Ankle Instability In Athletes Research Articles

Restoring stability and proprioception: the use of postural re-education and proprioceptive exercises for chronic ankle instability in athletes

Restoring stability and proprioception: the use of postural re-education and proprioceptive exercises for chronic ankle instability in athletes

Magnetic Resonance Imaging Characteristics of a Lateral Ligament Injury in Acute Ankle Sprains Among Athletes

Background: It is important to identify the location and pattern of lateral ligament injuries that are related to the development and prognosis of chronic ankle instability in athletes with ankle sprains. Purpose: To describe the location and pattern of lateral ligament injuries on magnetic resonance imaging (MRI) in elite-level or amateur athletes with acute ankle sprains and to further assess the risk of associated concomitant injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) of 110 athletes with an ankle lateral ligament injury (mean age, 24.7 years) were evaluated. MRI scans were evaluated for the location and pattern of ATFL and CFL tears such as sleeve avulsions as well as concomitant deltoid ligament injuries, bone contusions, and osteochondral lesions of the talus (OLTs). Results: On MRI, 52 (47.3%) athletes had an isolated ATFL tear, 56 (50.9%) athletes had both ATFL and CFL tears, and 2 (1.8%) athletes had an isolated CFL tear. ATFL injuries occurred at the fibula, midsubstance, and talus in approximately equal numbers, whereas the majority of CFL injuries occurred at the calcaneal insertion. Concomitant deltoid ligament injuries were identified in 18 (16.4%) athletes. In addition, concomitant bone contusions and OLTs were identified in 38 (34.5%) and 6 (5.5%) athletes, respectively. Using linear-by-linear analysis, CFL injuries correlated with concomitant deltoid ligament and bone injuries ( P = .023 and P = .001, respectively) and a sleeve injury pattern ( P = .005). Conclusion: After an acute ankle ligament rupture, almost all athletes involved in this study had injured their ATFL, and approximately 50% had a concomitant injury to the CFL. The rate of sleeve-type CFL injuries at the calcaneal insertion was high, and concomitant deltoid ligament injuries and OLTs were associated with this pattern of injury.

Kinesiophobia, self-reported ankle function, and sex are associated with perceived ankle instability in college club sports athletes with chronic ankle instability

ObjectiveTo investigate the association between sex, self-reported ankle function, pain intensity, kinesiophobia, and perceived ankle instability in athletes with chronic ankle instability (CAI). DesignCross-Sectional Study. SettingUniversity. ParticipantsCollege club sports athletes with CAI (n = 42). Main outcome measuresRelationships with the Cumberland Ankle Instability Tool (CAIT) score and the Tampa Scale for Kinesiophobia-11 (TSK-11), the Foot and Ankle Ability Measure (FAAM), sex (0: male, 1: female), and ankle pain intensity by the Numeric Rating Scale were explored with multiple regression analysis. ResultsThe regression model explained 50.3% of the variance of the CAIT score (P < 0.001), and the TSK-11 score (B = −0.382, P = 0.002), the FAAM sports subscale score (B = 0.122, P = 0.038), and sex (B = −2.646, P = 0.031) were significant independent variables for the CAIT score (P < 0.001), while pain intensity was not significant (B = −0.182, P = 0.504). These results indicated that higher TSK-11 score, lower FAAM sports subscale score, and being female were related to lower CAIT score. ConclusionsKinesiophobia related to perceived instability along with self-reported function and sex in athletes with CAI. Clinicians should assess the psychological aspects of athletes with CAI.

EFFECT OF BALANCE TRAINING ON ATHLETES WITH FUNCTIONAL ANKLE INSTABILITY OF ANKLE JOINT

Introduction: The ankle is an amazing structure because it helps transfer vertical to horizontal weight bearing and rarely deteriorates over the course of a life time.This study aims to find out the prevalence of functional ankle instability in athletes and to determine the effect of posturography training on balance in athletes with functional ankle joint instability. Material and Methods: This study was conducted in two phases. In the first phase after obtaining the informed consent, a descriptive study was conducted among 453 students from the Department of Physical Education and were included in the study to determine the prevalence of functional ankle instability (FAI). The study participants were distributed with Modified Ankle Instability Instrument questionnaire with brief explanation about the questionnaire and the prevalence of FAI was studied. Modified ankle instability instrument has high reliability,feasible and has appropriate way to obtain information on the presence of instability symptoms.21It contains 11 yes/no type questions.9 questions focus on ankle injury,last 2 questions focus on knee for exclusion purpose.12 questionnaires were found to be incomplete and the remaining 441 completed questionnaires were taken for data analysis.Among the 441 questionnaires,207 was excluded as they have knee and leg injuries.With the remaining 234, 43 athletes have FAI with the prevalence of 18.4%.From them, 39 athletes entered phase II and were given balance training using a commercially available device, Posturograph-the Biodex Balance Stability System (BSS) (Biodex, Inc., Shirley, New York). Results: The prevalence of FAI was 18.4% in the present study.The most common age group of the present study was 21-25 years(52.2%). Male participants (58.5%) were outnumbered female participants(41.5%). Most of the athletes had normal BMI.Underweight population was 20.4% and overweight was 5.9%. The common events participated by the athletes of the present study were football (25.85%),basketball (14.51%) and volley ball (12.24%).Of the total 441 participants ,207 (46.9%) had associated knee and leg injuries and hence was not taken for analysis.There is no association found between FAI in relation to gender game - wise as demonstrated in the above table.There was significant association observed between FAI and BMI for football and hockey players ( = 6.195, p =0.045).There is significant difference in anterior reach distance,posteromedial and posterolateral reach distance between affected and normal ankle at baseline (p &lt;0.05) Conclusion: The present study results showed that balance training with posturograph effectively improved the functional ankle instability in athletes and also enhances the stability of the normal ankle. In addition, the balance training may increase patients interest and participation rate in treatment more than existing therapy methods.

Functional Tests for Ankle Instability Assessment in Athletes: A Review of Literature

Background and Aims: Ankle joint injuries and lateral sprains are the most common sports injuries. Understanding this injury through functional tests can reduce the risk of recurrence, and athlete's medical expenses reduce keeping athletes away from sports fields and smooth out the way of rehabilitation and return to exercise. This study aimed to collect functional tests that identify the ankle instability and the overall summary of these tests. Methods: In this study, comprehensive search to identify articles and studies conducted on functional tests for ankle instability PEDRO, PubMed, MEDLINE, Web of Science, Science Direct, Cochrane Central Register of Controlled Clinical Trials, Google Scholar, and Scopus based in the period 1994 to 2020 took place. In addition, a manual search and comprehensive review of article sources were conducted. Results: Out of 49 different tests that studied the functional tests for ankle instability, 23 articles were selected, and their results were reported. 25 performance-related tests, 7 postural control system tests, 10 self-report tests, and 7 scoring system tests were identified for ankle function evaluation. Conclusion: An analysis of studies showed that 4 different testing tools had been used in the literature to evaluate functional ankle instability in athletes. The present study identifies and explains how these tests are applied. Therefore, it performs an elaborated analysis of the 4 existing tests to see which one offers a more accurate analysis of functional ankle instability in athletes.

Evolution in Surgical Management of Ankle Instability in Athletes.

Recent concepts are changing the management of ankle instability. These include concurrent medial and lateral instabilities, use of ankle arthroscopy, use of suture anchors, all-arthroscopic stabilization, synthetic augmentation, and early postoperative rehabilitation. Medial sided injuries occur in up to 72% of the lateral ankle sprains, and concomitant repair may provide greater stability. Suture anchors are equally as strong as transosseous tunnels, and the technique is simple, reproducible, and may decrease complications, but anchors do increase costs. Synthetic augmentation demonstrates greater strength than Broström alone in cadaver-based biomechanical testing. Although clinical studies of synthetic augmentation have demonstrated equivocal stability and pain compared with Broström alone, synthetic augmentation may expedite rehabilitation. All-arthroscopic ankle stabilization is gaining popularity with increasing publications. Early findings demonstrate comparable biomechanical and clinical data compared with open techniques. Early postoperative weight-bearing within 2 weeks seems to be safe and may shorten time to return to play. Surgeons may consider using these novel techniques in the management of lateral ankle instability.

The Time of Return to Play after Surgery for Chronic Lateral Ankle Instability in Athletes: A Systematic Review

Purpose The study aimed to assess the average time to return to play following surgery for chronic lateral ankle instability in athletes. Methods A literature search was conducted (1976 to 2019) by two independent reviewers using the Medline, Embase, and Cochrane library databases. Articles were retrieved by an electronic search using individual keywords (“lateral ankle instability,” “surgery,” “operation,” “return to sport,” “return to play”) and their combinations. Studies that met the inclusion criteria were assessed for pertinent data. Results Six randomized controlled trials were included in this analysis. The mean follow-up period was 44.8 months (range, 31.8–58.1 months) in 219 patients (male, 126; female, 113). The mean age was 23.2 years (range, 18.2–28.2 years). Different criteria for returning to sports were used in each paper. In the papers included in this study, different methods and definitions were used for the postoperative recovery method for lateral ankle instability injury. The average time until return to play was 16.53 weeks. Conclusion There are limitations to the application of different surgical techniques and data from different athletes for chronic lateral ankle instability. However, these results suggest that sports physicians evaluate the surgical outcome and may be utilized as reference data for informing the athletes about their time until return.

Surgical Management of Lateral Ankle Instability in Athletes.

Ankle sprains are common injuries involving the lateral ankle ligaments and affect athletes of all levels. Most patients heal uneventfully, but those with symptoms persisting past 3 months should be evaluated for chronic ankle instability and its associated conditions as well as for the presence of varus malalignment. Chronic ankle instability is initially treated nonoperatively, with surgical management reserved for those who have failed to improve after 3 to 6 months of bracing and functional rehabilitation. Anatomic repair using a modification of the Broström procedure is the preferred technique for initial surgery. Anatomic reconstruction with tendon graft should be considered when repair is not possible, as it maintains physiological joint kinematics. Nonanatomic reconstructions are seldom indicated. Arthroscopic repair or reconstruction of the lateral ankle ligaments is a promising new technique with results similar to those of open surgery.

Return to Play Following Arthroscopic vs. Open Treatment of Lateral Ankle Instability in Recreational/Athletic

Background: Ankle sprains are very common injuries among athletic populations. Sparse data exists regarding return to play (RTP) following common lateral ligament repairs. Our purpose is to compare RTP timelines and outcomes between open and arthroscopic treatment of lateral ankle instability in athletes.Methods: In this systematic review, MEDLINE and EMBASE searches were performed to identify available literature through November 2017 describing open and/or arthroscopic treatment of lateral ankle instability in athletes, their outcomes, and a RTP timeline.Results: A total of ten studies met criteria. 174 athletes were treated with open ankle instability procedures (9 studies) and 19 athletes were treated with arthroscopic procedures (1 study). 167/174 patients with open treatment returned to sport (96% RTP rate, weighted mean RTP timeline of 2.85 months). In comparison, all 19 patients in the arthroscopic group returned to sport (100% RTP rate, weighted mean RTP timeline of 3.794 months).Conclusion: Very few articles describing outcomes of lateral ligament repair in athletes include return to play metrics. Considering the data available, athletes treated with open ankle ligament repair procedures (nine studies with 167 athletes) returned to play almost 1 month earlier than athletes treated with arthroscopic procedures (1 study with 19 athletes). As timing of return to activities is a valuable metric to compare surgical and rehabilitative techniques, more studies that detail return to sport are needed as part of a description of ankle ligament repairs.

Effects of 6 Weeks of Balance Training on Chronic Ankle Instability in Athletes: A Randomized Controlled Trial.

The objective of the present study was to determine the effectiveness of a 6-week balance training program on patients with Chronic Ankle Instability (CAI) in relation to the results obtained in Dynamic Balance, subjective feeling of instability and pain using a single-blind randomized controlled trial. 70 athletes were randomly assigned to control or intervention group. The control group performed their usual training, and the intervention group was administered the same usual activity in addition to a balance program. The paired t-test was performed to evaluate the change scores in each group. The t-test for independent samples was performed to evaluate between-group differences in change scores. Significance level was assigned for p-values less than 0.05 for all analyses. There were significant differences between groups in change scores in CAIT and all of the SEBTs reach distances (p<0.001) but not in Pain (p=0.586). The effect sizes were larger for the outcomes measures that showed significant differences. In the within-group change, the experimental groups showed larger effect sizes in CAIT, SEBT posteromedial and SEBT posterolateral, and moderate effect sizes in SEBT anterior. Exercise therapy training based on multi-station balance tasks led to significant improvements in dynamic balance and self-reported sensation of instability in patients with CAI.

Functional Evaluation after Modified Brostrom Procedure with Suture Bridge Technique for Chronic Ankle Instability in Athletes

Functional Evaluation after Modified Brostrom Procedure with Suture Bridge Technique for Chronic Ankle Instability in Athletes

Foot &amp; ankle

The February 2013 Foot &amp; Ankle Roundup360 looks at: replacement in osteonecrosis of the talus; ankle instability in athletes; long-term follow-up of lateral ankle ligament reconstruction; an operation for Stage II TPD; whether you should operate on Achilles tendon ruptures; Weil osteotomies and Freiberg’s disease; MRI scanning not sensitive for intra-articular lesions; and single-stage debridement and reconstruction in Charcot feet.

Modified Watson-Jones technique for chronic lateral ankle instability in athletes: Clinical and radiological mid- to long-term follow-up

We clinically and radiologically assessed mid- to long-term follow-up of a group of patients treated with a modified Watson-Jones technique for chronic ankle instability. Fourteen athletes were retrospectively evaluated with physical examination, and Tegner, Good and AOFAS scales; moreover, a 2-view stress, side-to-side X-ray, was performed. All patients were followed-up at a mean of 10.8 years. No one reported further ankle sprains. Mean Good scale value decreased from 3.7 to 1.6, while the Tegner scale decreased from 6.8 to 5.1; the mean AOFAS score was 92.2. Mean sagittal-plane ROM was 62.3° (4.9° S/S difference), while mean coronal-plane ROM was 25.5° (3.8° S/S difference). Mean X-ray talar tilt angle was 4.5° (0.1° S/S difference), while mean anterior drawer test angle was 5.4 mm (0.5 mm S/S difference). The modified Watson-Jones procedure seems to be a reliable technique in providing satisfactory mid- to long-term clinical and radiological results.

Clinical Results and Functional Evaluation of the Chrisman-Snook Procedure for Lateral Ankle Instability in Athletes

There is no consensus regarding optimum surgical treatment for chronic ankle instability. The purpose of this study is to describe a variation of the Chrisman-Snook lateral ligament reconstruction that the senior author uses in patients with chronic ankle instability recalcitrant to conservative management. All patients who underwent reconstruction from 1997 to 2006 were identified, and those with a minimum 2-year follow-up were included, representing a total of 44 ankles in 43 patients. All underwent clinical evaluation and completion of the Foot and Ankle Outcome Survey and the Kaikkonen Scale. At mean follow-up of 4.4 years, mean dorsiflexion loss was 2° compared with the nonoperative side. The postoperative mean Foot and Ankle Outcome Survey score was 74 ± 16 (range, 36-98), while the mean Kaikkonen total score was 77 ± 14 (range, 40-95). Thirty-eight patients (84.6%) were satisfied with their result. Six patients (13.6%) underwent reoperation, including 4 with peroneal tendon scarring requiring tenolysis. Return to sport was achieved in 28 of 35 patients (80%) at a median of 6 months postoperatively. It is concluded that dorsiflexion loss can be minimized and return to sport expected in most patients following this variation of the Chrisman-Snook reconstruction.

Analysis of Running Biomechanics in Subjects with Ankle Instability

Ankle instability (AI) is the term that is commonly used to denote the occurrence of episodes of ankle “giving way” following an initial ankle sprain. Recently contributions of foot biomechanics to the development of this pathology have been reported, without definitive conclusions. Because of the complexity of the foot/ankle region one would intuitively expect to find differences in biomechanical measurements between uninjured and injured populations. PURPOSE: To determine if differences in ankle joint mechanics existed between athletes with self-reported AI and athletes that sustained a single inversion ankle sprain yet had not developed signs of AI. METHODS: Three-dimensional kinetic and kinematic analysis of straight-ahead running (self-selected speed) was performed using a modified Helen-Hayes marker set on the lower limbs of 8 NCAA Division I-AA football players. The subjects were equally divided into two groups (AI [age: 23±5 yrs., ht.: 185±10 cm, mass: 112±15 kg vs. no AI [age: 20±2yrs., ht.: 186±7 cm, mass: 109±27 kg]). Ankle instability status was derived through the use of a self-reported questionnaire. Ten high-speed cameras operating at 120 Hz and 2 force plates operating at 960 Hz were utilized for data collection. A fully-automated, three-dimensional gait measurement system was used for data acquisition. All kinetic data were normalized for body mass. Comparisons of ankle joint kinetics and kinematics were made using independent samples t-tests (P <0.05). RESULTS: Time to maximal dorsiflexion angle was significantly smaller (P = .02) in the AI group (18.1 ± 2.0°) vs. noAI(22.8±3.0°). Although not significantly different (P = 0.06), time to maximal ankle power was less in the AI group (24.2 ±2.0 ms) vs. the no AI group (29.4 ± 4.0 ms). Additionally, maximal power during the support phase was higher in the AI subjects (3.6 ± 6.0 W) vs. the no AI subjects (2.7 ± 5.0 W), but was not significant (P = 0.07). CONCLUSIONS: The increased joint velocity at which the AI subjects move into dorsiflexion is intriguing and may signal an attempt by them to place the ankle joint in a more stable position earlier in the support phase. Although not significant, the increased power and reduced time to maximal power during the support phase of running suggests that the AI subjects may be utilizing a quick stretch of the posterior calf musculature to facilitate a more powerful contraction for torque generation. Even though this preliminary study reports using a small sample size, the data does provide an interesting look at the running biomechanics associated with AI in athletes.

Surgical treatment of ankle instability in athletes.

Eighteen athletes with symptoms of recurrent sprain and instability of the ankle during activity were treated by reconstructing the lateral ligament by the Evans technique. Before the operation 55 per cent had given up all athletic activities because of pain, swelling or instability, and 17 per cent had restricted their activities. The average age at operation was 24.6 years and the average follow-up period 3.1 years. Normal stability was achieved in 67 per cent and improved stability in 11 per cent, but only 33 per cent were still engaged in athletic activities without any complaints from the ankle. The results are similar to other methods of surgical repair.