Background Lateral (LAS) and high ankle sprains (HAS) receive a great deal of recognition in collegiate athletics. Little is known about the prognosis of medial ankle sprains (MAS). RTP timelines for ankle injuries specific to NCAA athletes will assist clinicians in making prognoses of return to participation for MAS injured athletes.

Objective To compare the probability of RTP at specified time points following LAS, MAS, and HAS.

Design Epidemiological.

Setting Collegiate athletics.

Participants NCAA male and female athletes participating in sports at high-risk for ankle sprains (football, soccer, basketball, and volleyball) who sustained an ankle sprain during NCAA-sanctioned events.

Interventions Ankle sprains that occurred during a school-sponsored practice or competition and subsequently recorded in the NCAA Injury Surveillance System from 2005–09 were analysed and stratified by specific location of injury (LAS, MAS, HAS).

Main outcome measures The dependent variable was days lost from participation after ankle sprain injury. Kaplan-Meier estimators were used to determine probabilities of RTP at specified time points. A Mantel-Cox log-rank test was used to contrast RTP probabilities by specific injury location (LAS, MAS, SAS). Alpha level was set a priori at p < 0.05.

Results In total, 4,462 ankle sprains were analysed (LAS = 3,336 (75%); SAS = 730 (16%); MAS = 396 (9%)). The median (IQR) days to RTP for LAS = 6 (3, 11); MAS = 7 (3, 13); HAS = 13 (5, 22). HAS had lower RTP probabilities at earlier time frames compared to LAS (p < 0.001) and MAS (p < 0.001). RTP probability timelines for LAS were faster than MAS (p = 0.02).

Conclusion This study represents the first prognostic evidence for MAS. Based on the lower prevalence of MAS compared to LAS and HAS, it would seem that MAS would also have a protracted RTP timeframe. Instead, MAS has a fairly similar impact on participation time loss when compared to LAS. While relatively rare, more attention needs to be drawn to the recognition, risk, and treatment of MAS.