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Khazaei F, Sayyed-Hosseinian SH, Miri HH, Zeinalzadeh A, Nazary-Moghadam S. Prognostic Values of Clinical and Anthropometric Characteristics in Lateral Ankle Sprain Following Physiotherapy. J Foot Ankle Surg 2024; 63:495-501. [PMID: 38641313 DOI: 10.1053/j.jfas.2024.04.001] [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: 08/29/2023] [Revised: 03/06/2024] [Accepted: 04/06/2024] [Indexed: 04/21/2024]
Abstract
Lateral ankle sprain (LAS) is a common injury in sports and daily activities. The present study aimed to determine the prognostic value of clinical and anthropometric parameters in predicting LAS recovery after physiotherapy. Twenty-seven patients with acute LAS were included in this cohort study. First, prognostic factors and anthropometric variables were assessed, along with the time elapsed since the injury, pain score on a visual analogue scale (VAS), navicular drop, ankle range of motion (ROM), and ambulation status. Second, patients received physiotherapy, and their recovery status was assessed using the foot and ankle outcome score (FAOS) questionnaire immediately (first evaluation) and one month after physiotherapy (second evaluation). Univariate regression analysis and stepwise regression were used to evaluate the association between prognostic factors and outcome predictability. The results of this paper have shown that ambulation status was significantly correlated with all FAOS subscales in both the first and second evaluations, except for the FAOS-symptoms (FAOS-Sx) and FAOS-quality of life (FAOS-QOL) subscales in the first evaluation. The eversion ROM was significantly correlated with the FAOS-Sx and FAOS-Sports and Recreational activities (FAOS-Sport/Rec) subscales in the first evaluation. Additionally, age, height, and VAS were significantly correlated with FAOS-activity of daily living (FAOS-ADL) in the first evaluation, so this means that ambulation status is a valuable predictor of treatment success immediately and one month after physiotherapy intervention and compared to other FAOS subscales, the FAOS-QOL subscale is a more reliable predictor of the effectiveness of physiotherapy.
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Affiliation(s)
- Farzaneh Khazaei
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Hamid Heidarian Miri
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afsaneh Zeinalzadeh
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Salman Nazary-Moghadam
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Orthopaedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Ni M, Chen W, Zhao Q, Zhao Y, Yuan H. Deep Learning Approach for MRI in the Classification of Anterior Talofibular Ligament Injuries. J Magn Reson Imaging 2023; 58:1544-1556. [PMID: 36807381 DOI: 10.1002/jmri.28649] [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: 01/10/2023] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Diagnosing anterior talofibular ligament (ATFL) injuries differs among radiologists. Further assessment of ATFL tears is valuable for clinical decision-making. PURPOSE To establish a deep learning method for classifying ATFL injuries based on magnetic resonance imaging (MRI). STUDY TYPE Retrospective. POPULATION One thousand seventy-three patients from a single center with ankle MRI within 1 month of reference standard arthroscopy (in-group dataset), were divided into training, validation, and test sets in a ratio of 8:1:1. Additionally, 167 patients from another center were used as an independent out-group dataset. FIELD STRENGTH/SEQUENCE Fat-saturation proton density-weighted fast spin-echo sequence at 1.5/3.0 T. ASSESSMENT Patients were divided into normal, strain and degeneration, partial tear and complete tear groups (groups 0-3). The complete tear group was divided into five sub-groups by location and the potential avulsion fracture (groups 3.1-3.5). All images were input into AlexNet, VGG11, Small-Sample-Attention Net (SSA-Net), and SSA-Net + Weight Loss for classification. The results were compared with four radiologists with 5-30 years of experience. STATISTICAL TESTS Model performance was evaluated by the receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC), and so on. McNemar's test was used to compare performance among the different models, and between the radiologists and models. The intraclass correlation coefficient (ICC) was used to assess the reliability of the radiologists. P < 0.05 was considered statistically significant. RESULTS The average AUC of AlexNet, VGG11, SAA-Net, and SSA-Net + Weight Loss was 0.95, 0.99, 0.99, 0.99 in groups 0-3 and 0.96, 0.99, 0.99, 0.99 in groups 3.1-3.5. The effect of SSA-Net + Weight Loss was similar to SSA-Net but better than AlexNet and VGG11. In the out-group test set, the AUC of SSA-Net + Weight Loss ranged from 0.89 to 0.99. The ICC of radiologists was 0.97-1.00. The effect of SSA-Net + Weight Loss was better than each radiologist in the in-group and out-group test sets. DATA CONCLUSION Deep learning has potential to be used for classifying ATFL injuries. SSA-Net + Weight Loss has a better diagnostic effect than radiologists with different experience levels. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ming Ni
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Wen Chen
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Qiang Zhao
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Yuqing Zhao
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China
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Li D, Tang Q, Liu Q, Hu J, Mao M, Deng T, Liao L, Zhu W. Arthroscopic anterior talofibular ligament repair with Internal Brace and lasso-loop technique for chronic ankle lateral instability. INTERNATIONAL ORTHOPAEDICS 2022; 46:2821-2828. [PMID: 36069956 DOI: 10.1007/s00264-022-05541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To introduce the surgical technique and clinical outcomes of arthroscopic anterior talofibular ligament (ATFL) repair using the Internal Brace and lasso-loop technique for chronic ankle lateral instability. METHODS A retrospective study was performed on 29 patients who underwent all-arthroscopic ATFL repair with the Internal Brace and lasso-loop technique from January to August 2020. The patients included 24 males and five females, with a mean age of 30.17 years. Through the accessory anterolateral (AAL) portal, we drilled the bone tunnels and fixed the tape with 4.75 mm and 3.5 mm "SwiveLock" anchors and reattached the torn ligament by the lasso-loop technique. RESULTS All 29 patients underwent all-arthroscopic procedures smoothly without serious complications, such as infection and important nerve or vessel injuries. There were eight cases of lateral malleolar avulsion fractures and ten cases of talus cartilage injury. The visual analog scale (VAS), Karlsson-Peterson, Tegner, and American Orthopedic Foot and Ankle Society (AOFAS) scores were used to evaluate the clinical consequences. All the patients were followed up for 18.66 ± 4.85 months on average. The average pre-operative VAS score was 4.69 ± 1.04, which was significantly higher than the average post-operative VAS score of 1.14 ± 1.56. At the final follow-up appointments, the averages of Karlsson-Peterson, AOFAS, and Tenger scores were 75.83 ± 9.44, 88.31 ± 6.81, and 6.93 ± 1.79, respectively, which was significantly higher than that before the operation. CONCLUSION This arthroscopic anterior talofibular ligament repair with the Internal Brace and lasso-loop technique achieves satisfactory clinical outcomes with the benefits of high safety and reliability for chronic ankle lateral instability.
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Affiliation(s)
- Ding Li
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Qi Tang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Qian Liu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Junjiao Hu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Minzhi Mao
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Ting Deng
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Lele Liao
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
| | - Weihong Zhu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
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Xiong S, Xie X, Shi W, Chen L, Jiang D, Jiao C, Hu Y, Guo Q. Treatment of Symptomatic Subfibular Ossicle by Excision and Modified Broström Procedure for Skeletally Immature Patients. Foot Ankle Int 2022; 43:1554-1561. [PMID: 36259105 DOI: 10.1177/10711007221125795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ossicle resection combined with ligament repair using the modified Broström procedure (MBP) is generally associated with favorable results in adults with symptomatic subfibular ossicles; however, the surgical results of this approach in skeletally immature patients remain unclear. The purpose of this study was to investigate the midterm clinical outcomes and radiographic outcomes including leg length and physeal growth of skeletally immature patients after this procedure. METHODS Twenty-six consecutive skeletally immature patients who underwent ossicle resection combined with the MBP were retrospectively evaluated. Clinical scores were evaluated using the visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Karlsson-Peterson score, and Tegner score. The talocrural angle, fibular length on radiographs, and tape-measured leg length between the 2 ankles were also measured at the final follow-up. Time of return to sports and postoperative complications were also evaluated. RESULTS Fourteen girls (53.8%) and 12 boys (46.2%) had surgery at a mean age of 12.7±2.4 years. Mean postoperative follow-up time was 40.0±10.8 months. Mean VAS pain score improved from 4.1 preoperatively to 0.5 at final follow-up (P < .05). Mean AOFAS score, Karlsson score, and Tegner score all improved from 62.0, 54.0, and 2.8 preoperatively to 95.5, 94.0, and 5.4 (P < .05), respectively, at final follow-up. Median time of return to sports was 17.0 weeks. Mean talocrural angle, fibular length, and tape-measured leg length of the injured ankle were not significantly different from those of the contra-side at the final follow-up. All patients were satisfied with the results; repeat ligamentous injury occurred in 2 patients (7.7%). We had no cases of wound infection, nerve injury, compartment syndrome, or any other complications. CONCLUSION Ossicle resection combined with the MBP performed in skeletally immature patients with symptomatic subfibular ossicles resulted in improved clinical outcomes without disruption of fibular physeal growth by an average of 3.3-year follow-up. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Shikai Xiong
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Xing Xie
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Weili Shi
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Linxin Chen
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yuelin Hu
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Qinwei Guo
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
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Sugimoto K, Isomoto S, Samoto N, Matsui T, Tanaka Y. Comparison of symptomatic unstable ankle with and without os subfibulare. J Orthop Sci 2022; 28:603-606. [PMID: 35144867 DOI: 10.1016/j.jos.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/25/2021] [Accepted: 01/16/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study aimed to compare the patients background, clinical scores, condition of the lateral ligament, mechanical instabilities, and chondral lesions in ankles with symptomatic os subfibulare compared to those in ankles with chronic lateral instability without os subfibulare. METHODS Of the 212 ankles with a chronic lateral instability that were surgically treated, 72 ankles had an os subfibulare. All ankles were examined by arthroscopy during surgery. Age, sex, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale scores, remnant condition of the lateral ligaments, and chondral lesions were compared between ankles with symptomatic os subfibulare and ankles with chronic lateral instability without os subfibulare. RESULTS There were no statistically significant differences between the groups in terms of the sex ratio (males: females, 35:37 vs. 53:87, n.s.) and the AOFAS Ankle-Hindfoot Scale scores (median; 75 vs. 77, n.s.). There were statistically significant differences in patient age (median: 20 vs. 24.5 years, p < 0.01), talar tilt angle (median: 9.0° vs 12.0°, p < 0.01), anterior drawer distance (6.2 vs. 7.0 mm, p < 0.01), chondral lesions (G0:G1:G2:G3, 35:21:66:5 vs. 40:44:27:29, p < 0.01), condition of the anterior talofibular ligament (intact: repairable remnant: poor remnant, 0:70:2 vs. 1:112:27, p < 0.01), and condition of the calcaneofibular ligament (intact: repairable remnant: poor remnant, 44:26:2 vs. 77:35:28, p < 0.01) between the groups. CONCLUSION This study suggests that the condition of the lateral ligaments including mechanical instability and cartilage of the ankle were less severe in the ankles with symptomatic os subfibulare than in those with chronic lateral instability without os subfibulare. The patients' age was lower in the ankles with symptomatic os subfibulare than in those with chronic lateral instability without os subfibulare. The clinical scores and gender ratio were not statistically different between the group.
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Affiliation(s)
- Kazuya Sugimoto
- Nara Prefecture General Medical Center, Narshi, Nara, 6308581 Japan.
| | - Shinji Isomoto
- Nara Prefecture General Medical Center, Narshi, Nara, 6308581 Japan
| | | | - Tomohiro Matsui
- Imperial Gift Saiseikai Nara Hospital, Nara-shi Nara, 6308145 Japan
| | - Yasuhito Tanaka
- Nara Medical University, School of Medicine, Kashihara-shi, Nara, 6348522 Japan
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唐 一, 梁 晓, 赵 宏, 张 言. [Progress in diagnosis and treatment of fibular fracture in ankle fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:117-121. [PMID: 35038809 PMCID: PMC8844619 DOI: 10.7507/1002-1892.202108091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/11/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To summarize the diagnosis and treatment of fibular fracture in ankle fracture. METHODS Relevant literature at home and abroad in recent years was widely consulted, and various types of fractures were discussed and summarized according to Danis-Weber classification. RESULTS Conservative treatment is not an ideal treatment for type A avulsion fracture. The operation method should be determined according to the position and size of bone mass. For simple type B fracture, both conservative treatment and surgical treatment can achieve good results. When the position of type C fracture is high and does not affect the stability of ankle joint, it can be treated conservatively, while when the position is low and affects the stability of ankle joint, it needs surgical treatment. CONCLUSION First of all, whether the fibular fracture in the ankle fracture is stable or not should be determined. Whether it is treated surgically or not, the purpose is to restore the tibiofibular syndesmosis and restore the motor function of the ankle.
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Affiliation(s)
- 一丁 唐
- 西安医学院附属红会医院足踝外科(西安 710054)Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi’an Medical College, Xi’an Shaanxi, 710054, P. R. China
| | - 晓军 梁
- 西安医学院附属红会医院足踝外科(西安 710054)Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi’an Medical College, Xi’an Shaanxi, 710054, P. R. China
| | - 宏谋 赵
- 西安医学院附属红会医院足踝外科(西安 710054)Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi’an Medical College, Xi’an Shaanxi, 710054, P. R. China
| | - 言 张
- 西安医学院附属红会医院足踝外科(西安 710054)Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi’an Medical College, Xi’an Shaanxi, 710054, P. R. China
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Cao Y, Xu Y, Huang Q, Xu Y, Hong Y, Xu X. Outcomes of ossicle resection and anatomic reconstruction of lateral ligaments for chronic ankle instability with large malleolar accessory ossicles. Foot Ankle Surg 2021; 27:736-741. [PMID: 33046382 DOI: 10.1016/j.fas.2020.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 09/13/2020] [Accepted: 09/21/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Malleolar accessory ossicles can be found in patients with chronic lateral ankle instability (CLAI). Ossicle resection combined with the modified Broström procedure is the most commonly used surgical method. However, an unrepairable gap after ossicle resection often occurs in patients with large ossicles. PURPOSE This study analysed the clinical outcomes of ossicle resection and anatomic ligament reconstruction (ALR) for CLAI with large malleolar accessory ossicles. METHODS This study was a retrospective case series. Since 2014, we have adopted ALR for patients with difficulties using the modified Broström procedure after ossicle resection. Sixteen patients with chronic ankle instability and malleolar accessory ossicles were treated with this method between December 2014 and February 2018. The average age of the patients at the time of surgery was 28.9 (range, 16-65) years. They were followed up for an average time of 26.9 (range, 12-47) months. The clinical outcomes were evaluated using the Visual Analogue Scale, Karlsson-Peterson ankle scoring system, subjective satisfaction of patients, and radiographic parameters. RESULTS All unrepairable cases occurred in patients with ossicles larger than or equal to 10 mm. The VAS score improved from 3.5 ± 1.6 preoperatively to 1.4 ± 1.0 at the final follow-up (p < 0.05), and the Karlsson-Peterson score improved significantly from 52.7 ± 15.1 to 86.4 ± 8.2 (p < 0.05). There was also an obvious change in the varus talar tilt angle (15.4 ± 2.0° vs 6.2 ± 1.6°, p < 0.05) and anterior talar displacement (14.3 ± 2.1 mm vs 6.3 ± 1.4 mm, p < 0.05). Fourteen patients (87.5%) were satisfied (excellent or good) with their clinical outcomes. CONCLUSION If modified Broström procedure is difficult to accomplish effectively after ossicle resection for chronic ankle instability with large malleolar accessory ossicles, ALR is a viable option with satisfactory clinical results.
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Affiliation(s)
- Yongxing Cao
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Orthopedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yangbo Xu
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Qiang Huang
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Orthopedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Xu
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Orthopedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Hong
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Orthopedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangyang Xu
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Orthopedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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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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Feng SM, Sun QQ, Wang AG, Zhang ZY, Hao L. Long-term functional outcomes of all-inside arthroscopic repair of anterior talofibular ligament avulsion fracture. Foot Ankle Surg 2021; 27:156-161. [PMID: 32414701 DOI: 10.1016/j.fas.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/26/2020] [Accepted: 03/22/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The main purpose of this study was to describe the all-inside arthroscopic technique for repairing anterior talofibular ligament (ATFL) avulsion fractures at the attachment points of the fibula and talus, and to evaluate the functional outcomes during long-term follow-up. METHODS The data of 78 patients with ATFL avulsion fracture treated in our hospital from August 2013 to November 2016 were analyzed retrospectively. All patients underwent surgery. Patients were divided into two groups according to whether they had undergone all-inside arthroscopic treatment or open treatment. The American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), Foot and Ankle Outcome Score (FAOS) and a 36-item Short Form Health Survey questionnaire (SF-36) were used to evaluate functional outcomes. RESULTS The postoperative follow-up period was 24-48 months. All patients reported subjective improvements to ankle stability without any nerve, blood vessel or tendon complications. At the final follow-up, there was no significant difference in the AOFAS, SF-36 or sport participation rate between the arthroscopic group and the open group; however, the KAFS and FAOS were significantly higher in the arthroscopic group than in the open group. CONCLUSIONS For ATFL avulsion fractures, the all-inside ankle arthroscopic procedure produced better outcomes than did the open procedure. The all-inside ankle arthroscopic procedure provides a minimally invasive technique with acceptable long-term functional outcomes.
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Affiliation(s)
- Shi-Ming Feng
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China; Professor of Medicine, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China.
| | - Qing-Qing Sun
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China; Professor of Medicine, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China
| | - Ai-Guo Wang
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China
| | - Zai-Yi Zhang
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China
| | - Lin Hao
- Professor of Medicine, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China; Surgical Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China.
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Murata K, Kumai T, Hirose N. Lateral Ankle Sprains and Their Association with Physical Function in Young Soccer Players. Open Access J Sports Med 2021; 12:1-10. [PMID: 33469390 PMCID: PMC7811480 DOI: 10.2147/oajsm.s283421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/03/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose Lateral ankle sprain (LAS) in childhood can result in lateral malleolus avulsion fractures; additionally, bone nonunion may occur. Physical maturity relates to the development of bone morphology and physical functionality. It is unknown how changes in physical functionality attributable to physical maturity affect young soccer players with abnormal lateral malleolus (ALM) morphology. Hence, the present study aimed to investigate the bone morphology of the lateral malleolus in young soccer players and to examine its relationship with physical functionality at different maturity levels. Subjects and Methods Two hundred and ninety young soccer players aged 6–15 years were included. The presence of ALM was assessed using ultrasonography. The subjects were allocated to three groups based on physical maturity (Pre-, Mid-, and Post-peak height velocity age [PHVA]). The prevalence of ALM and the relationship between ALM and physical maturity were examined for body composition, foot pressure distribution, foot alignment, ankle mobility, and single-leg balance. Results The prevalence of ALM was 17.6%. For physical maturity, the post-PHVA group showed a decrease in ankle dorsiflexion and eversion and an increase in one-leg hop distance compared to the Pre-PHVA group (P < 0.05). In the ALM group, the center of pressure during heel raising was distributed laterally in the Post-PHVA (P < 0.01), and the weight-bearing dorsiflexion angle was decreased in the Mid- and Post-PHVA (P < 0.05). Conclusion In the Post-PHVA young soccer players, decreased ankle dorsiflexion and eversion and increased one-leg hop distance were observed. The ALM group exhibited lateral loading during heel raising in the Post-PHVA group and decreased weight-bearing ankle dorsiflexion angle in the Mid- and Post-PHVA groups. The findings indicate the importance of secondary prevention of LAS and ultrasonography. Prospective studies of LAS in young athletes are required in the future.
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Affiliation(s)
- Kenichiro Murata
- Graduate School of Sport Sciences, Waseda University, Nishi-tokyo, Japan
| | - Tsukasa Kumai
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Norikazu Hirose
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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Yin Q, Rui Y, Wu Y, Liu J, Ma Y, Gu S, Zhou M, Yu J. Surgical treatment of avulsion fracture around joints of extremities using hook plate fixation. BMC Musculoskelet Disord 2019; 20:200. [PMID: 31077172 PMCID: PMC6511219 DOI: 10.1186/s12891-019-2585-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/23/2019] [Indexed: 11/10/2022] Open
Abstract
Purpose This study proposed to access the clinical outcome of avulsion fractures around joints of extremities using the hook plate. Methods A total of 60 patients with avulsion fractures of joints admitted in our hospital between January 2011 and June 2016 were performed the surgery of hook plate fixation. Functional recovery was evaluated using the Lysholm knee score, Kaikkonen ankle injury score, Mayo elbow and wrist function score, and Neer shoulder function score. Results All the patients were healed within 3 months after surgery with stage I healing incision without vascular or nerve injuries. The average follow-up period was 18.1 months. At the last follow-up, no instability of joints, looseness of internal fixation or traumatic arthritis was observed. Mild joint fibrosis occurred in 5 cases. A total of 57 patients were well recovered with the excellent and good rate of 95%. Three patients with humeral avulsion fracture of the greater tuberosity had shoulder joint adhesion and peri humeral inflammation at the last follow-up due to the poor cooperation for early rehabilitation exercise. In the last follow-ups, the functional score of the affected limb was markedly greater than that in the 3-month follow-ups (p < 0.05). Conclusion Hook plate fixation has the therapeutic effect on treating avulsion fractures around joints of extremities with the advantages of reliable fixation, early rehabilitation after operation, high recovery rates of joint function, wide indications, and convenient uses.
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Affiliation(s)
- Qudong Yin
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No.999 Liangxi Rd, Wuxi, 214062, Jiangsu Province, People's Republic of China
| | - Yongjun Rui
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No.999 Liangxi Rd, Wuxi, 214062, Jiangsu Province, People's Republic of China
| | - Yongwei Wu
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No.999 Liangxi Rd, Wuxi, 214062, Jiangsu Province, People's Republic of China.
| | - Jun Liu
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No.999 Liangxi Rd, Wuxi, 214062, Jiangsu Province, People's Republic of China
| | - Yunhong Ma
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No.999 Liangxi Rd, Wuxi, 214062, Jiangsu Province, People's Republic of China
| | - Sanjun Gu
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No.999 Liangxi Rd, Wuxi, 214062, Jiangsu Province, People's Republic of China
| | - Mingxia Zhou
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No.999 Liangxi Rd, Wuxi, 214062, Jiangsu Province, People's Republic of China
| | - Jiwen Yu
- Department of Orthopaedics, Lianyungang People's Hospital, Lianyungang, 222002, China
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