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Chen Y, Cao S, Wang C, Zhang C, Huang J, Wang X, Ma X. Diagnostic Evaluation of Mechanical Ankle Instability by Comparing Injured and Uninjured Contralateral Ankles Using Arthrometry. J Athl Train 2023; 58:934-940. [PMID: 36827611 PMCID: PMC10784880 DOI: 10.4085/1062-6050-0494.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
CONTEXT Individuals with mechanical ankle instability (MAI) have obvious lateral ligament laxity and excessive ankle joint motion beyond the physiological range. Arthrometry has been introduced to quantitatively measure the laxity of the ankle joint. However, the diagnostic accuracy of arthrometry in MAI is still debatable. OBJECTIVES To (1) evaluate the difference in laxity between bilateral ankles in patients with and those without MAI and (2) calculate the diagnostic accuracy of ankle arthrometry using bilateral comparisons. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 38 individuals with unilateral MAI (age = 31.24 ± 7.90 years, height = 168.93 ± 7.69 cm, mass = 65.72 ± 10.47 kg) and 38 individuals without MAI (control group; age = 32.10 ± 7.10 years, height = 166.59 ± 7.89 cm, mass = 62.93 ± 10.72 kg). MAIN OUTCOME MEASURE(S) Bilateral ankle laxity in each participant was quantitatively measured by performing the arthrometric anterior drawer test. Continuous data of loading force and joint displacement were recorded. Data from both ankles were compared for the ankle joint displacement at a loading force of 75 N (D75) and load-displacement ratio from 10 to 40 N (LDR 10-40). RESULTS The D75 between injured and uninjured ankles in patients with MAI was different (t37 = 9.78, P < .001). The mean LDR 10-40 in injured ankles was higher than that in uninjured ankles (t37 = 9.80, P < .001). In the control group, no differences were found between the left and right ankles. The MAI group had larger bilateral differences than the control group (t37 range = 7.33-8.18; P < .001). When LDR 10-40 was used to diagnose MAI, the arthrometer showed sensitivity and specificity of 0.900 and 0.933, respectively, with a cutoff value of 0.0351 mm/N. CONCLUSIONS An ankle arthrometer can be used to quantitatively measure the difference in bilateral ankle laxity in patients with MAI. Arthrometer-measured LDR 10-40 can be used to diagnose MAI with high diagnostic accuracy.
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Affiliation(s)
- Yungu Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
| | - Shengxuan Cao
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
| | - Chen Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
| | - Chao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
| | - Jiazhang Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
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Chen Y, Cao S, Wang C, Ma X, Wang X. Quantitative analysis with load–displacement ratio measured via digital arthrometer in the diagnostic evaluation of chronic ankle instability: a cross-sectional study. J Orthop Surg Res 2022; 17:287. [PMID: 35606774 PMCID: PMC9125832 DOI: 10.1186/s13018-022-03177-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/17/2022] [Indexed: 12/26/2022] Open
Abstract
Background Arthrometry has been introduced to evaluate the laxity of ankle joint in recent years. However, its role in the diagnosis of chronic ankle instability is still debatable. Therefore, we assessed the diagnostic accuracy of a digital arthrometer in terms of sensitivity and specificity. Methods According to the inclusion and exclusion criteria proposed by the International Ankle Consortium, we recruited 160 uninjured ankles (control group) and 153 ankles with chronic ankle instability (CAI group). Ankle laxity was quantitively measured by a validated digital arthrometer. Data of loading force and joint displacement were recorded in a continuous manner. Differences between the control and CAI groups were compared using 2-tailed independent t test. A receiver operating characteristic curve analysis was used to calculate area under a curve, sensitivity and specificity. Results Load–displacement curves of the two groups were depicted. Differences of joint displacement between the control and CAI groups were compared at 30, 45, 60, 75, 90, 105 and 120 N, which were all of statistical significance (all p < 0.001) with the largest effect size at 90 N. Statistical significance was found in the differences between the two groups in load–displacement ratio at 10–120 N, 10–40 N, 40–80 N and 80–120 N (all p < 0.001), with the largest effect size at 10–40 N. Load–displacement ratio at the interval of 10–40 N had the highest area under a curve (0.9226), with sensitivity and specificity of 0.804 and 0.863, respectively, when the cutoff point was 0.1582 mm/N. Conclusion The digital arthrometer measurement could quantitively analyze the ankle laxity with high diagnostic accuracy. The load–displacement ratio would be a reliable and promising approach for chronic ankle instability diagnosis. Level of evidence level II.
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Kataoka K, Hoshino Y, Nagamune K, Nukuto K, Yamamoto T, Yamashita T, Kanzaki N, Kakutani K, Matsushita T, Kuroda R. The quantitative evaluation of anterior drawer test using an electromagnetic measurement system. Sports Biomech 2021; 21:550-561. [PMID: 34016026 DOI: 10.1080/14763141.2021.1918754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The anterior drawer test (ADT) is the gold standard examination for the diagnosis of anterior talofibular ligamentinsufficiency,although there is noquantitative evaluation of ADT that is generally usable and reliable.An electromagnetic sensor (EMS)has been used to quantitatively evaluate joint kinematics, and has a high potential to be applied to the ankle joint. The aim of this study was to validatethe EMS measurement of the ADTin comparison to the fluoroscopic evaluationand to evaluate the reproducibility of the EMS measurement.Six feet were included,and an examinerperformed the ADT5 times for each foot while the anterior translation of the ankle jointwas quantitative evaluatedusing EMS and fluoroscope simultaneously. The anterior translation of the ankle joint during the ADT in EMS and in fluoroscope was 8.1 ± 5.7 mm and 3.6 ± 2.4 mm.Astrong correlation was observed between the measurements using EMS and fluoroscope (p < 0.01, the correlation coefficient = 0.91). Another 20 feet were included, and three examiners performed the ADT five times for each foot with the EMS measurement. The intra and inter-examiner reliability was 0.99 and 0.89.The EMS could quantify the anterior translation during the ADT which corresponds to fluoroscopic evaluation.
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Affiliation(s)
- Kiminari Kataoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kouki Nagamune
- Department of Human and Artificial Intelligent Systems, University of Fukui
| | - Koji Nukuto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tetsuya Yamamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Yamashita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Guerra-Pinto F, Cunha J, Sousa L, Gomes TM, Andrade R, Oliva XM, Consciência JG, Fernandes PR. Gravity stress tibiotalar laxity evaluation with a biomedical gyroscopes device - cadaver study with progressive sectioning of lateral ankle ligaments. J Exp Orthop 2020; 7:53. [PMID: 32696272 PMCID: PMC7374536 DOI: 10.1186/s40634-020-00269-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/01/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose Despite the evidence on the role of gravity stress test to access the instability of other ankle injuries, there is limited literature regarding gravity stress on the lateral ankle ligament’s insufficiency. The objective of our study was to objectively measure the tibiotalar angular movement under gravity stress after progressive sectioning of the lateral ankle ligaments. Methods We performed sequential sectioning of the anterior talofibular (ATFL), calcaneofibular (CFL), and posterior talofibular ligaments (PTFL) in twelve ankle specimens. Under gravity stress, we measured the angular movement of the talus in relation to the tibia. The measuring device is based on a three-axis gyroscope and accelerometer. Results Comparing to the intact condition, the plantar flexion increased on average 1.78° (95% confidence interval [CI] 1.15;2.42), 5.13° (95%CI 3.10;7.16) and 8.63° (95%CI 6.05;11.22), the rotation increased by 1.00° (95 CI -0.51;2.51), 3.68° (95%CI 1.97;5.40) and 15.62° (95%CI 10.09;21.14), and the varus increased 2.89° (95% CI 1.39, 4.39), 8.12° (95% CI 5.16, 11.07) and 11.68° (95% CI 7.91, 15.46), after sectioning the ATFL, CFL, and PTFL, respectively. The overall changes were statistically significant. Conclusions There was a significant tibiotalar laxity after sectioning of lateral ankle ligaments when the foot position is influenced only by gravity. The tibiotalar angular displacement was significant when the CFL and PTFL were cut which suggests that the gravity test could be used to assess combined lateral ankle ligament injury. This evidence might be a step forward in the development of lateral ankle ligaments gravity stress tests. Level of evidence 5 (cadaver study)
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Affiliation(s)
- F Guerra-Pinto
- Department of Orthopaedics, Hospital Ortopédico de Sant'Ana, R. Benguela 501, 2775-229, Parede, Portugal. .,Department of Orthopaedics, Hospital da Cruz Vermelha Portuguesa, Lisbon, Portugal. .,NOVA Medical School, Lisbon NOVA University, Lisbon, Portugal. .,Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
| | - J Cunha
- IDMEC, Instituto Superior Técnico, Lisbon University, Lisbon, Portugal
| | - L Sousa
- IDMEC, Instituto Superior Técnico, Lisbon University, Lisbon, Portugal
| | - T M Gomes
- Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - R Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal. Dom Henrique Research Centre, Porto, Portugal.,Faculty of Sports, University of Porto, Porto, Portugal
| | - X M Oliva
- Department of Orthopedics, Clinica Del Remei, Barcelona, Spain.,Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - J G Consciência
- NOVA Medical School, Lisbon NOVA University, Lisbon, Portugal.,Head of Orthopaedics Departement at CHLO - S. F. Xavier Hospital, Lisbon, Portugal
| | - P R Fernandes
- IDMEC, Instituto Superior Técnico, Lisbon University, Lisbon, Portugal
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Lohrer H, Bonsignore G, Dorn-Lange N, Li L, Gollhofer A, Gehring D. Stabilizing lateral ankle instability by suture tape - a cadaver study. J Orthop Surg Res 2019; 14:175. [PMID: 31196154 PMCID: PMC6567661 DOI: 10.1186/s13018-019-1218-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/29/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Suture tape is a recent development to augment a Brostrom repair at least during the healing phase of the native tissues used for stabilization of the lateral ankle ligaments. The purpose of this study was to evaluate whether suture tape is an effective mechanical stabilizer against anterior talar drawer in a cadaver experiment when tested with a validated arthrometer. METHODS Different stability conditions were created in 14 cadaveric foot and leg specimens. Following anterior talofibular ligament (ATFL) dissection, isolated suture tape ATFL reconstruction was compared to the unaltered specimens, to the condition with ATFL cut, to the ATFL plus calcaneofibular ligament (CFL) cut conditions, and to the ATFL, CFL, and posterior talofibular ligament transected specimens. Three-dimensional bone-to-bone movement between fibula and calcaneus were simultaneously recorded using bone pin markers. Anterior translation was analysed between 20 and 40 N anterior talar drawer load, applied by an ankle arthrometer. Test conditions were compared using non-parametric statistics. RESULTS Dissection of ATFL increased anterior talar drawer in arthrometer and bone pin marker analyses (p = 0.003 and 0.004, respectively). When the CFL was additionally cut, no further increase of the anterior instability could statistically be documented (p = 0.810 and 0.626, respectively). Following suture tape reconstruction of the ATFL, stability was not different from the unaltered ankle (p = 0.173). CONCLUSIONS Suture tape augmentation of the ATFL effectively protects the unstable anterolateral ankle in the sagittal plane. The CFL does not seem to stabilize against the anterior talar drawer load.
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Affiliation(s)
- Heinz Lohrer
- ESN – European Sportscare Network, Borsigstraße 2, 65205 Wiesbaden, Germany
- Lilium Klinik, Borsigstraße 2, 65205 Wiesbaden, Germany
- Institut für Sport und Sportwissenschaft, Albert-Ludwigs-Universität Freiburg, Schwarzwaldstraße 175, 79117 Freiburg, Germany
| | - Giuseppe Bonsignore
- Institut für funktionelle und klinische Anatomie, Johannes Gutenberg-Universität Mainz, Johann-Joachim-Becher-Weg 13, 55128 Mainz, Germany
| | - Nadja Dorn-Lange
- Institut für funktionelle und klinische Anatomie, Johannes Gutenberg-Universität Mainz, Johann-Joachim-Becher-Weg 13, 55128 Mainz, Germany
| | - Lu Li
- Institut für Sport und Sportwissenschaft, Albert-Ludwigs-Universität Freiburg, Schwarzwaldstraße 175, 79117 Freiburg, Germany
| | - Albert Gollhofer
- Institut für Sport und Sportwissenschaft, Albert-Ludwigs-Universität Freiburg, Schwarzwaldstraße 175, 79117 Freiburg, Germany
| | - Dominic Gehring
- Institut für Sport und Sportwissenschaft, Albert-Ludwigs-Universität Freiburg, Schwarzwaldstraße 175, 79117 Freiburg, Germany
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