Narrative review of the mechanisms, intrinsic risk and predictive factors, and incidence of lateral ankle sprains amongst male and female athletes participating in sex-similar sports

BACKGROUND: Lateral ankle sprains (LAS) are the most common sports-related injuries. Despite increased female participation in sport, there is little information explaining how sex-specific musculoskeletal anatomy lends itself to the mechanisms that cause LAS. OBJECTIVE: Perform a narrative review of the literature from 2000 to the present (2025) that investigates if and how sex affects the mechanism, risk and predictive factors, and incidence of LAS amongst male and female athletes participating in sex-similar sports and activities. Included articles contained information regarding the lateral ligament complex (LLC) or LAS in individuals participating in sex-similar sports, activities, or movements. Articles focused on the diagnosis, recovery, prevention, and long-lasting effects of LAS were excluded. For parallel LAS incidence studies conducted on males and females, two-sample t-tests, assuming unequal variances, were performed using a 5% significance level. RESULTS: One hundred sixteen articles met the study inclusion criteria. Lower body kinematics and kinetics, history of previous sprain, and multiple hop and balance tests were risk factors for LAS in males and females. History of previous sprain, anatomical alignment, weight, ankle joint laxity, general balance, BMI, and hip strength may be more prevalent risk factors in males, while postural sway and instability may be a more prevalent risk factor in females. Epidemiology studies investigating LAS incidence relative to all injuries did not find females to sustain significantly more LAS than males. Epidemiology studies investigating LAS incidence relative to all ankle injuries found females to sustain significantly more LAS than males. CONCLUSIONS: Although sex was found to influence the morphology and morphometry of the LLC, there was a lack of research that used these anatomical differences to justify differences in LAS risk factors, thresholds for injury, or mechanisms of injury that exist between males and females. Future work should look to distinguish whether musculoskeletal anatomical differences between male and female ankles influence sex-specific biomechanics and mechanisms of injury, as these factors contribute to LAS incidence and risk factors.