Acute Sprain Research Articles

Immediate efficacy of auricular acupuncture combined with active exercise in the treatment of acute lumbar sprains in 10 minutes: Protocol of a randomized controlled trial.

Acute lumbar sprain (ALS) is common musculoskeletal disorder characterized by severe low back pain and activity limitation, which significantly impacts the patient's work and life. Immediate relief of pain and restoration of mobility in a short period of time are the main needs of patients when they visit the clinic. This study aims to evaluate the immediate efficacy of this combined treatment for ALS within 10 minutes. This is a single-center, prospective, randomized clinical trial. 128 eligible patients with ALS will be randomly allocated in a 1:1 ratio to either the auricular acupuncture (AA) group or the sham auricular acupuncture (SAA) group. All patients will receive a single 10-minute treatment. The primary outcome will be the change in pain intensity after 10 minutes of treatment. The secondary outcomes include changes in pain intensity at other time points (2, 5 minutes), changes in lumbar range of motion (ROM) at different time points, blinded assessment, treatment effect expectancy scale evaluation, and treatment satisfaction scale evaluation. All participants will be included in the analysis according to the intention-to-treat principle. This is the first randomized controlled trial to assess the immediate efficacy of AA combined with active exercise for ALS. The findings of this study are expected to provide a simple and rapid treatment for ALS in clinical. Chinese Clinical Trial Registry ChiCTR2400083740. Registered 30 April 2024.

Acupotomy combined with Korean medicine treatment in a patient with acute sacroiliac pain unresponsive to conventional therapy: A case report

RationaleAcute injury to the sacroiliac joint (SIJ) can result from high-energy external forces that cause a combination of axial loading and sudden rotational movements, resulting in severe pain that cannot be relieved by regular nonsteroidal anti-inflammatory drugs. The treatment includes injections of steroids and local anesthetics to reduce pain and promote healing. Here, we report the case of a patient with acute sacroiliac pain who did not respond to conventional injection therapy. Patient concernsA 58-year-old male patient who did not exercise regularly experienced pain in his left groin and difficulty walking while kicking on his right leg. He received two injections and manual therapy at a local orthopedic clinic; however, his symptoms did not improve despite taking painkillers. DiagnosesRadiographic images showed no abnormalities. After confirming the cause of onset, pain pattern, physical examination, and tenderness, the patient was diagnosed with an acute SIJ sprain (static blood). InterventionsAt the first visit, a single acupotomy was performed on the seven treatment points identified during the physical examination, and immediate improvement in symptoms was confirmed. From then on, Korean medicine (KM) treatments, such as acupuncture, cupping, chuna, and bee venom pharmacopuncture, were performed. OutcomesImmediately after acupotomy, groin pain improved by 80 %, gait immediately normalized, and the patient showed no symptoms at the 9th visit. LessonsFor SIJ-type groin pain that does not respond to existing treatments, immediate relief is achieved after a single acupotomy at the exact treatment point. Therefore, in the future, the importance of identifying a precise treatment point for SIJ pain should be recognized, and the use of Korean medicine treatment techniques, including acupotomy, should be considered.

Assessment of Efficacy and Safety of Dr.Ortho Capsules in Managing Musculoskeletal Disorders: A Phase IV Post-Marketing Surveillance Study

Objectives: This study aimed to evaluate the potential efficacy and safety of Dr. Ortho capsules in managing various musculoskeletal conditions, including knee pain, joint stiffness, arthritis, bulky shoulders, joint inflammation, acute sports injuries, strains, and sprains. Methods: The study was a single centric, open-label, non-randomized, post-marketing surveillance study involving 120 subjects. Subjects were selected based on inclusion and exclusion criteria. The study assessed changes in pain intensity and disability levels after the administration of Dr. Ortho capsules, employing the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), respectively. Additionally, safety was evaluated through physical examinations, vital sign monitoring, and laboratory safety parameters. Results: The study revealed significant reductions in pain intensity and disability levels among the participants. Pain intensity, as measured by VAS, decreased significantly (p< 0.0001) from a mean score of 4.84 at baseline (day 1) to 0.38 at the end of the study (day 30). Disability levels, indicated by ODI, significantly improved (p<0.0001) from a mean score of 14.73% at baseline to 1.88% at the end of the study. There were no reported adverse events during the study, and all safety parameters remained within normal ranges. Conclusion: The findings of the study suggest that Dr. Ortho capsules may offer effective relief for individuals with musculoskeletal conditions, reducing pain intensity and improving functional abilities. The absence of adverse events and the maintenance of normal safety parameters indicate the safety of Dr. Ortho capsules for human consumption.

Increased Calcaneal Pitch and Subtalar Instability are Predictors Associated with Surgical Reconstruction for Patients who Develop Chronic Lateral Ankle Instability

Category: Ankle; Sports Introduction/Purpose: Most acute lateral ankle sprains are treated non-operatively, however, up to 20% of acute sprains (LAS) develop Chronic Lateral Ankle Instability (CLAI) requiring surgical reconstruction. CLAI risk factors have not been analyzed in the context of a multifactorial system. This study aims to identify a model to identify patients who are at increased risk for CLAI after acute lateral ankle sprains utilizing clinical and radiographic findings, in order to identify patients who may benefit from early surgical intervention (LAR). Methods: This retrospective study identified 78 patients who presented with acute lateral ankle sprains and 50 patients with CLAI who underwent lateral ankle reconstruction (LAR), diagnosed 2010-2020. Patients’ clinical exam findings and radiographic data were collected from direct clinical notes evaluation from a single Orthopedic Foot and Ankle surgeon's records. Descriptive statistics were utilized to determine difference, with a regression model used to determine risk factor significance. Results: A clinical diagnosis of subtalar instability (SI) was made in 32% of CLAI patients as compared to 2.5% (p=0.0001) of acute sprains. Assessment of calcaneal pitch (CP) yielded a significant difference between CLAI [µ:30.7, Median: 30.9] and acute sprains [µ=25.8, p< 0.0001, Median=25.8]. Correlation analysis yielded a predictive model for CLAI; -10.618 + 0.328CP + 3.33SI, indicating both increased calcaneal pitch [OR: 1.388 (95% CI: 1.185-1.625)] and subtalar instability [OR: 27.931 (95% CI: 4.235 – 184.210)] are significant predictors of CLAI. The sensitivity of this model is 62.5% and specificity is 83.3%, with both variables demonstrating a significance (P < 0.001 for both variables). Conclusion: These data indicate subtalar instability and increased calcaneal pitch angle are predictors of CLAI development and a higher risk of requiring LAR after LAS. These predictors can aid clinicians in determining ideal candidates for more aggressive non- operative treatment and those who may necessitate earlier surgical lateral ankle reconstruction. Identification of these patients will assist the clinician in management, counseling, treatment, and evaluation after LAS and after developing more chronic symptoms. Future prospective studies are needed to further characterize these risk factors as indicators for failure of and optimal non- operative management as well as patients who may qualify for early LAR.

Don't Miss Me: Midfoot Sprains, A Point-of-Care Review.

Athletes practicing high-contact sports are exposed to an increased risk of midfoot injuries, namely midtarsal sprains. The complexity of reaching an accurate diagnosis is clearly depicted in the reported incidence of midtarsal sprains, ranging from 5% to 33% of ankle inversion injuries. Because the focus of the treating physician and physical therapist is on lateral stabilizing structures, midtarsal sprains are missed at initial evaluation in up to 41% of patients, with delayed treatment as a result.Detecting acute midtarsal sprains requires a high degree of clinical awareness. Radiologists must become familiar with the characteristic imaging findings of normal and pathologic midfoot anatomy to avoid adverse outcomes such as pain and instability. In this article we describe Chopart joint anatomy, mechanisms of midtarsal sprains, clinical importance, and key imaging findings with a focus on magnetic resonance imaging. A team effort is essential to provide optimal care for the injured athlete.

Call for Special Issue Papers: The Role of Acupuncture in Sports Injuries and Best Practices: Deadline for Manuscript Submission: May 5, 2023.

Medical AcupunctureVol. 35, No. 1 Calls for PapersFree AccessCall for Special Issue Papers: The Role of Acupuncture in Sports Injuries and Best PracticesDeadline for Manuscript Submission: May 5, 2023Guest Editors: Matt Callison and Michael CorradinoGuest Editors: Matt CallisonPresident - AcuSport Seminar Series, Inc. (dba AcuSport Education); President - Sports Medicine Acupuncture Certification ProgramSearch for more papers by this author and Michael CorradinoPresident and Founder - Neuropuncture, Inc.; Doctor of Neuroscience Acupuncture - Program DirectorSearch for more papers by this authorPublished Online:15 Feb 2023https://doi.org/10.1089/acu.2022.29223.cfpAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Dear Acupuncture Community:As guest editors of a special issue in Medical Acupuncture on “The Role of Acupuncture in Sports Injuries and Best Practices,” we invite you to contribute your clinical experience and research on the use of acupuncture and electroacupuncture in treating sports injuries. Your paper will undergo blinded peer review, and if accepted for publication, will be included in the special issue and promoted globally. The issue will provide a broad overview of the best practices of acupuncture to palliate and assist in healing acute and chronic sport injuries.In the interest of fostering an understanding of the underlying mechanisms and evidence for the effectiveness of acupuncture and electroacupuncture, this special issue seeks to provide practical recommendations that advocate and promote a rapid restoration for: 1.Acute trauma, for example, acute sprain, strain, and hematoma (bone and soft tissue trauma).2.Chronic repetitive and overuse injuries (ie: tendinopathies).3.The use of acupuncture in dysfunctional movement patterns and neuromuscular reeducation (ie: acupuncture for muscle and postural imbalances).4.Electroacupuncture stimulation protocols for acute and chronic injuries.5.Electroacupuncture parameters and their effects on the resolution of nerve damage versus muscle damage versus bone damage.6.Head injures (concussions) and mild traumatic brain injuries.7.Acupuncture and electroacupuncture for athletic performance, including endurance, healing and recovery, and reaction time.8.Other sport injury articles of clinical or research interest.The deadline for manuscript submission is May 5, 2023.Visit our website to read about the journal and to view a sample issue: www.liebertpub.com/acuPlease review our Instructions for Authors, including Manuscript Types and Guidelines to submit your manuscripts online to our web-based manuscript submission and peer-review system.Editorial questions?Contact the Editor-in-Chief, Richard Niemtzow: Rniemtzow@liebertpub.comManuscript preparation or technical questions?Contact the Managing Editor, Yael BenPorat, LAc: Ybenporat@liebertpub.comVisit the Instructions for Authors:www.liebertpub.com/acuSubmit your paper for peer review online:https://mc.manuscriptcentral.com/acuFiguresReferencesRelatedDetails Volume 35Issue 1Feb 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Guest Editors: Matt Callison and Michael Corradino.Call for Special Issue Papers: The Role of Acupuncture in Sports Injuries and Best Practices.Medical Acupuncture.Feb 2023.1-2.http://doi.org/10.1089/acu.2022.29223.cfpPublished in Volume: 35 Issue 1: February 15, 2023Online Ahead of Print:January 13, 2023PDF download

Clinical trial to evaluate the efficacy of Sandhaniya Cast in Ankle Sprain

Ankle is the most common site for acute musculoskeletal injuries and sprains. Acute ankle trauma is responsible for 10-30% of sports related injuries in young athletes. Ankle sprain is characterized by pain, swelling with or without deformity. According to the Modern science the treatment modalities adopted for the ankle sprain are ankle brace, below knee cast and ankle strap. Inadequate treatment of ankle sprain can lead to chronic problems such as decreased range of motion, pain and joint instability. Acharya Sushruta advocates Alepa with Asthisandhaniya Dravyas for the management of Bhagna. These dravyas when used in the form of Lepa have the properties of Sandhaniya, Shophahara and Vedanasthapaka action. It is a need of hour to bring up new innovative, readily available, patient friendly and time saving techniques which possess the same effect. Hence this study is taken up to bring the Manjistadi Lepa in the modified form as Sandhaniya cast. Such kind of medicated casts weren’t in use till date which makes it unique. This would not only help in immobilization like any other ankle brace or ankle binder, but also reduces localized edema and pain due to its Vedanasthapaka and Shophahara properties and also accelerates the healing.

Biomechanical Analysis of Different Footwork Foot Movements in Table Tennis.

In order to solve the problem of athletes with lower limb movement injuries in table tennis footwork, with the increasing risk of sports, the incidence of acute injury also increased. The increase in athletic training, on the one hand, improves the skill level of the athlete; on the other hand, it increases the chances of more chronic injuries. Through the investigation of the injury site of 143 table tennis players, the researchers found that the lower limb injury accounted for 32% of the total injuries and the upper limb injury rate accounted for 33.14% of the trunk, accounting for 34.29%. The injury sites are mostly concentrated in the lumbar region, followed by the shoulders and knees. Through epidemiological research on the injuries of outstanding table tennis players, the survey results show that the probability of lower extremity injuries ranks in the top three, and most of them are acute sprains and chronic strain injuries. By applying the principles of sports biomechanics, a biomechanical analysis of the asynchronous foot movement in table tennis is proposed; from three aspects of kinematics, dynamics, and plantar pressure, it is found that the injury of table tennis is closely related to technical play connect. The risk of sports injury is inevitable in a sense, due to the long-term local overload, which causes the strain of the sports system. In order to avoid or reduce the occurrence of such sports injuries, coaches should standardize the technical movements of the players and arrange the exercise load reasonably according to the characteristics of the sports.

Analysis of the Existing Treatment Methods for Ballet Dancers with Ankle Joints Injuries. Literature Review

In a study by American scientists, it was noted that most of the injuries of ballet dancers occur on the lower limbs, as they are subjected to increased loads. Ankle joints injury with ligament injuries is the most frequent and complication-prone type of injury. Insufficient attention is paid to the accidents prevention and replenishment of the sensorimotor deficit in the process of recovering from this injury. According to a focused literature review by Mackenzie M.H. et al. on the epidemiology of acute sprain of the ankle ligaments, chronic instability of the ankle joint develops in 40% of patients who have experienced such an injury for the first time, characterized by repeated sprains and sensations of instability of the ankle joint. Aim. To analyze the process of rehabilitation of ballet dancers with the ankle joint injury, identify the shortcomings of rehabilitation programs, to study the effect of proprioceptive training programs in reducing the incidence of repetitive ankle sprains in athletes and ballet dancers with a history of ankle injuries. Conclusion. Suspension systems exercises can provide training not only for individual muscle groups, but also for proprioceptive sensitivity training, correction of postural disorders due to trauma, and most importantly, sensorimotor training under controlled conditions, which reduces the risk of possible re-traumatization.

A novel synergistic device for joint inflammation – efficacy on ankle sprain cases

Joint inflammation results from soft-tissue injuries and cartilage damage. PRICE is the standard treatment approach for acute soft tissue injuries like ankle sprain. Electrical stimulation, application of orthotic braces, etc. is also effective for this. In a synergistic device all these components are combined and applied simultaneously. This device was developed for joint inflammation and tested for grade I & II acute ankle joint sprain. To test a synergistic – semirigid device, combining PRICE & electrical stimulation for acute ankle sprains of grades I & II for pain, range of motion and swelling is a case series was the objective. Device was developed using novel concept of synergistic applications of PRICE with electrical stimulation. The joint contour of ankle and specific biomechanical bony surface landmarks were considered. Ethical approval was taken from NTCC committee, AIPT. Recordings were taken from eight patients of acute ankle sprain with – in two days of injury, after getting ethical approval. Elevation to the ankle was provided by keeping the part over the pillow and data was recorded with the help of: 1.VAS scale for pain; 2. Measuring tape; 3. Goniometry. t-test was used to find out the significant difference pre and post the application of device. There was a significant reduction in pain (p = 0.006), edema (p = 0.011), dorsi-flexion (p = 0.015), and plantar flexion (p =0.008). The synegistic device has been effective for acute ankle inflammation - grade I & II ankle sprains in 5 sessions; sufficient for the return of function.

New classification of osteochondral lesions of the talus in adults

Osteochondral lesions (OCL) of the ankle in adults are frequent lesions that mainly affect the cartilage and the subchondral bone, are relatively common, and have varied etiologies. However, in 50% of patients, these lesions may occur concomitantly with chronic instability of the ankle associated with lower limb deformities, acute sprains of the ankle, or fractures. We propose a classification into four types of lesions (traumatic, non-traumatic, with lateral instability of the ankle, and with mechanical axis defects), focusing not only on the diagnosis and treatment of OCL but also on associated injuries, such as instability and/or supramalleolar and hindfoot deformities. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Assessment of the diversity of comfrey (Symphytum officinale L. and S.\u2009\xd7\u2009uplandicum Nyman)

Comfrey Symphytum officinale L. (true comfrey) and S. × uplandicum Nyman (a hybrid between S. asperum Lepech × S. officinale L., Russian comfrey) are used externally for the treatment of pain, inflammation and swelling of muscles and joints in degenerative arthritis, in acute myalgia, sprains, contusions and strains after accidents. Besides plant secondary compounds associated with beneficial activities (e.g. rosmarinic acid and allantoin) comfrey forms also toxic pyrrolizidine alkaloids (PA). To improve further breeding and study the genetic relationships of a comfrey collection, a sample set of 219 S. officinale and 5 hybrid plants of S. × uplandicum were analysed with 34 SNP markers by KASP (Kompetitive Allele Specific PCR), developed from a next generation sequencing approach of three different individuals of S. officinale. In parallel, the plants were analysed for the polyphenol rosmarinic acid, the purine derivative allantoin, and the toxic pyrrolizidine alkaloids. Besides the two beneficial compounds, further 13 polyphenols and 10 purine derivatives were determined. The plants were grouped into six distinct genetic clusters. Rosmarinic acid was not linked to any of the clusters, while one cluster was distinctively different for some compounds, amongst them allantoin and globoidnan A. Also linked to a certain genetic cluster was a low content of PA, which could become a valuable gene pool for minimizing PA content by breeding. A subset of the samples was analysed in a second year again where rosmarinic acid and allantoin showed a medium stability, while globoidnan A was completely unstable.

Effect of Ankle Proprioceptive Training on Preventing Ankle Injury of Martial Arts Players

The ankle joint is an important weighted joint of the human body, and it is very easy to sprain in daily sports and life. Furthermore, functional ankle instability can be easily caused by an acute sprain of the ankle, which increases the risk of re-spraining. In view of this, this article summarizes and analyzes the literature on rehabilitation treatment of functional ankle instability, and explores the effect of proprioceptive training of ankle joints on the prevention of ankle injury in martial arts. This article selects a university martial arts team as the research object, and randomly divides them into 5 male and female experimental groups and 5 control groups. The experimental group received ankle muscle strength training, and the control group received ankle muscle strength training and ankle proprioception training. The dynamic balance system was used to perform balance tests before and after training in all control groups and experimental groups. After training, it has a significant effect on the average direction control ability, forward and left direction control ability, the value after training significantly increases, and the P values are 0.017, 0.032, and 0.043, respectively. The experiments in this paper show that both ankle muscle strength training and ankle joint proprioceptive training combined with muscle strength training can improve the dynamic and static balance ability of martial arts players; moreover, the combination of the two training combined to improve the balance ability is more significant and can effectively prevent the ankle joint the appearance of damage.

Epidemiology of Acromioclavicular Joint Injuries in Professional Baseball

Objectives:Shoulder injuries account for a large portion of all recorded injures in professional baseball. Much is known about other shoulder pathologies in the overhead athlete, but the incidence and impact of acromioclavicular (AC) joint injuries in this population is unknown. The purpose of this study was to examine the incidence, rates, and characteristics of AC joint injuries in professional baseball, and determine the impact on time missed.Methods:The Major League Baseball Health and Injury Tracking System (HITS) was used to compile records of all major and minor league player from 2011-2017 with documented AC joint injuries. These injuries were classified as acute (sprain or separation) or chronic (AC joint arthritis or distal clavicular osteolysis), and associated data included laterality, date of injury, player position, activity, mechanism of injury, length of return to play (RTP), and need for surgical intervention.Results:A total of 312 AC joint injuries (183 MiLB, 129 MLB; range 39-60 per year) were recorded (acute n=201, 64.4%; chronic n=111, 35.6%). A total of 81% of acute injuries resulted in time missed with an average RTP of 22.8 days whereas 59% of chronic injuries resulted in days missed with an average RTP of 32.2 days (p<0.001). Acute injuries occurred most commonly in outfielders (42.7%), followed by infielders (27.3%). Chronic injuries were seen in higher proportions among pitchers and catchers (45.5-56.4% chronic injuries). Acute AC injuries occurred most often while playing defense (n=100; 49.8%) in the infield or outfield (n=138; 68.7%), with 63.2% the result of a contact injury. Chronic AC joint injuries were most commonly with throwing or pitching (n=48; 43.2%) and non-contact injuries (n=79; 71.2%).Conclusion:Acute AC joint injuries are contact injuries occurring most commonly among infielders and outfielders that result in more than 3 weeks missed before return to play whereas chronic AC joint injuries occur more commonly in pitchers and catchers from repetitive overhead activity. Knowledge of these data can better guide expectation management in this elite population to better elucidate the prevalence of two common injury patterns in the acromioclavicular joint.

Epidemiology of acromioclavicular joint injuries in professional baseball: analysis from the Major League Baseball Health and Injury Tracking System

Shoulder injuries account for a large portion of all recorded injuries in professional baseball. Much is known about other shoulder pathologies in the overhead athlete, but the incidence and impact of acromioclavicular (AC) joint injuries in this population are unknown. We examined the epidemiology of AC joint injuries in Major League Baseball (MLB) and Minor League Baseball (MiLB) players and determined the impact on time missed. The MLB Health and Injury Tracking System was used to compile records of all MLB and MiLB players from 2011 to 2017 with documented AC joint injuries. These injuries were classified as acute (sprain or separation) or chronic (AC joint arthritis or distal clavicular osteolysis), and associated data extracted included laterality, date of injury, player position, activity, mechanism of injury, length of return to play, and need for surgical intervention. A total of 312 AC joint injuries (183 in MiLB players and 129 in MLB players; range, 39-60 per year) were recorded: 201 acute (64.4%) and 111 chronic (35.6%). A total of 81% of acute and 59% of chronic injuries resulted in time missed, with a mean length of return to play of 21 days for both. Of the injuries in outfielders, 79.6% were acute (P < .0001), as were 66.3% of injuries in infielders (P = .004). Pitchers and catchers had more equal proportions of acute and chronic AC injuries (P > .05for all). Acute AC injuries occurred most often while fielding (n = 100, 84.7%), running (n = 25, 80.6%), and hitting (n = 19, 61.3%), whereas chronic injuries tended to be more common while pitching (n = 26, 68.4%). Of contact injuries, 82.5% were acute (P < .0001), whereas 59.0% of noncontact injuries were chronic (P = .047). MLB players showed consistently higher regular-season rates of both acute and chronic AC injuries than MiLB players (P < .0001 for each). Acute AC joint injuries are contact injuries occurring most commonly among infielders and outfielders while fielding that result in 3 weeks missed before return to play, whereas chronic AC joint injuries occur more commonly in pitchers and catchers from noncontact repetitive overhead activity. Knowledge of these data can better guide expectation management in this elite population to better elucidate the prevalence of 2 common injury patterns in the AC joint.

Biomechanical Taping and standard physical therapy were effective in the management of acute ankle inversion sprain: a pre- and post- intervention study

Biomechanical Taping and standard physical therapy were effective in the management of acute ankle inversion sprain: a pre- and post- intervention study

TL 18136 - Short-term results for acute instability of the syndesmosis treated with arthroscopic reduction and percutaneous fixation

Introduction: Acute syndesmotic sprain is rarely associated with instability in the absence of fracture. The surgical treatment of these injuries is usually performed as an open procedure with direct visualization of the anatomical reduction of the joint. However, direct visualization of the reduction can be achieved by arthroscopy with minor incisions avoiding damage to the soft tissues. The aim of this study is to present the short-term outcomes of a series of patients with acute unstable syndesmotic injuries who were surgically treated through an arthroscopic reduction and percutaneous fixation with a suture button. Methods: We report a series of 8 patients with a mean age of 25,62 years with acute instability of the syndesmosis without fracture who were treated through arthroscopic reduction of the syndesmosis followed by percutaneous fixation using a suture button, between October 2014 and May 2018. Medical records, the visual analogue scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, pre and postoperative radiological results (stress radiographs, computed tomography and magnetic resonance imaging) and complications were retrospectively reviewed. Results: After a mean follow-up of 13,4 months, the mean VAS was 0 and the mean AOFAS was 100. All patients were able to return to their preinjury activities and were completely satisfied with the treatment outcomes. Two patients had an associated deltoid ligament rupture and were treated by open repair at the same time. Two complications were observed. One patient developed an aseptic cyst over the distal knot, and one evolved with complex regional pain syndrome. The last one required a reoperation to remove the anterior button. Conclusion: Arthroscopic treatment represents an effective approach for acute syndesmotic instability. In the short-term, it provides satisfactory clinical and functional results, allowing patients to return to their previous activities. It is reliable regarding anatomic reduction of the syndesmotic joint and percutaneous fixation with a suture button without aggression toward the soft tissue of the ankle.

What is the quality of clinical practice guidelines for the treatment of acute lateral ankle ligament sprains in adults? A systematic review

BackgroundAcute lateral ankle ligament sprains (LALS) are a common injury seen by many different clinicians. Knowledge translation advocates that clinicians use Clinical Practice Guidelines (CPGs) to aid clinical decision making and apply evidence-based treatment. The quality and consistency of recommendations from these CPGs are currently unknown. The aims of this systematic review are to find and critically appraise CPGs for the acute treatment of LALS in adults.MethodsSeveral medical databases were searched. Two authors independently applied inclusion and exclusion criteria. The content of each CPG was critically appraised independently, by three authors, using the Appraisal of Guidelines for REsearch and Evaluation (AGREE II) instrument online version called My AGREE PLUS. Data related to recommendations for the treatment of acute LALS were abstracted independently by two reviewers.ResultsThis study found CPGs for physicians and physical therapists (Netherlands), physical therapists, athletic trainers, physicians, and nurses (USA) and nurses (Canada and Australia). Seven CPGs underwent a full AGREE II critical appraisal. None of the CPGs scored highly in all domains. The lowest domain score was for domain 5, applicability (discussion of facilitators and barriers to application, provides advice for practical use, consideration of resource implications, and monitoring/auditing criteria) achieving an exceptionally low joint total score of 9% for all CPGs. The five most recent CPGs scored a zero for applicability. Other areas of weakness were in rigour of development and editorial independence.ConclusionsThe overall quality of the existing LALS CPGs is poor and majority are out of date. The interpretation of the evidence between the CPG development groups is clearly not consistent. Lack of consistent methodology of CPGs is a barrier to implementation.Systematic reviewSystematic review registered with PROSPERO (CRD42015025478).

Foot and Ankle Injuries in Soccer.

The ankle is one of the most commonly injured joints in soccer and represents a significant cost to the healthcare system. The ligaments that stabilize the ankle joint determine its biomechanics-alterations of which result from various soccer-related injuries. Acute sprains are among the most common injury in soccer players and are generally treated conservatively, with emphasis placed on secondary prevention to reduce the risk for future sprains and progression to chronic ankle instability. Repetitive ankle injuries in soccer players may cause chronic ankle instability, which includes both mechanical ligamentous laxity and functional changes. Chronic ankle pathology often requires surgery to repair ligamentous damage and remove soft-tissue or osseous impingement. Proper initial treatment, rehabilitation, and secondary prevention of ankle injuries can limit the amount of time lost from play and avoid negative long-term sequelae (eg, osteochondral lesions, arthritis). On the other hand, high ankle sprains portend a poorer prognosis and a longer recovery. These injuries will typically require surgical stabilization. Impingement-like syndromes of the ankle can undergo an initial trial of conservative treatment; when this fails, however, soccer players respond favorably to arthroscopic debridement of the lesions causing impingement. Finally, other pathologies (eg, stress fractures) are highly encouraged to be treated with surgical stabilization in elite soccer players.

Indications of Lateral Ankle Ligament Reconstruction with a Free Tendon and Associated Evidence

Ankle sprain is one of the most common musculoskeletal injuries. Although most ankle sprains respond well to conservative measures, chronic instability following an acute sprain has been reported to occur in 20% to 40% of patients. Some individuals are eventually indicated for a lateral ankle ligament reconstruction due to persistent ankle instability. More than 80 surgical procedures have been described to address lateral ankle stability. These range from direct repair of the anterior talofibular ligament (ATFL) and of the calcaneofibular ligament (CFL) to reconstructions based on the use of autograft or allograft tissues. However, the best surgical option remains debatable. The modified Broström procedure is most widely used for direct ligament repair, but not always possible because of the poor ATFL or CFL quality or deficiency of these ligaments, which prevents effective shortening imbrication. Furthermore, the importance of a CFL reconstruction has been emphasized recently. On the other hand, it is difficult to achieve an efficient CFL reconstruction during the Broström procedure. Others have reported that an anatomic reconstruction of injured ligaments restores the normal resistance to anterior translation and inversion without restricting subtalar or ankle motion, and as a result, anatomic reconstructions for lateral ankle instability utilizing an autograft or allograft tendon have gained popularity.