankle sprain, and 1543 (3.85%) of those individuals developed ankle OA. Of the 154,517 healthy individuals (79.1%), 4062 (2.66%) cases had progressed to OA. The sprained group had 46% (HR, 1.46; 95% CI, 1.38–1.55) greater rate of progression to ankle OA than did healthy individuals. In the sprain group, individuals who were female, obese, and overweight had 40% (HR, 1.40; 95% CI, 1.26–1.55), 43% (HR, 1.43; 95% CI, 1.12–1.82), and 22% (HR, 1.22; 95% CI, 1.10–1.35) higher incidence to develop ankle OA, respectively, compared to those who were male, underweight and normal.

Conclusions

This study found that ankle sprain was a significant risk factor for a diagnosis of early OA. Female gender and high BMI increased the incidence of ankle OA after sprain.

Section snippets

Practical implications

  • Early rehabilitation is necessary after an onset of ankle sprain to prevent further development to post-traumatic ankle OA.

  • Personalized intervention may be needed considering their gender and BMI to effectively decrease ankle OA risk after a sprain incidence.

  • Physical exercise neither increases nor decreases the likelihood of getting diagnosed with ankle OA. Hence further clinical research is necessary to find proper exercise program after ligament injuries.

Methods

We used a sample cohort dataset provided by the Korean National Health Insurance Sharing Service (NHISS).21 The National Health Insurance Corporation (NHIC) manage insurance data for all South Korean citizens and has enabled access to their data from 2002 and on, for the purpose of research on health improvement issues. We used a “sample cohort database” consisting of 448,754 randomly selected individuals of age 40 or older using a stratified sampling method according to gender, age, status of

Results

This population consisted of 115,029 (58.9%) males and 80,364 (41.1%) females. Among the whole population of 195,393 individuals, 40,876 (20.9%) were diagnosed with an ankle sprain, and 1543 (3.85%) of those individuals developed ankle OA within the 11-year follow-up period. Similarly, of the 154,517 healthy individuals (79.1%), 4062 (2.66%) cases had progressed to OA by December 2013. The demographic characteristics of the sprained and healthy populations are presented in Table 1.

The sprained

Discussion

Our major finding is that individuals who had one or more sprain history along the 11-year study period had a significantly greater disease rate of being diagnosed with ankle OA than did healthy people with no sprains. The analysis with sprained population showed that female, overweight, and obese populations were each more likely to develop ankle OA than were the counterpart male and normal-weight populations respectively.

Ankle OA development rate after sprain was 3.85% within the 11-year

Conclusion

In the present study, we found that ankle sprain was a significant risk factor for a diagnosis of early OA. Female gender and high BMI increased the incidence of ankle PTOA after a sprain. As a result, we expect that these results will offer new knowledge to clinicians and trainers for the development of treatment strategies after an ankle sprain and the prevention of further aggravation of cartilage disease.

Funding information

This study was supported by the Ministry of Education and the National Research Foundation of Korea (NRF2015S1A5B8036349).

Declaration of interest statement

None.

Confirmation of ethical compliance

This study was approved by the Yonsei University Institutional Review Board (IRB No.: 7001988-201803-HR-330-01E).

Acknowledgments

This study was supported by the Ministry of Education and the National Research Foundation of Korea (NRF2015S1A5B8036349).

References (40)

  • P.A. Parmelee et al.

    Sleep disturbance in osteoarthritis: linkages with pain, disability, and depressive symptoms

    Arthritis Care Res

    (2015)
  • V. Valderrabano et al.

    Etiology of ankle osteoarthritis

    Clin Orthop Relat Res

    (2009)
  • C.L. Saltzman et al.

    Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center

    Iowa Orthop J

    (2005)
  • K. Song et al.

    Osteoarthritis prevalence in retired National Football League Players with a history of ankle injuries and surgery

    J Athl Train

    (2019)
  • K. Sugimoto et al.

    Chondral injuries of the ankle with recurrent lateral instability: an arthroscopic study

    JBJS.

    (2009)
  • K.D. Harrington

    Degenerative arthritis of the ankle secondary to long-standing lateral ligament instability

    J Bone Joint Surg Am

    (1979)
  • B. Hintermann et al.

    Arthroscopic findings in patients with chronic ankle instability

    Am J Sports Med

    (2002)
  • R. Lofvenberg et al.

    The outcome of nonoperated patients with chronic lateral instability of the ankle: a 20-year follow-up study

    Foot Ankle Int

    (1994)
  • I. Taga et al.

    Articular cartilage lesions in ankles with lateral ligament injury an arthroscopic study

    Am J Sports Med

    (1993)
  • K. Song et al.

    Osteoarthritis prevalence in retired National Football League Players with a history of ankle injuries and surgery

    J Athl Train

    (2019)
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