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Ryan PM, Eakin JL, Goodrum JT. Subtle Syndesmotic Instability. J Am Acad Orthop Surg 2024; 32:719-727. [PMID: 38295390 DOI: 10.5435/jaaos-d-23-00707] [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: 08/12/2023] [Indexed: 02/02/2024] Open
Abstract
Latent or subtle syndesmotic instability is defined as an injury to the syndesmosis which is not apparent on static radiographs of the ankle. Syndesmotic injuries have also been referred to as high ankle sprains. Injury to the syndesmosis typically occurs with collision sports and often involves an external rotation force to the ankle. Diagnosis can be delayed because of negative initial imaging studies. Physical examination tests including the external rotation test, proximal squeeze test, and fibular shuck test can assist in the diagnosis. Advanced imaging modalities such as MRI and weight-bearing CT have been studied and can provide prognostic indications for management, although arthroscopic stress evaluation remains the benchmark for diagnosis. Both surgical and nonsurgical management techniques have been described, which can assist patients in returning to their preinjury level of function.
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Affiliation(s)
- Paul M Ryan
- From the Lake Tahoe Sports Medicine Fellowship, Department of Surgery, Barton Memorial Hospital, South Lake Tahoe, CA (Ryan, Eakin, Goodrum), University of Nevada, Reno School of Medicine, Reno, NV (Ryan), Uniformed Services University, Bethesda, MD (Ryan)
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Chen J, Peng X, Yang Y, Tang X, Yang S, Liu T, Shi H, Zhang L. In Different Gender Groups, What Is the Impact of the Fibular Notch on the Severity of High Ankle Sprain: A Retrospective Study of 360 Cases. Orthop Surg 2023; 15:2557-2565. [PMID: 37537373 PMCID: PMC10549795 DOI: 10.1111/os.13833] [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: 02/10/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVES The role of the distal tibiofibular ligament in the occurrence of high ankle sprain (HAS) has been widely studied. But previous studies have overlooked the physiological and anatomical differences between males and females and have not further refined gender. Therefore, the impact of the anatomical morphology of fibular notch (FN) on HAS in different genders is still unclear. This study aimed to explore the impact of different types of FN on the severity of HAS and to estimate the prognosis of patients with HAS while excluding anatomical differences caused by gender. METHODS One hundred and eighty patients with HAS were included in this study as the experimental group (i.e., HAS group). They were further divided into four groups according to gender and FN depth, with deep concave FN ≥ 4 mm and shallow flat FN < 4 mm. Another 180 normal individuals were set as the control group. The FN morphological indicators, tibiofibular distance (TFD), and ankle mortise indexes were measured and compared with those in HAS group. The independent t-test was used to compare continuous variables between groups, the intraclass correlation coefficient (ICC) was used to analyze the reliability of intra-observer measurement, and the Pearson correlation coefficient was used to verify the correlation between FN and the severity of HAS. RESULTS In males with shallow flat type, the measurements of anterior tibiofibular distance (aTFD), middle tibiofibular distance (mTFD), posterior tibiofibular distance (pTFD), front ankle mortise width (fAMW), middle ankle mortise width (mAMW), posterior ankle mortise width (pAMW), and depth of ankle mortise (DOAM) in HAS group were significantly larger than those in normal group (p < 0.05). In male patients with deep concave type, the measurements of aTFD, mTFD, fAMW, mAMW, and DOAM were significantly larger than those in normal group (p < 0.05). Among female patients with shallow flat type, the measurements of aTFD, mTFD, pTFD, fAMW, mAMW, pAMW, and DOAM were found to be significantly larger than those in normal group (p < 0.05). Among female patients with deep concave type, the measurements of mTFD, pTFD, fAMW, mAMW, and DOAM were found to be significantly larger than those of the normal group (p < 0.05). The depth of FN was negatively correlated with TFD, and the AOFAS score of patients with shallow flat type was significantly lower than that of patients with deep concave type after treatment (p < 0.05). CONCLUSIONS In different gender groups, compared with the normal controls, the TFD and partial ankle mortise indices were significantly different in HAS patients. Moreover, FN depth was negatively correlated with TFD, and the AOFAS score of shallow flat patients was significantly lower than that of deep concave patients. These suggested that shallow flat FN may be associated with more severe distal tibiofibular ligament injury and ankle mortise widening, leading to poorer prognosis. This should be taken seriously in clinical practice.
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Affiliation(s)
- Junyao Chen
- School of Clinical MedicineSouthwest Medical UniversityLuzhouChina
| | - Xiaoyao Peng
- School of Clinical MedicineSouthwest Medical UniversityLuzhouChina
| | - Yuening Yang
- School of Clinical MedicineSouthwest Medical UniversityLuzhouChina
| | - Xiangyu Tang
- School of Clinical MedicineSouthwest Medical UniversityLuzhouChina
| | - Siyi Yang
- School of Integrated Traditional Chinese and Western MedicineSouthwest Medical UniversityLuzhouChina
| | - Tianyu Liu
- School of Clinical MedicineSouthwest Medical UniversityLuzhouChina
| | - Houyin Shi
- Department of OrthopedicsThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhouChina
| | - Lei Zhang
- Department of OrthopedicsThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhouChina
- Center for Orthopedic Diseases ResearchThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhouChina
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Mutschler M, Naendrup JH, Pfeiffer TR, Jaecker V, Arbab D, Shafizadeh S, Buchhorn T. Current status of the management of isolated syndesmotic injuries in Germany. Arch Orthop Trauma Surg 2023; 143:2019-2026. [PMID: 35403865 PMCID: PMC10030432 DOI: 10.1007/s00402-022-04423-3] [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: 10/06/2021] [Accepted: 03/10/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Although non-fracture-related syndesmotic injuries of the ankle are relatively rare, they may lead to poor clinical outcome if initially undiagnosed or managed improperly. Despite a variety of literature regarding possibilities for treatment of isolated syndesmotic injuries, little is known about effective applications of different therapeutic methods in day-to-day work. The aim of this study was to assess the current status of the treatment of isolated syndesmotic injuries in Germany. MATERIALS AND METHODS An online-questionnaire, capturing the routine diagnostic workup including clinical examination, radiologic assessment and treatment strategies, was sent to all members of the German Society of Orthopedic Surgery and Traumatology (DGOU) and Association of Arthroscopic and Joint Surgery (AGA). Statistical analysis was performed using Microsoft excel and SPSS. RESULTS Each question of the questionnaire was on average answered by 431 ± 113 respondents. External rotation stress test (66%), squeeze test (61%) and forced dorsiflexion test (40%) were most commonly used for the clinical examination. In the diagnostic workup, most clinicians relied on MRI (83%) and conventional X-ray analysis (anterior-posterior 58%, lateral 41%, mortise view 38%). Only 15% of the respondents stated that there is a role for arthroscopic evaluation for the assessment of isolated syndesmotic injuries. Most frequently used fixation techniques included syndesmotic screw fixation (80%, 42% one syndesmotic screw, 38% two syndesmotic screws), followed by suture-button devices in 13%. Syndesmotic screw fixation was mainly performed tricortically (78%). While 50% of the respondents stated that syndesmotic screw fixation and suture-button devices are equivalent in the treatment of isolated syndesmotic injuries with respect to clinical outcome, 36% answered that syndesmotic screw fixation is superior compared to suture-button devices. CONCLUSIONS While arthroscopy and suture-button devices do not appear to be widely used, syndesmotic screw fixation after diagnostic work-up by MRI seems to be the common treatment algorithm for non-fracture-related syndesmotic injuries in Germany.
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Affiliation(s)
- Manuel Mutschler
- Witten/Herdecke University, Witten/Herdecke, Germany, Alfred-Herrhausen-Straße 50, 58448.
- Department of Foot Surgery, Waldkrankenhaus Bonn, Johanniter GmbH, Bonn, Germany, Waldstraße 73, 53177.
| | - Jan-Hendrik Naendrup
- Department of Trauma Surgery, Orthopaedic Surgery and Sports Traumatology, Witten/Herdecke University, Cologne Merheim Medical Centre, Cologne, Germany
- Department of Oncology, HaematologyInfectiology and Internistic Critical Care Medicine, University of Cologne, Cologne, Germany
| | - Thomas R Pfeiffer
- Department of Trauma Surgery, Orthopaedic Surgery and Sports Traumatology, Witten/Herdecke University, Cologne Merheim Medical Centre, Cologne, Germany
| | - Vera Jaecker
- Department of Trauma Surgery, Orthopaedic Surgery and Sports Traumatology, Witten/Herdecke University, Cologne Merheim Medical Centre, Cologne, Germany
| | - Dariusch Arbab
- Witten/Herdecke University, Witten/Herdecke, Germany, Alfred-Herrhausen-Straße 50, 58448
- Department of Orthopaedic Surgery, Klinikum Dortmund, Dortmund, Germany
| | - Sven Shafizadeh
- Witten/Herdecke University, Witten/Herdecke, Germany, Alfred-Herrhausen-Straße 50, 58448
- Department of Trauma Surgery, Orthopaedic Surgery and Sports Traumatology, Sana Medical Centre Cologne, Cologne, Germany
| | - Tomas Buchhorn
- Foot and Ankle Department, Sporthopaedicum Straubing-Regensburg, Straubing, Germany
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Nichols JA, Baratta C, Reb CW. Biomechanical Sequelae of Syndesmosis Injury and Repair. Foot Ankle Clin 2023; 28:77-98. [PMID: 36822690 DOI: 10.1016/j.fcl.2022.10.004] [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] [Indexed: 01/04/2023]
Abstract
This review characterizes fibula mechanics in the context of syndesmosis injury and repair. Through detailed understanding of fibula kinematics (the study of motion) and kinetics (the study of forces that cause motion), the full complexity of fibula motion can be appreciated. Although the magnitudes of fibula rotation and translation are inherently small, even slight alterations of fibula position or movement can substantially impact force propagation through the ankle and hindfoot joints. Accordingly, implications for clinical care are discussed.
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Affiliation(s)
- Jennifer A Nichols
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL 32611, USA; Department of Orthopaedic Surgery & Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32607, USA.
| | - Chloe Baratta
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL 32611, USA
| | - Christopher W Reb
- Orthopaedics, Veterans Health Administration North Florida / South Georgia Health System, Malcolm Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608, USA
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Kramer Z, Woo Lee Y, Sherrick R. Acute Ankle Sprains. Clin Podiatr Med Surg 2023; 40:117-138. [PMID: 36368838 DOI: 10.1016/j.cpm.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Understanding the types of ankle sprains is essential in determining the most appropriate treatment and preventing substantial missed time from sports. Commonly known and recognized is an acute lateral ankle sprain, however, a differentiation should also be made to understand high (syndesmotic) ankle sprains as the mechanism of injury and recovery periods differ between these two types.
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Affiliation(s)
- Zachary Kramer
- Scripps Memorial Hospital, 310 Santa Fe Drive #112, Encinitas, CA 92024, USA
| | - Yessika Woo Lee
- Dignity Health, St. Mary's Medical Center, 450 Stanyan Street, San Francisco, CA 94117, USA.
| | - Ryan Sherrick
- Foot & Ankle Surgery, Innovative Medical Solutions Foot & Ankle Institute, 2080 Century Park East, STE 710, Los Angeles, CA 90067, USA
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Elite Athletes Successfully Return to the Preinjury Level of Sport Following Ankle Syndesmosis Injuries: A Systematic Review and Meta-Analysis. Clin J Sport Med 2023; 33:90-96. [PMID: 36599363 DOI: 10.1097/jsm.0000000000001019] [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: 01/26/2021] [Accepted: 12/31/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To comprehensively review and report the outcomes of ankle syndesmotic injury management in elite athletes. DATA SOURCES Three databases were searched for articles reporting the rate of return to sport following treatment of ankle syndesmotic injuries in elite athletes (collegiate or professional level). Ten articles and 440 athletes were included. Articles reporting the rate of return to sport following high ankle sprain injury in elite athletes. Data collected included demographics, type of treatment received, and return to sport (RTS) information. A random effects model was used. MAIN RESULTS The estimated overall rate of RTS was 99% (95% CI, 95.5-99.9). The mean time to RTS was 38 ± 18 (range, 14-137) days. Of the 440 athletes, 269 (269/440%, 61%) were treated nonoperatively (nonoperative group); the rate of RTS was 99.6%, and the athletes returned at a mean time of 29 ± 14 (range, 13-45) days. A total of 171 athletes (171 of 440%, 39%) underwent surgical treatment (operative group). All (171 of 171%, 100%) athletes returned at a mean time of 50.3 ± 13 (range, 41-137) days. Almost all athletes who underwent surgery had suture button fixation (164 of 171 athletes, 96%), and the mean time to RTS was 7 weeks with 9.1% complication rate. CONCLUSIONS Elite athletes with ankle syndesmosis injury return to sport at an extremely high rates, following operative or nonoperative treatment. Return to the preinjury level of competition should be expected at 4 weeks and 7 weeks in high-level athletes who undergo nonoperative and operative management, respectively. Suture button fixation was used by the majority of studies reporting surgical management of ankle syndesmosis injuries in athletes.
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Hogan MV, Boakye L, James NA, Brown CL, Yan AA. Syndesmosis Injury. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Shumway JD, Vraa D. Short-Term Effect of Manual Therapy & Taping on Subacute Ankle Sprains with Potential Syndesmotic Sprain: A Case Series. J Man Manip Ther 2021; 30:116-123. [PMID: 34511056 DOI: 10.1080/10669817.2021.1974240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
STUDY DESIGN Case Series. BACKGROUND Syndesmotic ankle sprains can occur in up to 17% of ankle trauma and can lead to long-term disability. This study describes the management of seven patients with subacute, high-grade ankle sprains with concerns of concurrent syndesmotic strain utilizing manual therapy and rigid sports taping. METHODS Seven active duty military members with clinically diagnosed, high-grade ankle sprains and concern for syndesmotic sprain participated in this case series. All patients received multi-modal treatment consisting of manual therapy, rigid sports taping, progressive exercises, and proprioceptive training. Decrease in Numeric Pain Rating Scale (NPRS) following manual therapy and taping treatment, number of sessions before discharge, and the Global Rating of Change (GROC) at discharge were retrospectively reviewed. RESULTS All patients demonstrated an immediate decrease in NPRS following treatment on average of 5 points (range, 3-8 points) with a functional asterisk sign. The improvement in pain and function was maintained until the next treatment session with a mean GROC score of +3. The mean time until recovery was 5.4 weeks (range, 1-8 weeks). DISCUSSION A multimodal approach for patients diagnosed clinically with high-grade ankle sprains and concern for syndesmotic sprain was useful to immediately reduce pain and improve function, and improvements were maintained throughout the duration of care. This study is the first to assess a combination of manual therapy and rigid sports taping for the treatment of suspected syndesmotic ankle sprains, and more stringent research is needed to validate the findings. LEVEL OF EVIDENCE Therapy, 4.
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Affiliation(s)
- Joshua D Shumway
- Operational Medicine Readiness Squadron, Langley AFB, VA, United States.,Tactical Sports and Orthopedic Manual Physical Therapy Fellowship, US Air Force Academy, CO, United States
| | - Derek Vraa
- Tactical Sports and Orthopedic Manual Physical Therapy Fellowship, US Air Force Academy, CO, United States
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Haksever B, Duzgun I, Baltaci G. The Dynamic Innovative Balance System Improves Balance Ability: A Single Blind, Randomized Controlled Study. Int J Sports Phys Ther 2021; 16:1025-1032. [PMID: 34386281 PMCID: PMC8329320 DOI: 10.26603/001c.25756] [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: 12/04/2020] [Accepted: 04/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Functional balance training is crucial for both rehabilitation and prevention. A Dynamic Innovative Balance System (DIBA) is readily available for utilization in both functional and postural control training in a wide variety of dynamic conditions. PURPOSE The purpose of this study was to compare the effectiveness of the DIBA and standard balance training tools on dynamic and static balance. STUDY DESIGN Randomized controlled trial. METHODS Thirty-six healthy males (18 to 32 years) were randomly assigned to group DIBA (n=18) or to the control group (n=18) who performed balance training using a balance board, a wobble board, the BOSU, or a soft cushion block for eight weeks. Each participant was assessed before training, at the end of the fourth and eighth week by using the Flamingo balance test (FBT) for assessing static balance ability and using Y-Balance Test (YBT) for dynamic balance ability. RESULTS No significant differences were found in FBT and YBT between the DIBA and control groups at the end of fourth week (p>0.05). However, at the end of the eighth week, the DIBA group demonstrated statistically significantly better balance ability on the anterior component of YBT (p=0.001) and FBT (p=0.024) than controls. CONCLUSION The results of this study suggest that the DIBA was effective in both static and dynamic balance training and it may be used alongside other balance tools in a clinical setting. Further studies should include in lower extremity problems to confirm that DIBA training adaptations are transferred to clinical improvements in performance and balance qualities. LEVEL OF EVIDENCE 2d.
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Moore ML, Haglin JM, Hassebrock JD, Anastasi MB, Chhabra A. Management of ankle injuries in professional basketball players: Prevalence and rehabilitation. Orthop Rev (Pavia) 2021; 13:9108. [PMID: 33953893 PMCID: PMC8077287 DOI: 10.4081/or.2021.9108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/27/2021] [Indexed: 11/23/2022] Open
Abstract
Basketball is a popular internationally played sport. With the physical requirements the game has on athletes, players are at risk of injury. Ankle injuries are the most common injury type suffered by basketball players. In this comprehensive review, we present an analysis and overview of the most common ankle injuries among basketball players, including sprains, fractures, impingement, and Achilles tendon pathology. The review includes treatment modalities for such injuries. More research is warranted regarding prevention strategies.
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Affiliation(s)
- M. Lane Moore
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ
| | - Jack M. Haglin
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ
| | | | | | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
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Abstract
Foot and ankle pathology is common in the pediatric population. Common issues may be traumatic in nature, congenital, or age dependent. This article reviews common problems and pathology found in the pediatric foot and ankle.
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Affiliation(s)
- Aron Green
- Seaview Orthopedic & Medical Associates, 1200 Eagle Avenue, Ocean, NJ 07712, USA.
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McKiernan S, Fenech M, Fox D, Stewart I. Sonography of the ankle: The lateral ankle and ankle sprains. SONOGRAPHY 2017. [DOI: 10.1002/sono.12120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Wolfinger CR, Davenport TE. PHYSICAL THERAPY MANAGEMENT OF ICE HOCKEY ATHLETES: FROM THE RINK TO THE CLINIC AND BACK. Int J Sports Phys Ther 2016; 11:482-95. [PMID: 27274432 PMCID: PMC4886814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND The increasing number of athletes playing hockey compels rehabilitation professionals working in orthopedic and sports settings to understand the unique functional demands of ice hockey and the patterns of injuries they may promote. PURPOSE The purpose of this clinical perspective is to: (1) discuss the functional implications of different positions and age levels on injury prevalence within the sport; (2) summarize the seven most common injuries sustained by ice hockey athletes; and (3) present a conceptual model for the clinical management and prevention of these injuries by rehabilitation professionals. METHODS A narrative review and synthesis was conducted of currently available literature on prevalence, etiology, rehabilitative intervention, prognosis, and prevention of ice hockey injuries. RESULTS Research evidence is available to support the prevalence of injuries sustained while participating in ice hockey, as well as the most effective clinical treatment protocols to treat them. Most of the existing protocols are based on clinical and sports experience with incorporation of scientific data. CONCLUSION This clinical commentary reviews the current concepts of ice hockey injury care and prevention, based on scientific information regarding the incidence, mechanism, rehabilitation protocols, prognosis, and prevention of injuries. Science-based, patient-centered reasoning is integral to provide the highest quality of rehabilitative and preventative care for ice hockey athletes by physical therapists. LEVEL OF EVIDENCE 5.
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Affiliation(s)
| | - Todd E. Davenport
- Department of Physical Therapy, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, California, USA
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Ryan PM, Rodriguez RM. Outcomes and Return to Activity After Operative Repair of Chronic Latent Syndesmotic Instability. Foot Ankle Int 2016; 37:192-7. [PMID: 26385610 DOI: 10.1177/1071100715606488] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study is a retrospective review of prospectively gathered data determining the postoperative outcomes of patients who underwent operative treatment to address chronic syndesmotic instability. METHODS The cohort is composed of 19 individuals who elected to undergo operative treatment of chronic syndesmotic instability. The operative repair consisted of arthroscopic debridement in all cases with reduction and suture button fixation of those patients who had greater than 4 mm of syndesmotic diastasis on arthroscopic evaluation. All patients had a minimum of 24 months follow-up. This study retrospectively examined the prospectively gathered preoperative and postoperative outcome scores to include a Visual Analog Scale (VAS) pain score and an American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. In addition, patients were questioned on their ability to return to their preinjury level of activity and their ability to continue running sports. Fourteen patients returned their postoperative surveys. RESULTS Mean AOFAS scores improved significantly from 48 to 82.7 (P = .014). Mean VAS scores improved from 6.1 to 1.0 (P = .002). Overall, 86% (12/14) of patients were able to return to running and 79% (11/14) of patients were able to return to their preinjury level of sport. Preoperative and postoperative weight-bearing ankle radiographs were reviewed to evaluate the tibiofibular clear space and overlap. The clear space measured on anteroposterior (AP) radiographs decreased from 5.4 mm to 4.6 mm (P = .005), the clear space evaluated on the mortise radiograph decreased from 4.5 mm to 3.6 mm (P = .006), and the overlap measured on the AP radiograph increased from 5.7 mm to 6.9 mm (P = .019). All radiographs were measured by a board-certified musculoskeletal radiologist. CONCLUSION This study presents a treatment method that can be instituted at the time of diagnosis for syndesmotic injuries with greater than 4 mm of diastasis that were treated with debridement and stabilization. The results of this treatment technique are promising, with significant improvements in subjective outcome scores and a high rate of return to running sports. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Paul M Ryan
- Tripler Army Medical Center, Orthopaedic Clinic, Honolulu, HI, USA
| | - Ryan M Rodriguez
- Madigan Army Medical Center, Orthopaedic Clinic, Tacoma, WA, USA
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Farjadian AB, Kong Q, Gade VK, Deutsch JE, Mavroidis C. VRACK: measuring pedal kinematics during stationary bike cycling. IEEE Int Conf Rehabil Robot 2013; 2013:6650453. [PMID: 24187270 DOI: 10.1109/icorr.2013.6650453] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ankle impairment and lower limb asymmetries in strength and coordination are common symptoms for individuals with selected musculoskeletal and neurological impairments. The virtual reality augmented cycling kit (VRACK) was designed as a compact mechatronics system for lower limb and mobility rehabilitation. The system measures interaction forces and cardiac activity during cycling in a virtual environment. The kinematics measurement was added to the system. Due to the constrained problem definition, the combination of inertial measurement unit (IMU) and Kalman filtering was recruited to compute the optimal pedal angular displacement during dynamic cycling exercise. Using a novel benchmarking method the accuracy of IMU-based kinematics measurement was evaluated. Relatively accurate angular measurements were achieved. The enhanced VRACK system can serve as a rehabilitation device to monitor biomechanical and physiological variables during cycling on a stationary bike.
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