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Picot B, Fourchet F, Rauline G, Freiha K, Wikstrom E, Lopes R, Hardy A. Ankle-GO score is associated with the probability of becoming coper after lateral ankle sprain: a 1-year prospective cohort study. Br J Sports Med 2024:bjsports-2024-108361. [PMID: 39122369 DOI: 10.1136/bjsports-2024-108361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE To analyse the association between Ankle-GO score during the return to sport process and the probability of becoming a coper 1 year after lateral ankle sprain (LAS). Copers were defined as patients returning to their preinjury sport without loss of function and reporting no episodes of reinjury or giving-way. METHODS Two months after a LAS, patients performed the Ankle-GO assessment which includes a cluster of four functional tests and two self-reported questionnaires for a maximum score of 25 points. One year after injury, participants were classified as copers or non-copers. Eight potential predictive variables associated with coper status were compared between the groups. Receiver operating characteristic curves (area under the curve (AUC)) and multivariable logistic regression models with OR and 95% CIs were used to determine the association of potential factors, including the Ankle-GO score, with copers. RESULTS 64 patients (56% females; age 33.7±13.2 years) completed the Ankle-GO-GO at 2 months postinjury. At 1 year postinjury, 10 patients (15%) were lost to follow-up, and only 17 of 54 patients (31%) became copers. Two-month Ankle-GO score was higher among copers (9.9±4.9 points vs 6.9±3.7, p=0.015) and was associated with future coper status at 1 year (AUC=0.70). Patients with an Ankle-GO score above 11 points and male patients were more likely to become copers (OR=12.1; 95% CI 2.5 to 59, p=0.002 and OR=5.2; 95% CI 1.2 to 22.4, p=0.026, respectively). CONCLUSION The Ankle-GO may help identify patients more likely to become copers within a year of injury. Those with low Ankle-GO scores and female patients should receive additional rehabilitation to increase the odds of becoming a coper.
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Affiliation(s)
- Brice Picot
- Interuniversity Laboratory of Human Movement Sciences, EA 7424, F-73000, C, University Savoie Mont Blanc, Chambery, France
- French Society of Sports Physical Therapist, Pierrefitte-sur-Seine, France
| | - François Fourchet
- French Society of Sports Physical Therapist, Pierrefitte-sur-Seine, France
- Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Switzerland
| | | | | | - Erik Wikstrom
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Ellis LN, Karzon AL, Bariteau JT, Labib SA, Kadakia RJ, Coleman MM. Lateral Ankle Ligament Repair Is Not Only for Young Patients: Trends in Incidence and Demographics. Foot Ankle Spec 2024:19386400241266361. [PMID: 39101246 DOI: 10.1177/19386400241266361] [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: 08/06/2024]
Abstract
The purpose of this study was to examine the changes in annual incidence and patient population undergoing lateral ankle ligament repair (LALR) for the surgical treatment of chronic ankle instability. The IBM Watson Health MarketScan Database was queried for patients who underwent LALR from January 2009 to December 2019 based on CPT code 27698. Volume and incidence per 100 000 population were determined for annual sums, gender, age, and geographical regions based on population estimates from the United States Census Bureau. Future annual volumes were statistically projected with linear regression modeling to the year 2032. Overall, 160 457 LALR procedures were identified in the database from 2009 to 2019. Annual incidence increased 76.6% from 3.46 to 6.11 cases per 100 000 population, while estimates of annual volumes are projected to increase 61.5% from 19 829 to 32 033 procedures to the year 2032. Interestingly, the greatest increase in incidence was observed among patients above 70 years old, which might suggest older patients are staying active longer and desiring elective procedures to maintain their activity levels. As the incidence of LALR increases in older patients, more research will be needed to understand the unique surgical considerations and risk factors impacting patient-reported outcomes.Level of Evidence: Level IV.
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Affiliation(s)
- Lauren N Ellis
- Emory University School of Medicine, Atlanta, Georgia
- Medical College of Georgia, Augusta, Georgia
| | | | | | - Sam A Labib
- Emory University School of Medicine, Atlanta, Georgia
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Yeum WJ, Lee MY, Lee BH. The Influence of Hip-Strengthening Program on Patients with Chronic Ankle Instability. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1199. [PMID: 39202481 PMCID: PMC11356047 DOI: 10.3390/medicina60081199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/07/2024] [Accepted: 07/16/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: Repetitive ankle sprains lead to mechanical instability of the ankle. Patients with chronic ankle instability may experience decreased muscle strength and limited postural control. This study investigated the effects of a hip-strengthening exercise program on muscle strength, balance, and function in patients with chronic ankle instability. Materials and Methods: A total of 30 patients participated in the study and were randomly assigned to the two groups. Among the 30 participants, 14 were assigned to the hip joint-strengthening exercise group and 16 to the control group. The experimental group underwent a hip-strengthening exercise program and received training for 40 min per session twice a week for four weeks. The control group received the same frequency, duration, and number of sessions. Measurements were performed before and after the training period to assess changes in hip strength, balance, and function. Results: In the within-group and between-group comparisons, both groups showed significant differences in hip joint strength, static balance, dynamic balance, and function (FAAM; foot and ankle ability measures) (p < 0.05). Statistically significant differences were observed in the time × group interaction effects among the hip abductors and external rotation in hip joint strength, path length in static balance, posterolateral and posteromedial in dynamic balance, and FAAM-ADL and FAAM-SPORT functions (p < 0.05). Conclusions: Accordingly, this study confirmed that hip joint-strengthening exercises have a positive effect on the strength, balance, and function of patients with chronic ankle instability, and we believe that hip joint-strengthening exercises will be recommended as an effective intervention method for patients suffering from chronic ankle instability.
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Affiliation(s)
- Woo-Jin Yeum
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea
| | - Mi-Young Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea;
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea;
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Migliorini F, Maffulli N, Cocconi F, Schäfer L, Bell A, Katusic D, Vaishya R. Better outcomes using suture button compared to screw fixation in talofibular syndesmotic injuries of the ankle: a level I evidence-based meta-analysis. Arch Orthop Trauma Surg 2024; 144:2641-2653. [PMID: 38740648 DOI: 10.1007/s00402-024-05354-x] [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: 08/30/2023] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION The present meta-analysis evaluated current level I clinical trials which compared the use of a suture button (SB) versus syndesmotic screw (SS) fixation techniques for syndesmosis injuries of the ankle. The outcomes of interest were to compare patient-reported outcome measures (PROMs) and complications. It was hypothesised that SB might achieve better PROMs along with a lower rate of complications. METHODS This study was conducted according to the 2020 PRISMA statement. In August 2023, PubMed, Web of Science, Google Scholar, and Embase were accessed. All the randomised controlled trials (RCTs) which compared SB versus SS fixation for syndesmosis injuries of the ankle were accessed. Data concerning the American Orthopaedic Foot & Ankle Society (AOFAS), and Olerud-Molander score (OMS) were collected at baseline and at last follow-up. Data on implant failure, implant removal, and joint malreduction were also retrieved. RESULTS Data from seven RCTs (490 patients) were collected. 33% (161 of 490) were women. The mean length of the follow-up was 30.8 ± 27.4 months. The mean age of the patients was 41.1 ± 4.1 years. Between the two groups (SB and SS), comparability was found in the mean age, and men:women ratio. The SS group evidenced lower OMS (P = 0.0006) and lower AOFAS (P = 0.03). The SS group evidenced a greater rate of implant failure (P = 0.0003), implant removal (P = 0.0005), and malreduction (P = 0.04). CONCLUSION Suture button fixation might perform better than the syndesmotic screw fixation in syndesmotic injuries of the ankle.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
| | - Nicola Maffulli
- Department of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke On Trent, ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK
| | - Federico Cocconi
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
| | - Luise Schäfer
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany
| | - Dragana Katusic
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India
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Dombrowski N, Cleary CJ, Bernard CD, Vopat BG, Herda AA. Psychological Readiness Is Weakly Related to Physical Function Tests at Return to Sport for Men and Not at All for Women Following Anterior Cruciate Ligament Reconstruction and Rehabilitation. Arthroscopy 2024; 40:1870-1878. [PMID: 38061685 DOI: 10.1016/j.arthro.2023.11.029] [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: 07/10/2023] [Revised: 11/07/2023] [Accepted: 11/19/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE To assess the relationships between physical function tests of the operative limb and psychological readiness to return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction (return to sport after injury [ACL-RSI]) by sex. The secondary purpose was to quantify sex-specific differences in physical function test outcomes. METHODS Patient records were retrospectively identified as cases who performed RTS physical function testing (strength, horizontal hops, vertical jumps, single-leg leg press, and drop landing knee excursion, etc.), and completed a 6-question ACL-RSI survey at the time point they were cleared to RTS. Independent t-tests compared all variables between sex at P ≤ .05. Correlations and regression models were produced per sex to identify factors related to operative limb physical function tests and ACL-RSI scores. RESULTS With a total of 127 patients (63 men; 64 women), there was no difference in ACL-RSI scores and leg press repetitions between sex (P = .32 and P = .12, respectively). There were sex differences for all other physical performance outcomes (P < .001 for all). To estimate readiness using physical function test scores, the men's regression model identified knee excursion (β = 0.345; P = .033) as the only contributor to ACL-RSI (R2 = 0.089), whereas there was no relationship between physical performance outcomes and ACL-RSI in women (R2 = 0.00, P = 1.00). CONCLUSIONS Men and women reported similar ACL-RSI scales, indicating high readiness to return to sport. Likely due to sex-related physiological differences, men performed better at most physical function tests. Further, male ACL-RSI could be predicted using only one physical function outcome and 91% variability of the ACL-RSI coming from other contributors not evaluated, as indicated by R2. No physical function variables predict ACL-RSI in women. The evaluated variables are considered the primary indicators relevant for patients to be permitted to RTS yet cannot adequately predict psychological readiness in these patients. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Nicholas Dombrowski
- School of Medicine, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Christopher J Cleary
- Department of Health, Sport, and Exercise Sciences, University of Kansas Edwards Campus, Overland Park, Kansas, U.S.A
| | - Christopher D Bernard
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Bryan G Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Ashley A Herda
- Department of Health, Sport, and Exercise Sciences, University of Kansas Edwards Campus, Overland Park, Kansas, U.S.A..
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Huang Y, Li W, Shi X, Wang W, Xu C, Adams RD, Lyu J, Han J, He Y. Knee osteoarthritis patients assessed during walking for ankle inversion movement discrimination sensitivity. Front Bioeng Biotechnol 2024; 12:1372679. [PMID: 38699433 PMCID: PMC11063258 DOI: 10.3389/fbioe.2024.1372679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/03/2024] [Indexed: 05/05/2024] Open
Abstract
Background: Knee osteoarthritis (KOA) is a common musculoskeletal condition that affects dynamic balance control and increases the risk of falling during walking. However, the mechanisms underlying this are still unclear. Diminished ankle proprioception during walking has been found to be related to fear of falling in older adults, with a gender difference in incidence of falling. This study aimed to determine 1) whether ankle inversion proprioceptive acuity during walking is impaired in patients with KOA; and 2) whether there is any difference between genders. Methods: Thirty-two patients with KOA (F:M = 17:15, Median age = 52.5, BMI = 22.3 ± 3.0) and 34 healthy controls without KOA (HC) (F:M = 17:17; median age = 49.0, BMI = 22.5 ± 2.7) were recruited. In patients with KOA, ankle inversion proprioceptive acuity was measured on the affected side using the ankle inversion discrimination apparatus for walking (AIDAW), whilst HC were assessed on a randomly selected side. Two-way (2*2) analysis of variance (ANOVA) was performed to determine the main effects and interaction between gender and KOA condition. Results: Two-way ANOVA showed a significant KOA main effect (F = 26.6, p < 0.001, ƞp 2 = 0.3) whereby AIDAW scores during walking for individuals with KOA were significantly lower than those without KOA (KOA vs. HC: 0.746 ± 0.057 vs. 0.807 ± 0.035). There was neither a gender main effect nor interaction (both p > 0.05). Conclusion: Individuals with KOA demonstrated lower ankle proprioception scores during walking compared to their healthy counterparts, with a similar level of impairment in ankle proprioceptive acuity between male and female patients. A low score may contribute to an increased risk of falling in the KOA population. The current findings suggest the need for global concern about lower limb proprioception in the clinical management of KOA.
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Affiliation(s)
- Yanfeng Huang
- Department of Orthopedics, Jinshan District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Wanjuan Li
- Department of Orthopedics, Jinshan District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Xiaojian Shi
- School of Health Science, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Wenchao Wang
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Chengshuo Xu
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Roger David Adams
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Jie Lyu
- Department of Orthopedics, Jinshan District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Jia Han
- Department of Orthopedics, Jinshan District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Yaohua He
- Department of Orthopedics, Jinshan District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Chang S, Tan Y, Cheng L, Zhou L, Wang B, Liu H. Effect of strength training with additional acupuncture on balance, ankle sensation, and isokinetic muscle strength in chronic ankle instability among college students. Front Physiol 2024; 15:1324924. [PMID: 38645693 PMCID: PMC11026675 DOI: 10.3389/fphys.2024.1324924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose: The effects of the combination of strength training and acupuncture on chronic ankle instability have not been studied. This study examined effects of strength training combined with acupuncture on balance ability, ankle motion perception, and muscle strength in chronic ankle instability among college students. Methods: Forty-six chronic ankle instability college students were randomly categorized into the experimental group (n = 24, strength training + acupuncture) and the control group (n = 22, strength training) for an 8-week intervention. Results: For the results at 8 weeks, compared with the baseline, in the experimental group, the chronic Ankle Instability Tool (CAIT) score, ankle dorsiflexion, plantar flex, eversion peak torque (60°/s), and plantar flex peak torque (180°/s) increased by 13.7%, 39.4%, 13.7%, 14.2%, and 12.3%, respectively. Dorsiflexion, plantar flexion, inversion, and eversion kinesthetic sensation test angles decreased by 17.4%, 20.6%, 15.0%, and 17.2%, respectively. Anterior-posterior and medial-lateral displacement, and anterior-posterior and medial-lateral velocity decreased by 28.9%, 31.6%, 33.3%, and 12.4%, respectively. Anterior-posterior and medial-lateral displacement, and anterior-posterior and medial-lateral mean velocity decreased by 28.9%, 31.6%, 33.3%, and 12.4%, respectively. In the control group, the Cumberland Ankle Instability Tool score and the ankle dorsiflexion peak torque (60°/s) increased by 13.8% and 17.9%, respectively. The inversion kinesthetic sensation test angle decreased by 15.2%, whereas anterior-posterior and medial-lateral displacement, and anterior-posterior and medial-lateral mean velocity decreased by 17.1%, 29.4%, 12.3%, and 16.8%, respectively. 2) For the comparison between the groups after 8 weeks, the values of ankle dorsiflexion and plantar flex peak torque (60°/s) in the experimental group were greater than those in the control group. The values of ankle plantar flex kinesthetic sensation test angle, the anterior-posterior displacement, and anterior-posterior mean velocity in the experimental group were lower than those in the control group. Conclusion: Acupuncture treatment in conjunction with muscle strength training can further improve the balance ability of anterior-posterior, ankle dorsiflexion, and plantar flex strength and plantar flex motion perception in chronic ankle instability participants.
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Affiliation(s)
- Shuwan Chang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
- Department of Sports and Human Science, Sichuan Sports College, Chengdu, China
| | - Yajun Tan
- Sport Hospital, Chengdu Sport University, Chengdu, China
| | - Liang Cheng
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
- Department of Sports and Human Science, Sichuan Sports College, Chengdu, China
| | - Liping Zhou
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Bingcheng Wang
- Department of General Practice, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Heng Liu
- College of Physical Education, Chongqing University, Chongqing, China
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Bates K, Zeppieri G, Young C, Bruner M, Moser M, Farmer KW, Pozzi F. Preseason lower extremity range of motion, flexibility, and strength in relation to in-season injuries in NCAA division I gymnasts. PHYSICIAN SPORTSMED 2024; 52:200-206. [PMID: 37216208 PMCID: PMC10803174 DOI: 10.1080/00913847.2023.2215775] [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: 10/07/2022] [Revised: 04/21/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To determine if preseason lower extremity ROM, flexibility, and strength differ in collegiate gymnasts (NCAA Division 1) who do or do not sustain an injury during the competitive season. METHODS Over four seasons, a total of 15 female gymnasts (age = 20.5 ± 1.0 years) underwent preseason screening (30 gymnast-season). We tested joint ROM (hip: flexion, internal and external rotation; ankle: weightbearing dorsiflexion), muscle flexibility (passive straight leg raise, Thomas,' Ober's, Ely's tests) and strength (hip extensors, abductors, and flexors isometric strength via a handheld dynamometer; knee: quadriceps and hamstring isokinetic strength at 60°/sec). The team athletic trainer tracked overuse lower extremity injuries (restricted gymnasts from full participation, occurred as from participation in organized practice or competition, and required medical attention) during each season. For athletes that tested multiple seasons, each encounter was considered independent, and each preseason assessment was linked to overuse injuries sustained during the same competitive season. Gymnasts were dichotomized into injured and non-injured groups. An independent t-test was used to measure differences in preseason outcomes between injured and non-injured groups. RESULTS During four years, we recorded 23 overuse lower extremity injuries. Gymnasts that sustained an in-season overuse injury demonstrated significantly lower hip flexion ROM (mean difference: -10.6°; 95% confidence interval: -16.5, -4.6; p < 0.01) and lower hip abduction strength (mean difference: -4.7% of body weight; 95% confidence interval: -9.2, -0.3; p = 0.04). CONCLUSION Gymnasts who sustain an in-season overuse lower extremity injury have significant preseason deficit of hip flexion ROM and weakness in the hip abductors. These findings indicate potential impairments in the kinematic & kinetic chains responsible for skill performance and energy absorption during landing.
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Affiliation(s)
- Kaysha Bates
- Victory lab PT and performance, Jackson, Wyoming, USA
- Sport Physical Therapy Residency Program, University of Florida Health, Gainesville, FL, USA
| | - Giorgio Zeppieri
- Department of Rehabilitation, University of Florida Health, Gainesville, FL, USA
| | - Candace Young
- Sport Physical Therapy Residency Program, University of Florida Health, Gainesville, FL, USA
- Department of Rehabilitation, Hospital for Special Surgery, New York, NY, USA
| | - Michelle Bruner
- Department of Orthopaedics and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Michael Moser
- Department of Orthopaedics and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin W. Farmer
- Department of Orthopaedics and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Federico Pozzi
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
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Shi X, Ganderton C, Tirosh O, Adams R, Ei-Ansary D, Han J. Test-retest reliability of ankle range of motion, proprioception, and balance for symptom and gender effects in individuals with chronic ankle instability. Musculoskelet Sci Pract 2023; 66:102809. [PMID: 37354602 DOI: 10.1016/j.msksp.2023.102809] [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: 01/07/2023] [Revised: 05/15/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVES To determine the reliability of the commonly used musculoskeletal assessments in individuals with chronic ankle instability (CAI). DESIGN Within and between-days test-retest reliability. SETTING University laboratory. PARTICIPANTS Twenty-four individuals with unilateral CAI. METHOD For both sides, ankle dorsiflexion range of motion (DFROM) was assessed by a goniometer and weight-bearing lunge test (WBLT), proprioception by the active movement extent discrimination apparatus (AMEDA), and balance by the Star Excursion Balance Test with anterior (SEBTA), posteromedial (SEBTPM) and posterolateral (SEBTPL) components. All measures were taken at enrollment, after 30 min and one week later. RESULTS For the asymptomatic side, all assessments demonstrated good to excellent reliability, with ICCs (3,1) between 0.8 and 0.96. On the symptomatic side, WBLT, SEBTA and SEBTPM showed excellent reliability, with ICCs (3,1) above 0.90, while SEBTPL, goniometer and AMEDA showed moderate reliability, with the 95% CI of the ICCs (3,1) crossing 0.5. Three-way repeated measures ANOVA showed a side main effect, with asymptomatic worse, for WBLT (F = 16.9, p < 0.001) and SEBTA (F = 5.4, p = 0.03); an overall improving time main effect for SEBTPL (F = 6.9, p = 0.02). Neither a gender main effect nor any interaction effect was found. CONCLUSIONS WBLT, SEBTA and SEBTPM can be strongly recommended for measuring ankle dorsiflexion mobility and dynamic balance for both sides of individuals with unilateral CAI, while only WBLT can be used for side-to-side comparison. The application of a goniometer to measure DFROM, SEBTPL or AMEDA should be done cautiously for this specific cohort, considering their poor to good reliability for the symptomatic side.
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Affiliation(s)
- Xiaojian Shi
- School of Health Science, Swinburne University of Technology, Hawthorn, 3122, Victoria, Australia; School of Exercise and Health, Shanghai University of Sport, Shanghai, 200090, China.
| | - Charlotte Ganderton
- School of Health Science, Swinburne University of Technology, Hawthorn, 3122, Victoria, Australia; College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China; School of Biomedical Science and Health, Royal Melbourne Institute of Technology University, Bundoora, 3083, Victoria, Australia
| | - Oren Tirosh
- School of Health Science, Swinburne University of Technology, Hawthorn, 3122, Victoria, Australia
| | - Roger Adams
- Research Institute for Sport and Exercise, University of Canberra, ACT2600, Australia
| | - Doa Ei-Ansary
- School of Biomedical Science and Health, Royal Melbourne Institute of Technology University, Bundoora, 3083, Victoria, Australia
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China; School of Exercise and Health, Shanghai University of Sport, Shanghai, 200090, China; Research Institute for Sport and Exercise, University of Canberra, ACT2600, Australia.
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Han J, Yang Z, Witchalls J, Ganderton C, Adams R, Waddington G. Ankle Inversion Proprioception Impairment in Persons with Chronic Ankle Instability Is Task-Specific. Percept Mot Skills 2022; 129:1736-1748. [PMID: 36113161 DOI: 10.1177/00315125221125608] [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: 11/15/2022]
Abstract
While investigators have often compared ankle proprioception between groups with and without chronic ankle instability (CAI), findings have been inconsistent. Possibly this is because ankle proprioceptive impairment in this population is task-specific. Thus, we aimed to compare ankle inversion proprioception in individuals with and without CAI in two task conditions: (i) when standing (not challenging) and (ii) when on a step-down landing (minimally-challenging). Ankle inversion proprioception was measured in both conditions for 38 recreational sport player volunteers with CAI (n = 19) and without CAI (n = 19). We used the Active Movement Extent Discrimination Apparatus (AMEDA) for the standing condition and the Ankle Inversion Discrimination Apparatus-Landing (AIDAL) for step-down landing. From analysis of variance (ANOVA) tests, CAI and non-CAI participants performed equally well on the AMEDA when standing; but the CAI group performed significantly worse than the non-CAI group on the AIDAL step-down landing task (p = 0.03). Within the non-CAI group, the AIDAL proprioceptive scores, as area under the receiver operating characteristics curve (AUC), were significantly higher than their AMEDA AUC scores (p = 0.03), while there was no significant difference between AIDAL and AMEDA AUC scores in the CAI group. Cumberland Ankle Instability Tool CAIT scores were significantly correlated with AIDAL scores (Spearman's rho = 0.391, p = 0.015), but not with the AMEDA scores; and there was no significant correlation between the AIDAL and AMEDA scores. Thus, an ankle inversion proprioceptive deficit was evident for persons with CAI on the step-down AIDAL, and in a dose-response way, but not evident on the standing AMEDA, suggesting that ankle proprioceptive impairment is task-specific. Selected proprioceptive tests must present some minimal degree of challenge to the ankle joint in a functional task in order to differentiate CAI from non-CAI participants.
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Affiliation(s)
- Jia Han
- College of Rehabilitation Sciences, 191610Shanghai University of Medicine and Health Sciences, Shanghai, China.,Research Institute for Sport and Exercise, 2234University of Canberra, Canberra, ACT, Australia.,Faculty of Health, Arts and Design, 444935Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Zonghan Yang
- Department of Physiotherapy, 85084University of Melbourne, Melbourne, VIC, Australia
| | - Jeremy Witchalls
- Research Institute for Sport and Exercise, 2234University of Canberra, Canberra, ACT, Australia
| | - Charlotte Ganderton
- Faculty of Health, Arts and Design, 444935Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Roger Adams
- Research Institute for Sport and Exercise, 2234University of Canberra, Canberra, ACT, Australia
| | - Gordon Waddington
- Research Institute for Sport and Exercise, 2234University of Canberra, Canberra, ACT, Australia
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Kang M, Zhang T, Yu R, Ganderton C, Adams R, Han J. Effect of Different Landing Heights and Loads on Ankle Inversion Proprioception during Landing in Individuals with and without Chronic Ankle Instability. Bioengineering (Basel) 2022; 9:bioengineering9120743. [PMID: 36550949 PMCID: PMC9774139 DOI: 10.3390/bioengineering9120743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
Proprioception is essential for neuromuscular control in relation to sport injury and performance. The effect of landing heights and loads on ankle inversion proprioceptive performance in individuals with or without chronic ankle instability (CAI) may be important but are still unclear. Forty-three participants (21 CAI and 22 non-CAI) volunteered for this study. The Ankle Inversion Discrimination Apparatus for Landing (AIDAL), with one foot landing on a horizontal surface and the test foot landing on an angled surface (10°, 12°, 14°, 16°), was utilized to assess ankle proprioception during landing. All participants performed the task from a landing height of 10 cm and 20 cm with 100% and 110% body weight loading. The four testing conditions were randomized. A repeated measures ANOVA was used for data analysis. The result showed that individuals with CAI performed significantly worse across the four testing conditions (p = 0.018). In addition, an increased landing height (p = 0.010), not loading (p > 0.05), significantly impaired ankle inversion discrimination sensitivity. In conclusion, compared to non-CAI, individuals with CAI showed significantly worse ankle inversion proprioceptive performance during landing. An increased landing height, not loading, resulted in decreased ankle proprioceptive sensitivity. These findings suggest that landing from a higher platform may increase the uncertainty of judging ankle positions in space, which may increase the risk of ankle injury.
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Affiliation(s)
- Ming Kang
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
| | - Tongzhou Zhang
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
| | - Ruoni Yu
- School of Medicine, Jinhua Polytechnic, Jinhua 321000, China
| | - Charlotte Ganderton
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Roger Adams
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT 2234, Australia
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China
- Correspondence:
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