Acute lateral ankle sprain to chronic ankle instability: a pathway of dysfunction

Safety and Efficacy of One vs Two Incision Broström Gould with Calcaneal Osteotomy and Peroneal Tendon Debridement Surgery

Surgical intervention, such as the Broström-Gould procedure, is typically indicated for patients with chronic lateral ankle instability. In this study, we are comparing the safety and efficacy of the Broström-Gould procedure with peroneal tendon debridement, a sliding lateralizing calcaneal osteotomy, and adjuvant procedures performed with a single- versus double-incision approach. Our retrospective analysis included patients who underwent the procedure of interest between 2011 and 2020. Patients were divided into two groups: undergoing either a one-incision (n=53) or a two-incision approach (n=47), both with a lateralizing calcaneal osteotomy. A significant difference in skin bridge breakdown was observed between the two-incision (n = 6 (13%)) and one-incision groups (n = 0 (0%)). There were no significant differences in infection, deep wound dehiscence, nerve palsy, or neuroma between patients in the two groups. Furthermore, no statistically significant differences in mean PROMIS scores existed between the cohorts. The described Broström-Gould procedure shows promise for treating chronic ankle instability. While patients in both single- and double-incision groups had similar rates of postoperative complications, the decreased incidence of skin bridge breakdown in the one-incision group highlights the approach's safety and potential benefits in reducing wound-related complications.

Immediate effect of the use of toe separators on dynamic balance and ankle range of motion: a pilot study

BACKGROUND AND OBJECTIVES

Injuries involving ankle stability and range of motion are among the most frequent in athletes and in the general population. In response, this study aimed to assess the immediate effects of toe separators on dynamic stability and ankle range of motion in healthy young individuals.

METHODS

Among the 68 eligible participants, 50 healthy and active subjects completed all trials. The impact of the intervention was evaluated using the Weight Bearing Lunge Test and Y-Test. The control condition performed the tests without toe separators, while the experimental condition performed the tests with toe separators. All participants performed both conditions with a wash-out period of at least 7 days between trials.

RESULTS

Statistical analysis revealed no significant differences in dynamic balance (p > 0.05) and range of motion (p > 0.05) between the two conditions. Additionally, no asymmetries were detected between the lower limbs in both tests (p > 0.05).

CONCLUSIONS

The results of this pilot study indicate that using toe separators does not have an immediate effect on ankle range of motion and dynamic balance in young, healthy individuals. Future research should consider evaluating intervention programs of longer duration and exploring different populations.

Bröstrom Repair Review

Since its introduction in 1966, the Bröstrom repair has been the workhorse for the treatment of chronic ankle instability. The procedure has expanded with the advent of arthroscopy, ultrasound, and other techniques. Because chronic ankle sprains/instability pose a barrier to athletes who perform high-level activities for a living, discussions concerning postoperative recovery and return to play criteria are important. Here we present an update on the Bröstrom-Gould procedure from preoperative management to return to play.Level of Evidence: Level V.

Effect of Progressive Balance Control Strategies on Chronic Ankle Instability in Middle-Aged Obese Women

INTRODUCTION

Chronic ankle instability (CAI) is a disease characterized by persistent feelings of instability in the ankle joint and a propensity for recurrent ankle sprains. It is often caused by ligamentous laxity or neuromuscular deficits. Middle-aged obese females represent a demographic subset at increased risk for CAI due to factors such as reduced proprioception and increased loading on the ankle joint. The gaps in the current evidence suggest that more research is needed on middle-aged obese females, who are particularly vulnerable to CAI due to physiological changes associated with poor balance.

OBJECTIVES

This study aims to determine the effect of progressive balance control strategies on CAI in middle-aged obese women.

METHOD

In this experimental study, 72 patients with CAI in middle-aged women were selected randomly using a simple random sampling method. Females aged 35-45 with a body mass index (BMI) greater than 27 kg/m2 and a history of ankle sprains greater than one and having residual symptoms. The experimental group (Group B) received progressive balance control strategies, and the conventional group (Group A) received conventional balance exercises. Foot and ankle ability measure (FAAM) scale, push-and-release test (PART), single-leg stance test (SLST), evaluations, and star excursion balance test (SEBT) were used for pre- and posttreatment.

RESULTS

The experimental group post-intervention for static balance, dynamic balance, and postural control tests showed extremely significant improvement with a p-value of <0.0001. Between groups A and B, the dynamic balance was considered very significant, with a p-value of 0.0001. In the single-leg stance test, Group B's result was significantly greater than that of Group A's (63.4 + 16.1 and 63.4 + 16.1). PART results indicate that Group B is more significant than Group A (0.76 and 0.51, respectively).

CONCLUSIONS

The study concluded that progressive balance control strategy training is effective in middle-aged obese women with CAI.

All-Inside Arthroscopic and Open Techniques of the Modified Broström Procedure for the Treatment of Lateral Ankle Instability: Comparison of the Times to Return to Play

Background and Objectives: Lateral ankle injuries are commonly encountered injuries, and the open modified Broström operation (OMBO) is the primary treatment option. Recently, an arthroscopic modification of the Broström operation (AMBO) was developed; many studies have shown that there are no significant differences in clinical and radiological outcomes between the two surgical methods. However, no studies have been conducted comparing the two surgical methods in terms of return to play (RTP) time. This study assesses the time to RTP and the functional clinical outcomes. Materials and Methods: Sixty patients were enrolled from January 2012 to July 2014. They were segregated into two cohorts: the AMBO group comprised 30 patients, while the OMBO group comprised another 30 patients. Each participant underwent standardized treatment and rehabilitation regimens and RTP time was measured using seven questions that explored the times to return of painless walking, running, jumping, squatting, climbing stairs, and rising up on the heels and toes. We compared the time intervals from the onset of instability to the date of surgery. Clinical outcomes were evaluated before the surgery, 6 weeks after surgery, and 6 months after surgery. The assessments included the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the pain visual analog scale (VAS) score, subjective satisfaction with rehabilitation, and activity level. Results: In terms of RTP, AMBO was associated with a shorter interval to walking without pain (7.07 ± 2.96 weeks) relative to OMBO (11.03 ± 8.58 weeks). No disparities were observed in the time to return to play (RTP) between OMBO and AMBO. While there were no discrepancies in the 6-month postoperative AOFAS or VAS scores, the 6-week postoperative VAS score was notably lower in the AMBO group compared to the OMBO group. AMBO provided a faster RTP in terms of two of the seven questions in a group exhibiting high-level physical activity. The rate of subjective satisfaction with rehabilitation was higher for AMBO than for OMBO. Conclusions: Aside from walking, the duration to return to play and the clinical outcomes were similar between AMBO and OMBO treatments for lateral ankle instability. AMBO is a good treatment option and should be carefully considered for athletes with lateral ankle instability. AMBO demonstrated positive outcomes in a group with higher activity levels compared to others, particularly in terms of time to RTP, subjective satisfaction, and postoperative pain.

Osteochondral Lesions of the Talus: Etiology, Clinical Presentation, Treatment Options, and Outcomes

This article reviews the etiology, clinical presentation, classification schemes, and treatment options for osteochondral lesions of the talus. These lesions typically occur after a traumatic injury and are best diagnosed on MRI. Asymptomatic lesions and incidentally found lesions are best treated conservatively; however, acute displaced osteochondral fragments may require surgical treatment. Lesion characteristics may dictate surgical technique. Outcomes following surgical treatment may be impacted by patient age, BMI, and lesion characteristics.

Bilateral Sensorimotor Impairments in Individuals with Unilateral Chronic Ankle Instability: A Systematic Review and Meta-Analysis

BACKGROUND

Chronic ankle instability (CAI) is manifested by sensorimotor impairments in the sprained ankle, including deficits in sensation, motor function, and central integration or processing. These impairments have a significant impact on physical activities and daily life. Recently, some studies have suggested that bilateral deficits were observed in unilateral CAI, but contradictory evidence disputes this finding. Therefore, the objective of this study was to investigate whether bilateral sensorimotor deficits presented in individuals with unilateral CAI.

METHODS

Without language restriction, the following databases were retrieved from database inception up until 3 November 2023, including PubMed, WOS, EMBASE, Cochrane, SPORTDiscus and CINAHL. Case-control and cross-sectional studies that investigated bilateral sensorimotor functions in individuals with unilateral CAI were included. Sensorimotor functions contained static and dynamic balance, functional performance, muscle strength and activation, as well as sensation. Outcome measures contained centre-of-pressure parameters, normalised reach distance, activation time and magnitude of muscle, sensory errors and threshold. The risk of bias and quality assessment of included studies were evaluated using a standardised tool recommended by the Cochrane Collaboration and the Epidemiological Appraisal Instrument, respectively. To explore the potential bilateral deficits associated with unilateral CAI, a comprehensive meta-analysis was conducted using Review Manager version 5.4. The analysis compared the injured limb of unilateral CAI with healthy controls and the uninjured limb with healthy controls. The main focus of this study was to investigate the differences between the uninjured limb and healthy controls. A random-effects model was employed and effect sizes were estimated using the standardised mean difference (SMD) with 95% confidence intervals (CIs). Effect sizes were deemed as weak (0.2-0.5), moderate (0.5-0.8), or large (> 0.8).

RESULTS

A total of 11,442 studies were found; 30 studies were contained in the systematic review and 20 studies were included in the meta-analysis. Compared with healthy controls, those with unilateral CAI presented weak to moderate impairments in their uninjured limbs in static balance with eyes open (SMD = 0.32, 95% CI: 0.08 to 0.56), functional performance (SMD = 0.37; 95% CI: 0.08 to 0.67), kinesthesia (SMD = 0.52; 95% CI: 0.09 to 0.95) and tibialis anterior activation (SMD = 0.60, 95% CI: 0.19 to 1.01). There were no significant differences in other comparisons between the uninjured limb and healthy controls.

CONCLUSIONS

Patients with unilateral CAI may present bilateral deficits in static balance with eyes open, functional performance and kinaesthesia. However, further evidence is required to confirm this point due to limited studies included in some analyses and small effect size.

REGISTRATION

The protocol was registered in the International Prospective Register of Systematic Reviews platform (CRD: 42,022,375,855).

Screening of Undiagnosed Increased Lateral Ankle Laxity Using Stress Ultrasonography

Background

Some patients with lateral ankle sprain (LAS) will experience chronic lateral ankle instability (CLAI). However, not all of those with residual increased lateral ankle laxity (ILAL) become symptomatic. There is a lack of evidence regarding the prevalence of undiagnosed ILAL in the general population.

Purpose

To evaluate the prevalence of undiagnosed ILAL with the use of stress ultrasonography (US) and to investigate the percentage of ankle sprain copers (ASCs) with ILAL.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

The anterior talofibular ligament (ATFL) lengths in college students without diagnosis of CLAI were measured consecutively in stress and nonstress positions. The ATFL ratio was calculated as an indicator of lateral ankle laxity according to a previously reported method. The manual anterior drawer test was also performed. The Cumberland Ankle Instability Tool (CAIT) and Ankle Instability Instrument (AII) were used to assess subjective impairments related to CLAI. The correlation between the ATFL ratio and CAIT score was evaluated.

Results

A total of 207 ankles from 106 participants (mean age, 23.9 ± 2.2 years; male/female, 64/42) were included. Overall, 38 participants (35.8%; 50 ankles [24.2%]) were classified as having undiagnosed ILAL. Of the ankles with no history of LAS, 8% showed ILAL. Overall, 53 participants (50%) had a history of LAS and were all classified as ASCs. Of the 82 ankles from these ASCs, 40 (48.8%) were regarded as having undiagnosed ILAL. There was no correlation between the ATFL ratio and CAIT scores (r = -0.09, P = .414).

Conclusion

The prevalence of undiagnosed ILAL by stress US screening was approximately one-third in young adults. In this study, 48.8% of the ankles from ASCs showed ILAL.

A static posturography guide to implementing time-to-boundary

The emergence of time-to-boundary provides an advanced representation of the spatiotemporal characteristics of postural control through the estimation of the time required for the center of pressure to reach the boundary of the base of support. Time-to-boundary has demonstrated its utility in several healthy and clinical adoptions; however, unknown inconsistencies among studies exist. Text and graphical representations understandably highlight idealistic standards, but new investigators to this measure are forced to wade through the same potential pitfalls that others have addressed, but the field has neglected to concatenate. The purpose of this communication is to share recent methodological advancements made to enhance time-to-boundary and describe the components of the time-to-boundary code that is being made publicly accessible for the first time. We anticipate future researchers who wish to apply this methodology to their data processing toolbox could utilize our script in full, with any deviations in potential future developments noted in clear fashion. Historically, researchers (including ourselves) have had to interpret text-based descriptions of the existing literature into quantitative steps in a computational mathematics script. In contrast to fixed process measures that do not require investigator input (e.g., path length), time-to-boundary poses two distinct but connected challenges to investigators. The coding process itself can be a hurdle for novices or practitioners. Second, transferring logical considerations such as robust, objective event detection routines must be defended in the review process. This comprehensive guide to time-to-boundary, as used in our applications, should enhance adoption and advance the comprehension of postural control.

Deficits in neurocognitive performance in patients with chronic ankle instability during a neurocognitive balance task - A retrospective case-control study

OBJECTIVES

To assess the neurocognitive performance while maintaining balance of patients experiencing CAI compared to healthy controls. In patients with CAI, the affected limb was also compared to the contralateral limb.

DESIGN

A retrospective case-control study.

SETTING

Laboratory study.

PARTICIPANTS

We included 27 patients with CAI and 21 healthy controls.

METHODS

The study consisted of two sessions, namely familiarisation and experimentation, which were scheduled with a gap of at least one week between them. During the experimental trial, both groups performed the Y-Balance Test and Reactive Balance Test once on each limb.

MAIN OUTCOME MEASURES

The main outcome measures are accuracy and visuomotor response time (VMRT) calculated via video-analysis and with the Fitlight™-hardware and software respectively during the Reactive Balance Test (RBT).

RESULTS

No data was excluded from the final analysis. Patients with CAI exhibited significantly lower accuracy than healthy controls, with a mean difference of 8.7% (±3.0)%. There were no differences for VMRT between groups. Additionally, no significant differences were observed between the affected and contralateral limb of the patient group for both accuracy and VMRT.

CONCLUSIONS

Patients with CAI showed lower accuracy, but similar VMRT compared to healthy controls during a neurocognitive balance task, indicating impaired neurocognitive function. Patients exhibit comparable speed to healthy individuals when completing neurocognitive balance tasks, yet they display a higher frequency of accuracy errors in accurately perceiving their environment and making decisions under time constraints. Future research should gain more insights in which other cognitive domains are affected in patients with CAI for a better grasp of this condition's underlying mechanism.

Randomized controlled trial study of intelligent rehabilitation training system for functional ankle instability

To investigate the intervention effect of an intelligent rehabilitation training system on patients with functional ankle instability (FAI) and to advance the research to optimise the effect of FAI rehabilitation training. Thirty-four FAI patients who participated in this trial in Guilin City from April 2023 to June 2023 were recruited as research subjects, and all subjects were randomly divided into the control group (n = 17) and the observation group (n = 17). Both groups received the conventional rehabilitation training intervention for 6 weeks, and the observation group received the additional training using the intelligent rehabilitation training system training invented by our team. Visual analogue scale (VAS), ankle active mobility, ankle muscle strength and Y-balance test (YBT) were assessed before and after treatment. Two-way repeated measures ANOVA shows that the interaction effect between time and group of VAS scores was significant (F = 35.644, P < 0.05). The interaction effect between time and group of plantar flexion mobility was significant (F = 23.948, P < 0.05), the interaction effect between time and group of dorsiflexion mobility was significant (F = 6.570, P < 0.05), the interaction effect between time and group of inversion mobility was significant (F = 8.360, P < 0.05), the interaction effect between time and group of eversion mobility was significant (F = 10.113, P < 0.05). The interaction effect between time and group of inversion muscle strength was significant (F = 18.107, P < 0.05). The interaction effect between time and group of YBT scores was significant (F = 33.324, P < 0.05). The Intelligent Rehabilitation Training System can effectively reduce pain in FAI patients, improve joint range of motion, increase inversion strength, and improve dynamic balance of the affected limb.

Test-retest, intra- and inter-rater reliability of the reactive balance test in patients with chronic ankle instability

Introduction

The Reactive Balance Test (RBT) could be a valuable addition to research on chronic ankle instability (CAI) and clinical practice, but before it can be used in clinical practice it needs to be reliable. It has already been proven reliable in healthy recreational athletes, but not yet in patients with CAI who have shown persistent deficits in dynamic balance. The study aimed to determine the test-retest, intra-, and inter-rater reliability of the RBT in patients with CAI, and the test-retest and inter-rater reliability of the newly developed RBT score sheet.

Methods

We used a repeated-measures, single-group design to administer the RBT to CAI patients on three occasions, scored by multiple raters. We included 27 participants with CAI. The study used multiple reliability measures, including Pearson r, intra-class correlations (ICC), standard error of measurement (SEM), standard error of prediction (SEP), minimal detectable change (MDC), and Bland-Altman plots, to evaluate the reliability of the RBT's outcome measures (visuomotor response time and accuracy). It also assessed the test-retest and inter-rater reliability of the RBT score sheet using the same measures.

Results

The ICC measures for test-retest reliability were similar for accuracy (0.609) and VMRT (0.594). Intra-rater reliability had high correlations and ICCs for accuracy (r = 0.816, ICC = 0.815) and VMRT (r = 0.802, ICC = 0.800). Inter-rater reliability had a higher ICC for VMRT (0.868) than for accuracy (0.690).

Conclusion

Test-retest reliability was moderate, intra-rater reliability was good, and inter-rater reliability showed moderate reliability for accuracy and good reliability for VMRT. Additionally, the RBT shows robust SEM and mean difference measures. The score sheet method also demonstrated moderate test-retest reliability, while inter-rater reliability was good to excellent. This suggests that the RBT can be a valuable tool in assessing and monitoring balance in patients with CAI.

Clinical outcomes of arthroscopic all-inside anterior talofibular ligament suture augmentation repair versus modified suture augmentation repair for chronic ankle instability patients

BACKGROUND

To compare the clinical efficacies of arthroscopic anterior talofibular ligament suture augmentation repair and modified suture augmentation repair in patients with chronic ankle instability (CAI).

METHODS

From October 2019 to August 2020, 100 patients with CAI were enrolled after propensity score matching analysis and observed for two years. Among them, 50 underwent modified suture augmentation repair and the other 50 underwent suture augmentation repair. The clinical efficacies of CAI treatments were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) clinical rating scale, visual analog scale (VAS), and anterior drawer test scores.

RESULTS

The postoperative AOFAS score of the modified suture augmentation repair group (83.8 ± 11.3) was significantly higher than that of the suture augmentation repair group (76.3 ± 11.3; P = 0.001). The VAS (P = 0.863) and anterior drawer test (P = 0.617) scores were not significantly different between the two treatment groups.

CONCLUSION

Both the modified suture augmentation repair and suture augmentation repair demonstrated good clinical efficacies. The AOFAS score of the modified suture augmentation repair group was superior to that of the conventional suture augmentation repair group. Thus, modified suture augmentation repair is a feasible and practical surgical technique for CAI treatment.

Diagnostic value of measuring the talofibular space using stress sonography in chronic lateral ankle instability

OBJECTIVES

To investigate the diagnostic value of measuring the talofibular space using stress sonography for chronic lateral ankle instability (CLAI).

MATERIALS & METHODS

We recruited patients who were clinically diagnosed with CLAI between October 2018 and December 2019 (CLAI group). A control group of healthy volunteers was also included for this study. Both groups underwent a preliminary stress sonographic examination. First, the ultrasonic characteristics of the anterior talofibular ligament (ATFL), including length, thickness, relaxation, calcification, and rupture, were observed using conventional sonography. Second, the talofibular space at the passive neutral position (D1) and maximum varus position (D2) was measured (by stress sonographic images), and the difference (ΔD = D1-D2) between them was determined. Third, the parameters of the two groups were statistically compared. Finally, receiver operating characteristic (ROC) curves and area under the curve (AUC) analyses were performed for parameters with significant differences.

RESULTS

The CLAI group comprised 60 patients, yielding data on 60 ankles, whereas the control group comprised 35 participants, yielding data for 70 ankles. Differences in D1, D2, and ΔD of the talofibular space between the two groups were significant, with ΔD proving to be the best diagnostic indicator (P < 0.001). Its AUC, optimal cutoff value, sensitivity, and specificity were 0.922, 0.11 cm, 73 %, and 94 %, respectively, followed by D2 (0.850, 0.47 cm, 67 %, and 94 %, respectively; P < 0.001) and D1 (0.635, 0.47 cm, 67 %, and 94 %, respectively; P = 0.006).

CONCLUSION

Measurement of talofibular space in stress sonography is a valuable diagnostic indicator for CLAI, especially the ΔD between the neutral and stress position.

Individuals with chronic ankle instability show altered regional activation of the peroneus longus muscle during ankle eversion

Individuals with chronic ankle instability (CAI) present muscular weakness and potential changes in the activation of the peroneus longus muscle, which likely explains the high recurrence of ankle sprains in this population. However, there is conflicting evidence regarding the role of the peroneus longus activity in CAI, possibly due to the limited spatial resolution of the surface electromyography (sEMG) methods (i.e., bipolar sEMG). Recent studies employing high-density sEMG (HD-sEMG) have shown that the peroneus longus presents differences in regional activation, however, it is unknown whether this regional activation is maintained under pathological conditions such as CAI. This study aimed to compare the myoelectric activity, using HD-sEMG, of each peroneus longus compartment (anterior and posterior) between individuals with and without CAI. Eighteen healthy individuals (No-CAI group) and 18 individuals with CAI were recruited. In both groups, the center of mass (COM) and the sEMG amplitude at each compartment were recorded during ankle eversion at different force levels. For the posterior compartment, the sEMG amplitude of CAI group was significantly lower than the No-CAI group (mean difference = 5.6% RMS; 95% CI = 3.4-7.6; p = 0.0001). In addition, it was observed a significant main effect for group (F1,32  = 9.608; p = 0.0040) with an anterior displacement of COM for the CAI group. These findings suggest that CAI alters the regional distribution of muscle activity of the peroneus longus during ankle eversion. In practice, altered regional activation may impact strengthening programs, prevention, and rehabilitation of CAI.

Effects of Kinesio taping on lower limb biomechanical characteristics during unexpected jumping in patients with chronic ankle instability

PURPOSE

The current biomechanical research on the application of Kinesio taping (KT) to patients with chronic ankle instability (CAI) has focused on testing the expected movements. However, unexpected movements are more common in actual sports. Therefore, the present study aimed to investigate the effects of KT on the biomechanical characteristics of the knee and ankle joints during unexpected jumping movements.

METHODS

Twenty-one patients with unilateral CAI were recruited to capture the biomechanical parameters during unexpected jumping movements under different interventions: no taping (NT), placebo taping (PT), and KT. A one-way repeated measures analysis of variance was used to compare the differences in knee and ankle biomechanical characteristics among patients with CAI between the three intervention conditions.

RESULTS

At initial contact, the KT group demonstrated a significant decrease in ankle plantarflexion and knee flexion angles compared to the NT group (p < 0.05). At the early landing phase, the KT group had a significant increase in peak ankle dorsiflexion angle, peak ankle eversion angle, peak ankle dorsiflexion moment, and peak ankle eversion moment compared to the NT and PT groups (p < 0.05). Furthermore, the KT group had a significantly reduced peak knee flexion angle, peak knee eversion angle, and peak vertical ground reaction force (p < 0.05) compared to the NT and PT groups.

CONCLUSION

KT significantly improves the sprain-prone touchdown posture of patients with CAI. And reducing the risk of ankle sprains during the early landing phase by promoting ankle dorsiflexion and eversion angles and moments.

Plantar flexion with inversion shows highest elastic modulus of calcaneofibular ligament using ultrasound share wave elastography

PURPOSE

The functional role of the calcaneofibular ligament (CFL) is still controversial. We aimed to investigate the anatomical features of the CFL on sonography and the elastic modulus of the CFL in different ankle positions using ultrasound shear-wave elastography (SWE).

METHODS

In 14 cadaveric ankles, the angle of the CFL with respect to the long axis of the fibula was measured in the following ankle positions: neutral (N), 30° plantar flexion (PF), and 20° dorsiflexion (DF). In addition, in 24 ankles of healthy adult volunteers, the elastic modulus of the CFL was evaluated with ultrasound SWE in the following ankle positions: neutral (N), 30° plantar flexion with inversion (PI), 30° plantar flexion with eversion (PE), 20° dorsiflexion with inversion (DI), and 20° dorsiflexion with eversion (DE).

RESULTS

The mean angle of the CFL in N, PF, and DF positions was 139.9° ± 12.7°, 121.3° ± 14.1°, and 158.6° ± 13.1°, respectively. The angle of the CFL in N was significantly greater than that in PF and smaller than that in DF (P < 0.0001, both). The mean elastic modulus of the CFL in the N, PI, PE, DI, and DE positions was: 63.6 ± 50.8, 148.0 ± 39.4, 75.8 ± 40.6, 88.1 ± 31.6, and 61.7 ± 29.4 kPa, respectively. The elastic modulus in PI was significantly higher than in other positions, while the values obtained in DI and DE were also significantly different (P < 0.001, both).

CONCLUSIONS

The angle of the CFL increased with DF. Moreover, ultrasound SWE showed that the CFL was tensed and likely to be injured in the PI position.

Five-year clinical follow-up of arthroscopically treated chronic ankle instability

INTRODUCTION

Arthroscopic treatment of lateral ankle instability is a recent innovation. In 2014, a prospective study was initiated by the French Society of Arthroscopy demonstrating the feasibility, morbidity and short-term results of arthroscopic treatment of ankle instability.

HYPOTHESIS

The functional results of arthroscopic treatment of chronic ankle instability found after one year were maintained in the medium term.

MATERIAL AND METHODS

The prospective follow-up of the patients included in the initial cohort was continued. The Karlsson and AOFAS scores, as well as patient satisfaction, were assessed. The causes of failure underwent univariate and multivariate analyzes. The results of 172 patients were included (40.2% ligament repairs; 59.7% ligament reconstructions). The average follow-up was 5years. The average satisfaction was 8.6/10, the average Karlsson score was 85 points and the average AOFAS score was 87.5 points. The reoperation rate was 6.4% of patients. The failures were related to an absence of sports practice, a high BMI and female gender. A high BMI and the intense sports practice were associated to ligament repair failure. The absence of sports practice and the intraoperative presence of the anterior talofibular ligament were associated to ligament reconstruction failure.

DISCUSSION

Arthroscopic treatment of ankle instability confers high satisfaction in the medium term, as well as long-lasting results with a low reoperation rate. A more detailed evaluation of the failure criteria could help guide the choice of treatment between ligament reconstruction or repair.

LEVEL OF EVIDENCE

II.

Balance and Muscle Synergies During a Single-Limb Stance Task in Individuals With Chronic Ankle Instability

The aim of this study was to investigate balance performance and muscle synergies during a Single-Limb Stance (SLS) task in individuals with Chronic Ankle Instability (CAI) and a group of healthy controls. Twenty individuals with CAI and twenty healthy controls were asked to perform a 30-second SLS task in Open-Eyes (OE) and Closed-Eyes (CE) conditions while standing on a force platform with the injured or the dominant limb, respectively. The activation of 13 muscles of the lower limb, hip, and back was recorded by means of surface electromyography. Balance performance was assessed by identifying the number and the duration of SLS epochs, and the Root-Mean-Square (RMS) in Antero-Posterior (AP) and Medio-Lateral (ML) directions of the body-weight normalized ground reaction forces. The optimal number of synergies, weight vectors, and activation coefficients were also analyzed. CAI group showed a higher number and a shorter duration of SLS epochs and augmented ground reaction force RMS in both AP and ML directions compared to controls. Both groups showed an increase in the RMS in AP and ML forces in CE compared to OE. Both groups showed 4 optimal synergies in CE, while controls showed 5 synergies in OE. CAI showed a significantly higher weight of knee flexor muscles in both OE and CE. In conclusion, muscle synergies analysis provided an in-depth knowledge of motor control mechanisms in CAI individuals. They showed worse balance performance, a lower number of muscle synergies in a CE condition and abnormal knee flexor muscle activation compared to healthy controls.

Ankle biomechanics of the three-step layup in a basketball player with chronic ankle instability

At present, the effects of chronic ankle instability (CAI) on the biomechanics of the ankle joint in the three-step layup of basketball players are not clear. This work aims to thoroughly investigate the impact of CAI on the biomechanical characteristics of the ankle during the execution of a three-step layup in basketball players. Thirty male basketball players were stratified into distinct groups-namely, a CAI group and a non-CAI group-comprising 15 individuals each, based on the presence or absence of CAI. Demographic attributes, including age, weight, height, and the Cumberland Ankle Instability Tool (CAIT) score, were subjected to rigorous statistical examination within both athlete cohorts. The research employed four Whistler 9281CA 3D force measuring platforms (Switzerland), recording at 1000 Hz, in conjunction with eight camera motion analysis systems (USA), functioning at a frequency of 200 Hz. The study recorded maximal plantarflexion angle, inversion angle, dorsiflexion angle, and peak ankle dorsiflexion moment across the subjects during the distinct phases of push-off, landing, and the ensuing landing period. The findings notably exhibited that within the context of the one-foot push-off phase, the maximum ankle inversion angle was notably diminished in the CAI group as contrasted with the non-CAI group, demonstrating statistical significance (t = - 3.006, P < 0.01). The CAI group exhibited a lesser alteration in ankle inversion angle compared to the non-CAI group. Notably, during the one-foot landing period, the CAI group demonstrated a significantly greater maximum ankle inversion angle in contrast to the non-CAI group (t = 8.802, P < 0.001). Furthermore, the CAI group displayed a substantially larger maximum dorsiflexion angle at the ankle joint compared to the non-CAI group (t = 2.265, P < 0.05). Additionally, the CAI group exhibited a prolonged peak time for ankle dorsiflexion moment as compared to the non-CAI group (t = - 2.428, P < 0.05). Collectively, the findings elucidated a reduction in the maximum ankle joint inversion angle during the one-foot push-off phase in individuals with CAI. Furthermore, increased maximum inversion angle and maximum dorsiflexion angle of the ankle joint were observed during the one-foot landing period, alongside a lengthening of the peak time of ankle dorsiflexion moment. These results contribute valuable insights into the selection of training methodologies for basketball players afflicted by CAI.

Risk factors for chronic ankle instability after first episode of lateral ankle sprain: A retrospective analysis of 362 cases

BACKGROUND

Chronic ankle instability (CAI) is a common sequela following an acute lateral ankle sprain (LAS). To treat an acute LAS more effectively and efficiently, it is important to identify patients at substantial risk for developing CAI. This study identifies magnetic resonance imaging (MRI) manifestations for predicting CAI development after a first episode of LAS and explores appropriate clinical indications for ordering MRI scans for these patients.

METHODS

All patients with a first-episode LAS who received plain radiograph and MRI scanning within the first 2 weeks after LAS from December 1, 2017 to December 1, 2019 were identified. Data were collected using the Cumberland Ankle Instability Tool at final follow-up. Demographic and other related clinical variables, including age, sex, body mass index, and treatment were also recorded. Univariable and multivariable analyses were performed successively to identify risk factors for CAI after first-episode LAS.

RESULTS

A total 131 out of 362 patients with a mean follow-up of 3.0 ± 0.6 years (mean ± SD; 2.0-4.1 years) developed CAI after first-episode LAS. According to multivariable regression, development of CAI after first-episode LAS was associated with 5 prognostic factors: age (odds ratio (OR) = 0.96, 95% confidence interval (95%CI): 0.93-1.00, p = 0.032); body mass index (OR = 1.09, 95%CI: 1.02-1.17, p = 0.009); posterior talofibular ligament injury (OR = 2.17, 95%CI: 1.05-4.48, p = 0.035); large bone marrow lesion of the talus (OR = 2.69, 95%CI: 1.30-5.58, p = 0.008), and Grade 2 effusion of the tibiotalar joint (OR = 2.61, 95%CI: 1.39-4.89, p = 0.003). When patients had at least 1 positive clinical finding in the 10-m walk test, anterior drawer test, or inversion tilt test, they had a 90.2% sensitivity and 77.4% specificity in terms of detecting at least 1 prognostic factor by MRI.

CONCLUSION

MRI scanning is valuable in predicting CAI after first-episode LAS for those patients with at least 1 positive clinical finding in the 10-m walk test, anterior drawer test, and inversion tilt test. Further prospective and large-scale studies are necessary for validation.

Role of interventions targeting plantar cutaneous receptors in improving postural control in chronic ankle instability: A systematic review with meta-analysis

INTRODUCTION

Chronic ankle instability (CAI) is a disorder that occurs after one or more acute ankle sprains and is characterised by persistent symptoms which include episodes of ''giving way'' a sensation of instability, recurrent ankle sprains, and functional deficits. Despite of effective treatment strategies a comprehensive approach is needed that can break this continuum of disability and improve the postural control. A systematic review with meta-analysis assessing the effectiveness of interventions targeting plantar cutaneous receptors for improving postural control in individuals with chronic ankle instability.

METHODS

The systematic review with meta-analysis was performed following PRISMA guidelines. Outcome measure used to evaluate the improvement in which static postural control was assessed on SLBT (Single limb balance test) and COP (Centre of pressure) whereas dynamic postural control was assessed on SEBT (star excursion balance test) and scores expressed as mean ± SD and random-effects model were performed, and heterogeneity between the studies was calculated using the I2 statistic.

RESULTS

A total of 168 CAI populations were included among the 8 selected studies in the meta-analysis. In which,5 studies using Plantar massage and 3 studies using foot insole were assessed, with moderate to high quality on the Pedro scale (range 4-7). For single and six-sessions of plantar massage showed insignificant effect on SLBT COP and for the single session of custom moulded FO showed insignificant effect on SEBT.

CONCLUSION

The meta-analysis showed non-significant pooled results for plantar massage and foot orthotics on static and dynamic postural control when assessed on postural outcome measures. Further high-quality evidence-based trials would be required to highlight the importance of sensory targeted approaches to treat the postural instability in CAI patients.

Minimally Invasive Reconstruction of the Ankle Lateral Ligament Complex in Chronic Ankle Instability: Clinical Outcomes, Return to Sport and Recurrence Rate at Minimum Follow up of 5 Years

Background: Chronic ankle instability is a common condition that develops after lateral ankle sprains. Many surgical techniques have been described in case of failure of conservative treatment. The purpose of this paper is to present the results in terms of clinical outcomes, return to sport and recurrence rate after reconstruction of the lateral ligament complex of the ankle with a minimally invasive approach at a minimum follow up of five years. Methods: This retrospective study involved forty-seven patients treated for chronic ankle instability from January 2013 to November 2017. The clinical outcomes were evaluated with the American Orthopedic Foot and Ankle Society ankle and hindfoot score (AOFAS score), the University of California–Los Angeles Rating Scale (UCLA Rating Scale), the Karlsson–Peterson ankle instability score and the Halasi scale at a mean follow up time of 80 months. Results: The mean age of the patients was 42 years (23–63). The mean VAS pain score decreased from 5.6 (2–9) pre-operatively to 0.7 (0–7) post-operatively. The mean UCLA Rating Scale score improved from 7.7 (4–8) before surgical treatment to 9.2 (6–10) afterwards. The AOFAS score increased from a pre-operative mean value of 66.5 (40–95) to a post-operative mean value of 94 (88–100) and the Halasi scale from a pre-injury mean value of 4.3 (2–8) to 4.5 post-operatively (2–8). The mean Karlsson–Peterson ankle instability score increased from 71 (40–90) pre-operatively to 87.9 (70–90) post-operatively. During this period of follow up, the procedure survival rate was 95.7%, with two cases of recurrence of ankle sprain post-operatively after twelve months in one case and forty months in the other case. Conclusions: The described technique of reconstruction of the anterior talofibular and calcaneofibular ligament with a minimally invasive approach with a semitendinosus autograft is a viable treatment option for chronic ankle instability and enables the majority of patients to regain their activity and sport level with a low recurrence rate at a mid-term follow up.

External Ankle Support and Ankle Biomechanics in Chronic Ankle Instability: Systematic Review and Meta-Analysis

OBJECTIVE

To systematically review the literature to determine whether external ankle supports influence ankle biomechanics in participants with chronic ankle instability (CAI) during sport-related tasks.

DATA SOURCES

A literature search of MEDLINE, SPORTDiscus, and CINAHL databases was conducted in November 2021.

STUDY SELECTION

Included studies were randomized crossover or parallel-group controlled trials in which researchers assessed ankle biomechanics during landing, running, or change of direction in participants with CAI using external ankle supports compared with no support.

DATA EXTRACTION

Two authors independently identified studies, extracted data, and assessed risk of bias (Cochrane risk-of-bias tool version 2) and quality of evidence (Grading of Recommendations Assessment, Development and Evaluation). Random-effects meta-analysis was used to compare between-groups mean differences with 95% CIs. Grading of Recommendations Assessment, Development and Evaluation recommendations were used to determine the certainty of findings.

DATA SYNTHESIS

A total of 13 studies of low to moderate risk of bias were included. During landing, very low-grade evidence indicated external ankle supports reduce frontal-plane excursion (mean difference [95% CI] = -1.83° [-2.97°, -0.69°], P = .002), plantar-flexion angle at initial contact (-3.86° [-6.18°, -1.54°], P = .001), and sagittal-plane excursion (-3.45° [-5.00°, -1.90°], P < .001) but not inversion angle at initial contact (-1.00° [-3.59°, 1.59°], P = .45). During running, very low- to low-grade evidence indicated external ankle supports reduce sagittal-plane excursion (-5.21° [-8.59°, -1.83°], P = .003) but not inversion angle at initial contact (0.32° [-2.11°, 1.47°], P = .73), frontal-plane excursion (-1.31° [-3.24°, 0.63°], P = .19), or plantar-flexion angle at initial contact (-0.12° [-3.54°, 3.29°], P = .94). Studies investigating changes of direction were insufficient.

CONCLUSIONS

Very low-grade evidence indicated external ankle supports reduce frontal-plane excursion but not inversion angle at initial contact in participants with CAI during landing. Limiting frontal-plane excursion may reduce ankle-sprain risk. Frontal-plane ankle kinematics were not influenced by external ankle supports during running. Sagittal-plane reductions were observed with external ankle supports during landing and running with low to very low certainty, but their influence on ankle-sprain risk is undetermined.

Brain Neuroplasticity Related to Lateral Ankle Ligamentous Injuries: A Systematic Review

BACKGROUND

Lateral ankle sprains are the most common ankle injuries in sports and have the highest recurrence rates. Almost half of the patients experiencing lateral ankle sprains develop chronic ankle instability. Patients with chronic ankle instability experience persistent ankle dysfunctions and detrimental long-term sequelae. Changes at the brain level are put forward to explain these undesirable consequences and high recurrence rates partially. However, an overview of possible brain adaptations related to lateral ankle sprains and chronic ankle instability is currently lacking.

OBJECTIVE

The primary purpose of this systematic review is to provide a comprehensive overview of the literature on structural and functional brain adaptations related to lateral ankle sprains and in patients with chronic ankle instability.

METHODS

PubMed, Web of Science, Scopus, Embase, EBSCO-SPORTDiscus and Cochrane Central Register of Controlled Trials were systematically searched until 14 December, 2022. Meta-analyses, systematic reviews and narrative reviews were excluded. Included studies investigated functional or structural brain adaptations in patients who experienced a lateral ankle sprain or with chronic ankle instability and who were at least 18 years of age. Lateral ankle sprains and chronic ankle instability were defined following the recommendation of the International Ankle Consortium. Three authors independently extracted the data. They extracted the authors' name, publication year, study design, inclusion criteria, participant characteristics, the sample size of the intervention and control groups, methods of neuroplasticity testing, as well as all means and standard deviations of primary and secondary neuroplasticity outcomes from each study. Data reported on copers were considered as part of the control group. The quality assessment tool for observational and cross-sectional studies was used for the risk of bias assessment. This study is registered on PROSPERO, number CRD42021281956.

RESULTS

Twenty articles were included, of which only one investigated individuals who experienced a lateral ankle sprain. In all studies combined, 356 patients with chronic ankle instability, 10 who experienced a lateral ankle sprain and 46 copers were included. White matter microstructure changes in the cerebellum have been related to lateral ankle sprains. Fifteen studies reported functional brain adaptations in patients with chronic ankle instability, and five articles found structural brain outcomes. Alterations in the sensorimotor network (precentral gyrus and supplementary motor area, postcentral gyrus and middle frontal gyrus) and dorsal anterior cingulate cortex were mainly found in patients with chronic ankle instability.

DISCUSSION

The included studies demonstrated structural and functional brain adaptations related to lateral ankle sprains and chronic ankle instability compared to healthy individuals or copers. These adaptations correlate with clinical outcomes (e.g. patients' self-reported function and different clinical assessments) and might contribute to the persisting dysfunctions, increased re-injury risk and long-term sequelae seen in these patients. Thus, rehabilitation programmes should integrate sensorimotor and motor control strategies to cope with neuroplasticity related to ligamentous ankle injuries.

Altered gut microbiota richness in individuals with a history of lateral ankle sprain

This study aimed to examine differences in the intestinal microbiota diversity in individuals with and without a history of a lateral ankle sprain (LAS). Fifty male college student athletes with (n=32) and without (n=18) a LAS history participated in this study. Faecal samples were collected in the morning after awakening during an off-season, and faecal microbiota were characterized via bacteria 16S rRNA amplicon sequencing. Alpha-diversity metrics and ß-diversity indices were calculated to assess the gut microbiota diversity. The LAS-history group significantly had lower Chao1 (p=0.020) and abundance-based coverage estimators (p=0.035) indices compared to the control group. Gut microbiota composition was not significantly different between athletes with a LAS history and controls (R2 =0.01, p 0.414). Athletes with a history of LASs had significantly higher proportions of Bacteroides Fragilis (p=0.024) and Ruminococcus Gnavus (p=0.021) compared with controls. The gut microbiota of athletes with a LAS history had less richness compared to controls, indicating potential associations between a LAS and the gut microbiota. This study highlights the potential link of a LAS to global health. This study may help raise awareness of strategies to prevent long-term health-related negative consequences in people suffering from LASs.

Effects of plantar-sensory treatments on postural control in chronic ankle instability: A systematic review and meta-analysis

OBJECTIVE

This study aimed to examine the effects of plantar-sensory treatments on postural control in individuals with chronic ankle instability (CAI).

METHODS

This study was registered in PROSPERO (registration number CRD42022329985) on May 14, 2022. An extensive search was performed in Pubmed, Embase, Cochrane, Web of Science, and Scopus to identify the potential studies on plantar-sensory treatments affecting postural control before May 2022. The methodological quality of involved studies was assessed using the scale of Physiotherapy Evidence Database (PEDro). The Cochrane Tool and the Risk of Bias in Non-randomized Studies of Interventions assessment tool were used to evaluate the risk of bias in randomised controlled trials (RCTs) and non-RCTs respectively. RevMan 5.4 was utilised to calculate the standardised mean difference (SMD), with 95% confidence interval (CI).

RESULTS

Eight RCTs with a mean PEDro rating of 6 and four non-RCTs with a mean PEDro rating of 4.75 were included in the quantitative analysis. The types of plantar-sensory treatments included plantar massage, whole-body vibration and textured surface-stimulation treatment. A significant effect of static balance with eyes open (SMD = -0.54; 95% CI: -0.81 to -0.27; p < 0.001) was found and subgroup analysis showed that plantar massage (SMD = -0.49; 95% CI: -0.84 to -0.14; p = 0.006) and whole-body vibration (SMD = -0.66; 95% CI: -1.12 to -0.19; p = 0.005) had positive effects. In the subgroup analysis of anterior dynamic balance, whole-body vibration revealed a significant increase (SMD = 0.60; 95% CI: 0.06-1.14; p = 0.03). The pooled results or subgroup analysis including eyes-closed static balance and other directions of dynamic balance indicated no significant difference (p > 0.05).

CONCLUSIONS

This meta-analysis indicated that plantar-sensory treatments could improve postural control in CAI, especially the treatments of plantar massage and long-term whole-body vibration.

Does mechanical loading restore ligament biomechanics after injury? A systematic review of studies using animal models

BACKGROUND

Mechanical loading is purported to restore ligament biomechanics post-injury. But this is difficult to corroborate in clinical research when key ligament tissue properties (e.g. strength, stiffness), cannot be accurately measured. We reviewed experimental animal models, to evaluate if post-injury loading restores tissue biomechanics more favourably than immobilisation or unloading. Our second objective was to explore if outcomes are moderated by loading parameters (e.g. nature, magnitude, duration, frequency of loading).

METHODS

Electronic and supplemental searches were performed in April 2021 and updated in May 2023. We included controlled trials using injured animal ligament models, where at least one group was subjected to a mechanical loading intervention postinjury. There were no restrictions on the dose, time of initiation, intensity, or nature of the load. Animals with concomitant fractures or tendon injuries were excluded. Prespecified primary and secondary outcomes were force/stress at ligament failure, stiffness, laxity/deformation. The Systematic Review Center for Laboratory animal Experimentation tool was used to assess the risk of bias.

RESULTS

There were seven eligible studies; all had a high risk of bias. All studies used surgically induced injury to the medial collateral ligament of the rat or rabbit knee. Three studies recorded large effects in favour of ad libitum loading postinjury (vs. unloading), for force at failure and stiffness at 12-week follow up. However, loaded ligaments had greater laxity at initial recruitment (vs. unloaded) at 6 and 12 weeks postinjury. There were trends from two studies that adding structured exercise intervention (short bouts of daily swimming) to ad libitum activity further enhances ligament behaviour under high loads (force at failure, stiffness). Only one study compared different loading parameters (e.g. type, frequency); reporting that an increase in loading duration (from 5 to 15 min/day) had minimal effect on biomechanical outcomes.

CONCLUSION

There is preliminary evidence that post-injury loading results in stronger, stiffer ligament tissue, but has a negative effect on low load extensibility. Findings are preliminary due to high risk of bias in animal models, and the optimal loading dose for healing ligaments remains unclear.

Physical Examination of Ankle Sprain and Ankle Instability: Can We Really Divide It into Low and High Ankle Sprains?

Lateral ankle ligament sprains and syndesmotic injuries are two different entities. However, they may be combined under the same spectrum depending on the arch of violence during the injury. Currently, the clinical examination has a limited value in the differential diagnosis between an acute anterior talofibular ligament rupture and a syndesmotic high ankle sprain. However, its use is indispensable for raising a high index of suspicion for detecting these injuries. Based on the mechanism of injury, clinical examination plays an essential role in guiding further imaging and early diagnosis of low/high ankle instability.

The role of sural nerve reflexes during drop-landing in subjects with and without chronic ankle instability

The purpose of this study was to investigate the functional role of cutaneous reflexes during a single-leg drop-landing task among healthy, neurologically intact adults, and to identify whether individuals with chronic ankle instability (CAI) demonstrate altered reflexes and subsequent ankle kinematics. All subjects were physically active adults and were categorized as control (n = 10, Male = 6, Female = 4) or CAI (n = 9, Male = 4, Female = 5) depending on whether they scored a 0 or ≥ 11 on the Identification of Functional Ankle Instability questionnaire, respectively. Subjects performed 30-40 single-leg drop-landing trials from a platform set to the height of their tibial tuberosity. Muscle activity of four lower leg muscles was collected via surface electromyography, while ankle kinematics were recorded via an electrogoniometer. Non-noxious stimulations were elicited randomly to the ipsilateral sural nerve at two unique phases of the drop-landing task (takeoff and landing). Unstimulated and stimulated trials were used to calculate middle latency reflex amplitudes (80-120 ms) and net ankle kinematics (140-220 ms) post-stimulation. Mixed-factor ANOVAs were used to identify significant reflexes within groups and differences in reflex amplitudes between groups. Unlike the CAI group, the control group experienced significant facilitation of the Peroneus Longus (PL) and inhibition of the Lateral Gastrocnemius (LG) when stimulated at takeoff, resulting in eversion immediately prior to landing. When stimulated at landing, the control group experienced significantly more inhibition of the PL compared to the CAI group (p = 0.019). These results suggest lower neural excitability for individuals with CAI, which may predispose them to recurrent injury during similar functional tasks.

The effect of thickness and elastic modulus of the anterior talofibular ligament on anterior ankle joint stiffness: A subject-specific finite element study

Ankle sprain is a frequent type of sports injury leading to lateral ligament injury. The anterior talofibular ligament (ATFL) is a primary ligamentous stabilizer of the ankle joint and typically the most vulnerable ligament injured in a lateral ankle sprain (LAS). This study aimed to quantitively investigate the effect of the thickness and elastic modulus of ATFL on anterior ankle joint stiffness (AAJS) by developing nine subject-specific finite element (FE) models under acute injury, chronic injury, and control conditions of ATFL. A 120 N forward force was applied at the posterior calcaneus leading to an anterior translation of the calcaneus and talus to simulate the anterior drawer test (ADT). In the results, the ratio of the forward force to the talar displacement was used to assess the AAJS, which increased by 5.85% in the acute group and decreased by 19.78% in the chronic group, compared to those of the control group. An empirical equation described the relationship between AAJS, thickness, and elastic modulus (R-square 0.98). The equation proposed in this study provided an approach to quantify AAJS and revealed the effect of the thickness and the elastic modulus of ATFL on ankle stability, which may shed light on the potential diagnosis of lateral ligament injury.

A test battery for evaluation of muscle strength, balance and functional performance in subjects with chronic ankle instability: a cross-sectional study

BACKGROUND

Studies investigating ankle condition in subjects with chronic ankle instability (CAI) using an on-the-field test battery are scarce. Understanding which tests that are most challenging for these subjects has the potential to set realistic goals in rehabilitation and return-to-sports criteria. Thus, the primary aim of this study was to investigate CAI subjects regarding strength, balance and functional performance with an easily used test battery that required minimal equipment.

METHODS

This study was conducted with a cross-sectional design. A total of 20 CAI subjects, engaged in sports, and 15 healthy subjects serving as a control group, were tested for assessment of strength, balance and functional performance. A test battery was developed accordingly; isometric strength in inversion and eversion, the single leg stance test (SLS), single leg hop for distance (SLHD) and side hop test. The limb symmetry index was calculated to determine whether a side-to-side lower limb difference could be classified as normal or abnormal. The sensitivity of the test battery was also calculated.

RESULTS

The subjects were 20% weaker on the injured side compared with the non-injured side in eversion (p < 0.01) and 16% weaker in inversion (p < 0.01) (Table 2). For the SLS test, the mean score of the injured side was 8 points (67%) higher (more foot lifts) compared to the non-injured side (p < 0.01). The mean distance of the SLHD was 10 cm (9%) shorter for the injured side compare to the non-injured side (p = 0.03). The mean number of side hop was 11 repetitions (29%) fewer for the injured side compare to the non-injured side (p < 0.01). Six of the 20 subjects obtained abnormal LSI values in all five tests whereas none obtained normal values in all tests. The sensitivity of the test battery was 100%.

CONCLUSION

Deficits in muscle strength, balance and functional performance appear to be present in CAI subjects with the largest impairments in balance and side hop performance, which stresses the need for return to sport criteria for this group of subjects.

TRIAL REGISTRATION

Registered retrospectively on 24/01/2023. NCT05732168.

Efficacy of Platelet-Rich Plasma for Chronic Lateral Ankle Instability After Modified Broström-Gould surgery: A Randomized, Single-Blinded, Prospective Controlled Trial

Background

Modified Broström-Gould (MBG) surgery is frequently used for chronic lateral ankle instability (CLAI). However, conventional postoperative management (CPOM) due to prolonged immobilization may have adverse effects on tendons, ligaments, and joints, causing stiffness. This prospective, randomized controlled trial aimed to determine outcomes among patients randomized to receive CPOM plus ultrasonography-guided triple injections of leukocyte-rich platelet-rich plasma (LR-PRP) compared to patients who receive only CPOM after MBG surgery.

Methods

The present study included 40 patients with symptomatic CLAI who were candidates for the MBG surgery. The patients were randomized into 2 groups of 20, the control and PRP groups. In the PRP group, patients were injected with 3 doses of LR-PRP solution using ultrasonographic guidance. In the first injection, 2 mL of LR-PRP was injected near the injury site, and in the second and third injections, 4 mL of LR-PRP was injected in the tibiotalar joint. All patients received a short leg splint for 2 weeks, followed by 4 weeks in a walking boot. The primary outcome measure was the visual analog scale (VAS), and the secondary outcome measures were the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and ankle total range of motion (total ROM). The assessment was performed at baseline and 3 and 6 months after surgery.

Results

The mean VAS and AOFAS scores improved significantly in both groups 6 months after surgery (P < .001). However, the PRP group did not significantly improve in VAS or AOFAS scores compared with the control group. No clinically significant difference was observed between the 2 groups regarding the total ROM scores at month 3.

Conclusion

The application of LR-PRP after MBG surgery did not show any superior clinical or functional improvement over CPOM.

Level of Evidence

Level II, prospective randomized trial.

Effectiveness of the SMART training intervention on ankle joint function in patients with first-time acute lateral ankle sprain: study protocol for a randomized controlled trial

BACKGROUND

The lateral ankle sprain (LAS) is the most common injury in the field of everyday and sports-related activities. There is a high rate of patients with LAS who will develop chronic ankle instability (CAI). A possible explanation for this high rate is an insufficient rehabilitation and/or a premature return to intense exercise and workloads. Currently, there are general rehabilitation guidelines for LAS but there is a lack of standardized evidenced-based rehabilitation concepts for LAS, which effectively reduce the high CAI rate. The primary aim of the study is to investigate the effectiveness of a 6-week sensorimotor training intervention (SMART-Treatment, SMART) in contrast to standard therapy (Normal Treatment, NORMT) after an acute LAS on perceived ankle joint function.

METHODS

This study will be a prospective, single-center, interventional randomized controlled trial with an active control group. Patients (14-41 years) with an acute LAS and a MRI confirmed lesion or rupture of at least one ankle ligament will be included. Exclusion criteria are acute concomitant injuries of the ankle, pre-injuries of the ankle, serious lower-extremity injuries of the last 6 months, lower-extremity surgery, and neurological diseases. The primary outcome measure will be the Cumberland Ankle Instability Tool (CAIT). Secondary outcomes include the Foot and Ankle Ability Measurement (FAAM), isokinetic and isometric strength diagnostics, joint repositioning sense, range of motion, measurements of postural control, gait and run analysis, and jump analysis. This protocol will follow the SPIRIT guidance.

DISCUSSION

Current management of LAS rehabilitation lacks since there is a high rate of patients developing a CAI. It has been shown that exercise therapy improves ankle function in acute LAS as well as in patients with CAI. It is further recommended to address specific impairment domains in ankle rehabilitation. However, empirical data for such a holistic treatment algorithm is missing. Therefore, this study has the potential to improve the healthcare for LAS patients and might be used for a future standardized evidence-based rehabilitation concept.

TRIAL REGISTRATION

"Prospectively registered" ISRCTN - ISRCTN13640422 17/11/2021; DRKS (German Clinical Trials Register) - DRKS00026049.

Current Challenges in Chronic Ankle Instability: Review and Perspective

Chronic ankle instability (CAI) is common, disabling, and represents a significant socioeconomic burden. Current treatment options are not adequately efficacious. CAI is multifaceted, yet it is commonly addressed in terms of either mechanical instability or functional impairment. Both are inherently linked. Basic research must be conducted to foster reliable translational research encompassing both mechanical and functional aspects. A review was conducted to identify CAI risk factors for inclusion in future studies, and we offer here opinions and perspectives for future research.

Impairment-based assessments for patients with lateral ankle sprain: A systematic review of measurement properties

STUDY DESIGN

Systematic review.

BACKGROUND AND OBJECTIVE

The International Ankle Consortium developed a core outcome set for the assessment of impairments in patients with lateral ankle sprain (LAS) without consideration of measurement properties (MP). Therefore, the aim of this study is to investigate MPs of assessments for the evaluation of individuals with a history of LAS.

METHODS

This systematic review of measurement properties follows PRISMA and COSMIN guidelines. Databases Pubmed, CINAHL, Embase, Web of Science, Cochrane Library and SPORTDiscus were searched for eligible studies (last search: July 2022). Studies on MP of specific tests and patient-reported outcome measurements (PROMs) in patients with acute and history of LAS (>4 weeks post injury) were deemed eligible.

RESULTS

Ten studies of acute LAS and 39 studies of history of LAS patients with a total of 3313 participants met the inclusion criteria. Anterior Drawer Test (ADT) in supine position five days post injury and Reverse Anterolateral Drawer Test are recommended in acute settings in single studies. In the history of LAS patients, Cumberland Ankle Instability Tool (CAIT) (4 studies) as a PROM, Multiple Hop (3 studies) and Star Excursion Balance Tests (SEBT) (3 studies) for dynamic postural balance testing showed good MPs. No studies investigated pain, physical activity level and gait. Only single studies reported on swelling, range of motion, strength, arthrokinematics, and static postural balance. Limited data existed on responsiveness of the tests in both subgroups.

CONCLUSION

There was good evidence to support the use of CAIT as PROM, Multiple Hop, and SEBT for dynamic postural balance testing. Insufficient evidence exists in relation to test responsiveness, especially in the acute situation. Future research should assess MPs of assessments of other impairments associated with LAS.

The incidence rate of ACL injuries and ankle sprains in basketball players: A systematic review and meta-analysis

OBJECTIVE

To quantify the incidence rate of anterior cruciate ligament (ACL) injuries and ankle sprains according to player sex, playing level, and exposure setting (training vs. games) in basketball players.

METHODS

PubMed, MEDLINE, Google Scholar, and ScienceDirect were searched. Only studies reporting the number of ACL injuries and/or ankle sprains alongside the number of athlete-exposures (training sessions and/or games) in basketball players were included.

RESULTS

Thirty studies (17 reporting ACL injuries and 16 reporting ankle sprains) were included in the meta-analysis. Higher (p < 0.05) ACL injury incidence rates per 1000 athlete-exposures were recorded in females (female: 0.20 95% confidence intervals [0.16-0.25]; male: 0.07 [0.05-0.08]; female-to-male ratio: 3.33 [3.10-3.57]), in players competing at higher playing levels (amateur: 0.06 [0.04-0.09]; intermediate: 0.16 [0.13-0.20]; elite: 0.25 [0.14-0.64]), and in games (games: female, 0.27 [0.21-0.32]; male, 0.06 [0.03-0.08]; training: female, 0.03 [0.02-0.05]; male: 0.01 [0.00-0.02]; game-to-training ratio: 7.90 [4.88-12.91]). Higher (p < 0.05) ankle sprain incidence rates per 1000 athlete-exposures were observed in males (female: 0.82 [0.61-1.03]; male: 0.90 [0.61-1.19]; female-to-male ratio: 0.91 [0.83-0.99]), in players competing at higher playing levels (amateur: 0.54 [0.51-0.57]; intermediate: 1.12 [1.00-1.24]; elite: 1.87 [1.29-2.46]), and in games (games: 2.51 [1.85-3.16]; training: 0.80 [0.52-0.80]; game-to-training ratio: 2.77 [2.35-3.26]).

CONCLUSION

According to player sex, ACL injury incidence rate is higher in females, while ankle sprain incidence rate is greater in males. ACL injury and ankle sprain incidence rates are greater in players competing at higher playing levels and during games compared to training.

Diagnostic value of the posterior talofibular ligament area for chronic lateral ankle instability

An injured posterior talofibular ligament (PTFL) is one of the reasons for chronic lateral ankle instability (CLAI). Previous researches have demonstrated that the PTFL thickness (PTFLT) is associated with chronic ligament injuries. However, ligament hypertrophy is different from ligament thickness. Thus, we created the PTFL cross-sectional area (PTFLCSA) as a diagnostic image parameter to assess the hypertrophy of the whole PTFL. We assumed that the PTFLCSA is a key morphological diagnostic parameter in CLAI. PTFL data were obtained from 15 subjects with CLAI and from 16 normal individuals. The T1-weighted axial ankle-MR (A-MR) images were acquired at the level of PTFL. We measured the PTFLT and PTFLCSA at the posterior aspect of the ankle using our imaging analysis program. The PTFLT was measured as the thickness between point of anterior and posterior fiber of PTFL. The PTFLCSA was calculated as the whole cross-sectional PTFL area. The average PTFLT was 3.43 ± 0.52 mm in the healthy group and 4.89 ± 0.80 mm in the CLAI group. The mean PTFLCSA was 41.06 ± 12.18 mm 2 in the healthy group and 80.41 ± 19.14 mm 2 in the CLAI group. CLAI patients had significantly greater PTFLT ( P < .001) and PTFLCSA ( P < .001) than the healthy group. A receiver operating characteristic curve analysis demonstrated that the optimal cutoff score of the PTFLT was 4.19 mm, with 93.3% sensitivity, 93.7% specificity, and an area under the curve of 0.97. The most suitable cutoff value of the PTFLCSA was 61.15 mm 2 , with 93.3% sensitivity, 100% specificity, and area under the curve of 0.99. Even though the PTFLT and PTFLCSA were both significantly associated with CLAI, the PTFLCSA was a more exact morphological measurement parameter.

Reliability and validity of the ankle inversion discrimination apparatus during walking in individuals with chronic ankle instability

Purpose: 1) to explore the test-retest reliability of a new device for measuring ankle inversion proprioception during walking, i.e., the Ankle Inversion Discrimination Apparatus-Walking (AIDAW) in individuals with or without Chronic Ankle instability (CAI); 2) to assess its discriminant validity in differentiating individuals with or without CAI; 3) to investigate its convergent validity by examining its association with Cumberland Ankle Instability Tool (CAIT) and the Y Balance Test (YBT). Methods: For test-retest reliability, 15 participants with CAI and 15 non-CAI healthy controls were recruited. Participants completed the AIDAW test twice with a 7-day interval. The area under the receiver operating curve (AUC) was obtained as the AIDAW score. The intraclass correlation coefficient (ICC) and MDC₉₀ were calculated. For the validity study, another 20 individuals with CAI and 20 non-CAI healthy controls were involved. The AIDAW scores were analyzed by an independent samples t-test, and the optimal cutoff value of AIDAW scores to best distinguish individuals with CAI was calculated by Youden's index. Spearman or Pearson correlation analysis was used to analyze the correlation between AIDAW proprioceptive scores and the CAIT and final YBT scores. Results: For test-retest reliability, the ICC values for the CAI, non-CAI, and the whole group were 0.755, 0.757, and 0.761 respectively. The MDC₉₀ of the CAI and non-CAI group was 0.04 and 0.05. Regarding discriminant validity, the AIDAW proprioceptive discrimination scores in the CAI group were significantly lower than those in the non-CAI group (p = 0.003); and the cutoff score for distinguishing CAI from the non-CAI participants was 0.759. For convergent validity, the AIDAW scores were significantly correlated with the functional balance YBT final scores (p = 0.001) and the CAIT scores (p = 0.009). Conclusion: The AIDAW is a reliable and valid device for evaluating ankle inversion proprioception during walking in individuals with and without CAI. AIDAW can be used as a clinical assessment tool to discriminate CAI from non-CAI individuals and to monitor effects of rehabilitation. The AIDAW proprioceptive discrimination scores were significantly and positively correlated with YBT and CAIT scores.

Effect of Q-angle, lateral distal tibial angle and hip muscle torques on ankle injury

BACKGROUND

The ankle sprain is the most common ankle injury. Although the factors that increase the risk of ankle injury are included in the literature, the definitive evidence is controversial.

OBJECTIVE

The aim of our study was to examine whether Q-angle, lateral distal tibial angle (LDTA), and hip muscle torque are associated with ankle sprain.

METHODS

Thirty-six individuals who underwent an axial X-ray examination of the lower extremity following ankle sprain were included. The Q-angle and LDTA were measured on the axial knee X-rays on both sides. The isometric muscle strength was measured with a digital handheld dynamometer for the quadriceps femoris muscle, the gluteus medius muscle and the gluteus maximus muscle. Muscle torques were calculated by multiplying isometric muscle strength values with the distance to the joint center.

RESULTS

Discrimination analysis shows that the gluteus maximus (0.90), gluteus medius (0.49), quadriceps femoris muscle torques (0.34), and lateral distal tibial angle (0.43) were the factors that most contributed to ankle sprain. No significant relationship was found between the Q-angle and ankle sprain (p = 0.603). A strong relationship was found between LDTA, quadriceps femoris, gluteus medius and gluteus maximus muscle torques and ankle sprain (p = 0.014, p < 0.001, p = 0.011, p = 0.002, respectively).

CONCLUSIONS

In conclusion, the torques of the proximal muscle may be more related than the Q-angle to lateral ankle sprain injury. Individuals with high LDTA should also be carefully examined for the risk of ankle sprain.

Physiotherapists’ knowledge of and adherence to evidence-based practice guidelines and recommendations for ankle sprains management: a cross-sectional study

Background

Lateral ankle sprain (LAS) is a common and burdensome injury. However, the quality of its management is scant. Nowadays, physiotherapy management of musculoskeletal diseases seems to be generally not based on research evidence. Studies that investigated the knowledge-to-practice gap in LAS management are yet to be carried out. Therefore, this research investigated physiotherapists’ knowledge of and adherence to LAS Clinical Practice Guidelines (CPGs) and recommendations.

Methods

A cross-sectional study based on an online survey structured in three sections. The first section collected demographic data. The second section showed two clinical cases (with positive and negative Ottawa Ankle Rules (OAR), respectively). The participants indicated which treatments they would adopt to manage them. Participants were classified as ‘following’, ‘partially following’, ‘partially not following’ and ‘not following’ the CPGs and recommendations. In the third section, participants expressed their agreement with different CPG and recommendation statements through a 1-5 Likert scale.

Results

In total, 483 physiotherapists (age: 34 ± 10; female 38%, male 61.5%, other 0.5%) answered the survey: 85% completed the first two sections, 76% completed all three sections. In a case of acute LAS with negative OAR, 4% of the participants were considered as ‘following’ recommended treatments, 68% as ‘partially following’, 23% as ‘partially not following’, and 5% as ‘not following’. In a case of acute LAS with positive OAR, 37% were considered ‘following’ recommended treatments, 35% as ‘partially following’, and 28% as ‘not following’. In the third section, the consensus was achieved for 73% of the statements.

Conclusion

This study showed that although there is a good knowledge about first-line recommended treatments, a better use of CPGs and recommendations should be fostered among physiotherapists. Our results identify an evidence-to-practice gap in LAS management, which may lead to non-evidence-based practice behaviors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05914-5.

Morphologic evaluation of injured and contralateral uninjured ankles in patients with unilateral chronic ankle instability

OBJECTIVE

To compare the morphological anatomy and abnormalities of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in unilateral chronic ankle instability (CAI).

METHODS

22 patients (men: women, 13:9; mean age, 28.95 ± 8.127 years) with unilateral CAI and 18 healthy volunteers (men: women, 9:9, mean age, 28.33 ± 3.678 years) were recruited. MRI scans were divided into Group 1 (22 injured ankles), Group 2 (22 contralateral uninjured ankles), and Group 3 (36 healthy volunteer ankles). The morphologic variables, MRI signal intensity (SI) values were evaluated.

RESULTS

The ATFL proximal, intermediate, and distal sites and the CFL proximal and distal sites in Group 3 were narrower than those in Group 1 (P ＜0.05). Both ATFL and CFL in Group 1 were thicker than those in Group 3 (P ＜0.01). The proximal and intermediate sites of the ATFL and the proximal site of the CFL in Group 3 were narrower than those in Group 2 (P ＜0.01). The intermediate site of the ATFL and the proximal and distal sites of the CFL in Group 2 were thicker than those in Group 3 (P ＜0.01). The mean SI values of the ATFL in Group 1 were higher than those in Groups 2 and 3 (P ＜0.01). The ATFL and CFL SI values were higher in Group 2 than those in Group 3 (P ＜0.05).

CONCLUSION

Both the injured and contralateral uninjured ankles had wider ATFL and CFL, more thickness, and higher SI values compared with those of healthy volunteer ankles.

ADVANCES IN KNOWLEDGE

High-resolution three-dimensional MRI provides a potential tool assisting clinical decision on the treatment and rehabilitation therapy of patients with unilateral CAI.

Application of Doctor-Nurse-Patient Co-Decision-Making Nursing Intervention Based on Evidence-Based Problems in the Rehabilitation of Acute Ankle Lateral Collateral Ligament Injury

Objective

The aim of this study is to study the application effects of doctor-nurse-patient co-decision-making nursing intervention based on evidence-based problems in the rehabilitation of acute ankle lateral collateral ligament injury.

Methods

150 patients with acute ankle lateral collateral ligament injury who were treated in the hospital between December 2020 and December 2021 were selected, and they were divided into the routine group and the evidence-based group by the random number table method, with 75 cases in each group. The patients in the routine group received routine nursing intervention, while the patients in the evidence-based group adopted doctor-nurse-patient co-decision-making nursing intervention based on evidence-based problems, and both groups were intervened for 1 month. The rehabilitation time (swelling subsidence time, fixation removal time, and normal walking time), ankle active range of motion (dorsiflexion and plantar flexion), ankle function (ankle Kofoed score) before and after intervention, and the total incidence rate of complications (tendon injury, ankylosis, and traumatic arthritis) within 1 month of intervention were compared between the two groups of patients.

Results

The swelling subsidence time, fixed removal time, and normal walking time in the evidence-based group were significantly shorter than those in the routine group (P < 0.05). After 1 month of intervention, the ranges of motion of dorsiflexion and plantar flexion and ankle Kofoed scores of the two groups were significantly higher than those before intervention, and the abovementioned indicators in the evidence-based group were significantly higher than those in the routine group (P < 0.05). Within 1 month of intervention, the total incidence rate of tendon injury, ankylosis, and traumatic arthritis was significantly lower in the evidence-based group than that in the routine group (P < 0.05).

Conclusion

Nursing intervention of doctor-nurse-patient co-decision-making based on evidence-based problems in patients with acute ankle lateral collateral ligament injury can promote postoperative rehabilitation and restore the ankle function of patients.

Differences in health-related quality of life among patients after ankle injury

Ankle sprains are the most common injuries sustained in the physically active, often associated with pain and functional limitations long after initial recovery. In recent years, the impact of ankle sprains on general health and health-related quality of life (HRQoL) has been noted in athletes, but is not well-documented in the general population. We examined differences in HRQoL and general health between individuals with ankle sprain history and healthy controls. Those with ankle sprain reported significantly higher body mass index and general body pain, and lower SF-8 physical component scores than healthy controls. Additionally, there is some indication that physical activity is lower in those with ankle sprain history. This is an important step in illustrating the adverse sequelae of ankle sprains on population health and HRQoL.

Predicting the success of multimodal rehabilitation in chronic ankle instability based on patient-reported outcomes

Background

The aim of this study was to identify potential indicators to predict the success of multimodal rehabilitation in chronic ankle instability (CAI) patients based on patient-reported outcomes.

Methods

Sixty patients with self-reported CAI participated. Their demographic information, injury history, and symptoms were recorded. Physical examinations and dynamic posture control tests were performed. The participants underwent sixteen 30-min treatment sessions of multimodal rehabilitation over 8 weeks. Fifty-one patients (85.0%) were available for follow-up after 8 weeks of the intervention. Treatment success was defined based on the participants’ perceived recovery using the global rating of change (GRC). Potential predictor variables were entered into a stepwise logistic regression model to identify variables for the prediction of treatment success.

Results

Forty of 51 participants (78.4%) were considered to have a successful outcome. Of the variables assessed, time since last sprain ≤ 8 months was a predictor of treatment success (p < 0.05). If a patient met the criteria, there was an 88.03% probability of successful multimodal rehabilitation.

Conclusion

A time since the last sprain ≤ 8 months may predict successful patient-reported outcomes after multimodal rehabilitation in CAI patients.

Level of evidence

Prospective study, Level 2.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05676-0.

Tertiary rehabilitation in acute ankle sprain caused by sports training

BACKGROUND

An ankle sprain is a common joint sprain in sports injury, which is closely related to its physiological position and anatomical characteristics, and may progress into chronic ankle instability after improper early treatment or premature exercise.

OBJECTIVE

To analyze the tertiary rehabilitation effect of acute lateral ankle sprain caused by sports training.

METHOD

Ninety-six athletes with acute lateral ankle sprain diagnosed from January 2019 to June 2020 were included and divided into the control group and the rehabilitation group using the random number table grouping method, with 48 cases in each group. The two groups received standardized treatment, and the rehabilitation group additionally received tertiary rehabilitation. The American Orthopedic Foot and Ankle Society (AOFAS ) scores, degree of ankle swelling, pain, and re-injury rate were compared between the two groups.

RESULTS

The AOFAS scores of the two groups increased after treatment (P< 0.05). The degree of swelling in both groups after treatment was improved (P< 0.05). The Visual Analogue Scale (VAS) scores in both groups declined two weeks after treatment, with lower results observed in the rehabilitation group The two groups showed similar results of the follow-up visit (P< 0.05).

CONCLUSION

Rehabilitation exercise on acute lateral ankle sprain effectively relieves ankle swelling and pain.

Isolation and Characterization of Synovial Mesenchymal Stem Cells Derived From Patients With Chronic Lateral Ankle Instability: A Comparative Analysis of Synovial Fluid, Adipose Synovium, and Fibrous Synovium of the Ankle Joint

Background:

Synovial mesenchymal stem cells (MSCs) have high proliferative potential and are considered an excellent source for stem cell therapy.

Purposes:

To isolate MSCs from the synovium of ankle joints in patients with chronic lateral ankle instability (CLAI) and to compare the characteristics of MSCs derived from the synovium anterior to the talus with those from the surrounding anterior talofibular ligament (ATFL) synovium.

Study Design:

Controlled laboratory study.

Methods:

The synovium was harvested from 2 locations in the ankle, the synovium anterior to the talus and the surrounding ATFL synovium, of 14 patients who underwent arthroscopic ATFL repair for CLAI without osteochondral lesions of the talus (OLTs). Synovial fluid was also harvested. MSCs were isolated from both types of synovial tissue, as well as synovial fluid. The number of MSCs in the synovium and their viability, proliferation, colony-forming units, and potential to differentiate into adipose, bone, and cartilage tissues were determined and compared between groups. Additionally, real-time polymerase chain reaction was used to assess the differentiation capacity of adipose, bone, and cartilage tissues from both samples. The Wilcoxon signed rank test was used to compare the sample weight, number of colonies, number of nucleated cells per colony, yield obtained, and phenotypic characteristics of MSCs derived from different locations of the synovium.

Results:

No significant differences were observed in the sample weight ( P = .051), number of nucleated cells per milligram ( P = .272), number of colonies ( P = .722), and yield obtained ( P = .099) between the 2 groups. MSCs could not be isolated from synovial fluid. The frequency of oil red O–positive adipogenic colonies ( P = .028) and the expression of the adipsin gene ( P < .05) were significantly increased in the cells from the synovium anterior to the talus compared to those in the cells from the surrounding ATFL synovium. However, chondrogenic and osteogenic potentials were not significantly different between the 2 groups.

Conclusion:

Synovial MSCs obtained from the ankle joint had self-renewal and multilineage differentiation potential, although the adipogenesis potential of MSCs from the synovium anterior to the talus was superior to that from the surrounding ATFL synovium.

Clinical Relevance:

Both the adipose synovium and fibrous synovium in the ankle joints of patients with CLAI may be a good source of MSCs for stem cell therapy applications, whereas synovial fluid appeared unsuitable.

Acute lateral ankle sprain alters muscle and tendon properties: Case series

BACKGROUND

Acute lateral ankle sprain (LAS) is the most prevalent acute sports trauma. Ankle muscle atrophy and tendon volume decrease have not been analyzed concomitantly with functional impairment and pain following LAS. The objective of the present study was to investigate muscle cross-section area (CSA), tendon CSA and volume, ankle function, and pain in individuals who suffered an acute LAS.

METHODS

A series of cases, cross-sectional study with 20 participants who suffered moderate (grade II) and severe (grade III) acute LAS was undertaken. CSA for muscles (Tibialis Posterior, Fibularis, and Soleus) and tendons (Tibialis Anterior, Tibialis posterior, Fibularis, and Achilles), and volume were measured by magnetic resonance imaging (MRI) less than 48 h (baseline) and 6-weeks after the acute LAS. Ankle function (Cumberland Ankle Instability Tool [CAIT] and Foot and Ankle Outcome Score [FAOS]), ankle mechanical instability (Anterior Drawer Test [ADT]), and pain were also assessed.

RESULTS

All tendons and muscles showed a significant reduction in CSA and volume between baseline and 6-weeks (P < .001). A significant decrease in ankle function was observed 6 weeks after the LAS, along with a reduction in pain and mechanical instability (P = .001). Regarding sprain magnitude, the only difference observed was greater atrophy in muscle CSA in participants with grade III ankle sprain.

CONCLUSION

Patients with acute LAS showed atrophy of ankle muscles and decreased tendon volume and CSA, followed by function impairments at 6-week follow-up.

LEVEL OF EVIDENCE

IV, Case series study.