Chronic Ankle Sprain Research Articles

Effects of Closed-Chain Exercise Versus Neuromuscular Training on Functional Performance in Football Players with Chronic Ankle Sprain

Background: Chronic ankle sprain is a common condition among football players, leading to functional instability and reduced athletic performance. Appropriate rehabilitation strategies are crucial to restore function and prevent recurrence.Objective: To compare the effects of closed-chain exercises versus neuromuscular training on functional performance in football players with chronic ankle sprain.Methods: A randomized clinical trial was conducted with 34 football players (aged 18-35 years), divided into two groups: Group A (closed-chain exercises) and Group B (neuromuscular training), with 17 participants in each group. The interventions were administered thrice weekly for four weeks. Functional performance was assessed using single-leg balance, wobble board balance, Star Excursion Balance Test (SEBT), Y Balance Test, and validated questionnaires: IdFAI, AII, and FAAM. Data were analyzed using SPSS version 25.0, applying Wilcoxon Signed Rank and Mann-Whitney U tests.Results: Group A demonstrated significantly higher post-intervention scores in SEBT (69.59 vs. 63.59; p = 0.018) and Y Balance Test (73.35 vs. 68.88; p = 0.030) compared to Group B. Both groups showed significant within-group improvements (p < 0.05).Conclusion: Closed-chain exercises were more effective than neuromuscular training in enhancing functional performance, suggesting their priority in early rehabilitation for chronic ankle instability.

Sensor-based isometric contraction examination tool after ankle sprain injury and ankle instability

Background. Previous studies have examined the application and benefits of sensors, both in sports and health. Unfortunately, the design of sensor-based isometric contraction examination tools after ankle sprain injuries and ankle instability is still rarely carried out. Purpose. The aim of this research is to design a sensor-based isometric contraction examination tool after ankle sprain injury and ankle instability. Material and Methods. The design used is research and development involving experts, namely instrumentation physics, sports physiology, and physiotherapy to assess the suitability of the tool before field trials. The tool developed is the “Isometric Contractions Test”, which is designed in the form of a box with dimensions of 10 cm (height) x 10 cm (width) x 25 cm (length). Various electronic components are also used, such as Arduino Pro Mini, Flexi Sensors, switch buttons, and OLED LCD as digital reading output. A total of 10 participants aged 18-23 years participated voluntarily for the field trial. Participants were men and women who had experienced sub-acute or chronic ankle sprains and ankle instability. The data obtained were analyzed using the correlation method. Result. The results of this study report that this sensor-based isometric contraction examination tool is valid, reliable, effective, and practical in detecting and treating post-injury healing of ankle sprains and ankle instability. Conclusions. This tool can be used to assist physiotherapists in carrying out observations and evaluations to treat healing quickly and precisely, both in athletes and non-athletes.

Effectiveness of Non-Elastic Rigid Tape Application on Static and Dynamic Balance in Players with Chronic Inversion Ankle Sprain- A Pilot Study

Background – Chronic Repetitive Inversion Ankle Sprain is one of the common injuries that occurs in contact as well as non-contact sports especially combat and jumping sports. As this injury is directly related to the ligament, proprioceptive deficit is observed in such players. The effect of taping on functional performance is still a topic of discussion. The purpose of this pilot study is to evaluate whether players with chronic repetitive inversion ankle sprain have any functional deficit and whether taping with non-stretchable athletic tape improves speed and agility. Methods - Players playing contact sports between the age of 18-24 years were included in the study after the initial screening for chronic repetitive inversion ankle sprain using IdFAI index and history of their injury. Speed was assessed using 10-m Sprint test while Agility was assessed using T-test for Agility. Post-application of the tape, data was collected on three time-intervals, i.e. immediate post-application of tape, post-3 days and post-14 days of application of tape. Results - Collected data was analyzed using One-way ANOVA test and the result showed statistically non-significant results in speed and agility, i.e. p=0.954 & p=0.999 respectively. These results suggest that there is statistically non-significant improvement in speed and agility post-application of the tape but comparing with the means of pre-test measures, there is an improvement in speed and agility after the application of the tape.

Effectiveness of Non-Elastic Rigid Tape Application on Static and Dynamic Balance in Players with Chronic Inversion Ankle Sprain- A Pilot Study

Chronic Inversion Ankle Sprain is one of the common injuries that occurs in sports especially combat and jumping sports. As this injury is directly related to the ligament, proprioceptive deficit is observed in players with chronic inversion ankle sprain. The effect of taping on functional performance is still a topic of discussion. The need of this pilot study is to evaluate whether players with chronic inversion ankle sprain have any functional balance deficit and whether taping with non-elastic rigid tape improves static and dynamic balance. Players playing contact sports between the age of 18-24 years were included in the study after the initial screening for chronic inversion ankle sprain using a IdFAI index and history of their injury. Static balance was assessed using Sensamove Mini Balance Board and Dynamic Balance was assessed using Single Leg Hoping Course Board. Data was collected on three intervals, i.e. immediate post-application of tape, post-3 days and post-14 days of application of tape. Collected data was analyzed using One-way ANOVA test and the result showed statistically significant improvement in static and dynamic balance, i.e. p=0.048 & p=0.040 respectively. These results suggest that after immediate post-application of tape and post-3 days of the application of tape there is an improvement in static and dynamic balance while no improvement post-14 days of application of non-elastic rigid tape. Non-elastic rigid tape application significantly improves static and dynamic balance in players with chronic inversion ankle sprain.

Development of Physiotherapy Standard Operating Procedures Case of Ankle Sprain in Basketball Players

Physiotherapy is a form of health service aimed at individuals and groups as maintaining and restoring body movement functions throughout life. Ankle Sprain is a stretching or tearing that occurs due to (overstretch) trauma to the lateral ligament complex, due to inversion and plantar flexion movements that occur excessively when the foot is unable to provide perfect support on the floor/ground. A common injury to the ankle is Ankle Sprain, a sports injury that often occurs in volleyball and basketball players. To develop Standard Operating Procedures in performing physiotherapy treatment in chronic Ankle Sprain cases. This study was conducted using the research method of developing physiotherapy operational standards with this ankle sprain injury handling model starting with preliminary studies, history taking, assessment, diagnosis, intervention, and evaluation. The type of research conducted is Quantitative research using quasi experimental methods with pretest-posttest control group design. Experimental and control groups conducted an initial test. Both groups received different treatments, where the experimental group received thrust manipulation intervention and the control group received non thrust intervention in the form of myofascial release. There was a significant reduction in pain after manipulation therapy with the thrust and nonthrust methods on two groups were measured using the Numeric Rating Scale and after being evaluated for two weeks the pain did not increase. The provision of thrust and nonthrust manipulation therapy measures is highly recommended for the treatment of ankle pain. However, between the two methods there has not been. However, there is no significant difference between the two methods given the limited time of the study.

Effectiveness of Foot Intensive Exercise Training for Subjects with Chronic Ankle Sprain: Experimental Study

Background: This study was developed to determine the effectiveness of Foot Intensive Exercise Training amongsubjects with Chronic Ankle Sprain.Purpose: To determine the effect of Foot Intensive Exercise Training and Proprioception Exercise Training insubjects with Chronic Ankle Sprain.Materials and Methods: Thirty subjects with Chronic Ankle Sprain were divided randomly into two equal groups.“Foot Intensive Exercise Group” received plyometric exercises while the Control Group received proprioceptionexercises on alternate days for 6 weeks. Cumberland Ankle Instability Tool (CAIT) and Y-Balance Test were usedto evaluate subjects at two intervals (Pre-Treatment and Post-Treatment). The entire process was performed fromNovember 2022 to March 2023.Result: Statistical analysis of Cumberland Ankle Instability Tool and Y-Balance Test post values revealed constantlysignificant differences, with the p value of <0.0001.Conclusion: Foot Intensive Exercise is effective and increases functional ankle stability and decreases episodes ofgiving away in subjects with chronic ankle sprain.

Differences in abductor hallucis activity during running in individuals with chronic ankle instability and copers

BackgroundAssessment of neuromuscular dysfunction following a lateral ankle sprain during running typically focuses on the activities of the extrinsic foot muscles. Although the interaction between intrinsic and extrinsic foot muscles has been reported, there are no studies on the activities of intrinsic foot muscles in individuals with chronic ankle instability and ankle sprain copers. Research questionDo copers and individuals with chronic ankle instability (CAI) have different abductor hallucis activity? MethodsThis study included 11 controls, 11 copers, and 16 CAI participants. A wireless surface electromyography system was applied to the abductor hallucis, peroneus longus, tibialis anterior, and medial gastrocnemius muscles. Running was performed on a treadmill (speed of 3.5 m/s). The stance phase is divided into four functional phases. The muscle activities during these phases were calculated using the root mean square standardized by the root mean square during static standing with a double-leg stance. ResultsAbductor hallucis activity was significantly lower during most phases in the coper and control groups than in the CAI group (P < 0.05). There were no differences in the extrinsic foot muscles among the groups (P > 0.05). SignificanceSimultaneous investigations of muscle activity in the abductor hallucis and extrinsic foot muscles identified neuromuscular dysfunction after ankle sprains. Increased activity of the abductor hallucis may be associated with recurrent ankle sprains.

Cross-sectional study on ankle sprain and its related factors in physical education college

To explore prevalence, risk factors and treatment of ankle sprain of young college student , in order to obtain accurate epidemiological data. From March 2019 to May 2019, 552 college students(1 104 sides of anke joints) from Xi'an Physical Education university were enrolled in study according to inclusion and excludion standard, including 309 males and 243 females aged from 16 to 24 years old with an average of (20.9±3.7) years old. Age, gender, and body mass indes(BMI) etc were recorded. Morbidity of acute and chronic ankle sprains of physical students, treatment after the first sprain (cold compress, cast or plaster bracing and medicine), visual analogue scale (VAS) during walking were assessed through ankle sprain questionnaire;Cumberland ankle instability tool (CAIT), Maryland foot score were applied to assess ankle function. Lateral ankle ligament injury was objectively assessed by musculoskeletal ultrasonography. The prevalence of acute ankle sprain(AAS) was 96.20% (531/552), and the incidence of AAS was 59.96% (622/1 104). The prevalence of chronic ankle joint instability(CAI) was 16.85% (93/552), and the incidence of CAI was 8.97% (99/1 104). In the four categories of sports, college student suffered from multiple sprains in performance majors group was 22.20% (14/63), including of aerobicsand dance performance. The incidence of AAS of ball sports was 8.60%(14/163). After the first sprain, most college students(94.4%) were received cold compression, about 60% of them went to hospital;however, only 44.7% students were received standard treatmens(cast or plaster), only 35.3% of them were received hard ankle orthosis. In 552 college students, 44 students were suffered from more than 4 times of ankle sprain, and the total incidence was 7.97% (44/552). Cumberland score was 26.6±2.4, Cumberland score of students sprained ankle joint more than 4 times was (29.2±1.1), suggested it was a risk factor for ankle joint instability. VAS of students sprained ankle joint more than 4 times was higher than that of less than 4 times(P<0.05), Maryland foot score was significantly lower than that of that of <4 times(P<0.05). Musculoskeletal ultrasonography measured the thickness of anterior tibiofibular ligament(ATFL) was (2.41±0.41) mm, and the thickness of calcaneofibular ligament(CFL) was (1.92±0.21) mm, and had no statistical difference(P>0.05). Ninty-four percent college students had at least once ankle sprain, ankle sprains were more common in erobics and ball sports. After the first sprain, the proportion of cast or plaster treatment was less than 50%. Sprained ankle joint more than 4 times is a risk factor, and musculoskeletal ultrasonography showed thickening of both ATFL and CFL, while no statstical difference.

Validity and Reliability of Hindi version of Foot and Ankle Disability Index in patients with chronic recurrent lateral ankle sprain

BackgroundLateral Ankle Sprain (LAS) is a recurrent musculoskeletal injury commonly noticed in primary care, podiatry, orthopaedics, and physical therapy centers. The Foot and Ankle Disability Index (FADI) is a self-reported and region-specific tool with no previous literature available on the translation of the FADI scale into Hindi language. AimThe study aims to translate and evaluate each translated domain of FADI to see its cross-cultural adaptation, content validity and reliability for patients with chronic recurrent LAS. Study designA Cross-Sectional Study. MethodsThe scale was translated from the reference language to the target language, Hindi, using the instructions provided in the literature. Delphi survey was conducted for content validation followed by recruitment of 51 participants with a history of long lasting repetitive lateral sprain of ankle to evaluate test-retest reliability of Hindi version of FADI. ResultThe S-CVI/Ave and S-CVI/UA came out to be 0.988 and 0.884, respectively and I-CVI for all items of Hindi version of FADI were more than 0.90. The ICC (Intra-class Correlation Coefficient) and internal consistency was evaluated, which came out to 0.961 and 0.980, respectively for Hindi version of FADI. ConclusionHindi version of FADI is a valid and reliable scale that has been translated and adapted to be implemented among Indian population suffering from long lasting repetitive LAS.

Rotational ankle instability: A current concept review.

Ankle sprains are extremely common. It is important to have a clear insight of the course of recovery after such injury to evaluate the effective strategies to guide management decisions, and understand the potential risk factors involved in the development of chronic problems and recurrent ankle sprains. When a prompt diagnosis is not formulated, ligament tears can remain untreated, and chronic ankle instability can result after acute lateral or medial ankle sprain. When the medial ligament complex (MLC), in particular the anterior fascicle of the deltoid ligament, is involved, rotational ankle instability (RAI) can develop. Generally, a tear of the anterior fibres of the MCL accompanied by anterior talofibular ligament (ATFL) insufficiency has been associated with RAI, while injury of the intermediate fibres of the MLC has been associated with medial ankle instability (MAI). Conservative management is the first line of treatment, with surgery reserved for special cases or if rehabilitation has failed. Regarding surgery, several options are available, including anatomic repair, anatomic reconstruction, and tenodesis procedures. Ankle arthroscopy is increasingly used to address ligament insufficiency and to identify and treat intra-articular pathologies. Repair of MLC tears by an arthroscopic all-inside procedure is effective in both MAI and RAI.

The effect of perturbation training with and without applying the dry needling on leg muscles in patients with chronic ankle sprain

IntroductionAnkle sprain is a common musculoskeletal injury that leads to recurrent instability. Repeated ankle sprain can be a mechanism for creating trigger point. Proper treatment of trigger points, in addition to preventing recurrence of sprains, may reduce pain and improve muscle function. This improvement can be the result of preserving the surrounding tissues from excessive pressure. ObjectiveInvestigate the added value of dry needling into perturbation training protocol for chronic ankle sprain. DesignRandomized clinical trial; assessor-blind; before and after comparison. SettingTreatment of patients referred to the institutional rehabilitation clinics. Main outcome measure(s)Functional assessment with FAAM questionnaire score, Pain with NPRS scale, ankle instability severity with Cumberland tool. MethodsTwenty-four patients with chronic ankle instability participated in this clinical trial and were randomly divided into two groups. Intervention was 12 sessions in which one group received only perturbation training and the other group received perturbation training along with dry needling. Repeated measures ANOVA was used to investigate the effect of treatment. ResultsData Analysis showed significant difference in NPRS and FAAM and Cumberland score before and after treatment in each group (P < 0.001). Comparison of the results between the groups did not show any significant difference (P > 0.05). ConclusionThe findings showed that adding dry needling technique to the perturbation training does not have greater effects on the pain and function of patients with chronic ankle instability.

Differences in Ankle Dorsiflexion Deficit Performance between Male and Female Athletes with a History of Lateral Ankle Sprain: The Functional Pre-Participation Evaluation

The objective of this study was to determine the effects of deficit of ankle dorsiflexion in athletes who sustained a chronic lateral ankle sprain to the hopping performance. A comparative study was designed to compare the deficit and non-deficit condition of ankle dorsiflexion as a result of the weight bearing lunges test to distance hopping ability with single leg hop, which was normalized with leg length. There were no statistically significant differences in hopping performance, deficit vs non-deficit ankle dorsiflexion within-group comparisons in males (P = 0.932) or females (P = 0.999). Between group comparisons showed that ankle dorsiflexion deficit among female resulted lower hopping performance compared to male with / without ankle dorsiflexion deficit (P = 0.041 and P = 0.039). Surprisingly, hopping performance among male with ankle dorsiflexion deficit was further than female without ankle dorsiflexion deficit (P = 0.044). Meanwhile, hopping performance between male versus female without ankle dorsiflexion deficit were not significant (P = 0.054). The deficit of ankle dorsiflexion had no influence on hopping performance in athlete with a history of LAS, both male and female. Sex influenced hopping performance in athletes with ankle dorsiflexion deficits, with female athletes performing worse than male. During recovery, there might be differences in biomechanical adaptation between ankle dorsiflexion deficit conditions in female athletes compared to male. Keywords: Ankle-dorsiflexion deficit, Sex, Ankle sprain, Hopping distance, Adaptaion

Hindi translation, cross-culture adaptation, validation and relaibility of foot and ankle disability index instrument in patients with chronic recurrent lateral ankle sprain—A study protocol

BackgroundAnkle sprains are one of the most common musculoskeletal injuries. English and Italian versions of the Foot and Ankle Disability Index (FADI) questionnaire are available for assessment, but no Hindi version of the FADI questionnaire is yet available for the population who only communicate and understand the Hindi language. AimThis study aims to translate and culturally adapt the Hindi version of the FADI questionnaire and to evaluate its validity. Study designA Cross-Sectional Study. MethodIn accordance with Beaton guidelines, the FADI questionnaire will be translated into Hindi by two translators with medical and non-medical backgrounds, respectively. The recording observer will then take a seat to create a T1–2 version of the translated questionnaire. A Delphi survey with 6–10 experts will be conducted. The pre-final form will be fully tested on 51 patients, and the scale validity will be reported. Finally, the translated questionnaire version will be analyzed by the ethics committee. ResultStatistical analysis will be done using the Scale-level Content Validity Index (S-CVI). An individual item of the questionnaire will be validated and documented in the context of the Item-level Content Validity Index (I-CVI). This will be achieved with the help of the Averaging method (S-CVI/Ave) and the Universal Agreement calculation method (S-CVI/UA). Both absolute and relative reliability will be calculated. For absolute reliability, Bland and Altman agreement will be used. Intra-class correlation coefficient (ICC) and Cronbach's alpha (internal consistency), along with Spearman Rank rho and Pearson product, will be analysed for relative reliability. ConclusionThe study will determine the content validity and reliability of the Hindi version of the FADI questionnaire in patients with a chronic recurrent lateral ankle sprain.

Comparison of thrust manipulation and non-thrust mobilization techniques on pain in athletes with chronic ankle sprain

Background: Chronic ankle sprains can be effectively treated with either thrust manipulation or non-thrust mobilisation of the ankle joint, according to a number of studies. On the other hand, it is unknown if thrust manipulation or non-thrust mobilization is superior to other techniques in terms of improving clinical and functional outcomes. Comparison of the pain-relieving benefits of thrust manipulation versus non-thrust mobilization was the primary objective of this study, which was conducted on athletes with chronic ankle sprains. Methodology: It was a randomized control trial. The study was completed from May 2021 to Jan 2022 and it was conducted at Pakistan sports board and Model town football club, Lahore. Purposive sampling techniques was used to collect the data as per inclusion criteria the participant age between 16 to 40 years males. Screening was carried out of 30 participants, 20 fulfilled the inclusion criteria and 16 finally gave written consent for enrollment in the study. All the participants were placed into two groups by sealed envelope method. In group A high-velocity manual intervention was given at proximal and distal tibiofibular joint, and distraction thrust manipulation technique at talo-crural joint.

Efficacy of Different Types of Foot Orthoses on Postural Control in Subjects With Lateral Ankle Sprain: A Systematic Review

Objectives: Lateral ankle sprain is one of the most common injuries to the musculoskeletal system, especially among active people. This injury causes complex complications, such as recurrent sprain because of reduced postural control. Foot orthoses are among the interventions used to improve postural control in this population. This review aims to investigate foot orthoses to improve postural control among patients with an acute or chronic lateral ankle sprain. Methods: Four electronic databases (Scopus, PubMed, Web of Sciences, and Google scholar) were searched for experimental studies. Articles were selected using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method. The articles were reviewed for their quality based on the standards for reporting diagnostic accuracy statements and then entered into this review. Results: The search results in all databases provided a total of 48 articles. After reviewing the documents, we excluded 38 articles that did not pass the inclusion criteria, resulting in 10 remaining articles. Data extraction from population, interventions, and outcome measures was done for these 10 articles. Discussion: Foot orthoses are effective in improving the postural control of individuals with an acute or chronic lateral ankle sprain. Considering the existence of mechanical and functional instability, foot orthosis which is made to affect the proprioception and follow the biomechanics of the body seems to be the most effective in this field; however, more studies are required to confirm this

Outcomes Following Broström Repair with Internalbrace Ligament Augmentation vs Broström Repair Alone for the Treatment of Anterior Talofibular Ligament Injury of the Lateral Ankle

Category: Ankle; Sports Introduction/Purpose: The Broström procedure is indicated for lateral ankle instability in the setting of acute or chronic ankle sprains, with injury of the anterior talofibular ligament (ATFL) being the most common. While the procedure is anatomically favorable, one disadvantage of the Broström procedure is significantly reduced strength of the repair when compared with the native ligament. Broström repair with augmentation of an InternalBrace (Arthrex, Naples, FL), nonabsorbable suture tape fixed directly to the bone, has demonstrated increased strength and stiffness of the repaired ATFL; however, there is a paucity of literature published on clinical outcomes. The purpose of this study is to compare clinical outcomes following treatment of ATFL injuries with Broström repair alone versus Broström repair with InternalBrace augmentation. Methods: Between January 2009 and December 2017, patients 18-75 years old who underwent surgical treatment for an ATFL injury of the lateral ankle injury with either a Broström repair alone (Cohort A) or Broström repair with InternalBrace augmentation (Cohort B) performed by two surgeons (TOC or CTH) and at least 2 years post-operative were identified. Minimum 2-year follow-up was obtained with patients completing subjective questionnaires including Foot and Ankle Ability Measure (FAAM) with Activities of Daily Living (ADL) and Sport subscales, Short Form-12 (SF-12) Mental Component Summary (MCS) and Physical Component Summary (PCS), Tegner activity scale, and patient satisfaction with surgical outcome. Demographics and patient-reported outcomes were compared between groups. Results: In total, 103 patients were included in the study. Cohort A had 54 patients (29 females) with median age of 32 (range: 19 to 68) and 49 of 54 patients (91%) completed follow-up at an median of 2.32 years (range: 2 to 12 years). Cohort B had 49 patients (29 females) with median age of 37 (range: 18 to 66) and 38 of 49 patients (78%) completed follow-up at an median of 3.07 years (range 2 to 7 years). There was no significant difference in age or sex between cohorts (p&gt;0.05 for all). At earliest minimum 2-year follow-up, there was no significant difference in median post-operative FAAM ADL (97% vs 98%, p=0. 979), FAAM Sport (91% vs 91%, p=0.976), SF-12 PCS (56 vs 54, p=0.143), SF-12 MCS (56.6 vs 57.0, p=0.155), Tegner score (6 vs 5, p=0.214), or patient satisfaction (9 vs 9, p=0.781). Conclusion: Patients treated for ATFL injury of the lateral ankle with Broström repair with InternalBrace augmentation demonstrated similar clinical outcomes to those treated with Broström repair alone. With its advantages in strength and stiffness, the InternalBrace should be considered when treating lateral ankle instability in the setting of ligamentous injury since it allowed an earlier return to full weight bearing and a quicker rehabilitation protocol.

Association between unilateral functional ankle instability, limited ankle dorsiflexion range of motion and low back pain

There is growing evidence that supports the correlation between incidence of ankle dysfunction and low back pain (LPB). Although the spine and ankle seem like distant regions of the body, they are functionally connected by the lower extremity kinematic chain. The aim of the current study was to investigate the association between functional ankle instability (FAI), limited ankle dorsiflexion (DF) range of motion (ROM) and (LPB). One hundred two subjects with chronic ankle sprain pain participated in this study. The mean ± SD age, weight, height, and BMI of the study group were 43.5 ± 12.96 years, 85.27 ± 14.22 kg, 172.9 ± 8.45 cm, and 28.59 ± 4.72 kg/m². LPB was measured by Visual Analogue Scale (VAS), FAI was measured by the anterior drawer test and DF ROM was measured by the lunge test. All statistical analyses were performed using the Statistical Package for Social Studies (SPSS) version 25 for Windows. There was no statistically significant association between pain and age, pain and BMI, pain, and sex (p &gt; 0.05). There was a statistically significant association between pain and drawer test (odd ratio 5.68, p = 0.02) and a statistically significant association between pain and DF ROM (odd ratio 1.16, p = 0.01). The current study supported previous studies recommending FAI and limited ankle DF ROM as a factor in LPB. The authors suggest conducting similar studies with a larger number of participants and include functional measures scales or questionnaires to increase the validity and generalizability of the results.

Exosomes derived from platelet-rich plasma administration in site mediate cartilage protection in subtalar osteoarthritis

Subtalar osteoarthritis (STOA) is often secondary to chronic ankle sprains, which seriously affects the quality of life of patients. Due to its etiology and pathogenesis was not studied equivocally yet, there is currently a lack of effective conservative treatments. Although they have been used for tissue repair, platelet-rich plasma-derived exosomes (PRP-Exo) have the disadvantage of low retention and short-lived therapeutic effects. This study aimed to determine whether incorporation of PRP-Exo in thermosensitive hydrogel (Gel) increased their retention in the joint and thereby playing a therapeutic role on STOA due to chronic mechanical instability established by transecting lateral ligaments (anterior talofibular ligament (ATFL)/calcaneal fibular ligament (CFL)). PRP-Exo incorporated Gel (Exo-Gel) system, composed of Poloxamer-407 and 188 mixture-based thermoresponsive hydrogel matrix in an optimal ratio, was determined by its release ability of Exo and rheology of Gel response to different temperature. The biological activity of Exo-Gel was evaluated in vitro, and the therapeutic effect of Exo-Gel on STOA was evaluated in vivo. Exo released from Exo-Gel continuously for 28 days could promote the proliferation and migration of mouse bone mesenchymal stem cells (mBMSCs) and chondrocytes, at the same time enhance the chondrogenic differentiation of mBMSCs, and inhibit inflammation-induced chondrocyte degeneration. In vivo experiments confirmed that Exo-Gel increased the local retention of Exo, inhibited the apoptosis and hypertrophy of chondrocytes, enhanced their proliferation, and potentially played the role in stem cell recruitment to delay the development of STOA. Thus, Delivery of PRP-Exo incorporated in thermosensitive Gel provides a novel approach of cell-free therapy and has therapeutic effect on STOA.Graphical

Bilateral symmetry of vertical time to stabilization in postural sway after double-leg landing in elite athletes with unilateral chronic ankle sprain

BackgroundLower limb asymmetry among athlete with unilateral chronic ankle instability (CAI) during bilateral landing can be a potential source of ankle sprain reinjury. The aim of study was to investigate the effect of bilateral symmetry of vertical time to stabilization (vTTS) in postural sway after double-leg landing (DLL) in elite athletes with unilateral CAI.MethodsTwenty professional players with unilateral CAI and ten healthy controls were assigned to three groups (soccer, basketball, and control groups, n = 10 each). The postural balance during DLL tasks was assessed based on center of pressure (CoP) and vTTS. Multiple analysis of variance was conducted to statistically analyse the CoP and vTTS which followed by Bonferroni’s post hoc test (P < 0.05).ResultsThe vTTS of the injured foot was significantly longer in the soccer and basketball players than in the control players (P = 0.006, p < 0.001 respectively). The intragroup comparison showed a significant difference in the vTTS of CAI and uninjured feet among the basketball players (mean difference = 1.3 s). The basketball group exhibited a worse balance in CoP oscillations results between groups.ConclusionsThe findings suggested that symmetry between double-leg vTTS values, may be important as much as the sooner vTTS in reduced CoP oscillations and enhanced balance after DLL. Balancing exercises should achieve sooner vTTS in soccer players and symmetry in the double-leg vTTS of basketball players with unilateral CAI while maintaining static balance during dynamic-to-static postural changes to reduce recurrent ankle sprain.

Running gait biomechanics in females with chronic ankle instability and ankle sprain copers

ABSTRACT Limited evidence exists comparing running biomechanics between individuals with chronic ankle instability (CAI) and those who fully recover (copers). The purpose of this study was to simultaneously analyse running gait kinematics, kinetics, and surface electromyography (sEMG) between ankle sprain copers and individuals with CAI. Twenty-six (13 CAI, 13 Coper) recreationally active females participated and ran shod on an instrumented treadmill at 2.68 m/s. We assessed lower extremity kinematics and kinetics and sEMG amplitude for the fibularis longus, tibialis anterior, medial gastrocnemius, and gluteus medius muscles. Ten consecutive strides from the beginning of the trial were analysed using statistical parametric mapping (SPM) independent t-test. The CAI group had significantly more ankle inversion during 0–6%, 42–53%, and 96–100% of the running stride cycle compared to the coper group. At initial contact (0%), the CAI group was in an inverted ankle position (5.9°±6.8°) and the coper group was in an everted ankle position (−3.2°±5.5°; p = 0.01, d = 1.5). There were no significant differences identified for any other outcome measures. Increased ankle inversion during the swing phase leading into the loading phase is concerning because the ankle is in an open packed position and inversion is a primary mechanism of injury for sustaining a lateral ankle sprain.