Chronic Ankle Instability Research Articles

Decreased proprioception is associated with inferior postural control during unplanned landing in individuals with chronic ankle instability

ABSTRACT Poor postural control during jump landing may increase ankle sprain incidences among people with chronic ankle instability (CAI). The effects of anticipation on it and its relationship with proprioception need further examination. Fifteen participants with CAI and 15 healthy controls were recruited to perform single-leg jump landings when knowing the landing side before (planned) or after (unplanned) take-off respectively, along with a step-down proprioception test differentiating four inclination platforms (inverted 12°, 14°, 16° and 18°). Ground reaction force data (peak force, loading rate and time of stabilisation) during landings and proprioception scores were collected and analysed. The CAI group exhibited a higher loading rate (59.6 ± 7.6 vs 49.4 ± 6.7 N/kg*seconds, p = 0.011) and longer medial-lateral time to stabilisation (4.82 ± 0.69 vs 4.11 ± 0.47 seconds, p = 0.023) compared to the control group during an unplanned landing. Furthermore, the above variables were negatively correlated with the step-down proprioception score only in the unplanned condition but not in the planned condition. CAI participants had inferior medial-lateral time-to-stabilisation and loading attenuation during unplanned jump landing than healthy controls, which were associated with decreased proprioception, highlighting the importance of addressing proprioception to improve balance control during unpredictable landing situations.

All-Inside Endoscopic Classic Bröstrom-Gould Technique: Medium-term Results.

Short-term results after arthroscopic/endoscopic lateral ligament repair for chronic lateral ankle instability have been satisfactory, although medium- to longer-term results are lacking. The purpose of this study was to report the medium-term results of an all-inside endoscopic classic Bröstrom-Gould procedure where both the both lateral ligaments and the inferior extensor retinaculum can be approached directly, interchanging between arthroscopy for intracapsular structures and endoscopy for extracapsular structures. It was hypothesized that the all-inside endoscopic classic Bröstrom-Gould procedure would produce sustainable good outcomes at a medium term of 5 years. Case series; Level of evidence, 4. A prospective database for 43 patients who underwent an all-inside endoscopic classic Bröstrom-Gould repair of the anterior talofibular ligament and calcaneofibular ligament with inferior extensor retinaculum augmentation was reviewed. Patient details, American Orthopaedic Foot & Ankle Society score, Karlsson score, ankle activity score (AAS), and patient satisfaction were collected and analyzed. The study cohort of 43 patients with a mean age of 29.4 years (SD, 11.9 years) were reviewed at a mean follow-up of 63.1 months (SD, 8.5 months). The American Orthopaedic Foot & Ankle Society scores showed significant improvement from a mean of 69.6 (SD, 13.9) to 93.7 (SD, 10.7), while the Karlsson score improved from 59.7 (SD, 14.5) to 91.5 (SD, 14.5) at the final follow-up. The AAS showed that 32 (74.4%) patients maintained or had improvement in the AAS, from a mean of 5.38 (SD, 2.8) to 5.41 (SD, 2.8), with a mean satisfaction rate of 9.1 (SD, 1.3). Although the remaining 11 patients had a reduced AAS, at a mean of 4.6 (SD, 2.6), they reported a mean satisfaction rate of 7.4 (SD, 2.9). There were no surgical complications or reoperations reported in this cohort, although there were 3 patients with recurrent instability at their last follow-up, resulting in a failure rate of 7%. The current study is the first to report the medium-term outcomes of an all-inside endoscopic classic Bröstrom-Gould procedure. Overall, 93% of the patients had good functional outcomes, but approximately 25% of patients had decreased ankle activity levels at a mean of 5 years postoperatively, albeit with good satisfaction rates.

Exploring low- and high-order functional connectivity in chronic ankle instability through resting-state fMRI.

The functional connectivity (FC) has emerged as a valuable tool for comprehending the cerebral operational mechanism. Understanding the FC changes in patients with chronic ankle instability (CAI) helps reveal the underlying central nervous system mechanisms of the disease and provides clues for developing personalized treatment plans. To explore differences between low- and high-order FC in patients with CAI and healthy controls, as well as the correlation among the feature connections and clinical data. In our study, we recruited 40 patients with CAI and 42 healthy individuals who had not experienced ankle injuries. All participants underwent clinical assessments of ankle joints, collected the number of ankle sprains within the past 6 months, and performed resting-state functional magnetic resonance imaging (rs-fMRI) scans. Pearson correlation and matrix variate normal distribution (MVND) were used to construct low-order and high-order FC networks, respectively. Feature selections between groups were performed by two-sample t-tests, and a multi-kernel support vector machine (MK-SVM) was subsequently applied to combine the multiple connection patterns for the classification. Using leave-one-out cross-validation (LOOCV) to assess classification performance and identify the consensus connections contributing most to classification. FC was reduced in certain brain regions of CAI patients. More consensus connections were recognized in low-order FC network than in high-order FC network. The highest classification accuracy of 91.30% was achieved by combining three connection patterns. The most discriminating functional connections were primarily centered on the default mode network and spanned the visual network, sensorimotor network, ventral attention network, and central executive network. In addition, FC strength in the left cingulate and paracingulate gyrus (DCG.L) and right superior temporal gyrus (STG.R) was negatively correlated with the number of ankle sprains in the past 6 months in all FC networks (p<0.05). Abnormalities in connectivity in patients with CAI were observed in both low- and high-order FC networks. The adaptive changes in the brain related to CAI may extend beyond the sensorimotor networks, primarily involving higher-level default mode networks associated with attention. Moreover, the FC strength between DCG.L and STG.R may predict the risk of ankle re-sprains and help clinicians develop personalized treatment plans.

Impact of chronic ankle instability on gait loading strategy in individuals with chronic ankle instability: a comparative study

BackgroundLateral ankle sprains rank among the most prevalent musculoskeletal injuries, while chronic ankle instability (CAI) is its most common cascade. In addition to the conflicting results of the previous studies and their methodological flaws, the specific gait loading strategy is still not well studied.PurposeThe study aimed to investigate the fluctuations in gait loading strategy in people with chronic ankle instability compared to health control.MethodsA total of 56 male subjects participated in this study and were allocated into two groups: (A) CAI group: 28 subjects with unilateral CAI (age 24.79 ± 2.64 and BMI 26.25 ± 3.50); and (B) control group: 28 subjects without a history of ankle sprains (age 24.57 ± 1.17 and BMI 26.46 ± 2.597). Stance time, weight acceptance time, and load distribution were measured to investigate gait loading strategy.ResultsThe study findings revealed that the CAI group had a significant higher load over the lateral rearfoot. However, MANOVA indicates that there was no overall significant difference in gait loading strategy between the CAI and control groups. Furthermore, in terms of stance time, time of weight acceptance phase, load over medial foot, and load over lateral foot, CAI and healthy controls seemed to walk similarly.ConclusionsThe findings revealed that individuals with CAI had the significant alteration in the lateral rearfoot loading, suggesting a potential compensatory mechanism to address instability during the weight acceptance phase. This could manifest a laterally deviated center of pressure and increased frontal plane inversion during the early stance phase. However, it is acknowledged that these alterations could be both the result and the origin of CAI. The study highlights the vulnerability of CAI during the early stance phase, emphasizing the need for gait reeducation as individuals return to walking as healthcare clinicians should focus on treatment modalities aimed at reducing rearfoot inversion in individuals with CAI.

Epidemiology of ankle sprain and chronic ankle instability in elite adolescent dancesport athletes

ABSTRACT Background Dancesport is performed in high-heeled shoes. Dancesport athletes may have a higher prevalence and incidence of ankle sprains, which can affect their performance. However, the occurrence of ankle sprains among dancesport athletes remains unclear. This study aimed to determine the prevalence and incidence of ankle sprains among elite dancesport athletes and to investigate the related information. Method We conducted a mixed descriptive epidemiological study (cross-sectional and longitudinal) involving 198 elite adolescent dancesport athletes, using past medical records and questionnaires administered to the participants. Data on the occurrence of ankle sprains among all participants were compiled using medical records and information on injury mechanisms, missed days, severity types, and countermeasures for ankle sprains were collected. The prevalence of chronic ankle instability (CAI) among the participants was assessed using a questionnaire. Following the initial survey, we conducted a one-year follow-up study to investigate the incidence of ankle sprains, incidence rate per 1000 exposure hours, and recurrence of ankle sprains. Result The cross-sectional study and longitudinal study included 198 participants and 92 elite dancesport athletes, respectively. The prevalence of ankle sprains and CAI was 49.5% and 45.1%, respectively. Of all ankle sprains, 88% were medial injuries. The most common injury mechanisms were turning (46.9%) and jumping (46.9%). The average number of missed days due to ankle sprains was 11.2 days. Most injuries were managed with rest, and only one male athlete underwent surgery due to an ankle sprain sustained during dancing. During the one-year follow-up, the incidence of ankle sprains, incidence rate per 1000 exposure hours, and recurrence rate of ankle sprains were 46.6% (male, 41.2%; female, 48.8%), 0.65 ankle sprains/1000 h, and 35.3%, respectively. No sex-related differences were observed. Conclusion It is crucial to focus on the occurrence of ankle sprains and CAI in dancesport athletes with high heels. Future research should clarify the impact of ankle sprains on dancesport performance and develop preventive measures to reduce the incidence and recurrence of these associated injuries.

Rebuilding Stability: Exploring the Best Rehabilitation Methods for Chronic Ankle Instability.

Background: Chronic Ankle Instability (CAI) is a common condition characterized by repeated episodes of ankle "giving way" and impaired balance, leading to functional limitations. Various rehabilitation techniques, including balance training, proprioceptive exercises, whole-body vibration (WBV), and novel approaches like stroboscopic vision, are used to address these deficits. This review evaluates the effectiveness of different rehabilitation interventions for CAI management. Methods: A review was conducted by analyzing 11 randomized controlled trials that investigated the impact of balance and proprioceptive training programs on CAI. The primary outcomes assessed were the Star Excursion Balance Test (SEBT), Cumberland Ankle Instability Tool (CAIT), and Foot and Ankle Ability Measure (FAAM). Methodological quality was assessed using the PEDro scale, and the risk of bias was evaluated with the ROB 2 tool. Results: All rehabilitation interventions demonstrated significant improvements in SEBT, CAIT, and FAAM scores. However, no single intervention was found to be consistently superior. Traditional balance training, strength exercises, BAPS, and WBV all provided meaningful functional gains. Stroboscopic vision training showed similar effectiveness compared to conventional approaches. The evidence supports a combination of balance and strength training for optimal recovery. Conclusions: Balance and proprioceptive exercises are effective in managing CAI, with improvements in both dynamic stability and subjective outcomes. No intervention stands out as the best, but personalized programs incorporating various methods are recommended. Future research should explore the long-term effects and potential synergies of combined interventions.

Chronic ankle instability: a cadaveric anatomical and 3D high-resolution MRI study for surgical reconstruction procedures

ObjectivesTo quantitatively investigate the anatomy of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) for surgical reconstruction procedures in chronic ankle instability (CAI).Methods3D MRI was performed on five fresh-frozen cadaveric ankles using six different spatial resolutions (0.3 × 0.3 × 0.3 mm3, 0.45 × 0.45 × 0.45 mm3, 0.6 × 0.6 × 0.6 mm3, 0.75 × 0.75 × 0.75 mm3, 0.9 × 0.9 × 0.9 mm3, 1.05 × 1.05 × 1.05 mm3). After comparing the MRI results with cadaver dissection, a resolution of 0.45 × 0.45 × 0.45 mm³ was selected for bilateral ankles MRI on 24 volunteers. Classification of the ATFL and four distances of surgically relevant bony landmarkers were analyzed (distance 1 and 3, the fibular origin of the ATFL and CFL to the tip of fibula, respectively; distance 2, the talar insertion of the ATFL to the bare zone of talus; distance 4, the calcaneal insertion of the CFL to the peroneal tubercle).ResultsIn subjective evaluation, the interobserver ICC was 0.95 (95% confidence interval (CI): 0.94–0.97) between two readers. The spatial resolution of 0.3 × 0.3 × 0.3 mm3 and 0.45 × 0.45 × 0.45 mm3 received highest subjective score on average and demonstrated highest consistency with autopsy measurements in objective evaluation. Measurements on the 48 volunteer ankles, distance 1 in type I and II were 12.65 ± 2.08 mm, 13.43 ± 2.06 mm (superior-banded in Type II) and 7.69 ± 2.56 mm (inferior-banded in Type II) (means ± SD), respectively. Distance 2 in type I and II were 10.90 ± 2.24 mm, 11.07 ± 2.66 mm (superior-banded in Type II), and 18.44 ± 3.28 mm (inferior-banded in Type II), respectively. Distance 3 and 4 were 4.71 ± 1.04 mm and 14.35 ± 2.22 mm, respectively.ConclusionWe demonstrated the feasibility of quantifying the distances between bony landmarkers for surgical reconstruction surgery in CAI using high-resolution 3D MRI.Critical relevance statementHigh-resolution 3D MRI examination may have a guiding effect on the preoperative evaluation of chronic ankle instability patients.Key PointsSpatial resolutions of 0.3 × 0.3 × 0.3 mm3 and 0.45 × 0.45 × 0.45 mm3 demonstrated highest consistency with autopsy measurements.The spatial resolution of 0.45 × 0.45 × 0.45 mm3 was conformed more to clinical needs.3D MRI can assist surgeons in developing preoperative plans for chronic ankle instability.Graphical

Application of blood flow restriction training in lower limb rehabilitation

With the popularity of national fitness campaigns, sports injuries, especially lower limb injuries such as anterior cruciate ligament tears and ankle sprains, are increasing year by year. There are limitations in traditional treatment such as muscle atrophy. In recent years, the blood flow restriction training method (BFRT) which simulates high-intensity exercise with low intensity and limits arterial and venous blood flow to promote muscle growth and strength enhancement, has drawn attention as a novel approach to rehabilitation. This article reviews the application of BFRT in the rehabilitation of lower limb injuries, discusses its effects on muscle function, pain management and quality of life, and evaluates its safety and prospects for clinical application. BFRT reduces mechanical stress, relieves pain, improves endurance and aerobic capacity, and improves cardiovascular function. However, there are discomfort and potential risks, such as muscle injury and thrombosis, which require individualised adjustments and standardised training. BFRT has shown positive result(reducing pain &amp;oedema and improving function)s in rehabilitation of ACL reconstruction (ACLR) and chronic ankle instability (CAI). In addition, BFRT has been shown to aid in the functional recovery of the lower extremity in patients with Achilles tendon injuries and strokes. Despite the positive effects of BFRT, relevant studies have problems such as small sample sizes and non-uniform parameters. BFRT is considered a safe training modality, but contraindications should be examined before clinical application. Future research endeavours should investigate the impact of BFRT in many rehabilitation contexts and enhance tailored rehabilitation strategies. In order to maximize the therapeutic benefit, a rehabilitation training program should be developed and refined with a minimum effective dose based on the quantification of the in vivo physiological response to BFRT. The identification of the optimal prognostic approach will help to advance the standardisation of BFR treatment methods.

Plantar massage or ankle mobilization do not alter gait biomechanics in those with chronic ankle instability: a randomized controlled trial

ABSTRACT Objectives Chronic ankle instability (CAI) is characterized by persistent neuromechanical impairments following an initial lateral ankle sprain. Ankle joint mobilization and plantar massage have improved the range of motion and static postural control in those with CAI. This study aimed to determine the impact of two-week joint mobilization and plantar massage interventions on gait kinematics and kinetics in individuals with CAI. Methods A single-blind randomized trial was conducted with 60 participants with CAI, randomized into three groups: joint mobilization (n = 20), plantar massage (n = 20), and control (n = 20). The two treatment groups received six 5-min sessions manual therapy over a 2-week, while the control group received no intervention. Gait biomechanics were assessed on an instrumented treadmill before and after the intervention using 3D kinematics and kinetics analysis. Analyses compared biomechanical outcomes from each treatment group to the control group individually using a 1-dimensional statistical parametric mapping. The alpha level was set at p < 0.05. Results Eighteen participants per group were part of the final analysis. No significant main or interactions effects were found for ankle sagittal or frontal plane positions following either intervention (p > 0.05 for all comparisons). COP location relative to the lateral border of the foot also did not change (p > 0.05). Conclusion The findings suggest that two-week joint mobilization and plantar massage interventions do not significantly alter gait biomechanics in individuals with CAI. These results support the need for gait-specific interventions to modify biomechanics in this population.

Modified Broström vs Suture Tape Augmentation: A Systematic Review

Ankle sprains are common musculoskeletal injuries which can develop into residual chronic lateral ankle instability. When non-surgical treatments fail, surgical intervention is often indicated. We performed a systematic review of the literature comparing outcome measures of modified Broström repair to suture tape augmentation for lateral ankle stabilization. All studies available in PubMed up to July 2023 were screened. Three randomized controlled trials involving 235 patients met inclusion criteria. All the studies reported on Foot and Ankle Ability Measure, two of the three studies found higher postoperative Sports Activity scores in the suture tape group. Two of the studies reported Foot and Ankle Outcome Score, neither were found to be significantly different. The third study analyzed return to pre-injury level of activity between the two surgical techniques and found a faster return to activity for suture tape compared to modified Broström procedure. Overall, outcome measures show no significant difference between modified Broström and suture tape augmentation.

Clinical Outcomes of a Minimally Invasive Percutaneous Brostrom Technique without Arthroscopic Assistance.

Surgical management of chronic lateral ankle instability has traditionally been performed using an open technique. Arthroscopic-assisted and all-arthroscopic techniques have gained popularity as they have achieved strong clinical outcomes. However, they rely on the surgeon's arthroscopic skills and familiarity with arthroscopic anatomy. Recently, a minimally invasive percutaneous technique without arthroscopic assistance has been developed that incorporates the benefits of arthroscopy, such as minimal soft tissue disruption, without the additional requirements of performing an arthroscopic technique. The aim of the current study is to describe the minimally invasive percutaneous technique for chronic lateral ankle instability and report on its clinical outcomes. Fifty-four consecutive patients without intra-articular ankle pathology underwent lateral ligament repair for chronic ankle instability with a percutaneous technique at a single institution by a fellowship-trained foot and ankle surgeon. Foot Function Index (FFI) score was recorded pre-operatively and post-operatively at final follow-up. All patients had a minimum follow-up of 12 months. Post-operative complications and patient satisfaction were also recorded. A significant improvement (p < 0.001) in FFI compared to pre-operative values (from 55, SD 4.1, to 10, SD 1.9) was observed. A single patient required a return to the operating room for open revision with allograft reconstruction following a fall 2.5 months post-operatively. There were no other complications including infection or nerve injury. The overall rate of satisfaction after surgery was 98.1%, with one patient dissatisfied due to excessive ankle stiffness. The described minimally invasive percutaneous Brostrom procedure is safe and effective for the treatment of chronic lateral ankle instability without intra-articular ankle pathology.

The impact of fatigue on dynamic balance in coopers athletes with chronic ankle instability

Athletes who have successfully regained high sports performance despite prior inversion injuries, and who do not have persistent symptoms, are referred to as “copers” in the literature. The aim of the study was to assess dynamic stability under fatigue in patients with chronic ankle instability in comparison to healthy controls. We conducted a case - controlled study on a group of 60 young, physically active individuals aged 29.8 ± 4.6. They were divided into 3 groups: I - unilateral ankle instability n = 14, II - bilateral ankle instability n = 15, III - no ankle instability, n = 31. All participants filled out questionnaires on the health, the FADI and FADI-S. The study protocol consisted of a dynamic stability measurements by Biodex Balance System, followed by a fatigue test, followed by the series of the same measurements. General stability index value before and value after fatigue test did not differ significantly. The differences between groups in measurements taken before fatigue test (F (2.49) = 1.59; p = 0.214; ηp2 = 0.06) and after fatigue test also proved insignificant (F (2.49) = 1.28; p = 0.286; ηp2 = 0.05). The incidence of structural ankle instability did not affect functional stability. “Copers” had efficient neural-muscular control in dynamic stabilography tests.

Correlations of Postural Stability to Proprioception, Tactile Sensation, and Strength Among People With Chronic Ankle Instability.

The static and dynamic correlations of postural stability to its three potential contributors, namely, proprioception, tactile sensation, and strength remain unclear among people with chronic ankle instability (CAI). This study aimed to compare static and dynamic postural stability, along with proprioception, tactile sensation, and strength between people with and without CAI and explore their correlations. Sixty-seven participants with CAI and 67 participants without CAI were enrolled in this study. Ankle proprioception, plantar tactile sensation, and lower limb strength were measured by a proprioception test device, a set of monofilaments, and a strength testing system, respectively. Static and dynamic postural stability were measured during standing and jump landing on a force plate and indicated by the root mean square of center of pressure and time to stability. Compared to people without CAI, people with CAI had poorer postural stability, proprioception, tactile sensation, and strength. Both groups demonstrated correlation between proprioception and static postural stability, but only people without CAI showed correlation between proprioception and dynamic postural stability. Both groups demonstrated a correlation between tactile sensation and static postural stability, but not with dynamic stability. Both groups demonstrated a correlation between strength and both static and dynamic postural stability. People with CAI had deficits in static and dynamic postural stability, proprioception, tactile sensation, and strength. Among people with CAI, proprioception, tactile sensation, and strength can help maintain static postural stability; strength can help maintain dynamic postural stability, whereas proprioception may not provide sufficient information for dynamic postural stability.

Effect of Foot Position on Ankle Muscle Activity During Wobble Board Training in Individuals With Chronic Ankle Instability

ObjectiveThe purpose of this study was to compare the effects of foot positioning on muscle activities of the peroneus longus (PL), medial gastrocnemius (MG), and tibialis anterior (TA)/PL ratio in individuals with chronic ankle instabilities (CAI) during wobble board training. MethodsThirty individuals with CAI were included, and statistical significance of PL and MG muscle activities was determined using 1-way repeated measures analysis of variance alongside TA/PL activity ratio at the university research laboratory. The participants performed the wobble board training in 3 different foot positions: medial from the centerline of the wobble board (WBT-M), middle from the centerline of the wobble board, and lateral from the centerline of the wobble board (WBT-L). Peroneus longus, MG, and TA muscle activities were measured using surface electromyography. ResultsPeroneus longus activity was significantly higher in the WBT-L position than in the other 2 positions, and it was significantly higher in the middle from the centerline of the wobble board than in the WBT-M position. Medial gastrocnemius activity was significantly greater in the WBT-L position than in the other 2 positions. Tibialis anterior/PL ratio was higher in the WBT-M position than in the other 2 positions. ConclusionThe findings of this study showed that WBT-L increased PL muscle activity by >70% of the maximal voluntary isometric contraction without increasing TA/PL ratio in individuals with CAI.

Effects Of Persistent Pain On Kinematics During Walking In Individuals With Chronic Ankle Instability

Effects Of Persistent Pain On Kinematics During Walking In Individuals With Chronic Ankle Instability

Effect of cerebellar transcranial direct current stimulation on postural control and associated neuroplastic alternations in chronic ankle instability

Effect of cerebellar transcranial direct current stimulation on postural control and associated neuroplastic alternations in chronic ankle instability

Effect Of Reduced Plantar Cutaneous Sensation On Balance Control Among People With Chronic Ankle Instability

Effect Of Reduced Plantar Cutaneous Sensation On Balance Control Among People With Chronic Ankle Instability

Sensory reweighting revealed by superior parietal lobule-based functional connectivity in chronic ankle instability

Sensory reweighting revealed by superior parietal lobule-based functional connectivity in chronic ankle instability

Comparison Of The Effects Of Different Non-surgical Treatments For The Ability Of Foot And Ankle And Dynamic Balance In Patients With Chronic Ankle Instability: A Network Meta-analysis

Comparison Of The Effects Of Different Non-surgical Treatments For The Ability Of Foot And Ankle And Dynamic Balance In Patients With Chronic Ankle Instability: A Network Meta-analysis

In chronic ankle instability, sensitized pressure pain threshold is associated with impaired ankle proprioception, poor static balance and more negative self-report

In chronic ankle instability, sensitized pressure pain threshold is associated with impaired ankle proprioception, poor static balance and more negative self-report