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Kazemi K, Javanshir K, Saadi F, Goharpey S, Shaterzadeh Yazdi MJ, Calvo-Lobo C, López-López D, Nassadj G. The Effect of Additional Neuromuscular Training on Peri-Ankle Muscle Morphology and Function in Chronic Ankle Instability Subjects: A Randomized Controlled Trial. Sports Health 2024:19417381241258467. [PMID: 38898814 DOI: 10.1177/19417381241258467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Lateral ankle sprain is one of the most common musculoskeletal issues during sports and activities of daily living. This study investigated the effect of combined neuromuscular training and conventional training (including strengthening, range of motion, and balance exercises) on muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with chronic ankle instability (CAI). HYPOTHESIS The combination of neuromuscular and conventional training programs might result in additional benefits on the morphology of muscle, dynamic balance, and functional capacity in subjects with CAI. STUDY DESIGN A single-blind parallel-arm randomized controlled trial. LEVEL OF EVIDENCE Level 2. METHODS A total of 34 participants with CAI were divided randomly into experimental (EG) and control groups (CG). The EG received conventional and neuromuscular training, while the CG underwent conventional training. Cross-sectional areas of the peroneus longus and tibialis anterior muscles were measured using ultrasonography. Measurements included reaching direction distance, ankle instability, and the foot and ankle outcome score, all evaluated before and immediately after 12 intervention sessions and 4 weeks later in the follow-up phase. RESULTS Repeated-measures analysis of variance (ANOVA) revealed significant improvement in the EG, particularly in the cross-sectional area of the tibialis anterior muscle on the injured side and the posteromedial reaching direction displacement of the Y balance test. Moreover, the EG's foot and ankle outcome scores increased significantly compared with the CG (P < 0.05). However, the group effect size ranged from minor to moderate (Hedges g, 0.40-0.73). CONCLUSION Combining neuromuscular and conventional training programs yields greater benefits than conventional training alone regarding tibialis anterior muscle morphology, posteromedial dynamic balance, and functional capacity in persons with CAI. CLINICAL RELEVANCE The combination of neuromuscular and conventional training programs could enhance muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with CAI.
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Affiliation(s)
- Khadijeh Kazemi
- Department of Rehabilitation, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Khodabakhsh Javanshir
- Department of Physiotherapy, Mobility Impairment Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Feryal Saadi
- Department of Radiology, Medicine School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahin Goharpey
- Department of Physiotherapy, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Jafar Shaterzadeh Yazdi
- Department of Physiotherapy, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | - Daniel López-López
- Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, Ferrol, Spain
| | - Gholamhossein Nassadj
- Department of Physiotherapy, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Sierevelt IN, van Kampen PM, Terwee CB, Nolte PA, Kerkhoffs GMMJ, Haverkamp D. The minimal important change is not a universal fixed value across diagnoses when using the FAOS and FAAM in patients undergoing elective foot and ankle surgery. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38860725 DOI: 10.1002/ksa.12308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE This study aimed to calculate region and diagnosis-specific minimal important changes (MICs) of the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM) in patients requiring foot and ankle surgery and to assess their variability across different foot and ankle diagnoses. METHODS The study used routinely collected data from patients undergoing elective foot and ankle surgery. Patients had been invited to complete the FAOS and FAAM preoperatively and at 3-6 months after surgery, along with two anchor questions encompassing change in pain and daily function. Patients were categorised according to region of pathology and subsequent diagnoses. MICs were calculated using predictive modelling (MICPRED) and receiver operating characteristic curve (MICROC) method and evaluated according to strict credibility criteria. RESULTS Substantial variability of the MICs between forefoot and ankle/hindfoot region was observed, as well as among specific foot and ankle diagnoses, with MICPRED and MICROC values ranging from 7.8 to 25.5 points and 9.4 to 27.8, respectively. Despite differences between MICROC and MICPRED estimates, both calculation methods exhibited largely consistent patterns of variation across subgroups, with forefoot conditions systematically showing smaller MICs than ankle/hindfoot conditions. Most MICs demonstrated high credibility; however, the majority of the MICs for the FAOS symptoms subscale and forefoot conditions exhibited insufficient or low credibility. CONCLUSION The MICs of the FAOS and FAAM vary across foot and ankle diagnoses in patients undergoing elective foot and ankle surgery and should not be used as a universal fixed value, but recognised as contextual parameters. This can help clinicians and researchers in more accurate interpretation of the FAOS and FAAM change scores. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Inger N Sierevelt
- Department of Orthopedic Surgery, Xpert Clinics, Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Spaarnegasthuis Academy, Hoofddorp, The Netherlands
| | - Paulien M van Kampen
- Department of Research and Innovation, Bergman Clinics, Naarden, The Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, The Netherlands
| | - Peter A Nolte
- Department of Orthopedic Surgery, Spaarnegasthuis Academy, Hoofddorp, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Daniel Haverkamp
- Department of Orthopedic Surgery, Xpert Clinics, Amsterdam, The Netherlands
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Lewis TL, Goff TAJ, Ray R, Dhaliwal J, Carmody D, Wines AP. Clinical outcomes of subtalar arthroereisis for the treatment of stage 1 flexible progressive collapsing foot deformity. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04007-4. [PMID: 38814449 DOI: 10.1007/s00590-024-04007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The use of subtalar arthroereisis as an adjunct to the surgical treatment of stage 1 flexible progressive collapsing foot deformity (PCFD) is controversial. The aim was to investigate the clinical outcomes and report the implant removal rate of subtalar arthroereisis as an adjunct for stage 1 PCFD. METHODS A retrospective study of 212 consecutive feet undergoing operative management of stage 1 PCFD with adjunctive subtalar arthroereisis between October 2010 and April 2018. The primary outcome was the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included Foot and Ankle Disability Index (FADI), Euroqol-5D-5L Index and implant removal rate. RESULTS Post-operative clinical FAOS outcomes were collected for 153 feet (72.2%). At mean 2.5-year follow-up, the mean ± standard deviation FAOS for each domain was as follows; Pain: 81.5 ± 18.5, Symptoms: 79.5 ± 12.9, Activities of Daily Living: 82.5 ± 15.4 and Quality of Life: 64.2 ± 23.7. EQ-5D-5L Index was 0.884 ± 0.152. Pre-operative scores were available for 20 of these feet demonstrating a statistically significant improvement in all FAOS, FADI and EQ-5D-5L domains (p < 0.05). The implant removal rate for persistent sinus tarsi pain was 48.1% (n = 102). CONCLUSION Use of a subtalar arthroereisis implant as an adjunct to conventional procedures in stage 1 flexible PCFD can result in significant improvement in pain and function. Patients should be counselled as to the relatively frequent rate of subsequent implant removal. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Thomas L Lewis
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK.
| | | | - Robbie Ray
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | | | - David Carmody
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia
| | - Andrew P Wines
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia
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Lineham B, Maggs R, Pandit H, Sharma H, Foster P. Outcomes of ankle joint distraction in a paediatric and young adult cohort presenting with symptomatic ankle arthritis. J Pediatr Orthop B 2024; 33:246-250. [PMID: 37548659 DOI: 10.1097/bpb.0000000000001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Ankle arthritis in paediatric and young adult patients causes significant morbidity; therefore, joint-preserving procedures are preferable. Ankle joint distraction (AJD) is a technique that preserves the native joint. However, only short-term outcomes are reported in paediatric patients. Therefore, this study reports on intermediate-term outcomes in a paediatric cohort. Demographics for all patients who underwent AJD at two centres were prospectively collected. Case records were reviewed retrospectively for complications and further intervention. Mean joint space at baseline and follow-up radiographs were evaluated by two independent observers. All patients were contacted for completion of a Foot and Ankle Outcome Score (FAOS). Seven patients received AJD between February 2016 and June 2019. Median age at surgery was 15 years (9.0-24.6 years). Complications included one superficial pin-site infection and one patient death due to complications from juvenile idiopathic arthritis 6.2 years post-operatively. Two patients were converted to fusion, at 12.6 months and 26.2 months following frame removal; one patient underwent spontaneous fusion at 9 months following frame removal. The four patients who continued without further intervention achieved 2.59 mm mean joint space at last follow-up (0.65-5.08 mm) and FAOS of 35-79%. Mean follow-up length was 4.3 years (2.9-6.3 years) with final radiographs at mean 2.6 years. While recognising the limitations of this retrospective review, several patients had significant, sustained improvements in joint space with good clinical outcome. Complications for this procedure are minimal, and it is a potential joint-preserving option for managing end-stage ankle arthritis in young patients.
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Affiliation(s)
| | | | - Hemant Pandit
- University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Patrick Foster
- University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
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van den Heuvel S, Penning D, Sanders F, van Veen R, Sosef N, van Dijkman B, Schepers T. Functional outcome of routine versus on-demand removal of the syndesmotic screw. Bone Jt Open 2023; 4:957-963. [PMID: 38108322 PMCID: PMC10726379 DOI: 10.1302/2633-1462.412.bjo-2023-0061] [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: 12/19/2023] Open
Abstract
Aims The primary aim of this study was to present the mid-term follow-up of a multicentre randomized controlled trial (RCT) which compared the functional outcome following routine removal (RR) to the outcome following on-demand removal (ODR) of the syndesmotic screw (SS). Methods All patients included in the 'ROutine vs on DEmand removal Of the syndesmotic screw' (RODEO) trial received the Olerud-Molander Ankle Score (OMAS), American Orthopaedic Foot and Ankle Hindfoot Score (AOFAS), Foot and Ankle Outcome Score (FAOS), and EuroQol five-dimension questionnaire (EQ-5D). Out of the 152 patients, 109 (71.7%) completed the mid-term follow-up questionnaire and were included in this study (53 treated with RR and 56 with ODR). Median follow-up was 50 months (interquartile range 43.0 to 56.0) since the initial surgical treatment of the acute syndesmotic injury. The primary outcome of this study consisted of the OMAS scores of the two groups. Results The median OMAS score was 85.0 for patients treated with RR, and 90.0 for patients treated with ODR (p = 0.384), indicating no significant difference between ODR and RR. The secondary outcome measures included the AOFAS (88.0 in the RR group and 90.0 for ODR; p = 0.722), FAOS (87.5 in the RR group and 92.9 for ODR; p = 0.399), and EQ-5D (0.87 in the RR group and 0.96 for ODR; p = 0.092). Conclusion This study demonstrated no functional difference comparing ODR to RR in syndesmotic injuries at a four year follow-up period, which supports the results of the primary RODEO trial. ODR should be the standard practice after syndesmotic screw fixation.
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Affiliation(s)
- Stein van den Heuvel
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Diederick Penning
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Fay Sanders
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ruben van Veen
- Department of Trauma Surgery, OLVG, Amsterdam, the Netherlands
| | - Nico Sosef
- Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Bart van Dijkman
- Department of Trauma Surgery, Flevoziekenhuis, Almere, the Netherlands
| | - Tim Schepers
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - On behalf of the RODEO Collaborator group
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Trauma Surgery, OLVG, Amsterdam, the Netherlands
- Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
- Department of Trauma Surgery, Flevoziekenhuis, Almere, the Netherlands
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Larsen P, Rathleff MS, Roos EM, Elsoe R. Foot and Ankle Outcome Score (FAOS): Reference Values From a National Representative Sample. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231213369. [PMID: 38058979 PMCID: PMC10697047 DOI: 10.1177/24730114231213369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Background The Foot and Ankle Outcome Score (FAOS) is widely used in clinical practice and research. However, FAOS reference values are missing to aid interpretation. This study aimed to establish national record-based reference values for the FAOS. Methods A national representative sample of 9996 adult Danish citizens was derived from the Danish Civil Registration System. The FAOS questionnaire was sent to all participants, including 2 supplemental questions regarding previous foot and ankle problems and body mass index (BMI). A threshold of 10 FAOS points was predefined as a clinically relevant difference across all 5 subscales. Results A total of 2759 participants completed the FAOS. Mean age of participants was 60.5 years, and 51% were women. The mean FAOS subscale scores were as follows: pain, 87.1 (95% CI 86.4-87.8); symptoms, 85.1 (95% CI 84.5-85.8); activity of daily living (ADL), 88.9 (95% CI 88.2-89.6); sport and recreation function 78.5 (95% CI 77.4-79.6); and quality of life (QOL), 79.9 (95% CI 79.0-80.9). The mean difference between men and women was small and not clinically relevant (ranged from 0.9 in ADL to 3.4 in QOL). The largest differences in mean scores between age groups ranged from 4.3 in symptoms to 16.4 in sport/rec. Except for the subscale sport/rec, all age-related differences were below the predefined threshold of 10 for clinical relevance. The difference in mean subscale scores between the lowest BMI group (<24.7) and the obese group (>30) ranged from 19.6 in ADL to 39.1 in sport/rec. Conclusion We found in our population that BMI severely impacted FAOS scores. We recommend using BMI-specific reference FAOS values. Separate FAOS reference values for men and women appear not needed. Stratifying reference values for age is likely not needed except for the subscale sport and recreation function. Level of evidence Level III, cohort study.
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Affiliation(s)
- Peter Larsen
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Michael S. Rathleff
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
| | - Ewa M. Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Rasmus Elsoe
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
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Mohd Rothi I, Åkerback M, Bister V. Bilateral distal Achilles tendon sleeve avulsion: a case report. J Med Case Rep 2023; 17:155. [PMID: 37085917 PMCID: PMC10122362 DOI: 10.1186/s13256-023-03892-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/16/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND While Achilles tendon rupture is a common injury sustained especially in sporting events, distal Achilles tendon rupture is less common. Even rarer is a bilateral traumatic distal Achilles tendon sleeve rupture, with outcomes of such injury unknown. The following case report describes this rare injury, not reported to date elsewhere. CASE A 57-year-old Finnish man with no predisposing medical history had a traumatic bilateral distal Achilles tendon sleeve avulsion injury. Clinical and radiological evaluation confirmed the diagnosis. Treatment included suture anchors in a modified suture bridge style with customized rehabilitation protocol postoperatively. Symptoms continued to be relieved at 1 year postoperatively. CONCLUSION A modified suture bridge style and meticulous rehabilitation protocol including motivated patient contributed to very satisfying results in this very rare bilateral injury.
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Affiliation(s)
- Illina Mohd Rothi
- Department of Orthopaedics and Traumatology, Peijas Hospital, Helsinki University Hospital, Vantaa, Finland
| | - Mikael Åkerback
- Department of Orthopaedics and Traumatology, Peijas Hospital, Helsinki University Hospital, Vantaa, Finland
| | - Ville Bister
- Department of Orthopaedics and Traumatology, Peijas Hospital, Helsinki University Hospital, Vantaa, Finland.
- Department of Surgery, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
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Intermediate-term Outcomes in Adolescent Recurrent Ankle Instability Managed With a Modified Broström-Gould Procedure Augmented With Distal Fibular Periosteum Incorporation. J Pediatr Orthop 2023; 43:e199-e203. [PMID: 36729607 DOI: 10.1097/bpo.0000000000002329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Once a child has developed chronic ankle instability with recurrent events despite conservative treatment, then ligamentous repair is warranted. We utilize a modification of the modified Broström-Gould technique that further incorporates the distal fibular periosteum into the construct. The purpose of this study was to describe the intermediate-term outcomes of our modified Broström-Gould technique for chronic lateral ankle instability in childhood athletes. METHODS A retrospective review of children who underwent the surgical technique over a 10-year time period (2010 to 2019) was performed, excluding those with <2 years of follow-up. Demographic, surgical, and clinical data were recorded, as well as outcome scores: (1) the Marx activity scale, (2) University of California, Los Angeles activity score, and (3) foot and ankle outcomes score. Recurrent instability events, repeat surgeries, satisfaction with the surgical experience, and return to sport (if applicable) were also recorded. RESULTS Forty-six children (43 females) with 1 bilateral ankle met the criteria with a mean age at surgery of 14.8 years, and a mean follow-up duration of 4.9 years. The mean Marx activity score was 9.0±5.1, the mean University of California, Los Angeles score was 8.3±1.8, and the mean total foot and ankle outcomes score was 84.0±15.6. Twenty-six ankles (55.3%) reported having at least 1 recurrent episode of instability and 6 of the ankles (12.8%) underwent revision surgery between 3.5 months and 6.5 years of the index procedure. Thirty-nine (84.8%) patients responded that they would undergo our surgery again. CONCLUSION A modified Broström-Gould procedure can be performed in children with the incorporation of the adjacent periosteum, but recurrence of instability is distinctly possible with longer follow-up with a risk for revision surgery despite good subjective outcomes. LEVEL OF EVIDENCE Level IV; retrospective case series.
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Empfehlung für Fragebögen zur Untersuchung der Fuß- und Sprunggelenkfunktion vom Research-Komitee der AGA. ARTHROSKOPIE 2023. [DOI: 10.1007/s00142-023-00594-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
ZusammenfassungDas standardisierte Erheben von Behandlungsergebnissen findet immer mehr Einzug in die moderne Medizin. Hierbei ist vor allem das subjektive Ergebnis aus Patientensicht und die damit häufig einhergehende Zufriedenheit mit der medizinischen Behandlung in den Fokus gerückt. Dies hat in den letzten Jahren nicht nur in der akademischen Landschaft, sondern auch auf gesundheitspolitischer Ebene deutlich an Bedeutung gewonnen. Dies bedeutet, dass das Behandlungsergebnis immer mehr Einfluss auf die Vergütung der Leistungserbringer erhält, auch „value-based healthcare“ genannt. Insbesondere in der Orthopädie und Traumatologie gibt es dabei zahlreiche gelenkspezifische Messinstrumente (Fragebögen, Scores oder „patient-reported outcome measures“ [PROMs]), wobei in der Fuß- und Sprunggelenkchirurgie hierfür eine Vielzahl an Fragebögen verfügbar ist, die sich jedoch häufig sehr heterogen und selten pathologiespezifisch darstellen. In Anbetracht der derzeitigen Mannigfaltigkeit an PROMs in der aktuellen Literatur ist es deshalb von Interesse, die wissenschaftliche Qualität zu prüfen und gleichzeitig die Forschungskommunikation zu vereinheitlichen, indem etablierte und gemäß akademischen Gütekriterien ausgewählte Fragebögen zum Einsatz kommen. Ziel ist es, valide, verlässliche und möglichst repräsentative Daten zu gewinnen, um eine akkurate Darstellung der tatsächlichen Ergebnisse zu erreichen. Dies bedingt neben qualitativen Kriterien auch immer kompakte und leicht verständliche Fragenkataloge, um so eine möglichst hohe Rücklaufquote zu generieren. Schließlich sollte auch immer eine Einschätzung der klinischen Relevanz der erhaltenen Ergebnisse stattfinden. Hierfür hat sich der kleinste vom Patienten als klinische Veränderung wahrgenommene Wert des jeweiligen PROM („minimal clinically important difference“, MCID) durchgesetzt. Für den Fuß- und Sprunggelenkbereich werden dabei vom Research Komitee der AGA unter Berücksichtigung dieser Kriterien folgende Messinstrumente empfohlen: FAOS (Foot and Ankle Outcome Score) zur Beurteilung der allgemeinen Schmerzsymptomatik und Funktion sowie der EQ-5D-Fragebogen zur Beurteilung der Lebensqualität. Zwar kann aufgrund fehlender Datenlage keine pathologiespezifische Empfehlung abgegeben werden, jedoch ist der FAOS für eine Vielzahl von Fuß- und Sprunggelenkpathologien validiert und liegt zudem in deutscher Sprache vor.
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Lee J, Ryu H, Park JY. Single lateral approach for open reduction and internal fixation of posterior malleolar fragment in Weber B rotational ankle fracture. Medicine (Baltimore) 2023; 102:e32725. [PMID: 36701732 PMCID: PMC9857474 DOI: 10.1097/md.0000000000032725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Ankle fractures involving the posterior malleolus are a relatively common injuries, but various surgical approaches are still being introduced, and the selection of an appropriate surgical method is still controversial. The aim of this study was to introduce the surgical method using a single lateral approach for open reduction and internal fixation for posterior malleolar (PM) fractures associated with Weber B type ankle fractures. In this retrospective study, the single lateral approach was used for osteosynthesis of the PM fracture with Weber B lateral malleolar fractures. A total of 40 patients were followed up at for least 12 months (mean, 23.3; range, 12-88). Clinical assessment was based on the Olerud and Molander score, Foot and Ankle Outcome Score, visual analog scale, and subjective patient satisfaction 1 year after surgery. The accuracy of reduction was evaluated as <1 mm of displacement on the lateral view of the postoperative radiographs. The mean Olerud and Molander ankle score was 85.6 ± 12.7 and the mean Foot and Ankle Outcome Score was 82.7 ± 15.9 at 1-year postoperatively. Acceptable reduction was achieved in 38 of 40 (95%) cases. During the follow-up period, arthritic change was observed in 1 case and limited range of motion was confirmed in 2 cases. There was 1 case of postoperative wound problem and no case of sural nerve injury. The single lateral approach is a relatively simple and convenient method that enables accurate reduction and minimizing complication for fixation of the PM fractures with Weber B lateral malleolar fractures.
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Affiliation(s)
- Jaehyung Lee
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Hwan Ryu
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Jae Yong Park
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, Republic of Korea
- * Correspondence: Jae Yong Park, Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do 14068, Republic of Korea (e-mail: )
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Jiang Q, Kim Y, Choi M. Kinetic Effects of 6 Weeks' Pilates or Balance Training in College Soccer Players with Chronic Ankle Instability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12903. [PMID: 36232203 PMCID: PMC9566560 DOI: 10.3390/ijerph191912903] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
Lateral ankle sprain (LAS) is a common sports injury that frequently occurs in active individuals. LAS is characterized by a high recurrence rate, with a large proportion of patients progressing to chronic ankle instability (CAI). Pilates exercises have provided positive results in health care and in rehabilitation. This study compared Pilates training (PT) with traditional balance training (BT) in patients with CAI. Fifty-one college football players with CAI, divided into PT (n = 26) and BT (n = 25) groups, were included in the study. The groups performed PT or BT training as assigned, three times per week for 6 weeks. Isokinetic ankle strength, one-leg hop tests, Y-balance test (YBT), and foot and ankle outcome score (FAOS) were evaluated before and after training. There were considerable improvements in both the PT and BT groups after training. Group and time comparisons revealed that the PT group achieved better triple hop test results than the BT group, whereas the BT group exhibited a greater improvement in YBT posteromedial and posterolateral reach distances. In athletes with CAI, both PT and BT effectively improved symptoms and function. These findings suggest that ankle strength, balance, and core stability should be comprehensively evaluated and targeted in CAI rehabilitation programs.
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Affiliation(s)
- Quan Jiang
- Department of Public Sports, Luoyang Normal University, Luoyang 471934, China
| | - Yonghwan Kim
- Department of Physical Education, Gangneung-Wonju National University, Gangneung 25457, Korea
| | - Moonyoung Choi
- Department of Sports Science Convergence, Dongguk University, Seoul 04620, Korea
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Tapaninaho K, Saarinen AJ, Ilves O, Uimonen MM, Häkkinen AH, Sandelin H, Repo JP. Structural validity of the foot and ankle outcome score for orthopaedic pathologies with Rasch Measurement Theory. Foot Ankle Surg 2022; 28:193-199. [PMID: 33757731 DOI: 10.1016/j.fas.2021.03.005] [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] [Received: 12/24/2020] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Foot and Ankle Outcome Score (FAOS) is one of the most frequently used patient-reported outcome measures for foot and ankle conditions. The aim is to test the structural validity of the Finnish version of the FAOS using Rasch Measurement Theory. METHODS FAOS scores were obtained from 218 consecutive patients who received operative treatment for foot and ankle conditions. The FAOS data were fitted into the Rasch model and person separation index (PSI) calculated. RESULTS All the five subscales provided good coverage and targeting. Three subscales presented unidimensional structure. Thirty-eight of the 42 items had ordered response category thresholds. Three of the 42 items had differential item functioning towards gender. All subscales showed sufficient fit to the Rasch model. PSI ranged from 0.73 to 0.94 for the subscales. CONCLUSIONS The Finnish version of the FAOS shows acceptable structural validity for assessing complaints in orthopaedic foot and ankle patients.
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Affiliation(s)
- Krista Tapaninaho
- Department of Surgery, Central Finland Hospital District, Jyväskylä, Finland
| | - Antti J Saarinen
- Department of Surgery, Central Finland Hospital District, Jyväskylä, Finland
| | - Outi Ilves
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Mikko M Uimonen
- Department of Surgery, Central Finland Hospital District, Jyväskylä, Finland
| | - Arja H Häkkinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Department of Physical Medicine, Central Finland Healthcare District, Jyväskylä, Finland
| | - Henrik Sandelin
- Department of Orthopaedics and Traumatology, Vaasa Central Hospital, Vaasa and University of Helsinki, Helsinki, Finland; Mehiläinen Sports Hospital, Vaasa, Finland; Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland.
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Saarinen AJ, Bondfolk AS, Repo JP, Sandelin H, Uimonen MM. Longitudinal Validity and Minimal Important Change for the Modified Lower Extremity Functional Scale (LEFS) in Orthopedic Foot and Ankle Patients. J Foot Ankle Surg 2022; 61:127-131. [PMID: 34384700 DOI: 10.1053/j.jfas.2021.07.004] [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] [Received: 01/13/2021] [Accepted: 07/10/2021] [Indexed: 02/03/2023]
Abstract
The lower extremity functional scale (LEFS) is a patient-reported outcome measure for lower extremity disorders. Aim of this study was to assess the longitudinal validity including responsiveness and test-retest reliability of the revised 15-item version, and to define the minimal important change (MIC) of the modified LEFS in a generic sample of orthopedic foot and ankle patients who underwent surgery. Responsiveness, effect size, and standardized response mean were measured by determining the score change between the baseline and 6 months administration of the LEFS from 156 patients. There was no significant difference between preoperative (median 78, interquartile range [IQR] 64.2-90.3) and postoperative (median 75.0, IQR 61.7-95.0) scores. Both effect size and standardized response mean were low (0.06 and 0.06, respectively). Test-retest reliability of the LEFS was satisfactory. Intraclass correlation coefficient was 0.85 (95% confidence interval 0.81-0.88). MIC value could not be estimated due to the lack of significant score change. The modified LEFS presented with relatively low longitudinal validity in a cohort of generic orthopedic foot and ankle patients. The findings of this study indicate that the modified LEFS might not be the optimal instrument in assessing the clinical change over time for these patients.
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Affiliation(s)
- Antti J Saarinen
- Department of Surgery, Central Finland Hospital, Jyväskylä, Finland; Faculty of Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Anton S Bondfolk
- Faculty of Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Jussi P Repo
- Department of Orthopedics and Traumatology, Unit of musculoskeletal Surgery, Tampere University Hospital and University of Tampere, Finland.
| | - Henrik Sandelin
- Department of Orthopedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mehiläinen Sports Hospital, Helsinki, Finland
| | - Mikko M Uimonen
- Department of Surgery, Central Finland Hospital, Jyväskylä, Finland
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Rupp MC, Degenhardt H, Winkler PW, Hinz M, Ehmann YJ, Imhoff AB, Pogorzelski J, Themessl A. High return to sports and return to work rates after anatomic lateral ankle ligament reconstruction with tendon autograft for isolated chronic lateral ankle instability. Knee Surg Sports Traumatol Arthrosc 2022; 30:3862-3870. [PMID: 35357531 PMCID: PMC9568480 DOI: 10.1007/s00167-022-06937-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate clinical outcomes as well as return to sports (RTS) and return to work (RTW) rates following anatomic lateral ankle ligament reconstruction with a tendon autograft for chronic lateral ankle instability (CLAI) in a high-risk population, and to compare these outcome parameters between patients having received a gracilis tendon autograft (GT) and free split peroneus brevis tendon (PBT) autograft. METHODS Twenty-eight consecutive patients, who were diagnosed with CLAI, presenting with ≥ 1 risk factor (ligamentous hyperlaxity, insufficient substance of native ligament and/or high-demand athlete), who underwent ankle ligament reconstruction with a tendon autograft between January 2011 and December 2018, were included in this retrospective study. At 63.7 ± 28.0 months (24-112), 23 patients with a mean age of 29.7 ± 10.9 years were available for follow-up. The Karlsson Score, the Foot and Ankle Outcome Score (FAOS), the Tegner Activity Scale and the visual analog scale (VAS) for pain were collected at a minimum follow-up of 24 months. RTS and RTW were evaluated by questionnaire. A subgroup analysis with regard to the graft used for ankle ligament reconstruction (GT versus PBT) was performed. RESULTS Patients reported a Karlsson score of 82.1 ± 17.5 (37-100), a FAOS score of 87.8 ± 8.4 (73-99), a median Tegner activity scale of 5.0 (IQR 4-6) and a VAS for pain of 0.5 ± 0.9 (0-4) at rest and of 2.0 ± 2.1 (0-7) during activities at final follow-up. Postoperatively, 96% of patients had returned to sports after 8.3 ± 6.2 months. All patients (100%) had returned to work at 3.5 ± 5.7 (0-24) months, with 87% reporting an equal or improved working ability compared to that preoperatively. Postoperatively, exercise hours per week were significantly reduced compared to preoperatively in patients with a split PBT (n = 12; 13.0 ± 12.9 to 5.6 ± 6.4 h, p = 0.038) autograft as opposed to patients with a GT autograft (n = 11; 13.1 ± 8.7 to 12.4 ± 7.1 h, n.s.). No other group differences were observed. CONCLUSION Good patient-reported outcomes as well as excellent RTS and RTW rates can be achieved in high-risk patients undergoing ankle ligament reconstruction with a tendon autograft for CLAI. These results may be helpful in preoperatively managing patients' expectations regarding sports- and work-related outcomes and provide tangible data on the expectable time frame of the individual return to sports and work trajectory. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marco-Christopher Rupp
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Hannes Degenhardt
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Philipp W. Winkler
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Maximilian Hinz
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Yannick J. Ehmann
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Jonas Pogorzelski
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Alexander Themessl
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,Alps Surgery Institute, Clinique Générale Annecy, 4 Chem. de la Tour la Reine, 74000 Annecy, France
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Wang H, Yu H, Kim YH, Kan W. Comparison of the Effect of Resistance and Balance Training on Isokinetic Eversion Strength, Dynamic Balance, Hop Test, and Ankle Score in Ankle Sprain. Life (Basel) 2021; 11:life11040307. [PMID: 33916136 PMCID: PMC8065734 DOI: 10.3390/life11040307] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 12/26/2022] Open
Abstract
Ankle sprain is a commonly recurring sports injury. This study aimed to compare the rehabilitation effects of resistance and balance training programs in patients with recurrent ankle sprain. Patients with recurrent lateral ankle sprain completed a home-based rehabilitation program comprising resistance training (RT; n = 27) or balance training (BT; n = 27). RT consisted of exercises using elastic tube bands, and BT consisted mainly of exercises performed using a variety of balance tools. Exercises were performed for 6 weeks, twice a day for 20 min, 5 days per week. Isokinetic eversion strength, Y-Balance test and hop tests, and foot and ankle outcome score (FAOS) were evaluated. Both RT and BT significantly improved strength and dynamic balance (p < 0.05). Compared to RT, BT also significantly improved the outcome of the crossover hop test (p = 0.008). The changes reflected group and time in pain (p = 0.022), sports (p = 0.027), and quality of life (p = 0.033) of FAOS were significantly greater in BT than RT.
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Affiliation(s)
- Haifang Wang
- School of Physical Education, Luoyang Normal College, Yibin District, Luoyang City 471934, China;
| | - Hailong Yu
- Department of Athletic Sports, Beijing Sport University, Beijing 100084, China;
| | - Yong Hwan Kim
- Department of Physical Education, Gangneung–Wonju National University, Gangwon 25457, Korea
- Correspondence: (Y.H.K.); (W.K.); Tel.: +82-33-640-2557 (Y.H.K.); +86-13-9301-00387 (W.K.); Fax: +82-33-641-3659 (Y.H.K.); +86-931-891-2129 (W.K.)
| | - Wencong Kan
- Sports Teaching and Research Department, Lanzhou University, Lanzhou 730000, China
- Correspondence: (Y.H.K.); (W.K.); Tel.: +82-33-640-2557 (Y.H.K.); +86-13-9301-00387 (W.K.); Fax: +82-33-641-3659 (Y.H.K.); +86-931-891-2129 (W.K.)
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