Sprain Injury Research Articles

The clinical characteristics and outcomes of Maisonneuve fractures

Objective To investigate the clinical characteristics and outcomes of Maisonneuve fractures. Methods Data of 21 cases of Maisonneuve fractures from February 2015 to December 2017 were retrospectively analyzed. There were 16 males and 5 females with an average age of 38.8 years (range, 21 to 61 years). The fractures occurred on the left side in 11 patients and on the right side in 10 patients. The causes of injuries were traffic accident in 4 patients, sprain injury in 9 patients and falling injury from height in 8 patients. There were 16 cases of medial malleolar fractures and 5 cases of ruptures of deltoid ligament (4 entirely and 1 partial). There were 17 cases of fractures of the posterior malleolus, among which there were 5 of typeⅠ, 8 of typeⅡ and 4 of type Ⅲ according to the Bartonicek classification of posterior malleolus. There were 4 cases without fracture of posterior malleolus including 1 complete disruption of posterior inferior tibiofibular ligament. Four cases were overlooked of Maisonneuve fracture at the first time. The interval between injury and operation was 2-12 days (mean, 4.9 days). Results Stabilization of proximal fibular fractures were achieved with plate in 3 cases. There were 16 cases of medial malleolar fractures, and the fixation were achieved with cannulated screws in 13 cases and with anti-glide plates in 3 cases. The entirely rupture of deltoid ligament was repaired in 4 cases with suture anchors, the partial rupture of deltoid ligament was not repaired. There were 17 cases of posterior malleolar fractures, 12 cases treated with open reduction and internal fixation including cannulated screws in 9 cases and anti-glide plates in 3 cases. Stabilization of syndesmosis was achieved with syndesmotic plate in 1 case; the medial and posterior malleolar fractures were stabilized and anterior inferior tibiofibular ligament was repaired with suture anchor in 1 case; the other 19 cases were stabilized with syndesmotic screws, 2 screws in 11 cases and 1 screw in 8. Twenty-one patients were followed up for 13-48 months with an average of 25.6 months. The time of bony union was from 3 to 6 months with an average time of 4.9 months after operation. All patients received anatomical reduction without postoperative complications such as incision infection, reduction lose, breakage of screw and posttraumatic arthritis. In 13 cases, the syndesmotic screw was removed at the mean time of 15.38 weeks postoperative (range, 13-25 weeks). At the latest follow up, AOFAS score was from 84 to 100, with excellent in 13 cases, good in 8 cases, and the excellent and good rate was 100% (21/21). Baird-Jackson score was from 83 to 100, with excellent in 11 cases, good in 8 and fair in 2, and the excellent and good rate was 90.48%(19/21). Conclusion The diagnosis of proximal fibular fracture of Maisonneuve fracture is easily missed. The complete rupture of deep deltoid ligament and displaced obviously of posterior malleolar fracture should be reduction and stabilization. The accuracy of reduction of the syndesmosis is of great concern. The outcome of operation is satisfied. Key words: Ankle joint; Fibula; Fractures, bone; Ligaments

Ankle Sprains Risk Factors in a Sample of French Firefighters: A Preliminary Prospective Study.

Firefighters participating in mandatory physical exercise sessions are exposed to a high risk of ankle sprain injury. Although both physiological and psychological risk factors have been identified, few prospective studies considered the complex interaction of these factors in firefighters. To prospectively determine whether intrinsic physical risk factors and work-related environments predict ankle sprains occurring during on-duty physical exercise in firefighters during an 8-month follow-up period. Prospective. Fire Department and Rescue Service. Thirty-nine firefighters were selected based on convenience sampling. Participants performed physical tests and completed questionnaires. Lower Quarter Y-Balance Test, Weight-Bearing Lunge Test, anthropometric measures, postural stability, chronic ankle instability (Cumberland Ankle Instability Tool) scores, previous injuries, and perceived psychosocial work environment (Copenhagen Psychosocial Questionnaire [COPSOQ]). During the follow-up, 9 firefighters sustained an injury. Lower Quarter Y-Balance Test and Weight-Bearing Lunge Test performances, Cumberland Ankle Instability Tool scores, history of previous ankle sprain, and specific dimensions of the COPSOQ significantly differed between injured and uninjured firefighters. Lower-limbs asymmetries of the Lower Quarter Y-Balance Test (ie,anterior, posteromedial, and posterolateral directions) and the Weight-Bearing Lunge Test were predictors of ankle sprains. These findings originally provide evidence that intrinsic factors mainly contribute to ankle sprains, although psychosocial work environment assessment could also characterize firefighters at risk.

Establishing return to play criteria after acute lateral ankle sprain injuries: An international Delphi study

Establishing return to play criteria after acute lateral ankle sprain injuries: An international Delphi study

Frequency of Sportive Injuries in Amateur Athletes and Factors Affecting Injuries

ABSTRACT It is possible to face injury risk whether the sport is recreational or contest purpose based. Exposure to injury can be attributed to many factors (field, competitor, etc.). Because of an injury amateur or elite athletes may move away from their sporting lives. This study aims to investigate frequency of sport injuries and factors affecting injuries to amateur athletes in Samsun region. 666 amateur athletes serving in various amateur sports clubs in Samsun province were selected randomly. 462 participants were men, 204 were women. 240 athletes in individual sports branches (wrestling, table tennis, taekwondo, wrist wrestling, wushu, athletics), and 426 athletes in team sports (basketball, football, handball, volleyball) constitute the sample. The subjects completed a sports injury survey developed by the researchers. X 2 was used for statistical analysis of the data. Participants were most often (44.6%) faced with a sprain injury. The most injured areas were the wrists and ankles, with a ratio of 36.4%. The period of disability was found to be 0-1 days with 62.8%. The injured rested for 7 days or less with a ratio of 57.4%. Athletes were found to exercise partially intensively during injury (52.1%). Treatment applied during injury was mostly performed by the self, the doctor and others. Among the causes of injuries, opponent player was found to be the leading factor with 33.6%. ddition, medical personnel can be provided to amateur sports clubs with the support of the state.

Effect of ankle sprain on postural control and electrical activity of selected muscles after single-leg jump landing task

Background: Ankle joint plays an important role in restoring the balance of individuals. Ankle sprain injury effects on balance of affected individuals. The changes in the postural control and activity of the ankle muscle, because of ankle sprain, can put the patients at reinjure risk and lower extremity injuries, especially during dynamic activities. The aim of this study was to investigate the electrical activity of ankle joint stabilizer muscles and postural stability after single-leg jump landing in individuals with ankle sprain. M aterials and Methods: In this cross-sectional study, 30 non-athletic students were participated. They were divided in two groups of 15 people, in the form of accessible and purposeful. Subjects was asked to land on a force plate with Single-leg, by at least 80% of their maximum jump. The com-cop changes assessment was used as an indicator for postural control evaluation. After jump landing, muscles activity was recorded on the ankle joint by surface electromyography (EMG) device. MATLAB software was used to analyze data, and MANOVA test was performed to compare two groups. R es ults: The results showed a significant reduction in EMG of soleus, gastrocnemius, and peroneus longus muscles (p=0.03, p=0.01 and p=0.006 respectively). Tibialis anterior activity significantly increased (p=0.001) in patient group than to healthy group. Postural control was significantly lower in patient group than healthy group, in all directions (p=0.00 and p=0.00 respectively). C onclusion: Decreased postural control indicates changes in EMG of the stabilizer muscles of this joint in people with ankle sprain injury.

A COMPARATIVE STUDY OF CORE MUSCULATURE ENDURANCE AND STRENGTH BETWEEN SOCCER PLAYERS WITH AND WITHOUT LOWER EXTREMITY SPRAIN AND STRAIN INJURY

Lower extremity sprain and strain injury constitutes a large percentage of lower extremity injuries experienced by soccer players. Yet, very limited data exists on the association between core strength and endurance and this injury. The purpose of this study was to compare core muscle endurance and hip muscle strength between soccer players who experienced non-contact lower extremity sprain and/or strain injury during their season and those who did not. Additionally, the frequency of injury was correlated with core muscle endurance and hip strength, and endurance was used for predicting the risk for injury. Prospective cohort. Twenty-one (35.59%) athletes experienced non-contact lower extremity sprain and/or strain injury during the season. Fifty-nine male athletes (mean age 20.92 ± 4.08 years, mass 77.34 ± 12.02 kg and height 1.79 ± 0.06m) were tested. Prior to the start of the season, prone-bridge, side-bridge, trunk flexion and horizontal back extension hold times were recorded for endurance assessment and peak hip abductor and external rotator isokinetic torques for strength assessment. Prone-bridge and side-bridge hold times were significantly longer in the non-injured players when compared with the times of the injured players (p=0.043 & 0.008 for the prone-bridge and side-bridge, respectively). There were significant negative correlations between the frequency of injury and both prone-bridge (r=-0.324, p=0.007) and side-bridge (r=-0.385, p=0.003) hold times. Logistic regression analysis revealed that side-bridge hold time was a significant predictor of injury (OR=0.956, CI=0.925-0.989). Soccer players with non-contact lower extremity sprain and/or strain have less core endurance than non-injured players. Reduced core endurance is associated with increased incidence of injury. Improving side-bridge hold time, specifically, may reduce the risk for injury. 1b.

A kinematic analysis of the Spraino® realignment mechanism during simulated noncontact ankle sprain injuries

Sprains to the lateral ligaments of the ankle joint are the most common type of acute musculoskeletal injuries (Vuurberg et al., 2018). These injuries are especially prevalent in indoor sports wher...

Relative and absolute within-session reliability of the modified Star Excursion Balance Test in healthy elite athletes.

BackgroundThe Star Excursion Balance Test (SEBT) is commonly used to assess dynamic postural balance both in clinical practice and research. The aim of our study was to assess the within-session relative and absolute reliability of participants’ performance of the modified SEBT (mSEBT) using a single practice trial in healthy elite athletes who were familiar with the test.MethodsAn intra-session repeated-measures design was used to investigate the relative and absolute reliability of participants’ (healthy athletes partaking in sports at a high-risk of ankle sprain injury) performance of the mSEBT. A total of 122 healthy elite athletes from soccer (n = 73), basketball (n = 15), and volleyball (n = 34) performed one practice trial and three test trials within one session, in three directions (anterior, postero-medial, and postero-lateral), for both legs. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest detectable change at a 95% confidence were calculated.ResultsWe found a good to excellent relative within-session intra-rater reliability between the three trials on specified directions, with an ICC (3,1) from 0.90 to 0.95. SEM and SDC95 for normalized and composite scores, for both legs ranged from 0.91 to 2.86, and 2.54 to 7.94, respectively.ConclusionsIn conclusion, we report good to excellent within-session reliability for the mSEBT. Our results confirm that the test can be reliably used with only one practice trial in healthy elite athletes familiar with the test.

ANKLE SPRAIN RISK FACTORS: A 5-MONTH FOLLOW-UP STUDY IN VOLLEY AND BASKETBALL ATHLETES

ABSTRACT Introduction Ankle sprain is a frequent sports injury among volley and basketball players, and identifying risk factors is necessary to prevent injuries and prolong their careers. Objective To identify intrinsic and extrinsic factors in basketball and volleyball players related to the risk of ankle sprain injury over a five-month follow-up period. Methods Ninety-four Brazilian young competitive athletes (15.8±1.7 years, 47 basketball and 47 volleyball players) participated in this study. They were evaluated for intrinsic risk factors (previous history of ankle sprain, dominant lower limb, ankle ligament laxity, range of motion of the ankle-foot complex, electromyographic response time of ankle evertors, postural control and muscular torque of ankle invertors and evertors) and extrinsic risk factors (type of shoes worn, use of orthosis, previous injuries while training or competing, and the players’ position). Results During the study period, 18 (19%) athletes suffered unilateral sprains. Multivariate logistic regression analysis gave a final regression with four factors: dominant leg (p=0.161), type of shoes worn (p=0.049), player’s position (p=0.153), and peroneus brevis muscle reaction time (p=0.045). There was an 86.1% probability of an ankle sprain if the athlete had a left dominant leg, wore shoes without vibration dampeners, or played in the small forward, wing/hitter spiker, middle blocker, or opposite spiker positions, and had a peroneus muscle reaction time longer than 80ms. However, only the player’s position was significantly (p=0.046) associated with lesion occurrence. Conclusion The player’s position appeared to be a risk factor in both sports, and this result may help professionals to prevent ankle sprains. Level of Evidence I; High quality randomized clinical trial with or without statistically significant difference but with narrow confidence intervals.

The Epidemiology Of Ankle Sprains In Youth, High School, And College Lacrosse

Understanding how ankle sprain injury incidence varies by level of play in male and female lacrosse players is important in informing level- and sport-specific injury prevention strategies. PURPOSE: Describe the epidemiology of ankle sprains in youth, high school (HS), and college lacrosse in the 2014/15-2016/17 seasons. METHODS: Youth data originated from 10 leagues in 5 states (21 boys’ and 21 girls’ team-seasons). HS data originated from the National Athletic Treatment, Injury and Outcomes Network (22 boys’ and 15 girls’ team-seasons). College data originated from the National Collegiate Athletic Association Injury Surveillance Program; 20 men’s and 47 women’s team-seasons). Athletic trainers (ATs) reported athlete-exposure (AE) and injury data from practices and competitions. Injury rate ratios (IRR) compared injury rates by level of play. Sex differences were not examined as these sports have different rules. IRRs with 95% confidence intervals (CI) excluding 1.00 were considered significant. We calculated the proportions of time loss (TL) injuries (resulting in participation restriction time ≥24 hours) and injury mechanism distributions. RESULTS: Ankle sprain rates per 1000AE were 0.77 (n=20), 0.36 (n=13), and 0.54 (n=62) in youth, HS, and collegiate male players, respectively, and 1.20 (n=11), 0.90 (n=20), and 0.56 (n=55) in youth, HS, and collegiate female players, respectively. Ankle sprain rates were higher in youth girls versus college women (IRR=2.15, 95%CI: 1.12-4.11), and youth boys versus HS boys (IRR=2.14, 95%CI: 1.07-4.31). Overall, 50% of ankle sprains in female lacrosse players were TL injuries; proportions of TL injuries in male lacrosse players increased with level of play (40.0%, 62.9% and 71.2%, respectively). Also, 56.2% of male ankle sprains and 39.2% of female ankle sprains were due to non-contact mechanisms. Overall, proportions of player contact-related ankle sprains increased with level of play (6.5%, 18.2%, and 29.1%, respectively). CONCLUSIONS: Ankle sprain rates varied by level of play in male and female lacrosse players. Variations associated with TL injuries and player contact-related injuries may highlight the need for level-specific injury prevention strategies. Future research should target reducing the incidence of non-contact ankle sprains.

Ankle Sprain Affects Lower Leg Muscle Activation on Vertical Landing, Half Point, and Gait in Female Ballet Students

Purpose: This study aimed to investigate effect of ankle instability on peripheral muscle activation among female ballet dancers to pro vide information on the development of prevention programs for ankle injury rehabilitation. Methods: 32 female ballet dancers were randomly divided into two groups: experience ankle sprain group (n=16, age, 20.7±0.8years, BMI 18.6±1.2kg/m2) and non-experience ankle sprain group (n=16, age=21.0±0.8 years, BMI 19.6±2.0kg/m2). Activation of the per oneus longus, tibialis anterior muscle, and gastrocnemius during vertical landing, half pointe, and gait between the two groups were measured. Body composition analyzer was used to examine skeletal muscle mass and body fat mass. Results: A total of 32 patients were included. In the experience ankle sprain group (n=16: left sprain 14, right sprain 2), average ankle sprain injury occurred 7.5 months before the study. The average age of the dancers in the experience ankle sprain group and non-experi ence ankle sprain group was 20.7±0.8 and 21.0±0.8years, major period was 64.5±23.8 and 71.6±25.8months, BMI was 18.6±1.2 and 19.5±2.0kg/m2, respectively. No significant differences were found on body composition between the two groups (p>0.05). The experi ence ankle sprain group showed significantly lower tibialis anterior and peroneus longus muscle activation (p<0.5), while gastrocnemius muscle activation appeared to be significantly higher (p<0.05) during landing, half pointe, and normal gait. Conclusion: Ankle sprain can cause a decline in peripheral muscle activation and coordination, which increased the risk for repetitive ankle sprain in the future. Moreover, ankle peripheral muscle selective strength training, coordination program development, and appli cation need to be considered to prevent ankle sprain.

Quantifying Functional Ankle Rehabilitation Progression Criteria Using GPS: A Preliminary Study.

Contemporary developments in Global Positioning System (GPS) technology present a means of quantifying mechanical loading in a clinical environment with high ecological validity. However, applications to date have typically focused on performance rather than rehabilitation. To examine the efficacy of GPS microtechnology in quantifying the progression of loading during functional rehabilitation from ankle sprain injury, given the prevalence of reinjury and need for quantifiable monitoring. Furthermore, to examine the influence of unit placement on the clinical interpretation of loading during specific functional rehabilitation drills. Repeated measures. University athletic facilities. Twenty-two female intermittent team sports players. All players completed a battery of 5 drills (anterior hop, inversion hop, eversion hop, diagonal hop, and diagonal hurdle hop) designed to reflect the mechanism of ankle sprain injury, and progress functional challenge and loading. GPS-mounted accelerometers quantified uniaxial PlayerLoad for each drill, with units placed at C7 and the tibia. Main effects for drill type and GPS location were investigated. There was a significant main effect for drill type (P < .001) in the mediolateral (η2 = .436), anteroposterior (η2 = .480), and vertical planes (η2 = .516). The diagonal hurdle hop elicited significantly greater load than all other drills, highlighting a nonlinear progression of load. Only the mediolateral load showed evidence of progressive increase in loading. PlayerLoad was significantly greater at the tibia than at C7 for all drills, and in all planes (P < .001, η2 ≥ .662). Furthermore, the tibia placement was more sensitive to between-drill changes in mediolateral load than the C7 placement. The placement of the GPS unit is imperative to clinical interpretation, with both magnitude and sensitivity influenced by the unit location. GPS does provide efficacy in quantifying multiplanar loading during (p)rehabilitation, in a field or clinical setting, with potential in extending GPS analyses (beyond performance metrics) to functional injury rehabilitation and prevention.

Anticipating ankle inversion perturbations during a single-leg drop landing alters ankle joint and impact kinetics

Anticipatory responses to inversion perturbations can prevent an accurate assessment of lateral ankle sprain mechanics when using injury simulations. Despite recent evidence of the anticipatory motor control strategies utilized during inversion perturbations, kinetic compensations during anticipated inversion perturbations are currently unknown. The purpose of this investigation was to examine the influence of anticipation to an inversion perturbation during a single-leg drop landing on ankle joint and impact kinetics. Fifteen young adults with no lateral ankle sprain history completed unanticipated and anticipated single-leg drop landings onto a 25° laterally inclined platform from a height of 30 cm. One-dimensional statistical parametric mapping (SPM) was used to analyze net ankle moments and ground reaction forces (GRF) during the first 150 ms post-landing, while peak GRFs, time to peak GRF, peak and average loading rates were compared using a dependent samples t-test (p ≤ 0.05). Results from the SPM analysis revealed significantly greater plantar flexion moment from 58 to 83 ms post-landing (p = 0.004; d = 0.64–0.77), inversion moment from 89 to 91 ms post-landing (p = 0.050; d = 0.58–0.60), and medial GRF from 62 to 97 ms post-landing (p < 0.001; d = 1.00–2.39) during the unanticipated landing condition. Moreover, significantly greater peak plantarflexion (p < 0.001; d = 1.10) and peak inversion moment (p = 0.007; d = 0.94), as well as greater peak (p = 0.002; d = 1.03) and average (p = 0.042; d = 0.66) medial loading rates, were found during the unanticipated landing condition. Our findings suggest alterations to ankle joint and impact kinetics occur during a single-leg drop landing when inversion perturbations are anticipated. Researchers and practitioners using drop-landings onto a tilted surface to assess lateral ankle sprain injury risk should consider implementing protocols that mitigate anticipatory responses.

Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis

The aim of this systematic review was to identify prospective studies that used a criteria-based return to sport (RTS) decision-making process for patients with lateral ankle sprain (LAS) injury. Systematic review and narrative synthesis. The PubMed (MEDLINE), Web of Science, PEDro, Cochrane Library, SPORTDiscus (EBSCO), ScienceDirect, and Scopus databases were searched to 23 November 2018. Studies were included if they prospectively applied a criteria-based RTS decision-making process for patients with LAS injury, but were excluded if they merely gathered outcome measures at the RTS time point. Studies were also excluded if patients were recovering from ankle fracture, high ankle sprain, medial ankle sprain, chronic ankle instability or complex ankle injury. No studies were identified that used a criteria-based RTS decision-making process for patients with LAS injury. We were unable to conduct a quantitative synthesis or meta-analysis, therefore we provide a narrative synthesis of relevant questionnaires, as well as clinical and functional assessments commonly used in studies retrieved in the search. There are currently no published evidence-based criteria to inform RTS decisions for patients with an LAS injury. Based on our narrative synthesis, we propose a number of variables that could be used to develop a criteria-based RTS decision paradigm. Future research should aim to reach consensus on these variables and apply them to actual RTS decisions within prospective study designs. Furthermore, we suggest that complex systems theory and the RTS continuum could be used to inform the development of an RTS decision-making paradigm for athletes with LAS injury.

Current trends in sport injury prevention

Participation in sport and recreation has important positive implications for public health across the lifespan; however, the burden of sport-related musculoskeletal injury is significant, with the greatest risk being in youth and young adults. Moving upstream to primary prevention of injury is a public health priority that will have significant implications for reducing the long-term consequences of musculoskeletal injury including early post-traumatic osteoarthritis. The primary targets for the prevention of musculoskeletal injury in sport include neuromuscular training (NMT), rule modification, and equipment recommendations. Currently, there is significant high-quality evidence to support the widespread use of NMT warm up programs in team and youth sport, with an expected significant impact of reducing the risk of musculoskeletal injury by over 35%. Policy disallowing body checking in youth ice hockey has led to a >50% reduction in injuries, and rules limiting contact practice in youth American football has significant potential for injury prevention. There is evidence to support the use of bracing and taping in elite sport to reduce the risk of recurrent ankle sprain injury but not for use to prevent the primary injury, and wrist guards are protective of sprain injuries in snowboarding. Future research examining the maintenance of NMT programs across real-world sport and school settings, optimization of adherence, additional benefit of workload modification, and evaluation of rule changes in other sports is needed.

Acute Effects of Different Stretching Techniques on Lower Limb Kinematics, Kinetics and Muscle Activities during Vertical Jump

The purpose of this study was to examine the acute effects of different stretching techniques on performance and lower limb kinematics, kinetics and muscle activities during vertical jump in female aerobics athletes. 10 female college aerobics athletes participated in this study. Three-dimensional kinematic and kinetic data, as well as electromyography of rectus femoris, biceps femoris and gastrocnemius medialis were collected using Vicon motion analysis system, Kistler force plate and Wireless surface electromyographic system respectively during the test. No significant differences in jump height had been determined among these 3 warm-up methods. Hip peak flexion and internal rotation angles decreased significantly after BSM and peak adduction angle decreased significantly after SSM and BSM during landing. Knee peak flexion and internal rotation angles increased significantly after SSM and BSM during take-off. Also, BSM showed significantly greater peak flexion compared with SSM. Ankle peak plantarflexion angle increased significantly after BSM. In addition, BSM showed significantly greater improvement in the variation range than SSM except for the ankle int-external rotation. Existence of no significant differences in the peak value of vertical ground reaction force during take-off and landing phase had been determined among these 3 warm-up methods, and muscle activities of rectus femoris, biceps femoris and gastrocnemius medialis were likewise not significantly different. The results of this study suggest that it would be suitable for female aerobics athletes to perform ballistic stretching in warm-up in order to improve flexibility without decreasing the following vertical jumping event and may also reduce the risk of ankle sprain injury.

Sonographic Detection of Pseudoaneurysm From Ankle Sprain Injury

Aneurysms and pseudoaneurysms, of the anterior tibial artery, are very rare. Pseudoaneurysms of the anterior tibial artery are commonly due to iatrogenic injury, blunt trauma, fracture, or sharp penetrating injury. A young man presented to a pediatric emergency department with a pseudoaneurysm of the left anterior tibial artery due to an ankle sprain injury. Radiography, magnetic resonance imaging, and duplex sonographic imaging were completed to rule out all previously suspected diagnoses, and ultimately duplex sonography diagnosed and characterized the pseudoaneurysm. The utilization of duplex sonography in the investigation and diagnosis of injuries, particularly with extensive soft tissue swelling, provided quick diagnostic information and an expedited treatment plan. Conservative observation was initially attempted, followed by sonographic compression, sonography-guided thrombin injection, vessel ligation, and coil embolization. After initial treatment attempts failed, the patient was transferred to an adult hospital, with a specialized vascular surgery team, for vessel ligation and ultimate successful treatment with coil embolization.

Neuromuscular Mechanosensitivity in Subjects with Chronic Ankle Sprain: A Cross-Sectional Study.

Ankle sprain is one of the most common musculoskeletal injuries in sports, at work, and at home. Subjects who suffer from this injury may develop ankle instability. Functional instability has been associated with a high rate of resprain and impaired neuromuscular control in patients with ankle instability. Measurement of neural and muscular mechanosensitivity after ankle sprain injury and establishment of the relationship between these variables. A cross-sectional case-control study was performed with a sample of 58 students from Alcalá de Henares University (21 males and 37 females, mean age ± SD = 21 ± 3.7 years). Subjects were divided into two groups: a case group (N = 29, subjects with unstable ankle) and a control group (N = 29, healthy subjects). The pressure pain threshold (PPT) of the tibialis anterior, peroneus longus, and peroneus brevis muscles and mechanosensitivity of the common peroneus and tibial nerves were evaluated in all subjects through a manual mechanical algometer. Neuromuscular PPTs showed significant differences (P < 0.05) between both groups, such that, compared with the control group, the case group exhibited significantly lower PPT levels. In the case group, a strong positive correlation was observed between neural and muscular homolateral mechanosensitivity in both lower limbs. Participants with chronic ankle instability showed higher neuromuscular mechanosensitivity in muscles and nerves surrounding the ankle joint than healthy subjects. These findings indicate that low PPT values may be associated with symptoms that characterize this disease.

EVALUATION OF THE EFFECT OF ELASTIC BANDAGE ON THE ANKLE BASKETBALL PLAYERS WITH AND WITHOUT CHRONIC INSTABILITY

ABSTRACT Introduction: Basketball is a sport that requires good motor coordination as well as intense and multidirectional movements. Chronic ankle instability affects about 40% of patients who have sustained a sprain injury. In order to minimize the effects of this dysfunction, functional elastic tape has been widely used due to its mechanical properties, having some positive effects on athletes’ functional performance. Objective: To evaluate the effect of elastic tapes on the ankles of basketball players with and without chronic instability. Method: Thirteen athletes from a varsity basketball team of both sexes, aged between 18 and 30 years (23.2 ± 3.2 years), who had been playing the sport for at least one year and trained at least twice a week. The subjects were assessed using the anterior drawer test for the presence or absence of chronic ankle instability and in three different situations: placebo, elastic tape and control, and the order of use of the implements was randomly determined, using the Star Excursion Balance Test (SEBT) to assess the ankle stability of these athletes. Results: Among the eight directions proposed in the SEBT, there was statistical significance in the difference in three directions for the placebo method in comparison to elastic taping and control. There was no statistical significance in the difference in four directions between the assessments, and there was no statistical significance in the difference in all directions between the control and elastic tapes. Conclusion: It can be inferred from the study that elastic taping does not have positive effects on joint stability in athletes with and without chronic instability, taking into account their functionality. Levef of Evidence I; High quality randomized trial with statistically significant difference or no statistically significant difference but narrow confidence intervals.

Accuracy of Point-of-Care Ultrasonography for Pediatric Ankle Sprain Injuries.

In children with radiograph fracture-negative lateral ankle injuries, the main objective of this pilot study was to explore the accuracy, sensitivity, and specificity of point-of-care ultrasound (POCUS) performed by a pediatric emergency physician in diagnosing anterior talofibular ligament injuries, radiographically occult distal fibular fractures, and effusions compared with reference standard magnetic resonance imaging (MRI). This was a prospective cohort pilot study. Children aged 5 to 17 years with an isolated, acute lateral ankle injury and fracture-negative ankle radiographs were eligible for enrolment. Within 1 week of the injury, enrolled children returned for MRI and POCUS of both ankles. Seven children were enrolled, with a mean age 12.1 (SD, 3.0) years. Overall, POCUS agreed with MRI with respect to anterior talofibular ligament injury in 4 (57%) of 7 cases. Of the 2 cases with MRI-confirmed ligament damage, POCUS accurately identified and graded the extent of ligament damage in 1 case. Point-of-care ultrasound falsely identified ligament injuries in 2 cases. Both imaging modalities confirmed the absence of cortical fractures in all 7 cases. For all findings, POCUS sensitivity and specificity were 57% and 86%, respectively. In this pilot study, we established that POCUS diagnosed the specific pathology of radiograph-negative lateral ankle injuries with poor sensitivity but good specificity. Thus, POCUS could act as a tool to exclude significant ligamentous and radiographically occult bony injury in these cases. A larger study is needed to validate the utility of POCUS for this common injury.