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Choi JH, Choi YH, Kim JG, Koo S, Lee KM. Postoperative Stability in Displaced Ankle Fractures With Concomitant Ligamentous Injuries. J Foot Ankle Surg 2024:S1067-2516(24)00072-3. [PMID: 38663821 DOI: 10.1053/j.jfas.2024.04.003] [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: 11/09/2023] [Revised: 04/01/2024] [Accepted: 04/10/2024] [Indexed: 05/14/2024]
Abstract
Ankle instability, which can be attributed to either the deltoid or lateral ligamentous complex, may be both a cause and a consequence of ankle fractures. This study aimed to assess postoperative ankle instability in patients with displaced ankle fractures. A total of 54 patients with displaced ankle fractures were included. Malleolar fractures were surgically reduced and fixated, and if necessary, the syndesmosis was stabilized. Concomitant deltoid injuries were left unrepaired. Ankle stress radiographs were taken approximately 25.4 months after surgery, with a standard deviation of 20.5 months. Radiographic measurements included the tibiotalar tilt angle (TT) on varus stress view, anterior translation of the talus (AT) on the anterior drawer view, and the medial clear space (MC) and tibiotalar tilt angle on the valgus stress view. These measurements were compared between the injured and the noninjured contralateral ankle for all patients as well as in a subgroup of 19 patients with concomitant deltoid and syndesmosis injuries. There were no significant differences in Varus TT (p = .675, p = .394), AT (p = .516, p = .967), Valgus MC (p = .190, p = 0.498), and Valgus TT (p = .173, p = .442) between the injured and noninjured ankles in the whole group of patients as well as in the subgroup of patients with concomitant deltoid and syndesmosis injuries. Patients with displaced ankle fractures exhibited radiographically stable ankles postoperatively. Syndesmosis fixation without deltoid ligament repair is a viable treatment option for achieving ankle stability postoperatively in fractures with both ligament injuries.
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Affiliation(s)
- Ji Hye Choi
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Yoon Hyo Choi
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jung Geul Kim
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Seungbum Koo
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejon, South Korea
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea.
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2
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Lee H, Dennis HE, Han S, Hopkins JT, Seeley MK. Decreased rate of torque development in ankle evertors for individuals with chronic ankle instability. Clin Biomech (Bristol, Avon) 2023; 109:106096. [PMID: 37725866 DOI: 10.1016/j.clinbiomech.2023.106096] [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: 06/12/2023] [Revised: 08/30/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Individuals with chronic ankle instability have decreased peak torque during maximum voluntary contraction in ankle evertors/invertors, and hip abductors. However, it is unclear whether individuals with chronic ankle instability and/or copers demonstrate decreased rate of torque development in ankle evertors/invertors, and hip abductors. METHODS 54 university-aged participants (18 chronic ankle instability, 18 copers, and 18 controls) performed three maximal isometric contractions for ankle evertors and invertors, and hip abductors. Rate of torque development was defined as the linear slope of the torque-time curve during the first 200 ms of each contraction and compared between the three groups using a one-way analysis of variance (α = 0.05). FINDINGS The chronic ankle instability group showed 38.1% less rate of torque development than the coper (P = 0.03 and d = 0.84) and 37.1% than the control groups (P = 0.03 and d = 1.03) in the ankle evertors. For the hip abductors, there were moderate effects between the chronic ankle instability group and the copers (P = 0.06 and d = 0.70), and control groups (P = 0.06 and d = 0.75). INTERPRETATIONS The observed between-groups differences in rate of torque development indicate that restoring rate of torque development after lateral ankle sprain may be important to reduce risk of reinjury and development of chronic ankle instability. Clinicians should consider the rate of torque development in the ankle evertors and hip abductors during rehabilitation chronic ankle instability patients.
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Affiliation(s)
- Hyunwook Lee
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hayden E Dennis
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA
| | - Seunguk Han
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA.
| | - J Ty Hopkins
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA
| | - Matthew K Seeley
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA
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3
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Lee H, Oh M, Han S, Hopkins JT. Unexpected inversion perturbation during a single-leg landing in patients with chronic ankle instability. Sports Biomech 2023:1-15. [PMID: 37339269 DOI: 10.1080/14763141.2023.2226649] [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: 10/20/2022] [Accepted: 06/13/2023] [Indexed: 06/22/2023]
Abstract
It remains unclear how unexpected perturbations during single-leg landings affect lower extremity kinematics and muscle activations in patients with chronic ankle instability (CAI). The purpose of this study was to identify the differences in lower extremity movement patterns among CAI subjects, copers, and healthy controls. Sixty-six people including 22 CAI subjects, 22 copers, and 22 healthy controls volunteered to participate in the study. Lower extremity joint kinematics and EMG activations from 200-ms pre to 200-ms post the initial contact during unexpected tilted landings were measured. Functional data analysis was used to evaluate between-group differences for outcome measures. Relative to copers and healthy controls, CAI subjects showed more inversion from 40-ms to 200-ms after initial contact. Relative to healthy controls, CAI subjects and copers showed more dorsiflexion. Relative to healthy controls, CAI subjects and copers showed more muscle activation in tibialis anterior and peroneus longus, respectively. In conclusion, CAI subjects demonstrated greater inversion angles and muscle activation before initial contact compared to LAS copers and healthy controls. This suggests that CAI subjects and copers prepare for their landing with protective movements, but the prepared movements shown by CAI subjects may be insufficient to reduce risk of recurrent injury.
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Affiliation(s)
- Hyunwook Lee
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA
| | - Minsub Oh
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA
| | - Seunguk Han
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA
| | - J Ty Hopkins
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA
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Lalevée M, Anderson DD, Wilken JM. Current Challenges in Chronic Ankle Instability: Review and Perspective. Foot Ankle Clin 2023; 28:129-143. [PMID: 36822682 DOI: 10.1016/j.fcl.2022.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Chronic ankle instability (CAI) is common, disabling, and represents a significant socioeconomic burden. Current treatment options are not adequately efficacious. CAI is multifaceted, yet it is commonly addressed in terms of either mechanical instability or functional impairment. Both are inherently linked. Basic research must be conducted to foster reliable translational research encompassing both mechanical and functional aspects. A review was conducted to identify CAI risk factors for inclusion in future studies, and we offer here opinions and perspectives for future research.
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Affiliation(s)
- Matthieu Lalevée
- CETAPS EA3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, F-76821 Mont-Saint-Aignan, France; Department of Orthopedic Surgery, Rouen University Hospital, 37 Bd Gambetta, Rouen 76000, France
| | - Donald D Anderson
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, IA 52242, USA; Department of Biomedical Engineering, The University of Iowa, Iowa City, IA 52242, USA; Department of Industrial and Systems Engineering, The University of Iowa, Iowa City, IA 52242, USA
| | - Jason M Wilken
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa, 500 Newton Road, 1-249 Medical Education Building, Iowa City, IA 52242-1089, USA.
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5
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Chen Y, Cao S, Wang C, Ma X, Wang X. Quantitative analysis with load–displacement ratio measured via digital arthrometer in the diagnostic evaluation of chronic ankle instability: a cross-sectional study. J Orthop Surg Res 2022; 17:287. [PMID: 35606774 PMCID: PMC9125832 DOI: 10.1186/s13018-022-03177-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/17/2022] [Indexed: 12/26/2022] Open
Abstract
Background Arthrometry has been introduced to evaluate the laxity of ankle joint in recent years. However, its role in the diagnosis of chronic ankle instability is still debatable. Therefore, we assessed the diagnostic accuracy of a digital arthrometer in terms of sensitivity and specificity. Methods According to the inclusion and exclusion criteria proposed by the International Ankle Consortium, we recruited 160 uninjured ankles (control group) and 153 ankles with chronic ankle instability (CAI group). Ankle laxity was quantitively measured by a validated digital arthrometer. Data of loading force and joint displacement were recorded in a continuous manner. Differences between the control and CAI groups were compared using 2-tailed independent t test. A receiver operating characteristic curve analysis was used to calculate area under a curve, sensitivity and specificity. Results Load–displacement curves of the two groups were depicted. Differences of joint displacement between the control and CAI groups were compared at 30, 45, 60, 75, 90, 105 and 120 N, which were all of statistical significance (all p < 0.001) with the largest effect size at 90 N. Statistical significance was found in the differences between the two groups in load–displacement ratio at 10–120 N, 10–40 N, 40–80 N and 80–120 N (all p < 0.001), with the largest effect size at 10–40 N. Load–displacement ratio at the interval of 10–40 N had the highest area under a curve (0.9226), with sensitivity and specificity of 0.804 and 0.863, respectively, when the cutoff point was 0.1582 mm/N. Conclusion The digital arthrometer measurement could quantitively analyze the ankle laxity with high diagnostic accuracy. The load–displacement ratio would be a reliable and promising approach for chronic ankle instability diagnosis. Level of evidence level II.
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Brown CN, Samson CO, Hsieh KL. Hysteresis and stiffness of the lateral ankle complex in those with chronic ankle instability. Sports Biomech 2022; 21:517-530. [PMID: 34027822 DOI: 10.1080/14763141.2021.1925335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/28/2021] [Indexed: 09/30/2022]
Abstract
The role of mechanical laxity and viscoelastic tissue properties in chronic ankle instability (CAI) is unclear, but may influence repeated injury. The purpose was to determine if lateral ankle complex stiffness and hysteresis was altered in CAI individuals with and without mechanical laxity, compared to copers and uninjured controls. Thirty-five recreational athletes (19 females, 22.1 ± 2.7 years, 69.7 ± 15.7 kg, 168.4 ± 10.7 cm) were assessed for ankle injury history and self-reported instability. An instrumented arthrometer was applied and laxity, stiffness and hysteresis values were captured. Results from ANOVA tests indicated the CAI with laxity group had lower beginning- (3.2 ± 0.6 N/mm) and end-range stiffness (4.5 ± 0.4 N/mm) than the CAI without laxity group (4.7 ± 0.6; 6.0 ± 0.6 N/mm) and uninjured controls (4.6 ± 1.1; 5.8 ± 0.8 N/mm, p < 0.003). Hysteresis was greater in the CAI with laxity group than without laxity (91.0 ± 17.3 vs 62.8 ± 12.0 dN•mm; p = 0.03). Altered tissue properties in a CAI with laxity group likely indicate diminished ability of the lateral ankle complex to respond to loading. Accurately assessing, then avoiding or restoring tissue impairments after injury, may encourage better patient outcomes.
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Affiliation(s)
- Cathleen N Brown
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Christine O Samson
- Department of Kinesiology and Outdoor Recreation, Southern Utah University, Cedar City, UT, USA
| | - Katherine L Hsieh
- Wake Forest School of Medicine, Department of Internal Medicine, J Paul Sticht Center on Aging, Winston-Salem, NC, USA
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7
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Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. J Orthop Sports Phys Ther 2021; 51:CPG1-CPG80. [PMID: 33789434 DOI: 10.2519/jospt.2021.0302] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This revised clinical practice guideline (CPG) addresses the distinct but related lower extremity impairments of those with a first-time lateral ankle sprain (LAS) and those with chronic ankle instability (CAI). Depending on many factors, impairments may continue following injury. While most individuals experience resolution of symptoms, complaints of instability may continue and are defined as CAI. The aims of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. J Orthop Sports Phys Ther 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302.
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8
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Wei S, Fan D, Han F, Tang M, Kong C, Xu F, Cai X. Using arthroscopy combined with fluoroscopic technique for accurate location of the bone tunnel entrance in chronic ankle instability treatment. BMC Musculoskelet Disord 2021; 22:289. [PMID: 33736616 PMCID: PMC7977304 DOI: 10.1186/s12891-021-04165-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 03/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Minimally invasive reconstruction techniques are used for anatomical ligament construction of the lateral collateral ligament complex of the ankle, but the two key elements, the bone tunnel and the appropriate graft tension, for the identification of the anatomic location during the surgery are not clearly stated. Methods The patients with chronic ankle instability who received arthroscopic anatomic lateral ligament complex reconstruction were retrospectively analyzed. The anatomical location of the bone tunnel was performed under arthroscopy combined with fluoroscopy for accurate location of the bone tunnel entrance. The graft tension and routing were controlled under arthroscopic visualization. The clinical outcomes were assessed using the Karlsson-Peterson score, Sefton articular stability scale, and Visual Analogue Scale (VAS). The complications were recorded during the follow-up. Results A total of 18 patients were enrolled in this study. The mean follow-up was 33.33 ± 3.69 (range from 24 to 36) months. No patient had recurrence of ankle instability after the operation. According to the Sefton articular stability scale, 94.5% of the patients had excellent/good function. The mean value of the anterior drawer tests and the talar tilt angle examination were decreased. The mean of the Karlsson-Peterson score and the Visual Analogue Scale(VAS) score were both improved significantly. Conclusions The anatomic reconstruction of the ankle lateral ligament complex to treat chronic ankle instability using the arthroscopy combined with the fluoroscopic technique could improve the clinical functions, satisfaction, and reduced pain of patients.
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Affiliation(s)
- Shijun Wei
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China. .,The First Clinical Medical School of Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China.
| | - Dongsheng Fan
- Department of Orthopaedics, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Province, People's Republic of China
| | - Fang Han
- Department of Nutrition, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), Wuhan, Hubei Province, People's Republic of China
| | - Ming Tang
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China
| | - Changwang Kong
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China
| | - Feng Xu
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China.,The First Clinical Medical School of Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Xianhua Cai
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China.,The First Clinical Medical School of Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
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9
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Ankle laxity affects ankle kinematics during a side-cutting task in male collegiate soccer athletes without perceived ankle instability. Phys Ther Sport 2020; 46:89-96. [DOI: 10.1016/j.ptsp.2020.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 01/25/2023]
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10
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Lan S, Zeng W, Yuan G, Xu F, Cai X, Tang M, Wei S. All-Inside Arthroscopic Anterior Talofibular Ligament Anatomic Reconstruction With a Gracilis Tendon Autograft for Chronic Ankle Instability in High-Demand Patients. J Foot Ankle Surg 2020; 59:222-230. [PMID: 32130983 DOI: 10.1053/j.jfas.2018.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Indexed: 02/03/2023]
Abstract
The goal of this study was to evaluate the surgical technique and clinical outcome of all-inside arthroscopic anterior talofibular ligament anatomic reconstruction with a gracilis tendon autograft for chronic ankle instability in high-demand patients. Fifteen consecutive patients (14 [93.3%] males and 1 [6.7%] female, mean age 31.9 ± 7.8 [range 21 to 48] years) with chronic ankle instability were enrolled in this study. Under direct arthroscopic visualization, bone tunnels were created in the fibula and talus by a 4.5-mm cannulated drill system. The gracilis tendon autograft was passed through the tunnels and secured by 5.0-mm interference screws. At the final follow-up, functional evaluation was carried out according to the Ankle-Hindfoot Score by the American Orthopaedic Foot and Ankle Society, Sefton grading system, and visual analog scale score. Complications were also recorded. Mean follow-up was 19.5 ± 1.8 (range 18 to 24) months. No complications of wound infection and nerve injury were noted. No patients experienced recurrent ankle instability. Radiologically, the mean varus tilting angle was 15.2° ± 1.5° before surgery and 4.3° ± 1.2° at the last follow-up (p ≤ .001). The anterior drawer distance was 13.2 ± 1.5 mm before surgery and 4.8 ± 1.1 mm at last follow-up (p ≤ .001). The mean American Orthopaedic Foot and Ankle Society and visual analog scale scores were 56.8 ± 10.5 and 5.7 ± 1.3 before surgery, which became 90.2 ± 6.2 and 0.5 ± 0.8 after surgery. Fourteen (93.3%) patients reported excellent/good functional results according to the Sefton grading system (6 [40.0%] excellent, 8 [53.3%] good, and 1 [6.7%] fair). From our clinical experience, all-inside arthroscopic anterior talofibular ligament anatomic reconstruction with a gracilis tendon is an effective treatment for chronic ankle instability in high-demand patients.
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Affiliation(s)
- Shenghui Lan
- Surgeon, Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command, Hubei Province, China
| | - Wenbo Zeng
- Surgeon, Department of Orthopaedics, Southern Medical University, Guangdong Province, China
| | - Gongwu Yuan
- Surgeon, Department of Orthopaedics, Southern Medical University, Guangdong Province, China
| | - Feng Xu
- Professor, Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command, Hubei Province, China
| | - Xianhua Cai
- Professor, Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command, Hubei Province, China
| | - Ming Tang
- Surgeon, Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command, Hubei Province, China
| | - Shijun Wei
- Associate Professor, Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command, Hubei Province, China.
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Rosen AB, McGrath ML, Maerlender AL. Males with chronic ankle instability demonstrate deficits in neurocognitive function compared to control and copers. Res Sports Med 2020; 29:116-128. [PMID: 31992081 DOI: 10.1080/15438627.2020.1723099] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to determine if there were neurocognitive deficits among controls, copers and those with chronic ankle instability (CAI). Participants included those without history of ankle injury (n = 14), ankle sprain copers (n = 13) and patients with self-reported CAI (n = 14). They completed a battery of valid and reliable computer-based neurocognitive tests. The differences between neurocognitive domain scores were compared across the Control, Coper and CAI groups. Patients with CAI had lower composite memory, visual memory and simple attention compared to controls. In males with CAI, large differences in memory and attention were found relative to control participants. These differences may contribute to uncontrolled episodes of giving way through deficits in spatial awareness and/or an inability to identify environmental obstacles. Clinicians should explore ways to provide additional stimuli through innovative rehabilitation protocols aimed at maximizing neurocognitive abilities in patients with CAI.
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Affiliation(s)
- Adam B Rosen
- School of Health and Kinesiology, University of Nebraska at Omaha , Omaha, NE, USA
| | - Melanie L McGrath
- Department of Health and Human Performance, University of Montana , Missoula, MO, USA
| | - Arthur L Maerlender
- Center for Brain, Biology and Behavior, University of Nebraska at Lincoln , Lincoln, NE, USA
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Vuurberg G, Altink N, Rajai M, Blankevoort L, Kerkhoffs GMMJ. Weight, BMI and stability are risk factors associated with lateral ankle sprains and chronic ankle instability: a meta-analysis. J ISAKOS 2019; 4:313-327. [PMID: 33835938 DOI: 10.1136/jisakos-2019-000305] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/29/2019] [Accepted: 09/06/2019] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Lateral ankle sprains (LAS) are common in the general population and may lead to chronic ankle instability (CAI). If patients at risk could be identified, they could receive adequate and on-time treatment. OBJECTIVE The purpose of the current review was to identify all reported intrinsic factors associated with sustaining a LAS or progressing to CAI after an initial sprain. EVIDENCE REVIEW PubMed, Embase, MEDline, Cochrane and PEDro were searched for studies published until July 2019. Articles were selected if they included intrinsic factors related to LAS or CAI, subjects of at least 16 years old, and contained a minimum of 10 patients and 10 controls. Studies were excluded if they concerned reviews or case reports, included patients with previous surgical interventions, concomitant injuries or joint pathology other than ankle instability. Quality of included studies was assessed using the Quality in Prognostic Studies tool and quality of evidence was assessed using the GRADEpro tool. In case outcomes were described by at least three studies, data were pooled and assessed by performing a meta-analysis. Based on the pooled data, either a fixed-effects model or random-effects model was selected to correct for the degree of heterogeneity. FINDINGS The search resulted in a total of 4154 studies. After title and abstract screening and subsequent full-text screening, 80 relevant studies were included. Results of the meta-analyses indicated that, compared with healthy controls, patients with LAS had a higher mean body mass index (BMI). In patients with CAI, a higher weight and a longer time to stabilise after performing a task (eg, jumping) were found compared with healthy controls. Other outcomes could not be compared using a meta-analysis due to heterogeneity in outcome measurement and the great number of different outcomes reported. Identification of the risk factors when patients present themselves after a LAS may help to determine which patients are at risk of recurrent sprains or developing CAI. CONCLUSIONS AND RELEVANCE Based on the findings in this review, a higher BMI, and a higher weight and neuromuscular stability deficits may be regarded risk factors for sustaining a LAS or developing CAI, respectively. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Gwendolyn Vuurberg
- Orthopaedic surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands .,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Nienke Altink
- Orthopaedic surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Morteza Rajai
- Orthopaedic surgery, Iran University of Medical Sciences, Tehran, the Islamic Republic of Iran
| | - Leendert Blankevoort
- Orthopaedic surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Orthopaedic surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
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Chronic Ankle Instability Does Not Influence Tibiofemoral Contact Forces During Drop Landings Using a Musculoskeletal Model. J Appl Biomech 2019; 35:426–430. [PMID: 31629342 DOI: 10.1123/jab.2018-0436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 06/05/2019] [Accepted: 07/08/2019] [Indexed: 11/18/2022]
Abstract
The purpose of the study was to compare the tibiofemoral contact forces of participants with chronic ankle instability versus controls during landings using a computer-simulated musculoskeletal model. A total of 21 female participants with chronic ankle instability and 21 pair-matched controls performed a drop landing task on a tilted force plate. A 7-camera motion capture system and 2 force plates were used to test participants' lower-extremity biomechanics. A musculoskeletal model was used to calculate the tibiofemoral contact forces (femur on tibia). No significant between-group differences were observed for the peak tibiofemoral contact forces (P = .25-.48) during the landing phase based on paired t tests. The group differences ranged from 0.05 to 0.58 body weight (BW). Most participants demonstrated a posterior force (peak, ∼1.1 BW) for most duration of the landing phase and a medial force (peak, ∼0.9 BW) and large compressive force (peak, ∼10 BW) in the landing phase. The authors conclude that chronic ankle instability may not be related to the increased tibiofemoral contact forces or knee injury mechanisms during landings on the tilted surface.
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Medina McKeon JM, Hoch MC. The Ankle-Joint Complex: A Kinesiologic Approach to Lateral Ankle Sprains. J Athl Train 2019; 54:589-602. [PMID: 31184957 DOI: 10.4085/1062-6050-472-17] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Copious research exists regarding ankle instability, yet lateral ankle sprains (LASs) persist in being among the most common recurrent musculoskeletal injuries. Key anatomical structures of the ankle include a triform articulating structure that includes the inferior tibiofibular, talocrural, and subtalar joints. Functionally, force absorption and propulsion through the ankle complex are necessary for any task that occurs in weight bearing. For optimal ankle performance and avoidance of injury, an intricate balance between stability and mobility is necessary to ensure that appropriate force transfer occurs during sports and activities of daily living. Consideration for the many structures that may be directly or indirectly involved in LASs will likely translate into advancements in clinical care. In this clinical review, we present the structure, function, and relevant pathologic states of the ankle complex to stimulate a better understanding of the prevention, evaluation, and treatment of LASs.
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Affiliation(s)
| | - Matthew C Hoch
- Sports Medicine Research Institute, University of Kentucky, Lexington
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Abstract
Lateral ankle sprains (LASs) are among the most common injuries incurred during participation in sport and physical activity, and it is estimated that up to 40% of individuals who experience a first-time LAS will develop chronic ankle instability (CAI). Chronic ankle instability is characterized by a patient's being more than 12 months removed from the initial LAS and exhibiting a propensity for recurrent ankle sprains, frequent episodes or perceptions of the ankle giving way, and persistent symptoms such as pain, swelling, limited motion, weakness, and diminished self-reported function. We present an updated model of CAI that aims to synthesize the current understanding of its causes and serves as a framework for the clinical assessment and rehabilitation of patients with LASs or CAI. Our goal was to describe how primary injury to the lateral ankle ligaments from an acute LAS may lead to a collection of interrelated pathomechanical, sensory-perceptual, and motor-behavioral impairments that influence a patient's clinical outcome. With an underpinning of the biopsychosocial model, the concepts of self-organization and perception-action cycles derived from dynamic systems theory and a patient-specific neurosignature, stemming from the Melzack neuromatrix of pain theory, are used to describe these interrelationships.
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Affiliation(s)
- Jay Hertel
- Department of * Kinesiology, University of Virginia, Charlottesville.,Department of Orthopaedic Surgery, University of Virginia, Charlottesville
| | - Revay O Corbett
- Department of * Kinesiology, University of Virginia, Charlottesville
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16
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Wenning M, Lohrer H, Gollhofer A, Gehring D. In vivo arthrometer measurements of mechanical ankle instability-A systematic review. J Orthop Res 2019; 37:1133-1142. [PMID: 30908733 DOI: 10.1002/jor.24280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/25/2019] [Indexed: 02/04/2023]
Abstract
Chronic ankle instability is caused by functional and/or mechanical deficits. To differentiate the two entities, mechanical ankle instability can be assessed using arthrometers. The measurement of mechanical instability is essential, since it can only be addressed surgically. The aim of this systematic literature review was to find out whether chronic mechanical ankle instability could be adequately and objectively assessed using in vivo arthrometer measurements. Articles were included if the main focus was to evaluate the contribution of mechanical deficits to chronic ankle instability and if they provided sufficient description of the device used. This systematic review was performed according to the PRISMA-recommendations. Initially 47 articles were screened for eligibility, of which 33 studies reporting 10 different devices were included. While the reliability of the measurements was mostly good to excellent, only two studies aimed to assess the sensitivity and specificity of their results in regard to chronic ankle instability. Several devices reported conflicting results about mechanical deficits. In summary, this systematic review reveals a substantial deficit in diagnostic accuracy when assessing mechanical ankle instability in a clinical setting. Biases in recruiting and classification of participants raise the question whether the two entities of functional and mechanical ankle instability are properly defined. Clinical Significance: In recent years, this may have led to a misinterpretation of mechanical deficits and the subsequent need for surgical intervention. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Markus Wenning
- Department of Sport and Sport Science, University of Freiburg, Freiburg 79117, Germany
| | - Heinz Lohrer
- Department of Sport and Sport Science, University of Freiburg, Freiburg 79117, Germany.,European SportsCare Network (ESN), Zentrum für Sportorthopädie, Borsigstrasse 2, 65205 Wiesbaden-Nordenstadt, Germany.,Lilium-Klinik, Borsigstrasse 2, 65205 Wiesbaden-Nordenstadt, Germany
| | - Albert Gollhofer
- Department of Sport and Sport Science, University of Freiburg, Freiburg 79117, Germany
| | - Dominic Gehring
- Department of Sport and Sport Science, University of Freiburg, Freiburg 79117, Germany
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17
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Attention is associated with postural control in those with chronic ankle instability. Gait Posture 2017; 54:34-38. [PMID: 28254684 PMCID: PMC5481467 DOI: 10.1016/j.gaitpost.2017.02.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/20/2017] [Accepted: 02/22/2017] [Indexed: 02/02/2023]
Abstract
Chronic ankle instability (CAI) is often debilitating and may be affected by a number of intrinsic and environmental factors. Alterations in neurocognitive function and attention may contribute to repetitive injury in those with CAI and influence postural control strategies. Thus, the purpose of this study was to determine if there was a difference in attentional functioning and static postural control among groups of Comparison, Coper and CAI participants and assess the relationship between them within each of the groups. Recruited participants performed single-limb balance trials and completed the CNS Vital Signs (CNSVS) computer-based assessment to assess their attentional function. Center of pressure (COP) velocity (COPv) and maximum range (COPr), in both the anteroposterior (AP) and mediolateral (ML) directions were calculated from force plate data. Simple attention (SA), which measures self-regulation and attention control was extracted from the CNSVS. Data from 45 participants (15 in each group, 27=female, 18=male) was analyzed for this study. No significant differences were observed between attention or COP variables among each of the groups. However, significant relationships were present between attention and COP variables within the CAI group. CAI participants displayed significant moderate to large correlations between SA and AP COPr (r=-0.59, p=0.010), AP COPv (r=-0.48, p=0.038) and ML COPr (r=-0.47, p=0.034). The results suggest a linear relationship of stability and attention in the CAI group. Attentional self-regulation may moderate how those with CAI control postural stability. Incorporating neurocognitive training focused on attentional control may improve outcomes in those with CAI.
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Tenenbaum S, Chechik O, Bariteau J, Bruck N, Beer Y, Falah M, Segal G, Mor A, Elbaz A. Gait abnormalities in patients with chronic ankle instability can improve following a non-invasive biomechanical therapy: a retrospective analysis. J Phys Ther Sci 2017; 29:677-684. [PMID: 28533609 PMCID: PMC5430272 DOI: 10.1589/jpts.29.677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 01/10/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to evaluate the changes in gait patterns and clinical outcomes of patients with chronic ankle instability (CAI) following treatment with a home-based non-invasive biomechanical device. [Subjects and Methods] Thirty-three patients with CAI were compared with 43 healthy controls. Patients underwent a spatiotemporal gait assessment before and three months following treatment. Clinical evaluation was recorded with SF-36 Health Survey and the Foot and Ankle Outcome Score (FAOS). [Results] Significant baseline differences were found between groups. Patients with CAI showed a statistically significant improvement in velocity, cadence, symptomatic limb step length and single limb support over time. Significant improvements in SF-36 PCS and FAOS outcome scores were found in patients with CAI. [Conclusion] Patients with CAI have baseline spatiotemporal gait abnormalities as compared with healthy controls. However, clinical and gait metrics improvement can be expected after 12 weeks of perturbation training using a non-invasive biomechanical device.
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Affiliation(s)
- Shay Tenenbaum
- Department of Orthopedic Surgery, Chaim Sheba Medical
Center at TEL: Hashomer, affiliated to the Sackler Faculty of Medicine TEL: Aviv
University, Israel
| | - Ofir Chechik
- Department of Orthopedic Surgery, Sourasky Medical Center,
Israel
| | - Jason Bariteau
- Department of Orthopedics, Emory University School of
Medicine, USA
| | - Nathan Bruck
- Department of Orthopedic Surgery, Chaim Sheba Medical
Center at TEL: Hashomer, affiliated to the Sackler Faculty of Medicine TEL: Aviv
University, Israel
| | - Yiftah Beer
- Department of Orthopedic Surgery, Assaf Harofeh Medical
Center, Israel
| | - Mazen Falah
- Department of Orthopedic Surgery, Rambam Health Care
Campus, Israel
| | | | - Amit Mor
- AposTherapy Research Group, Israel
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