Recurrent Sprains Research Articles

Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis

BackgroundAnkle sprains are highly prevalent with high risk of recurrence. Consequently, there are a significant number of research reports examining strategies for treating and preventing acute and recurrent sprains (otherwise...

Epidemiological Patterns of Ankle Sprains in Youth, High School, and College Football

Background: Variations in ankle injury rates and distributions among competition levels are unclear, but such data may help inform strategies to prevent ankle sprains during American football. Purpose: To describe the epidemiological patterns of ankle sprains in youth, high school (HS), and collegiate American football. Study Design: Descriptive epidemiological study. Methods: Data regarding youth, HS, and college football athletes were collected from 3 injury surveillance programs: (1) the Youth Football Safety Study (YFSS), (2) the National Athletic Treatment, Injury and Outcomes Network (NATION), and (3) the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP). During the 2012-2014 seasons, the YFSS, NATION, and NCAA ISP included 310, 184, and 71 football team-seasons, respectively. Athletic trainers (ATs) attended each practice and game and reported injuries and athlete-exposures (AEs) via their preferred injury documentation application. Ankle sprain rates for each type of ankle sprain were calculated overall, by event type (ie, practices and games), and specifically for severe injuries (ie, participation restriction time >21 days) and recurrent injuries (as defined by ATs). Rate ratios (RRs) were used to compare ankle sprain rates by competition level and event type. Injury proportion ratios (IPRs) were used to compare differences in severity, surgical needs, recurrence, injury mechanism, and injury activity by competition level. RRs and IPRs with 95% confidence intervals excluding 1.00 were considered statistically significant. Results: A total of 124, 897, and 643 ankle sprains were reported in youth, HS, and college football, respectively. This led to respective rates of 0.59, 0.73, and 1.19 sprains per 1000 AEs. The ankle sprain rate in college football was higher than the rates in HS (RR = 1.64; 95% CI, 1.48-1.82) and youth (RR = 2.01; 95% CI, 1.65-2.43) football. The proportion of ankle sprains that were recurrent in youth football was higher than the proportions in HS (IPR = 2.73; 95% CI, 1.68-4.50) and college (IPR = 2.19; 95% CI, 1.33-3.61) football. Conclusion: Ankle sprain rates were highest in college athletes. However, level-specific variations in ankle sprain severity and recurrence may highlight the need to develop level-specific policies and prevention strategies to reduce injury incidence.

Long-term prognosis of acute lateral ankle ligamentous sprains: high incidence of recurrences and residual symptoms.

Acute lateral ankle ligamentous sprains (ALALS) are common injuries. This injury does not always have a favourable long-term outcome. Studies reporting the prognosis of ALALS after functional treatment are scarce. To determine the prognosis of functionally treated ALALS, in terms of recurrent ALALS and residual symptoms. Retrospective cohort study. Patients were recruited from 20 family practices, nine physical therapy practices, the emergency departments of a regional hospital and a university hospital. Adult patients with an ALALS caused by an inversion trauma were invited to participate in this study 2.5-5 years after their initial injury. Functional treatment of the initial ALALS. Acute lateral ankle ligamentous sprain recurrences and residual symptoms. A total of 44 patients were included, with an average follow-up period after the initial ankle sprain of 204 weeks (range 150-274 weeks). Eight patients (18.1%) had reinjured their ankle. Explicit pain around the ankle joint at physical examination was experienced by 45.5%. Clinical symptoms of anterior ankle impingement were present in 25% (all athletes), with radiologically confirmed tibiotalar osteophyte bone formation in 82% of them. A large proportion of patients with ALALS experience recurrences and persistent symptoms after their initial ankle injury. The high percentage of patients with anterior ankle impingement syndromes illustrates the need for early assessment of this impairment in patients with persistent complaints.

Peroneal electromechanical delay and fatigue in patients with chronic ankle instability.

The purpose of this study was to investigate the effect of chronic ankle instability (CAI) on electromechanical delay times (EMD) before and after fatigue. Understanding the mechanisms that contribute to CAI is essential for the development of effective rehabilitation programmes. It was hypothesized that patients with CAI will demonstrate prolonged EMD times compared to healthy subjects and that fatigue will cause greater increases in EMD times in the CAI group. Twenty-one male volunteers participated in the study providing data on 16 ankles with CAI and 26 with no history of ankle injury. EMD was measured on an isokinetic dynamometer. Measurements were taken with the ankle in neutral (0°) and at 30° of inversion. All subjects followed an isokinetic fatigue protocol until eversion torque fell below 50% of initial torque for three consecutive repetitions. A 2×2×2 ANOVA was used to calculate the effect of ankle status (CAI vs. healthy), fatigue, angle (0° vs. 30°) and their interactions on EMD. Fatigue caused a significant increase on EMD [non-fatigued: 122(29)ms vs. fatigue 155(54)ms; p<0.001]. EMD times were shorter at 30° of inversion compared to neutral [neutral: 145(39)ms vs. 30° of inversion: 132(40)ms, p=0.015]. An interaction effect for ankle status and angle was found (p=0.026) with CAI ankles demonstrating longer EMD [CAI: 156(45)ms vs. healthy: 133(40)ms] in neutral but not at 30° of inversion [CAI: 133(46)ms vs. 132(33)ms]. Patients with CAI had longer EMD times in neutral, but not when the ankle was placed in inversion. This suggests that rehabilitation programmes may be more effective when retraining occurs with the ankle in neutral position. It is likely that low EMD times prevent ankle acceleration at the beginning of the mechanism of injury, but they are less important when the ankle has already inverted at 30°. Both CAI and healthy subjects demonstrated longer EMD after fatigue, emphasizing the importance of proper conditioning in the prevention of delayed peroneal response and subsequent ankle injury. Improving resistance to fatigue of the peroneals may prove to be an effective prevention tool of ankle sprain recurrence in patients with CAI. III.

Diminished Foot and Ankle Muscle Volumes in Young Adults With Chronic Ankle Instability.

Background:Patients with chronic ankle instability (CAI) have demonstrated altered neuromuscular function and decreased muscle strength when compared with healthy counterparts without a history of ankle sprain. Up to this point, muscle volumes have not been analyzed in patients with CAI to determine whether deficits in muscle size are present following recurrent sprain.Purpose:To analyze intrinsic and extrinsic foot and ankle muscle volumes and 4-way ankle strength in young adults with and without CAI.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Five patients with CAI (mean age, 23.0 ± 4 years; 1 male, 4 females) and 5 healthy controls (mean age, 23.8 ± 4.5 years; 1 male, 4 females) volunteered for this study. Novel fast-acquisition magnetic resonance imaging (MRI) was used to scan from above the femoral condyles through the foot and ankle. The perimeter of each muscle was outlined on each axial slice and then the 2-dimensional area was multiplied by the slice thickness (5 mm) to calculate the muscle volume. Plantar flexion, dorsiflexion, inversion, and eversion isometric strength were measured using a handheld dynamometer. Patients with CAI were compared with healthy controls on all measures of muscle volume and strength. Extrinsic muscle volumes of patients with CAI were also compared with a normative database of healthy controls (n = 24) by calculating z scores for each muscle individually for each CAI subject.Results:The CAI group had smaller total shank, superficial posterior compartment, soleus, adductor hallucis obliqus, and flexor hallucis brevis muscle volumes compared with healthy controls as indicated by group means and associated 90% CIs that did not overlap. Cohen d effect sizes for the significant group differences were all large and ranged from 1.46 to 3.52, with 90% CIs that did not cross zero. The CAI group had lower eversion, dorsiflexion, and 4-way composite ankle strength, all with group means and associated 90% CIs that did not overlap. No other significant differences were identified.Conclusion:Patients with CAI demonstrate atrophy of intrinsic and extrinsic foot and ankle musculature accompanied by lower ankle strength.Clinical Relevance:Clinicians should be aware of the muscle atrophy and strength deficits when prescribing rehabilitation for patients with lateral ankle sprain or CAI.

The Prevalence of Selected Intrinsic Risk Factors for Ankle Sprain Among Elite Football and Basketball Players.

BackgroundLateral ankle sprains (LAS) are among the most common sports- related injuries and the reinjury rate is very high.ObjectivesThis study aimed to evaluate the prevalence of some intrinsic risk factors among professional football and basketball players with or without history of acute or recurrent ankle sprain.Patients and MethodsOne hundred and six professional football and basketball players who were referred for pre-participation examinations were recruited in this study. Prepared checklist was completed for each participant. Athletes were asked for any history of previous ankle sprain and the severity (based of self-description of signs and symptoms by the athlete), level and number of injuries in the last two years. All players were assessed for measures of foot posture index- 6, foot length and width, Beighton generalized joint laxity score, anterior drawer and talar tilt tests, star excursion and single leg balance tests and goniometric assessment of ankle plantarflexion, ankle dorsiflexion and first metatarsophalangeal dorsiflexion.ResultsForty eight basketball players (45.3%) and 58 football players (54.7%) with mean (SD) age of 19.8 (4.5) years participated. About 58.5% and 14.2% of athletes had a history of ankle sprain and recurrent sprain in at least one extremity, respectively. Sprains were more prevalent in basketball players and in dominant leg. There was no significant difference in assessed risk factors between athletes with and without history of ankle sprain, except for positive single leg balance test which was more prevalent in athletes with history of ankle sprain and also for positive talar tilt test and decreased ankle plantarflexion range of motion in acute and recurrent injury of left ankle.ConclusionsSome intrinsic risk factors including lateral ankle ligaments laxity, balance and ankle plantarflexion seem to be related to acute or recurrent LAS in athletes. Further research is needed to reveal the role of different arthrokinematics following lateral ankle sprain.

Evaluation Of Smartphone-Based Assessment System In Chronic Ankle Instability

Ankle sprains are the most common sports-related injury. About 80% subjects suffer recurrent sprains. Repeated injuries may cause chronic ankle instability, which will affect sports efficacy and postural control ability. In recent years, smartphones had become very popular and powerful devices, and been showed to have good validity on measuring range of motion and assessing gait patterns. The purpose of this study is to evaluate the feasibility of smartphone-based system in postural control ability assessment on chronic ankle instability. METHODS: Fifteen subjects (6 male, 9 female; age=23.4±5.28 y/o) who have at least one leg scoring lower than 27 points in Cumberland Ankle Instability Tool were recruited. ASUS Zenfone 2 smartphone was used to conduct the postural control assessment, by recording its built-in accelerometer data with an App developed using MIT App inventor. Subjects performed single leg stance for 20 seconds in eyes-open and eyes-closed conditions with each leg. The smartphone was fixed on the middle of shin with an exercise armband. The average of recorded acceleration data was used to represent the postural control performance, and the higher value indicated more instability. Data was analyzed with paired t-test with SPSS 17.0, and statistical significance was set as alpha < 0.05. RESULTS: Significant difference was found between sound leg and injured leg under both eyes-open and eyes-closed conditions (eyes-open: sound leg 0.051±0.018 vs injured leg 0.072±0.034, p=0.027; eyes-closed: sound leg 0.100±0.031 vs injured leg 0.123±0.038, p=0.001, unit: g). Significant difference was also found between eyes-open and eyes-closed conditions under both single leg standing with sound leg and injured leg (sound leg: eyes-open 0.051±0.018 vs eyes-closed 0.100±0.031, p<0.001; injured leg: eyes-open 0.072±0.034 vs eyes-closed 0.123±0.038, p=0.001, unit: g). The results demonstrate that the smartphone can be used to discriminate the different performance between sound leg and injured leg, and also between eyes-open and eyes-closed conditions. CONCLUSION: The study shows that smartphone may have the potential to be a convenient, easy-used and valid tool for assessment of postural control ability on chronic ankle instability.

Four Weeks of Balance Training does not Affect Ankle Joint Stiffness in Subjects with Unilateral Chronic Ankle Instability.

Balance training has been shown to be effective in preventing ankle sprain recurrences in subjects with chronic ankle instability (CAI) but the biomechanical pathways underlying the clinical outcomes are still unknown. This study was conducted to determine if a 4-week balance training intervention can alter the mechanical characteristics in ankles with CAI. Twenty-two recreationally active subjects with unilateral CAI were randomized to either a control (n = 11, 35.1 ± 9.3 years) or intervention (n = 11, 33.5 ± 6.6 years) group. Subjects in the intervention group were trained on the affected limb with static and dynamic components using a Biodex balance stability system for 4-weeks. The ankle joint stiffness and neutral zone in inversion and eversion directions on the involved and uninvolved limbs was measured at baseline and post-intervention using a dynamometer. At baseline, the mean values of the inversion stiffness (0.69 ± 0.37 Nm/degree) in the involved ankle was significantly lower (p < 0.011, 95% CI [0.563, 0.544]) than that of uninvolved contralateral ankle (0.99 ± 0.41 Nm/degree). With the available sample size, the eversion stiffness, inversion neutral zone, and eversion neutral zone were not found to be significantly different between the involved and uninvolved contralateral ankles. The 4-week balance training intervention failed to show any significant effect on the passive ankle stiffness and neutral zones in inversion and eversion. Decreased inversion stiffness in the involved chronic unstable ankle was found that of uninvolved contralateral ankle. The 4-week balance training program intervention was ineffective in altering the mechanical characteristics of ankles with CAI. Randomized controlled clinical trial; Level of evidence, 1.

EFFECT OF ANKLE BRACING ON RECURRENCE OF ANKLE SPRAIN IN MALE FOOTBALL PLAYERS

Abstract Background and purpose of study: Ankle injuries are among the most common sports-related injuries, accounting for up to 20% of injuries. Ankle sprains account for 33–73% of ankle injuries. The aim of this study was to evaluate the effectiveness of ankle bracing in preventing recurrences of ankle sprains, especially in male soccer players. Methods: A randomized controlled study was conducted in Prince Sattam bin Abdul Aziz University. 30 football players in university football team aged 18 to 23 years were obtained between November 2014 and May 2015, 15 were randomly selected to the study group (Ankle bracing group) and 15 to the control group (Untreated group without bracing). Subjects: All football players who had suffered from past history of ankle sprain (30 players) were identified as subjects. Measurements: Each previously injured ankle (n = 30) was considered as a case for the analysis. Ankles that had a past sprain received one of two groups; ankle bracing group (n = 15) and untreated group (n = 15). Results: There was significant difference between intervention group and control group. Ankle sprain recurrence frequency was 0% and 27% for the braced and control group, respectively. The recurrence incidence for the braced group was significantly fewer than that of the control group. Conclusions: It was concluded that this study suggest that ankle bracing is effective in preventing the incidence of ankle sprains in male football players with a past history of ankle sprains.

History-dependent changes in the recovery process of the middle latency cutaneous reflex gain after ankle sprain injury.

We previously reported that suppressive middle latency cutaneous reflexes (MLRs) in the peroneus longus (PL) are exaggerated in subjects with chronic ankle instability, and the changes are related to functional instability. However, the time-varying history of these neurophysiological changes after an ankle sprain is yet to be elucidated. Therefore, in the present study, we investigated the time course of the changes in the PL MLR after an ankle sprain in relation to the number of sprain recurrences. Twenty-three subjects with ankle sprain were classified into 3 groups according to their history of ankle sprain: first ankle sprain, 2-3 ankle sprains, and ≥4 ankle sprains. Twenty-three age-matched control subjects also participated. The PL MLRs were elicited by stimulating the sural nerve while the subjects performed different levels of isometric ankle eversion. Gain of MLR was estimated using linear regression analysis (slope value) of the amplitude modulation of MLRs obtained from graded isometric contractions. The gain of MLRs first increased 4 weeks after the injury. In subjects with their first ankle sprain, the MLRs returned to almost baseline levels after 3 months. In contrast, the increase in MLR gain persisted even after 3 months in subjects with recurrent ankle sprains. In addition, the MLR gains were closely related to functional recovery of the ankle joint. Our findings suggest that the recovery process of MLR gains were strongly affected by the history of ankle sprains as well as the functional recovery of the ankle joint.

Can balance training affect the ankle joint stiffness in subjects with unilateral chronic ankle instability?

Background: Lateral ankle sprain is one of the most frequent sports-related injuries, accounting for up to 60% of all athletic injuries. The development of repetitive ankle sprains and persistent residual symptoms such as repeated episodes of ankle giving way, pain, weakness, loss of function, and feeling of ankle instability after injury has been termed chronic ankle instability (CAI). The signs and symptoms of initial injury often resolve with time but mechanical joint laxity may last longer leading to residual symptoms. Balance training has been shown to be effective in preventing ankle sprain recurrences in subjects with CAI but the biomechanical and/or neurophysiological pathways underlying the clinical outcomes are still unknown. Balance training is routinely used in clinical practice for sprained ankles, however to our knowledge, only one study has examined the effects of balance training intervention on flexibility characteristics of the ankle joint in patients with CAI. Purpose: This study was conducted to determine if a 4week balance training intervention can alter the mechanical characteristics in ankles with CAI. Methods: Twenty-two recreationally active subjects with unilateral CAI were randomized to either a control (n= 11, 35.1± 9.3 years) or intervention (n= 11, 33.5± 6.6 years) group. Subjects in the intervention group were trained on the affected limb with static and dynamic components using a Biodex balance stability system for 4-weeks. The ankle joint stiffness and neutral zone in inversion and eversion directions on the involved and uninvolved limbs was measured at baseline and post-intervention using a dynamometer. Results:Atbaseline, themeanvalues of the inversion stiffness (0.69± 0.37Nm/degree) in the involved ankle was significantly lower (p< 0.011, 95% CI [0.563, 0.544]) than that of uninvolved contralateral ankle (0.99± 0.41Nm/degree). With the available sample size, the eversion stiffness, inversion neutral zone, and eversion neutral zone were not found to be significantly different between the involved and uninvolved contralateral ankles. The 4-week balance training intervention failed to show any significant effect on the passive ankle stiffness and neutral zones in inversion and eversion. Conclusion(s): Decreased inversion stiffness in the involved chronic unstable ankle was found that of uninvolved contralateral ankle. The 4-week balance training program intervention was ineffective in altering the mechanical characteristics of ankles with CAI. Implications:Traditionally, taping and bracing have been used to improve stability and prevent recurrent ankle injury in patients with CAI. However, the beneficial effects of ankle taping have been attributed to enhanced proprioception and mechanical restriction, but there is no indication of restoring ligamentous stability. Further research with additional stiffness measures along with functional tests, larger sample size, and progressive balance training exercises is needed to identify if the mechanical characteristics of chronic unstable ankles can be altered.

A snapshot of chronic ankle instability in a cohort of netball players.

Ankle injuries account for the highest percentage of injuries in netball, yet the chronic nature of ankle sprains is under reported within this population group. Chronic ankle instability is a term used to describe certain insufficiencies that persist after an acute ankle sprain. The aim of this study was to investigate recurrent sprain, perceived ankle instability and mechanical ankle instability in a cohort of netball players. Cross-sectional study. Ninety-six female netball players (24.1±7.9 years) were recruited (42 club players and 54 inter-district players). Recurrent sprain was defined as two or more lifetime sprains to the same ankle. Perceived ankle instability was quantified with the Cumberland Ankle Instability Tool - Youth. Mechanical ankle instability was quantified via inversion-eversion rotations using an ankle arthrometer at torques of 3Nm. Forty-seven percent of the cohort had recurrently sprained an ankle. Of the 69 players with a previously sprained ankle, 64% had a moderate-severe degree of perceived ankle instability. The total inversion-eversion angle was 31.1±8.7 degrees. Club players had more cases of moderate-severe perceived ankle instability (p=0.01) and larger inversion-eversion angles (p=0.001) compared to inter-district players. Recurrent ankle sprain and perceived ankle instability are easily identifiable aspects of chronic ankle instability shown to be prevalent within this cohort. Additional research is required to quantify a cut-off value for mechanical instability. Club netball players were found to have more counts of moderate-severe perceived ankle instability and larger inversion-eversion angles when compared to the inter-district netball players.

Epidemiology of Ankle Sprains and the Risk of Separation From Service in U.S. Army Soldiers.

Retrospective cohort study. To report the incidence rate of ankle sprains in active-duty soldiers and to examine if soldiers who sustain ankle sprain injuries are more likely to leave the Army than those who do not sustain an ankle sprain. Ankle sprains are one of the most common musculoskeletal injuries in physically active people and have been identified as the most common foot or ankle injury in active-duty Army personnel, with a rate of 103 sprains per 1000 soldiers per year. Data were analyzed on the entire active-duty US Army population from 2000 to 2006 (n = 1 014 042). A semi-parametric Cox proportional hazard model was built. The overall incidence rate for ankle sprains was 45.14 per 1000 person-years. After controlling for length of service prior to the study period, soldiers who sustained a single ankle sprain were 27% less likely (relative risk ratio = 0.73; 95% confidence interval: 0.73, 0.75) to leave the service than soldiers who had no documented history of an ankle sprain. However, this trend toward increased service time no longer held true for those who sustained a recurrent sprain (risk ratio = 1.07; 95% confidence interval: 0.99, 1.15). It appears that individuals who sustain an incident ankle sprain have longer time in service in the Army than those who do not sustain this injury. However, this trend toward longer service time no longer held true for soldiers who sustained a recurrent. Prognosis, level 2b.

The trAPP-study: cost-effectiveness of an unsupervised e-health supported neuromuscular training program for the treatment of acute ankle sprains in general practice: design of a randomized controlled trial.

BackgroundAnkle sprains are one of the most frequent injuries of the musculoskeletal system, with yearly around 680.000 new sprains in the Netherlands. Of these, about 130.000 people will visit the general practitioner (GP) each year. In addition, patients have an increased risk of a recurrent ankle sprain and about a third report at least one re-sprain. No optimal treatment strategy has proven to be effective in general practice, however promising results were achieved in a preventive trial among athletes. Therefore, the objective is to examine the (cost)-effectiveness of an unsupervised e-health supported neuromuscular training program in combination with usual care in general practice compared to usual care alone in patients with acute ankle sprains in general practice.Method/DesignThis study is a multi-center, open-label randomized controlled trial, with a one-year follow-up. Patients with an acute lateral ankle sprain, aged between 14 and 65 years and visiting the GP within three weeks of injury are eligible for inclusion. Patients will be randomized in two study groups. The intervention group will receive, in addition to usual care, a standardized eight-week neuromuscular training program guided by an App. The control group will receive usual care in general practice alone. The primary outcome of this study is the total number of ankle sprain recurrences reported during one year follow-up. Secondary outcomes are subjective recovery after one year follow-up, pain at rest and during activity, function, return to sport, cost-effectiveness and compliance of the intervention. Measurements will take place monthly for the study period of 12 months after baseline measurement.DiscussionFor general practitioners the treatment of acute ankle sprains is a challenge. A neuromuscular training program that has proven to be effective for athletes might be a direct treatment tool for acute ankle sprains in general practice. Positive results of this randomized controlled trial can lead to changes in practice guidelines for general practitioners. In addition, since this training program is e-health supported, positive results can also lead to a novel way of injury prevention.Trial registrationDutch Trial Registration: NTR4765.

Muscle timing in injured and non-injured leg of athletes with chronic ankle instability in response to a visual stimulus during forward jumping

The aim of this study was to investigate premotor time, motor time and reaction time of the injured and non-injured leg muscles of athletes with chronic ankle instability in response to a visual stimulus during forward jumping. Surface electromyography was performed on injured and non-injured leg of eight athletes with chronic ankle instability during forward jumping. Results showed that premotor time of the peroneus longus was significantly longer in non-injured leg compared with injured leg (489.37±220.22ms vs. 306.46±142.92ms, P=0.031); on the contrary, motor time of the peroneus longus was significantly shorter in non-injured leg compared with injured leg (569.04±318.62ms vs. 715.12±328.72ms, P=0.022). No significant difference was noted in the timing of other calf muscles (P>0.05). According to the results of this study, rehabilitation protocols, regarding ankle instability, need to put greater emphasis on tasks that require proper timing of muscles and muscle re-education so that protocols could reduce residual symptoms after sprain and prevent recurrent sprains.

Effects of soft bracing or taping on a lateral ankle sprain: a non-randomised controlled trial evaluating recurrence rates and residual symptoms at one year.

BackgroundAfter sustaining an ankle sprain, taping is often the standard treatment in primary care. Ankle braces are sometimes used as an alternative. This study aimed to compare the effects of four weeks of soft bracing or taping following acute lateral ankle ligamentous sprain (ALALS) on sprain recurrence rates and residual symptoms at one year.MethodsIn this pragmatic, non-randomised controlled trial, 157 adult participants with an ALALS caused by an inversion trauma were alternately allocated to a four week treatment with a soft brace (intervention group) or a four week treatment with ankle tape (control group) in order of presentation. The primary outcome was the 1-year incidence of the self-reported recurrence of ALALS. The secondary outcome was the occurrence of residual symptoms.ResultsBaseline characteristics did not differ appreciably between the treatment groups. Thirteen patients (17%) in the brace group reported a re-injury versus 11 patients (14%) treated with tape, corresponding to a risk difference of 3.1% (relative risk 1.2, 95% CI 0.6 to 2.6). Cox regression analysis showed a hazard ratio of self-reported ankle sprain recurrence within 52 weeks in the brace group compared to the tape group of 0.9 (95% CI 0.4 to 1.9). After one year, patients in the brace group had poorer scores on the manual anterior ankle test, corresponding to a risk difference of 15.4% (RR 2.4, 95% CI 1.1 to 5.0).ConclusionALALS recurrences and residual symptoms appear to be similar at one year when an ALALS is treated with four weeks of soft bracing or taping.Trial registrationISRCTN92030205

The Effects of a Static and Dynamic Balance-Training Program in Female Volleyball Players

The Effects of a Static and Dynamic Balance-Training Program in Female Volleyball Players Acute ankle injuries are prevalent in female volleyball players. Despite relatively mild severity and time away from sport, most individuals will experience recurrent sprains. Based on the high incidence rate of ankle injuries in female volleyball players, the purpose of this study was to determine the effects of a 6-week static and dynamic balance training program on self-reported disability and functional reach.

Ankle Arthroscopy, Lateral Ligament Repair and Peroneal Tendon Reefing for Chronic Lateral Ankle Instability: The Triad vs Arthroscopy with Ligament Repair

Peroneal tendon and retinacular pathology contributes to chronic lateral ankle instability. The “gold standard” surgical treatment for chronic lateral ankle instability has been the Brostrom-Gould procedure with its modifications. An ankle arthroscopy is an adjuvant procedure to address any intra-articular pathology. We review our results of two study groups. The first group underwent an ankle arthroscopy and a Brostrom-Gould procedure. The second group (triad) underwent an ankle arthroscopy, the Brostrom-Gould procedure and excision of low lying peroneal muscle belly with tightening of the inferior peroneal retinaculum. The triad technique was performed on 97 patients and results compared to 71 ankle arthroscopies with the Brostrom-Gould procedure. The patients were contacted at a mean follow-up time of 30 months for postoperative ACFAS scores, VAS scores, and overall satisfaction. Patients were also asked to report incidence of ankle sprain recurrence. The average postoperative ACFAS hindfoot and ankle score was 92 for the triad group and 89 for the arthroscopic debridement and Brostrom-Gould group. The average overall satisfaction was 98% in the triad group and 91% in the scope and Brostrom group. There were 4 (4.3%) recurrences in the triad group and 12 (17.6%) in the Brostrom-Gould with scope group. Each group had a similar incidence of wound healing complications. Peroneal tendon and retinacular pathology contributes to continued ankle instability and pain. We believe that the triad procedure is superior to the Brostrom-Gould procedure.

Chronic ankle instability in sporting populations.

Chronic ankle instability (CAI) is a term used to identify certain insufficiencies of the ankle joint complex following an acute ankle injury. Acute ankle injuries are often associated with sporting mishaps; however, this review was the first to identify the aspects of CAI (perceived instability, mechanical instability and recurrent sprain), and persisting symptoms following an ankle sprain, that have been reported within sporting cohorts. To determine the presence of common aspects of CAI within individual sports. A systematic search of the MEDLINE, Web of Science, CINAHL, SPORTDiscus and AMED databases up until 1 October, 2013 produced 88 studies appropriate for review. A calculated weighted percentage of the outcome data allowed the comparison of figures across a range of sports. Soccer, basketball and volleyball were the most represented sports and recurrent ankle injury/sprain was the most reported aspect of CAI. Soccer had the highest percentage of participants with recurrent sprain (61%) and mechanical instability (38%), whilst track and field had the highest percentage of participants with perceived instability (41%). Gymnasts had the highest percentage of ankles with persisting symptoms following an initial ankle sprain. This review was the first to assess aspects of CAI within sporting cohorts and has identified limitations to the research reporting these data. The problem of CAI across a range of sports remains unclear and thus advocates the need for further controlled research in the area to ascertain the true extent of CAI within sporting populations.

Individuals with chronic ankle instability exhibit decreased postural sway while kicking in a single-leg stance

Individuals with chronic ankle instability (CAI) usually experience deficits in balance control, which increase displacement in the body's center of pressure (COP) when they balance on a single leg. Little is known, however, about whether or not these individuals use the strategies of postural adjustment properly, especially during functional tasks that may predispose them to ankle sprain. The aim of this study was to investigate anticipatory (APA) and compensatory (CPA) postural adjustments in individuals with and without CAI as they kick a ball while standing in a single-leg stance with their ankle in neutral and supinated positions. COP displacements were calculated and their magnitudes (range) analyzed during APA and CPA intervals and over the duration of the whole task, represented by the COP area of sway and mean velocity. The CAI group exhibited a significant decrease in CPA and area of sway over the whole task, relative to controls. These results suggest that the decreased balance sway could be caused by the need for further stabilization of the ankle in more unstable postures to prevent recurrent sprain. Our findings could help clinicians to better understand the strategies of postural adjustments in individuals with CAI, and may assist and motivate new investigations into balance control interventions in such individuals, as well as proactively address recurrent ankle sprain conditions.