Development and validation of the Ankle-GO score for discriminating and predicting return to sport

Key points

1. 01The Ankle-GO sums 6 tests into a single score out of 25, covering balance, hopping, agility, daily and sport function, and psychological readiness.
2. 02It showed strong internal consistency (Cronbach's alpha 0.79) and near-perfect test-retest reliability (ICC 0.99), with a smallest detectable change of just 1.2 points.
3. 03Scores clearly separated injured patients at 2 months (7.7), at 4 months (13.9), and healthy controls (19.6), confirming it tracks recovery.
4. 04A 2-month score predicted return to the same or higher sport level at 4 months reasonably well (AUC 0.77); below 8 points signalled unlikely return to preinjury level.
5. 05Only half of patients (50%) had returned to their same or higher sport level by 4 months, underscoring how common incomplete recovery is.

How it was conducted

Design

Prospective diagnostic validation study, Level of Evidence 2

Participants

64 patients with lateral ankle sprain (mean age 33.7 years) and 30 healthy controls (mean age 31.7 years)

Intervention

Ankle-GO administered at 2 and 4 months after injury; score is the sum of 6 tests, max 25 points

Components

ALR-RSI readiness, FAAM daily and sport function, single-leg stance, modified Star Excursion Balance Test, side-hop test, figure-8 test

Primary outcome

Return to sport at the same or higher preinjury level at 4 months

Analyses

Construct validity, internal consistency, discriminant validity, test-retest reliability, and ROC predictive value

What they found

• Internal consistency was acceptable (Cronbach's alpha 0.79; mean inter-item correlation 0.55).
• Test-retest reliability was near perfect (ICC 0.99; SEM 0.41; minimal detectable change 1.2 points), with no floor or ceiling effects (scores ranged 1 to 23).
• Scores differed significantly across groups: patients at 2 months 7.7 plus or minus 4, at 4 months 13.9 plus or minus 4.6, and controls 19.6 plus or minus 3.4 (P < 0.01).
• The 2-month score predicted return to the same or higher level at 4 months with AUC 0.77 (95% CI 0.65 to 0.89); an 8-point cut-off gave sensitivity 72% and specificity 66% (Youden J = 0.38).
• The 2-month score predicted no return to sport at 4 months with AUC 0.77; a 7-point cut-off gave sensitivity 67% and specificity 92% (Youden J = 0.44).
• At 4 months, 32 of 64 patients (50%) returned to the same or higher preinjury level, 20 returned at a lower level, and 12 did not return to sport.

Limitations

• Injury severity was not graded and the sample was heterogeneous, mixing recurrent and primary injuries.
• Rehabilitation was prescribed but not standardized or controlled across participants.
• The score does not assess return to performance under fatigue or multitasking conditions.
• Predictive accuracy was moderate (AUC 0.77) and validated in a single cohort, so external validation in other populations is still needed.

Why it matters

For patients

If you are recovering from an ankle sprain, a low Ankle-GO score at 2 months is a realistic sign you may need more rehab time before safely returning to your sport.

For clinicians

The Ankle-GO offers an objective, reliable composite score to inform return-to-sport decisions that are otherwise made on time alone, with a sub-8 cut-off at 2 months flagging at-risk patients.

For readers

This study introduces and validates the first objective composite tool to predict and track sport recovery after a lateral ankle sprain.