Epidemiology of Ankle Sprains and Chronic Ankle Instability

Anterior talofibular ligament footprint dimension measured using three-dimensional magnetic resonance imaging

OBJECTIVE

Knowledge of footprint anatomy is essential for ankle anterior talofibular ligament repair and reconstruction. We aimed to determine the intra- and inter-rater measurement reliability of the anterior talofibular ligament footprint dimension using three-dimensional MRI.

METHODS

MRI images of 20 ankles with intact ligaments, including 11 with a single bundle and nine with double-bundle ligaments, were analyzed. Imaging was performed using a 3.0-Tesla MRI. Isotropic three-dimensional proton density-weighted images with a voxel size of 0.6 mm were obtained. The fibular and talar footprints were manually segmented using image processing software to create three-dimensional ligament footprints. The lengths, widths, and areas of each sample were measured. A certified orthopedic surgeon and a senior orthopedic fellow performed the measurements twice at 6-week intervals. The intra- and inter-rater differences in the measurements were calculated.

RESULTS

The length, width, and area of the single-bundle fibular footprint were 8.7 mm, 5.4 mm, and 37.4 mm2, respectively. Those of the talar footprint were 8.4 mm, 4.3 mm, and 30.1 mm2, respectively. The inferior bundle of the double-bundle ligament was significantly smaller than the single and superior bundles (p < 0.001). No differences were observed between intra-rater measurements by either rater, with maximum differences of 0.7 mm, 0.5, and 1.7 mm2, in length, width, and area, respectively. The maximum inter-rater measurement differences were 1.9 mm, 0.5, and 2.4 mm2, respectively.

CONCLUSION

Measurements of the anterior talofibular ligament dimensions using three-dimensional MRI were sufficiently reliable. This measurement method provides in vivo quantitative data on ligament footprint anatomy.

Future risk of falls induced by ankle-foot sprains history: An observational and mendelian randomization study

Background

Ankle-foot sprains are the most common musculoskeletal injuries, which can impair balance and theoretically increase the risk of falls, but still, there is a lack of evidence supporting the direct association between ankle-foot sprains and the future risk of falls.

Methods

UK Biobank cohort was utilized to measure the association between ankle-foot sprains and fall risk with covariates adjusted. Then, the two-sample Mendelian randomization (MR) analysis was applied based on the genetically predicated ankle-foot sprains from FinnGen to validate causal relationship. Finally, genetically predicated cerebellar neuroimaging features were used to explore the mediating role of maladaptive neuroplasticity between ankle-foot sprains and falls by two-step MR analyses.

Results

Patients with ankle-foot sprains history exhibited a slightly increased risk of falls than the matched controls before and after adjustment for covariates (odd ratio [OR] ranged from 1.632 to 1.658). Two-sample MR analysis showed that ankle-foot sprains led to a higher risk of falls (OR ​= ​1.036) and a lower fractional anisotropy of superior cerebellar peduncle (SCP) (left, β ​= ​-0.052; right, β ​= ​-0.053). A trend of mediating effect was observed for the fractional anisotropy of right SCP in the causal effects of ankle-foot sprains on falls (β ​= ​0.003).

Conclusion

The history of ankle-foot sprains is associated with a slightly increased risk of falls. These findings improve our understanding of the clinical consequences of ankle-foot sprains in terms of fall risk and suggest the importance of adopting more efficient strategies for managing residual functional deficits after the injuries.

Effectiveness of exercise therapy on chronic ankle instability: a meta-analysis

Lateral ankle sprains are one of the most common musculoskeletal injuries. Up to 70% of individuals who sustain lateral ankle sprains develop chronic ankle instability (CAI). Exercise therapy is considered an effective treatment for patients with CAI. This meta-analysis investigated the efficacy of exercise therapy in CAI patients by reviewing 15 randomized controlled trials (RCTs) involving 586 participants. Databases including PubMed, EMBASE, Cochrane Library, and Web of Science were searched from inception to September 13, 2024. The Cochrane Risk of Bias Tool was used to assess study quality. Meta-analysis, sensitivity analysis, and publication bias analysis were conducted using RevMan 5.3.0 and Stata 18.0 software. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was applied to evaluate the quality of evidence. Main outcomes were assessed using the Foot and Ankle Ability Measure (FAAM) and the Star Excursion Balance Test (SEBT). The results demonstrated that exercise therapy significantly improved FAAM-S (MD = 7.98, CI: 4.11 to 11.86, p < 0.0001, I² = 30%). Long-term exercise therapy (over 4 weeks) significantly enhanced FAAM-A (MD = 10.95, CI: 6.60 to 15.29, p < 0.00001, I² = 0%) and dynamic balance ability of ankle joint (SBET-A: MD = 4.83, CI: 1.04 to 8.63, p = 0.01, I² = 62%; SEBT-PM: MD = 6.93, CI: 2.37 to 11.48, p = 0.003, I² = 69%; and SEBT-PL: MD = 8.98, CI: 2.66 to 15.29, p = 0.005, I² = 86%). After categorizing by exercise type, the results indicated that strength training was more effective in improving SEBT-PL (MD = 8.15, CI: 6.09 to 10.21, p < 0.00001, I² = 0%), joint mobilization was more effective in improving SEBT-A (MD = 7.65, CI: 4.93 to 10.37, p < 0.00001, I² = 0%), and proprioceptive training was more effective in improving SEBT-PM (MD = 10.46, CI: 5.27 to 15.65, p < 0.0001, I² = 33%). In conclusion, long-term, multifaceted exercise therapy demonstrates superior rehabilitation efficacy for patients with CAI. Personalized treatment plans, informed by SEBT assessment results, should prioritize targeted interventions such as joint mobilization, strength training, or proprioceptive training. This approach holds significant theoretical and practical value for optimizing CAI treatment strategies and enhancing patient outcomes.

Effectiveness of manual techniques, exercise therapy, or combined treatments in the management of ankle sprains or chronic ankle instability in adult athletes: a systematic review protocol

OBJECTIVE

The objective of this review will be to synthesize the evidence on the effectiveness of manual techniques, exercise therapy, or combined treatments in the management of ankle sprains and chronic ankle instability in adult athletes.

INTRODUCTION

Acute ankle sprains and chronic ankle instability are common in athletes. These conditions can result in varying degrees of disability, including reduced athletic performance and time out of competition, which may have adverse psychological effects.

INCLUSION CRITERIA

The review will consider randomized controlled trials evaluating the effectiveness of manual techniques and/or exercise therapy for ankle sprain or chronic ankle instability in adult athletes. The comparators will include sham treatment, no treatment, and other conservative interventions. The outcomes of interest will be pain intensity, functional disability, ankle joint range of motion, ankle muscle strength, postural control, and subjective stability.

METHODS

The review will follow the JBI methodology for systematic reviews of effectiveness. Searches will be conducted to locate published and unpublished studies in the following sources: MEDLINE (Ovid), CENTRAL (Ovid), Embase, SPORTDiscus (EBSCOhost), Physiotherapy Evidence Database (PEDro), Google Scholar, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP). Two independent reviewers will select the study, critically appraise it, and extract data. Then, a narrative synthesis and, if appropriate, a meta-analysis will be performed. The certainty of findings will be determined using the GRADE approach.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42023493687.

Association between lower extremity movement patterns and ACL loading in CAI patients across varied ankle sprain frequencies within a year

PURPOSE

To investigate the relationship between the biomechanical characteristics of lower extremity and anterior cruciate ligament (ACL) loading during single-leg landing in patients with chronic ankle instability (CAI) who have different ankle sprain frequencies within a year.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

The incidence of ankle sprains among 74 male participants was meticulously documented over a one-year period. The participants had an average age of 21.78 years, a height of 176.37 cm, and a weight of 72.61 kg. Subsequently, a one-year monitoring period was implemented to assess the incidence of ankle sprains among the participants. The participants were classified into five groups according to their documented frequency of ankle sprains. The categories were as follows: The 2, 3, 4, 5, and 6 or more ankle sprain groups. Kinematic, kinetic, and electromyographic data were collected while participants performed a single-leg landing task. Lower extremity muscle force and ACL loading were modeled using OpenSim software.

RESULTS

CAI patients with more than four ankle sprains had higher peak ACL loading during single-leg landing than those with only two or three ankle sprains (P < 0.05). Additionally, CAI patients with more than four ankle sprains exhibited a limited range of ankle dorsiflexion and biceps femoris muscle force, which was significantly correlated with ACL loading (P < 0.05). CAI patients with more than 5 ankle sprains had greater ankle inversion angle, inversion angular velocity, vertical ground reaction force (GRF), rectus femoris muscle strength, and lower gastrocnemius, soleus muscle force during single-leg landing, and these biomechanical indices were significantly correlated with ACL strain (P < 0.05).

CONCLUSION

Based on these findings, it appears that experiencing four ankle sprains within a year might be a threshold for the development of knee compensation in CAI patients. This compensation could result in a significant increase in ACL loading. The study also found that CAI patients with more than four ankle sprains commonly exhibited altered motor characteristics such as limited ankle dorsiflexion angle, increased ankle inversion angle, excessive vertical GRF, and insufficient gastrocnemius and soleus muscle force during the landing phase. These characteristics might be responsible for the observed increase in ACL loading. In the future, clinical practice and scientific research may benefit from targeted interventions to prevent ACL injuries in CAI patients with different sprain histories, in accordance with the findings of this study.

Imaging of soccer injuries in adolescent female athletes

Soccer participation is increasing among female adolescents with a concomitant rise of injuries in this group. Age- and sex-related factors, such as the transition from skeletal immaturity to skeletal maturity as well as anatomic, physiologic, neuromuscular, and behavioral differences between females and males, all play a role in injury patterns for these athletes. Anterior cruciate ligament (ACL) tears in this group have received a great deal of attention in the medical literature and the media in recent years with increasing knowledge about causative factors, surgical management, and injury prevention. There have been fewer studies specifically focused on female adolescent soccer players in relation to other types of injuries, such as patellar dislocation/instability; other knee and ankle ligament tears; hip labral tears; muscle strains and tears; and overuse injuries such as apophysitis, patellofemoral pain syndrome, and bone stress injuries. Because imaging plays a critical role in diagnosis of soccer-related injuries in female adolescents, knowledge of the mechanisms of injury, imaging findings, and clinical considerations are essential for radiologists involved in the care of these patients.

Hop Stabilization Training Improves Functional Movement Patterns and Quality of Life in Female Athletes With Chronic Ankle Instability

CONTEXT

Chronic ankle instability (CAI) is a common consequence of a lateral ankle sprain. Sex differences in functional outcomes exist, but there is a lack of female-specific intervention studies. Hop stabilization training is effective in male athletes with CAI but has not been investigated in female athletes. Therefore, the purpose of this investigation was to describe the effect of hop stabilization exercises on functional movement patterns and patient-reported outcomes in female athletes with CAI. We also compared the current effect sizes with those observed in an all-male cohort following an identical intervention.

DESIGN

Randomized controlled trial.

METHODS

Fourteen female CAI participants completed hop stabilization training (age = 25.29 [5.86] y), and 14 female CAI participants were in the control group (age = 24.73 [6.97] y). Inclusion criteria were consistent with the International Ankle Consortium recommendations. The hop stabilization program consisted of three 20-minute sessions per week for 6 weeks. Sessions consisted of increasing foot-to-ground contacts each week until a taper in the final week. Exercise difficulty was also modified throughout the program. Functional movement patterns via the Functional Movement Screen and Fusionetics Scores, dorsiflexion range of motion, and select region-specific patient-reported outcomes were captured.

RESULTS

The hop training group (pre: 12.68 [1.32] cm, post: 13.42 [1.35] cm) had a significant improvement (P< .001) in dorsiflexion range of motion relative to the control group (pre: 13.62 [1.22] cm, post: 13.68 [1.16] cm). Hop training also significantly improved (P,<0.01) functional movement patterns and all patient-reported outcomes. Relative to an all-male cohort who previously underwent the same hop stabilization program, the current female cohort demonstrated larger effect sizes, but all 95% CIs overlapped.

CONCLUSIONS

A 6-week hop training program significantly improves patient-reported outcomes, dorsiflexion range of motion, and functional movement patterns in female athletes with CAI .

Physiotherapists Approach in Lateral Ankle Sprain Rehabilitation: A Survey Study

BACKGROUND

To investigate how physiotherapists approach lateral ankle sprain (LAS) rehabilitation and their rationale for exercise progression. We also sought to determine typical exercise dosage prescribed and the extent to which they rely on objective outcomes for guiding rehabilitation progression and return-to-sports decisions.

METHODS

We distributed an online survey using Qualtrics. The survey comprised a combination of 23 open and 8 closed questions to capture data on: participant demographics and clinical experience, typical caseload, LAS rehabilitation dosage, with clinical vignettes used to determine the time taken to reach key rehabilitation milestones, use of objective markers to inform rehabilitation progress, and progression to each milestone. Data were analyzed descriptively; open questions were inventoried and categorized. Proportions were then calculated per category.

RESULTS

Ninety-six physiotherapists from Belgium, the Netherlands, and the United Kingdom responded to the survey, of which 23 completed all sections. On average, less than half (46%) of the responding therapists use objective measurements to guide rehabilitation progress. The estimated time to reach key clinical milestones is equivocal among participating physiotherapists. Most physiotherapists use pain and ankle impairments (eg, range of motion and muscle strength) to guide rehabilitation progress.

CONCLUSION

This study indicates that progress in LAS rehabilitation is determined subjectively and that not the entire spectrum of impairments is assessed. Physiotherapists should implement more objective measures throughout LAS rehabilitation.

Plantar Pressure Analysis and the Ankle Instability Index: Quantifying "Giving Away" in Functional Ankle Instability

BACKGROUND

Individuals with functional ankle instability (FAI) typically present with abnormal plantar pressure distribution, while "giving away" is the most significant symptom. This study aims to explore the relationship between ankle instability and the deviation of the center of pressure (COP) trajectory during stance, which could potentially serve as an objective parameter for quantifying the giving away and identifying FAI.

METHODS

A total of 243 participants (20.3±1.1 years) were categorized into FAI group and the Coper group based on ankle stability status and the presence of giving away. Plantar pressure analysis was conducted to measure the maximum medial-lateral deviation of the COP during the forefoot contact phase and foot flat phase, which was defined as the Ankle Instability Index (AII). The difference in AII between the 2 groups was assessed using an independent-sample t test. The relationship between AII and self-reported ankle instability was explored, and a discriminant function analysis was performed to determine the optimal cut-off value of AII for identifying FAI, subsequently the diagnostic accuracy was explored.

RESULTS

A significant difference in AII was observed between the 2 groups (FAI: 18.06±4.82, Coper: 9.13±3.82, P < .001), and a significant correlation was found between AII and the scores of the Cumberland Ankle Instability Tool (CAIT) and Identification of Functional Ankle Instability (IdFAI) (r = -0.927 and r = 0.976, respectively, P < .001). AII exhibited a robust diagnostic value for FAI, with an area under the receiver operating characteristic curve of 0.931. The optimal threshold for AII in identifying FAI was 11.4, yielding an overall diagnostic accuracy of 91.99%.

CONCLUSION

The findings revealed a robust correlation between the severity of ankle instability and AII, which is an effective parameter for quantifying giving away and ankle stability status.

LEVEL OF EVIDENCE

Level III, retrospective case-control.

Effect of internal rotation of the hindfoot on diagnosis of anterior talofibular ligament injury: An in vitro simulation study

BACKGROUND

The anterior drawer test of the ankle is widely used to diagnose anterior talofibular ligament injuries caused by ankle sprains; however, low sensitivity has been reported. The braking effect of the deltoid ligament is likely responsible for this low sensitivity. This study aimed to examine the effect of consistent and mandated internal rotation of the hindfoot, which leads to relaxation of the deltoid ligament, on the conventional anterior drawer test.

METHODS

Seven cadaveric ankle specimens were subjected to quantitative analysis with a stretchable strain sensor at 30° plantarflexion, with or without 10° internal rotations, under accurate three-axial joint angle monitoring using inertial measurement units. The anterior drawer distance (mm) was calculated from the measured change in the capacitance value (picofarad) detected using the stretchable strain sensor and compared with that measured with the anterior talofibular ligament detached.

FINDINGS

A two-way repeated measures analysis of variance and post-hoc pairwise analysis revealed that the anterior drawer test with internal rotation revealed a significantly greater mean value than the conventional anterior drawer test (4.7 ± 1.6 mm vs. 2.2 ± 1.5 mm) in anterior talofibular ligament-detached samples (P < 0.001). The capacitance data revealed an intraclass correlation coefficient (1,1) of 0.903.

INTERPRETATION

Present findings suggest that our modified anterior drawer test with consistent and mandatory internal rotation, prevents the braking effect of the deltoid ligament and is expected to improve the sensitivity in assessing anterior talofibular ligament injuries.

Importance of observer experience in clinical assessment of ankle and subtalar joint laxity: Validation of a multidirectional 3D opto-electronic motion analysis protocol

BACKGROUND

Role of ankle and subtalar ligaments remains poorly understood due to inconsistent literature. This study validates a protocol for analyzing multidirectional foot and ankle motions and assesses the impact of experience on clinical evaluations of ankle and subtalar instability.

METHODS

Five cadaveric feet were tested using a 3D opto-electronic system to measure talus, tibia, and calcaneus motions under varying ligament conditions. Anterior Drawer Test (ADT), varus talar tilt test in neutral flexion (VTTT), and in dorsiflexion (VTTTF) were tested by one experienced and one inexperienced observer. The system measured multidirectional angular rotations.

RESULTS

Intra-observer ICC exceeded 0.97. For ADT, flexion/extension and internal/external rotation correlated significantly with laxity scores for both observers (p < 0.05). For VTTT, varus/valgus correlations were stronger for the experienced observer, VTTTF correlations were significant only for the experienced observer.

CONCLUSION

3D opto-electronic is reliable for foot and ankle multidirectional motion analysis. Experience improves subtalar instability assessment accuracy.

LEVEL OF EVIDENCE

Level 5 (cadaveric study).

Participant demographics and research questions from 10-years of chronic ankle instability studies: A scoping review

OBJECTIVES

To determine 'who' and 'what' were studied over the previous 10-years as it relates to individuals with chronic ankle instability.

DESIGN

Scoping review.

METHODS

Web of Science™ was used to identify all studies that referenced the International Ankle Consortium selection criteria guidelines. Original research reports which cited adherence to the guidelines were included. Data related to demographic information and outcome measures were synthesized to form a descriptive analysis.

RESULTS

A total of 377 studies were included which equated to 11,604 participants with chronic ankle instability. The combined average age of participants was 23.9 years. For measures related to ankle sprain history, participants averaged 4.3 ± 3.7 sprains and 6.2 ± 5.9 years since their first ankle sprain. Across the studies, the number of ankle sprains was reported in 42.7 % of studies and time since first ankle sprain was reported in 10.9 % of studies. Nearly 80 % of studies reported information from at least one validated questionnaire related to ankle instability or ankle function. The primary aim of most studies (44 %) was to determine differences in motor-behavioral impairments between individuals with and without chronic ankle instability.

CONCLUSIONS

Although many studies indicated that they adhered to the International Ankle Consortium selection criteria for chronic ankle instability, variables related to demographic information were inconsistently reported, which may inhibit the external validity of studies related to chronic ankle instability. In addition, much of the research related to chronic ankle instability pertained to young-adults and aimed to identify various motor-behavioral impairments.

Assessing Physiotherapists' Adherence to Clinical Practice Guidelines for Ankle Sprain Management in Saudi Arabia: A Cross-Sectional Study with National Online Survey

Background/Objectives: Ankle sprain is one of the most common sports injuries globally. Despite its prevalence, the adequacy of knowledge in managing ankle sprain among physiotherapists in Saudi Arabia has not been assessed. This study aimed to assess the knowledge and degree of adherence to clinical practice guidelines (CPG) for the management of ankle sprains among physiotherapists. Methods: This study was a cross-sectional with national online questionnaire administered to participants through an online platform. It comprised three sections. The first section collected demographic data. The second section presented two clinical cases as the basis for the participants' management decisions (the first with negative Ottawa Ankle Rules (OAR) and the second with positive OAR); participants were classified as "following", "partially following", "not following", and "partially not following" the CPGs. In the third section, on a Likert scale (1-5), participants indicated how much they agreed with various CPGs statements. Results: A total of 381 physiotherapists (mean age: 28 ± 5; male: 57.1%) completed the questionnaire. In the case of acute ankle sprain with negative OAR, 0.2% of the participants were considered as "following" CPGs, 31.4% as "partially following", 19.6% as "partially not following", and 48.5% as "not-following". In the case of acute ankle sprain with positive OAR, 5.2% were considered as "following" CPGs, 55.9% as "partially not following", and 38.8% as "not following". The knowledge assessment section elicited a 50% agreement among the participants on the 11 provided statements. Conclusions: Most physiotherapists have suboptimal adherence to CPG for managing ankle sprains, thus highlighting an evidence-to-practice gap.

Isometric and isokinetic hip strength in males with chronic ankle instability and its relationship with dynamic balance and self-reported instability

OBJECTIVES

To investigate isometric and isokinetic hip strength as well as dynamic balance in males with chronic ankle instability (CAI) and explore potential associations between hip strength, dynamic balance, and self-reported instability.

DESIGN

Cross-sectional study.

SETTING

University laboratory.

PARTICIPANTS

Fifty male participants (25 with CAI and 25 healthy controls).

MAIN OUTCOME MEASURES

Hip isometric and isokinetic torque normalized to body weight, Lower Quarter Y-balance Test (YBT-LQ), the Polish version of The Cumberland Ankle Instability Tool (CAIT-PL).

RESULTS

Significant differences were observed only in the hip isometric abductors/adductors strength ratio (p = 0.034, ES = 0.65), which was lower in the CAI group. CAI participants showed reduced dynamic balance in posterolateral reach (p = 0.006, ES = 0.92) and composite score of YBT-LQ (p = 0.012, ES = 0.91). There was a moderate positive correlation between dynamic balance and hip abductors strength during posteromedial (r = 0.40, p = 0.049) and posterolateral (r = 0.40, p = 0.048) YBT-LQ reaches, and isometric hip abductors strength moderately positively correlated with self-reported instability (r = 0.46, p = 0.021) in the CAI group.

CONCLUSION

Males with CAI exhibit deficits in frontal plane hip isometric strength, specifically in the hip abductor/adductor ratio, while no deficits were observed in isokinetic strength. The relationships between hip abductors strength, dynamic balance, and self-reported ankle instability may suggest the importance of hip abductors isometric strength for functional outcomes in CAI-patients.

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

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.

[Online resources for ankle sprains : A German language web analysis]

BACKGROUND

With the Internet as the main source of information for health content, the quality of websites with medical information is of high importance.

OBJECTIVE

This study analysed 250 websites on acute ankle sprain (ASD), one of the most common musculoskeletal disorders, for their quality and readability. Based on the results, a guide for patients was created.

METHOD

The quality of the websites was assessed using a 25-item content score and the EQIP36 score for medical information material. The reading level could be determined using the Flesch-Kincaid index and the calculated readability. The best three websites were evaluated in a user survey.

RESULTS

Of the 250 websites recorded 77 were included in the study. The quality of these varied significantly, with none achieving the maximum score. Sources in the healthcare system showed higher quality, while commercially influenced sites were below average in terms of completeness of content. Only 14% of the websites reached the recommended reading level. A significant negative correlation was found between completeness of content and readability. The user survey showed a mixed level of satisfaction and participants with previous medical knowledge were more critical than laypersons.

CONCLUSION

Online resources about ASD are suboptimal and differ considerably. Deficiencies in content, readability and structure were identified, which limit the effective use by patients. Health information publishers should work harder to improve the comprehensibility and quality of the information provided.

Use of Ankle-GO to Assess and Predict Return to Sport After Lateral Ankle Reconstruction for Chronic Ankle Instability

Background

Chronic ankle instability (CAI) develops in 20% to 40% of patients after ankle sprains because of inappropriate management or a premature return to sports (RTS). Patients become candidates for surgery when nonoperative treatment fails. The results of arthroscopic lateral ligament reconstruction have been shown to be excellent. However, there is no consensus on the RTS criteria in these cases. The Ankle-GO score, which has been validated in lateral ankle sprains, is an evidence-based protocol for RTS.

Purpose

To evaluate the discriminant and predictive capacity of the Ankle-GO score for RTS after arthroscopic lateral ankle reconstruction.

Study Design

Cohort study. Level of evidence, 2.

Methods

This prospective multicenter cohort study, conducted between January 2022 and January 2023, evaluated patients with CAI who underwent arthroscopic anatomic lateral ankle ligament reconstruction using gracilis tendon autografts or allografts. The RTS rates at 4 and 6 months postoperatively were the primary and secondary outcomes, respectively. The evaluated variable at both timelines was the Ankle-GO score-a composite of 4 functional tests and 3 questionnaires. The study determined the discriminant validity of the Ankle-GO score for RTS at each timeline-Ankle-GO scores at 4 months for RTS at 4 months; Ankle-GO scores at 6 months for RTS at 6 months. The predictive capacity of the Ankle-GO score at 4 months for RTS at 6 months was also evaluated.

Results

A total of 51 patients, with a mean age of 32.8 years, were included, of whom 23 (45%) had returned to sports at 4 months and 39 (76.5%) at 6 months. The mean Ankle-GO score was significantly higher in the group that returned to sports than in the group that did not (12 ± 4.7 vs 8.8 ± 4.7 at 4 months, respectively, P = .003; 16.8 ± 3.6 vs 11.3 ± 4.8 at 6 months, respectively, P = .002).The predictive capacity of the Ankle-GO score at 4 months for RTS at 6 months was good, with an area under the curve of 0.74 (95% CI, 0.58-0.90; P = .005). The optimal threshold was 6 (sensitivity, 95%; specificity, 50%). The odds ratio of RTS when surpassing the Ankle-GO cutoff score was 18.5 (95% CI, 3-113.95; P = .002).

Conclusion

The Ankle-GO score is effective in discriminating the RTS status at 4 and 6 months after lateral ligament reconstruction of the ankle. In addition, the Ankle-GO score at 4 months was also moderately predictive of RTS at 6 months after surgery.

Physical Therapy Intervention Effects on Alteration of Spinal Excitability in Patients With Chronic Ankle Instability: A Systematic Review and Meta-analysis

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.

Patients With Chronic Lateral Ankle Instability and Small Osteochondral Lesions of the Talus Obtain Good Postoperative Results: A Minimum 10-Year Follow-up With Radiographic Evidence

BACKGROUND

Few studies reported the long-term clinical outcomes and joint degeneration of patients with chronic lateral ankle instability (CLAI) and small osteochondral lesions of the talus (OLTs) following simultaneous open modified Broström-Gould (MBG) surgery and arthroscopic bone marrow stimulation (BMS). The purpose of this study was to study the long-term results of patients after BMS and BMG surgery, and to further evaluate the potential effect of OLT size on postoperative results.

METHODS

In this retrospective study, 110 CLAI patients were divided into 57 patients with OLTs (including 24 patients having combined small osteochondral lesions of the tibial plafond) receiving simultaneous BMS and MBG surgeries (BMS+MBG group), and 53 patients without OLTs receiving isolated open MBG surgery (MBG group). The OLT size and pre- and postoperative Kellgren-Lawrence grade were assessed. The subjective scores (visual analog scale pain score, Tegner activity, and Karlsson-Peterson scores), surgical complications, and return to sports were also compared pre- and postoperatively.

RESULTS

Patients were followed up at a mean of 144.2 ± 14.9 and 145.6 ± 11.4 months for the BMS+MBG and MBG groups, respectively. Subjective scores were significantly improved (P < .001), and no difference was found in subjective scores or surgical complications between the 2 groups (P > .05). Both groups showed progression of osteoarthritis grade (P < .001), but with no significant difference of changes from the preoperative to the final follow-up (BMS+MBG group: 0.84 ± 0.75 to 1.32 ± 0.80; MBG group: 0.32 ± 0.48 to 0.86 ± 0.56, changes: 0.48 ± 0.59 vs 0.55 ± 0.51, P = .575). For sports function, both groups had similar results in Tegner scores (5.8 ± 1.3 vs 6.2 ± 1.3, P = .081). However, in a subgroup analysis, we found that in the BMS+MBG group, patients exceeding the mean size of OLTs (50 mm2) were associated with an average lower postoperative Karlsson-Peterson score (P = .025) and higher postoperative osteoarthritis grade (P = .037), with more changes (P = .017) than those with OLTs <50 mm2.

CONCLUSION

Patients with CLAI and small OLTs following simultaneous open MBG surgery and arthroscopic BMS showed good long-term outcomes and only mild progression of joint degeneration-overall similar to patients treated for CLAI with MBG surgery. Moreover, as OLT size increased, good outcomes were less predictable.

Effects of augmented feedback on landing mechanics after anterior cruciate ligament reconstruction in collegiate females compared to healthy controls

OBJECTIVE

To analyze if immediate visual and verbal feedback influenced landing mechanics during single and dual-task conditions in recreationally active females with a history of anterior cruciate ligament reconstruction (ACLr) compared to healthy controls.

DESIGN

Cross-sectional cohort study.

SETTING

Motion Laboratory.

PARTICIPANTS

33 college-aged females with two to five years status post-ACLr and 33 matched health controls.

MATERIALS AND METHODS

30 Drop landings were performed over one single session with immediate post-trial feedback followed by a retention trial on peak vGRF and symmetry.

MAIN OUTCOME MEASURES

Vertical ground reaction forces (vGRFs) during drop landing from a 50-cm platform and loading rate (LR) normalized to body weight.

RESULTS

For peak vGRF, there was a time effect from baseline, post-test, and transfer task trials. Based on baseline, post-test, and transfer tasks, there was a significant group-by-time interaction between the ACLr and a healthy group. For peak vGRF asymmetry, there was no time effect from baseline, post-test, and transfer task trials. There was a significant group effect for peak vGRF asymmetry. Total LR did not show a time effect from baseline, post-test, and transfer task. The ACLr group demonstrated higher LR compared to the health group.

CONCLUSIONS

Results demonstrated a reduction in peak vGRF and asymmetry in vGRF during drop landings with the inclusion of augmented feedback. The ACLr group demonstrated higher LR than the control group. Rehabilitation specialists may be able to incorporate targeted feedback as an intervention to help resolve landing asymmetries following ACLr.

Clinical outcomes of arthroscopic all-inside anterior talofibular ligament trans- augmentation repair versus modified trans- augmentation repair for patients with chronic ankle instability

BACKGROUND

Chronic ankle instability (CAI) often requires surgical intervention, but the optimal suturing repair technique remains unclear. This study aimed to compare the clinical efficacy of modified trans augmentation (MTA) suturing repair and trans augmentation (TA) suturing repair to provide a feasible option for patients with CAI and their surgeons.

METHODS

This single-center retrospective study included 73 patients with CAI who treated between February 2019 and January 2021. Patients were assigned to MTA or TA groups based on ligament condition. Clinical outcomes were assessed using the American Orthopedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), anterior drawer test, patient satisfaction, and postoperative complications.

RESULTS

Postoperative AOFAS scores were significantly higher in the MTA group (91.0 ± 7.1) compared to the TA group (83.3 ± 9.4, P < 0.001). Similarly, patient satisfaction was higher in the MTA group (8.6 ± 0.9 vs. 8.1 ± 1.0, P = 0.02), whereas VAS scores were lower (1.2 ± 0.4 vs. 1.4 ± 0.5, P = 0.01). There were no significant differences in anterior drawer test results between the groups (P = 0.32).

CONCLUSIONS

MTA suturing repair demonstrates superior clinical outcomes compared to TA suturing repair, providing a feasible for patients with CAI. These findings highlight the potential of MTA repair to improve patient satisfaction and functional recovery.

The ankle instability severity score. A simple preoperative score to select patients for ankle ligament repair or reconstruction Surgery

BACKGROUND

Currently, there is no established preoperative clinical tool for determining whether to opt for surgical reconstruction or repair in cases of chronic ankle instability.

HYPOTHESIS

This study aimed to develop a predictive score for the likelihood of instability recurrence after surgical repair.

PATIENTS AND METHODS

A multicenter case-control study was conducted, comparing patients who experienced recurrence of instability after surgical repair of the lateral ankle ligament (ATFL) to those who did not experience recurrence within 2 years post-surgery. Preoperative risk factors associated with instability recurrence at the 2-year mark were identified. Utilizing these datas along with existing literature, the Ankle Instability Severity Score (AISS) for predicting the risk of recurrence after ATFL repair was formulated. Subsequently, this score was calculated for all patients in the study cohort to evaluate its predictive capability.

RESULTS

Gender (p = 0.03), age (p = 0.02), BMI (p = 0.02), and participation in pivot sports (p = 0.04) were identified as risk factors for recurrence. The 9-point AISS score was applied to the patient cohort. When the score was three or lower, the recurrence rate after ATFL repair stood at 10.6% (OR 0.11 [0.04;0.28], p < 0.001). Conversely, if the score exceeded five, the recurrence rate was substantially higher at 80.0% (OR 11.9 [1.67;237.0], p = 0.03). Using ROC analysis, a threshold value of AISS score at 3.5 (sensitivity = 77.4%, specificity = 72.8%, AUC = 0.78) was identified to develop a instability recurrence after surgical repair.

DISCUSSION

This study introduces the AISS score, which relies on straightforward preoperative criteria to assist in deciding whether patients with chronic ankle instability should undergo ligament repair surgery or explore alternative treatment options.

LEVEL OF EVIDENCE

IV; retrospective study.

Primary Ankle Fracture Dislocation Is Not a Negative Prognostic Factor for the Surgical Treatment of Syndesmotic Injury-A Retrospective Analysis of 246 Patients

Background/Objectives: Acute ankle sprains are common injuries that significantly affect both sports and daily activities. Syndesmotic injuries, a specific type of ligamentous damage, can occur as a part of a sprain or alongside fractures, affecting approximately 20% of ankle fractures. The aim of this study was to evaluate negative prognostic factors influencing surgical outcomes in tibiofibular syndesmotic injuries associated with ankle fractures. Methods: Data from 246 patients were analyzed to examine the impact of initial ankle dislocation, fracture type, and fixation method on postoperative complications and reoperation rates. Ankle joint fractures were treated with open reduction and internal fixation using an anatomically contoured plate designed for optimal tibia and fibula fixation. Four methods of syndesmosis fixation were recorded: one three-cortical screw, one four-cortical screw, two screws (either both four-cortex screws or one three-cortex and one four-cortex screw), or one endobutton. Data analysis was performed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results: Key findings reveal no significant association between initial dislocation and the necessity for reoperation (p = 0.613). However, smoking combined with dislocation significantly increases reoperation rates (35% vs. 15.5%, p = 0.026). Fixation type influenced outcomes, with single four-cortex screws linked to pain but fewer infections. Infection was the most common complication (33.3%), predominantly after fixation with a single three-cortex screw. Men had higher rates of fixation destabilization and infections, while women experienced pain persisting beyond six months postoperatively Conclusions: Patient-specific factors influence syndesmotic injury outcomes. Smoking, gender, and fixation type impact complications, emphasizing the need for tailored surgical approaches to enhance recovery and minimize reoperation risks. Future research should aim to corroborate these findings in larger, multicentric cohorts to refine surgical strategies for syndesmotic injury management.

Clinical outcomes of all-inside arthroscopic lateral ankle ligament reconstruction for chronic lateral ankle instability: A prospective series with minimum 12 month outcomes

BACKGROUND

Chronic lateral ankle instability (CAI) is a common condition that can be effectively treated with lateral ankle ligament reconstruction to restore ankle stability and function. The aim was to assess the functional outcomes of arthroscopic lateral ligament reconstruction using the Manchester-Oxford Foot Questionnaire (MOXFQ), Visual Analog Score (VAS) and Euroqol-5D-5L (EQ-5D) patient-reported outcome measures (PROMs).

METHODS

This prospective series included 36 consecutive patients who underwent isolated arthroscopic lateral ligament reconstruction for CAI between November 2020 and November 2022 with minimum 12-month follow up. All patients completed the MOXFQ, VAS, and EQ5D PROMs preoperatively, and a minimum of 12 months postoperatively. The MOXFQ is a foot and ankle-specific PROM that assesses foot and ankle function, the VAS measures pain and the EQ5D evaluates general health-related quality of life.

RESULTS

Patients were followed up for 12-25 months. In all patients, there was significant improvement in all postoperative PROMs (p < 0.05). The MOXFQ index decreased from 59.1 ± 19.2-13.5 ± 18.1 (p < 0.01), EQ-5D index increased from 0.607 ± 0.224-0.854 ± 0.175 (p < 0.01) and VAS pain decreased from 36.6 ± 22.3-13.6 ± 18.4 (p < 0.01).A total of 6 patients(16.3 %) were lost to follow up and mean follow-up time was 1.63 ± 0.54 years.

CONCLUSION

Arthroscopic lateral ankle ligament reconstruction is an effective treatment for chronic ankle instability, with significant improvements in clinical and health-related quality of life outcomes.

LEVEL OF EVIDENCE

IV.

Effects of stair riser height on ankle proprioception in individuals with and without chronic ankle stability

Background

Ankle sprains during stair descent are prevalent, especially in those with chronic ankle instability (CAI), which may be attributed to diminished ankle proprioception associated with CAI.

Objective

This study aimed to determine whether individuals with CAI have lower ankle proprioceptive performance during stair descent and to determine to what extent stair riser height may affect ankle proprioception.

Methods

40 university students, including 21 CAI (9 males and 12 males, mean age 22.38 years, mean height 169.97 cm and mean weight 64.88 kg) and 19 healthy controls (11 males and 8 males, mean age 23.05 years, mean height 169.42 cm and mean weight 65.18 kg) volunteered. The Ankle Inversion Discrimination Apparatus for Stair Descent (AIDASD) was used to measure ankle inversion proprioception across 3 different riser heights: 15 cm, 17.5 cm, and 20 cm during stair descent.

Results

ANOVA showed that individuals with CAI performed significantly worse than health group across all tested riser heights (F = 44.066, p < 0.001), with a significant main effect of riser height (F = 13.288, p < 0.001). Significant differences in proprioceptive acuity were found between 15 cm and higher risers (p < 0.001), but not between 17.5 cm and 20 cm (p = 0.675), alongside a significant linear downward trend with increasing riser height (F = 15.476, p < 0.001). No significant interaction was observed between the group and riser height (F = 0.745, p = 0.478).

Conclusion

The presence of ankle instability and increased riser height significantly negatively affected ankle inversion proprioceptive performance during stair descent, which may increase the risk of ankle sprain.

Application

Potential applications of this research include the assessment of ankle proprioception during stair descent attributable to effective ankle instability rehabilitation and riser height selection for safe stair design.

Is chronic ankle instability associated with contractile thickness of gluteus medius and gluteus maximus during functional movement and exercise? A systematic review and meta-analysis

INTRODUCTION

The gluteus medius (GMED) and gluteus maximus (GMAX) play a crucial role in postural control, and postural control is impaired in individuals with chronic ankle instability (CAI). However, the association between CAI and the recruitment of these muscles remains unclear. The purpose of this study was to explore the contractile thickness of GMED and GMAX during functional movements in individuals with CAI compared to healthy controls.

EVIDENCE ACQUISITION

A systematic search was conducted in six databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, and PEDro). Included studies involved the contractile thickness of GMED and/or GMAX comparing CAI with non-CAI. The extracted data were subjected to meta-analysis for observing the differences between the two. The correlation and difference in contraction between GMED and GMAX were analyzed using the Pearson Correlation Coefficient (PCC) and t-test, respectively.

EVIDENCE SYNTHESIS

Six studies with 176 participants were found. Contractile thickness measured by ultrasound showed GMED thickness change to be lower in CAI than in controls during functional movements and exercise (WMD: -0.08; 95% CI: -0.11, -0.04; P<0.00001). There was no significant difference between the two groups with respect to contraction of GMAX (WMD: 0.02; 95% CI: -0.01, 0.05; P=0.25). The PCC and P value (t-test) between the ratio of contractile thickness of GMED and GMAX in CAI were 0.397 and 0.029 respectively, indicating activity differences.

CONCLUSIONS

CAI may be associated with weaker GMED recruitment during functional movements and exercise, but the activation of GMAX in CAI may be unaffected.

Kinematic and kinetic characteristics of individuals with coping lateral ankle sprain during landing and walking/running tasks: A systematic review with meta-analysis

BACKGROUND

We aimed to synthesize the kinematics and kinetics during landing and walking/running tasks of ankle copers compared with patients with chronic ankle instability and controls.

METHODS

We systematically searched PubMed, CINAHL, SPORTDiscus, and Web of Science. Tri-planar lower extremity biomechanics (joint angle and moment at maximum and initial contact, and joint displacement) were synthesized using standard mean difference and 95 % confidence intervals. We assessed methodological quality, study heterogeneity, and publication bias.

FINDINGS

We identified 13 studies. Pooled evidence indicated that copers had less inversion and eversion angles, and ankle frontal displacement during landing compared with patients with chronic ankle instability (|standard mean difference| 0.31-0.40). Copers revealed greater dorsiflexion, plantarflexion, and ankle sagittal displacement during landing and less plantarflexion moment during walking than patients with chronic ankle instability (|standard mean difference| 0.29-0.46); however, most ankle biomechanics of copers were not significantly different from those of controls. In the proximal joints, copers revealed less knee valgus angle at maximum and initial contact (|standard mean difference| 0.25-0.33); and less hip flexion angle at maximum and initial contact, hip external rotation angle and sagittal and frontal displacement during landing (standard mean difference 0.49-0.73) than patients with chronic ankle instability. Copers had less hip extension moment during walking and greater maximum hip adduction angle during landing than controls (|standard mean difference| 0.66-0.77).

INTERPRETATIONS

Our results provide insight into the lower extremity biomechanics of copers during dynamic tasks, contributing injury coping mechanisms and developing rehabilitation programs to return to sports.

Uphill Treadmill Running and Joint Mobilization Improve Dynamic Stability and Ankle Dorsiflexion Range of Motion in Young Adults With Chronic Ankle Instability: A Four-Arm Randomized Controlled Trial

OBJECTIVE

To observe the effect of uphill running and the combined effect of uphill running plus joint mobilizations on dynamic stability and ankle dorsiflexion in young adults with chronic ankle instability (CAI).

DESIGN

Four-arm randomized controlled trial.

SETTING

A college rehabilitation center.

PARTICIPANTS

Individuals with CAI (N=73).

INTERVENTIONS

Participants were randomly assigned to 4 groups: combined uphill running and joint mobilization (URJM), uphill running alone (UR), joint mobilization alone (JM), and control group. The URJM and UR groups received 20-minute running sessions, and the URJM and JM groups received ankle joint mobilizations, all 3 times a week for 4 weeks.

MAIN OUTCOME MEASURES

Cumberland Ankle Instability Tool (CAIT) and Y-balance test (YBT) in anterior, posteromedial (PM), and posterolateral (PL) directions for dynamic stability; weight-bearing lunge test and non-weight-bearing ankle dorsiflexion degree using a goniometer (NWBG) for dorsiflexion.

RESULTS

The UR group showed significant improvements in CAIT, YBT-PL, YBT-PM, and NWBG compared to the control group. The URJM group demonstrated large treatment effects in NWBG compared to both UR and JM groups. Responder analysis indicated that the UR, JM, and URJM groups had a higher likelihood of achieving clinically significant changes (exceeding minimal detectable change or minimal clinically important difference) in CAIT, YBT-PM, YBT-PL, and NWBG compared with the control group. Additionally, the combination of UR and JM was superior to either intervention alone for NWBG, with success rates 1.55 times greater than UR alone and 2.08 times greater than JM alone.

CONCLUSIONS

A 4-week UR program improves the subjective feeling of instability, dynamic postural control, and ankle dorsiflexion in young adults with CAI. Compared to UR or JM alone, their combined application can better improve the non-weight-bearing ankle dorsiflexion range of motion.

A New Way to Treat Central Nervous System Dysfunction Caused by Musculoskeletal Injuries Using Transcranial Direct Current Stimulation: A Narrative Review

BACKGROUND

Musculoskeletal injuries can have far-reaching consequences on brain function, leading to reduced motor control, altered movement patterns, increased inhibition of the injured muscle and joint, and changes in neuroplasticity. These deficits, controlled in part by the central nervous system (CNS), might be alleviated with an appropriate adjuvant treatment. One possibly suited treatment at the CNS level is transcranial direct current stimulation (tDCS), which modulates cortical excitability and further neuroplasticity.

OBJECTIVES

The present review outlines the multifaceted repercussions of common musculo-skeletal injuries on CNS functions and presents original studies that mostly report beneficial effects regarding the use of the tDCS intervention in people who had experienced musculoskeletal injury rehabilitation.

RESULTS

The first evidence suggests that tDCS, targeting brain areas responsible for motor control or on sensory and pain-related brain regions, may offer significant benefits in the recovery of brain function and motor performance following musculoskeletal injuries. Key findings include enhanced motor function, altered CNS excitability and inhibition, and reduced pain perception, all contributing to improved rehabilitation outcomes. However, the paucity of studies and the heterogeneity of injuries render it challenging to ascertain the optimal treatment parameters. Furthermore, the variability regarding stimulation parameters is a crucial aspect that remains to be addressed and limits the possibility of generalizing these first findings.

CONCLUSIONS

It is concluded that well-powered trials with standardized protocols should be conducted to confirm these effects and establish clear clinical guidelines for the use of tDCS in sports injury rehabilitation.

Clinical outcomes of arthroscopic modified suture augmentation versus InternalBrace™ reconstruction in the treatment of chronic ankle instability

BACKGROUND

At present, the modified suture augmentation (MSA) repair and the InternalBrace™ (IB) reconstruction techniques are commonly used for the treatment of chronic ankle instability (CAI). This study aimed to evaluate and compare the clinical efficacy of the MSA repair and IB reconstruction techniques, providing a reference for clinical practice.

METHODS

After propensity score matching, 50 patients with CAI between May 2021 and May 2022 were included in this retrospective study. Of these, 26 underwent IB reconstruction surgery and 24 underwent MSA repair surgery. The American Orthopedic Foot and Ankle Society (AOFAS) scores, visual analog scale (VAS) scores, anterior drawer tests, and patient satisfaction were used for clinical efficacy evaluation.

RESULTS

The postoperative AOFAS scores in the MSA group (88.8 ± 3.0) were significantly higher than those in the IB group (84.3 ± 5.4, P = 0.001). However, the patient satisfaction scores in the IB group (7.3 ± 0.8) were higher than those in the MSA group (6.7 ± 0.8, P = 0.02). There were no significant differences between the two groups in the anterior drawer test results and VAS scores (P < 0.05). In addition, regarding postoperative complications, only one patient (4.2%) in the MSA group had joint laxity.

CONCLUSIONS

MSA repair was superior to IB reconstruction in terms of AOFAS scores. However, IB reconstruction was superior in terms of patient satisfaction. These findings highlight the potential of MSA repair and IB reconstruction techniques for the treatment of CAI.

Effects of kinesio taping on lower limb biomechanical characteristics during dynamic postural control tasks in individuals with chronic ankle instability

PURPOSE

Previous studies have demonstrated significant biomechanical differences between individuals with chronic ankle instability (CAI) and healthy controls during the Y-balance test. This study aimed to examine the effects of kinesio taping (KT) on lower limb biomechanical characteristics during the Y-balance anterior reach task in individuals with CAI.

METHODS

A total of 30 participants were recruited, comprising 15 individuals with CAI and 15 healthy controls. All participants were randomly assigned three taping conditions: no taping (NT), placebo taping (PT), and KT, followed by the Y-balance anterior reach task. Each condition was separated by one-week intervals. Kinematic and kinetic data of the lower limbs during the movement phase were collected using the Vicon motion capture system (Vicon, T40, 200 Hz) and two Kistler force platforms (Kistler, 1000 Hz).

RESULTS

KT significantly improved the Y-balance anterior reach distance (P = 0.003) and peak ankle eversion angle (P = 0.019) compared to NT. Additionally, KT resulted in increased peak knee flexion angle (P = 0.002, P = 0.011) and peak ankle dorsiflexion angle (P <0.001, P = 0.005) relative to both NT and PT. KT also significantly reduced mediolateral center of pressure (COP) displacement (P = 0.001) and average velocity of mediolateral COP displacement (P = 0.033) in comparison to NT. Furthermore, KT decreased mediolateral center of gravity displacement (P = 0.002, P = 0.003) relative to both NT and PT.

CONCLUSION

KT significantly improved abnormal ankle posture by promoting greater ankle dorsiflexion and eversion angles. Additionally, KT reduced mediolateral COP displacement and average velocity to improve postural stability. These changes may contribute to reduced risk of ankle sprains. Therefore, KT may serve as an effective tool for managing recurrent ankle sprains in individuals with CAI.

Bilateral alterations in sensorimotor function and altered sensory strategy in individuals with unilateral chronic ankle instability

Objective

This study aimed to evaluate bilateral sensorimotor function in patients with unilateral CAI. Furthermore, sensory reweighting ability and vestibular modulation were assessed.

Methods

Twenty individuals with unilateral CAI and twenty healthy controls participated in this study. All participants executed ankle proprioception, plantar sensation, unilateral stance, Y balance, motor control test (MCT) and sensory organisation test (SOT) assessments. Proprioception assessment included joint position sense and force sense (FS), and plantar sensation evaluation consisted of light-touch, vibration and two-point discrimination (TPD) thresholds at the heel, head of the first metatarsal (1 MF), base of the fifth metatarsal (5 MF), centre of foot and forefoot. MCT and SOT tests were conducted using NeuroCom Balance Manager System. Except for SOT, all tests evaluated bilateral limbs, and the order of limbs was randomly selected. 2 (group) × 2 (limb) mixed model analyses of variance were performed for outcome measures of unilateral stance, Y balance and MCT, and independent t-test was used to analyse the outcomes of SOT between two groups. Mann-Whitney U and Wilcoxon test were applied to examine the differences in plantar sensation between groups and limbs.

Results

For plantar sensation, increased light-touch threshold at heel and 1 MF and the TPD threshold at 1 MF were observed bilaterally in CAI group (p < 0.05). No differences were observed in joint position sense (JPS), but bilateral deficit was found in plantarflexor FS with moderate effect size (uninjured side: ES = 0.67; injured side: ES = 0.61) in CAI group. For unilateral stance with eyes closed, moderate postural instability was displayed bilaterally in the anteroposterior direction (uninjured side: ES = 0.71; injured side: ES = 0.86). The delayed latency of MCT with medium-backward translation was also observed in both sides of unilateral CAI (uninjured: ES = 0.74; injured: ES = 0.92). Compared with healthy controls, higher visual reliance was shown moderately in the injured and uninjured sides of unilateral CAI (uninjured: ES = 0.78; injured: ES = 0.91). Sensory analysis of SOT displayed decreased use of visual (p = 0.001) and vestibular information (p < 0.000) in CAI group.

Conclusion

Unilateral CAI presented impaired plantar sensation and ankle proprioception on both sides. Higher visual reliance, delayed motor response and postural instability under unreliable visual clues were also displayed bilaterally. Except for bilateral sensorimotor alterations, reduced ability of sensory reweighting and fixed sensory strategy also presented in CAI group, but the somatosensory clue still served as the main sensory source in CAI.

Effects of Tai Chi training on functionality, dynamic balance, kinesiophobia, and quality of life in athletes with functional ankle instability

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.

Increasing Incidence of Pickleball Injuries Presenting to US Emergency Departments: A 10-year Epidemiologic Analysis of Mechanisms and Trends

Background

Pickleball is one of the fastest-growing sports in the United States. It is popular among seniors but has recently grown across all age groups. As pickleball has gained interest, its corresponding injury burden has also increased.

Purpose/Hypothesis

The purpose of this study was to identify pickleball-related injury trends and underlying mechanisms across different age groups presenting to US emergency departments. It was hypothesized that (1) pickleball-related injuries would increase significantly between 2013 and 2022, (2) older age groups would have the greatest frequency of injury, and (3) falls would be the most common mechanism of injury.

Study Design

Descriptive epidemiology study.

Methods

The National Electronic Injury Surveillance System (NEISS) was queried for pickleball injuries between January 1, 2013, and December 31, 2022. The demographic information, injury site, and diagnosis were recorded, and case narratives were reviewed to identify the injury mechanism. The statistical sample weight assigned for NEISS cases by hospital was used to calculate national estimates (NEs). Injury trends over time were evaluated by linear regression.

Results

A total of 1110 NEISS cases representing 66,350 nationally estimated pickleball-related injuries were included. The mean age was 64 ± 14.7 years (range, 4-93 years). Most injuries occurred in those aged 65 to 80 years (NEISS cases = 643; NE = 40,507 [61.1%]), followed by those aged 35 to 64 years (NEISS cases = 349; NE = 20,785 [31.3%]). Falls were the most common injury mechanism overall (NEISS cases = 699; NE = 43,434 [65.5%]). However, being hit with a paddle and a twist/inversion were the most common mechanisms for ages 0 to 17 and 18 to 34 years, respectively. Fractures were the most common diagnosis (NEISS cases = 363; NE = 21,703 [32.7%]), followed by strains/sprains (NEISS cases = 327; NE = 20,419 [30.8%]). Also, 69.1% of all fractures occurred in female players. The wrist was the most injured, accounting for 12.7% of all injuries. Significant increases in pickleball injuries were seen over time (P < .001) and across all age groups (P < .05).

Conclusion

There was a significant increase in pickleball-related injuries presenting between 2013 and 2022, with most injuries arising from a fall. Notably, injuries decreased by 14% between 2019 and 2020 but rose again by 41% between 2020 and 2021 during the coronavirus 2019 pandemic. Older players disproportionately presented to the emergency department with pickleball-related injuries. Increased awareness and comprehensive injury prevention initiatives may be warranted to address the considerable prevalence of fractures and overuse/strain injuries.

Recent advances in the management of chronic ankle instability

Ankle sprains are the most common lesion of the ankle joint which might result in chronic ankle instability (CAI). Significant strides have been taken to enhance our comprehension of the underlying mechanisms of CAI, as the exploration of novel surgical techniques and the identification of previously unrecognized anatomical components. The present review aims to provide an extensive overview of CAI, encompassing its pathophysiology, epidemiology, clinical assessment, treatment, and rehabilitation. Treatment of CAI requires a multifaceted algorithm, involving historical analysis, clinical evaluations, and diagnostic imaging. Surgical interventions for CAI primarily involve the anatomical and/or non-anatomical reconstruction and/or repair of the anterior talofibular ligament. Anatomical repair has exhibited superior functional outcomes and a reduced risk of secondary osteoarthritis compared to non-anatomical repair. Non-anatomical approaches fall short of replicating the normal biomechanics of the anterior talofibular ligament, potentially leading to postoperative stiffness. This review seeks to academically review and up-to-date literature on this issue, tailored for clinical practice, with the intent of aiding surgeons in staying abreast of this critical subject matter.

Risk factors for the recurrence of instability after operative treatment of chronic lateral ankle instability: A systematic review

Purpose

To identify, review and summarize risk factors for failure of lateral ankle ligament operative treatment for chronic lateral ankle instability (CLAI).

Methods

A Systematic review according to PRISMA guidelines was performed. In July 2023, a bibliographic search of the PubMed, Medline, CINAHL, Cochrane, and Embase databases was performed. Articles were included if they were quantitative studies published in English and reported risk factors for recurrence of instability.

Results

A total of 496 articles were identified using the search strategy, and nine articles were included. All were low-quality cohort studies (level 3 or 4 evidence). These nine studies comprising 762 participants met the criteria for inclusion. Eighty-nine patients (11%) had treatment failure as defined by recurrence of instability, with rates ranging from 5.7% to 28.5%. Six risk factors were divided into three categories: patient demographics (generalized joint laxity [GJL], high-level sports activities and female sex), imaging features (varus hindfoot alignment), and surgical findings (poor quality of the remnant lateral ligaments, intraoperative syndesmosis widening).

Conclusion

The presence of risk factors such as GJL, high-level sports activities, female sex, varus hindfoot alignment, poor ligament quality, and intraoperative syndesmosis widening should guide surgical strategy to reduce the risk of treatment failure in lateral ankle ligament repair for CLAI.

Level of Evidence

Level IV, systematic review.

The feasibility of diagnosing sprained ankle via 3D MRI reconstructing three-dimensional model of anterior talofibular ligament

Introduction

The anterior talofibular ligament (ATFL) is the most vulnerable ligament in ankle sprains. Most patients recover after this injury with conservative treatment, while 20%-40% progress to chronic ankle instability that requires surgical stabilization. Conventional MRI does not provide a comprehensive image of the ATFL. We aimed to evaluate the feasibility of using 3D MRI to facilitate the understanding of ATFL injuries and the operative planning.

Methods

A total of 21 healthy asymptomatic volunteers with 30 normally functioning ankles and 13 patients with 18 sprained ankles were studied. MRI scans were divided into two groups: Group 1 (normal ankle) and Group 2 (injured ankle). The data of all 48 cases were exported to Mimics and reconstructed into 3D models. The image quality of all 3D models was evaluated using a 5-point subjective scoring system. The length, width, and thickness of the ATFL were measured in the 3D model in Mimics and compared to the 3D MPR image data.

Results

The image quality score was 4.57 ± 0.32. There was no statistically significant difference between the 3D model and the 3D MPR image of ATFL measurements in both groups (P > 0.05).

Discussion

We concluded that 3D MRI can be used to reconstruct a 3D model of the ATFL for accurate measurements of the ATFL anatomical structure, which holds potential to improve preoperative planning and intraoperative navigation for young sports medicine doctor, facilitate diagnosis of ATFL injuries and make the decision about the operative method.

Comparison of the effects of exergaming and balance training on dynamic postural stability during jump-landing in recreational athletes with chronic ankle instability

The primary inquiry of this study was to determine if exergaming is more effective than balance training in improving dynamic postural control during jump-landing movements among athletes with chronic ankle instability (CAI). Additionally, the study aimed to compare the effectiveness of these interventions on clinical and psychological outcomes. This study was a randomized, single-blinded, controlled trial in which participants were assigned to either an exergaming group or a balance training group. Outcome measures were assessed before, after, and one month following the intervention. Primary outcomes included the stability index (SI) and time to stabilization (TTS) in the anteroposterior (AP), mediolateral (ML), and vertical (V) directions, the dynamic postural stability index (DPSI), and the resultant vector time to stabilization (RVTTS). Secondary outcomes included performance, fear of movement, and perceived ankle instability, measured using the side-hop test, the Tampa Scale for Kinesiophobia (TSK), and the Cumberland Ankle Instability Tool (CAIT), respectively. Results indicated a significant decrease in ML SI in both groups one month after treatment compared to before and after treatment (P = 0.013 and P<0.001, respectively). Additionally, one-way ANCOVA revealed a significant difference between the groups post-treatment (F(1,31) = 6.011, P = 0.020, η2 = 0.162) and one month post-treatment (F(1,31) = 4.889, P = 0.035, η2 = 0.136), with ML SI being significantly lower in the exergaming group than the balance training group at both time points. In both group, the DPSI also decreased significantly one month post-treatment compared to before and after treatment (P = 0.040 and P = 0.018, respectively). Both groups showed improvements in performance, severity of perceived ankle instability, and fear of movement. Thus, the study concluded that both exergaming and balance training effectively improved postural control during jump-landing, with exergaming showing superior performance in the ML direction both after and one month post-treatment. In terms of clinical and psychological outcomes, both interventions were effective, with neither showing superiority over the other.

Diagnosis, treatment, and prevention of ankle sprains: Comparing free chatbot recommendations with clinical guidelines

BACKGROUND

Free chatbots powered by large language models offer lateral ankle sprains (LAS) treatment recommendations but lack scientific validation.

METHODS

The chatbots-Claude, Perplexity, and ChatGPT-were evaluated by comparing their responses to a questionnaire and their treatment algorithms against current clinical guidelines. Responses were graded on accuracy, conclusiveness, supplementary information, and incompleteness, and evaluated individually and collectively, with a 60 % pass threshold.

RESULTS

The collective analysis of the questionnaire showed Perplexity scored significantly higher than Claude and ChatGPT (p < 0.001). In the individual analysis, Perplexity provided significantly more supplementary information than the other chatbots (p < 0.001). All chatbots met the pass threshold. In the algorithm evaluation, ChatGPT scored significantly higher than the others (p = 0.023), with Perplexity below the pass threshold.

CONCLUSIONS

Chatbots' recommendations generally aligned with current guidelines but sometimes missed crucial details. While they offer useful supplementary information, they cannot yet replace professional medical consultation or established guidelines.

Assessment of peroneal tendon lesions using 2-dimensional and 3-dimensional isotropic magnetic resonance imaging with surgical correlation

Accurate diagnoses of peroneal pathologies remains a challenge due to limitations of conventional 2D (dimensional) imaging, which can impact long-term patient outcomes. This study evaluates MRI accuracy and inter-reader reliability of peroneal compartment pathology for 2D and 3D MRI. A consecutive series of patients who underwent peroneal compartment surgery with preoperative 1.5- or 3.0-Tesla ankle MRIs from 2009 to 2024 included 32 scans (22 with 2D, 10 with 2D+3D) from 31 patients (ages 17-74 years, all genders). Three musculoskeletal readers blinded to surgical findings independently analyzed MRI scans for common peroneal tenosynovitis, peroneus brevis and peroneus longus tenosynovitis, tendinopathy, and tears. Inter-reader reliability and diagnostic performance measures were calculated. Using majority vote, overall accuracy, sensitivity, and specificity for peroneal tendons using 2D MRI were 80%, 81%, and 79%, respectively. Using 3D MRI sequences, whether in isolation or combination with 2D MRI, accuracy, sensitivity, and specificity increased to 85%, 88%, and 83%, respectively. The inter-reader reliability for peroneus brevis lesions was 0.45-0.75 for 2D, 0.25-0.35 for 3D, and 0.31-0.54 for combined 2D+3D, while for peroneus longus lesions, it was 0.45-0.90 for 2D, 0.20-0.71 for 3D, and 0.64-0.81 for combined 2D+3D scans. The inter-reader reliability for tenosynovitis ranged from 0.62-0.64 for 2D, 0.25-0.37 for 3D, and 0.57-0.66 for combined 2D+3D scans. The addition of 3D MRI to 2D high-resolution ankle MRI protocol or 3D MRI alone increases accuracy of peroneal compartment lesion detection with minor decrease in inter-reader reliability for peroneal brevis tendon assessment. Larger studies may help validate our findings.

Middle and Long Latency Cutaneous Reflexes During the Stance Phase of Gait in Individuals with and Without Chronic Ankle Instability

BACKGROUND/OBJECTIVES

Lower limb cutaneous reflex amplitudes can modulate across gait, which helps humans adjust rhythmic motor outputs to maintain balance in an ever-changing environment. Preliminary evidence suggests people who suffer from repetitive ankle sprains and residual feelings of giving way demonstrate altered cutaneous reflex patterns in the gastrocnemius. However, before cutaneous reflex assessment can be implemented as a clinical outcome measure, there is a need to substantiate these early findings by measuring reflex amplitudes across longer latency periods and exploring the variability of reflexes within each subject.

METHODS

Forty-eight subjects with and without chronic ankle instability (CAI) walked on a treadmill at 4 km/h while activity of the lateral gastrocnemius (LG) was measured via surface electromyography. Non-noxious stimulations were elicited randomly to the ipsilateral sural nerve at the mid-stance phase of gait, and reflex amplitudes were calculated offline by comparing muscle activity during unstimulated and stimulated gait cycles. Two primary outcome measures were compared between groups at the middle latency (MLR: 80-120 ms) and late latency (LLR: 120-150 ms) time windows: (1) average reflex amplitudes and (2) standard deviation of reflex amplitudes for each subject across 10 trials.

RESULTS

Both groups demonstrated an equal amount of LG inhibition at the MLR and LG facilitation at the LLR. However, subjects with CAI showed significantly higher variability in LLR amplitude across trials than healthy controls.

CONCLUSIONS

Increased variability of cutaneous reflex amplitudes may relate to symptoms associated with CAI. These findings suggest that reflex variability following sural nerve stimulation could serve as an objective measure to track treatment progress in patients with CAI, offering clinicians a new tool for conducting rehabilitation assessments in a controlled environment.

Immediate Effects of Calf Tissue Flossing on Ankle Joint Torque and Dorsiflexion Range of Motion in Healthy Individuals: A Randomized Controlled Crossover Trial

Tissue flossing involves wrapping a rubber band around a muscle group for a few minutes while performing joint motion, enhancing ankle joint torque and range of motion. As limited ankle dorsiflexion range of motion and plantar flexion muscle weakness are risk factors for sports injury, assessing the therapeutic effects of tissue flossing is important. This study aimed to evaluate the immediate effects of calf tissue flossing on enhancing ankle joint torque and dorsiflexion range of motion. We conducted a randomized controlled crossover trial involving 19 healthy adult males who received two interventions (low and high-pressure tissue flossing bands) and a control condition (underwrap). Each intervention was applied for 2 minutes on the non-dominant calf, with 5-10 days between sessions. A pressure sensor placed on the posterior calf monitored the wrapping compression force. The intervention exercise comprised six voluntary isometric contractions of the ankle at three angles (20° plantar flexion, neutral 0°, and 10° dorsiflexion) for 3 seconds each using a dynamometer. The maximal isometric ankle plantar flexion torque and dorsiflexion range of motion were evaluated pre- and post-intervention. Significant interactions were observed in ankle plantar flexion torque at 10° dorsiflexion (p < 0.01) but not at 0° or 20° plantar flexion. The low- and high-pressure bands significantly enhanced ankle plantar flexion torque by 4.3 Nm (effect size [ES]: 0.14, p = 0.02) and 4.9 Nm (ES: 0.15, p < 0.05), respectively, and also enhanced the ankle dorsiflexion range of motion by 1.7° (ES: 0.43, p < 0.01) and 1.3° (ES: 0.35, p = 0.02), respectively, compared to the control. The low- and high-pressure band conditions had comparable effects on torque and range of motion. A few minutes of the calf tissue flossing intervention significantly enhanced ankle plantar flexion torque and dorsiflexion range of motion, although the effect sizes were trivial to small.

Exploratory Analysis of Unstable Surface Training: A Systematic Review and Meta-Analysis for Chronic Ankle Instability

Objective

To conduct an exploratory systematic review and meta-analysis to evaluate the effect of unstable surface training on balance and hop function in individuals with chronic ankle instability (CAI).

Data Sources

Four major electronic databases were searched, including Cochrane Library, PubMed, Embase, and Web of Science, from January 1, 2000 to June 20, 2024.

Study Selection

Randomized controlled trials that compare unstable surface training with either general intervention or no intervention in individuals with CAI were included.

Data Extraction

The physical therapy evidence database scale was used to assess the risk of bias and methodological quality of included studies. The mean differences (MDs) with 95% confidence intervals (CIs) were calculated using Review Manager 5.4 software.

Data Synthesis

The review ultimately included 9 studies involving 308 participants. Compared with the other exercises or no exercise, unstable surface training could improve the significant effects of the star excursion balance test (SEBT) in the direction of posterolateral (MD=5.80; 95% CI, 1.60-9.99; P=.007), posteromedial (MD=6.24; 95% CI, 2.32-10.16; P=.002), medial (MD=9.11; 95% CI, 6.42-11.80; P<.00001), anteromedial (MD=7.25; 95% CI, 2.33-12.17; P=.004), the time-in-balance test (MD=8.45; 95% CI, 1.50-15.40; P=.02), the foot-lift test (MD=-1.39; 95% CI, -2.49 to -0.28; P=.01). However, there was no significant difference in the anterior direction of the SEBT (MD=3.22; 95% CI, -0.66 to 7.10; P=.10), the side-hop test (MD=-1.94; 95% CI, -4.82 to 0.95; P=.19), and the figure-of-8 hop test (MD=-0.97; 95% CI, -2.39 to 0.46; P=.18) between groups.

Conclusions

Compared with the other exercises or no exercise, unstable surface training has potential benefits in improving balance in people with CAI but has no significant effect on hop function. However, the exploratory nature of this study highlights the need for further research to confirm these findings.

Ultrasound of Postoperative Ankle Instability: How to Manage with Arthroscopic Reparation or Anatomical Reconstruction of Lateral Ankle Ligaments

Surgical repair or reconstruction of lateral ankle ligaments is indicated in patients with persistent ankle instability, with arthroscopic/endoscopic treatment becoming more frequent. Although presurgical imaging of the ankle is always standard procedure, more is needed to understand the evolution of the repaired ligament or the tendinous graft to help improve length of postoperative time and functional results. This review describes the normal ultrasound aspects and possible complications of repaired/reconstructed ankle ligaments after an all-inside endoscopic repair/reconstruction of the anterior talofibular ligament and the calcaneofibular ligament.

Neuromuscular Electrical Stimulation of Peroneal Longus Improve Balance Control Ability in Young Adults With Chronic Ankle Instability: A Randomized Controlled Trial

OBJECTIVE

This study aimed to investigate the effects of 6 wks of peroneal longus neuromuscular electrical stimulation on the balance control ability in young adults with chronic ankle instability.

DESIGN

This study is a double-blind randomized controlled trial. Six weeks of neuromuscular electrical stimulation and placebo intervention were conducted in the neuromuscular electrical stimulation and control groups for 20 mins, three times a week, respectively. Thirty-eight participants successfully completed the whole intervention and single-leg standing tests. The kinetics data of the center of pressure trajectory during static single-leg stance were measured using a Kistler force platform. Two-way repeated measures analysis of variance was used to analyze the electrical stimulation effects.

RESULTS

Significant interactions were detected in Cumberland Ankle Instability Tool scores and all balance parameters including displacement X, displacement Y, 95% confidence ellipse area, root-mean-square, and center of pressure mean displacement velocity ( P < 0.05, 0.103 ≤ η 2 ≤ 0.201). Significant between-group differences were found in Cumberland Ankle Instability Tool scores ( P = 0.003, Cohen's d = 0.215), displacement X ( P = 0.045, Cohen's d = 0.107), root-mean-square ml ( P = 0.019, Cohen's d = 0.143), and 95% confidence ellipse area ( P = 0.031, Cohen's d = 0.123) after the 6-wk interventions.

CONCLUSIONS

Six weeks of neuromuscular electrical stimulation on the peroneus longus can improve static balance control ability in young adults with chronic ankle instability, especially the stability of ankle frontal plane.

Effects of dual-task paradigm on the injury potential during landing among individuals with chronic ankle instability

Purpose

Chronic ankle instability (CAI) causes maladaptive neuroplastic changes in the central nervous system, which may lead to high injury potential under dual-task conditions. This study aims to explore the effects of dual-task paradigm on the injury potential during landing among individuals with CAI.

Methods

Twenty participants with CAI (4 female and 16 male, 12 were affected with their right limbs and 8 were affected with their left limbs, 20.4 ± 1.7 years, 176.9 ± 5.0 cm, and 72.0 ± 11.1 kg) and eighteen without CAI (6 female and 12 male, 20.2 ± 1.5 years, 173.5 ± 7.0 cm, and 70.3 ± 10.8 kg) were recruited. They drop-landed on a trap-door device, with their affected or matched limbs on a flippable platform, under single- (drop-landing only) and dual-task (drop-landing while subtracting of serial threes) conditions. A twelve-camera motion capture system was used to capture the kinematic data. Two-way ANOVA with mixed design (CAI vs non-CAI groups by single-vs dual-task conditions) was used to analyze the data.

Results

Significant group-by-condition interactions were detected in the ankle inversion angle (P = 0.040, η 2 p = 0.012) and ankle inversion angular velocity (P = 0.038, η 2 p = 0.114). Both indicators decreased among individuals without CAI from single-to dual-task conditions, while remained unchanged among those with CAI; and they were higher among individuals with CAI under both single- and dual-task conditions, compared to those without CAI.

Conclusion

Individuals with CAI have a reduced ability to limit ankle inversion compared to those without CAI. Under dual-task conditions, individuals without CAI limited their ankle inversion, while those with CAI did not. Drop-landing, especially under dual-task conditions, poses a high risk of excessive ankle inversion for individuals with CAI.

Visualized trends and bibliometric analysis in ankle cartilage repair from 2004 to 2024

Ankle cartilage injuries are a common sports-related condition that significantly impairs patients' daily activities and imposes substantial economic burdens on both families and society. Effective cartilage repair strategies are crucial to addressing this pathological condition. Current conservative treatments include muscle strengthening, use of ankle braces, physical therapy, and the administration of NSAIDs. In cases of severe injury, surgical interventions such as osteophyte resection and cartilage transplantation may be necessary. However, the inherent regenerative capacity of articular cartilage is limited, and conventional treatments are insufficient to promote cartilage regeneration and repair. Consequently, innovative therapies such as stem cell therapy, exosome therapy, and cartilage regeneration scaffolds are prioritized for future development. In recent years, significant progress has been made in ankle cartilage repair. While bibliometric studies on cartilage repair exist, specific analyses focused on ankle cartilage repair are lacking. This study aims to address this gap by conducting a bibliometric analysis of 131 articles published over the past two decades, highlighting development trajectories, research hotspots, and evolutionary trends through knowledge mapping. Our findings indicate growing global interest, with the United States leading in international collaboration, funding, publication output, and citation frequency. Foot & Ankle International emerges as the leading journal for publication and dissemination in this field, with Kerkhoffs GMMJ identified as the most influential author. Notable hotspot keywords include "osteochondral lesions" and "platelet-rich plasma." By highlighting critical research hotspots and collaboration patterns, this study not only enriches the existing literature on ankle cartilage repair but also serves as a foundational resource for clinicians and researchers aiming to develop innovative strategies for improving patient outcomes. Furthermore, our findings underscore the necessity of interdisciplinary collaboration in advancing the understanding and treatment of ankle cartilage injuries. Ultimately, the visual characterization of these trends provides valuable insights into the field's evolutionary trajectory, offering guidelines for future research directions and encouraging further exploration of this promising area.

Comparison of the distance between the talus and lateral malleolus during the stance phase with and without chronic ankle instability

The level of dynamic mechanical instability between the bony parts of the ankle joint provides important information on biomechanical function. However, the dynamics of the distance between the talus and lateral malleolus during gait remain unclear. This study aimed to compare the distance between the talus and lateral malleolus and the ankle joint angles during the stance phase of gait between individuals with chronic ankle instability (CAI) and healthy adults. The comparison was conducted using a synchronized ultrasound (US) imaging with a three-dimensional motion analysis (MA) system. This cross-sectional study included 12 participants (5 males, 7 females; age, 20.5 ± 1.8 years; height, 166.6 ± 9.4 cm; body weight, 60.2 ± 5.3 kg; body mass index, 21.7 ± 2.0 kg/m2; 16 feet) with CAI and 10 healthy controls (4 males, 6 females; age, 21.2 ± 1.6 years; height, 164.6 ± 10.5 cm; body weight, 56.8 ± 11.3 kg; body mass index, 20.8 ± 2.6 kg/m2; 20 feet). The distance between the talus and lateral malleolus during gait was significantly increased in the CAI group compared with that in the control group throughout the stance phase. The ankle dorsiflexion angle was smaller in the CAI group during the middle and terminal stance phases. Additionally, the ankle inversion angle was greater in the CAI group than in the control group. Our findings show the application of the synchronized US and MA system in the assessment of mechanical instability in CAI group, which may be used to determine treatment efficacy.

Effects of visual disruption on static and dynamic postural control in people with and without chronic ankle instability

Introduction

Chronic Ankle Instability (CAI) is a chronic syndrome resulting from repeated ankle sprains that lead to persistent dysfunction.the purpose of this study is to determine whether visual disruption could influence static and dynamic postural control in people with and without chronic ankle instability (CAI), with the objective of gaining a comprehensive understanding of the interactions between visual inputs and postural control.

Methods

Thirty people with CAI (21 males and 9 females, age = 22.0 ± 1.8 years, height = 174.4 ± 10.2 cm, body mass = 72.5 ± 15.4 kg; Cumberland Ankle Instability Tool (CAIT) score = 19.7 ± 1.8) and twenty-nine without CAI (24 males and 5 females, age = 22.9 ± 1.6 years, height = 172.8 ± 8.0 cm, body mass = 69.0 ± 11.3 kg; CAIT score = 29.0 ± 0.7) were recruited. Their static and dynamic postural control was measured in two conditions with or without visual disruption, simulated using stroboscopic glasses. Static postural control was measured during single-limb standing and represented by root mean square (RMS) of the plantar center of pressure (CoP), dynamic postural control was measured during a Y-balance test and represented by the relative reach distance. Two-way mixed ANOVA (between group: CAI vs non-CAI, within group: normal vision vs visual disruption) was used to analyze data.

Results and discussion

Significant interactions were detected in the CoP-RMS in the anteroposterior (AP) (p = 0.021, η2 p = 0.090) and mediolateral (ML) (p < 0.001, η2 p = 0.208) directions, and the relative reach distances in the posteromedial (PM) p = 0.023, η2 p = 0.088) and posterolateral (PL) (p = 0.009, η2 p = 0.113) directions, from normal vision to visual disruption. The CoP-RMS in the AP and ML directions significantly increased and the relative reach distances in the PM and PL directions significantly decreased in people with CAI while remaining unchanged in those without CAI. People with CAI are susceptible to visual disruption on postural control, highlighting the importance of visual input in maintaining stable posture in this population.