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Krombholz D, Willwacher S, Consmüller T, Linden A, Utku B, Zendler J. Comparison of an Adaptive Ankle Brace to Conventional Taping for Rehabilitation of Acute Ankle Injury in Young Subelite Soccer Players: A Pilot Study. J Sport Rehabil 2024; 33:562-569. [PMID: 39084618 DOI: 10.1123/jsr.2023-0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/09/2024] [Accepted: 05/08/2024] [Indexed: 08/02/2024]
Abstract
CONTEXT Ankle sprains are a common injury in sports, for which use of external ankle support during rehabilitation has been suggested to improve clinical outcomes. DESIGN Cohort study. METHODS Thirteen soccer players experiencing acute lateral ankle sprain injury were provided a novel adaptive ankle brace or conventional ankle taping (control) as external ankle support throughout the injury rehabilitation process. All other clinical procedures were identical, and rehabilitation was supervised by the same team staff member. Time from injury to clearance to return to sport was tracked. Player experience with the ankle brace also was queried via electronic surveys. RESULTS The median time to return to sport was less for the Brace group (52.5 d) compared to the Control group (79.5 d), but the distributions of the 2 groups were not found to differ significantly (P = .109). Player surveys indicated they felt the brace to be comfortable or very comfortable, with better freedom of movement than other braces and the same freedom of movement as wearing no brace. All players reported wearing the brace to be the same or better experience as ankle taping. DISCUSSION These preliminary results indicate that the adaptive ankle brace is at least as effective as ankle taping for providing external support during the rehabilitation phase following acute lateral ankle sprain and suggest it may be a more effective ankle support solution in terms of patient compliance than conventional bracing or taping.
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Affiliation(s)
| | - Steffen Willwacher
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University of Applied Sciences, Offenburg, Germany
| | | | - Anna Linden
- Betterguards Technology GmbH, Berlin, Germany
| | - Burkay Utku
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University of Applied Sciences, Offenburg, Germany
| | - Jessica Zendler
- Rimkus, Houston, TX, USA
- University of Michigan, Ann Arbor, MI, USA
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Yalfani A, Azizian M, Gholami-Borujeni B. Adding Neurofeedback Training to Neuromuscular Training for Rehabilitation of Chronic Ankle Instability: A 3-Arm Randomized Controlled Trial. Sports Health 2024; 16:797-807. [PMID: 38149335 PMCID: PMC11346238 DOI: 10.1177/19417381231219198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Neurofeedback training (NFT) can aid in the treatment of the abnormal patterns of the brain brought on by physical injury, enhancing cognitive and behavioral abilities. The present study aimed to compare the effectiveness of combining neuromuscular training (NMT) and NFT (NMT+NFT) with NMT alone in rehabilitating athletes with chronic ankle instability (CAI). HYPOTHESIS NMT+NFT will be more effective than NMT alone. STUDY DESIGN A 3-arm, single-blind randomized controlled trial. LEVEL OF EVIDENCE Level 2. METHODS A total number of 62 athletes, aged 18 to 25 years, with CAI, participated in this study. The study subjects were allocated randomly to 3 groups: 21 cases in the control group, 21 cases in the combination group (CG) receiving NMT+NFT, and 20 cases in the neuromuscular group (NG) practicing NMT alone, undergoing exercises related to their groups for 8 weeks. Data were recorded and analyzed before and after the 8-week training program. The primary outcome measures were postural sway indices; secondary outcomes included ankle proprioception and biopsychosocial indices. RESULTS NMT+NFT was more effective than NMT alone in terms of improving postural control during single- and 2-legged standing positions under the conditions of eyes closed and eyes open, proprioception at 20° of plantar flexion, as well as anxiety and depression in athletes with CAI. However, the findings revealed that NMT+NFT and NMT alone could both improve such indices. CONCLUSION NMT+NFT as a treatment protocol improved postural control, ankle proprioception, anxiety, and depression greater than NMT alone. CLINICAL RELEVANCE A combined protocol of NFT and NMT led to greater improvement compared with NMT alone. NFT was recommended as an adjunct therapy in the rehabilitation of athletes suffering from CAI.
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Affiliation(s)
- Ali Yalfani
- Department of Sport Rehabilitation, Faculty of Sport Sciences, Bu Ali Sina University, Hamedan, Iran
| | - Masoud Azizian
- Department of Sport Rehabilitation, Faculty of Sport Sciences, Bu Ali Sina University, Hamedan, Iran
| | - Behnam Gholami-Borujeni
- Department of Sport Biomechanics and Motor Behavior, Faculty of Sport Sciences, University of Mazandaran, Mazandaran, Babolsar, Iran
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Koshino Y, Kobayashi T. Noninstrumented Clinical Assessment of Static Postural Stability in Chronic Ankle Instability: A Systematic Review and Meta-Analysis. J Sport Rehabil 2024:1-11. [PMID: 39159931 DOI: 10.1123/jsr.2023-0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 04/22/2024] [Accepted: 06/25/2024] [Indexed: 08/21/2024]
Abstract
CONTEXT Several clinical tests are available to assess static postural stability in individuals with chronic ankle instability (CAI); however, it is unclear which test should be used. OBJECTIVE To determine which noninstrumented clinical tests should be used to detect static postural stability deficits in individuals with CAI. EVIDENCE ACQUISITION We searched 4 databases from their inception to February 2023, and included studies comparing static postural stability in individuals with CAI and healthy controls using noninstrumented assessments. Two reviewers independently extracted study characteristics, participant information, static postural stability assessment methods, and results. We calculated the pooled standardized mean difference (SMD) and 95% confidence interval using a random effects meta-analysis and assessed the certainty of the evidence. EVIDENCE SYNTHESIS Fourteen cross-sectional studies (293 participants with CAI and 284 healthy controls) were included. The meta-analysis showed no significant differences between the CAI and healthy groups in the double-leg stance condition of the Balance Error Scoring System (BESS) (SMD, -0.03; low-certainty evidence). Significant group differences were found in the BESS single-leg stance (SLS) on firm and foam surfaces (SLS firm: SMD, 0.47, very low-certainty evidence; SLS foam: SMD, 0.80, very low-certainty evidence), the tandem stance (TS) on firm and foam surfaces (TS firm: SMD, 0.39, low-certainty evidence; TS foam: SMD, 0.76, low-certainty evidence), and the total BESS in the foam conditions (SMD, 1.12, very low certainty evidence). Significant differences were also found between the CAI and healthy groups in the foot-lift (SMD, 1.24; very low certainty evidence) and time-in-balance tests (SMD, -0.94; very low certainty evidence). CONCLUSIONS Due to the large magnitude of the differences, the SLS foam, TS foam, and the total BESS in the foam conditions, as well as the foot-lift test or time-in-balance test, may be the most appropriate to clinically identify static postural stability impairment in individuals with CAI.
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Affiliation(s)
- Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Takumi Kobayashi
- Graduate School of Health Science, Gunma University, Maebashi, Japan
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Stevens K, Winiger K, DiLiberto F. Foot and Ankle Curricular Guidelines in Entry-Level Physical Therapist Education: How Are We Doing? JOURNAL, PHYSICAL THERAPY EDUCATION 2024:00001416-990000000-00125. [PMID: 39116394 DOI: 10.1097/jte.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 05/30/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION The Foot and Ankle Curricular Guidelines for Physical Therapist Professional Degree Programs (FACG) provided recommendations regarding essential entry-level content and skills. Eight years later, the extent of its implementation is unknown. This study characterizes entry-level Doctor of Physical Therapy (DPT) programs' foot and ankle curriculum with reference to the FACG. REVIEW OF LITERATURE Curricular guidelines offer recommendations to professional degree programs striving for excellence. Review and revisions of guidelines are important to keep pace with and reflect evolving evidence and practice. SUBJECTS One faculty member from 116 of 250 DPT programs participated (46.6% response rate). Participants were an average of 50.8 years old and taught a mean of 14.5 years. METHODS A cross-sectional 25-item online survey assessed foot and ankle contact hours, coverage of FACG recommended content, coverage of surgical procedures, and the use of FACG for curricular assessment, modification, and development. RESULTS Foot and ankle content was covered in physical therapy curriculum for a mean of 48.2 hours (range 12-120 hours). Eleven of the 25 recommended diagnoses, 29 of the 49 examination skills, 6 of the 7 intervention skills, and 3 of the 14 surgical procedures were covered by most (≥90%) of the programs. Reported use of FACG for curricular processes averaged 50.1-51.5 (0-100 numerical scale). DISCUSSION AND CONCLUSIONS Across a wide range of contact hours, coverage of FACG recommended content was approximately 57% (46/81 recommended elements in ≥90% of programs). Although not specifically recommended by FACG, surgical procedures were less commonly covered by programs. Study findings question FACG implementation and may reflect differences across programs in depth and breadth of content. Identified curricular gaps may warrant addressing in future guidelines.
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Affiliation(s)
- Karen Stevens
- Karen Stevens is an associate professor and assistant program director in the Department of Physical Therapy at the Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064 . Please address all correspondence to Karen Stevens
- Kyle Winiger is a senior assistant athletic trainer in the Sports Medicine Department at the University of Arkansas
- Frank DiLiberto is an associate professor in the Department of Physical Therapy at the Rosalind Franklin University of Medicine and Science
| | - Kyle Winiger
- Karen Stevens is an associate professor and assistant program director in the Department of Physical Therapy at the Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064 . Please address all correspondence to Karen Stevens
- Kyle Winiger is a senior assistant athletic trainer in the Sports Medicine Department at the University of Arkansas
- Frank DiLiberto is an associate professor in the Department of Physical Therapy at the Rosalind Franklin University of Medicine and Science
| | - Frank DiLiberto
- Karen Stevens is an associate professor and assistant program director in the Department of Physical Therapy at the Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064 . Please address all correspondence to Karen Stevens
- Kyle Winiger is a senior assistant athletic trainer in the Sports Medicine Department at the University of Arkansas
- Frank DiLiberto is an associate professor in the Department of Physical Therapy at the Rosalind Franklin University of Medicine and Science
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Mineta S, Koyama T, Yamaguchi S, Inagaki H, Sekine Y. Epidemiology of lateral ankle sprain focusing on indirect contact mechanism in male and female soccer players: An 18.5-month cohort study. Injury 2024; 55:111699. [PMID: 38970925 DOI: 10.1016/j.injury.2024.111699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/12/2024] [Accepted: 06/19/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Epidemiological research highlights the need to understand sports injuries for effective prevention. Yet, detailed knowledge about lateral ankle sprain (LAS) in soccer, especially related to indirect contact mechanisms and specific sports movements, remains scarce. This study aimed to determine the prevalence of LAS by examining injury mechanisms, focusing on indirect contact, and analyzing sports-related movements. STUDY DESIGN Prospective study. METHODS In this prospective study, 304 high-school and college soccer players (age: 19.0 ± 2.2 years, height: 168.3 ± 10.6 cm, weight: 64.2 ± 11.1 kg) were monitored for 18.5 months. Attendance and LAS incidents were recorded daily. Injury details, including movement at the time of injury, contact presence, and direction, were collected through interviews conducted on the injury day. LAS were categorized into direct contact, indirect contact, and non-contact mechanisms. Direct contact injuries were due to external forces on the lower leg or foot. Indirect contact injuries resulted from impacts on areas other than the lower leg or foot, and non-contact injuries involved no interaction with the ball or opponent. Incidence rates per 1,000 athlete exposures and 95 % confidence intervals (CIs) were calculated, along with rate ratios (RR) to assess sex differences. RESULTS The study recorded 59 LAS injuries. Indirect injuries were predominant, accounting for 47.5 % (n = 28) of the cases. Men experienced a higher incidence of indirect injuries, with an RR of 2.29 (95 % CI: 1.06-4.96). Outward contact was the most common (77.8 %; n = 21), while inward contact occurred in 22.2 % of the cases (n = 6). CONCLUSION High school and college soccer players primarily sustained injuries through indirect contact mechanisms, with a significant number of injuries occurring during lateral contact. Men were more prone to indirect contact injuries. Furthermore, 47.5 % of LAS incidents involved reactive movements, and injuries frequently occurred during specific sports actions, such as ball interception.
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Affiliation(s)
- Shinshiro Mineta
- Faculty of Health and Welfare, Fukuyamaheisei University, Hiroshima, Japan.
| | - Takeshi Koyama
- School of Physical Education, Tokai University, Kanagawa, Japan
| | | | - Honoka Inagaki
- Graduate School of Sport Sciences, Waseda University, Saitama, Japan
| | - Yuta Sekine
- Faculty of Humanities and Social Sciences, Teikyo Heisei University, Tokyo, Japan
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Zhou Z, Zhou H, Jie T, Xu D, Teo EC, Wang M, Gu Y. Analysis of stress response distribution in patients with lateral ankle ligament injuries: a study of neural control strategies utilizing predictive computing models. Front Physiol 2024; 15:1438194. [PMID: 39113939 PMCID: PMC11303170 DOI: 10.3389/fphys.2024.1438194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 07/10/2024] [Indexed: 08/10/2024] Open
Abstract
Background Ankle sprains are prevalent in sports, often causing complex injuries to the lateral ligaments. Among these, anterior talofibular ligament (ATFL) injuries constitute 85%, and calcaneofibular ligament (CFL) injuries comprise 35%. Despite conservative treatment, some ankle sprain patients develop chronic lateral ankle instability (CLAI). Thus, this study aimed to investigate stress response and neural control alterations during landing in lateral ankle ligament injury patients. Method This study recruited twenty individuals from a Healthy group and twenty CLAI patients performed a landing task using relevant instruments to collect biomechanical data. The study constructed a finite element (FE) foot model to examine stress responses in the presence of laxity of the lateral ankle ligaments. The lateral ankle ligament was modeled as a hyperelastic composite structure with a refined representation of collagen bundles and ligament laxity was simulated by adjusting material parameters. Finally, the validity of the finite element model is verified by a high-speed dual fluoroscopic imaging system (DFIS). Result CLAI patients exhibited earlier Vastus medialis (p < 0.001) and tibialis anterior (p < 0.001) muscle activation during landing. The FE analysis revealed that with laxity in the ATFL, the peak von Mises stress in the fifth metatarsal was 20.74 MPa, while with laxity in the CFL, it was 17.52 MPa. However, when both ligaments were relaxed simultaneously, the peak von Mises stress surged to 21.93 MPa. When the ATFL exhibits laxity, the CFL is subjected to a higher stress of 3.84 MPa. Conversely, when the CFL displays laxity, the ATFL experiences a peak von Mises stress of 2.34 MPa. Conclusion This study found that changes in the laxity of the ATFL and the CFL are linked to shifts in metatarsal stress levels, potentially affecting ankle joint stability. These alterations may contribute to the progression towards CLAI in individuals with posterolateral ankle ligament injuries. Additionally, significant muscle activation pattern changes were observed in CLAI patients, suggesting altered neural control strategies post-ankle ligament injury.
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Affiliation(s)
- Zhifeng Zhou
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Huiyu Zhou
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Tianle Jie
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Datao Xu
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Faculty of Engineering, University of Pannonia, Veszprem, Hungary
| | - Ee-Chon Teo
- Faculty of Sports Science, Ningbo University, Ningbo, China
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Meizi Wang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
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Altun A, Dixon S, Rice H. Task-specific differences in lower limb biomechanics during dynamic movements in individuals with chronic ankle instability compared with controls. Gait Posture 2024; 113:265-271. [PMID: 38970928 DOI: 10.1016/j.gaitpost.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/06/2024] [Accepted: 07/02/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Chronic ankle instability (CAI) has been associated with lower limb deficits that can lead to altered biomechanics during dynamic tasks. There have been contradictory findings in terms of ankle and hip joint biomechanics to date, influenced by the variety of movement tasks and varying definitions of the CAI condition. RESEARCH QUESTION How do biomechanical variables of the lower extremity differ during walking, running, and jump-landing in individuals with CAI compared with those without CAI? METHODS Thirty-two individuals (17 CAI and 15 controls) participated in this retrospective case-control study. Sagittal and frontal plane ankle and hip joint angles and moments, and mediolateral foot balance (MLFB) were calculated during the tasks. Statistical parametric mapping (SPM) was used for the whole trajectory analysis to detect group differences. Discrete variables, including initial contact (IC) and peak angles and moments, were additionally compared. RESULTS No differences were found between groups during walking. During running, the CAI group exhibited a lower plantar flexor moment (p < 0.001) and more laterally deviated MLFB (p = 0.014) during mid-stance when compared to controls. Additionally, participants with CAI had a significantly greater peak plantar flexion angle in early stance (p = 0.022) and a reduced peak plantar flexor moment (p = 0.002). In the jump-landing, the CAI group demonstrated an increased hip extensor moment (p = 0.008), and a greater peak hip adduction angle (p = 0.039) shortly after ground contact compared to the control group. SIGNIFICANCE Differences in ankle and hip biomechanics were observed between groups during running and jump landing, but not during walking. These differences may be indicative of impairments in the sensorimotor system or of learnt strategies adopted to try to minimise instability and injury risk and can help to inform future intervention design.
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Affiliation(s)
- Abdulaziz Altun
- Department of Public Health and Sport Sciences, University of Exeter, Exeter, United Kingdom.
| | - Sharon Dixon
- Department of Public Health and Sport Sciences, University of Exeter, Exeter, United Kingdom.
| | - Hannah Rice
- Department of Physical Performance, Norwegian School of Sports Sciences, Oslo, Norway.
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Hagiwara Y, Natsume Y, Wagatsuma T, Hasegawa T, Yoshida R. Low Back Pain Caused by Traction Peripheral Neuropathy Due to Chronic Ankle Instability: Three Clinical Cases. Cureus 2024; 16:e65405. [PMID: 39188445 PMCID: PMC11346748 DOI: 10.7759/cureus.65405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
Non-specific low back pain without identifiable causes on imaging is a common and frustrating problem for both patients and physicians. While proximal symptoms such as shoulder pain from distal upper extremity neuropathies such as carpal tunnel syndrome are well-known, peripheral neuropathy of the foot or ankle is rarely considered in the differential diagnosis for low back pain. This study aims to highlight the potential link between chronic ankle instability (CAI) and low back pain. We present three cases: a 32-year-old woman with chronic low back pain for over 10 years, a 59-year-old woman with transient low back pain after long drives, and a 42-year-old woman with acute low back pain while gardening. All patients had normal imaging studies but exhibited CAI on examination. Diagnostic modalities included the ankle anterior drawer test, application of ankle brace, superficial peroneal nerve (SPN) blocks, and assessment of the active straight leg raise (aSLR) angle. In the first case, low back pain disappeared after SPN neurolysis and ankle ligament reconstruction. The second case showed significant improvement in aSLR and pain reduction with SPN block and ankle brace. The third case experienced substantial pain relief with the use of an ankle brace. These findings suggest that addressing ankle instability and associated traction neuropathy can significantly alleviate low back pain symptoms. CAI may be an underrecognized cause of non-specific low back pain. Interventions such as ankle brace, SPN blocks, SPN decompression, and ankle ligament reconstruction can be effective for diagnosis and treatment, potentially offering relief for patients with chronic low back pain.
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Affiliation(s)
| | - Yumiko Natsume
- Orthopaedic Surgery, Toho Kamagaya Hospital, Chiba, JPN
- Orthopaedic Surgery, Oshima Medical Association Hospital, Kagoshima, JPN
| | | | - Tetsuya Hasegawa
- Orthopaedic Surgery, Toho Kamagaya Hospital, Chiba, JPN
- Research into Artifacts, Center for Engineering (RACE) School of Engineering, The University of Tokyo, Tokyo, JPN
| | - Ryu Yoshida
- Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
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Miyachi R, Kanazawa Y, Fujii Y, Kitagawa T, Yamazaki T. Effects of 6 weeks of whole-body vibration training on ankle motor control: a randomized controlled trial. J Sports Med Phys Fitness 2024; 64:676-684. [PMID: 38916091 DOI: 10.23736/s0022-4707.24.15788-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND Interventions on ankle motor control are important to prevent recurrent ankle sprains. Training using whole-body vibration may easily and effectively improve ankle motor control, but the effects have not been investigated. Therefore, this study aimed to clarify the effects of 6 weeks of training with whole-body vibration on ankle motor control in a dynamic movement task among healthy participants. METHODS Twenty healthy university students (6 males and 14 females) were randomly allocated to whole-body vibration training and control groups, with 10 participants in each group. The training was performed twice a week for 6 weeks in both groups. Primary outcome was mean ankle angular jerk cost in the star excursion balance test. Secondary outcomes were maximum ankle motion angle and maximum reach distance in the star excursion balance test, ankle proprioception, and range of ankle dorsiflexion motion in the loaded position. RESULTS There was a significant group × period (pre- and postintervention) interaction for mean ankle angular jerk cost in the direction of ankle abduction/adduction during posterolateral reaching, which was significantly lower at postintervention than that at preintervention in the whole-body vibration group In the whole-body vibration group, the maximum ankle dorsiflexion motion angle during anterior and posterolateral reaching was significantly higher at postintervention than that at preintervention. CONCLUSIONS Training with whole-body vibration improves ankle motor control in dynamic movement tasks, although the direction of reach and plane of motion are limited. Additionally, training with whole-body vibration is also effective in increasing the ankle dorsiflexion angle during dynamic movement tasks.
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Affiliation(s)
- Ryo Miyachi
- Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa, Japan -
| | - Yuji Kanazawa
- Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa, Japan
| | - Yoshinari Fujii
- Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa, Japan
| | - Takashi Kitagawa
- School of Health Sciences, Department of Physical Therapy, Shinshu University, Matsumoto, Japan
| | - Toshiaki Yamazaki
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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Archuleta QA, McIlvain G, Leigh S, Timmons MK. Lower leg muscle activation during the ebbets foot drills. J Bodyw Mov Ther 2024; 39:279-284. [PMID: 38876639 DOI: 10.1016/j.jbmt.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/15/2024] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
Lateral ankle sprains (LAS) often lead to chronic ankle instability (CAI). The Ebbets foot drills were created to strengthen the lower leg muscles and reduce the risk of LAS. The current study aimed to explore the activation of the lower leg muscles during the Ebbets foot drills. Twenty-two (22) college students without LAS participated in the study. Surface electromyography (sEMG) of the tibialis anterior (TA), tibialis posterior (TP), and peroneus longus (PL) was collected during each of the Ebbets foot drills and a normal walking trial. The sEMG mean root mean square (RMS) was calculated for each walking and Ebbets foot drill trial duration. The mean RMS was higher during the Ebbets foot drills compared to normal walking for all muscles. The TA sEMG mean RMS was greater (4.0-68.3%, P = 0.001-0.023) during all the Ebbets foot drills than during the walking trial. The TP had greater mean RMS during the toe-in (50.4%, P < 0.001), toe-out (55.0%, P < 0.001), and backward walking (47.3%, P < 0.001) drills, than during the walking trial. The PL had greater mean RMS during all Ebbets foot drills (19.4-53.7%, P < 0.001) except for the heel walking and inversion drills. Ebbets foot drills higher muscle activity than regular walking, suggesting that the Ebbets foot drills could aid in the strengthening of the TA, TP, and PL muscles. These results build evidence on Ebbets' theory and indicate that these drills may be used to rehabilitate LAS and CAI.
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Affiliation(s)
- Quentin A Archuleta
- School of Kinesiology, College of Health Professions, Marshall University, Huntington, WV, 25703, USA
| | - Gary McIlvain
- School of Kinesiology, College of Health Professions, Marshall University, Huntington, WV, 25703, USA
| | - Steven Leigh
- School of Kinesiology, College of Health Professions, Marshall University, Huntington, WV, 25703, USA
| | - Mark K Timmons
- School of Kinesiology, College of Health Professions, Marshall University, Huntington, WV, 25703, USA.
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Luo X, Huang B, Huang Y, Li M, Niu W, Wang T. Central imaging based on near-infrared functional imaging technology can be useful to plan management in patients with chronic lateral ankle instability. J Orthop Surg Res 2024; 19:361. [PMID: 38890731 PMCID: PMC11184706 DOI: 10.1186/s13018-024-04790-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/08/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Near infrared brain functional imaging (FNIRS) has been used for the evaluation of brain functional areas, the imaging differences of central activation of cognitive-motor dual tasks between patients with chronic lateral ankle instability (CLAI) and healthy population remain unclear. This study aimed to evaluated the role of central imaging based on FNIRS technology on the plan management in patients with CLAI, to provide insights to the clinical treatment of CLAI. METHODS CLAI patients treated in our hospital from January 1, 2021 to June 31, 2022 were selected. Both CLAI patients and health controls were intervened with simple task and cognitive-motor dual task under sitting and walking conditions, and the changes of oxygenated hemoglobin concentration in bilateral prefrontal cortex (PFC), premotor cortex (PMC) and auxiliary motor area (SMA) were collected and compared. RESULTS A total of 23 participants were enrolled. There were significant differences in the fNIRS ΔHbO2 of barefoot subtractive walking PFC-R and barefoot subtractive walking SMA-R between experimental and control group (all P < 0.05). There was no significant difference in ΔHbO2 between the experimental group and the control group in other states (P > 0.05). There was no significant difference in ΔHbO2 between the experimental group and the control group in each state of the brain PMC region. CONCLUSION Adaptive alterations may occur within the relevant brain functional regions of individuals with CLAI. The differential activation observed between the PFC and the SMA could represent a compensatory mechanism emerging from proprioceptive afferent disruptions following an initial ankle sprain.
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Affiliation(s)
- Xiaoming Luo
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, 201619, China
| | - Ben Huang
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, 201619, China
| | - Yonglei Huang
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, 201619, China
| | - Ming Li
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, 201619, China
| | - Wenxin Niu
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, 201619, China.
| | - Taoli Wang
- Department of Rehabilitation, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China.
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, 201619, China.
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Yin R, Chen H, Wang C, Qin C, Tao T, Hao Y, Wu R, Jiang Y, Gui J. Transformer-Based Multilabel Deep Learning Model Is Efficient for Detecting Ankle Lateral and Medial Ligament Injuries on Magnetic Resonance Imaging and Improving Clinicians' Diagnostic Accuracy for Rotational Chronic Ankle Instability. Arthroscopy 2024:S0749-8063(24)00409-2. [PMID: 38876447 DOI: 10.1016/j.arthro.2024.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 05/11/2024] [Accepted: 05/19/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE To develop a deep learning (DL) model that can simultaneously detect lateral and medial collateral ligament injuries of the ankle, aiding in the diagnosis of chronic ankle instability (CAI), and assess its impact on clinicians' diagnostic performance. METHODS DL models were developed and externally validated on retrospectively collected ankle magnetic resonance imaging (MRI) between April 2016 and March 2022 respectively at 3 centers. Included patients had confirmed diagnoses of CAI through arthroscopy, as well as individuals who had undergone MRI and physical examinations that ruled out ligament injuries. DL models were constructed based on a multilabel paradigm. A transformer-based multilabel DL model (AnkleNet) was developed and compared with 4 convolution neural network (CNN) models. Subsequently, a reader study was conducted to evaluate the impact of model assistance on clinicians when diagnosing challenging cases: identifying rotational CAI (RCAI). Diagnostic performance was assessed using area under the receiver operating characteristic curve (AUC). RESULTS Our transformer-based model achieved AUCs of 0.910 and 0.892 for detecting lateral and medial collateral ligament injury, respectively, both of which were significantly higher than those of CNN-based models (all P < .001). In terms of further CAI diagnosis, there was a macro-average AUC of 0.870 and a balanced accuracy of 0.805. The reader study indicated that incorporation with our model significantly enhanced the diagnostic accuracy of clinicians (P = .042), particularly junior clinicians, and led to a reduction in diagnostic variability. The code of the model can be accessed at https://github.com/ChiariRay/AnkleNet. CONCLUSIONS Our transformer-based model was able to detect lateral and medial collateral ligament injuries based on MRI and outperformed CNN-based models, demonstrating a promising performance in diagnosing CAI, especially patients with RCAI. CLINICAL RELEVANCE Developing such an algorithm can improve the diagnostic performance of clinicians, aiding in identifying patients who would benefit from arthroscopy, such as patients with RCAI.
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Affiliation(s)
- Rui Yin
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hao Chen
- Department of Clinical Neuroscience, Cambridge University, Cambridge, U.K; School of Computer Science, University of Birmingham, Birmingham, U.K
| | - Changjiang Wang
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Chaoren Qin
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tianqi Tao
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yunjia Hao
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Hand and Foot Microsurgery, Xuzhou Central Hospital, Xuzhou, China
| | - Rui Wu
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Orthopedics, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Yiqiu Jiang
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianchao Gui
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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13
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Aguilaniu A, Schwartz C, Abran G, Baudoux L, Croisier PJL. Ankle strength assessed by one repetition maximum: A new approach to detect weaknesses in chronic ankle lateral instability. Foot Ankle Surg 2024; 30:349-353. [PMID: 38429179 DOI: 10.1016/j.fas.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Ankle muscle strength should be assessed after a lateral ankle sprain (LAS) because a strength deficit can lead to chronic ankle instability (CAI). No field method is available to obtain quantitative ankle dynamic strength values. This study aimed to assess the reliability of the one-repetition maximal (1-RM) method and to compare ankle muscle strength between healthy volunteers and those with CAI using 1-RM strength assessment approach. METHODS We recruited 31 healthy volunteers and 32 with CAI. Dorsiflexor, evertor, and invertor 1-RM were performed twice at a one-week interval. The intraclass correlation coefficient (ICC) and minimal detectable change (MDC) were calculated. Strength values were compared between healthy volunteers and CAI. RESULTS The 1-RM method is reliable for assessing ankle dorsiflexor, evertor, and invertor strength, with an ICC ranging from 0.76 to 0.88, and MDC ranging from 19 to 31%. Volunteers with CAI obtained evertor (3.0 vs. 3.5 N/kg), invertor (2.9 vs. 3.7 N/kg), and dorsiflexor (5.9 vs. 6.5 N/kg) strength values that were lower than healthy volunteers (p < 0.05). CONCLUSION The 1-RM test can be used in practice to assess evertor, invertor, and dorsiflexor strength during the rehabilitation of LAS. This field method could help practitioners to detect a strength deficit and individualize a strengthening programme if necessary.
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Affiliation(s)
- Aude Aguilaniu
- LAM - Motion Lab, University of Liège, Liège, Belgium; Department of Physical Activity and Rehabilitation Sciences, University of Liège, Belgium.
| | - Cédric Schwartz
- LAM - Motion Lab, University of Liège, Liège, Belgium; Department of Physical Activity and Rehabilitation Sciences, University of Liège, Belgium
| | - Guillaume Abran
- LAM - Motion Lab, University of Liège, Liège, Belgium; Department of Physical Activity and Rehabilitation Sciences, University of Liège, Belgium
| | | | - Prof Jean-Louis Croisier
- LAM - Motion Lab, University of Liège, Liège, Belgium; Department of Physical Activity and Rehabilitation Sciences, University of Liège, Belgium; Central University Hospital of Liège, Belgium
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14
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Lee SH, Kim SH, Park SB, Oh SR, Choi SJ, Lee YK. 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. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:921. [PMID: 38929538 PMCID: PMC11206078 DOI: 10.3390/medicina60060921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024]
Abstract
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.
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Affiliation(s)
- Sang Heon Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea; (S.H.L.); (S.H.K.); (S.J.C.)
| | - Sung Hwan Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea; (S.H.L.); (S.H.K.); (S.J.C.)
| | - Sung Bum Park
- Department of Orthopaedic Surgery, Bonebridge Hospital, 214, Dogok-ro, Gangnam-gu, Seoul 06272, Republic of Korea;
| | - Seong Rok Oh
- Department of Orthopaedic Surgery, Gurosamsung Orthopedic Surgery Clinic, 204, Gyeongin-ro, Guro-gu, Seoul 04323, Republic of Korea;
| | - Seung Jin Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea; (S.H.L.); (S.H.K.); (S.J.C.)
| | - Young Koo Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea; (S.H.L.); (S.H.K.); (S.J.C.)
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15
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Dahmen J, Kerkhoffs GMMJ, Stufkens SAS. Ankle Cartilage: Chondral and Osteochondral Lesions: A Further Dive into the Incidence, Terminology, and the Cartilage Cascade. Foot Ankle Clin 2024; 29:185-192. [PMID: 38679432 DOI: 10.1016/j.fcl.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
The current concepts thoroughly highlight the ankle cartilage cascade focusing on the different stages and the different etiologic factors that can introduce a patient into the cascade. Moreover, the authors will provide the reader with a comprehensive overview of the types of lesions that may present as symptomatic, asymptomatic, and dangerous for progression into osteoarthritis, and the authors supply the reader with considerations and directions for future clinical implications and scientific endeavors.
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Affiliation(s)
- Jari Dahmen
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam; Academic Center for Evidence Based Sports Medicine (ACES); Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center.
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam; Academic Center for Evidence Based Sports Medicine (ACES); Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center
| | - Sjoerd A S Stufkens
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam; Academic Center for Evidence Based Sports Medicine (ACES); Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center
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16
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Liu S, Tang J, Hu G, Xiong Y, Ji W, Xu D. Blood flow restriction training improves the efficacy of routine intervention in patients with chronic ankle instability. SPORTS MEDICINE AND HEALTH SCIENCE 2024; 6:159-166. [PMID: 38708328 PMCID: PMC11067764 DOI: 10.1016/j.smhs.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/18/2023] [Accepted: 11/07/2023] [Indexed: 05/07/2024] Open
Abstract
As a new means of rehabilitation, blood flow restriction training (BFRT) is widely used in the field of musculoskeletal rehabilitation. To observe whether BFRT can improve the efficacy of routine rehabilitation intervention in patients with chronic ankle instability (CAI). Twenty-three patients with CAI were randomly divided into a routine rehabilitation group (RR Group) and a routine rehabilitation + blood flow restriction training group (RR + BFRT Group) according to the Cumberland Ankle Instability Tool (CAIT) score. The RR Group was treated with routine rehabilitation means for intervention, and the RR + BFRT Group was treated with a tourniquet to restrict lower limb blood flow for rehabilitation training based on routine training. Before and after the intervention, the CAIT score on the affected side, standing time on one leg with eyes closed, comprehensive scores of the Y-balance test, and surface electromyography data of tibialis anterior (TA) and peroneus longus (PL) were collected to evaluate the recovery of the subjects. Patients were followed up 1 year after the intervention. After 4 weeks of intervention, the RR + BFRT Group CAIT score was significantly higher than the RR Group (19.33 VS 16.73, p < 0.05), the time of standing on one leg with eyes closed and the comprehensive score of Y-balance were improved, but there was no statistical difference between groups (p > 0.05). RR + BFRT Group increased the muscle activation of the TA with maximum exertion of the ankle dorsal extensor (p < 0.05) and had no significant change in the muscle activation of the PL with maximum exertion of the ankle valgus (p > 0.05). There was no significant difference in the incidence of resprains within 1 year between the groups (36.36% VS 16.67%, p > 0.05). The incidence of ankle pain in the RR + BFRT Group was lower than that in the RR Group (63.64% VS 9.09%, p < 0.01). Therefore, four-weeks BFRT improves the effect of the routine intervention, and BFRT-related interventions are recommended for CAI patients with severe ankle muscle mass impairment or severe pain.
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Affiliation(s)
- Shen Liu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jiafu Tang
- Sports Health College, Tianjin University of Sport, Tianjin, China
| | - Guangjun Hu
- Sports Health College, Tianjin University of Sport, Tianjin, China
| | - Yinghong Xiong
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Weixiu Ji
- Sports Health College, Tianjin University of Sport, Tianjin, China
| | - Daqi Xu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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17
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Jie T, Xu D, Zhang Z, Teo EC, Baker JS, Zhou H, Gu Y. Structural and Organizational Strategies of Locomotor Modules during Landing in Patients with Chronic Ankle Instability. Bioengineering (Basel) 2024; 11:518. [PMID: 38790384 PMCID: PMC11117571 DOI: 10.3390/bioengineering11050518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Human locomotion involves the coordinated activation of a finite set of modules, known as muscle synergy, which represent the motor control strategy of the central nervous system. However, most prior studies have focused on isolated muscle activation, overlooking the modular organization of motor behavior. Therefore, to enhance comprehension of muscle coordination dynamics during multi-joint movements in chronic ankle instability (CAI), exploring muscle synergies during landing in CAI patients is imperative. METHODS A total of 22 patients with unilateral CAI and 22 healthy participants were recruited for this research. We employed a recursive model for second-order differential equations to process electromyographic (EMG) data after filtering preprocessing, generating the muscle activation matrix, which was subsequently inputted into the non-negative matrix factorization model for extraction of the muscle synergy. Muscle synergies were classified utilizing the K-means clustering algorithm and Pearson correlation coefficients. Statistical parameter mapping (SPM) was employed for temporal modular parameter analyses. RESULTS Four muscle synergies were identified in both the CAI and healthy groups. In Synergy 1, only the gluteus maximus showed significantly higher relative weight in CAI compared to healthy controls (p = 0.0035). Synergy 2 showed significantly higher relative weights for the vastus lateralis in the healthy group compared to CAI (p = 0.018), while in Synergy 4, CAI demonstrated significantly higher relative weights of the vastus lateralis compared to healthy controls (p = 0.030). Furthermore, in Synergy 2, the CAI group exhibited higher weights of the tibialis anterior compared to the healthy group (p = 0.042). CONCLUSIONS The study suggested that patients with CAI exhibit a comparable modular organizational framework to the healthy group. Investigation of amplitude adjustments within the synergy spatial module shed light on the adaptive strategies employed by the tibialis anterior and gluteus maximus muscles to optimize control strategies during landing in patients with CAI. Variances in the muscle-specific weights of the vastus lateralis across movement modules reveal novel biomechanical adaptations in CAI, offering valuable insights for refining rehabilitation protocols.
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Affiliation(s)
- Tianle Jie
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Datao Xu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
- Faculty of Engineering, University of Pannonia, 8201 Veszprem, Hungary
| | - Zanni Zhang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Ee-Chon Teo
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Julien S. Baker
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Huiyu Zhou
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
- Faculty of Engineering, University of Szeged, 6720 Szeged, Hungary
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Chen Z, Tirosh O, Han J, Adams R, El-Ansary D, Pranata A. Lower Limb Proprioception in Low Back Pain and Its Relationship With Voluntary Postural Control. J Mot Behav 2024:1-12. [PMID: 38697938 DOI: 10.1080/00222895.2024.2341712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024]
Abstract
This study aimed to investigate whether patients with low back pain (LBP) had impaired lower limb proprioception and its association with somatosensory acuity. Thirty patients with LBP and 30 asymptomatic people volunteered, using Sway Discrimination Apparatus tests to assess somatosensory acuity during voluntary anteroposterior and mediolateral postural sway. Results showed significantly reduced somatosensory acuity in mediolateral sway in LBP patients (p = 0.005) with ankle, knee, and hip proprioception showing significantly impairment compared to asymptomatic controls (all p ≤ 0.012). Regression analysis showed that ankle and hip proprioception were significantly associated with somatosensory perception (0.001 ≤ p ≤ 0.026, 0.067 ≤ R2≤ 0.235). Overall, findings suggested a global deterioration of lower limb proprioception in LBP patients, with ankle and hip proprioception playing crucial role in somatosensory perception.
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Affiliation(s)
- Zhengquan Chen
- Shanghai Yangpu District Mental Health Center, Shanghai University of Medicine & Health Sciences, Shanghai, China
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Oren Tirosh
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jia Han
- Shanghai Yangpu District Mental Health Center, Shanghai University of Medicine & Health Sciences, Shanghai, China
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine & Health Sciences, Shanghai, China
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Roger Adams
- College of Rehabilitation Sciences, Shanghai University of Medicine & Health Sciences, Shanghai, China
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Doa El-Ansary
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine & Health Sciences, Shanghai, China
- Department of Surgery, Melbourne Medical School, Melbourne, VIC, Australia
| | - Adrian Pranata
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine & Health Sciences, Shanghai, China
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, VIC, Australia
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Bagehorn T, de Zee M, Fong DTP, Thorborg K, Kersting UG, Lysdal FG. Lateral Ankle Joint Injuries in Indoor and Court Sports: A Systematic Video Analysis of 445 Nonconsecutive Case Series. Am J Sports Med 2024; 52:1572-1584. [PMID: 38634630 DOI: 10.1177/03635465241241760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Lateral ankle sprains are one of the most common injuries in indoor and court sports. Self-reports and case studies have indicated that these injuries occur via both contact and noncontact injury mechanisms typically because of excessive inversion in combination with plantarflexion and adduction of the foot. Video-based documentation of the injury mechanism exists, but the number of cases reported in the literature is limited. PURPOSE To retrieve and systematically analyze a large number of video-recorded lateral ankle injuries from indoor and court sports, as well as describe the injury mechanism, injury motion, and injury pattern across different sports. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 445 unique video-recorded lateral ankle sprain injuries were retrieved from indoor and court sports of broadcasted levels of competition. The videos were independently analyzed by 2 different reviewers. Outcomes included classification of the injury mechanism according to the International Olympic Committee consensus guidelines, primary and secondary motions of ankle joint distortion, and documentation of the fixation point (fulcrum) around which the foot rotates. RESULTS Overall, 298 (67%) injuries were direct contact, 113 (25%) were noncontact, and 32 (7%) were indirect contact incidents. Direct contact injuries were especially prevalent in basketball (76%), handball (80%), and volleyball (85%), while noncontact injuries dominated in tennis and badminton (96% vs 95% across both). Inversion (65%) and internal rotation (33%) were the primary distortion motions, with the lateral forefoot (53%) and lateral midfoot (40%) serving as the main fulcrums. Landing on another player's foot was the leading cause of injury (n = 246; 55%), primarily characterized by inversion (79%) around a midfoot fulcrum (54%). The noncontact and indirect landings on floor (n = 144; 33%) were primarily characterized by a distortion around a forefoot fulcrum (69%). CONCLUSION Two of 3 ankle sprains from online video platforms were direct contact injuries, with most involving landing on another player's foot. The distortion motion seems to be related to the injury mechanism and the fixation point between the foot and the floor. The injury mechanisms varied greatly between sports, and future studies should clearly differentiate and investigate the specific injury mechanisms.
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Affiliation(s)
- Timo Bagehorn
- ExerciseTech, Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
| | - Mark de Zee
- ExerciseTech, Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
| | - Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Kristian Thorborg
- Department of Physical and Occupational Therapy, Physical Medicine and Rehabilitation Research-Copenhagen, Amager-Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
- Department of Orthopedic Surgery, Sports Orthopedic Research Center-Copenhagen (SORC-C), Amager-Hvidovre Hospital, Copenhagen University, Hvidovre, Denmark
| | - Uwe G Kersting
- ExerciseTech, Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Filip Gertz Lysdal
- ExerciseTech, Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- Department of Civil and Mechanical Engineering, Technical University of Denmark, Kongens Lyngby, Denmark
- Faculty of Sport, Allied Health and Performance Science, St Mary's University, Twickenham, London, United Kingdom
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20
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Migel KG, Blackburn JT, Gross MT, Pietrosimone B, Thoma LM, Wikstrom EA. Effect of sensor location for modifying center of pressure during gait using haptic feedback in people with chronic ankle instability. Gait Posture 2024; 110:71-76. [PMID: 38537341 DOI: 10.1016/j.gaitpost.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/23/2024] [Accepted: 03/14/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Gait retraining using haptic biofeedback medially shifts the center of pressure (COP) while walking in orthopedic populations. However, the ideal sensor location needed to effectively shift COP medially has not been identified in people with chronic ankle instability (CAI). RESEARCH QUESTIONS Can a heel sensor location feasibly be employed in people with CAI without negatively altering kinematics? Does a heel sensor placement relative to the 5th metatarsal head (5MH) impact COP location while walking in people with CAI? METHODS In this exploratory crossover study, 10 participants with CAI walked on a treadmill with vibration feedback for 10 minutes with a plantar pressure sensor under the heel and 5MH. Separate 2×2 repeated measures analyses of covariances (rmANCOVAs) were used to compare the averaged COP location and 3-D lower extremity kinematics from the first 10% of stance before and after training and between sensor locations. Baseline measures served as covariates to adjust for baseline differences. RESULTS Feedback triggered by a heel sensor resulted in 40% of participants avoiding a heel strike. There were no significant main effects or interactions between time and sensor location on COP location when controlling for baseline COP (p>0.05). However, with the 5MH placement, participants displayed less ankle internal rotation(IR) (5MH/Heel: -4.12±0.00º/ -6.43±0.62º), less forefoot abduction (-4.29±0.00º/ -5.14±1.01º), more knee flexion (3.40±0.32º/ 0.14±0.57º), less knee external rotation (-10.95±0.00º/-11.24±1.48º), less hip extension (-0.20±0.00º/-1.42±1.05º), and less hip external rotation (3.12±0.00º/3.75±1.98º). SIGNIFICANCE A 5MH location may be more feasible based on difficulties maintaining heel strike when the sensor was under the heel. While no sensor location was statistically better at changing the COP, the 5MH location decreased proximal transverse plane motions making participants' gait more like controls. Individual response variations support comprehensive lower extremity assessments and the need to identify responder profiles using sensory feedback in people with CAI.
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Affiliation(s)
- Kimmery G Migel
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC 27268, USA.
| | - J Troy Blackburn
- MOTION Science Institute, University of North Carolina at Chapel Hill, Fetzer Hall CB 8900, Chapel Hill, NC 27599, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Fetzer Hall CB 8900, Chapel Hill, NC 27599, USA
| | - Michael T Gross
- Division of Physical Therapy, Bondurant Hall CB 7135, Chapel Hill, NC 27599, USA
| | - Brian Pietrosimone
- MOTION Science Institute, University of North Carolina at Chapel Hill, Fetzer Hall CB 8900, Chapel Hill, NC 27599, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Fetzer Hall CB 8900, Chapel Hill, NC 27599, USA
| | - Louise M Thoma
- Division of Physical Therapy, Bondurant Hall CB 7135, Chapel Hill, NC 27599, USA
| | - Erik A Wikstrom
- MOTION Science Institute, University of North Carolina at Chapel Hill, Fetzer Hall CB 8900, Chapel Hill, NC 27599, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Fetzer Hall CB 8900, Chapel Hill, NC 27599, USA
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21
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Zhang G, Li W, Yao H, Tan R, Li C. A modified "outside-in" Broström-Gould procedure yielding favorable outcomes for the management of chronic lateral ankle instability-a retrospective study with mid-term follow-up. J Orthop Surg (Hong Kong) 2024; 32:10225536241257760. [PMID: 38773724 DOI: 10.1177/10225536241257760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2024] Open
Abstract
Purpose: There are various surgical interventions available for the management of Chronic lateral ankle instability (CLAI). The Broström-Gould procedure has gained widespread recognition among foot and ankle specialists for its favorable surgical outcomes. However, with advancements in anatomical understanding and medical technology, further enhancements to the effectiveness of the Gould procedure are warranted. This study introduces a all-inside modified "outside-in" Broström -Gould procedure as an alternative approach for addressing lateral ankle instability. Methods: From August 2020 to October 2022, 40 patients with lateral ankle instability who underwent arthroscopic repair of the modified "outside-in" Broström-Gould procedure were retrospectively analyzed. All patients received standard non-surgical treatment before surgery for more than 6 months without symptom relief. Visual Analogue Scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) and Karlsson-Peterson score were used to evaluate the postoperative effect. Results: All patients were followed up for (14.62 ± 2.04) months. One year after operation, all patients could walk normally, ankle instability sensation disappeared, varus stress test and anterior drawer test were negative. The VAS , AOFAS and Karlsson-Peterson scores of all patients were significantly better compared with those before operation, and the difference between before and after operation was statistically significant. Conclusions: The modified "outside-in" Broström-Gould procedure can effectively treat CLAI, which can obtain satisfactory results. The procedure is straightforward, the impact is minimal, and the aesthetics are pleasing.
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Affiliation(s)
- Guolei Zhang
- Department of Hand, Foot and Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Wenqing Li
- Department of Hand, Foot and Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Haibo Yao
- Department of Hand, Foot and Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Rongzhi Tan
- Department of Hand, Foot and Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Chuyan Li
- Department of Hand, Foot and Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
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22
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Ambegaonkar JP, Jordan M, Wiese KR, Caswell SV. Kinesiophobia in Injured Athletes: A Systematic Review. J Funct Morphol Kinesiol 2024; 9:78. [PMID: 38651436 PMCID: PMC11036235 DOI: 10.3390/jfmk9020078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
Athletes have a high risk of injury. Kinesiophobia is a condition in which an individual experiences a fear of physical movement and activity after an injury occurs. Our purpose was to systematically review the literature about Kinesiophobia in athletes. A systematic review was conducted in February 2023 using PubMed, CINAHL, SPORTDiscus, Web of Science, Cochrane Library, and Medline. Studies were included if they were peer-reviewed, in English, within the last 20 years and included athletes who had been injured and tracked Kinesiophobia. Articles were checked for quality via the modified Downs and Black checklist. Fourteen studies were included in the review and had an average "fair" quality score. Authors examined Kinesiophobia in injured athletes with mostly lower-extremity injuries. Kinesiophobia was associated with lower physical and mental outcomes. Kinesiophobia exists in athletes and can affect both physical and mental factors. The Tampa Scale of Kinesiophobia (TSK) was the most common tool used to examine Kinesiophobia. Common mental factors associated with Kinesiophobia include anxiety, low confidence, and fear avoidance.
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Affiliation(s)
- Jatin P. Ambegaonkar
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Manassas, VA 20110, USA; (M.J.); (K.R.W.); (S.V.C.)
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23
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Hu X, Feng T, Li P, Liao J, Wang L. Bilateral Sensorimotor Impairments in Individuals with Unilateral Chronic Ankle Instability: A Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2024; 10:33. [PMID: 38589676 PMCID: PMC11001848 DOI: 10.1186/s40798-024-00702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/20/2024] [Indexed: 04/10/2024]
Abstract
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).
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Affiliation(s)
- Xiaomei Hu
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Ministry of Education, Shanghai, China
| | - Tianyi Feng
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Ministry of Education, Shanghai, China
| | - Pan Li
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Ministry of Education, Shanghai, China
| | - Jingjing Liao
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Ministry of Education, Shanghai, China
| | - Lin Wang
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Ministry of Education, Shanghai, China.
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24
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Watanabe K, Koshino Y, Nakagawa K, Ishida T, Kasahara S, Samukawa M, Tohyama H. The relationship between joint kinematic patterns during single-leg drop landing and perceived instability in individuals with chronic ankle instability. Clin Biomech (Bristol, Avon) 2024; 114:106237. [PMID: 38599131 DOI: 10.1016/j.clinbiomech.2024.106237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Perceived instability is a primary symptom among individuals with chronic ankle instability. However, the relationship between joint kinematics during landing remains unclear. Therefore, we investigated the relationships between landing kinematics and perceived instability in individuals with chronic ankle instability. METHODS In 32 individuals with chronic ankle instability, we recorded ankle, knee, and hip joint angles during a single-leg drop landing. Joint angle waveforms during 200 ms before and after initial contact were summarized into single values using two methods: peak joint angles and principal component scores via principal component analysis. Using Spearman's rank correlation coefficient (ρ), we examined the relationships of peak joint angles and principal component scores with the Cumberland Ankle Instability Tool score, with a lower score indicating a greater perceived instability (α = 0.05). FINDINGS The second principal component scores of ankle angle in the horizontal and sagittal planes significantly correlated with the Cumberland Ankle Instability Tool score (Horizontal: ρ = 0.507, P = 0.003; Sagittal: ρ = -0.359, P = 0.044). These scores indicated the differences in the magnitude of angles before and after landing. Significant correlations indicated a greater perceived instability correlated with smaller internal rotation and plantarflexion before landing and smaller external rotation and dorsiflexion after landing. In contrast, no peak joint angles correlated with the Cumberland Ankle Instability Tool score (P > 0.05). INTERPRETATION In individuals with chronic ankle instability, ankle movements during landing associated with perceived instability may be a protective strategy before landing and potentially cause ankle instability after landing.
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Affiliation(s)
- Kentaro Watanabe
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan; Department of Rehabilitation, Hokkaido University Hospital, Sapporo, Japan
| | - Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
| | - Kosumi Nakagawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | | | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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25
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Bagehorn T, Bill K, Mai P, Krosshaug T, Kersting UG. A biomechanical report of an acute lateral ankle sprain during a handball-specific cutting movement. Sports Biomech 2024:1-17. [PMID: 38451183 DOI: 10.1080/14763141.2024.2319134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024]
Abstract
Biomechanical measurements of accidental ankle sprain injuries are rare but make important contributions to a more detailed understanding of the injury mechanism. In this case study, we present the kinematics and kinetics of a lateral ankle sprain of a female athlete performing handball-specific fake-and-cut manoeuvres. Three-dimensional kinematics and kinetics were recorded and six previously performed trials were used as reference. Plantarflexion, inversion, and internal rotation angles were substantially larger than the reference trials and peaked between 190 and 200 ms after initial ground contact. We observed a highly increased inversion and internal rotation moment. However, compared to the non-injury trials the data also revealed a reduction in the second dorsiflexion moment peak. Ground reaction forces were lower throughout the injury trial. Other parameters at initial ground contact including ankle and hip position, step length, and the traction coefficient indicate that a preparatory maladjustment occurred. This study adds valuable contributions to the understanding of lateral ankle sprains by building upon previously published reports and considering the shoe-surface interaction as an important factor for injury.
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Affiliation(s)
- Timo Bagehorn
- ExerciseTech, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Kevin Bill
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Patrick Mai
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University, Offenburg, Germany
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Tron Krosshaug
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Uwe G Kersting
- ExerciseTech, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
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26
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Mohrsen A, Sørensen T, Lund H, Rasmussen SZ, Jensen A, Skov KB, Rathleff MS. "I Feel Like I Have Lost Part Of My Identity" - A Qualitative Study Exploring The Impact Of Chronic Ankle Instability. Int J Sports Phys Ther 2024; 19:316-325. [PMID: 38439771 PMCID: PMC10909303 DOI: 10.26603/001c.92908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/15/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction Lateral ankle sprain is the most common ankle injury and up to 40% of those who sustain a lateral ankle sprain will develop chronic ankle instability (CAI). The aim of this study was to explore the thoughts and expectations of CAI-patients concerning their condition and expectations of care in an orthopedic setting. . Study Design Qualitative study. Methods Nine semi-structured one-to-one interviews were conducted with CAI-patients who were referred to an orthopedic setting. Interviews were recorded, transcribed, and analyzed using systematic text condensation with an inductive goal free approach. . Results Seven themes emerged. The themes were Injury history and symptoms (Lateral ankle sprain during sport, pain and instability), Information from health professional (conflicting information about management and prognosis), Management (mental and physical challenges), Expectation and hope (explanation of symptoms, prognosis and imaging to provide clarification of condition), Activity and participation (restriction in sport and daily life and feelings of uncertainty), Support (support from family/friends) and Identity (low ability to participate in sport and social life result in loss of identity). . Conclusion The impact of CAI exceeds an experience of pain and instability. Patients experienced loss of identity, having to manage uncertainty regarding their diagnosis and prognosis and had hopes of being able to explain their condition. . Level of Evidence Not applicable.
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Affiliation(s)
- Anders Mohrsen
- Department of Health Science and Technology Aalborg University
| | - Thomas Sørensen
- Department of Health Science and Technology Aalborg University
| | - Henrik Lund
- Department of Health Science and Technology Aalborg University
| | | | - Asger Jensen
- Department of Health Science and Technology Aalborg University
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27
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Liu Y, Dong S, Wang Q, Liu Z, Song Q, Shen P. Deficits in proprioception and strength may contribute to the impaired postural stability among individuals with functional ankle instability. Front Physiol 2024; 15:1342636. [PMID: 38496300 PMCID: PMC10941841 DOI: 10.3389/fphys.2024.1342636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/12/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose: The correlations of postural stability with proprioception and strength may explain the recurrent sprains among individuals with functional ankle instability (FAI). This study aimed to compare anterior-posterior (AP) and medial-lateral (ML) postural stability, along with ankle proprioception and strength between individuals with and without FAI and investigated their correlations. Methods: Forty participants with FAI and another 40 without FAI were recruited. Their postural stability, represented by time to stabilization (TTS) in the AP (TTSAP) and ML (TTSML) directions, was calculated by the ground reaction force during jumping onto a force plate. Their ankle proprioception and strength during plantarflexion/dorsiflexion and inversion/eversion were measured using a proprioception device and a strength testing system, separately. Results: Individuals with FAI had longer TTSAP (p = 0.015) and TTSML (p = 0.006), larger ankle proprioception thresholds (p = 0.000-0.001), and less strength (p = 0.001-0.017) than those without FAI. Correlations between strength and TTSAP were detected among individuals with (ankle plantarflexion, r = -0.409, p = 0.009) and without FAI (ankle plantarflexion, r = -0.348, p = 0.028; ankle dorsiflexion, r = -0.473, p = 0.002). Correlations of proprioception (ankle inversion, r = 0.327, p = 0.040; ankle eversion, r = 0.354, p = 0.025) and strength (ankle eversion, r = -0.479, p = 0.002) with TTSML were detected among individuals without FAI but not among those with FAI. Conclusion: Individuals with FAI have worse postural stability and proprioception and less strength. Their proprioception and strength decreased to a point where they could not provide sufficient functional assistance to the ML postural stability. Improvements in proprioception and strength may be keys to prevent recurrent ankle sprains among individuals with FAI.
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Affiliation(s)
- Yanhao Liu
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Shiyu Dong
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Qi Wang
- College of Sports Human Sciences, Beijing Sport University, Beijing, China
| | - Ziyin Liu
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Qipeng Song
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Peixin Shen
- College of Sports and Health, Shandong Sport University, Jinan, China
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28
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Baltes TPA, Geertsema C, Geertsema L, Holtzhausen L, Arnáiz J, Al-Naimi MR, Al-Sayrafi O, Whiteley R, Slim M, D'Hooghe P, Kerkhoffs GMMJ, Tol JL. Acute clinical evaluation for the diagnosis of lateral ankle ligament injuries is useful: A comparison between the acute and delayed settings. Knee Surg Sports Traumatol Arthrosc 2024; 32:550-561. [PMID: 38385771 DOI: 10.1002/ksa.12079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE To determine the diagnostic value of seven injury history variables, nine clinical tests (including the combination thereof) and overall clinical suspicion for complete discontinuity of the lateral ankle ligaments in the acute (0-2 days post-injury) and delayed setting (5-8 days post-injury). METHODS All acute ankle injuries in adult athletes (≥18 years) presenting up to 2 days post-injury were assessed for eligibility. Athletes were excluded if imaging studies demonstrated a frank fracture or 3 T MRI could not be acquired within 10 days post-injury. Using standardized history variables and clinical tests, acute clinical evaluation was performed within 2 days post-injury. Delayed clinical evaluation was performed 5-8 days post-injury. Overall, clinical suspicion was recorded after clinical evaluation. MRI was used as the reference standard. RESULTS Between February 2018 and February 2020, a total of 117 acute ankle injuries were screened for eligibility, of which 43 were included in this study. Complete discontinuity of lateral ankle ligaments was observed in 23 (53%) acute ankle injuries. In the acute setting, lateral swelling had 100% (95% confidence interval [CI]: 82-100) sensitivity, haematoma had 85% (95% CI: 61-96) specificity and the anterior drawer test had 100% (95% CI: 77-100) specificity. In the delayed setting, sensitivity for the presence of haematoma improved from 43% (95% CI: 24-65) to 91% (95% CI: 70-98; p < 0.01) and the sensitivity of the anterior drawer test improved from 21% (95% CI: 7-46) to 61% (95% CI: 39-80; p = 0.02). Clinical suspicion had a positive likelihood ratio (LR) of 4.35 (95% CI: 0.55-34.17) in the acute setting and a positive LR of 6.09 (95% CI: 1.57-23.60) in the delayed setting. CONCLUSIONS In the acute setting, clinical evaluation can exclude complete discontinuity (e.g., absent lateral swelling) and identify athletes with a high probability of complete discontinuity (e.g., positive anterior drawer test) of the lateral ankle ligaments. In the delayed setting, the sensitivity of common clinical findings increases resulting in an improved diagnostic accuracy. In clinical practice, this study underlines the importance of meticulous clinical evaluation in the acute setting. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Thomas P A Baltes
- Department of Research, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Celeste Geertsema
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Liesel Geertsema
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Louis Holtzhausen
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Department of Exercise and Sports Science, University of the Free State, Bloemfontein, South Africa
| | - Javier Arnáiz
- Department of Radiology, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Maryam R Al-Naimi
- Department of Radiology, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Omar Al-Sayrafi
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Rod Whiteley
- Department of Rehabilitation, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Monia Slim
- National Sports Medicine Programme, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Pieter D'Hooghe
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Johannes L Tol
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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29
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Clark K, Trickett J, Donovan L, Dawson J, Goetschius J. Effects of Blood Flow Restriction on Balance Performance During Dynamic Balance Exercises in Individuals With Chronic Ankle Instability. J Sport Rehabil 2024; 33:181-188. [PMID: 38350443 DOI: 10.1123/jsr.2023-0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/15/2024]
Abstract
CONTEXT Blood flow restriction (BFR) is a rehabilitation tool which may introduce a constraint, similar to muscle fatigue, that challenge patients' sensorimotor system during balance exercises. The purpose of our study was to examine whether adding BFR to dynamic balance exercises produced a decrease in balance performance and an increase in ratings of perceived exertion and instability in individuals with chronic ankle instability (CAI) compared with dynamic balance exercises without BFR. DESIGNS Crossover design. METHODS Our sample included N = 25 young adults with a history of CAI. Participants completed 2 laboratory visits. At each visit, participants completed 4 sets (30×-15×-15×-15×) of dynamic balance exercises, performed similar to the modified star excursion balance test (SEBT), once with BFR and once with control (no BFR) conditions. We measured composite SEBT scores at baseline and during the final repetitions of each set of balance exercise (sets 1-4). We also measured ratings of perceived exertion and instability following each balance exercise set. RESULTS We observed no difference in composite SEBT scores between conditions at baseline; however, composite SEBT scores were significantly lower during all balance exercises sets 1 to 4 with the BFR condition compared with control. During the BFR condition, composite SEBT scores were significantly lower during all balance exercise sets compared with baseline. During the control condition, composite SEBT scores did not significantly change between baseline and each balance exercise set. Ratings of perceived exertion and instability scores were significantly greater in the BFR group compared with the control group during all balance exercise sets. CONCLUSIONS Individuals with CAI demonstrated lower composite SEBT scores and greater perceived instability and exertion during dynamic balance exercise with BFR compared to without BFR. BFR introduced a novel muscle fatigue constraint during dynamic balance exercises in individuals with CAI. Additional research is needed to determine if adding BFR to balance training could improve clinical outcomes in CAI patients.
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Affiliation(s)
- Krista Clark
- Department of Health Professions, James Madison University, Harrisonburg, VA, USA
| | - Justin Trickett
- Department of Health Professions, James Madison University, Harrisonburg, VA, USA
| | - Luke Donovan
- Department of Applied Physiology, Health, & Clinical Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Jordan Dawson
- Department of Health Professions, James Madison University, Harrisonburg, VA, USA
| | - John Goetschius
- Department of Health Professions, James Madison University, Harrisonburg, VA, USA
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30
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Kawabata S, Ozone K, Minegishi Y, Oka Y, Terada H, Takasu C, Kojima T, Kano T, Kanemura N, Murata K. Chronic Ankle Joint Instability Induces Ankle Sensorimotor Dysfunction: A Controlled Laboratory Study. Am J Sports Med 2024; 52:739-749. [PMID: 38279796 DOI: 10.1177/03635465231217490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Chronic ankle instability (CAI) is a clinical sequela that causes the recurrence of ankle sprain by inducing ankle sensorimotor dysfunction. Animal models of CAI have recently shown that ankle ligament injuries mimicking an ankle sprain result in chronic loss of ankle sensorimotor function. However, the underlying mechanisms determining the pathogenesis of CAI remain unclear. HYPOTHESIS Ankle instability after an ankle sprain leads to the degeneration of the mechanoreceptors, resulting in ankle sensorimotor dysfunction and the development of CAI. STUDY DESIGN Controlled laboratory study. METHODS Four-week-old male Wistar rats (N = 30) were divided into 2 groups: (1) the ankle joint instability (AJI) group with ankle instability induced by transecting the calcaneofibular ligament (n = 15) and (2) the sham group (n = 15). Ankle instability was assessed using the anterior drawer test and the talar tilt test at 4, 6, and 8 weeks after the operation (n = 5, for each group at each time point), and ankle sensorimotor function was assessed using behavioral tests, including ladder walking and balance beam tests, every 2 weeks during the postoperative period. Morphology and number of mechanoreceptors in the intact anterior talofibular ligament (ATFL) were histologically analyzed by immunofluorescence staining targeting the neurofilament medium chain and S100 proteins at 4, 6, and 8 weeks postoperatively (n = 5 per group). Sensory neurons that form mechanoreceptors were histologically analyzed using immunofluorescence staining targeting the mechanosensitive ion channel PIEZO2 at 8 weeks postoperatively (n = 5). RESULTS Ankle sensorimotor function decreased over time in the AJI group, exhibiting decreased ankle instability compared with the sham group (P = .045). The number of mechanoreceptors in the ATFL was reduced (P < .001) and PIEZO2 expression in the sensory neurons decreased (P = .008) at 8 weeks postoperatively. The number of mechanoreceptors was negatively correlated with ankle sensorimotor dysfunction (P < .001). CONCLUSION The AJI model demonstrated degeneration of the mechanoreceptors in the ATFL and decreased mechanosensitivity of the sensory neurons, which may contribute to CAI. CLINICAL RELEVANCE Ankle instability causes degeneration of mechanoreceptors and decreases the mechanosensitivity of sensory neurons involved in the development of CAI. This finding emphasizes the importance of controlling ankle instability after ankle sprains to prevent recurrence and the onset of CAI.
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Affiliation(s)
- Sora Kawabata
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kaichi Ozone
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
- Department of Rehabilitation, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Yuki Minegishi
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
- Physical Therapy Course, Department of Rehabilitation, Faculty of Health Sciences, Nihon Institute of Medical Science, Saitama, Japan
| | - Yuichiro Oka
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Hidenobu Terada
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Chiharu Takasu
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Takuma Kojima
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Takuma Kano
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Naohiko Kanemura
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan
| | - Kenji Murata
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan
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Bain KA, Kosik KB, Terada M, Gribble PA, Johnson NF. Contralateral thalamocortical connectivity is related to postural control in the uninvolved limb of older adults with history of ankle sprain. Gait Posture 2024; 109:115-119. [PMID: 38295486 DOI: 10.1016/j.gaitpost.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Sensorimotor brain connectivity is often overlooked when determining relationships between postural control and motor performance following musculoskeletal injury. Thalamocortical brain connectivity is of particular interest as it represents the temporal synchrony of functionally and anatomically linked brain regions. Importantly, adults over the age of 60 are especially vulnerable to musculoskeletal injury due to age-related declines in postural control and brain connectivity. RESEARCH QUESTION Is there a relationship between thalamocortical connectivity and static postural control in older adults with a history of LAS? METHODS Data were analyzed from twenty older adults (mean age = 67.0 ± 4.3 yrs; 13 females) with a history of LAS. The sensorimotor network (SMN) was identified from resting-state MRI data, and a priori thalamic and postcentral gyri regions of interest were selected in order to determine left and right hemisphere thalamocortical connectivity. Balance was assessed for the involved and non-involved limbs via center of pressure velocity (COPV) in the medial-lateral (ML) and anterior-posterior (AP) directions. RESULTS Contralateral thalamocortical connectivity was significantly associated with COPV_ML COPV_ML (r = -0.474, P = 0.05) and COPV_AP (r = -0.622, P = 0.008) in the non-involved limb. No significant association was observed between involved limb balance and contralateral thalamocortical connectivity (COPV_ML: r = -0.08, P = 0.77; COPV_AP: r = 0.12, P = 0.63). SIGNIFICANCE A significant relationship between thalamocortical connectivity and static postural control was observed in the non-involved, but not the involved limb in older adults with a history of LAS. Findings suggest that thalamocortical connectivity may lead to or be the product of LAS.
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Affiliation(s)
- Katherine A Bain
- Division of Physical Therapy, Shenandoah University, Leesburg, VA, USA.
| | - Kyle B Kosik
- Department of Athletic Training & Clinical Nutrition, University of Kentucky, Lexington, KY, USA
| | - Masafumi Terada
- Faculty of Sport and Health Science, Ritusmeikan University, Kusatusu, Shiga-ken, Japan
| | - Phillip A Gribble
- Department of Athletic Training & Clinical Nutrition, University of Kentucky, Lexington, KY, USA
| | - Nathan F Johnson
- Department of Physical Therapy, University of Kentucky, Lexington, KY, USA
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Werner D, Casey L, Myers E, Barrios JA. Lower limb squat biomechanics and select clinical measures in chronic ankle instability. Clin Biomech (Bristol, Avon) 2024; 113:106211. [PMID: 38430783 DOI: 10.1016/j.clinbiomech.2024.106211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/29/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Individuals with chronic ankle instability often present with clinical and biomechanical abnormalities, however squat biomechanics have not been investigated. The purpose of this study was to compare select clinical assessments and squat biomechanics between individuals with and without chronic ankle instability. METHODS Fifteen individuals with chronic ankle instability and a matched control group were studied. A weight-bearing dorsiflexion lunge test, foot posture, and an in-line half-kneeling motor control test for core stability were assessed. Lower limb 3D bilateral and unilateral squat biomechanics were captured. Groups, limbs and squat tasks were compared using an alpha of 0.05. FINDINGS Individuals with chronic ankle instability had less static weight-bearing dorsiflexion and failed the core stability test more frequently, but did not differ in foot morphology compared to the controls. When squatting, those with chronic ankle instability demonstrated reduced peak ankle dorsiflexion angles and moments in the involved limb (p < 0.04) during single limb squats and had interlimb differences in ankle dorsiflexion angle as well as hip and knee kinetics (p < 0.04) during double limb squats. In those with chronic ankle instability, there was less overall motion, but higher kinetic demands in single limb versus double leg squatting (p < 0.03). INTERPRETATION Individuals with chronic ankle instability had impaired weight-bearing dorsiflexion and showed impaired core stability more often, which accompanied altered squatting mechanics in both variations. Within the limbs with chronic ankle instability, single limb squats showed lesser kinematic demands but higher kinetic demands than double limb squatting.
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Affiliation(s)
- David Werner
- Physical Therapy Program, Department of Health and Rehabilitation Sciences, University of Nebraska Medical Center, Omaha, NE, USA; Office of Graduate Studies, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lauren Casey
- Department of Physical Therapy, School of Education and Health Sciences, University of Dayton, Dayton, OH, USA
| | - Ethan Myers
- Department of Physical Therapy, School of Education and Health Sciences, University of Dayton, Dayton, OH, USA
| | - Joaquin A Barrios
- Department of Physical Therapy, School of Education and Health Sciences, University of Dayton, Dayton, OH, USA.
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Hou X, Qian J, Cai J, Su W, Ruan B, Gao Q. Using clinician-oriented and laboratory-oriented assessments to study dynamic stability of individuals with chronic ankle instability. iScience 2024; 27:108842. [PMID: 38327777 PMCID: PMC10847673 DOI: 10.1016/j.isci.2024.108842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 10/08/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024] Open
Abstract
To compare the dynamic stability of lower extremities between Copers and individuals with chronic ankle instability (CAI) using clinician-oriented assessments (Y-balance test, YBT) and laboratory-oriented assessments (time to stabilization, TTS). 90 participants (Copers, 45; CAIs, 45) were recruited and measured by YBT and TTS to evaluate dynamic stability. The difference of dynamic stability between Copers and CAIs was examined using a two-factor MANOVA. Only for females in anterior direction, YBT scores for the AS side of Copers were significantly higher than that of CAIs. For males, the TTS of CAIs was significantly shorter than that of Copers in the anterior, lateral, and medial direction separately. For females, the TTS of CAIs is also significantly shorter than that of Copers in the anterior, lateral, and medial direction separately. There are opposite results when evaluating the dynamic stability difference between Copers and CAIs using YBT and TTS.
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Affiliation(s)
- Xiao Hou
- School of Sport Science, Beijing Sport University, Beijing, China
- Exercise Rehabilitation Science Laboratory, Beijing Sport University, Beijing, China
| | - Jinghua Qian
- Exercise Rehabilitation Science Laboratory, Beijing Sport University, Beijing, China
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Jingxian Cai
- Exercise Rehabilitation Science Laboratory, Beijing Sport University, Beijing, China
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Wanrongyu Su
- Exercise Rehabilitation Science Laboratory, Beijing Sport University, Beijing, China
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Bing Ruan
- Exercise Rehabilitation Science Laboratory, Beijing Sport University, Beijing, China
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Qi Gao
- Exercise Rehabilitation Science Laboratory, Beijing Sport University, Beijing, China
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
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Robbins JB, Stahel SA, Morris RP, Jupiter DC, Chen J, Panchbhavi VK. Radiographic Anatomy of the Lateral Ankle Ligament Complex: A Cadaveric Study. Foot Ankle Int 2024; 45:179-187. [PMID: 37994643 PMCID: PMC10860354 DOI: 10.1177/10711007231213355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND When lateral ankle sprains progress into chronic lateral ankle instability (CLAI), restoring precise anatomic relationships of the lateral ankle ligament complex (LALC) surgically is complex. This study quantifies the radiographic relationships between the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and prominent osseous landmarks visible under fluoroscopy to assist in perioperative practices for minimally invasive surgery for CLAI. METHODS Ten fresh frozen ankle specimens were dissected to expose the LALC and prepared by threading a radiopaque filament through the ligamentous footprints of the ATFL and CFL. Fluoroscopic images were digitally analyzed to define dimensional characteristics of the ATFL and CFL. Directional measurements of the ligamentous footprints relative to the lateral process of the talus and the apex of the posterior facet of the calcaneus were calculated. RESULTS Dimensional measurements of the ATFL were a mean length of 9.3 mm, fibular footprint of 9.4 mm, and talar footprint of 9.1 mm. Dimensional measurements of the CFL were a mean length of 19.4 mm, fibular footprint of 8.2 mm, and calcaneal footprint of 7.3 mm. From the radiographic apparent tip of the lateral process of the talus, the fibular attachment of the ATFL was found 13.3 mm superior and 4.4 mm posterior, whereas the talar attachment was found 11.5 mm superior and 4.8 mm anterior. From the radiographic apparent posterior apex of the posterior facet of the calcaneus, the fibular attachment of the CFL was found 0.2 mm inferior and 6.8 mm anterior, whereas the calcaneal attachment was found 14.3 mm inferior and 5.9 mm posterior. CONCLUSION The ATFL and CFL were radiographically analyzed using radiopaque filaments to outline the ligamentous footprints in their native locations. These ligaments were also localized with reference to 2 prominent osseous landmarks. These findings may assist in perioperative practices for keyhole incision placement and arthroscopic guidance. Perfect lateral ankle joint imaging with talar domes superimposed is required to be able to do this. CLINICAL RELEVANCE Radiographic evaluation of the ATFL and CFL with reference to prominent osseous landmarks identified under fluoroscopy may assist in perioperative practices for minimally invasive surgery to address CLAI for keyhole incision placement and arthroscopic guidance.
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Affiliation(s)
- Jordan B. Robbins
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Shepheard A. Stahel
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Randal P. Morris
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel C. Jupiter
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jie Chen
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Vinod K. Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
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Gerdesmeyer L, Vester J, Schneider C, Wildemann B, Frank C, Schultz M, Seilheimer B, Smit A, Kerkhoffs G. Topical Treatment Is Effective and Safe for Acute Ankle Sprains: The Multi-Center Double-Blind Randomized Placebo-Controlled TRAUMED Trial. J Clin Med 2024; 13:841. [PMID: 38337536 PMCID: PMC10856131 DOI: 10.3390/jcm13030841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Topical NSAIDs are widely used to treat ankle sprains. Traumed (Tr14) gel is a multicomponent formulation, demonstrating inflammation-resolution properties. METHODS This multicenter, double-blind trial investigated the efficacy and safety of Tr14 gel versus placebo gel and non-inferiority versus 1% diclofenac gel, applied 3×/day for 7 days after acute lateral ankle sprain (EudraCT Number: 2016-004792-50). The primary outcome was AUC for pain on passive movement, assessed by VAS from baseline to Days 4 and 7. RESULTS The trial population included 625 patients aged 18 to 78 years. The AUC scores were 187.88 and 200.75 on Day 4 (p = 0.02) and 294.14 and 353.42 on Day 7 (p < 0.001) for Tr14 and placebo, respectively. For Tr14 compared to diclofenac, the AUC scores were 187.50 and 197.19 on Day 4 (p = 0.3804) and 293.85 and 327.93 on Day 7 (p = 0.0017), respectively. On the FAAM-ADL subscale, Tr14 was superior to placebo and non-inferior to diclofenac at all time points. Time to 50% pain improvement was lowest for Tr14 (6.0 days), compared to placebo (7.1 days) and diclofenac (7.0 days). Adverse events were uncommon and minor. CONCLUSIONS Tr14 gel is effective and safe in acute ankle sprains, compared to placebo gel and diclofenac gel, and has faster pain resolution. TRIAL REGISTRATION The trial was registered in clinicaltrialsregister.eu, EudraCT number 2016-004792-50 on 07.06.2017.
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Affiliation(s)
- Ludger Gerdesmeyer
- Orthopedics and Trauma Surgery, Kiel Municipal Hospital, 24116 Kiel, Germany
| | | | | | - Britt Wildemann
- Experimental Trauma Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany
| | | | | | | | - Alta Smit
- Heel GmbH, 76532 Baden-Baden, Germany
| | - Gino Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Hu D, Wang N, Wang H, Fan D, Teng Q, Zheng X, Hou H. Clinical outcomes of arthroscopic all-inside anterior talofibular ligament suture augmentation repair versus modified suture augmentation repair for chronic ankle instability patients. BMC Musculoskelet Disord 2024; 25:48. [PMID: 38200504 PMCID: PMC10777501 DOI: 10.1186/s12891-023-07085-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/30/2023] [Indexed: 01/12/2024] Open
Abstract
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.
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Affiliation(s)
- Dahai Hu
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China
- International School, Jinan University, Guangzhou, 510632, Guangdong, China
| | - Nan Wang
- Department of Clinical Medicine, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Huajun Wang
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China
| | - Dongyi Fan
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China
| | - Qiang Teng
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China
| | - Xiaofei Zheng
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China.
| | - Huige Hou
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China.
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Guo C, Xu Y, Cao Y, Li X, Xu X. Does a rupture of the lateral ankle ligament need to be repaired in supination-adduction type II (OTA/AO 44A2) fractures? Arch Orthop Trauma Surg 2024; 144:229-237. [PMID: 37838982 DOI: 10.1007/s00402-023-05044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/20/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE To evaluate the outcomes of patients with supination-adduction (SAD) type II (OTA/AO 44A2) fractures who had a lateral ankle ligament rupture repaired compared with patients who did not have a lateral ankle ligament repaired using patients who underwent fibula fracture fixation as a control group. METHODS A retrospective analysis of all 104 patients diagnosed with SAD type II fractures from January 2011 to December 2020 and managed operatively was performed. The patients were divided into three groups: 32 patients with ruptures of the lateral ligaments that were not repaired (group A), 34 patients with ruptures of the lateral ligaments that were repaired (group B), and 38 patients with fibula fracture fixation acting as the control group (group C). The objective outcomes including radiographic findings, the ankle range of motion, the manual ankle stress tests, and complications were gained from the record of the last time in outpatient clinics. The functional outcomes including the identification of functional ankle instability (IdFAI) scores were collected postoperatively at 12-month intervals to assess clinical outcomes. The Manchester Oxford Foot Questionnaire (MOXFQ) and Karlsson scoring scale were also recorded at the last follow-up. RESULTS The mean follow-up of the objective and subjective functional outcomes was 23.4 (range, 13-42) and 76.9 (range, 25-134) months, respectively. There was no significant difference in the radiographic findings, the ankle range of motion and complications between the three groups. All ankles were found to be stable using the manual ankle stress test in both group A and group B. The IdFAI scores showed a significant difference between group A and group B (1.12 ± 1.3 vs 0.35 ± 0.69; p < 0.001) in the first year of follow-up and no significant difference after the first year. No differences were noted in MOXFQ scores or Karlsson scores among the groups. CONCLUSION Directly repairing the lateral ligament could minimize the proportion of the first year of postoperative functional ankle instability, although the final stability of the ankle and clinical outcomes were not significantly different in SAD type II fractures. LEVEL OF EVIDENCE Level III, retrospective comparative case series.
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Affiliation(s)
- Changjun Guo
- Department of Orthopaedics, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Rd, Shanghai, 20025, China
| | - Yang Xu
- Department of Orthopaedics, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Rd, Shanghai, 20025, China
| | - Yongxing Cao
- Department of Orthopaedics, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Rd, Shanghai, 20025, China
| | - Xingchen Li
- Department of Orthopaedics, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Rd, Shanghai, 20025, China
| | - Xiangyang Xu
- Department of Orthopaedics, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Rd, Shanghai, 20025, China.
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Steinberg N, Shenhar M, Witchalls J, Waddington G, Dar G, Paulman O, Finestone A(RS. Chronic Ankle Instability and Neuromuscular Performance in Prerecruitment Infantry Soldiers. J Athl Train 2024; 59:73-80. [PMID: 37459361 PMCID: PMC10783473 DOI: 10.4085/1062-6050-0564.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
CONTEXT Ankle instability can describe various impairments, including perceived instability (PI), mechanical instability (MI), and recurrent sprains (RSs), alone or combined. OBJECTIVE To examine the prevalence of 8 ankle impairment subgroups and their effect on neuromuscular performance in prerecruitment combat soldiers. DESIGN Cross-sectional study. SETTING Military infantry basic training base. PATIENTS OR OTHER PARTICIPANTS A total of 364 infantry male combat soldiers entering basic training (aged 18-21 years). MAIN OUTCOME MEASURE(S) Participants were assessed for PI (via the Cumberland Ankle Instability Tool), MI (using the Anterior Drawer Test and Medial Talar Tilt Test), and RSs (based on history) of their dominant and nondominant legs. Injuries were categorized in 8 subgroups: PI, RSs, PI + RSs, MI, PI + MI, MI + RSs, PI + MI + RSs, and none. Participants were screened for neuromuscular performance (dynamic postural balance, proprioceptive ability, hopping agility, and triceps surae muscle strength) during the first week of military basic training. RESULTS For the dominant and nondominant legs, RSs were reported by 18.4% (n = 67) and 20.3% (n = 74) of the participants, respectively; PI was reported by 27.1% (n = 99) and 28.5% (n = 104) of the participants, respectively; and MI was seen in 9.9% (n = 36) and 8.5% (n = 31) of the participants, respectively. A 1-way analysis of variance showed differences in the mean proprioceptive ability scores (assessed using the Active Movement Extent Discrimination Apparatus) of all subgroups with impairments in both the dominant and nondominant legs (F = 6.943, η2 = 0.081, P < .001 and F = 7.871, η2 = 0.091, P < .001, respectively). Finally, differences were found in the mean muscle strength of subgroups with impairment in the nondominant leg (F = 4.884, η2 = 0.056, P = .001). CONCLUSIONS A high prevalence of ankle impairments was identified among participants who exhibited reduced abilities in most neuromuscular assessments compared with those who did not have impairments. Moreover, participants with 1 impairment (PI, MI, or RSs) exhibited different neuromuscular performance deficits than those with >1 impairment.
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Affiliation(s)
- Nili Steinberg
- Levinsky-Wingate Academic College, Wingate Campus, Netanya, Israel
| | - Michal Shenhar
- Levinsky-Wingate Academic College, Wingate Campus, Netanya, Israel
| | | | | | - Gali Dar
- Physical Therapy, University of Haifa, Israel
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Hong CC, Tan KJ, Calder J. Chronic lateral ankle ligament instability - Current evidence and recent management advances. J Clin Orthop Trauma 2024; 48:102328. [PMID: 38274643 PMCID: PMC10806209 DOI: 10.1016/j.jcot.2023.102328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/14/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
Lateral ankle sprain is a common injury with a substantial negative impact on physical function, quality of life and health economic burden. Chronic lateral ankle instability (CLAI) as a sequela of lateral ankle sprain can lead to the development of posttraumatic ankle osteoarthritis in the long term. In this article, we explore the epidemiology, burden and definition of CLAI for the appropriate clinical assessment and imaging evaluation of patients with lateral ankle sprain and CLAI. Following that, recent advances and evidence on management of CLAI is critically distilled and summarized.
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Affiliation(s)
- Choon Chiet Hong
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Ken Jin Tan
- OrthoSports Clinic for Orthopedic Surgery and Sports Medicine, Mt Elizabeth Novena Specialist Centre, Singapore
| | - James Calder
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
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Li Q, Li Y, Shan J, Hua Y. Prevalence and Injury Patterns of CFL Injury in Chronic Lateral Ankle Instability: An Observational Cross-Sectional Study Using Ultrasound. J Foot Ankle Surg 2024; 63:27-32. [PMID: 37597584 DOI: 10.1053/j.jfas.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/18/2023] [Accepted: 08/13/2023] [Indexed: 08/21/2023]
Abstract
The purpose of this paper is to assess the prevalence and injury patterns of the calcaneofibular ligament (CFL) in chronic lateral ankle instability (CAI) patients using ultrasound imaging. This retrospective study included 938 ankle ultrasound images from January 2016 to May 2018. The patients' demographic data and the injury pattern classified by the injury location and the remnant quality were recorded and correlated using t tests, Fisher's exact tests, and post hoc tests accordingly. Of the 938 CAI patients, CFL injury was found in 408/938 (44%). Among the 408 anterior talofibular ligament (ATFL) and CFL complex injury patients, 71/408 (17%) presented with a completely absorbed ATFL, whereas 13/71 (18%) presented with an absorbed CFL. The total CFL absorption proportion in all patients was relatively low (30/938 = 3%). Post hoc tests indicated a negative association between thickened ATFLs and complex injuries. In addition, a positive association existed between absorbed ATFLs and complex injuries as well as absorbed ATFLs and absorbed CFLs. Thus, the results indicated that total tearing and absorption injury patterns of the CFL in CAI are not common. Even when the ATFL is absorbed, only approximately one-fifth (13/71 = 18%) of CFLs require reconstruction, suggesting that it is unnecessary to routinely repair or reconstruct CFLs in all lateral ligament surgeries.
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Affiliation(s)
- Qianru Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yibin Li
- Department of Sports Medicine, Quanzhou Orthopedic-Traumatological Hospital, Fujian University of Traditional Chinese Medicine, Quanzhou, Fujian, China
| | - Jieling Shan
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China.
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.
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Jamshidi AH, Mofateh R, Orakifar N, Seyedtabib M, Najarzadeh Z, Behdarvandan A. Immediate effects of local muscle vibration on static and dynamic balance control in individuals with chronic ankle instability. Phys Ther Sport 2024; 65:113-121. [PMID: 38128288 DOI: 10.1016/j.ptsp.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES To investigate the immediate effects of local muscle vibration (LMV) on static and dynamic balance control in individuals with and without chronic ankle instability (CAI). DESIGN Quasi-experimental study. SETTING Research laboratory. PARTICIPANTS Twenty-six individuals with CAI and 26 healthy controls. MAIN OUTCOME MEASURES Center of pressure variables (mean total velocity and displacement in anteroposterior (AP) and mediolateral (ML) directions) during single-leg standing with eyes open and eyes closed and also reach distances in anterior (ANT), posteromedial (PM), and posterolateral (PL) directions of the modified star excursion balance test (MSEBT) were assessed before and after LMV. RESULTS Statistical analyses showed a significant decrease in mean total velocity and displacement in AP direction from before to after LMV in eyes open condition for both individuals with CAI (p = 0.025, p = 0.041, respectively) and healthy controls (p = 0.001, p = 0.003, respectively). Similar results were observed in eyes closed condition for both individuals with CAI (p < 0.001, p < 0.001, respectively) and healthy controls (p = 0.040, p = 0.014, respectively). The results also showed increased reach distances in ANT (p < 0.001), PM (p < 0.001), and PL directions (p < 0.001) in all participants after LMV. CONCLUSION Our results suggest that LMV may be a useful tool in rehabilitation of static and dynamic balance deficits in individuals with CAI.
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Affiliation(s)
- Amir Hossein Jamshidi
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Razieh Mofateh
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Neda Orakifar
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Maryam Seyedtabib
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Zahra Najarzadeh
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Amin Behdarvandan
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Xue X, Lu R, Li H, Chen Z, Sheng D, Jin Z, Liu S, Liu A, Yan X, Tang W, Chen S, Hua Y. In Vivo Characterization of Cerebellar Peduncles in Chronic Ankle Instability: A Single and Multishell Diffusion-Weighted Imaging Study. Sports Health 2024; 16:38-46. [PMID: 38112261 PMCID: PMC10732106 DOI: 10.1177/19417381231156544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Ankle sprain causes proprioceptor injuries and prolonged joint deafferentation, which might lead to maladaptive neuroplasticity in patients with chronic ankle instability (CAI), especially in the cerebellum. Previous studies have indicated the impairment of superior cerebellar peduncle (SCP), but the inferior cerebellar peduncle (ICP) and middle cerebellar peduncle (MCP) have not been fully analyzed. HYPOTHESIS The cerebellar peduncles of participants with CAI would have altered fractional anisotropy (FA) and orientation dispersion index (ODI) in comparison with healthy controls without ankle injury history. In addition, FA and ODI would be correlated with the duration or severity of the sensorimotor deficits in CAI. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS A group of 27 participants with CAI and 26 healthy controls underwent diffusion-weighted imaging scanning, with the cerebellar peduncles as the regions of interest. The measures obtained by single-shell diffusion tensor imaging and the multishell neurite orientation dispersion and density imaging were used. Correlation analyses were performed to examine the potential relationship between the FA/ODI and both the normalized Y-balance scores and the durations of ankle instability. RESULTS The ipsilateral ICP of the injured ankle in participants with CAI showed significantly lower FA (Cohen d 95% CI, -1.33 to -0.21; P = 0.04) and marginally significant higher ODI (Cohen d 95% CI, 0.10 to 1.20, P = 0.08) when compared with the same measures in the control group, with the ODI being positively correlated with the duration of ankle instability (r = 0.42, P = 0.03). CONCLUSION The ICP in participants with CAI exhibited impaired integrity and a trend of abnormally organized neurites in comparison with a healthy control group. CLINICAL RELEVANCE The impairments of ICP might be an ongoing part of the pathological process of CAI, having the potential to become a target for the diagnostic evaluation of this clinical entity.
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Affiliation(s)
- Xiao’ao Xue
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Rong Lu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ziyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Dandan Sheng
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhengbiao Jin
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyin Liu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ailin Liu
- Department of Medical Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Xu Yan
- Scientific Marketing, Siemens Healthcare Ltd., Shanghai, China
| | - Weijun Tang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuang Chen
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Moisan G, Chicoine D, McBride S, Farahpour N, Isabelle PL, Dagenais C, Griffiths I. Supination resistance variations in foot and ankle musculoskeletal disorders: implications for diagnosis and customised interventions with wedged insoles. J Foot Ankle Res 2023; 16:91. [PMID: 38129924 PMCID: PMC10740238 DOI: 10.1186/s13047-023-00681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/03/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Supination resistance is a clinical outcome that estimates the amount of external force required to supinate the foot. A greater supination resistance may indicate greater loads on structures responsible for generating internal supination moments across the subtalar joint during static and dynamic tasks. As such, greater supination resistance may be an expected finding in medial foot and ankle musculoskeletal disorders, such as plantar fasciopathy (PF) and posterior tibial tendon dysfunction (PTTD), whereas reduced supination resistance may be present in lateral ankle disorders, such as chronic ankle instability (CAI). However, no studies have yet investigated the changes in supination resistance across these foot and ankle musculoskeletal disorders. This study aimed to quantify supination resistance in individuals with PF, PTTD and CAI compared to healthy controls. Additionally, this study aimed to explore the changes in supination resistance following the simulation of varus and valgus wedges, which are commonly used interventions for these disorders. METHODS Fourteen participants with PF, fourteen with PTTD, fourteen with CAI and fourteen healthy controls were recruited. Supination resistance was quantified on a level surface and on a 10-degree inclined surface with varus and valgus positions. RESULTS Supination resistance was lower for the injured foot for CAI (p < 0.001) and greater for PTTD (p < 0.001) compared to the healthy foot. There was no significant between-foot difference observed for PF (p = 0.275) and controls (p = 0.970). In the injured foot, CAI exhibited lower supination resistance compared to controls (p < 0.001), PF (p = 0.012) and PTTD (p = 0.014). Regardless of the groups, supination resistance increased when tested on a surface with valgus inclination (p < 0.001) and decreased when tested on a surface with varus inclination (p < 0.001). CONCLUSIONS Varus and valgus inclinations to the surface were effective in modifying supination resistance in PTTD and CAI, respectively. Supination resistance seemed unchanged in PF, and thus inclining the standing surface leads to greater between-feet asymmetries. This study also highlights the potential of wedged insoles as a mean to customise treatments and modify tissue stresses in these disorders. The findings contribute to the understanding of foot and ankle biomechanics and may aid in the development of more effective management and rehabilitation strategies.
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Affiliation(s)
- Gabriel Moisan
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
- Groupe de recherche sur les affections neuro-musculo-squelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Dominic Chicoine
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Sean McBride
- Department of Physical Therapy, University of Findlay, Findlay, OH, USA
| | - Nader Farahpour
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
- Department of Sport Biomechanics, Faculty of Sport Sciences, Bu Ali Sina University, Hamedan, Iran
| | - Pier-Luc Isabelle
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Camille Dagenais
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Ian Griffiths
- Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, UK.
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Yingyongsaksri S, Hiller CE, Tharawadeepimuk K, Nanbancha A. Reliability and validation of the Thai version of the Cumberland Ankle Instability Tool (CAIT-THA). Disabil Rehabil 2023; 45:3762-3767. [PMID: 36263888 DOI: 10.1080/09638288.2022.2135778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study aimed to provide a version of Cumberland Ankle Instability Tool (CAIT) for the Thai younger adult population and examine psychometric properties and determine the cut-off score. METHODS CAIT-Youth Thai version was modified to CAIT Thai version (CAIT-THA). To validate the CAIT-THA psychometric properties, 72 with chronic ankle instability (CAI) and 72 without (age 23.45 ± 4.45 years) were recruited. The validation was carried out by using internal consistency (Cronbach's alpha), concurrent validity (Spearman's rank correlation coefficient), discriminative validity (Receiver Operating Characteristic (ROC) curve), and test-retest reliability (intraclass correlation coefficient; ICC). A cut-off score was determined via Youden's index. RESULTS Validation showed good internal consistency (Cronbach's alpha = 0.837), and concurrent validity (Spearman's rank correlation coefficient = 0.762 and 0.731 for right ankle and left ankle, respectively). Test-retest reliability was excellent with ICC (2,1) of 0.945 (95% CI = 0.93-0.96). A cut-off score of ≤ 25, determined by ROC curve and Youden's index, was distinguished between participants with and without CAI. CAIT-THA obtained 97.2% sensitivity, 94.4% specificity, 0.03 negative, and 17.5 positive likelihood ratios. CONCLUSION CAIT-THA is a validated tool that can be used in Thai younger adults. Clinicians and researchers can confidently use a score of ≤ 25 to determine the presence of CAI.IMPLICATIONS FOR REHABILITATIONThe Cumberland Ankle Instability Tool Thai version (CAIT-THA) questionnaire is available for Thai young adults.The CAIT-THA had high sensitivity, specificity, and positive and negative likelihood cut-off ratio scores for discrimination between chronic ankle instability (CAI) and non-CAI.The CAIT-THA questionnaire may be used in rehabilitation and research settings for the identification and management of CAI conditions.
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Affiliation(s)
- Supannikar Yingyongsaksri
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Claire E Hiller
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Ampika Nanbancha
- College of Sports Science and Technology, Mahidol University, Salaya, Thailand
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45
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Koshino Y, Watanabe K, Akimoto M, Ishida T, Samukawa M, Kasahara S, Tohyama H. Factors associated with persistent pain in college athletes with a history of lateral ankle sprain. Phys Ther Sport 2023; 64:27-31. [PMID: 37666120 DOI: 10.1016/j.ptsp.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES To determine the factors associated with and prevalence of persistent pain in college athletes with chronic ankle instability (CAI) and with previous lateral ankle sprain (LAS) without CAI. DESIGN Cross-Sectional Study. SETTING Online survey at one university. PARTICIPANTS Of the 385 respondents surveyed online, 140 were identified as having experienced at least one LAS (CAI group: 69, coper group: 24, LAS group not classified as either: 47). MAIN OUTCOME MEASURES Factors associated with the presence of pain during activities of daily living (ADL) and sports were identified using multivariate logistic regression analyses. Independent variables were demographics, injury characteristics, the Identification of Functional Ankle Instability (IdFAI) score, the Foot and Ankle Ability Measure Sports (FAAM-Sports) and ADL subscales, and the Tampa Scale for Kinesiophobia-11 score. RESULTS The prevalence of pain during ADL and sports in the three groups was 16.7%-42.0% and 33.3%-56.5%, respectively. FAAM-Sports and IdFAI score were significantly associated with pain during ADL and sports in the CAI group (odd ratio: 0.923 and 1.145), respectively. No significant pain-related factors were found in the coper and LAS groups. CONCLUSIONS Lower self-reported function and greater perceived ankle instability may be important factors in pain management in athletes with CAI.
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Affiliation(s)
- Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
| | | | - Moeko Akimoto
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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Bleakley CM, Wagemans J, Schurz AP, Smoliga JM. How robust are clinical trials in primary and secondary ankle sprain prevention? Phys Ther Sport 2023; 64:85-90. [PMID: 37801794 DOI: 10.1016/j.ptsp.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES Determine the statistical stability of RCTs examining primary and secondary prevention of ankle sprains. METHODS Databases were searched to August 2023. We included parallel design RCTs, using conservative interventions for preventing ankle sprain, reporting dichotomous injury event outcomes. Statistical stability was quantified using Fragility Index (FI) and Fragility Quotient (FQ). Subgroup analyses were undertaken to test if FI varied based on by study objective, original approach to analysis (frequency vs time to event), follow-up duration, and pre-registration. RESULTS 3559 studies were screened with 45 RCTs included. The median number of events required to change the statistical significance (FI) was 4 (IQR 1-6). FI was similar regardless of study objective, original analysis, follow-up duration, and pre-registration status. Median (IQR) FQ was 0.015 (0.005-0.046), therefore reversing events <2 patients/100 would alter significance. In 80% of studies the number of patients lost to follow-up was greater than the FI. CONCLUSION RCTs informing primary and secondary prevention of ankle sprain are fragile. Only a small percentage of outcome event reversals would reverse study significance, and this is often exceeded by the number of drop outs. Robust reporting of dichotomous outcomes requires the use P values and key metrics such as FI or FQ.
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Affiliation(s)
- C M Bleakley
- Faculty of Life and Health Sciences, Ulster University, Belfast, United Kingdom.
| | - J Wagemans
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - A P Schurz
- Department of Health Professions, Bern University of Applied Sciences, Switzerland; Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussels, Belgium
| | - J M Smoliga
- Department of Physical Therapy, High Point University, United States; School of Medicine, Tufts University, United States
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Koumantakis GA, Galazoulas A, Stefanakis M, Paraskevopoulos E, Gioftsos G, Papandreou M. Greek Cross-Cultural Adaptation, Reliability, and Validity of the Quick Foot and Ankle Ability Measure Questionnaire. J Sport Rehabil 2023; 32:855-862. [PMID: 37591505 DOI: 10.1123/jsr.2022-0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 08/19/2023]
Abstract
CONTEXT An easy-to-administer, function-based questionnaire to assess patients with various foot problems was required for a Greek-speaking population. This study aimed to translate and cross-culturally adapt the Quick Foot and Ankle Ability Measure (Quick-FAAM) into Greek and evaluate its reliability and validity. DESIGN Cross-sectional study. METHODS Established international guidelines for the cross-cultural adaptation of questionnaires were followed. The face and content validity of the Greek version of the Quick-FAAM (Quick-FAAM-GR), as well as the internal consistency and test-retest reliability upon repeated administration after 5 days, were examined. In addition, the construct validity of the scale was examined via exploratory factor analysis as well as by testing for associations with the Manchester Foot Pain and Disability Index, the 12-item Short-Form Survey (version 2), and a functional balance assessment test-the Y-Balance Test. RESULTS Sixty participants (18 women) with self-reported chronic ankle instability symptoms, with a median (interquartile range) age of 27 (7.7) years, participated in the study. Half of the participants were included in the test-retest reliability study. The Quick-FAAM-GR demonstrated face and content validity. Excellent internal consistency (Cronbach α = .961) and intrarater test-retest reliability (intraclass correlation coefficient ICC[2,1] = .93) were demonstrated, with a comparable error margin to the original version (standard error of the measurement = 2.1, 95% minimum detectable change = 5.9). Associations of the Quick-FAAM-GR scores to other questionnaires ranged from weak to strong (Spearman rho), all being statistically significant (Manchester Foot Pain and Disability Index from -.26, P = .04, to -.67, P < .001, and 12-item Short-Form Survey, version 2, between .41 and .72, P < .001), and to the Y-Balance Test between lower-limb differences (-.35 to -.58, P < .001). The exploratory factor analysis confirmed the single-factor structure of this scale. No floor/ceiling effects were observed. CONCLUSIONS The Greek Quick-FAAM has proven to be a valid and reliable tool for evaluating chronic ankle instability and can be used for clinical and research purposes in Greek-speaking individuals.
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Affiliation(s)
- George A Koumantakis
- Department of Physiotherapy, Laboratory of Advanced Physiotherapy, School of Health & Care Sciences, University of West Attica (UNIWA), Athens,Greece
| | - Anastasios Galazoulas
- Department of Physiotherapy, Laboratory of Advanced Physiotherapy, School of Health & Care Sciences, University of West Attica (UNIWA), Athens,Greece
| | - Marios Stefanakis
- Department of Physiotherapy, Laboratory of Advanced Physiotherapy, School of Health & Care Sciences, University of West Attica (UNIWA), Athens,Greece
| | - Eleftherios Paraskevopoulos
- Department of Physiotherapy, Laboratory of Advanced Physiotherapy, School of Health & Care Sciences, University of West Attica (UNIWA), Athens,Greece
| | - George Gioftsos
- Department of Physiotherapy, Laboratory of Advanced Physiotherapy, School of Health & Care Sciences, University of West Attica (UNIWA), Athens,Greece
| | - Maria Papandreou
- Department of Physiotherapy, Laboratory of Advanced Physiotherapy, School of Health & Care Sciences, University of West Attica (UNIWA), Athens,Greece
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Zhao Q, Xu J, Yang YX, Yu D, Zhao Y, Wang Q, Yuan H. AI-assisted accelerated MRI of the ankle: clinical practice assessment. Eur Radiol Exp 2023; 7:62. [PMID: 37857868 PMCID: PMC10587051 DOI: 10.1186/s41747-023-00374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/04/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND High-spatial resolution magnetic resonance imaging (MRI) is essential for imaging ankle joints. However, the clinical application of fast spin-echo sequences remains limited by their lengthy acquisition time. Artificial intelligence-assisted compressed sensing (ACS) technology has been recently introduced as an integrative acceleration solution. We compared ACS-accelerated 3-T ankle MRI to conventional methods of compressed sensing (CS) and parallel imaging (PI) . METHODS We prospectively included 2 healthy volunteers and 105 patients with ankle pain. ACS acceleration factors for ankle protocol of T1-, T2-, and proton density (PD)-weighted sequences were optimized in a pilot study on healthy volunteers (acceleration factor 3.2-3.3×). Images of patients acquired using ACS and conventional acceleration methods were compared in terms of acquisition times, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), subjective image quality, and diagnostic agreement. Shapiro-Wilk test, Cohen κ, intraclass correlation coefficient, and one-way ANOVA with post hoc tests (Tukey or Dunn) were used. RESULTS ACS acceleration reduced the acquisition times of T1-, T2-, and PD-weighted sequences by 32-43%, compared with conventional CS and PI, while maintaining image quality (mostly higher SNR with p < 0.004 and higher CNR with p < 0.047). The diagnostic agreement between ACS and conventional sequences was rated excellent (κ = 1.00). CONCLUSIONS The optimum ACS acceleration factors for ankle MRI were found to be 3.2-3.3× protocol. The ACS allows faster imaging, yielding similar image quality and diagnostic performance. RELEVANCE STATEMENT AI-assisted compressed sensing significantly accelerates ankle MRI times while preserving image quality and diagnostic precision, potentially expediting patient diagnoses and improving clinical workflows. KEY POINTS • AI-assisted compressed sensing (ACS) significantly reduced scan duration for ankle MRI. • Similar image quality achieved by ACS compared to conventional acceleration methods. • A high agreement by three acceleration methods in the diagnosis of ankle lesions was observed.
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Affiliation(s)
- Qiang Zhao
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Jiajia Xu
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Yu Xin Yang
- United Imaging Research Institute of Intelligent Imaging, Beijing, People's Republic of China
| | - Dan Yu
- United Imaging Research Institute of Intelligent Imaging, Beijing, People's Republic of China
| | - Yuqing Zhao
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Qizheng Wang
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
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Wenning M, Schmal H. Chronic Ankle Instability - Mechanical vs. Functional. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:552-562. [PMID: 35158394 DOI: 10.1055/a-1696-2503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Chronic ankle instability arises from three interacting contributing factors: mechanical ankle instability, functional ankle instability, and perceived ankle instability. To decide on the most appropriate individual recommendation for therapeutic options, it is necessary to assess which of the two main aetiologies - functional vs. mechanical - is dominant in causing the perceived impairment. It is essential to perform a thorough analysis and diagnosis, even though quantifying mechanical ankle instability is still a challenge in the clinical approach to this common pathology. When diagnosing mechanical instability, the most established procedure is physical examination, although this unfortunately does not allow the deficit to be quantified. Additional options include stress-ultrasound, 3D stress-MRI (3SAM), ankle arthrometry, marker-based 3D motion analysis, and diagnostic ankle arthroscopy. Of these the latter is considered the gold standard, even though it is an invasive procedure, it may not be performed for diagnostic reasons only, and it also does not allow the mechanical instability to be quantified. For diagnosing functional instability there are non-instrumented tests such as the Star Excursion Balance Test or Y-Balance Test, posturography/stabilometry, and gait and running analysis, possibly combined with EMG acquisition and isokinetic strength testing.To date, the standard of care is conservative management of ankle instability, and the therapy should include sensorimotor training, strength training of the periarticular muscles, balance training, and gait and running exercises on different surfaces. However, it is increasingly clear that a certain degree of mechanical instability cannot be compensated for by functional training. Thus, it is the goal of differential diagnostics to identify those patients and guide them to mechanical therapy, including ankle bracing, taping, and surgical ligament reconstruction.
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Affiliation(s)
- Markus Wenning
- Department of Orthopedic and Trauma Surgery, Albert-Ludwigs-Universität Freiburg Medizinische Fakultät, Freiburg, Deutschland
| | - Hagen Schmal
- Department of Orthopedic and Trauma Surgery, Albert-Ludwigs-Universitat Freiburg Medizinische Fakultat, Freiburg, Deutschland
- Department of Orthopedic Surgery, Odense University Hospital Department of Orthopaedic Surgery, Odense, Denmark
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Kim J, Kim GL, Kim T, Cho J. Evaluation of chronic ankle instability and subtalar instability using the angle between the anterior talofibular ligament and calcaneofibular ligament. Knee Surg Sports Traumatol Arthrosc 2023; 31:4539-4545. [PMID: 37286900 DOI: 10.1007/s00167-023-07433-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/20/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE A series of studies have reported a change in the length or thickness of the anterior talofibular (ATFL) and calcaneofibular (CFL) ligaments in patients with chronic ankle instability. However, no study has examined the changes in the angle between the ATFL and CFL in patients diagnosed with chronic ankle instability. Therefore, this study analyzed the change in the angle between the ATFL and CFL in patients diagnosed with chronic ankle instability to confirm its relevance. METHODS This retrospective study included 60 patients who had undergone surgery for chronic ankle instability. Stress radiographs comprising the anterior drawer test, varus stress test, Broden's view stress test, and magnetic resonance imaging (MRI) were performed in all patients. The angle between the ATFL and CFL was measured by indicating the vector at the attachment site, as seen on the sagittal plane. Three groups were classified according to the angle between the two ligaments measured by MRI: group I when the angle was > 90°, Group II when the angle was 71-90°, and Group III when the angle was ≤ 70°. The accompanying injuries to the subtalar joint ligament were analyzed via MRI. RESULTS A comparison of the angles between the ATFL and CFL measured on MRI in Group I, Group II, and Group III with the angles measured in the operating room revealed a significant correlation. Broden's view stress test revealed a statistically significant difference among the three groups (p < 0.05). The accompanying subtalar joint ligament injuries differed significantly among the three groups (p < 0.05). CONCLUSION The ATFL-CFL angle in patients with ankle instability is smaller than the average angle in ordinary people. Therefore, the ATFL-CFL angle might be a reliable and representative measurement tool to assess chronic ankle instability, and subtalar joint instability should be considered if the ATFL-CFL angle is 70° or less. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jiyoun Kim
- Department of Orthopedic Surgery, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Korea
| | - Gab Lae Kim
- Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University School of Medicine, Seong-an Ro 150, Kang-dong Gu, Seoul, 05355, Korea.
| | - Taeho Kim
- Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University School of Medicine, Seong-an Ro 150, Kang-dong Gu, Seoul, 05355, Korea
| | - Junghyun Cho
- Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University School of Medicine, Seong-an Ro 150, Kang-dong Gu, Seoul, 05355, Korea
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