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Krombholz D, Willwacher S, Consmüller T, Linden A, Utku B, Zendler J. Comparison of an Adaptive Ankle Brace to Conventional Taping for Rehabilitation of Acute Ankle Injury in Young Subelite Soccer Players: A Pilot Study. J Sport Rehabil 2024; 33:562-569. [PMID: 39084618 DOI: 10.1123/jsr.2023-0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/09/2024] [Accepted: 05/08/2024] [Indexed: 08/02/2024]
Abstract
CONTEXT Ankle sprains are a common injury in sports, for which use of external ankle support during rehabilitation has been suggested to improve clinical outcomes. DESIGN Cohort study. METHODS Thirteen soccer players experiencing acute lateral ankle sprain injury were provided a novel adaptive ankle brace or conventional ankle taping (control) as external ankle support throughout the injury rehabilitation process. All other clinical procedures were identical, and rehabilitation was supervised by the same team staff member. Time from injury to clearance to return to sport was tracked. Player experience with the ankle brace also was queried via electronic surveys. RESULTS The median time to return to sport was less for the Brace group (52.5 d) compared to the Control group (79.5 d), but the distributions of the 2 groups were not found to differ significantly (P = .109). Player surveys indicated they felt the brace to be comfortable or very comfortable, with better freedom of movement than other braces and the same freedom of movement as wearing no brace. All players reported wearing the brace to be the same or better experience as ankle taping. DISCUSSION These preliminary results indicate that the adaptive ankle brace is at least as effective as ankle taping for providing external support during the rehabilitation phase following acute lateral ankle sprain and suggest it may be a more effective ankle support solution in terms of patient compliance than conventional bracing or taping.
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Affiliation(s)
| | - Steffen Willwacher
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University of Applied Sciences, Offenburg, Germany
| | | | - Anna Linden
- Betterguards Technology GmbH, Berlin, Germany
| | - Burkay Utku
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University of Applied Sciences, Offenburg, Germany
| | - Jessica Zendler
- Rimkus, Houston, TX, USA
- University of Michigan, Ann Arbor, MI, USA
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Koshino Y, Kobayashi T. Noninstrumented Clinical Assessment of Static Postural Stability in Chronic Ankle Instability: A Systematic Review and Meta-Analysis. J Sport Rehabil 2024:1-11. [PMID: 39159931 DOI: 10.1123/jsr.2023-0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 04/22/2024] [Accepted: 06/25/2024] [Indexed: 08/21/2024]
Abstract
CONTEXT Several clinical tests are available to assess static postural stability in individuals with chronic ankle instability (CAI); however, it is unclear which test should be used. OBJECTIVE To determine which noninstrumented clinical tests should be used to detect static postural stability deficits in individuals with CAI. EVIDENCE ACQUISITION We searched 4 databases from their inception to February 2023, and included studies comparing static postural stability in individuals with CAI and healthy controls using noninstrumented assessments. Two reviewers independently extracted study characteristics, participant information, static postural stability assessment methods, and results. We calculated the pooled standardized mean difference (SMD) and 95% confidence interval using a random effects meta-analysis and assessed the certainty of the evidence. EVIDENCE SYNTHESIS Fourteen cross-sectional studies (293 participants with CAI and 284 healthy controls) were included. The meta-analysis showed no significant differences between the CAI and healthy groups in the double-leg stance condition of the Balance Error Scoring System (BESS) (SMD, -0.03; low-certainty evidence). Significant group differences were found in the BESS single-leg stance (SLS) on firm and foam surfaces (SLS firm: SMD, 0.47, very low-certainty evidence; SLS foam: SMD, 0.80, very low-certainty evidence), the tandem stance (TS) on firm and foam surfaces (TS firm: SMD, 0.39, low-certainty evidence; TS foam: SMD, 0.76, low-certainty evidence), and the total BESS in the foam conditions (SMD, 1.12, very low certainty evidence). Significant differences were also found between the CAI and healthy groups in the foot-lift (SMD, 1.24; very low certainty evidence) and time-in-balance tests (SMD, -0.94; very low certainty evidence). CONCLUSIONS Due to the large magnitude of the differences, the SLS foam, TS foam, and the total BESS in the foam conditions, as well as the foot-lift test or time-in-balance test, may be the most appropriate to clinically identify static postural stability impairment in individuals with CAI.
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Affiliation(s)
- Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Takumi Kobayashi
- Graduate School of Health Science, Gunma University, Maebashi, Japan
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Yoshimoto Y, Yamaguchi S, Kimura S, Kitsukawa K, Matsumoto K, Shiko Y, Horii M, Watanabe S, Sasho T, Ohtori S. Intra- and interrater measurement reliability of lateral ankle ligament attachment locations using three-dimensional magnetic resonance imaging. J Orthop Sci 2024:S0949-2658(24)00154-4. [PMID: 39164182 DOI: 10.1016/j.jos.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/01/2024] [Accepted: 08/05/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND We aimed to evaluate the intra- and interrater measurement reliability of the lateral ankle ligament attachment locations using three-dimensional magnetic resonance imaging. METHODS We analysed 54 participants with a mean age of 43 years who underwent three-dimensional ankle magnetic resonance imaging and had normal lateral ligaments. Bony landmarks of the distal fibula, talus, and calcaneus were identified in the reconstructed images. The centers of the anterior talofibular ligament and calcaneofibular ligament attachments were also identified. The distances between the landmarks and attachments were measured. Two raters performed the measurements twice, and intra- and interrater intraclass correlation coefficients were calculated. RESULTS The intrarater intraclass correlation coefficient values were between 0.71 and 0.96 for the anterior talofibular ligament attachment measurements and between 0.77 and 0.95 for the calcaneofibular ligament attachments. The interrater intraclass correlation coefficient was higher than 0.7, except for the distance between the anterior talofibular ligament superior bundle and fibular obscure tubercle. The fibular attachment of a single-bundle anterior talofibular ligament was located 13.3 mm from the inferior tip and 43% along the anterior edge of the distal fibula. The superior and inferior bundles of the double-bundle ligament were located at 43% and 23%, respectively. The calcaneofibular ligament fibular attachment was 5.5 mm from the inferior tip, at 16% along the anterior edge of the distal fibula. CONCLUSION The measurements of anterior talofibular ligament and calcaneofibular ligament attachment locations identified on three-dimensional magnetic resonance imaging were sufficiently reliable. This measurement method provides in vivo anatomical data on the lateral ankle ligament anatomy.
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Affiliation(s)
- Yuriko Yoshimoto
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Satoshi Yamaguchi
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan; Graduate School of Global and Transdisciplinary Studies, Chiba University, Chiba, Japan.
| | - Seiji Kimura
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Kaoru Kitsukawa
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Koji Matsumoto
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yuki Shiko
- Biostatistics Section, Chiba University Hospital Clinical Research Center, Chiba, Japan
| | - Manato Horii
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Shotaro Watanabe
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Takahisa Sasho
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan; Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
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Beyraghi Z, Khanmohammadi R, Hadian MR. Reduction in preparatory brain activity preceding gait initiation in individuals with chronic ankle instability: A movement-related cortical potential study. Eur J Neurosci 2024. [PMID: 39149917 DOI: 10.1111/ejn.16501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 07/18/2024] [Accepted: 07/25/2024] [Indexed: 08/17/2024]
Abstract
Evidence suggests that chronic ankle instability (CAI) is not merely a peripheral musculoskeletal injury but should be recognized as a neurophysiological dysfunction. This reflects a paradigm shift from focusing on peripheral structural changes to emphasizing the central nervous system. However, changes in cortical activity during functional activities remain poorly understood. Thus, this study aimed to compare preparatory brain activity during gait initiation (GI) through movement-related cortical potentials (MRCPs) in individuals with CAI and healthy subjects. The proactive components of MRCPs, including contingent negative variation (CNV) and event-related desynchronization (ERD), were measured using electroencephalography. The primary outcomes were late CNV amplitude, CNV peak amplitude, CNV peak time, and alpha/beta ERD. The results indicated that the late CNV amplitude was significantly lower in the CAI group compared to the healthy group at the Fz and Cz electrodes (P < 0.001). The CAI group also demonstrated lower CNV peak amplitude at the Fz, Cz, and Pz electrodes (P < 0.0025). Additionally, in the CAI group, signals peaked earlier at the Cz electrode (P = 0.002). Furthermore, alpha ERD at Pz was significantly lower in the CAI group than in the healthy group (P = 0.003), suggesting diminished preparatory brain activity during GI in CAI subjects. Recognizing CAI as a condition involving both peripheral and central dysfunctions highlights the importance of a multidisciplinary approach in treatment and rehabilitation. This approach should target brain activity in addition to peripheral structures, potentially leading to improved long-term outcomes for patients.
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Affiliation(s)
- Zivar Beyraghi
- Physical Therapy Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Khanmohammadi
- Physical Therapy Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Hadian
- Physical Therapy Department, Tehran University of Medical Sciences, Tehran, Iran
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Friedman AMH, Madsen LP. Contralateral cutaneous reflex modulation during gait in individuals with and without chronic ankle instability. Gait Posture 2024; 113:490-497. [PMID: 39146860 DOI: 10.1016/j.gaitpost.2024.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/21/2024] [Accepted: 08/10/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Chronic ankle instability (CAI), a common seqeula to ankle injury is characterized by a variety of sensorimotor deficits extending beyond the previously injured limb. Cutaneous reflexes have been identified as a potential contributor to these functional limitations with recent studies identifying alterations in reflex patterns following sural nerve stimulation among those with CAI. To date, no studies have measured cutaneous reflexes of the unaffected limb in this population, therefore, the objective of this study was to measure contralateral cutaneous reflexes during gait in individuals with unilateral CAI and healthy controls. METHODS Muscle activity of 6 lower limb muscles was measured in nineteen participants while receiving random, non-noxious sural nerve stimulations during a walking task. RESULTS Control reflex patterns were generally well-aligned with previous literature while CAI patterns varied from controls in several muscles throughout the gait cycle. Namely, a lack of lateral gastrocnemius facilitation during late stance and medial gastrocnemius inhibition at midstance. Additionally, a lack of significant BF facilitation throughout contralateral swing was noted. These results indicate reflex alterations extend beyond the affected limb in those with unilateral CAI indicating changes at the spinal level following lateral ankle sprains (LAS). Considering the symptom variability in CAI, the lack of significant reflexes exhibited by the CAI group may be due to increased variability in motor output between subjects or between stimulation trials. CONCLUSIONS These findings highlight the importance of identifying reflex alterations arising from LAS and subsequently treating these limitations through rehabilitation targeting systemic neural pathways rather than local deficits.
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Affiliation(s)
| | - Leif P Madsen
- Indiana University, 1025 E 7th St., Bloomington, IN 47405, 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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Naderi A, Ebrahimi SZ. Effects of Tai Chi training on functionality, dynamic balance, kinesiophobia, and quality of life in athletes with functional ankle instability. Res Sports Med 2024:1-14. [PMID: 39099186 DOI: 10.1080/15438627.2024.2387350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 06/10/2024] [Indexed: 08/06/2024]
Abstract
This study investigated the effects of Tai Chi training on functionality, dynamic balance, kinesiophobia, and quality of life in athletes with Functional Ankle Instability (FAI). Forty-three athletes with FAI were randomly assigned to either a Tai Chi group (n = 21) or a control group (n = 22). The Tai Chi group followed a tailored exercise protocol addressing ankle instability through a three-phase progression, while the control group had no intervention but continued their usual activities. Measurements, including Cumberland Ankle Instability Tool (CAIT), Star Excursion Balance Test (SEBT), Tampa Scale for Kinesiophobia (TSK), Short Form-12 (SF-12), figure-8 hop test, and perceived treatment effect were assessed before and after the intervention. The Tai Chi group showed significant improvements in CAIT score and SEBT reach distance compared to the control group (p < 0.001). Tai Chi exercises also reduced TSK, improved figure-8 hop score, and enhanced the physical component of SF-12 (p < 0.005), with no significant effect on the mental component of SF-12 (p = 0.7). The findings imply that Tai Chi may be a valuable consideration for athletic trainers and sports medicine professionals working with athletes with FAI.
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Affiliation(s)
- Aynollah Naderi
- School of Sport Sciences, Shahrood University of Technology, Semnan, Iran
| | - Seyed Zahid Ebrahimi
- Department of Sport Science, University College of Omran and Tosseeh, Hamadan, Iran
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Bush M, Umlauf J, Pickens B. Point of Care Ultrasound Guided Management of Lateral Ankle Sprains: A Case Series. Int J Sports Phys Ther 2024; 19:1020-1033. [PMID: 39100935 PMCID: PMC11297534 DOI: 10.26603/001c.121601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024] Open
Abstract
Background Lateral ankle sprain (LAS) is a common injury with incidence rates reported at 7.2 per 1000 person-years. Physical examination strategies provide limited information to guide rehabilitation that can maximize clinical outcomes. Early and accurate diagnostic information using ultrasound imaging enables individualized care and the ability to monitor healing along with its response to activity and rehabilitation. Purpose The purpose of this study was to describe and observe the outcomes associated with Point of Care Ultrasound (POCUS) guided early management of acute and sub-acute lateral ankle sprains. Study Design Case series. Methods Individuals with a LAS within the prior 28 days underwent a clinical evaluation to include a POCUS exam to assess ligamentous integrity. Objective and POCUS findings were integrated to classify each LAS into one of four categories. Each grade of ankle sprain corresponded to levels of bracing for the protection of injured structures with each patient receiving physical therapy care based on rehabilitation guidelines. Participants completed the Foot and Ankle Ability Measure (FAAM) activities of daily living and Sports subscale, the Foot and Ankle Outcome Score (FAOS), Patient Reported Outcomes Measurement Information Systems Global Health, Tampa Scale of Kinesiophobia (TSK-11), Cumberland Ankle Instability Tool (CAIT), and the Numeric Pain Rating Scale as well as the Ankle Lunge Test and Figure 8 measurements at baseline, 4 weeks, 8 weeks and 12 weeks post enrollment. The FAAM Sport subscale, all FAOS subscales, and the TSK-11 were also collected at 24 weeks while the CAIT was collected at baseline and 24 weeks. Results Fourteen participants were enrolled with 11 participants completing all data collection. FAAM Sport scores significantly improved at 4, 8, 12 and 24 weeks. All components of the FAOS significantly increased except for Sport scores at four weeks and Quality of Life scores at four and eight weeks. Conclusion POCUS guided early management and ligamentous protection of LASs resulted in significant short and long-term improvement in function and return to sporting activity. This case series highlights the feasibility of using ultrasound imaging to assess the severity of ligamentous injury and align bracing strategies for ligamentous protection. The observations from this case series suggest that functional bracing strategies focused on ligamentous protection to promote healing and reduce re-injury rates does not delay improvement in functional outcomes. Level of Evidence Level IV, Case Series.
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Affiliation(s)
- Matthew Bush
- Navy Medicine Readiness and Training Command Yokosuka, Japan
| | - Jon Umlauf
- Army-Baylor University Doctoral Program in Physical Therapy
| | - Bryan Pickens
- Army-Baylor University Doctoral Program in Physical Therapy
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González-Devesa D, Hermo-Argibay A, Blanco-Martínez N, Ayán-Pérez C. Immediate effect of the use of toe separators on dynamic balance and ankle range of motion: a pilot study. PHYSICIAN SPORTSMED 2024; 52:374-380. [PMID: 37916670 DOI: 10.1080/00913847.2023.2278190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/29/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Injuries involving ankle stability and range of motion are among the most frequent in athletes and in the general population. In response, this study aimed to assess the immediate effects of toe separators on dynamic stability and ankle range of motion in healthy young individuals. METHODS Among the 68 eligible participants, 50 healthy and active subjects completed all trials. The impact of the intervention was evaluated using the Weight Bearing Lunge Test and Y-Test. The control condition performed the tests without toe separators, while the experimental condition performed the tests with toe separators. All participants performed both conditions with a wash-out period of at least 7 days between trials. RESULTS Statistical analysis revealed no significant differences in dynamic balance (p > 0.05) and range of motion (p > 0.05) between the two conditions. Additionally, no asymmetries were detected between the lower limbs in both tests (p > 0.05). CONCLUSIONS The results of this pilot study indicate that using toe separators does not have an immediate effect on ankle range of motion and dynamic balance in young, healthy individuals. Future research should consider evaluating intervention programs of longer duration and exploring different populations.
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Affiliation(s)
- Daniel González-Devesa
- Facultad de Ciencias de la Educación y del Deporte, Universidad de Vigo, Pontevedra, España
| | - Alberto Hermo-Argibay
- Department of Physiology, INCLIVA (Biomedical Research Institute Valencia), University of Valencia, Valencia, Spain
- Service of Endocrinology and Nutrition, Foundation for the Promotion of Health and Biomedical Research inthe Valencian Region (FISABIO), University Hospital Doctor Peset, Valencia, Spain
| | - Nerea Blanco-Martínez
- Facultad de Ciencias de la Educación y del Deporte, Universidad de Vigo, Pontevedra, España
| | - Carlos Ayán-Pérez
- Facultad de Ciencias de la Educación y del Deporte, Universidad de Vigo, Pontevedra, España
- Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Spain Well-Move Research Group, Vigo, Spain
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Wang X, Wang Z, Adams R, Ganderton C, Lyu J, Han J. Ankle inversion proprioception measured during stair descent can identify chronic ankle instability. Musculoskelet Sci Pract 2024; 72:102958. [PMID: 38643590 DOI: 10.1016/j.msksp.2024.102958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Individuals with chronic ankle instability (CAI) may experience recurrent ankle sprains and symptoms during daily activities such as stair descent, where the associated proprioceptive deficit is largely unevaluated. OBJECTIVES To evaluate the reliability and validity of an ankle inversion discrimination apparatus for stair descent, and examine whether proprioceptive scores from this apparatus are associated with patient-reported symptoms. DESIGN Cross-sectional study. METHOD Sixty-six participants volunteered in this study. The ankle inversion discrimination apparatus was purpose-built to assess ankle proprioception across four positions of ankle inversion (10°, 12°, 14°, and 16°) during stair descent. The Area Under the Receiver Operating Curve (AUC) was employed as the ankle proprioceptive discrimination score. RESULTS Test-retest reliability ICC (3,1) for the whole group was 0.825, with 0.747 for the non-CAI group (95%CI = 0.331-0.920) and 0.701 for CAI (95%CI = 0.242-0.904). The CAI group performed at a significantly lower level than non-CAI on the ankle inversion discrimination apparatus for stair descent assessment (0.769 ± 0.034 vs. 0.830 ± 0.035, F = 33.786, p < 0.001). CAIT scores were strongly and significantly correlated with scores from this apparatus (Spearman's rho = 0.730, p < 0.001). CONCLUSIONS The ankle inversion discrimination apparatus for stair descent is reliable and valid for assessing task-specific ankle proprioceptive impairments in CAI. The strong and significant relationship found between ankle proprioception during stair descent and the severity of CAI suggests that rehabilitation programs focusing on deficits in ankle inversion proprioception during stair descent may improve self-reported instability in CAI.
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Affiliation(s)
- Xueying Wang
- Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Zheng Wang
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Roger Adams
- Research Institute for Sport and Exercise, University of Canberra, Australia; College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, China
| | - Charlotte Ganderton
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, China; School of Health Science, Swinburne University of Technology, Australia; School of Biomedical Science and Health, Royal Melbourne Institute of Technology University, Australia
| | - Jie Lyu
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, China.
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, China.
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Lee H, Han S, Hopkins JT. Visual Disruption and Neuromechanics During Landing-Cutting in Individuals With Chronic Ankle Instability. J Athl Train 2024; 59:822-829. [PMID: 38014796 PMCID: PMC11340668 DOI: 10.4085/1062-6050-0379.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
CONTEXT Individuals with chronic ankle instability (CAI) demonstrate altered movement patterns when their vision is disturbed during simple tasks, such as single-legged standing and walking. However, it remains unclear whether visual disruption by stroboscopic glasses alters movement patterns during landing-cutting movements, considered highly demanding sport maneuvers that mimic a typical athletic movement. OBJECTIVES To identify altered lower extremity kinematics and muscle activation when vision is disrupted by stroboscopic glasses during landing-cutting tasks in individuals with CAI. DESIGN Case-control study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 18 individuals with CAI (age = 22.3 ± 2.3 years, height = 1.75 ± 0.1 m, mass = 72.5 ± 9.8 kg) and 18 matched healthy controls (age = 21.7 ± 2.3 years, height = 1.75 ± 0.1 m, mass = 71.9 ± 10.3 kg). INTERVENTION(S) All participants performed 5 trials of a landing-cutting task with (SV) and without (NSV) stroboscopic glasses. MAIN OUTCOME MEASURE(S) Frontal- and sagittal-plane lower extremity kinematics and 6 lower extremity muscle activations during the stance phase of a landing-cutting task in the SV and NSV conditions. RESULTS Individuals with CAI demonstrated more ankle-inversion angle from 18% to 22% and from 60% to 100% of the stance phase and more peroneus longus activation from initial contact to 18% of the stance phase under the SV condition than under the NSV condition. We observed no differences in knee- and hip-joint angles between the visual conditions for both groups. CONCLUSIONS When wearing stroboscopic glasses, individuals with CAI showed altered movement patterns, including increased ankle-inversion angle and peroneus longus activation during the stance phase of a landing-cutting task. The results suggest that they may lack the ability to reweight sensory information to adapt their movement to visual disruption.
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Affiliation(s)
- Hyunwook Lee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Seunguk Han
- Division of Sport Science, Pusan National University, Busan, Republic of Korea
| | - J. Ty Hopkins
- Department of Exercise Sciences, Brigham Young University, Provo, UT
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12
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Choi S, Jun HP. Effects of Rehabilitative Exercise and Neuromuscular Electrical Stimulation on Muscle Morphology and Dynamic Balance in Individuals with Chronic Ankle Instability. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1187. [PMID: 39064616 PMCID: PMC11279363 DOI: 10.3390/medicina60071187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 07/18/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Muscle atrophy caused by chronic ankle instability (CAI) can incur muscle weakness, altered movement patterns, and increased risk of injury. Previous studies have investigated the effects of rehabilitative exercises and neuromuscular electrical stimulation (NMES) on characteristics in CAI individuals, but few studies have examined their effects on foot and ankle muscle morphology. This study aimed to determine the effects of rehabilitative exercises and NMES on muscle morphology and dynamic balance in individuals with CAI. Materials and Methods: Participants with CAI (n = 47) were randomly divided into control (CG), rehabilitative exercise (REG), NMES (NG), and rehabilitative exercise and NMES combined (RNG) groups. The six-week intervention program consisting of rehabilitative exercises and NMES was applied to groups excluding CG. Muscle morphology and dynamic balance were evaluated using a portable wireless diagnostic ultrasound device and dynamic balance tests. For statistical analysis, an effect size with 95% confidence interval was calculated to assess mean differences according to intervention. Results: After six weeks, significant increases in morphology and dynamic balance were observed for all muscles except flexor hallucis longus (p > 0.05) in the intervention groups except for CG. However, no significant changes were observed in the CG (p > 0.05). Conclusions: These findings suggest that intervention programs may help prevent muscle atrophy and improve balance in CAI individuals.
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Affiliation(s)
| | - Hyung-pil Jun
- Department of Physical Education, Dong-A University, Busan 49315, Republic of Korea;
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Bsoul N, Ning L, Cai L, Mazmanyan D, Porter D. Evidence-based clinical practice guidelines for the management of acute ankle injuries according to: a PRISMA systematic review and quality appraisal with AGREE II. BMC Musculoskelet Disord 2024; 25:523. [PMID: 38978052 PMCID: PMC11229291 DOI: 10.1186/s12891-024-07655-z] [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: 03/10/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Acute ankle injuries are commonly seen in emergency rooms, with significant social impact and potentially devastating consequences. While several clinical practice guidelines (CPGs) related to ankle injuries have been developed by various organizations, there is a lack of critical appraisal of them. The purpose of this systematic review is to identify and critically appraise evidence-based clinical practice guidelines (EB-CPGs) related to acute ankle injuries in adults. METHOD We conducted searches in the Cochrane Library, MEDLINE, EMBASE databases, WHO, and reviewed 98 worldwide orthopedic association websites up until early 2023. Two authors independently applied the inclusion and exclusion criteria, and each evidence-based clinical practice guideline (EB-CPG) underwent independent critical appraisal of its content by all four authors using the Appraisal of Guidelines for REsearch and Evaluation (AGREE II) instrument. AGREE II scores for each domain were then calculated. RESULTS This review included five evidence-based clinical practice guidelines. The mean scores for all six domains were as follows: Scope and Purpose (87.8%), Stakeholder Involvement (69.2%), Rigour of Development (72.5%), Clarity of Presentation (86.9%), Applicability (45.6%), and Editorial Independence (53.3%). CONCLUSION The number of EB-CPGs related to ankle injuries are limited and the overall quality of the existing evidence-based clinical practice guidelines (EB-CPGs) for ankle injuries is not strong, with three of them being outdated. However, valuable guidance related to Ottawa rules, manual therapy, cryotherapy, functional supports, early ambulation, and rehabilitation has been highlighted. Challenges remain in areas such as monitoring and/or auditing criteria, consideration of the target population's views and preferences, and ensuring editorial independence. Future guidelines should prioritize improvements in these domains to enhance the quality and relevance of ankle injury management. SYSTEMATIC REVIEW Systematic review.
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Affiliation(s)
- Najeeb Bsoul
- Tsinghua University, Beijing, China
- First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Liang Ning
- Tsinghua University, Beijing, China.
- First Affiliated Hospital of Tsinghua University, Beijing, China.
| | - Leyi Cai
- Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Davit Mazmanyan
- Tsinghua University, Beijing, China
- First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Daniel Porter
- Tsinghua University, Beijing, China
- First Affiliated Hospital of Tsinghua University, Beijing, China
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14
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Miyachi R, Kanazawa Y, Fujii Y, Kitagawa T, Yamazaki T. Effects of 6 weeks of whole-body vibration training on ankle motor control: a randomized controlled trial. J Sports Med Phys Fitness 2024; 64:676-684. [PMID: 38916091 DOI: 10.23736/s0022-4707.24.15788-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND Interventions on ankle motor control are important to prevent recurrent ankle sprains. Training using whole-body vibration may easily and effectively improve ankle motor control, but the effects have not been investigated. Therefore, this study aimed to clarify the effects of 6 weeks of training with whole-body vibration on ankle motor control in a dynamic movement task among healthy participants. METHODS Twenty healthy university students (6 males and 14 females) were randomly allocated to whole-body vibration training and control groups, with 10 participants in each group. The training was performed twice a week for 6 weeks in both groups. Primary outcome was mean ankle angular jerk cost in the star excursion balance test. Secondary outcomes were maximum ankle motion angle and maximum reach distance in the star excursion balance test, ankle proprioception, and range of ankle dorsiflexion motion in the loaded position. RESULTS There was a significant group × period (pre- and postintervention) interaction for mean ankle angular jerk cost in the direction of ankle abduction/adduction during posterolateral reaching, which was significantly lower at postintervention than that at preintervention in the whole-body vibration group In the whole-body vibration group, the maximum ankle dorsiflexion motion angle during anterior and posterolateral reaching was significantly higher at postintervention than that at preintervention. CONCLUSIONS Training with whole-body vibration improves ankle motor control in dynamic movement tasks, although the direction of reach and plane of motion are limited. Additionally, training with whole-body vibration is also effective in increasing the ankle dorsiflexion angle during dynamic movement tasks.
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Affiliation(s)
- Ryo Miyachi
- Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa, Japan -
| | - Yuji Kanazawa
- Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa, Japan
| | - Yoshinari Fujii
- Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa, Japan
| | - Takashi Kitagawa
- School of Health Sciences, Department of Physical Therapy, Shinshu University, Matsumoto, Japan
| | - Toshiaki Yamazaki
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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15
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Lopes R, Moussa MK, Hardy A. Percutaneous Calcaneal Osteotomy Combined With Arthroscopic Lateral Ankle Ligament Reconstruction for Chronic Ankle Instability With Hindfoot Varus. Arthrosc Tech 2024; 13:102989. [PMID: 39100272 PMCID: PMC11293359 DOI: 10.1016/j.eats.2024.102989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/17/2024] [Indexed: 08/06/2024] Open
Abstract
Chronic ankle instability is the most frequent complication of lateral ankle sprain. Its reported incidence is approximately 40% after the first episode of instability. Although this rate varies depending on the type of activity, there are also certain risk factors associated with this condition, such as hyperlaxity, static or dynamic postural control deficits, and especially, hindfoot varus. If hindfoot varus is not managed when medical treatment fails and surgery is necessary, treatment may be unsuccessful, resulting in a poorer functional outcome and a higher rate of recurrent instability. Open hindfoot varus correction is often associated with poor wound healing and infectious complications. If ligament repair is also performed, the risk is increased by the numerous incisions. This article presents an arthroscopic lateral ankle ligament anatomic reconstruction technique with the gracilis tendon associated with percutaneous calcaneal osteotomy for the treatment of chronic ankle instability.
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16
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Archuleta QA, McIlvain G, Leigh S, Timmons MK. Lower leg muscle activation during the ebbets foot drills. J Bodyw Mov Ther 2024; 39:279-284. [PMID: 38876639 DOI: 10.1016/j.jbmt.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/15/2024] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
Lateral ankle sprains (LAS) often lead to chronic ankle instability (CAI). The Ebbets foot drills were created to strengthen the lower leg muscles and reduce the risk of LAS. The current study aimed to explore the activation of the lower leg muscles during the Ebbets foot drills. Twenty-two (22) college students without LAS participated in the study. Surface electromyography (sEMG) of the tibialis anterior (TA), tibialis posterior (TP), and peroneus longus (PL) was collected during each of the Ebbets foot drills and a normal walking trial. The sEMG mean root mean square (RMS) was calculated for each walking and Ebbets foot drill trial duration. The mean RMS was higher during the Ebbets foot drills compared to normal walking for all muscles. The TA sEMG mean RMS was greater (4.0-68.3%, P = 0.001-0.023) during all the Ebbets foot drills than during the walking trial. The TP had greater mean RMS during the toe-in (50.4%, P < 0.001), toe-out (55.0%, P < 0.001), and backward walking (47.3%, P < 0.001) drills, than during the walking trial. The PL had greater mean RMS during all Ebbets foot drills (19.4-53.7%, P < 0.001) except for the heel walking and inversion drills. Ebbets foot drills higher muscle activity than regular walking, suggesting that the Ebbets foot drills could aid in the strengthening of the TA, TP, and PL muscles. These results build evidence on Ebbets' theory and indicate that these drills may be used to rehabilitate LAS and CAI.
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Affiliation(s)
- Quentin A Archuleta
- School of Kinesiology, College of Health Professions, Marshall University, Huntington, WV, 25703, USA
| | - Gary McIlvain
- School of Kinesiology, College of Health Professions, Marshall University, Huntington, WV, 25703, USA
| | - Steven Leigh
- School of Kinesiology, College of Health Professions, Marshall University, Huntington, WV, 25703, USA
| | - Mark K Timmons
- School of Kinesiology, College of Health Professions, Marshall University, Huntington, WV, 25703, USA.
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17
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Hansoulle T, Peters-Dickie JL, Mahaudens P, Nguyen AP. Do we underestimate the frequency of ankle sprains in running? A systematic review and meta-analysis. Phys Ther Sport 2024; 68:60-70. [PMID: 38963954 DOI: 10.1016/j.ptsp.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/28/2024] [Accepted: 06/29/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE To provide a systematic review and meta-analysis of the proportion of ankle sprains in running practices. DESIGN Systematic review and meta-analysis. MAIN OUTCOME MEASURES We calculated the weighted summary proportion and conducted meta-analyses for runners, considering levels (elite/recreational) and disciplines (distance, track, cross-country, trail, and orienteering). RESULTS 32 studies were included in the systematic review and 19 were included in the meta-analysis with a level of quality ranging from poor to good. Proportion of ankle sprains in runners was 13.69% (95%CI = 7.40-21.54; I2 = 98.58%) in global, 12.20% (95%CI = 5.24-21.53; I2 = 89.31%) in elite, 19.40% (95%CI = 10.05-30.90; I2 = 99.09%) in recreational, 8.51% (95%CI = 4.22-14.12; I2 = 96.15%) in distance, 67.42% (95%CI = 0.50-82.85; I2 = 99.36%) in track, 27.07% (95%CI = 12.48-44.81; I2 = 97.97%) in cross-country, and 25.70% (95%CI = 19.87-32.14; I2 = 0.00) in orienteering. CONCLUSIONS Running practice results in significant proportion rate of ankle sprains. Recreational runners exhibit higher proportion than elite. Running disciplines, especially track, cross-country, and orienteering, influence reported ankle sprain rates, surpassing those of distance runners.
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Affiliation(s)
- Thomas Hansoulle
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 52, B-1200, Brussels, Belgium.
| | - Jean-Louis Peters-Dickie
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 52, B-1200, Brussels, Belgium; Katholieke Universiteit Leuven, Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Spoorwegstraat 12, B-8200, Sint-Michiels, Belgium; KU Leuven, Universitary Hospital Pellenberg, Clinical Motion Analysis Laboratorium (CMAL), Weligerveld 1, B-3212, Lubbeek, Belgium.
| | - Philippe Mahaudens
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 52, B-1200, Brussels, Belgium.
| | - Anh Phong Nguyen
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 52, B-1200, Brussels, Belgium; The Running Clinic, lac Beauport, Quebec, Canada.
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18
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Dalla Ali S, Alhiraki OA, Naeem T. Evaluating Compliance With the Ottawa Rules: A Retrospective Clinical Audit at a District General Hospital in the UK. Cureus 2024; 16:e65115. [PMID: 39171035 PMCID: PMC11338357 DOI: 10.7759/cureus.65115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND The Ottawa Rules are clinical decision tools designed to assist healthcare providers in determining the need for radiographs in patients with ankle or knee injuries. Compliance with these rules can lead to more efficient use of resources and reduced radiation exposure. OBJECTIVE This retrospective clinical audit aimed to evaluate healthcare provider's compliance with the Ottawa Rules in an Emergency Department setting and assess the positivity rates of requested knee and ankle X-rays. METHODS A two-cycle retrospective audit was conducted at Lincoln County Hospital's Emergency Department, involving 648 X-rays collected in two cycles. In between, multiple interventions were implemented to improve the outcomes. RESULTS The study revealed varying levels of compliance with the Ottawa Rules, with higher compliance observed for knee X-rays than ankle X-rays. The compliance for knee X-rays improved from 74.6% to 89.9% and ankle X-rays improved from 33.1% to 75.8%. Positivity rates for ankle radiographs were higher than knee radiographs in both cycles. The interventions implemented between the cycles significantly improved compliance rates with the Ottawa Rules. CONCLUSION The findings underscore the importance of adherence to the Ottawa Rules in optimizing patient care and resource utilization. The study suggests the need for continued education and periodic audits to maintain and further improve compliance rates. Additionally, the higher positivity rates for ankle radiographs highlight the importance of targeted imaging strategies based on clinical guidelines.
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Affiliation(s)
- Saif Dalla Ali
- General Surgery Department, Lincoln County Hospital, Lincoln, GBR
| | - Omar A Alhiraki
- Acute Medicine Department, Lincoln County Hospital, Lincoln, GBR
| | - Tahir Naeem
- Radiology Department, Lincoln County Hospital, Lincoln, GBR
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19
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Yin R, Chen H, Wang C, Qin C, Tao T, Hao Y, Wu R, Jiang Y, Gui J. Transformer-Based Multilabel Deep Learning Model Is Efficient for Detecting Ankle Lateral and Medial Ligament Injuries on Magnetic Resonance Imaging and Improving Clinicians' Diagnostic Accuracy for Rotational Chronic Ankle Instability. Arthroscopy 2024:S0749-8063(24)00409-2. [PMID: 38876447 DOI: 10.1016/j.arthro.2024.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 05/11/2024] [Accepted: 05/19/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE To develop a deep learning (DL) model that can simultaneously detect lateral and medial collateral ligament injuries of the ankle, aiding in the diagnosis of chronic ankle instability (CAI), and assess its impact on clinicians' diagnostic performance. METHODS DL models were developed and externally validated on retrospectively collected ankle magnetic resonance imaging (MRI) between April 2016 and March 2022 respectively at 3 centers. Included patients had confirmed diagnoses of CAI through arthroscopy, as well as individuals who had undergone MRI and physical examinations that ruled out ligament injuries. DL models were constructed based on a multilabel paradigm. A transformer-based multilabel DL model (AnkleNet) was developed and compared with 4 convolution neural network (CNN) models. Subsequently, a reader study was conducted to evaluate the impact of model assistance on clinicians when diagnosing challenging cases: identifying rotational CAI (RCAI). Diagnostic performance was assessed using area under the receiver operating characteristic curve (AUC). RESULTS Our transformer-based model achieved AUCs of 0.910 and 0.892 for detecting lateral and medial collateral ligament injury, respectively, both of which were significantly higher than those of CNN-based models (all P < .001). In terms of further CAI diagnosis, there was a macro-average AUC of 0.870 and a balanced accuracy of 0.805. The reader study indicated that incorporation with our model significantly enhanced the diagnostic accuracy of clinicians (P = .042), particularly junior clinicians, and led to a reduction in diagnostic variability. The code of the model can be accessed at https://github.com/ChiariRay/AnkleNet. CONCLUSIONS Our transformer-based model was able to detect lateral and medial collateral ligament injuries based on MRI and outperformed CNN-based models, demonstrating a promising performance in diagnosing CAI, especially patients with RCAI. CLINICAL RELEVANCE Developing such an algorithm can improve the diagnostic performance of clinicians, aiding in identifying patients who would benefit from arthroscopy, such as patients with RCAI.
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Affiliation(s)
- Rui Yin
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hao Chen
- Department of Clinical Neuroscience, Cambridge University, Cambridge, U.K; School of Computer Science, University of Birmingham, Birmingham, U.K
| | - Changjiang Wang
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Chaoren Qin
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tianqi Tao
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yunjia Hao
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Hand and Foot Microsurgery, Xuzhou Central Hospital, Xuzhou, China
| | - Rui Wu
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Orthopedics, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Yiqiu Jiang
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianchao Gui
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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20
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Abstract
Since its introduction in 1966, the Bröstrom repair has been the workhorse for the treatment of chronic ankle instability. The procedure has expanded with the advent of arthroscopy, ultrasound, and other techniques. Because chronic ankle sprains/instability pose a barrier to athletes who perform high-level activities for a living, discussions concerning postoperative recovery and return to play criteria are important. Here we present an update on the Bröstrom-Gould procedure from preoperative management to return to play.Level of Evidence: Level V.
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Affiliation(s)
- Daniel Chiou
- Warren Alpert Medical School, Providence, Rhode Island
| | - Brandon Morris
- Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Gregory Waryasz
- Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
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21
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Bergstein VE, Lu AZ, Hodgens BH, Bodendorfer BM, DeFroda SF, Kaplan J, Aiyer AA. Fantasy football points capture performance declines in National Football League offensive skill players following an ankle injury. J Orthop 2024; 52:124-128. [PMID: 38596620 PMCID: PMC10999692 DOI: 10.1016/j.jor.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Background The ankle is one of the anatomic sites most frequently injured in National Football League (NFL) players. Ankle injuries have previously been shown to have long-lasting negative impacts, and have been associated with impaired athletic performance. The aim of this study was to use fantasy football points as a metric to evaluate the impact of ankle injuries on NFL offensive skill player performance. Methods An open-access online database was used to identify NFL players who sustained ankle injuries from 2009 to 2020. Another public online database was used to determine fantasy points and other performance metrics for injured offensive skill players in the seasons before and after their ankle injury. Injured players were matched to a healthy control by position, age, and BMI. Paired T-tests were performed to evaluate performance metrics before and after the ankle injury. An ANCOVA was performed to assess the effect of return to play (RTP) time and injury type on fantasy performance. Results 303 players with ankle injuries were included. Fantasy output, including average points per game (PPG) and total fantasy points accrued in one season, significantly decreased in the season following a player's ankle injury (p < 0.0001). In running backs, tight ends, and wide receivers, performance significantly decreased in every metric evaluated (p < 0.0001). In quarterbacks, there was no significant change in performance, except for a decrease in the number of games played (p = 0.0033) and in the number of interceptions thrown (p = 0.029). Conclusion Assessing fantasy football output revealed a decrease in player performance in the season following an ankle injury, especially in route-running players. These results can be used to inform injury prevention and rehabilitation practices in the NFL.
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Affiliation(s)
| | - Amy Z. Lu
- Weill Cornell Medical College, New York, NY, USA
| | - Blake H. Hodgens
- Department of Orthopaedic Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC, USA
| | | | - Steven F. DeFroda
- Missouri Orthopaedic Institute, University of Missouri Healthcare, Columbia, MO, USA
| | - Jonathan Kaplan
- Duke Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Amiethab A. Aiyer
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
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22
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Sonsukong A, Vacshalathiti R, Kiratisin P, Richards J, Fong DTP, Sinsurin K. Ankle Biomechanics During Multidirectional Landings in Athletes With Chronic Ankle Instability. Foot Ankle Spec 2024; 17:249-258. [PMID: 37937743 DOI: 10.1177/19386400231208522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Assessing and understanding the control of the ankle during multidirectional jump landings in athletes with chronic ankle instability (CAI) would help health professionals develop interventions to reduce the risk of recurrent injuries. The aim of this study was to investigate the angle, angular velocity, and movements of the ankle joint, and the muscle activity of peroneus longus (PL), tibialis anterior (TA), and gastrocnemius (GAS) muscles during multidirectional landings in athletes with CAI. METHODS Nineteen athletes with CAI (≤25 Cumberland Ankle Instability Tool-Thai Score) participated. A Vicon Nexus motion analysis system synchronously collected data with an AMTI force plate and surface electromyography (EMG) to capture kinematics, kinetics, and muscle activity, respectively. Participants were asked to perform single-leg jump-landing tests in forward (0°), 30° diagonal, 60° diagonal, and lateral (90°) directions. Ankle joint kinematics, kinetics, and muscle activity of PL, TA, and GAS were analyzed. Repeated measure ANOVA (analysis of variance) and Friedman tests were used to analyze the main effects of the jump-landing direction. RESULTS Athletes with CAI exhibited significant differences in ankle angles, angular velocities, ankle movements, and average muscle activity of GAS between directions. Greatest average EMG of GAS muscle was observed during landing in the lateral direction compared with the forward and 30° diagonal directions. CONCLUSION Lateral and diagonal direction movements showed the greatest risks associated with recurrent ankle sprains. Impairments of neuromuscular control in both pre-landing and landing phases were observed in athletes with CAI when considered alongside previously published data. LEVEL OF EVIDENCE Laboratory-based observational study.
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Affiliation(s)
| | - Roongtiwa Vacshalathiti
- Musculoskeletal Physical Therapy Research Unit, Faculty of Physical Therapy, Mahidol University, Salaya, Thailand
| | | | - Jim Richards
- Allied Health Research Unit, University of Central Lancashire, Preston, UK
| | - Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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23
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Fu Z, Wang H, Guo X, Huang Y. Acupuncture for functional ankle instability: a case report. Acupunct Med 2024; 42:179-180. [PMID: 38126331 DOI: 10.1177/09645284231210576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Zhibin Fu
- Acupuncture and Massage Department, Affiliated Sport Hospital of CDSU, Chengdu, China
| | - Han Wang
- Acupuncture and Massage Department, Affiliated Sport Hospital of CDSU, Chengdu, China
| | - Xin Guo
- Acupuncture and Massage Department, Affiliated Sport Hospital of CDSU, Chengdu, China
| | - Yizhuan Huang
- Acupuncture and Massage Department, Affiliated Sport Hospital of CDSU, Chengdu, China
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24
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Hong G, Kong X, Zhang L, Zheng Y, Fan N, Zang L. Comparative analysis of arthroscopic technique for anterior talofibular and calcaneofibular ligament reconstruction versus open modified brostrom-gould procedure in chronic lateral ankle instability management. J Orthop Surg Res 2024; 19:312. [PMID: 38802920 PMCID: PMC11131230 DOI: 10.1186/s13018-024-04800-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/19/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Chronic Lateral Ankle Instability (CLAI) is a common condition treated using either Anterior Talofibular and Calcaneofibular Ligament (ATFL and CFL) reconstruction or Modified Brostrom Procedure (MBP). However, the comparative efficacy of these approaches is not well-studied. METHODS In this study, clinical data were retrospectively collected from 101 patients diagnosed with CLAI who underwent either ATFL and CFL reconstruction (n = 51) or the MBP (n = 50). Patients were comparable in terms of age, sex, Body Mass Index (BMI), post-injury duration, preoperative American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson score, Visual Analog Score (VAS), Anterior Talar Translation, and Talar Tilt Angle. RESULTS The post-operative measures showed no significant differences in AOFAS Score, Karlsson Score, and VAS between both treatment groups. However, patients who underwent ATFL and CFL reconstruction showed significantly lower follow-up Anterior Talar Translation (mean = 4.1667 ± 1.3991 mm) and Talar Tilt Angle (mean = 5.0549 ± 1.6173°) compared to those who underwent MBP. Further, patients treated with ATFL and CFL reconstruction experienced a significantly longer postoperative recovery time (median = 6 weeks) compared to MBP (median = 3 weeks). CONCLUSIONS Although both therapeutic techniques were generally effective in treating CLAI, the ATFL and CFL reconstruction approach delivered superior control of Anterior Talar Translation and Talar Tilt Angle. However, its longer recovery time merits further study to optimize the balance between therapeutic efficacy and recovery speed.
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Affiliation(s)
- Gang Hong
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, NO. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - XiaoChuan Kong
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, NO. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Le Zhang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, NO. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - YinFeng Zheng
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, NO. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, NO. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, NO. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China.
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25
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Lin CW, Jankaew A, Lin CF. Physical Therapy Intervention Effects on Alteration of Spinal Excitability in Patients With Chronic Ankle Instability: A Systematic Review and Meta-analysis. Sports Health 2024:19417381241253248. [PMID: 38804135 DOI: 10.1177/19417381241253248] [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: 05/29/2024] Open
Abstract
CONTEXT Chronic ankle instability (CAI) is a common injury in athletes. Different forms of physical therapy have been applied to the population with CAI to assess their impact on spinal excitability. OBJECTIVE The purpose of this systematic review and meta-analysis was to investigate the effectiveness of various physical therapy interventions on the alteration of spinal excitability in patients with CAI. DATA SOURCES Four databases (EMBASE, MEDLINE, Cochrane CENTRAL, and Scopus) were searched from inception to November 2022. STUDY SELECTION A total of 253 studies were obtained and screened; 11 studies on the effects of physical therapy intervention on the alteration of spinal excitability in patients with CAI were identified for meta-analysis. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 3a. DATA EXTRACTION A total of 11 studies that included the maximal Hoffmann reflex normalized by the maximal muscle response (H/M ratio) in the peroneus longus and soleus muscles were extracted and summarized. The quality of the studies was assessed using the PEDro scale. RESULTS The extracted studies had an average PEDro score of 4.7 ± 1.4, indicating that most of them had fair-to-good quality. The physical therapy interventions included cryotherapy, taping, mobilization, proprioceptive training, and dry needling. The overall effects showed that the H/M ratios of the peroneus longus (P = 0.44, I2 = 0%) and soleus (P = 0.56,I2 = 22%) muscles were not changed by physical therapy in patients with CAI. CONCLUSION The meta-analysis indicated that physical therapy interventions such as cryotherapy, taping, mobilization, proprioceptive training, and dry needling do not alter the spinal excitability in patients with CAI. Given that only 1 study reported ineffective changes in spinal excitability with dry needling, more research is essential to establish and validate its efficacy. PROSPERO REGISTRATION CRD42022372998.
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Affiliation(s)
- Chia-Wei Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Amornthep Jankaew
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Feng Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Physical Therapy Center, National Cheng Kung University Hospital, Tainan, Taiwan
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Michels F, Dewyn T, Bogaerts K, De Waele C, Hamers D. The evolution of patient-reported outcome measures after a first lateral ankle sprain: A prospective study. Foot Ankle Surg 2024:S1268-7731(24)00102-4. [PMID: 38714452 DOI: 10.1016/j.fas.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 04/03/2024] [Accepted: 04/28/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE A lateral ankle sprain is the most common musculoskeletal injury in the physically active population. However, it is unclear how the clinical condition evolves during the period after the injury and what proportion of patients develops chronic symptoms. Therefore, the purpose of this study is to assess the evolution of patient-reported outcome measures after a first time lateral ankle sprain. METHODS A prospective clinical study assessed the patient-reported outcome measures (PROMs) of a consecutive group of 100 patients during 1 year after a first lateral ankle sprain. The Karlsson score and Foot and Ankle Outcome Score (FAOS) were assessed at 6 weeks, 3 months, 6 months, 9 months and 1 year. The Cumberland Ankle Instability Tool (CAIT)-score was assessed at 6 months, 9 months and 1 year. The difference between the time points of all scores was analysed using the positive change over time (binomial test versus 50%) and the difference in score (signed rank test). The time to sustained excellent level was also assessed overall and in several subgroups: age, gender, degree of injury (2 or 3), avulsion fracture, use of crutches, use of cast. Differences between subgroups were assessed by a generalized log-rank test. RESULTS All clinical scores demonstrated an improvement up to 12 months after the sprain. The median Karlsson score (interquartile range) improved from 62 (50-80) at 6 weeks to 90 (72-100) at 3 months, to 97 (82-100) at 6 months to 100 (90-100) at 9 months, to 100 (100-100) at 1 year. The analysis of positive change over time demonstrated a significant positive change (P-value <.0005) between all time points except between 6 weeks and 12 weeks when using the FAOS quality score. The difference in score demonstrated a significant change (P-value <.01) between all time points except between 36 weeks and 48 weeks when using the FAOS pain and FAOS sports score. Age and presence of an avulsion fracture were correlated with a slower recovery and worse results. At 1 year, in total 13 patients (13%) had a worse outcome corresponding to a Karlsson score < 81 or CAIT score < 24. CONCLUSION The clinical condition after a first ankle sprain demonstrated a significant improvement in PROMs between the different time points in the first year. Twelve months after a first lateral ankle sprain 13% had a fair or poor outcome. Higher age and presence of an avulsion fracture were correlated with a slower recovery and worse results. This information is useful in clinical practice to predict further progression and inform patients. Moreover, it is valuable to improve treatment strategies. LEVEL OF EVIDENCE Level II (prospective cohort study).
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Affiliation(s)
- Frederick Michels
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium; MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France; Department of Development and Regeneration, Faculty of Medicine, University of Leuven campus Kortrijk, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium.
| | - Tim Dewyn
- Department of Emergency and Sports Medicine, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium.
| | - Kris Bogaerts
- KU Leuven, Department of public health and critical care, I-BioStat, Leuven, Belgium; UHasselt, I-BioStat, Hasselt, Belgium.
| | - Camille De Waele
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium.
| | - Delphine Hamers
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium.
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Liu N, Yang C, Song Q, Yang F, Chen Y. Patients with chronic ankle instability exhibit increased sensorimotor cortex activation and correlation with poorer lateral balance control ability during single-leg stance: a FNIRS study. Front Hum Neurosci 2024; 18:1366443. [PMID: 38736530 PMCID: PMC11082417 DOI: 10.3389/fnhum.2024.1366443] [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: 01/06/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Chronic Ankle Instability (CAI) is a musculoskeletal condition that evolves from acute ankle sprains, and its underlying mechanisms have yet to reach a consensus. Mounting evidence suggests that neuroplastic changes in the brain following ankle injuries play a pivotal role in the development of CAI. Balance deficits are a significant risk factor associated with CAI, yet there is a scarcity of evidence regarding the sensorimotor cortical plasticity related to balance control in affected individuals. This study aims to evaluate the differences in cortical activity and balance abilities between patients with CAI and uninjured individuals during a single-leg stance, as well as the correlation between these factors, in order to elucidate the neurophysiological alterations in balance control among patients with CAI. Methods The study enrolled 24 patients with CAI and 24 uninjured participants. During single-leg stance, cortical activity was measured using a functional near-infrared spectroscopy (fNIRS) system, which included assessments of the pre-motor cortex (PMC), supplementary motor area (SMA), primary motor cortex (M1), and primary somatosensory cortex (S1). Concurrently, balance parameters were tested utilizing a three-dimensional force platform. Results Independent sample t-tests revealed that, compared with the uninjured individuals, the patients with CAI exhibited a significant increase in the changes of oxyhemoglobin concentration (ΔHbO) during single-leg stance within the left S1 at Channel 5 (t = 2.101, p = 0.041, Cohen's d = 0.607), left M1 at Channel 6 (t = 2.363, p = 0.022, Cohen's d = 0.682), right M1 at Channel 15 (t = 2.273, p = 0.029, Cohen's d = 0.656), and right PMC/SMA at Channel 11 (t = 2.467, p = 0.018, Cohen's d = 0.712). Additionally, the center of pressure root mean square (COP-RMS) in the mediolateral (ML) direction was significantly greater (t = 2.630, p = 0.012, Cohen's d = 0.759) in the patients with CAI. Furthermore, a moderate positive correlation was found between ML direction COP-RMS and ΔHbO2 in the M1 (r = 0.436; p = 0.033) and PMC/SMA (r = 0.488, p = 0.016), as well as between anteroposterior (AP) direction COP-RMS and ΔHbO in the M1 (r = 0.483, p = 0.017). Conclusion Patients with CAI demonstrate increased cortical activation in the bilateral M1, ipsilateral PMC/SMA, and contralateral S1. This suggests that patients with CAI may require additional brain resources to maintain balance during single-leg stance, representing a compensatory mechanism to uphold task performance amidst diminished lateral balance ability in the ankle joint.
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Affiliation(s)
| | | | | | | | - Yan Chen
- College of Sport and Health, Shandong Sport University, Jinan, Shandong, China
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Hu X, Feng T, Li P, Liao J, Wang L. Bilateral Sensorimotor Impairments in Individuals with Unilateral Chronic Ankle Instability: A Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2024; 10:33. [PMID: 38589676 PMCID: PMC11001848 DOI: 10.1186/s40798-024-00702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/20/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Chronic ankle instability (CAI) is manifested by sensorimotor impairments in the sprained ankle, including deficits in sensation, motor function, and central integration or processing. These impairments have a significant impact on physical activities and daily life. Recently, some studies have suggested that bilateral deficits were observed in unilateral CAI, but contradictory evidence disputes this finding. Therefore, the objective of this study was to investigate whether bilateral sensorimotor deficits presented in individuals with unilateral CAI. METHODS Without language restriction, the following databases were retrieved from database inception up until 3 November 2023, including PubMed, WOS, EMBASE, Cochrane, SPORTDiscus and CINAHL. Case-control and cross-sectional studies that investigated bilateral sensorimotor functions in individuals with unilateral CAI were included. Sensorimotor functions contained static and dynamic balance, functional performance, muscle strength and activation, as well as sensation. Outcome measures contained centre-of-pressure parameters, normalised reach distance, activation time and magnitude of muscle, sensory errors and threshold. The risk of bias and quality assessment of included studies were evaluated using a standardised tool recommended by the Cochrane Collaboration and the Epidemiological Appraisal Instrument, respectively. To explore the potential bilateral deficits associated with unilateral CAI, a comprehensive meta-analysis was conducted using Review Manager version 5.4. The analysis compared the injured limb of unilateral CAI with healthy controls and the uninjured limb with healthy controls. The main focus of this study was to investigate the differences between the uninjured limb and healthy controls. A random-effects model was employed and effect sizes were estimated using the standardised mean difference (SMD) with 95% confidence intervals (CIs). Effect sizes were deemed as weak (0.2-0.5), moderate (0.5-0.8), or large (> 0.8). RESULTS A total of 11,442 studies were found; 30 studies were contained in the systematic review and 20 studies were included in the meta-analysis. Compared with healthy controls, those with unilateral CAI presented weak to moderate impairments in their uninjured limbs in static balance with eyes open (SMD = 0.32, 95% CI: 0.08 to 0.56), functional performance (SMD = 0.37; 95% CI: 0.08 to 0.67), kinesthesia (SMD = 0.52; 95% CI: 0.09 to 0.95) and tibialis anterior activation (SMD = 0.60, 95% CI: 0.19 to 1.01). There were no significant differences in other comparisons between the uninjured limb and healthy controls. CONCLUSIONS Patients with unilateral CAI may present bilateral deficits in static balance with eyes open, functional performance and kinaesthesia. However, further evidence is required to confirm this point due to limited studies included in some analyses and small effect size. REGISTRATION The protocol was registered in the International Prospective Register of Systematic Reviews platform (CRD: 42,022,375,855).
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Affiliation(s)
- Xiaomei Hu
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Ministry of Education, Shanghai, China
| | - Tianyi Feng
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Ministry of Education, Shanghai, China
| | - Pan Li
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Ministry of Education, Shanghai, China
| | - Jingjing Liao
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Ministry of Education, Shanghai, China
| | - Lin Wang
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Ministry of Education, Shanghai, China.
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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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Setliff JC, Paulus PF, Yamamoto T, Yang S, Hogan MV, Anderst WJ. Ankle and hindfoot motion of healthy adults during running revealed by dynamic biplane radiography: Side-to-side symmetry, sex-specific differences, and comparison with walking. Med Eng Phys 2024; 126:104151. [PMID: 38621840 DOI: 10.1016/j.medengphy.2024.104151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 04/17/2024]
Abstract
This study aimed to characterize ankle and hindfoot kinematics of healthy men and women during overground running using biplane radiography, and to compare these data to those previously obtained in the same cohort during overground walking. Participants ran across an elevated platform at a self-selected pace while synchronized biplane radiographs of their ankle and hindfoot were acquired. Motion of the tibia, talus, and calcaneus was tracked using a validated volumetric model-based tracking process. Tibiotalar and subtalar 6DOF kinematics were obtained. Absolute side-to-side differences in ROM and kinematics waveforms were calculated. Side-to-side and sex-specific differences were evaluated at 10 % increments of stance phase with mixed model analysis. Pearson correlation coefficients were used to assess the relationship between stance-phase running and walking kinematics. 20 participants comprised the study cohort (10 men, mean age 30.8 ± 6.3 years, mean BMI 24.1 ± 3.1). Average absolute side-to-side differences in running kinematics waveforms were 5.6°/2.0 mm or less at the tibiotalar joint and 5.2°/3.2 mm or less at the subtalar joint. No differences in running kinematics waveforms between sides or between men and women were detected. Correlations were stronger at the tibiotalar joint (42/66 [64 %] of correlations were p < 0.05), than at the tibiotalar joint (38/66 [58 %] of correlations were p < 0.05). These results provide a normative reference for evaluating native ankle and hindfoot kinematics which may be informative in surgical or rehabilitation contexts. Sex-specific differences in ankle kinematics during overground running are likely not clinically or etiologically significant. Associations seen between walking and running kinematics suggest one could be used to predict the other.
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Affiliation(s)
- Joshua C Setliff
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA.
| | - Paige F Paulus
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tetsuya Yamamoto
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shumeng Yang
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; University of Pittsburgh, Foot and Ankle Injury Research [F.A.I.R] Group, USA
| | - William J Anderst
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Tonsuthanluck S, Handoyo HR, Tharincharoen R, Angthong C. Comparative analyses of arthroscopic and open repairs of lateral ligament complex injuries of the ankle: a systematic review and meta-analysis of the medium-term outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1487-1495. [PMID: 38260990 DOI: 10.1007/s00590-023-03825-2] [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: 10/03/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE Little is known regarding the comparative analyses of the medium-term outcomes (with a mean minimum follow-up period of 24 months), between arthroscopic and open repairs of lateral ligament complex (LLC) injuries of the ankle. Thus, in this study, we aimed to explore the comparative analyses regarding the medium-term follow-up outcomes of these repairs, by conducting a systematic review and meta-analysis. METHODS The systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; data were extracted from the PubMed and Google Scholar databases. From an initial search, a total of 1182 abstracts (280 and 902 abstracts, from PubMed and Google Scholar, respectively) were found and screened in accordance with the eligibility criteria. Subsequently, six articles were found to be eligible for further review. RESULTS A total of 419 patients underwent surgical repairs; 205 and 214 patients underwent arthroscopic and open repairs, respectively. The mean minimum follow-up period was 29.2 months. The medium-term follow-up for arthroscopic LLC repairs was found to be superior to that of open LLC repairs, with more favorable outcomes; as evidenced by better clinical scores, lower pooled complication rates, earlier return times to pre-injury sport, and higher early sport ratios. CONCLUSIONS The findings of this systematic review and meta-analysis support near-future developments validating arthroscopic repair as the new gold standard for LLC repairs, similarly to arthroscopic ligament and tendon repairs, as well as arthroscopic reconstruction surgeries, of the knee and shoulder.
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Affiliation(s)
- Sora Tonsuthanluck
- Foot and Ankle surgery unit, Department of Orthopedic Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | | | - Ramita Tharincharoen
- Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang (KMITL), Bangkok, Thailand
| | - Chayanin Angthong
- Division of Digital and Innovative Medicine, Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang (KMITL), Bangkok, Thailand.
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Slaven EJ, Alarcio N, Fields C, Hayes M, Weiss E, Eckert NR. An investigation of neurological and/or biomechanical factors underpinning the effect of a thrust manipulation on chronic ankle symptoms: an observational study. J Man Manip Ther 2024; 32:198-205. [PMID: 37694967 PMCID: PMC10956908 DOI: 10.1080/10669817.2023.2251864] [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: 01/23/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Ankle sprains are a commonly occurring musculoskeletal injury potentially resulting in persistent pain and/or altered motion. Thrust manipulation may serve as an interventional strategy but limited evidence exists on the mechanism(s) by which a change to symptoms might occur. OBJECTIVE The study sought to quantify the immediate effect of a thrust manipulation to the ankle to determine a mechanism by which change to symptoms occurred. METHODS Eleven participants (6 m/5f, 26.09 ± 4.25 yrs) with a history of ankle sprain that occurred greater than three months ago with recurring pain and/or altered motion were recruited. Participants underwent neurophysiological testing to assess any pain alterations and instrumented gait analysis (IGA) for biomechanical assessment pre-post thrust manipulation to the ankle. RESULTS There were no significant differences in ankle dorsiflexion (DF) (p = 0.62), plantarflexion (PF) (p = 0.23), ground reaction force (GRF), or velocity (p = 0.63) following thrust manipulation compared to baseline; however, pre- and post-data did show differences in pain pressure threshold (p = 0.046). There were no significant differences in dynamic pain measurements. CONCLUSIONS Ankle sprains that result in persistent pain and/or altered motion can be impacted by a thrust manipulation which appears to act through neurophysiological mechanisms.
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Affiliation(s)
- Emily J. Slaven
- Krannert School of Physical Therapy, University of Indianapolis, IN, USA
| | - Nick Alarcio
- Krannert School of Physical Therapy, University of Indianapolis, IN, USA
| | - Chandler Fields
- Krannert School of Physical Therapy, University of Indianapolis, IN, USA
| | - Mallory Hayes
- Krannert School of Physical Therapy, University of Indianapolis, IN, USA
| | - Emily Weiss
- Krannert School of Physical Therapy, University of Indianapolis, IN, USA
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Dury J, Michel F, Ravier G. Electromyographic Activity of Lower Limb Muscles during Ankle Destabilizing Tests. Int J Sports Med 2024; 45:292-300. [PMID: 37871643 DOI: 10.1055/a-2197-1680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Ankle destabilizing devices were developed to improve the recruitment of the evertor muscles. Nevertheless, the activity of lower-leg muscles has never been compared to each other during functional tests performed with destabilization. The objectives were i) to compare the electromyographic activity between the lower-leg muscles during four functional tests performed with ankle destabilization, and ii) to determine sex-related differences in neuromuscular activation. Twenty-six healthy volunteers (13 males, 13 females) performed the modified Star Excursion Balance Test (mSEBT), unipedal balance and weight-bearing inversion and eversion tests with a destabilizing device, while recording electromyographic activity of the peroneus longus and brevis, tibialis anterior, gastrocnemius lateralis and gluteus medius. The activity of peroneal muscles was significantly greater than other muscles during all functional tests. Furthermore, the anterior direction of the mSEBT was the one implying the greatest activity of the peroneus longus muscle compared to the posteromedial (p=0.003) or posterolateral (p<0.001) directions. Finally, no significant sex-related differences in neuromuscular activity were reported. This study highlights the effectiveness of the destabilizing device to involve specifically the peroneal muscles when performing various functional tests. This device should be used by clinicians to be more specific to the stabilizers of the ankle joint during functional exercises.
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Affiliation(s)
- Jeanne Dury
- Laboratoire C3S UFR STAPS, Université de Franche-Comté, Besancon, France
| | - Fabrice Michel
- Laboratoire de Nanomédecine, Imagerie, Thérapeutique , Université de Franche-Comté, Besancon, France
| | - Gilles Ravier
- Laboratoire C3S UFR STAPS, Université de Franche-Comté, Besancon, France
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Laorungreungchai S, Siriphorn A. Accuracy to identify young adults with chronic ankle instability using a virtual reality - Balance error scoring system: A cross-sectional study. J Bodyw Mov Ther 2024; 38:506-513. [PMID: 38763600 DOI: 10.1016/j.jbmt.2024.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 01/23/2024] [Accepted: 03/18/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION The Balance Error Scoring System (BESS) assesses the ability to control postural stability by performing 3 different stances on two-type surfaces during closed eyes. Virtual reality technology combined with the BESS test (VR-BESS) may be used to disrupt visual inputs instead of closing the eyes, which may improve the sensitivity of diagnosing patients with chronic ankle instability (CAI). OBJECTIVE This study aimed to evaluate the accuracy to identify individuals with CAI of the VR-BESS test comparing with the original BESS test. METHODS The BESS and VR-BESS tests were administered to 68 young adults (34 participants with CAI and 34 without CAI). Frontal and lateral video views were used to measure the participant's performance errors. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was computed to determine the diagnostic test's overall accuracy. RESULTS The total score of the BESS test and the VR-BESS test were statistically significant in comparison to the AUC of no discrimination at 0.5, with AUC values of 0.63 and 0.64, respectively. The cut-off scores for the BESS and VR-BESS tests were 12 and 15, respectively. There was no significant difference between the ROC curves of the BESS and the VR-BESS test for identifying individuals with CAI. CONCLUSION The BESS and VR-BESS tests may be utilized interchangeably to identify individuals with CAI.
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Affiliation(s)
- Suwisit Laorungreungchai
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Akkradate Siriphorn
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand.
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Liu Y, Dong S, Wang Q, Liu Z, Song Q, Shen P. Deficits in proprioception and strength may contribute to the impaired postural stability among individuals with functional ankle instability. Front Physiol 2024; 15:1342636. [PMID: 38496300 PMCID: PMC10941841 DOI: 10.3389/fphys.2024.1342636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/12/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose: The correlations of postural stability with proprioception and strength may explain the recurrent sprains among individuals with functional ankle instability (FAI). This study aimed to compare anterior-posterior (AP) and medial-lateral (ML) postural stability, along with ankle proprioception and strength between individuals with and without FAI and investigated their correlations. Methods: Forty participants with FAI and another 40 without FAI were recruited. Their postural stability, represented by time to stabilization (TTS) in the AP (TTSAP) and ML (TTSML) directions, was calculated by the ground reaction force during jumping onto a force plate. Their ankle proprioception and strength during plantarflexion/dorsiflexion and inversion/eversion were measured using a proprioception device and a strength testing system, separately. Results: Individuals with FAI had longer TTSAP (p = 0.015) and TTSML (p = 0.006), larger ankle proprioception thresholds (p = 0.000-0.001), and less strength (p = 0.001-0.017) than those without FAI. Correlations between strength and TTSAP were detected among individuals with (ankle plantarflexion, r = -0.409, p = 0.009) and without FAI (ankle plantarflexion, r = -0.348, p = 0.028; ankle dorsiflexion, r = -0.473, p = 0.002). Correlations of proprioception (ankle inversion, r = 0.327, p = 0.040; ankle eversion, r = 0.354, p = 0.025) and strength (ankle eversion, r = -0.479, p = 0.002) with TTSML were detected among individuals without FAI but not among those with FAI. Conclusion: Individuals with FAI have worse postural stability and proprioception and less strength. Their proprioception and strength decreased to a point where they could not provide sufficient functional assistance to the ML postural stability. Improvements in proprioception and strength may be keys to prevent recurrent ankle sprains among individuals with FAI.
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Affiliation(s)
- Yanhao Liu
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Shiyu Dong
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Qi Wang
- College of Sports Human Sciences, Beijing Sport University, Beijing, China
| | - Ziyin Liu
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Qipeng Song
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Peixin Shen
- College of Sports and Health, Shandong Sport University, Jinan, China
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Teoh YX, Alwan JK, Shah DS, Teh YW, Goh SL. A scoping review of applications of artificial intelligence in kinematics and kinetics of ankle sprains - current state-of-the-art and future prospects. Clin Biomech (Bristol, Avon) 2024; 113:106188. [PMID: 38350282 DOI: 10.1016/j.clinbiomech.2024.106188] [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: 10/11/2023] [Revised: 12/26/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Despite the existence of evidence-based rehabilitation strategies that address biomechanical deficits, the persistence of recurrent ankle problems in 70% of patients with acute ankle sprains highlights the unresolved nature of this issue. Artificial intelligence (AI) emerges as a promising tool to identify definitive predictors for ankle sprains. This paper aims to summarize the use of AI in investigating the ankle biomechanics of healthy and subjects with ankle sprains. METHODS Articles published between 2010 and 2023 were searched from five electronic databases. 59 papers were included for analysis with regards to: i). types of motion tested (functional vs. purposeful ankle movement); ii) types of biomechanical parameters measured (kinetic vs kinematic); iii) types of sensor systems used (lab-based vs field-based); and, iv) AI techniques used. FINDINGS Most studies (83.1%) examined biomechanics during functional motion. Single kinematic parameter, specifically ankle range of motion, could obtain accuracy up to 100% in identifying injury status. Wearable sensor exhibited high reliability for use in both laboratory and on-field/clinical settings. AI algorithms primarily utilized electromyography and joint angle information as input data. Support vector machine was the most used supervised learning algorithm (18.64%), while artificial neural network demonstrated the highest accuracy in eight studies. INTERPRETATIONS The potential for remote patient monitoring is evident with the adoption of field-based devices. Nevertheless, AI-based sensors are underutilized in detecting ankle motions at risk of sprain. We identify three key challenges: sensor designs, the controllability of AI models, and the integration of AI-sensor models, providing valuable insights for future research.
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Affiliation(s)
- Yun Xin Teoh
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jwan K Alwan
- Department of Information Systems, Faculty of Computer Science and Information Technology, Universiti Malaya, Kuala Lumpur, Malaysia; University of Information Technology and Communications, Iraq
| | - Darshan S Shah
- Department of Mechanical Engineering, Indian Institute of Technology Bombay, Mumbai, India
| | - Ying Wah Teh
- Department of Information Systems, Faculty of Computer Science and Information Technology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Siew Li Goh
- Sports Medicine Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Centre for Epidemiology and Evidence-Based Practice, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
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Kawabata S, Ozone K, Minegishi Y, Oka Y, Terada H, Takasu C, Kojima T, Kano T, Kanemura N, Murata K. Chronic Ankle Joint Instability Induces Ankle Sensorimotor Dysfunction: A Controlled Laboratory Study. Am J Sports Med 2024; 52:739-749. [PMID: 38279796 DOI: 10.1177/03635465231217490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Chronic ankle instability (CAI) is a clinical sequela that causes the recurrence of ankle sprain by inducing ankle sensorimotor dysfunction. Animal models of CAI have recently shown that ankle ligament injuries mimicking an ankle sprain result in chronic loss of ankle sensorimotor function. However, the underlying mechanisms determining the pathogenesis of CAI remain unclear. HYPOTHESIS Ankle instability after an ankle sprain leads to the degeneration of the mechanoreceptors, resulting in ankle sensorimotor dysfunction and the development of CAI. STUDY DESIGN Controlled laboratory study. METHODS Four-week-old male Wistar rats (N = 30) were divided into 2 groups: (1) the ankle joint instability (AJI) group with ankle instability induced by transecting the calcaneofibular ligament (n = 15) and (2) the sham group (n = 15). Ankle instability was assessed using the anterior drawer test and the talar tilt test at 4, 6, and 8 weeks after the operation (n = 5, for each group at each time point), and ankle sensorimotor function was assessed using behavioral tests, including ladder walking and balance beam tests, every 2 weeks during the postoperative period. Morphology and number of mechanoreceptors in the intact anterior talofibular ligament (ATFL) were histologically analyzed by immunofluorescence staining targeting the neurofilament medium chain and S100 proteins at 4, 6, and 8 weeks postoperatively (n = 5 per group). Sensory neurons that form mechanoreceptors were histologically analyzed using immunofluorescence staining targeting the mechanosensitive ion channel PIEZO2 at 8 weeks postoperatively (n = 5). RESULTS Ankle sensorimotor function decreased over time in the AJI group, exhibiting decreased ankle instability compared with the sham group (P = .045). The number of mechanoreceptors in the ATFL was reduced (P < .001) and PIEZO2 expression in the sensory neurons decreased (P = .008) at 8 weeks postoperatively. The number of mechanoreceptors was negatively correlated with ankle sensorimotor dysfunction (P < .001). CONCLUSION The AJI model demonstrated degeneration of the mechanoreceptors in the ATFL and decreased mechanosensitivity of the sensory neurons, which may contribute to CAI. CLINICAL RELEVANCE Ankle instability causes degeneration of mechanoreceptors and decreases the mechanosensitivity of sensory neurons involved in the development of CAI. This finding emphasizes the importance of controlling ankle instability after ankle sprains to prevent recurrence and the onset of CAI.
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Affiliation(s)
- Sora Kawabata
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kaichi Ozone
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
- Department of Rehabilitation, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Yuki Minegishi
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
- Physical Therapy Course, Department of Rehabilitation, Faculty of Health Sciences, Nihon Institute of Medical Science, Saitama, Japan
| | - Yuichiro Oka
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Hidenobu Terada
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Chiharu Takasu
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Takuma Kojima
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Takuma Kano
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Naohiko Kanemura
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan
| | - Kenji Murata
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan
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Werner D, Casey L, Myers E, Barrios JA. Lower limb squat biomechanics and select clinical measures in chronic ankle instability. Clin Biomech (Bristol, Avon) 2024; 113:106211. [PMID: 38430783 DOI: 10.1016/j.clinbiomech.2024.106211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/29/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Individuals with chronic ankle instability often present with clinical and biomechanical abnormalities, however squat biomechanics have not been investigated. The purpose of this study was to compare select clinical assessments and squat biomechanics between individuals with and without chronic ankle instability. METHODS Fifteen individuals with chronic ankle instability and a matched control group were studied. A weight-bearing dorsiflexion lunge test, foot posture, and an in-line half-kneeling motor control test for core stability were assessed. Lower limb 3D bilateral and unilateral squat biomechanics were captured. Groups, limbs and squat tasks were compared using an alpha of 0.05. FINDINGS Individuals with chronic ankle instability had less static weight-bearing dorsiflexion and failed the core stability test more frequently, but did not differ in foot morphology compared to the controls. When squatting, those with chronic ankle instability demonstrated reduced peak ankle dorsiflexion angles and moments in the involved limb (p < 0.04) during single limb squats and had interlimb differences in ankle dorsiflexion angle as well as hip and knee kinetics (p < 0.04) during double limb squats. In those with chronic ankle instability, there was less overall motion, but higher kinetic demands in single limb versus double leg squatting (p < 0.03). INTERPRETATION Individuals with chronic ankle instability had impaired weight-bearing dorsiflexion and showed impaired core stability more often, which accompanied altered squatting mechanics in both variations. Within the limbs with chronic ankle instability, single limb squats showed lesser kinematic demands but higher kinetic demands than double limb squatting.
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Affiliation(s)
- David Werner
- Physical Therapy Program, Department of Health and Rehabilitation Sciences, University of Nebraska Medical Center, Omaha, NE, USA; Office of Graduate Studies, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lauren Casey
- Department of Physical Therapy, School of Education and Health Sciences, University of Dayton, Dayton, OH, USA
| | - Ethan Myers
- Department of Physical Therapy, School of Education and Health Sciences, University of Dayton, Dayton, OH, USA
| | - Joaquin A Barrios
- Department of Physical Therapy, School of Education and Health Sciences, University of Dayton, Dayton, OH, USA.
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Guyonnet C, Vieira TD, Wackenheim FL, Lopes R. Arthroscopic Modified Broström Repair with Suture-Tape Augmentation of the Calcaneofibular Ligament for Lateral Ankle Instability. Arthrosc Tech 2024; 13:102887. [PMID: 38584641 PMCID: PMC10995735 DOI: 10.1016/j.eats.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/04/2023] [Indexed: 04/09/2024] Open
Abstract
Surgical repair of acute or chronic lateral instability of the ankle may be unsuccessful in the presence of associated anterior fibulotalar ligament (AFTL) and calcaneofibular ligament (CFL) injury. This Technical Note presents an arthroscopic double-row repair technique of the AFTL associated with suture tape augmentation of the CFL. The patient is in the supine position with the ankle hanging over the edge of the surgical table. The anteromedial portal is created inside the anterior tibial tendon, and the anterolateral portal is created under arthroscopic control. The ATFL is released from the capsule with a beaver blade. The calcaneal tunnel is created percutaneously at the footprint of the CFL. A soft anchor is impacted at the tip of the lateral malleolus with thread and tape. With the foot in the neutral position, the tape is then passed into the calcaneal tunnel and attached with an interference screw to strengthen the CFL. The ATFL is grasped with a Mini-Scorpion suture passer and pressed against the anchor with the foot in neutral position. A knotless anchor is impacted 5 mm above with the threads of the soft anchor, creating double-row fixation. This technique is indicated in proximal tears of the AFTL associated with a stretched CFL.
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Affiliation(s)
- Clément Guyonnet
- Institut Médical Pérignat, Pérignat-lès-Sarliève, France
- Hôpital Privé la Châtaigneraie, Beaumont, France
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40
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Heitz PH, Miron MC, Beauséjour M, Hupin M, DiLiddo L, Jourdain N, Nault ML. Ultrasound Assessment of Ankle Syndesmotic Injuries in a Pediatric Population. Clin J Sport Med 2024; 34:83-90. [PMID: 37882722 DOI: 10.1097/jsm.0000000000001193] [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: 02/09/2023] [Accepted: 09/05/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To determine sensitivity and specificity for anterior-inferior tibiofibular ligament (AiTFL) integrity and tibiofibular clear-space (TFCS) cut-off points for dynamic evaluation using ultrasound (US) in a pediatric population. DESIGN Prospective cohort study. SETTING Tertiary care university-affiliated pediatric hospital patients between the ages of 12 and 18 sustaining acute ankle trauma with syndesmotic injury. INTERVENTIONS Participants were assigned to the syndesmotic injury protocol that included a standardized MRI and US. MAIN OUTCOME MEASURES Anterior-inferior tibiofibular ligament integrity for static assessment and TFCS measurements for dynamic assessment on US. For dynamic assessment, the distance between the distal tibia and fibula was first measured in neutral position and then in external rotation for each ankle. The US results on AiTFL integrity were compared with MRI, considered as our gold standard. Optimal cut-off points of TFCS values were determined with receiver operating characteristics curve analysis. RESULTS Twenty-six participants were included. Mean age was 14.8 years (SD = 1.3 years). Sensitivity and specificity for AiTFL integrity were 79% and 100%, respectively (4 false negatives on partial tears). For dynamic assessment, the cut-off points for the differences in tibiofibular distance between the 2 ankles in 1) neutral position (TFCS N I-U ) and 2) external rotation (TFCS ER I-U ) were 0.2 mm (sensitivity = 83% and specificity = 80%) and 0.1 mm (sensitivity = 83% and specificity = 80%), respectively. CONCLUSIONS Static US could be used in a triage context as a diagnostic tool for AiTFL integrity in a pediatric population as it shows good sensitivity and excellent specificity.
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Affiliation(s)
- Pierre-Henri Heitz
- Department of Surgery, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Surgery, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
| | - Marie-Claude Miron
- Department of Radiology, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Radiology, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
| | - Marie Beauséjour
- Department of Surgery, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Surgery, Université de Sherbrooke, Université de Sherbrooke-Campus Longueuil, Longueuil, QC, Canada
| | - Mathilde Hupin
- Department of Surgery, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Surgery, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
| | - Lydia DiLiddo
- Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Pediatrics, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
| | | | - Marie-Lyne Nault
- Department of Surgery, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Surgery, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
- Department of Surgery, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
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Rigby RB, Ptak NA. Incidence of Medial Deltoid Ligament Instability in 226 Patients With Chronic Ankle Instability. J Foot Ankle Surg 2024; 63:245-249. [PMID: 38043601 DOI: 10.1053/j.jfas.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
The deltoid ligament is vitally important in the stability of the ankle and preventing excessive medial ankle movement. Historically, the impact of medial ankle instability has not been well understood in the setting of chronic ankle instability. A retrospective review of 226 patients treated for ankle instability between 2017 and 2022 identified 40 patients who required both medial and lateral repair. Decision for medial deltoid repair was based upon patient presentation, MRI findings, intraoperative fluoroscopy and final confirmation via arthroscopic positive "drive-through sign". Preoperative and postoperative American Orthopedic Foot and Ankle Society (AOFAS) hindfoot-ankle scores, Patient-Recorded Outcomes Measurement Information System (PROMIS) scores, and Karlsson-Peterson Ankle Function (K&P) scores were obtained and compared. There were statistically significant improvements found in all 3 scoring systems at a mean follow-up time of 11.7 months postoperatively. In the setting of chronic ankle instability, consideration should be given to the evaluation and potential repair of the deltoid ligament in order to provide sufficient stability to the medial ankle.
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Affiliation(s)
- Ryan B Rigby
- Logan Regional Orthopedics, Intermountain Healthcare, Logan, UT.
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Cordier G, Boudahmane S, Ovigue J, Michels F, Araujo Nunes G, Dallaudiere B. MRI Assessment of Tendon Graft After Lateral Ankle Ligament Reconstruction: Does Ligamentization Exist? Am J Sports Med 2024; 52:721-729. [PMID: 38343192 DOI: 10.1177/03635465231225487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND No description exists in the literature about the normal evolution of tendon graft after a lateral ankle ligament (LAL) reconstruction. PURPOSE To assess the magnetic resonance imaging (MRI) characteristics and the evolution of the tendon graft during different moments in the follow-up after an endoscopic reconstruction of the LAL. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This prospective study included 37 consecutive patients who underwent an endoscopic reconstruction of the LAL with an autograft using the gracilis tendon to treat chronic ankle instability (CAI) resistant to nonoperative treatment (CAI group) and 16 patients without ankle instability (control group). All patients in the CAI group underwent a postoperative assessment at 6, 12, and 24 months using the Karlsson score and MRI examination. Only patients with good and excellent results were included in the study. Graft assessment consisted of qualitative measurements and quantitative evaluations of the reconstructed anterior talofibular ligament (RATFL) and reconstructed calcaneofibular ligament (RCFL), including signal-to-noise quotient (SNQ) and contrast-to-noise quotient (CNQ) measurements in proton density-fat suppressed (PD-FS) and T1-weighted sequences. The analysis of variance test was used to compare the SNQ and the CNQ at different time points for each sequence. RESULTS The MRI signal at 6 months was increased compared with that of the control group. Next, a significant signal decrease from 6 to 24 months was noted on PD-FS and T1-weighted images. SNQ measurements on PD-FS weighted images for both the RATFL and the RCFL demonstrated a significantly higher signal (P < .01 and P = .01, respectively) at 6 months compared with that of the control group. Subsequently, the signal decreased from 6 to 24 months. Similarly, CNQ measurements on PD-FS weighted images for both the RATFL and the RCFL demonstrated a significantly higher signal (P < .01 and P < .01, respectively) at 6 months compared with that of the control group. Subsequently, the signal decreased from 6 to 24 months. CONCLUSION The present study demonstrated an evolution of the MRI characteristics, suggesting a process of graft maturation toward ligamentization. This is important for clinical practice, as it suggests an evolution in graft properties and supports the possibility of creating a viable ligament.
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Affiliation(s)
- Guillaume Cordier
- Clinique du Sport, Vivalto Santé, Bordeaux-Merignac, France
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
| | - Sofiane Boudahmane
- Centre d'Imagerie Ostéo-articulaire, Clinique du Sport de Bordeaux-Merignac, Merignac, France
| | - Jordan Ovigue
- Clinique du Sport de Bordeaux-Merignac, Merignac, France
| | - Frederick Michels
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
- Orthopaedic Department, AZ Groeninge, Kortrijk, Belgium
- EFAS, ESSKA-AFAS Ankle Instability Group
| | - Gustavo Araujo Nunes
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
- Cote Brasília Clinic, DF, Brasilia, Brazil
| | - Benjamin Dallaudiere
- Centre d'Imagerie Ostéo-articulaire, Clinique du Sport de Bordeaux-Merignac, Merignac, France
- Centre de Résonance Magnétique des Systèmes Biologiques, Université de Bordeaux, Bordeaux, France
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Ko D, Choi Y, Lee K. Effects of Peroneus Brevis versus Peroneus Longus Muscle Training on Muscle Function in Chronic Ankle Instability: A Randomized Controlled Trial. Healthcare (Basel) 2024; 12:547. [PMID: 38470658 PMCID: PMC10930769 DOI: 10.3390/healthcare12050547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Chronic ankle instability (CAI) is a common injury that can occur in daily life or sporting events. Injuries to the anterior talofibular, posterior talofibular, and calcaneofibular ligaments are common, and the core of rehabilitation training involves strengthening the peroneus muscle. Many studies on rehabilitation training have focused on strengthening the peroneus brevis muscle, and few studies have focused on specific training to strengthen the peroneus longus muscle. Therefore, this study aims to investigate changes in the symptoms and functions of patients by applying training to strengthen the peroneus longus and peroneus brevis muscles. Home-based training and mobile monitoring were utilized for 12 weeks, divided into peroneus brevis training (PBT) and peroneus longus training (PLT), in 52 adult males with CAI. Participation was voluntary, with enrollment done through a bulletin board, and intervention training allocation was randomly assigned and conducted in a double-blind manner. This study was registered as a trial protocol (KCT 0008478). Foot and ankle outcome scores (FAOS), isokinetic ankle strength tests, and Y-balance tests were performed before and after the intervention. Both PLT and PBT significantly improved in FAOS, inversion, and eversion at angular velocities of 30°/s and 120°/s and in the anterior and posterolateral directions of the Y-balance test (p < 0.05). Interaction effects by time and group were not significant for the FAOS (p > 0.05). However, PLT improved eversion muscle strength and muscle power to a greater degree, compared with PBT, in the anterior and posterolateral directions of the Y-balance test (p < 0.05). In conclusion, both PLT and PBT were effective for CAI patients; in addition, PLT had greater potential for improving strength and balance.
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Affiliation(s)
- Dukhan Ko
- Department of Sports Science Convergence, Dongguk University, Seoul 04620, Republic of Korea;
| | - Yongchul Choi
- Department of Physical Education, Gangneung-Wonju National University, Gangneung 25457, Republic of Korea
| | - Kyujin Lee
- Department of Instructor Education, College of Cultural Convergence, Jeonju University, Jeonju 55070, Republic of Korea
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Chamorro-Moriana G, Perez-Cabezas V, Benitez-Lugo M. Effectiveness of functional or biomechanical bandages with athletic taping and kinesiotaping in subjects with chronic ankle instability: a systematic review and meta-analysis. EFORT Open Rev 2024; 9:94-106. [PMID: 38308953 PMCID: PMC10873244 DOI: 10.1530/eor-23-0129] [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: 02/05/2024] Open
Abstract
Purpose The aim of the study was to analyze the effects of functional or biomechanical bandages, whether elastic or inelastic, in Chronic Ankle Instability (CAI). Methods This review used PubMed, WoS, SCOPUS, and CINAHL following PRISMA and registering in Prospero. Main PICOS: (1) CAI; (2) intervention, functional/biomechanical bandages; (3) comparison, taping effect versus placebo/no taping, or another functional taping; (4) outcomes, improvement of CAI functionality (dynamic/static balance, ankle kinematic, perception, agility and motor control, endurance and strength; (5) experimental and preexperimental studies. The meta-analyses considered mean and s.d. of the results per variable; effect size (ES) of each study and for each type of intervention. Homogeneity (Q), heterogeneity (H 2 and I 2), and 95% CI were calculated. Results In total, 28 studies were selected. Significant differences were found for dynamic balance (66.66%) and static balance (87.5%), ankle kinematics (75.00%), perceptions (88.88%), plantar flexor strength (100%), muscle activity (66.6%), endurance (100%), functional performance (100%), and gait (66.6%). The main results of meta-analyses (eight studies) are as follows - h/M ratio soleus, ES: 0.080, 95% CI: -5.219-5.379; h/M ratio peroneus, ES: 0.070, 95% CI: -6.151-6.291; posteromedial KT, ES: 0.042 95% CI: -0.514-0.598; posteromedial-overall, ES: -0.006 95% CI: -1.071-0.819; mSEBT-KT, ES: 0.057 95% CI: -0.281-0.395; mSEBT-overall, ES: -0.035 95% CI: -0.190-0.590. Conclusions All biomechanical or functional bandages, whether elastic or inelastic, applied in CAI were favorable, highlighting patient perception, dynamic and static balance, kinematics and agility and motor control, for its effectiveness and evidence. Thus, bandages increase ankle functionality. The meta-analyses found no statistical significance. Clinically, soleus muscle activity, h-reflex/M-responses using fibular reposition with rigid tape, and dynamic balance with combined kinesiotaping during the modified star excursion balance test and with the posteromedial direction found improvements. Level of evidence Level of evidence according to Scottish Intercollegiate Guidelines Network: 1+. Level of evidence according to the Oxford Centre for Evidence-Based Medicine 2011: 1.
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Affiliation(s)
- Gema Chamorro-Moriana
- Department of Physiotherapy, Research Group “Area of Physiotherapy CTS-305”, University of Seville, Seville, Spain
| | - Veronica Perez-Cabezas
- Department of Nursing and Physiotherapy, Research Group MOVEIT (eMpOwering health by physical actiVity, Exercise and nutrition) CTS-1038, University of Cadiz, Cadiz, Spain
| | - Marisa Benitez-Lugo
- Department of Physiotherapy, Research Group “Area of Physiotherapy CTS-305”, University of Seville, Seville, Spain
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Robbins JB, Stahel SA, Morris RP, Jupiter DC, Chen J, Panchbhavi VK. Radiographic Anatomy of the Lateral Ankle Ligament Complex: A Cadaveric Study. Foot Ankle Int 2024; 45:179-187. [PMID: 37994643 PMCID: PMC10860354 DOI: 10.1177/10711007231213355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND When lateral ankle sprains progress into chronic lateral ankle instability (CLAI), restoring precise anatomic relationships of the lateral ankle ligament complex (LALC) surgically is complex. This study quantifies the radiographic relationships between the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and prominent osseous landmarks visible under fluoroscopy to assist in perioperative practices for minimally invasive surgery for CLAI. METHODS Ten fresh frozen ankle specimens were dissected to expose the LALC and prepared by threading a radiopaque filament through the ligamentous footprints of the ATFL and CFL. Fluoroscopic images were digitally analyzed to define dimensional characteristics of the ATFL and CFL. Directional measurements of the ligamentous footprints relative to the lateral process of the talus and the apex of the posterior facet of the calcaneus were calculated. RESULTS Dimensional measurements of the ATFL were a mean length of 9.3 mm, fibular footprint of 9.4 mm, and talar footprint of 9.1 mm. Dimensional measurements of the CFL were a mean length of 19.4 mm, fibular footprint of 8.2 mm, and calcaneal footprint of 7.3 mm. From the radiographic apparent tip of the lateral process of the talus, the fibular attachment of the ATFL was found 13.3 mm superior and 4.4 mm posterior, whereas the talar attachment was found 11.5 mm superior and 4.8 mm anterior. From the radiographic apparent posterior apex of the posterior facet of the calcaneus, the fibular attachment of the CFL was found 0.2 mm inferior and 6.8 mm anterior, whereas the calcaneal attachment was found 14.3 mm inferior and 5.9 mm posterior. CONCLUSION The ATFL and CFL were radiographically analyzed using radiopaque filaments to outline the ligamentous footprints in their native locations. These ligaments were also localized with reference to 2 prominent osseous landmarks. These findings may assist in perioperative practices for keyhole incision placement and arthroscopic guidance. Perfect lateral ankle joint imaging with talar domes superimposed is required to be able to do this. CLINICAL RELEVANCE Radiographic evaluation of the ATFL and CFL with reference to prominent osseous landmarks identified under fluoroscopy may assist in perioperative practices for minimally invasive surgery to address CLAI for keyhole incision placement and arthroscopic guidance.
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Affiliation(s)
- Jordan B. Robbins
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Shepheard A. Stahel
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Randal P. Morris
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel C. Jupiter
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jie Chen
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Vinod K. Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
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Gerdesmeyer L, Vester J, Schneider C, Wildemann B, Frank C, Schultz M, Seilheimer B, Smit A, Kerkhoffs G. Topical Treatment Is Effective and Safe for Acute Ankle Sprains: The Multi-Center Double-Blind Randomized Placebo-Controlled TRAUMED Trial. J Clin Med 2024; 13:841. [PMID: 38337536 PMCID: PMC10856131 DOI: 10.3390/jcm13030841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Topical NSAIDs are widely used to treat ankle sprains. Traumed (Tr14) gel is a multicomponent formulation, demonstrating inflammation-resolution properties. METHODS This multicenter, double-blind trial investigated the efficacy and safety of Tr14 gel versus placebo gel and non-inferiority versus 1% diclofenac gel, applied 3×/day for 7 days after acute lateral ankle sprain (EudraCT Number: 2016-004792-50). The primary outcome was AUC for pain on passive movement, assessed by VAS from baseline to Days 4 and 7. RESULTS The trial population included 625 patients aged 18 to 78 years. The AUC scores were 187.88 and 200.75 on Day 4 (p = 0.02) and 294.14 and 353.42 on Day 7 (p < 0.001) for Tr14 and placebo, respectively. For Tr14 compared to diclofenac, the AUC scores were 187.50 and 197.19 on Day 4 (p = 0.3804) and 293.85 and 327.93 on Day 7 (p = 0.0017), respectively. On the FAAM-ADL subscale, Tr14 was superior to placebo and non-inferior to diclofenac at all time points. Time to 50% pain improvement was lowest for Tr14 (6.0 days), compared to placebo (7.1 days) and diclofenac (7.0 days). Adverse events were uncommon and minor. CONCLUSIONS Tr14 gel is effective and safe in acute ankle sprains, compared to placebo gel and diclofenac gel, and has faster pain resolution. TRIAL REGISTRATION The trial was registered in clinicaltrialsregister.eu, EudraCT number 2016-004792-50 on 07.06.2017.
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Affiliation(s)
- Ludger Gerdesmeyer
- Orthopedics and Trauma Surgery, Kiel Municipal Hospital, 24116 Kiel, Germany
| | | | | | - Britt Wildemann
- Experimental Trauma Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany
| | | | | | | | - Alta Smit
- Heel GmbH, 76532 Baden-Baden, Germany
| | - Gino Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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McCann RS, Welch Bacon CE, Suttmiller AMB, Gribble PA, Cavallario JM. Assessments Used by Athletic Trainers to Decide Return-to-Activity Readiness in Patients With an Ankle Sprain. J Athl Train 2024; 59:182-200. [PMID: 35622952 PMCID: PMC10895399 DOI: 10.4085/1062-6050-0037.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Athletic trainers (ATs) often care for patients with ankle sprains. Expert consensus has been established for rehabilitation-oriented assessments (ROASTs) that should be included in ankle-sprain evaluations. However, the methods ATs use to determine return-to-activity readiness after an ankle sprain are unknown. OBJECTIVES To identify ATs' methods for determining patients' return-to-activity readiness after an ankle sprain and demographic characteristics of the ATs and their methods. SETTING Online survey. DESIGN Cross-sectional study. PATIENTS OR OTHER PARTICIPANTS We recruited 10 000 clinically practicing ATs. A total of 676 accessed the survey, 574 submitted responses (85% completion rate), and 541 respondents met the inclusion criteria. MAIN OUTCOME MEASURE(S) We distributed an online survey to ATs that asked about their assessment of pain, swelling, range of motion, arthrokinematics, strength, balance, gait, functional capacity, physical activity level, and patient-reported outcomes in deciding return to activity. Descriptive statistics were used to characterize participant demographics and frequencies of the assessment measures used by ATs. Chi-square analysis was conducted to identify relationships between the demographics and assessment selection. RESULTS Pain, swelling, range of motion, strength, balance, gait, and functional capacity were assessed by 76.2% to 96.7% of ATs. Arthrokinematics, physical activity level, and patient-reported outcomes were assessed by 25.3% to 35.1% of participants. When selecting specific assessment methods, ATs often did not use recommended ROASTs. Athletic trainers with higher degrees, completion of more advanced educational programs, employment in nontraditional settings, more clinical experience, and familiarity with expert consensus recommendations were more likely to use ROASTs. CONCLUSIONS Before approving return to activity for patients with ankle sprains, ATs did not use some recommended outcomes and assessment methods. Practice in nontraditional settings, more advanced degrees, more clinical experience, and familiarity with expert consensus guidelines appeared to facilitate the use of ROASTs.
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Affiliation(s)
- Ryan S. McCann
- Rehabilitation Sciences, Old Dominion University, Norfolk, VA
| | - Cailee E. Welch Bacon
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa
| | | | - Phillip A. Gribble
- Athletic Training and Clinical Nutrition, University of Kentucky, Lexington
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Hou Z, Shen W, Fong DTP, Winter SL. Anticipation of landing leg masks ankle inversion orientation deficits and peroneal insufficiency during jump landing in people with chronic ankle instability. Scand J Med Sci Sports 2024; 34:e14585. [PMID: 38356438 DOI: 10.1111/sms.14585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/20/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
Ankle inversion orientation and peroneal activation insufficiency may contribute to lateral ankle sprains during landing in chronic ankle instability (CAI); however, how anticipation alters these factors is neglected. This study aimed to assess the impact of anticipation on joint orientation and muscle activity during landing in individuals with CAI. Fifteen participants with CAI and 15 healthy participants (control) were recruited to perform single-leg landings after bilateral countermovement jumps when the landing limb was specified before (planned) or after (unplanned) take-off. Joint angle (hip, knee, and ankle) and electromyography (gluteus medius, rectus femoris, biceps femoris, gastrocnemius lateral head, tibialis anterior, and peroneal longus) were collected and analyzed with 2 (groups) × 2 (conditions) statistical parametric mapping ANOVA. In the unplanned condition, the CAI group demonstrated a less plantarflexed (maximum difference [MD] = 9.5°, p = 0.047) and more inverted ankle joint (MD = 4.1°, p < 0.001) before ground contact, along with lower peroneal activity at ground contact compared to the control group (MD = 28.9% of peak activation, p < 0.001). No significant differences between groups were observed in the planned condition. In conclusion, anticipation may mask jump landing deficits in people with CAI, including inverted ankle orientation and reduced peroneus longus activity pre- and post-landing, which were observed exclusively in unplanned landings. Clinicians and researchers need to recognize the impact of anticipation on apparent landing deficits and consider the implications for injury prevention and rehabilitation strategies.
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Affiliation(s)
- Zongchen Hou
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Wei Shen
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Samantha L Winter
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Hu D, Wang N, Wang H, Fan D, Teng Q, Zheng X, Hou H. Clinical outcomes of arthroscopic all-inside anterior talofibular ligament suture augmentation repair versus modified suture augmentation repair for chronic ankle instability patients. BMC Musculoskelet Disord 2024; 25:48. [PMID: 38200504 PMCID: PMC10777501 DOI: 10.1186/s12891-023-07085-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/30/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND To compare the clinical efficacies of arthroscopic anterior talofibular ligament suture augmentation repair and modified suture augmentation repair in patients with chronic ankle instability (CAI). METHODS From October 2019 to August 2020, 100 patients with CAI were enrolled after propensity score matching analysis and observed for two years. Among them, 50 underwent modified suture augmentation repair and the other 50 underwent suture augmentation repair. The clinical efficacies of CAI treatments were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) clinical rating scale, visual analog scale (VAS), and anterior drawer test scores. RESULTS The postoperative AOFAS score of the modified suture augmentation repair group (83.8 ± 11.3) was significantly higher than that of the suture augmentation repair group (76.3 ± 11.3; P = 0.001). The VAS (P = 0.863) and anterior drawer test (P = 0.617) scores were not significantly different between the two treatment groups. CONCLUSION Both the modified suture augmentation repair and suture augmentation repair demonstrated good clinical efficacies. The AOFAS score of the modified suture augmentation repair group was superior to that of the conventional suture augmentation repair group. Thus, modified suture augmentation repair is a feasible and practical surgical technique for CAI treatment.
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Affiliation(s)
- Dahai Hu
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China
- International School, Jinan University, Guangzhou, 510632, Guangdong, China
| | - Nan Wang
- Department of Clinical Medicine, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Huajun Wang
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China
| | - Dongyi Fan
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China
| | - Qiang Teng
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China
| | - Xiaofei Zheng
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China.
| | - Huige Hou
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China.
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Steinberg N, Shenhar M, Witchalls J, Waddington G, Dar G, Paulman O, Finestone A(RS. Chronic Ankle Instability and Neuromuscular Performance in Prerecruitment Infantry Soldiers. J Athl Train 2024; 59:73-80. [PMID: 37459361 PMCID: PMC10783473 DOI: 10.4085/1062-6050-0564.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
CONTEXT Ankle instability can describe various impairments, including perceived instability (PI), mechanical instability (MI), and recurrent sprains (RSs), alone or combined. OBJECTIVE To examine the prevalence of 8 ankle impairment subgroups and their effect on neuromuscular performance in prerecruitment combat soldiers. DESIGN Cross-sectional study. SETTING Military infantry basic training base. PATIENTS OR OTHER PARTICIPANTS A total of 364 infantry male combat soldiers entering basic training (aged 18-21 years). MAIN OUTCOME MEASURE(S) Participants were assessed for PI (via the Cumberland Ankle Instability Tool), MI (using the Anterior Drawer Test and Medial Talar Tilt Test), and RSs (based on history) of their dominant and nondominant legs. Injuries were categorized in 8 subgroups: PI, RSs, PI + RSs, MI, PI + MI, MI + RSs, PI + MI + RSs, and none. Participants were screened for neuromuscular performance (dynamic postural balance, proprioceptive ability, hopping agility, and triceps surae muscle strength) during the first week of military basic training. RESULTS For the dominant and nondominant legs, RSs were reported by 18.4% (n = 67) and 20.3% (n = 74) of the participants, respectively; PI was reported by 27.1% (n = 99) and 28.5% (n = 104) of the participants, respectively; and MI was seen in 9.9% (n = 36) and 8.5% (n = 31) of the participants, respectively. A 1-way analysis of variance showed differences in the mean proprioceptive ability scores (assessed using the Active Movement Extent Discrimination Apparatus) of all subgroups with impairments in both the dominant and nondominant legs (F = 6.943, η2 = 0.081, P < .001 and F = 7.871, η2 = 0.091, P < .001, respectively). Finally, differences were found in the mean muscle strength of subgroups with impairment in the nondominant leg (F = 4.884, η2 = 0.056, P = .001). CONCLUSIONS A high prevalence of ankle impairments was identified among participants who exhibited reduced abilities in most neuromuscular assessments compared with those who did not have impairments. Moreover, participants with 1 impairment (PI, MI, or RSs) exhibited different neuromuscular performance deficits than those with >1 impairment.
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Affiliation(s)
- Nili Steinberg
- Levinsky-Wingate Academic College, Wingate Campus, Netanya, Israel
| | - Michal Shenhar
- Levinsky-Wingate Academic College, Wingate Campus, Netanya, Israel
| | | | | | - Gali Dar
- Physical Therapy, University of Haifa, Israel
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