Recurrent Sprains Research Articles

Using the app "Injurymap" to provide exercise rehabilitation for people with acute lateral ankle sprains seen at the Hospital Emergency Department-A mixed-method pilot study.

Acute lateral ankle sprains (LAS) account for 4-5% of all Emergency Department (ED) visits. Few patients receive the recommended care of exercise rehabilitation. A simple solution is an exercise app for mobile devices, which can deliver tailored and real-time adaptive exercise programs. The purpose of this pilot study was to investigate the use and preliminary effect of an app-based exercise program in patients with LAS seen in the Emergency Department at a public hospital. We used an app that delivers evidence-based exercise rehabilitation for LAS using algorithm-controlled progression. Participants were recruited from the ED and followed for four months. Data on app-use and preliminary effect were collected continuously through the exercise app and weekly text-messages. Baseline and follow-up data were collected though an online questionnaire. Semi-structured interviews were performed after participants stopped using the app. Results: Health care professionals provided 485 patients with study information and exercise equipment. Of those, 60 participants chose to enroll in the study and 43 became active users. The active users completed a median of 7 exercise sessions. Most of the active users were very satisfied or satisfied (79%-93%) with the app and 95.7% would recommend it to others. The interviews showed that ankle sprains were considered an innocuous injury that would recover by itself. Several app users expressed they felt insufficiently informed from the ED health care professionals. Only 39% felt recovered when they stopped exercising, and 33% experienced a recurrent sprain in the study period. Conclusion: In this study, only few patients with LAS became active app users after receiving information in the ED about a free app-based rehabilitation program. We speculate the reason for this could be the perception that LAS is an innocuous injury. Most of the patients starting training were satisfied with the app, although few completed enough exercise sessions to realistically impact clinical recovery. Interestingly more than half of the participants did not feel fully recovered when they stopped exercising and one third experienced a recurrent sprain. https://clinicaltrials.gov/ct2/show/NCT03550274, preprint (open access): https://www.medrxiv.org/content/10.1101/2022.01.31.22269313v1.

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.

Effect of Arthroscopically Confirmed Syndesmotic Widening on Outcome Following Isolated Broström Operation for Chronic Lateral Ankle Instability.

Tibiofibular syndesmosis (TFS) widening sometimes is not evident on radiography but can be found under arthroscopy in chronic lateral ankle instability (CLAI). This study aimed to evaluate the effect of TFS widening severity on clinical outcomes and return to activities after isolated Broström operation in CLAI patients and to propose an indication for its surgical intervention. A total of 118 CLAI patients undergoing diagnostic ankle arthroscopy and open Broström-Gould operation were included. Based on the middle width of TFS measured under arthroscopy, patients were divided into the TFS-2 group (≤2 mm, n = 44), the TFS-3 group (2-4 mm, n = 42), and the TFS-4 group (≥4 mm, n = 32). The time to return to recreational sport and work, Tegner activity score, and proportion of returning to preinjury sports at the final follow-up were evaluated and compared. Other subjective evaluations included the American Orthopaedic Foot & Ankle Society score, visual analog scale, and Karlsson-Peterson score. Among the 3 groups, the TFS-4 group demonstrated the longest mean time to return to work and recreational sports, with the lowest proportion returning to preinjury sports. The TFS-4 group showed a significantly higher rate of sprain recurrence (12.5%) than the other 2 groups (P =.021). All the other subjective scores significantly improved after the operation without differences among the 3 groups. Concomitant severe syndesmotic widening adversely affects the return to activities after Broström operation in CLAI cases. The CLAI patients with a middle TFS width ≥4 mm were associated with delayed return to work and sports, a lower proportion of returning to preinjury sports, and more sprain recurrence, which might require further surgical intervention for syndesmosis in addition to Broström surgery. Level III, retrospective cohort study.

An update on tarsal coalitions

Tarsal coalitions are anomalous connections between two or more bones in the hindfoot or midfoot secondary to embryonic failure of segmentation and differentiation of the mesenchyme. Calcaneonavicular and talocalcaneal coalitions are the most common. Although it is a congenital deformity, presentation is usually in adolescence which coincides with ossification of the coalition. Patients typically present with diffuse foot pain, calf muscle pain, recurrent ankle ligament sprains and a rigid hindfoot valgus deformity. Initial management is non-operative and may involve activity reduction, a trial of immobilization in a walking boot or cast, physiotherapy, corticosteroid injections and regular analgesia. Close to a third of patients experience symptom relief but the remaining patients with persistent symptoms will require operative intervention. Patients without degenerative joint disease undergo resection of the coalition. It is now established that an associated severe hindfoot valgus foot should be addressed at this stage to prevent inevitable future joint degeneration. The indications for joint fusion remain unclear and the tendency is to postpone this when possible until a later age. In recent years, arthroscopic resection of talocalcaneal coalitions has gained popularity, despite being technically demanding. It gives good visualization of the coalition, better postoperative pain relief and quicker improvement of the hindfoot stiffness.

Lateral Chronic Ankle Instability: A Brief Review

Abstract Lateral ankle sprain (LAS) is considered “an acute traumatic injury to the lateral ligament complex of the ankle joint as a result of excessive inversion of the rear foot or a combined plantar flexion and adduction of the foot”. Chronic ankle instability (CAI) is characterized by a history of one significant LAS, subsequent recurrent sprains, episodes of the ankle giving way, or self-reported deficits in ankle function for &gt;1 year following the initial sprain. If untreated, instability may lead to cartilage deterioration and end in degenerative ankle disease. The objective of this review is to provide recent scientific evidence on CAI. Through this article, we have tried to put some light upon a problem that causes significant morbidity to the patient by compilation of the available evidence-based concepts. The need for this article is as there is the absence of a generalized treatment algorithm, the presence of various treatment modalities, the presence of two schools of opinion regarding treatment, and the absence of comprehensive text. Years of research have identified numerous impairments associated with CAI such as decreases in range of motion, strength, postural control, and altered movement patterns during functional activities when compared to individuals with no LAS history. As a result, an impairment-based rehabilitation model was developed to treat the common impairments associated with CAI. The impairment-based rehabilitation model has been shown to be an effective rehabilitation strategy at improving both clinical and patient-oriented outcomes in patients with CAI. We have reviewed the current literature regarding diagnosis, imaging, conservative methods, surgical approaches, and rehabilitation protocols.

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

Comparison of the Effectiveness of Kinesiology Taping and Rigid Taping on Ankle Kinematics During Drop Landing in Individuals with Lateral Ankle Injury.

Lateral ankle sprain is an injury that often occurs during sports or daily life activities. Athletic tape and kinesiology tape applications are among the external support treatment options especially for athletes to support the ankle and protect it from recurrent sprains. We sought to compare the kinematic stabilization effects of different ankle taping applications on the ankle joint during drop landing in individuals with a history of unilateral lateral ankle injury. In this randomized controlled study, 30 volunteers with unilateral ankle injury were evaluated. The participants were asked to land on one leg on the involved side and the contralateral side from a 30-cm-high platform. The same practice was repeated after applying kinesiology tape and rigid tape to the injured foot. Kinematic analysis of the foot and ankle was performed by recording three-dimensional spatial position information at a speed of 240 frames per second using infrared cameras. The highest inversion angles of the involved foot at initial contact and 150 msec after initial contact were higher than those of the uninvolved side (P = .03 and P = .04, respectively). There was no significant difference in ankle kinematic values in the involved foot among kinesiology taping, athletic taping, and no taping applications (P = .74). People with lateral ankle sprains show reduced inversion during landing. There were no significant differences among kinesiology taping, athletic taping, and no taping on the injured foot in terms of ankle kinematics. Care should be taken when using taping materials as protective measures for sports activities.

Health-seeking behaviours, management practices, and return to play decisions after an ankle sprain in netball: An international cross-sectional survey of 1,592 non-elite netballers

Introduction: Ankle sprains are the most common injury in netball. Approximately three in four netballers report sustaining an ankle sprain, with half suffering recurrent sprains and two-thirds reporting moderate-severe instability. There is limited evidence on ankle sprain management and return-to-play decisions, and differences between countries have not been explored. This study aims to compare netballers' health-seeking behaviours, management practices, and return-to-play decisions after an ankle sprain and compare inter-country differences.

Talocalcaneal Coalition Resection in the Adult Population: A Systematic Review.

Tarsal coalition is a congenital malformation of the tarsal bones of the foot that typically presents with features such as pain, recurrent sprains, and flat foot in childhood. In a small number of patients, a delayed presentation may be apparent, with symptoms instead presenting in adulthood. The most commonly accepted hypothesis is that the tarsal coalition becomes more symptomatic as the coalition progressively ossifies. To this date, no author has systematically evaluated the literature to identify the best approach when surgically managing these patients, in particular concerning the resection of the coalition.This study aims to systematically review the literature, searching EMBASE, MEDLINE, Web of Science, Google Scholar, and the Cochrane Library to identify and evaluate studies that presented an outcome for resection of the adult talocalcaneal coalition. Alongside overall outcomes, details on the extent of the coalition, surgical method, post-operative regimen, and presenting symptoms were extracted for each patient studied. This was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.With 72 patients, this is the largest evaluation of an adult tarsal coalition population to date. Our findings indicate that talocalcaneal coalition in adulthood presents differently from the classical peroneal spasm found in childhood. Better scores were reported for coalitions either managed with an endoscopic approach or with interposition of the flexor hallucis longus tendon. Despite some reported benefits in the literature, a trial of conservative management or the use of a rehabilitation regimen had a limited impact on the overall patient outcome.Tarsal coalition in adulthood requires rigorous clinical evaluation to identify appropriate management options. Resection of the coalition is a safe approach to definitively managing these patients, but consideration should be given to the surgical method to ensure each patient has the best outcomes. In particular, consideration should be given to using an endoscopic approach or interposition of the flexor hallucis longus tendon in order to achieve the best patient outcomes. However, there remains a paucity of literature evaluating this demographic and further high-impact studies are required to comprehensively evaluate this population.

The effects of the tension of figure-8 straps of a soft ankle orthosis on the ankle joint kinematics while walking in healthy young adults: A pilot study

BackgroundFigure-8 straps are commonly used in ankle orthoses, which are provided to reduce the risks of primary and recurrent sprain by providing functional support. Functional treatment with ankle orthoses can provide better rehabilitation than immobilization for a mild ankle sprain. However, it is not known how much tension should be applied to the straps while donning the orthosis to optimize its effectiveness. Research questionThe aim of this study was to investigate the effects of figure-8 strap tension of a soft ankle orthosis on ankle joint kinematics in the sagittal, coronal, and transverse planes during gait in healthy young adults. MethodsTen healthy adults (five males and five females) were enrolled in this study. The 3-dimensional motion analysis system was used to evaluate the ankle kinematics of the participants during gait under five conditions: no soft ankle orthosis, soft ankle orthosis with no figure-8 straps tension (lace-up only), 50 N, 80 N, and 110 N tension of the figure-8 straps, respectively. All participants walked in a straight path at a comfortable speed. ResultsPlantarflexion angles were significantly reduced with 110 N of tension in the figure-8 straps when compared to the lace-up only and a moderate correlation with r = 0.34 (p = 0.03) was observed between the tensions of figure-8 straps and maximum plantarflexion angles at pre-swing of a gait cycle. No significant effects on ankle joint angles were demonstrated in the coronal and transverse planes. SignificanceThis study showed that increasing the tension of the figure-8 straps could restrict the ankle joint plantarflexion angle during pre-swing in gait. However, it might not affect inversion/eversion or internal/external rotation angles of the ankle joint in individuals without ankle pathologies.

A new mouse model of ankle instability induced by multiple mechanical sprains with controlled inversion angle and speed.

Ankle sprain occurs by a sudden and extreme inversion and plantarflexion at the ankle joint to cause ligamentous injuries. A portion of ankle sprain patients experience recurrent ankle sprains and develop chronic ankle instability (CAI). The present CAI animal models are single events with severe ligamentous injury using surgical transection of ligaments or manually overextending the ankle. Purpose: To simulate the mechanical and recurrent sprain injuries in CAI patients, we established a new ankle instability model with multiple ankle injuries using a self-designed machine to sprain the ankle with a controlled inversion angle and speed. Methods: Male C57BL/6J mice were used and respectively subjected to a sham operation, calcaneofibular ligament (CFL) transection, and mechanical ankle sprains. Three mechanical sprains were performed on the 13th and 185th day after the initial mechanical ankle sprain. Results: The first mechanical sprain and CFL transection induced ankle injury as indicated by an average of a 62% decrease in ankle pressure pain threshold and a 114% increase in the ankle thickness compared with the contralateral untreated ankle. The second and third mechanical sprains induced recurrent ankle injuries. The foot slips during beam tests were increased after mechanical ankle sprains but not after CFL transection, indicating the induction of motor balance deficits. Multiple mechanical ankle sprains induced significant gait changes in longer duration of stance (an average of 194% increase), swing (134%), and step cycle (147%) compared with CFL transection or sham operation, and slower walking speed (78% reduction) and shorter step distance (91%) after the third sprain. Conclusion: These results elucidate that multiple mechanical sprains, which induce recurrent ankle injuries, balance deficits, and gait changes, are a good model for investigating the mechanisms of CAI induced by recurrent sprain injuries.

Biomechanical Characteristics of the Support Leg During Side-Foot Kicking in Soccer Players With Chronic Ankle Instability

Background:Chronic ankle instability (CAI) in soccer players can increase the risk of recurrent ankle varus sprains and damage the articular surface of the ankle joint, thus increasing the risk of osteoarthritis. It is important to understand the biomechanical characteristics of the support leg during kicking in soccer players with CAI.Purpose/Hypothesis:The purpose of this study was to clarify the kinematics of the kicking motion of soccer players with CAI. It was hypothesized that at the point before ball contact when the support leg makes flat-foot contact with the ground, soccer players with CAI will land with ankle inversion in the support leg during a side-foot kick compared with players without CAI.Study Design:Controlled laboratory study.Methods:The study cohort included 19 male college soccer players (mean age, 20.5 ± 0.9 years) with greater than 8 years of soccer experience who were recruited from August 2019 to March 2020. Of these athletes, 10 had CAI and 9 had no CAI in the support leg, as diagnosed according to the Cumberland Ankle Instability Tool. Kinematic data for the trunk, hip, knee, and foot of the support leg during a side-foot kick were obtained using a 3-dimensional, motion-analysis system. The Mann-Whitney U test or Student t test was selected to identify differences in variables between the CAI and non-CAI groups.Results:There were no significant differences in physical characteristics between the CAI and non-CAI groups. At the point when the support leg made flat-foot contact with the ground, the players with CAI had more eversion of the hindfoot with respect to the tibia (-28.3° ± 12.1° vs -13.9° ± 14.2°; P = .03), a more varus alignment of the knee (26.0° ± 10.7° vs 13.7° ± 10.5°; P = .03), and a lower arch height index (0.210 ± 0.161 vs 0.233 ± 0.214; P = .046) compared with non-CAI players.Conclusion:Significant differences between players with and without CAI were seen in the support leg kinematics at flat-foot contact with the ground during the kicking cycle.Clinical Relevance:The biomechanical alignment of the support leg during a side-foot kick in players with CAI may reflect a subconscious attempt to avoid inversion of the foot and further ankle sprains.

Anatomic reconstruction using the autologous gracilis tendon achieved less sprain recurrence than the Broström-Gould procedure but delayed recovery in chronic lateral ankle instability.

To compare the return-to-activity and long-term clinical outcomes between anatomic lateral ligament reconstruction using the autologous gracilis tendon and modified Broström-Gould (MBG) procedure in chronic lateral ankle instability (CLAI). It was hypothesised that there was no difference between the two techniques. From 2013 to 2018, 30 CLAI patients with grade III joint instability confirmed by anterior drawer test underwent anatomic reconstruction of lateral ankle ligament with the autologous gracilis tendon (reconstruction group) in our institute. Another 30 patients undergoing MBG procedure (MBG group) were matched in a 1:1 ratio based on demographic parameters. The post-operative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) pain score, Tegner activity score, Karlsson-Peterson score, surgical complications, return-to-activities and work were retrospectively evaluated and compared between the two groups. All subjective scores significantly improved after the operation (all with p < 0.001) without difference between the two groups (all n.s.). The MBG group showed a significantly higher proportion of postoperative sprain recurrence than the reconstruction group (26.7% vs. 0, p = 0.002). The reconstruction group showed a significantly longer period to start walking with full weight-bearing (10.5 ± 6.9 vs. 7.0 ± 3.1weeks, p = 0.015), jogging (17.1 ± 8.9 vs. 12.7 ± 6.9weeks, p = 0.043) and return-to-work (13.5 ± 12.6 vs. 8.0 ± 4.7weeks, p = 0.039) than the MBG group. Both anatomic reconstruction using the autologous gracilis tendon and MBG procedure could equally achieved reliable long-term clinical outcomes and the tendon reconstruction showed a relatively lower incidence of postoperative sprain recurrence but delayed recovery to walking, jogging and return-to-work. The MBG procedure was still the first choice with rapid recovery but the tendon reconstruction was recommended for patients with higher strength demand. III.

Simultaneous Treatment of Osteochondral Lesion Does Not Affect the Mid- to Long-Term Outcomes of Ligament Repair for Acute Ankle Sprain: A Retrospective Comparative Study with a 3-11-Year Follow-up.

PurposeThis study aims to evaluate the mid- to long-term outcome of concurrent arthroscopic treatment of osteochondral lesion (OCL) and open anatomical repair of lateral ankle ligaments for severe acute ankle sprain patients and compare them to the outcome of those without OCL.MethodsA total of 166 patients with grade III acute lateral ankle ligament injuries underwent concurrent ankle arthroscopy and open anatomic ligament repair. Forty-three patients (group A) with OCL underwent arthroscopic treatment followed by open ligament repair. A total of 105 patients (group B) without OCL were followed up as the control. The evaluation parameters included sports recovery, postoperative visual analog scale (VAS) pain score, American Orthopaedic Foot and Ankle Society (AOFAS) score, Tegner score, sprain recurrence, satisfaction, and range of motion. Patients in group A were then subgroup-analyzed according to age, sex, body mass index, injury side, OCL location, and stage (Ferkel and Cheng’s staging system).ResultsThe postoperative exercise level of the two groups recovered to more than 90% of the normal level (91.2% ± 11.2% in group A and 90.9% ± 13.3% in group B, n.s.). The average time of group A and group B to return to preinjury sports activity was respectively 4.4 ± 1.0 months and 4.4 ± 1.2 months with no significant difference (p = 0.716). No significant differences were found in the preoperation VAS pain score, AOFAS score, and Tegner score between the two groups. The postoperative VAS pain score in group A was significantly higher than that in group B (0.8 ± 1.7 vs. 0.3 ± 0.8, p = 0.027), but the difference was not clinically important. The postoperative VAS pain score of patients with stage D–F lesions was significantly higher than that of patients with stage B–C lesions (1.3 ± 2.1 vs. 0.3 ± 0.9, p = 0.038).ConclusionsFor the severe acute ankle sprain combined with OCL, the simultaneous arthroscopic treatment and open lateral ankle ligament repair achieved good mid- to long-term outcomes. Except that the pain was more pronounced than in the control group, there were no differences in other outcomes. Postoperative pain was positively correlated with the grade of OCL.

Is Kinesio Taping Effective for Sport Performance and Ankle Function of Athletes with Chronic Ankle Instability (CAI)? A Systematic Review and Meta-Analysis.

Background and Objectives: Ankle injuries are the most common type of injury in healthy active individuals. If not treated properly, recurrent sprains can lead to a condition of chronic ankle instability (CAI). The aim of the present review is to evaluate the effects of Kinesio Taping (or KT) on sports performances and ankle functions in athletes with CAI. Materials and Methods: This systematic review with meta-analysis was carried out following the criteria of the Prisma Statement system (registered on Open Science Framework, number: 10.17605/OSF.IO/D8QN5). For the selection of the studies, PubMed, Scopus and Web of Science were used as databases in which the following string was used: (“kinesiology tape” OR “tape” OR “taping” OR “elastic taping” OR “kinesio taping” OR “neuro taping”) AND (unstable OR instability) AND (ankle OR (ankle OR “ankle sprain” OR “injured ankle” OR “ankle injury”)). The Downs and Black Scale was used for the quality analysis. The outcomes considered were gait functions, ROM, muscle activation, postural sway, dynamic balance, lateral landing from a monopodalic drop and agility. Effect sizes (ESs) were synthesised as standardized mean differences between the control and intervention groups. Calculation of the 95% confidence interval (CI) for each ES was conducted according to Hedges and Olkin. Results: In total, 1448 articles were identified and 8 studies were included, with a total of 270 athletes. The application of the tape had a significant effect size on gait functions, ROM, muscle activation and postural sway. Conclusions: The meta-analysis showed a significant improvement in gait functions (step velocity, step and stride length and reduction in the base of support in dynamics), reduction in the joint ROM in inversion and eversion, decrease in the muscle activation of the long peroneus and decrease in the postural sway in movement in the mid-lateral direction. It is possible to conclude that KT provides a moderate stabilising effect on the ankles of the athletes of most popular contact sports with CAI.

What are the Injures that Lead to Post-Traumatic Ankle Osteoarthritis? A Long-Term Retrospective Analysis of 533 Patients

Category:Ankle Arthritis; Ankle; TraumaIntroduction/Purpose:Ankle osteoarthritis (AO) is an incapacitating condition for patients and a substantial burden for medical assistance. It is well known that the vast majority of AO occurs as a sequela of previous trauma. However, it is currently unknown what types of injuries of the foot and ankle most commonly lead to end-stage arthritis. Therefore, the purpose of this study was to investigate the etiology of end-stage ankle osteoarthritis in all patients who underwent ankle fusion or replacement at a tertiary care center over 20 years. We hypothesized that the most common injury patterns would correspond to low-energy lesions.Methods:The electronic medical record was queried using current procedural terminology (CPT) codes for ankle fusion or ankle replacement to identify all patients who underwent either of these procedures at a single tertiary academic center over 20 years. Etiologies were broadly grouped as Pilon/Plafond fracture, ankle fracture, talus fracture, tibia fracture, single or recurrent sprains, infection/septic joint, systemic disorder (Charcot arthropathy, rheumatoid arthritis, hemophilic arthropathy), and idiopathic/primary osteoarthritis. Each fracture pattern was then subclassified using commonly accepted classification systems by two independent observers in addition to the grade of arthritis at the time of fusion or replacement. Reliability among readers was assessed by Kleiss kappa. Normative data were analyzed by ANOVA and comparison among groups and methods by Student's T- test.Results:A total of 533 patients were included in this study. The initial injury patterns were broadly classified as pilon/plafond (65), ankle (173), sprains (110), talus (17), tibia (22), tibiotalar dislocation without fracture (1). Other identified etiologies included rheumatoid arthritis (18), Charcot arthropathy (11), progressive collapsing foot deformity (21), septic arthritis (5), and cavovarus (6). The average time interval between the initial injury and definitive treatment for end-stage arthritis was 558 days. Ankle fractures classified as 44C1 (14,1%), 44B3 (10.6%), 44B2 (9.3%) followed by pilon 43C3 (6.5%) and 43C1 (4.1%) were the most prevalent subclassification found in the fractures group.Conclusion:The primary etiology for AO is secondary due to trauma. A history of ankle sprains and instability was found in 20.6%. Fractures corresponded to 54,6% of our cohort, ankle fractures producing most of these lesions. When considering the subtype of injury, ankle fractures with a 44C1 and a 44B3 classification were the more frequent presentation. These findings could support the argument that complex low-energy rotational traumas do not carry a benign course. Comprehension of the AO etiology scenario may guide prevention policies and specific primary treatment guidelines to diminish disease impact on the population and health care system.

Distal insertion rupture of lateral ankle ligament as a predictor of weakened and delayed sports recovery after acute ligament repair: mid-term outcomes of 117 cases

BackgroundFor lateral ankle ligament rupture, surgical repair has been considered for patients requiring return to high-demanding sports. However, there is a lack of systematic research regarding arthroscopic treatment followed by ligament repair for severe acute ankle sprain. The purpose of this study was to analyze the mid-term outcomes of arthroscopy followed by open anatomic lateral ankle ligament repair surgery for acute lateral ankle sprain and the impact of ligament rupture site on the outcomes.MethodsProfessional or amateur athletes with clinically- and radiologically-confirmed grade III acute lateral ankle ligament injuries undergoing ankle arthroscopy followed by open anatomic ligament repair between June 2007 and May 2017 were reviewed. Intra-articular lesions and the location of rupture were first examined under arthroscopy. Simple suture repair was performed for mid- substance ligament rupture (middle group), while suture repair with anchors were used for the ruptures near the ligament attachment site on the fibular (proximal group), talar or the calcaneal side (distal group). Outcomes were evaluated at final follow-up, including visual analog scale (VAS) pain score, American Orthopaedic Foot & Ankle Society (AOFAS) score, Tegner score, time to return to sports, resumption of pre-injury sports level, sprain recurrence and range of motion (ROM).ResultsA total of 117 patients were included for analysis, with a mean follow-up duration of 46.4 ± 16.1 months. There were 48 (41%) cases in the proximal group, 41 (35%) cases in the middle group and 28 (24%) cases in the distal group respectively. At final follow-up, all of the VAS score, AOFAS score and the Tegner score were significantly improved from the pre-operative level (p < 0.001). 12 (10%) patients complained of sprain recurrence during follow-up. 14 (12%) patients reported mild ROM restriction and 7 (6%) patients experienced transient skin numbness. The average time to return to pre-injury sports was 4.34 ± 1.11 months. The smallest proportion (86% ± 13%) of resumption of pre-injury sports level was reported from the distal group, compared with 93% ± 12% for the proximal group and 89% ± 14% for the middle group (p = 0.037). Time to return to sports was significantly longer for the distal group, with an average of 4.59 ± 1.27 months compared to 3.99 ± 1.09 months for the proximal group and 4.58 ± 0.90 months for the middle group (p = 0.009).ConclusionsAnkle arthroscopy followed by open anatomic ligament repair is a reliable procedure for patients requiring return to high demanding sports after severe acute ankle sprains. Distal rupture near the talar or calcaneal end was associated with delayed return-to-sport and inferior performance in resuming pre-injury sports level.

The L-shaped tunnel technique showed favourable outcomes similar to those of the Y-graft technique in anatomic lateral ankle ligament reconstruction.

To compare the mid- to long-term clinical and radiological outcomes of the confluent L-shaped tunnel technique with the Y-graft technique for anatomic lateral ankle ligament reconstruction. This retrospective study involved 41 patients who underwent lateral ankle ligament reconstruction between 2013 and 2018. Based on the tunnel direction and tendon fixation method at the fibula side, patients were divided into two groups, with 17 patients in the L-shaped tunnel group and 24 patients in the Y-graft group. The American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) pain score, Tegner score, and Karlsson score were evaluated and compared preoperatively and at follow-up. Anterior talar translation and talar tilt at stress radiographs, postoperative sprain recurrence, range of motion (ROM) restriction, sensory disturbance, etc., were also collected and compared. The mean follow-up times were 72 and 42months for the L-shaped group and Y-graft group, respectively. The median VAS pain score, Tegner score, AOFAS score, Karlsson score significantly improved from a preoperative level in both groups (all with p < 0.01). No significant difference was found between the two groups regarding the changes from preoperatively to postoperatively except for the VAS pain score reduction (1.58 ± 1.58 in the L-shaped group vs. 2.53 ± 1.29 in the Y-graft group, p = 0.035). The incidence of flexion-extension ROM restriction (≥ 5°) was significantly higher in the Y-graft group (41.2%) than in the L-shaped group (12.5%) (p = 0.035). Both the confluent L-shaped tunnel technique and the Y-graft technique significantly improved symptoms, ankle function, and radiographic outcomes in patients with chronic lateral ankle instability (CLAI) at mid- to long-term follow-up. The confluent L-shaped tunnel technique resulted in lower rates of flexion-extension ROM restriction, while the Y-graft technique showed better VAS pain reduction. This result could provide further evidence for the surgical treatment of CLAI. III.

Validation of Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) in individuals with chronic ankle instability: a cross-sectional observational study

BackgroundAnkle sprain is the most common lower limb injury in physically active individuals. Loss of function, decreased postural control (PC), strength deficit, and reduced range of motion (ROM) are common after acute lateral ankle sprains. Some patients experienced long lasting symptoms, with recurrent sprains, and episodes of giving-way: a condition known as chronic ankle instability (CAI). Evaluating the function in patients with CAI in the clinical environment is important to identify the severity of the condition, in addition to allowing to assess the effectiveness of a given treatment. The aim of this study was to investigate the validation of the Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) in terms of muscle strength, PC and ROM in adults with CAI.MethodsThis is a cross-sectional study. Individuals with CAI aged between 18 and 45 years were eligible. Individuals with CAI were identified using the Identification of Functional Ankle Instability (IdFAI). All patients filled in the FAAM and FAOS scores. Muscle strength was assessed by manual dynamometry, ROM by the Lunge test, PC by computerized posturography, modified Star Excursion Balance Test (mSEBT) and modified Balance Error Score System (mBESS).Results50 participants were enrolled in the present study. The mean age of the patients was 27.2 ± 6.3 years, and the mean body mass index was 26.4 ± 4.8 kg/m2. 58% (29 of 50) were men and 42% (21 of 50) women. 18 individuals had unilateral (36%) and 32 bilateral (64%) CAI. The results of FAAM were associated with MCT, mSEBT, invertor muscles strength, plantar flexor muscles strength, dorsiflexor muscles strength, and external hip rotator muscles strength (P < 0.05). The results of FAOS were associated with mSEBT, invertor muscles strength, plantar flexor muscles strength, dorsiflexor muscles strength, evertor muscles strength, and external hip rotator muscles strength, and mBEES (P < 0.05).ConclusionBoth the FAAM and FAOS demonstrated validity to evaluate postural control and muscle strength in patients with CAI, while no association was found in relation to ankle dorsiflexion.

The effectiveness and sustainability of supervised balance training in chronic ankle instability with grade III ligament injury: a one-year prospective study

BackgroundTo determine the effectiveness and sustainability of supervised balance training in people with chronic ankle instability (CAI) with grade III ligament injury.MethodsTwenty young adults (12 males and 8 females) diagnosed with CAI with grade III ligament injury underwent 3 months of supervised balance training. The self-reported functional questionnaire, plantar pressure (walking and single leg standing), and isokinetic ankle strength were consecutively evaluated at pre-training, 3 months, 6 months and one year. Paired T tests were used to explore changes in muscle strength and plantar pressures following the supervised balance training. According to whether the patient had sprain recurrence, the patients were divided into sprain recurrence group and control group. The risk factors of sprain recurrence were explored with univariate analysis and multivariable logistic regression.ResultsThe self-reported functional scores, the plantar pressure distribution and the muscle strength showed significant immediate improvements after 3 months of supervised balance training. At 6 months post-training, peak force under 2nd metatarsal, time to peak force under the medial hindfoot, time to boundary measurements and dorsiflexion, and eversion strength were partly declined to the pre-training level. 16 patients (80%) resumed the daily life and sports without sprain recurrence during the follow-up. Four patients (20%) reported ankle sprain during the follow-up, and the sprain recurrence group showed significantly higher Beighton scores (p = 0.012) and weaker initial inversion strength (p = 0.022) than the control group.ConclusionsThree months’ of supervised balance training could effectively improve postural control and muscle strength of CAI cases with grade III ligament injury, although these improvements would partially deceased over time. Additional strength exercises for dorsiflexion and eversion should be supplemented from 6 months. Higher Beighton score and initial inversion muscle strength weakness might increase the risk of sprain recurrence.Trial registrationChiCTR, ChiCTR1900023999, Registered 21 June 2019, https://www.chictr.org.cn/edit.aspx?pid=39984&htm=4