Previous Ankle Research Articles

Pre- and Post-Surgical Cutaneous Reflexes and Perceived Instability During Gait in an Individual with Chronic Ankle Instability.

Context: Recent studies exploring chronic ankle instability (CAI) have found alterations in cutaneous reflexes of musculature surrounding the ankle which may contribute to perceived instability and recurrent LAS seen in this population. CAI is considered a multifaceted condition, making it difficult to determine the underlying cause of these altered reflexes. Objective: To observe how mechanical laxity of the ankle affects lower limb cutaneous reflexes and perceived instability during gait and how surgical intervention to correct laxity affects these measures. Design: Clinical Case Report Setting: Research Laboratory Patient: A physically active 25-year-old female (64in;130lbs) with 7 previous lateral ankle sprains (LAS) and met CAI diagnostic criteria based on CAI questionnaire scores. The patient underwent a Broström reconstruction of the CFL via allograft and partial synovectomy. Main Outcome Measures: CAI questionnaire scores, middle latency lower limb cutaneous reflexes, and perceived instability following sural nerve stimulation during gait. Results: Post-surgery, the patient's CAIT and FAAM questionnaire scores aligned with those of a healthy individual. PL reflexes were diminished or inhibitory during the stance phases of gait. Pronounced variability of PL reflexes may have contributed to this lack of facilitation. BF facilitation at midstance was absent during both testing sessions while BF and RF facilitation was generally reduced post-surgical intervention. The patient's average perceived instability following sural stimulation was markedly reduced from the pre-surgical (6.5±0.48) to post-surgical (1.9±0.24) session. Conclusions: Mechanical instability likely contributed to the reflex variations seen in this patient pre- surgically, while the enhanced static stability provided by the surgical procedure may have reduced the need for dynamic stability via lower limb cutaneous reflexes observed in the follow-up session. Identifying the specific limitations experienced by an individual with CAI will allow for a more effective monitoring and treatment and provide improved long-term health-related quality of life outcomes.

Development of the Foot and Ankle Activity Level Scale (FAALS) Instrument.

Activity level is a benchmark to document patient recovery; however, there is a lack of instrumentation to measure activity level specific to the foot and ankle. The purpose of this study was to develop a foot and ankle activity level scale (FAALS) instrument that will serve as an effective clinical tool for practitioners by assigning an activity level to patients. This was a 4-phase study with 3 rounds of data collection (n = 1432). Phase 1 was item generation using an expert panel to determine content validity (101 items). In phase 2, all items from phase 1 were piloted (n = 100) to remove poorly performing items (77 items). In phase 3 (n = 505), item reduction, reliability, and validity Rasch analyses were conducted, leaving a total of 22 items. Validity was assessed using outfit mean-square (MNSQ) and infit MNSQ statistics, with acceptable values between 0.5 and 1.5. An additional round of data collection was completed to serve as a validation data set to confirm FAALS instrument structure and psychometric analytics (n = 827). Correlation analysis was performed to assess convergent and divergent validity. Multiple linear regression analysis was conducted to determine whether the FAALS could detect differences in scores between groups with previously proven factors that affect functional status. Person reliability was 0.92 and item reliability was 1.00, demonstrating excellent reliability. There was excellent evidence of validity, with mean-square values between 0.5 and 1.5. The 22 FAALS items are summed for a total score that corresponds to one of 4 activity levels. The FAALS instrument demonstrated sensitivity in the ability to discern between groups with expected foot and ankle functional differences for previous ankle surgery status, t(502) = -7.69, P < .001, and body mass index, t(502) = -3.41, P < .001. The FAALS instrument is a short, clinically useful tool to measure activity level specific to the foot and ankle. FAALS normative values provide valuable information for physician-patient communication, which may serve to facilitate shared decision-making, improve postoperative care, and allow physicians to track recovery progress.

Health problems and injury management in adolescent handball: the Safeplay one-season cohort study of 679 players

ObjectivesTo assess (1) the 1-year prevalence of previous shoulder, knee and ankle injuries; (2) the in-season prevalence proportion (prevalence) of injuries and illnesses, injury incidence rate (ir) and injury burden...

The Relationships Among Proprioception, Balance, and Cognitive Perception of Body Awareness in College Students: A Pilot Study

Introduction: This pilot study examined the relationships among lower extremity proprioception, balance ability, and perception of body awareness. Researchers also evaluated the influence of sex, sport participation, leg dominance, and previous ankle injury. Methods: Eighteen participants (F = 11, M = 7) completed the initial testing, with eight (F = 4, M = 4) repeating the mLEPT one week later. Participant characteristics and mBARQ data were collected using an online survey. Measures included proprioception errors on the mLEPT, utilizing distances of 12 and 22 cm, and the Biodex Balance SystemÔ Limits of Stability Test. Results: For the mLEPT, good reliability was noted for the dominant leg 22 cm distance between trials 1 and 2 for all 18 participants (ICC = 0.83). Moderate test-retest reliability was observed when comparing the averages of day 1 to day 2 for the dominant leg 22 cm distance (ICC = 0.53), and for the overall error when collapsing across conditions (ICC = 0.63). Moderate reliability was also observed for the mBARQ (α = 0.76). Strong inverse relationships between proprioception error and directional control scores were observed, indicating an association between dynamic balance and lower extremity proprioception (r = -0.55-0.54, p = 0.02). Sex, sports participation, leg dominance, and previous ankle injury also influenced proprioception performance. Females displayed better lower extremity proprioception and balance control than males. In addition, participants without previous ankle injury scored higher on the mBARQ, and had better directional control and time to completion, indicating that those without ankle injury had a higher perception of body awareness and better dynamic balance. Conclusions: Both the mLEPT and mBARQ appear to have moderate reliability. mLEPT performance was strongly associated with dynamic balance measures. In addition, lower mBARQ scale scores in those with previous ankle injury were strongly associated with poorer proprioception. While preliminary findings are promising, a larger follow-up study is needed to determine if the mLEPT and mBARQ are potential quick and inexpensive tools to monitor changes in proprioception during rehabilitation post-injury.

Clinical and Radiographic Comparison of Lateral Malleolar Ankle Fractures Treated with or without Deltoid Fixation

Category: Ankle; Other Introduction/Purpose: There is a lack of consensus on how deltoid injuries should be addressed in the setting of acute ankle fractures. This study aims to evaluate whether deltoid repair during lateral malleolar fracture fixation leads to improved clinical outcomes compared to fixation without deltoid repair. Methods: This was a single-center retrospective study conducted from the institutional review board-approved Foot and Ankle Registry data, and the protocol was approved by the steering committee at the investigators’ institution. Patient-reported outcomes via PROMIS scores were collected preoperatively and at least one year postoperatively for all patients. Inclusion criteria included patients aged 18 or older who underwent open fixation for a SER IV equivalent lateral malleolar ankle fracture with a deltoid injury and had preoperative PROMIS scores. Excluded were patients without preoperative radiographs and patients with histories of previous ipsilateral ankle surgeries, rheumatoid arthritis, or gout. Retrospective review of the registry was performed, and 146 patients were included. 80 patients received a deltoid repair (DR) and 66 patients did not receive a deltoid repair (NDR). Preoperative and postoperative medial clear space (MCS) were reviewed for all patients. Results: Both DR and NDR cohorts demonstrated significant improvement in Physical Function, Pain Interference, Pain Intensity, and Global Physical Health. There were no significant differences in preoperative and postoperative PROMIS domains between the two cohorts. There were also no significant differences in preoperative MCS and postoperative MCS between the two cohorts. There were no significant differences in the incidence of subsequent procedures for removal of painful hardware, revisions, infections, progression to arthritis, and persistent pain. Conclusion: This study compares short- to medium-term patient-reported clinical outcomes and complications of lateral malleolar ankle fractures with and without deltoid repair. Repairing the deltoid did not increase the incidence of postoperative complications and produced similar PROMIS scores at 1-year minimum follow-up. This study suggests that any potential differences in outcomes between groups are not large enough to be clinically meaningful in the short term and that other factors may be more relevant in determining the best course of treatment. A longer follow-up is required to evaluate long-term functional and clinical outcomes.

Development of the Foot and Ankle Activity Level Scale (FAALS): A Clinical Tool for Orthopaedic Surgeons

Category: Ankle; Sports Introduction/Purpose: Activity level is a benchmark to document patient recovery. Currently, there is a lack of instrumentation that measures activity level in the foot and ankle. AAOS has recommended first establishing normative values when developing a new instrument to serve as a reference group for physicians, improving the interpretation of scores. The purpose of this study was to develop a foot and ankle activity level scale (FAALS) instrument that will serve as an effective clinical tool for practitioners and determine normative values for the FAALS instrument to serve as a baseline reference group for physicians. Methods: This was a 4-phase study (n=605). Items for the new instrument were develop in Phase 1 by interviewing experts through a systematic Delphi consensus process (orthopaedic surgeons, orthopaedic researchers/statisticians, physical therapists). Data were aggregated to form an initial pool of 101 activity items. Experts assessed items on content appropriateness and item difficulty. Items were reviewed for clarity and readability. Cognitive interviews were performed with two people in the normal population for interpretation assessment. From this review process, 24 items were removed, leaving 77 items for the pilot analysis in Phase 2. After final item reduction, there were 22 items included for the final FAALS instrument. Scale sensitivity was assessed with a multiple linear regression analysis. Normative values were determined for the remaining 22 items. Results: There are 4 activity levels with a defined point range for each activity level. Level 1 (lowest): 0-24 points, Level 2: 25-44 points, Level 3: 45-68 points, Level 4 (highest): 69-88 points. Person reliability was .92 and item reliability was 1.00, demonstrating excellent reliability. Mean-square infit/outfit values were between 1.28 and 0.73 demonstrating excellent evidence of validity. The FAALS instrument was sensitive to groups with expected foot and ankle functional differences for previous ankle surgery, t (502)=-7.69, p&lt;.001) and body mass index (BMI), t (502)=-3.41, p&lt;.001. Mean FAALS for individuals with previous ankle surgery was 56.7 (Level 3), and for no previous ankle surgery was 68.5 (Level 4). Mean FAALS for individuals with normal BMI was 73.3 (Level 4), and for obese or overweight was 63.2 (Level 3). Conclusion: A new 22-item foot and ankle activity level scale with 4 activity levels called the FAALS was developed for practitioners to quickly assess activity level in patients. There was excellent evidence of psychometric properties for reliability and validity of FAALS scores. The FAALS instrument demonstrated sensitivity in its ability to measure activity level between groups with known functional differences, including previous ankle surgery status and BMI. Orthopaedic practitioners can feel confident in using FAALS to assess activity level. Testing FAALS in the normal population was the first step according to AAOS recommendations. Further research should assess FAALS in surgical populations.

Clinical Results of Os Subfibulare Resection with Ligament Repair in Chronic Lateral Ankle Instability

Category: Sports; Ankle Introduction/Purpose: Previous studies still have conflicting views on the size of the ossicle during ligament repair after ossicle removal. However, there is no standard for measuring the size of the ossicle. Furthermore, ossicle has various sizes, shapes, and positions. This study aimed to investigate the subfibular ossicles' morphologic characteristics and correlations with variables and to determine the clinical outcomes of ossicle removal and ligament repair. Methods: From February 2012 to December 2022, we retrospectively studied patients who underwent ossicle removal and MBO for chronic lateral ankle instability. Patients with degenerative arthritis, a history of previous ankle ligament surgery, or bilateral subfibular ossicles were excluded. The ankle stress radiographs were taken, and anterior drawer distance and talar tilt angle were obtained. The size, location, and number of ossicles were evaluated on MRI and radiographs. The location of the ossicle was classified into three zones according to the insertion of the ankle ligaments. Ossicle size measurements in MRI were as follows: length: anterior-posterior distance, height: superior-inferior distance, width: medial-lateral distance. The greatest distance among the coronal and sagittal images was measured, respectively. Clinical results were assessed using the Karlsson-Peterson (KP) ankle score and Foot and ankle outcome score (FAOS). Results: Forty ankles out of 477 patients were included. As for the location of ossicles, the ATFL attachment site was the most common with 57.5% (23/40), the CFL attachment site was 17.5% (7/40), and the case that spanned both ATFL and CFL was 20% (8/40). Most showed one ossicle, but 5% (2/40) of ankles showed two. Ossicles with a length greater than 10 mm in the sagittal view were 30% (12/40). At the last follow-up, all clinical scores improved significantly. There were no significant differences in preoperative radiographic instability, ossicle size, and clinical outcomes according to ossicle location. Ossicle width showed a significant correlation with anterior drawer distance (Pearson coefficient=0.437, p=0.033). Ossicle size showed no significant correlation with clinical scores at the last follow-up. Conclusion: For chronic ankle lateral instability with ossicle, ossicle removal and Brostrom ligament repair can achieve good clinical results. The size and location of ossicles had no significant correlation with post-operative clinical outcomes. Depending on the width of the ossicles, instability is thought to be related to which anatomical ligaments are involved and how much.

Arthroscopically Assisted Deep Deltoid Ligament Reconstruction Utilizing Suture Tape Augmentation for Treatment of Medial Ankle Instability in Acute Ankle Fractures: A Novel Technique and Case Series

Category: Arthroscopy; Ankle Introduction/Purpose:Objective: To present a novel technique for deep deltoid ligament reconstruction using suture tape augmentation for medial ankle instability in acute ankle fractures and conduct a case series. Background: Circular movements involving ankle supination-external rotation, pronation-external rotation, or pronation-abduction are among the most common mechanisms behind acute ankle fractures. As a result of rotational fractures, the deltoid ligament–consisting of a superficial and deep component–is often damaged or ruptured. Disruption of the deltoid ligament is associated with medial ankle instability, thus warranting further repair; which has been historically done open. Using an arthroscopic approach will allow for direct visualization and increased accuracy of surgical management . Combining arthroscopy and with our novel suture tape augmentation technique may improve postoperative functional outcomes, stability, and decrease post-traumatic arthritis. Methods: This is a retrospective case study using de-identified patient data from 2 separate hospital systems. Data was obtained via chart review including pre-operative, intraoperative, and post-operative follow ups. Variables such as age, weight, body mass index (BMI), sex, side, history of previous ankle surgery, preoperative ambulatory status, length of hospital stay, as well as disposition were documented. Radiographs were reviewed for evidence of restoration of the medial clear space as well as hardware position and bony union. In addition, a technique guide was developed using two expert surgeons experience and opinion for using suture tape augmentation with the Arthrex InternalBrace system (Naples, FL). In addition, we present a novel technique for reconstruction of the deep deltoid ligament complex using our experience from these cases. Included in this guide are details on indications, setup, technique, postoperative protocol, and radiographic assessment. Results: We retrospectively reviewed 12 patients who had bimalleolar equivalent, tri-malleolar equivalent, or Maisonneuve-type fractures of the ankle with increased medial clear space widening and were surgically treated with this novel technique. All patients were initially non-ambulatory after their fracture and prior to their procedure. All patients had significant reduction in the medial clear space postoperatively. Additionally, all patients progressed to walking without assistance and returned to full weight bearing postoperatively. One patient developed a keloid scar that required a corticosteroid injection. One patient showed widening of the syndesmosis on follow up x-rays; which was managed with a CT scan of the ankle, and bilateral weight bearing radiographs. The patient was clinically asymptomatic and advanced to weight bearing as tolerated before 6 months. Conclusion: Arthroscopically assisted deep deltoid ligament reconstruction utilizing suture tape augmentation is a successful procedure for restoring ankle function and radiographic parameters of the medial clear space when used in conjunction with accepted open reduction and internal fixation (ORIF) techniques for bimalleolar ankle fracture equivalents or tri-malleolar fractures. Since this procedure is performed with a minimally invasive arthroscopic approach, it may be a preferred technique in the future with direct visualization of the superficial and deep deltoid ligament. We have also presented a novel technique for reconstruction of the deep deltoid ligament complex utilizing suture tape augmentation via an arthroscopically-assisted approach. Arthroscopic deltoid technique Drill sleeve arthroscopically, radiographic confirmation of talus K-wire, and insertion of FiberTak/ sutures arthroscopically

Outcomes of Subtalar Arthrodesis in the Setting of Isolated vs Following Ankle Arthrodesis

Category: Ankle Arthritis; Ankle Introduction/Purpose: Subtalar arthrodesis is commonly used to treat both primary subtalar arthritis and subtalar arthritis that develops secondary to the altered biomechanics present after ankle arthrodesis. Biomechanical studies have shown that ankle fusion increases the motion in the subtalar joint which may cause arthritis and increased difficulty healing after subtalar arthrodesis. A recent clinical study of subtalar fusion after ipsilateral ankle fusion2 found a higher non-union rate in the post-arthrodesis group, but the certainty of their conclusion was limited by the relatively small size of the of ankle arthrodesis group (n=13) compared to the non-arthrodesis group (n=138). This study aims to contribute to the expanding body of evidence that subtalar arthrodesis in the setting of prior ankle fusion, yields inferior outcomes compared to isolated subtalar arthrodesis. Methods: We conducted a single-center retrospective chart review of a consecutive series of 26 adult patients who underwent subtalar fusion with (n=12) compared to without (n=14) prior ankle arthrodesis. The average age was 57 years, comprising 10 males and 16 females. Minimum follow-up of 2 years. Demographic data, surgical techniques, risk factors, laterality, comorbidities, and pre- and post-orthopedic surgical interventions were extracted through chart review. Clinical outcomes included: (1) delayed union when there was less than 25% bony fusion of the posterior facet on CT scan obtained 3 -months after surgery, (2) Non-union when there was absence radiographic fusion on radiographs taken at 6 months with persistent symptoms, and (3) union rate was determined through XR and CT scans, monitoring the progression from wearing a boot to weight-bearing activities. Results: Delayed union occurred in 8 out of 14 patients (57.14%) with previous ankle arthrodesis, compared to 4 out of 12 patients (33.3%) without previous arthrodesis. Nonunion occurred in 7 out of 14 patients (50%) with prior ankle fusion compared to 3 out of 12 patients (25%) without prior fusion. Smoking history, diabetes, and gender did not significantly impact the rate of fusion. Following subtalar fusion, patients commonly underwent surgeries such as ankle arthroscopy, wound infection debridement, hardware removal, subtalar arthrodesis revision, and midfoot arthrodesis. Among the 12 patients with delayed healing, 9 required subsequent surgery, averaging 2.7 additional procedures. Conclusion: In this retrospective study of subtalar fusion outcomes in patients with and without prior ankle arthrodesis we found that the previous arthrodesis group had higher rates of delayed union (57.14%) and nonunion (50%) compared to the isolated subtalar group (33.3% and 25%, respectively). This study adds to the growing body of literature that demonstrates inferior outcomes for subtalar fusion after ankle fusion. Moreover, it supports the growing popularity of total ankle arthroplasty as an alternative to ankle fusion in the setting of preexisting subtalar arthritis.

Comparison of Ankle Fracture Outcomes Treated with Fibular Nail vs Conventional Fixation

Category: Ankle; Trauma Introduction/Purpose: Ankle fracture fixation can benefit from minimizing postoperative complications, particularly with wound healing and infection. Less invasive implant options necessitating smaller incisions have emerged, including the fibular intramedullary nail (i.e. Arthrex Fibulock) to minimize incisions and potentially allow earlier mobilization. The purpose of this study is to investigate the efficacy and clinical outcomes of a fibular intramedullary nail (Arthrex Fibulock) in ankle fracture treatment across a diverse patient cohort. Methods: A retrospective chart review from 2018 to 2022 was conducted in order to determine eligible patients. Inclusion criteria included adult patients treated for an ankle fracture with at least 3 months of follow-up and sufficient imaging available. Exclusion criteria included open fractures, other concomitant injuries, pilon and tibial shaft fractures, or previous ankle surgery. Results: A total of 132 patients were consecutively included, 44 in the conventional fixation group (33.33%) and 88 in the fibular nail group (66.67%). 4 out of 88 fibular nail patients (4.55%) and 3 out of 44 conventional patients (6.82%) had a postoperative infection (P = .43). 8 fibular nail (9.09%) and 6 conventional (13.64%) fixation patients underwent hardware removal postoperatively, which was not statistically significantly different (P = .55). Conclusion: This study shows no difference between the fibular nail device and a conventional plate and screw fixation approach in the treatment of ankle fractures when looking at postoperative infection and removal of hardware rates. The rate of postoperative infection and hardware removal trended higher in the conventional fixation patients but did not reach statistical significance. As such, the use of the fibular nail may offer a viable alternative for all patients undergoing ankle fracture operative treatment.

Good rate of satisfaction but suboptimal clinical outcome at long‐term follow‐up in a large series of patients who had operative stabilization of the deltoid ligament of the ankle

AbstractPurposeTo report results following deltoid ligament reconstruction in a large series of patients.MethodsFor consecutive patients who had a medial ankle ligament stabilization 2010–2018 information from their medical files was registered, and they were invited for follow‐up in 2021–2022. They answered questions about satisfaction with the treatment and current symptoms, and they completed the Foot and Ankle Measurement (FAAM) questionnaire.ResultsOf the 503 patients, 342 (68%) had a history of trauma to the ankle and 114 (23%) had previous ankle surgery. 67% had other procedures (besides synovectomy) simultaneous to medial ligament reconstruction. 269 patients (54%) responded to the invitation for follow‐up. For 182 (71%) of the responders, the operation solved their ankle problems. 163 (63%) were satisfied with the surgery. 192 (71%) would repeat the operation. 173 (67%) had pain in the ankle during the past week, and 86 (50%) of these were not able to run. FAAM ADL‐scores were significantly higher than in a mixed group of ankle/foot patients but not normal.ConclusionThe relatively high degree of satisfaction despite suboptimal clinical results may reflect the complex nature of the deltoid ligament insufficient ankle. It is concluded that repair or reconstruction of the deltoid ligament is only performed in patients reporting ankle instability and with peroperatively demonstrated medial instability and pathology to the ligament.Level of EvidenceLevel III.

Incidence of post-traumatic osteoarthritis in 44B ankle fractures: Analysis of risk factors

ObjectiveThe purpose of this study was to analyse the clinical and radiographic data of a consecutive series of patients treated surgically for AO/OTA 44B ankle fracture at Ferrara University Hospital, Italy, with a view to identifying risk factors contributing to worse clinical and radiographic outcomes with a minium follow up of 6 years. Materials and methodsFor each patient the following data were recorded: gender, age, Body Mass Index (BMI), follow up (months), previous ankle sprains, type of work, Kellgren-Lawrence (K&L) score, AO/OTA classification for ankle fracture, Foot and Ankle Disability Index (FADI score), ankle dislocation, syndesmotic transfixation, quality of reduction. ResultsFADI score in patients with AO/OTA 44B1 fracture was 95.5±7.5, in 44B2 it was 90.0±8.4 and in 44B3 it was 84.0±13.0 (p25 it was 88.6±11.4 (p=0.047 95%I.C. 0.01-8.10). In case of fracture-dislocation there was a statistically significant difference in the FADI (94.4±6.0 vs 85.8±11.98)(P=0.002 95% I.C. 0.01-8.9). In the former group, there was a statistically significant difference in the ​the K&L (1.97±0.65 vs 2.63±0.85) (P=0.006 95% I.C 0.01-1.00).Finally, the quality of the reduction was a statistically significant parameter in both the FADI and K&L (P=0.012 95% I.C. 0.90-10.60 and P=0.012 95%I.C. 0.01-1.00 respectively). ConclusionThe most influential risk factors for worse outcome in AO/OTA 44B ankle fractures were found to be BMI, injury severity, fracture-dislocation and reduction quality.

Quantifying donor site morbidity in anterior cruciate ligament reconstruction using peroneus longus tendon autograft

Objectives: The objective of this study was to assess the donor site morbidity in patients having anterior cruciate ligament reconstruction (ACLR) using peroneus longus tendon (PLT) autograft. Methods: A prospective cohort study was conducted at the orthopedic department of Pakistan Atomic Energy Commission General Hospital, Islamabad, from July 2021 to July 2023. A total of 150 patients aged between 20 and 40 years with an anterior cruciate ligament injury requiring ligament reconstruction were included in the study. Exclusion criteria included previous ankle ligamentous injuries, fractures or surgeries around the ankle, and high-risk sports like football. After the ACLR surgery, the patients were assessed for pain, range of motion (ROM), and muscle power in the 6th week, 3rd month, and 6th month. Return to jogging without discomfort at the ankle during 1st min of jogging was assessed at six months. Results: Of the 150 patients, 142 (94.6%) were male and 8 (5.4%) were female. The mean age of participants was 32.53 ± 4.78 years. Pain and loss of ROM around the ankle were reduced after six months compared to three months and six weeks, that is, P &lt; 0.05. Muscle power was increased after six months (n = 152; 94.0%) (P &lt; 0.001). In the 6th month, 133 patients (88.7%) were able to jog without discomfort around the ankle joint during the 1st min of jogging, but 17 patients (11.3%) started jogging after six months without discomfort at the ankle joint during the 1st min of jogging (P &lt; 0.001). Conclusion: ACLR using the PLT autograft resulted in a good functional outcome, smooth rehabilitation with an early return to sports, and minimal complications at the donor site.

Measurement properties of the Foot Function Index (FFI) questionnaire: A systematic review

Objective Large numbers of people are subject to alterations and pathologies in the foot. To quantify how these problems of foot function affect the quality of life, clinicians and researchers have developed measures such as the Foot Function Index (FFI). Our aim is to determine the methodological quality of the FFI including adaptations to other languages. Data sources The studies considered in this review were extracted from the PubMed, Embase and CINAHL databases. The inclusion criteria were followed: (1) studies of patients with no previous foot or ankle pathology and aged over 18 years; (2) based on English-language patient-reported outcome measures that assess foot function; (3) the patient-reported outcome measures should present measurement properties based on COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) criteria. Review methods The systematic review was conducted following the COSMIN criteria to establish the methodological quality of the original FFI, together with its variants and adaptations. The last search was carried out in May 2024. Results Of the 1994 studies obtained in the preliminary search, 20 were eligible for inclusion in the final analysis. These results are the validations and cross-cultural adaptations to the following languages: the original FFI has cross-cultural adaptation in 13 languages and the FFI-Revised Short Form has been adapted and validated for use in 2 languages. Conclusion In terms of methodological quality, the FFI-Revised Short Form questionnaire is a valuable instrument for evaluating ankle and foot function and could usefully be expanded to be available in more languages.

Ultrasound Imaging in Football Players with Previous Multiple Ankle Sprains: Keeping a Close Eye on Superior Ankle Retinaculum.

The superior extensor ankle retinaculum (SEAR), a transversely fascial thickening positioned above the tibia-talar joint, serves as a crucial anatomical structure in ankle stability. The purpose of this study was to measure and compare by ultrasound (US) imaging the bilateral thickness and echogenicity of SEAR in football players with previous multiple ankle sprains (group 1) and healthy volunteers (group 2). A cross-sectional study was performed using ultrasound imaging to measure longitudinal and transversal axes using a new protocol in a sample of 50 subjects: 25 football players with previous multiple ankle sprains and 25 healthy subjects. The findings for SEAR thickness revealed statistically significant differences for both axes (p = 0.0011 and p = 0.0032) between the healthy side and the previously sprained side, and with the corresponding side of group 2 (p = 0.003 and p = 0.004). Moreover, in group 1, regarding the ROI echogenicity, a statistically significant difference was found between the sides (p = 0.0378). These findings suggest that the football players with previous ankle sprains showed a thicker and inhomogeneous SEAR on the sprain side, unveiling a remodeling of this structure compared to the other side and to the healthy volunteers. In these athletes, during US examination, one needs to keep "a US eye" on side-to-side SEAR comparisons.

Influence of Anterior Talofibular Ligament Injury and Ankle Anterior Displacement on Symptoms in Individuals With Chronic Ankle Instability.

Repeated ankle sprains can lead to injuries, including those of the anterior talofibular ligament (ATFL); however, the extent to which these ligament injuries are associated with symptoms of chronic ankle instability (CAI) remains unclear. To examine the influence of ATFL injury and ankle anterior displacement on symptoms of CAI. Case-control study. University laboratory. A total of 122 of 426 college students who completed a questionnaire on the history of ankle sprain were enrolled in healthy (n = 34; 24 men, 10 women; age = 20.6 ± 0.5 years), coper (n = 49; 38 men, 11 women; age = 20.2 ± 1.2 years), and CAI groups (n = 39; 24 men, 15 women; age = 20.1 ± 1.1 years). One examiner measured the ATFL delineation using ultrasound and anterior ankle displacement using a capacitance-type sensor device. The Cumberland Ankle Instability Tool was applied to assess pain and perceived instability. The ATFL was normal more frequently in the healthy group and abnormal more frequently in the CAI group (χ2 = 18.45, P < .001). Anterior ankle displacement was greater in the coper and CAI groups than in the healthy group (both, P < .001), but no difference was observed between the coper and CAI groups (P = .16). We observed no correlation between the anterior ankle displacement and Cumberland Ankle Instability Tool scores (r = -0.004, P = .71) in participants with previous ankle sprains. Observation of an abnormal ATFL on ultrasonography was associated with anterior displacement of the ankle joint. However, the influence of anterior ankle displacement due to damage to the ATFL on the pain and perceived instability in CAI was assumed to be small.

Factors Associated With a Lateral Ankle Sprain in Young Female Soccer Players: A Prospective Cohort Study.

Previous studies have attempted to determine if certain risk factors can predict the occurrence of a lateral ankle sprain (LAS) in female soccer players. Unfortunately, there is limited evidence with regard to risk factors associated with an LAS in female soccer players. To identify intrinsic risk factors for an LAS among young female soccer players. Cohort study; Level of evidence, 2. Participants were 161 young female soccer players in Japan who were evaluated for LAS risk factors during a preseason medical assessment. The assessment included anthropometric, joint laxity, joint range of motion, muscle flexibility, muscle strength, and balance measurements. Each athlete's history of LASs was also collected. The participants were monitored during a single-yearseason for LASs, as diagnosed by physicians. There were 26 instances of an LAS in 25 players (15.5%) during the season. Injured players were significantly more likely to have sustained a previous ankle sprain (P = .045) and demonstrated significantly worse balance than their peers without an LAS during the double- and single-leg balance tests (P = .008 for both). Athletes with lower hamstring-to-quadriceps muscle strength ratios were also significantly more likely to sustain an LAS (P = .02). Poor balance, a low hamstring-to-quadriceps ratio, and a history of ankle sprains were associated with an increased risk of LASs in young female soccer players in the current study. These findings may be useful for developing a program to prevent LASs in this population.

Absorption function loss due to the history of previous ankle sprain explored by unsupervised machine learning

BackgroundAnkle sprains are common and cause persistent ankle function reduction. To biomechanically evaluate the ankle function after ankle sprains, the ground reaction force (GRF) measurement during the single-legged landing had been used. However, previous studies focused on discrete features of vertical GRF (vGRF), which largely ignored vGRF waveform features that could better identify the ankle function. PurposeTo identify how the history of ankle sprain affect the vGRF waveform during the single-legged landing with unsupervised machine learning considering the time-series information of vGRF. MethodsEighty-seven currently healthy basketball athletes (12 athletes without ankle sprain, 49 athletes with bilateral, and 26 athletes with unilateral ankle sprain more than 6 months before the test day) performed single-legged landings from a 20 centimeters (cm) high box onto the force platform. Totally 518 trials vGRF data were collected from 87 athletes of 174 ankles, including 259 ankle sprain trials (from previous sprain ankles) and 259 non-ankle sprain trials (from without sprain ankles). The first 100 milliseconds (ms) vGRF waveforms after landing were extracted. Principal component analysis (PCA) was applied to the vGRF data, selecting 8 principal components (PCs) representing 96% of the information. Based on these 8 PCs, k-means method (k = 3) clustered the 518 trials into three clusters. Chi-square test assessed significant differences (p < 0.01) in the distribution of ankle sprain and non-ankle sprain trials among clusters. FindingsThe ankle sprain trials accounted for a significantly larger percentage (63.9%) in Cluster 3, which exhibited rapidly increased impulse vGRF waveforms with larger peaks in a short time. SignificancePCA and k-means method for vGRF waveforms during single-legged landing identified that the history of previous ankle sprains caused a loss of ankle absorption ability lasting at least 6 months from an ankle sprain.

Non-contact lower limb injuries in Rugby Union: A two-year pattern recognition analysis of injury risk factors.

The cause of sport injuries are multifactorial and necessitate sophisticated statistical approaches for accurate identification of risk factors predisposing athletes to injury. Pattern recognition analyses have been adopted across sporting disciplines due to their ability to account for repeated measures and non-linear interactions of datasets, however there are limited examples of their use in injury risk prediction. This study incorporated two-years of rigorous monitoring of athletes with 1740 individual weekly data points across domains of training load, performance testing, musculoskeletal screening, and injury history parameters, to be one of the first to employ a pattern recognition approach to predict the risk factors of specific non-contact lower limb injuries in Rugby Union. Predictive models (injured vs. non-injured) were generated for non-contact lower limb, non-contact ankle, and severe non-contact injuries using Bayesian pattern recognition from a pool of 36 Senior Academy Rugby Union athletes. Predictors for non-contact lower limb injuries included dorsiflexion angle, adductor strength, and previous injury history (area under the receiver operating characteristic (ROC) = 0.70) Dorsiflexion angle parameters were also predictive of non-contact ankle injuries, along with slower sprint times, greater body mass, previous concussion, and previous ankle injury (ROC = 0.76). Predictors of severe non-contact lower limb injuries included greater differences in mean training load, slower sprint times, reduced hamstring and adductor strength, reduced dorsiflexion angle, greater perceived muscle soreness, and playing as a forward (ROC = 0.72). The identification of specific injury risk factors and useable thresholds for non-contact injury risk detection in sport holds great potential for coaches and medical staff to modify training prescriptions and inform injury prevention strategies, ultimately increasing player availability, a key indicator of team success.

CORRELAÇÃO ENTRE TESTES FUNCIONAIS E AVALIAÇÃO ISOCINÉTICA DO JOELHO EM ATLETAS CORREDORES DE RUA

ABSTRACT Introduction: The assessment of biomechanical changes related to the lower limbs is necessary in clinical practice to measure the potential risks of injury and the influences on existing dysfunction. Biomechanical changes related to previous ankle injuries are known to influence the performance of the entire lower limb. Objective: The aim of this study was to correlate muscle strength tests, performance tests and ankle stability with the Single Hop Test (SHT). Methods: 82 amateur runners were evaluated with isokinetic tests of quadriceps and hamstring muscle strength, as well as Y Balance Test (YBT), Weight-bearing Lung Test (WBLT), and the SHT. Results: The results showed there was a significant correlation between the SHT and the YBT in subjects with hamstring/quadriceps ratio (I/Q ratio) &lt;0.55, and the length of the unilateral SHT with the peak torque of ipsilateral knee extensors. Conclusion: The study was successful in correlating the functional tests in question with the results obtained in isokinetic dynamometry. Level of Evidence V; Cross-Sectional Study.