Sensitivity of a Subject-specific Ankle Sprain Simulation to Extrinsic Versus Intrinsic Biomechanical Factors.

Adam J Yoder,Anthony J Petrella,Shawn Farrokhi

doi:10.3389/fbioe.2021.765331

Abstract

Ankle sprains are the most common musculoskeletal injury in sport and military activity, despite existing prophylactic strategies. The purpose of this report was to develop a probabilistic simulation of lateral ankle sprains during single-limb drop landing, towards accelerating innovation in ankle sprain prevention. A deterministic, subject-specific musculoskeletal model was extended with automation and probabilistic distributions on sprain-related biomechanical factors. Probabilistic simulations were generated using traditional Monte Carlo techniques and the advanced mean value method, a more computationally-efficient approach. Predicted distributions of peak ankle joint rotations, velocities, and moments borne by supporting passive structures agreed favorably with the deterministic model and with reports of real sprain biomechanics. Parameter sensitivities identified that predictions were most strongly influenced by drop height, subtalar joint posture at contact, invertor/evertor co-activation, and passive ankle stiffness. The advanced mean value method predicted confidence bounds comparable to a 1000-trial Monte Carlo simulation, and required only 14 model evaluations and 4-min processing time. The extended probabilistic simulation may be useful to virtually test new prophylactic strategies for ankle sprains, and is made available for open-source use (https://simtk.org/projects/sprain-sim).

Highlights

Ankle sprains are the most common musculoskeletal injury in sport and military physical activities requiring medical care, with estimated prevalence as high as 10–12% (Ruscio et al, 2010; Doherty et al, 2014)
We extended the baseline model with a representation of external, ankle-foot structural support
The primary aim of this study was to develop a probabilistic simulation of ankle inversion sprains for virtual study of prophylactic interventions

Summary

Introduction

Ankle sprains are the most common musculoskeletal injury in sport and military physical activities requiring medical care, with estimated prevalence as high as 10–12% (Ruscio et al, 2010; Doherty et al, 2014). Among individuals who experience a first-time sprain, 40% will go on to develop chronic ankle instability, which can lead to recurrent sprains, time lost at work, and decreased quality of life (Doherty et al, 2016). The most strongly recommended intervention to date for prevention of first-time or recurrent lateral ankle sprains is use of a semi-rigid brace during high-intensity physical activity (Newman et al, 2017; Martin et al, 2021).

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