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Epidemiology and return to play following isolated syndesmotic injuries of the ankle: a prospective cohort study of 3677 male professional footballers in the UEFA Elite Club Injury Study
  1. Bart Lubberts1,
  2. Pieter D’Hooghe2,
  3. Håkan Bengtsson3,
  4. Christopher W DiGiovanni4,
  5. James Calder5,
  6. Jan Ekstrand3
  1. 1 Orthopaedic Foot and Ankle Service, Massachusetts General Hospital – Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  3. 3 Department of Medicine and Health, Linköping University, Linköping, Sweden
  4. 4 Department of Orthopaedic Surgery, Massachusetts General Hospital – Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Fortius Clinic, Imperial College, London, UK
  1. Correspondence to Dr Bart Lubberts, Orthopaedic Foot and Ankle Service, Massachusetts General Hospital - Harvard Medical School, Boston, Massachusetts 02114, USA; lubbertsb{at}


Aim To 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 one injury per team every three seasons. The injury incidence during match play was 13 times higher compared with 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 (R2=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 (R2=0.033, b=0.032, 95% CI −0.073 to 0.138, P=0.520). Seventy-four per cent 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 annually increased between 2001 and 2016.

  • ankle
  • epidemiology
  • soccer
  • sprain
  • injury prevention

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  • Contributors All authors were responsible for the conception and design of the study. HB and JE have been involved in the data collection over the study period. HB conducted the analyses, which were planned and checked with BL and PD. All authors contributed to the interpretation of the findings. BL wrote the first draft of the paper, which was critically revised by PD, HB, CWD, JC and JE. The final manuscript has been approved by all authors.

  • Funding The Football Research Group was established in Linköping, Sweden, in collaboration with Linköping University and through grants from the UEFA, the Swedish Football Association, the Football Association Premier League Limited and the Swedish National Centre for Research in Sports.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study design was approved by the UEFA Medical Committee and the UEFA Football Development Division.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Due to confidentiality reasons, there are no data that can be shared.