Ankle-GO score is associated with the probability of becoming a coper after lateral ankle sprain

Key points

1. 01Ankle-GO score at 2 months had fair-to-good predictive ability for 1-year coper status (AUC=0.70, 95% CI 0.53 to 0.86).
2. 02A cut-off of 11 points yielded sensitivity 53% and specificity 89%; scoring above 11 raised the probability of becoming a coper from 28.7% to 69%.
3. 03Scoring below 11 points dropped the probability of becoming a coper to 6.8%.
4. 04Male sex was independently associated with coper status (OR=5.2; 95% CI 1.2 to 22.4); female patients should receive more robust rehabilitation.
5. 05No single item within the Ankle-GO battery alone predicted coper status - the composite score was necessary.

How it was conducted

Design

1-year prospective monocentric cohort study

Setting

Clinique du Sport, Paris; January 2021 to June 2022

Participants

64 adults (56% female, mean age 33.7 years) with a lateral ankle sprain within 1 month of enrollment, returning to sport at least once per week

Exposure

Ankle-GO score at 2 months post-injury: four functional tests (Single Leg Stance, Star Excursion Balance Test, Side Hop Test, Figure-of-8 Test) plus two self-reported questionnaires; maximum 25 points

Primary outcome

Coper status at 12 months: no recurrent sprain or giving-way episodes, CAIT score ≥24, and return to preinjury sport

Analysis

ROC curve (AUC) for primary aim; multivariable logistic regression with OR and 95% CI for secondary predictors

What they found

• 17 of 54 patients (31.5%) with complete data were classified as copers at 1 year; 10 of 64 (15%) were lost to follow-up.
• Mean Ankle-GO score was higher in copers vs non-copers: 9.9±4.9 vs 6.9±3.7 points (p=0.015).
• AUC for Ankle-GO predicting coper status: 0.70 (95% CI 0.53 to 0.86; p=0.023); sensitivity analysis AUC pooled 0.70 (95% CI 0.64 to 0.78).
• Optimal cut-off of 11 points: sensitivity 53%, specificity 89%; LR+ 4.9 (95% CI 1.75 to 14), LR- 0.53 (95% CI 0.31 to 0.88).
• Ankle-GO score >11 points: OR=12.1 (95% CI 2.5 to 59; p=0.002) for becoming a coper.
• Male sex: OR=5.2 (95% CI 1.2 to 22.4; p=0.026) for becoming a coper.
• Multivariable model correctly classified 78% of cases (95% CI 65.5% to 87.5%); Nagelkerke R²=0.37.
• All patients who did not become copers scored below 14 points on the Ankle-GO.

Limitations

• Small sample size (n=54 with complete data) with wide confidence intervals, limiting generalisability; only powered for the primary aim.
• Rehabilitation content was not standardised across patients, which may have confounded outcomes.
• Recurrence and giving-way were assessed by a single telephone interview at 1 year without imaging, and severity or timing of reinjury events was not captured.
• The cohort was predominantly recreational athletes; findings may not extend to elite or highly competitive populations.

Why it matters

For patients

If your Ankle-GO score is below 11 out of 25 at 2 months after a lateral ankle sprain, your chance of full recovery without further episodes is low, and you should discuss more targeted rehabilitation with your clinician before returning to sport.

For clinicians

The Ankle-GO cut-off of 11 points provides a practical decision aid at the 2-month mark: patients below this threshold (and female patients) warrant intensified rehabilitation before return-to-sport clearance, as their probability of becoming a coper drops to under 7%.

For readers

This study introduces the first objective clinical score that predicts full recovery (coper status) after lateral ankle sprain, filling a gap where no such indicator previously existed, though the small sample and single-centre design call for replication in larger cohorts.