Ankle Instability Research Articles

Clinical and Radiologic Outcomes Following Autologous Osteochondral Transplantation for Lateral Osteochondral Lesions of the Talus.

Autologous osteochondral transplantation (AOT) is an option to treat large osteochondral lesions of the talus (OLTs), accompanying subchondral cyst, and previous unsuccessful bone marrow stimulation (BMS) procedures. Although there is extensive literature on the outcomes of surgical interventions for medial osteochondral lesions, research focusing on lateral lesions remains limited. This article presents the intermediate-term clinical and radiologic outcomes following AOT for lateral OLTs. Twenty-eight patients with lateral OLTs were followed up for a minimum of 3 years after AOT. Clinical evaluations included the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). Radiographic assessments evaluated articular surface (subchondral plate) irregularity, progression of degenerative arthritis, and changes in talar tilt and anterior talar translation. The quality of osteochondral graft was evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. The average FAOS and FAAM scores significantly increased from 39.6 to 91.2 and from 37.8 to 89.8 points, respectively, at the final follow-up (P < .001). Radiologic assessments revealed 2 patients (7.1%) with articular step-off ≥2 mm and 1 patient (3.6%) with progressive arthritis. The average MOCART score reached 92.8 points. Postoperative complications included 2 patients with wound problems, 1 with a superficial peroneal nerve injury, and 1 with donor site morbidity. The rate of return to preinjury level of sports activity was 82.1%. At a mean follow-up of 68.5 months, no patient required reoperation for OLT or recurrent ankle instability. AOT for lateral OLTs demonstrated favorable intermediate-term clinical and radiologic outcomes. Most lateral OLTs were accessible via lateral ankle ligament division and capsulotomy, with minimal occurrence of iatrogenic complications such as recurrent ankle instability. AOT appears to be an effective surgical option for patients with large lateral osteochondral lesions unresponsive to conservative treatment, large subchondral cysts, and prior unsuccessful BMS procedures.

Analyzing Lower Limb Muscle Imbalance Patterns Associated With Chronic Ankle Instability

Analyzing Lower Limb Muscle Imbalance Patterns Associated With Chronic Ankle Instability

Ankle instability and physiotherapy: Exploring novel rehabilitation approaches

AbstractA common ailment that affects many people, especially athletes, ankle instability is frequently brought on by acute injuries that result in long-term pain and functional restrictions. This article examines both cutting-edge techniques like neuromuscular training, sport-specific drills, and technology-enhanced rehabilitation as well as more conventional approaches like strength training and balance exercises. Physiotherapists can develop customised regimens that enhance recovery results and lower the chance of re-injury by combining these tactics. Validating these novel approaches and improving rehabilitation procedures require ongoing research.

Progress of the Exercise Therapy on Chronic Ankle Instability

This research delves into the effectiveness of various exercise therapies for Chronic Ankle Instability (CAI), a condition that frequently develops when initial ankle sprains are not adequately treated. CAI is characterized by repetitive sprains, joint instability, and reduced mobility, which can severely impact an individual's daily activities and sports performance. Different methods of rehabilitation, including muscle strengthening exercises, proprioceptive training, and balance improvement, were evaluated. The study emphasizes the advantages of combining traditional approaches such as resistance band exercises and newer techniques like blood flow restriction (BFR) training. These methods help enhance both strength and functionality in patients with CAI. Additionally, integrating proprioceptive exercises that focus on improving balance through unstable surface training has shown significant progress in restoring postural stability. Further, novel therapeutic interventions, including motor imagery, transcranial direct current stimulation (tDCS), and exergaming, demonstrate promising results in complementing traditional treatments. Ultimately, this review suggests a comprehensive rehabilitation plan that merges conventional and modern therapies to improve functional outcomes for individuals with CAI, though further research is necessary to optimize the combination of these therapies for long-term efficacy.

Foot tissue stress in chronic ankle instability during the stance phase of cutting.

Lower limb biomechanics of chronic ankle instability (CAI) individuals has been widely investigated, but few have evaluated the internal foot mechanics in CAI. This study evaluated bone and soft tissue stress in CAI contrasted with copers and non-injured participants during a cutting task. Integrating scanned 3D foot shapes and free-form deformation, sixty-six personalized finite element foot models were developed. Computed Achilles tendon forces and measured regional plantar pressure were applied as boundary loading conditions for simulation. It was observed that the primary group differences in foot stress occurred during midstance and heel-off phases of the cutting task. Specifically, healthy individuals had significantly higher stress in the talus and soft tissue around the talus compared to CAI participants. In contrast, CAI participants had significantly higher stress in the cuneiforms and lateral forefoot bones during mid-stance and push-off phases. CAI participants appeared to adopt a protective strategy by transferring greater force to the lateral forefoot at the heel-off phase while lowering stress around the talus, which may be associated with pain relief near the ankle. These findings suggest further attention should be placed on internal stress in CAI at the push-off phase with implications for long-term foot adaptation.

Augmentation with the inferior extensor retinaculum may facilitate earlier recovery in all-inside arthroscopic management of chronic lateral ankle instability

BackgroundTo compare the clinical outcomes of inferior extensor retinaculum (IER) augmentation following repair of the anterior talofibular ligament (ATFL) with isolated ATFL repair in patients with an arthroscopically confirmed grade 3 lesion of the ATFL.MethodsWe conducted a retrospective study of consecutive chronic lateral ankle instability (CLAI) patients who underwent arthroscopic ATFL repair between March 2018 and August 2022. The average age of the patients was 31.5 ± 7.4 years (range, 16–50 years). All patients underwent all-inside arthroscopic repair, and were divided into two groups based on the ligament repair method: the Broström-Gould group (n = 64) and the Broström group (n = 67). At 3, 6, 12 and 24 months after surgery, ankle inversion stress tests and anterior drawer tests were employed to assess the stability of the ankle joint. The American Orthopedic Foot and Ankle Society ankle hindfoot scale(AOFAS-AH) and Karlsson ankle function score (KAFS) were employed to assess ankle function; the Tegner score was employed to assess the patient’s level of exercise; the Foot and Ankle Outcome Score [FAOS, including score of symptoms-diseases, pain, function-daily living score, function in sports and recreational activities, and quality of life] was used to assess the patient’s daily activity ability.ResultsThe Tegner score, FAOS-function-daily living score, and FAOS-function in sports and recreational activities in the Broström-Gould group consistently outperformed the Broström group at 3 months and 6 months post-surgery, with the differences being statistically significant (all P < 0.05). However, although the differences are statistically significant, the clinical relevance of this statistical significance remains uncertain. At 12 and 24 months, there were no statistically significant differences between the two groups.ConclusionsFor CLAI patients with arthroscopic grade 3 lesion of the ATFL, both the all-inside arthroscopic Broström-Gould procedure and the Broström procedure provide stability and enhance ankle joint function, resulting in similar functional outcomes at a 2-year follow-up. IER augmentation following ATFL repair may facilitate earlier recovery exercises compared to isolated all-inside ATFL repair.

Comparison of tibiofibular syndesmosis stability following treatment of proximal, middle, and distal third fibula fractures

PurposeWhile treatment modalities for Maisonneuve fractures involving the proximal third of the fibula are established, no studies to date have reported outcomes associated with syndesmotic-only fixation of middle third fibular shaft fractures. The purpose of this study was to evaluate outcomes associated with syndesmotic-only fixation in the treatment of Maisonneuve fractures involving the middle third of the fibula.MethodsA retrospective review was conducted on 257 cases of syndesmotic ankle instability with associated fibular fractures at a level 1 trauma center between 2013 and 2023. Patients were divided into cohorts based on fibular fracture location in the proximal, middle, or distal third of the fibula. The Chi-square test of independence, two-sample t-test, and analysis of variance were used to compare outcome measures between cohorts.ResultsSixty-six patients were identified including 48% (n = 32) with proximal third fibular fractures, 20% (n = 13) with middle third fibular fractures, and 32% (n = 21) with distal third fibular fractures. Rates of infection, loss of reduction, wound healing complications, and reoperation did not vary significantly between cohorts. Functional outcome measures including range of motion, time to weight-bearing, and tibiofibular/medial clear space measurements at final follow-up were similar across cohorts.ConclusionPatients with Maisonneuve fractures involving the middle third of the fibula demonstrated positive outcomes with syndesmotic fixation alone, with no documented cases of infection, loss of reduction, or wound healing issues. By demonstrating maintenance of anatomic reduction and low rates of complications, our results support the use of syndesmotic-only fixation in the treatment of middle third Maisonneuve fractures.

Ultrasound-Guided Repair of the Anterior Talofibular Ligament With or Without Gould Augmentation Is Safe and Improves Clinical Outcomes for Chronic Lateral Ankle Instability: A Case Series of 49 Patients.

We have previously shown that ultrasound-guided repair results in an accurate anchor placement and restores ankle joint stability using cadaveric models. The objective is to assess the safety and clinical outcomes of ultrasound-guided ATFL repair with or without augmentation. Forty-nine patients with chronic lateral ankle instability underwent ultrasound-guided ATFL repair with or without augmentation. Following the procedure, patients completed a standardized post-operative rehabilitation protocol. The primary outcome was the complication rate in 49 subjects. The clinical outcomes were analyzed as a secondary outcome for 28 patients (20 athletes and 8 non-athletes) after excluding 21 subjects with such concomitant injuries that could affect clinical course. These included (1) Numerical Rating Scale (NRS) for pain, (2) Foot and Ankle Outcome Score (FAOS), (3) Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale (a Japanese equivalent of the American Orthopedic Foot and Ankle Society Ankle-Hindfoot score), and (4) Self-Administered Foot Evaluation Questionnaire Sports (SAFE-Q Sports) score at baseline, 3 months, and 6 months. The overall complication rate was 2.0% with one superficial peroneal nerve irritation out of 49 cases, which was improving at 6 months. All 4 clinical outcome scores resulted in statistically significant improvement at 6 months. NRS decreased from 3.6 ± 2.1 at baseline to 1.3 ± 1.6 (p < 0.001, student's t-test). FAOS increased from 74.7 ± 11.9 to 93.4 ± 8.1 (p < 0.001). JSSF scale increased from 56.9 ± 15.1 to 90.9 ± 10.2 (p < 0.001). All 20 athletes returned to sports at a pre-injury level, and their SAFE-Q sports activity scores increased from 40.7 ± 17.6 to 90.6 ± 0.2 (p < 0.001). Ultrasound-guided ATFL repair with or without augmentation for chronic lateral ankle instability is safe and results in clinical improvement at 6 months. V.

Changes to muscle and fascia tissue after eighteen days of ankle immobilization post-ankle sprain injury: an MRI case study

BackgroundAnkle sprains often result in muscle atrophy and reduced range of motion, which can cause long-term ankle instabilities. Understanding the changes to muscle—such as atrophy—and concomitant changes to deep fascia—which may thicken alongside muscle loss—after ankle sprain injury is important to understanding structural changes about the joint and how they might contribute to longer-term impairments. Here, we employ advanced MRI to investigate skeletal muscle and fascial structural changes during the recovery period of one patient undergoing immobilization after ankle sprains.Material and methodsIn this case study, a participant who suffered an ankle sprain underwent initial MRI scans and, after 21 days (18 of which included immobilization), a follow-up MRI. Techniques used included proton density, 3D stack of spirals, and diffusion tensor imaging to analyse muscle and fascia changes pre- and post-injury.ResultsResults showed muscle atrophy in most shank muscles, with volume loss ranging from no change in the lateral gastrocnemius to 12.11% in the popliteus. Thigh muscles displayed hypertrophy of 6% in the hamstrings, while the quadriceps atrophied by 2.5%. Additionally, fascia thickness increased from 0.94 mm to 1.03 mm. Diffusion tensor imaging indicated that the biceps femoris experienced the most significant changes in physiological cross-sectional area, while the rectus femoris showed minimal change.ConclusionThe findings highlight the variable responses of muscles and a notable thickening of deep fascia post-injury, underscoring its role in recovery from ankle sprains.

Effect of proprioceptive neuromuscular facilitation on patients with chronic ankle instability: A systematic review and meta-analysis.

This study conducts a rigorous meta-analysis of existing literature to rigorously examine the efficacy of Proprioceptive Neuromuscular Facilitation (PNF) in ameliorating functional deficits associated with Chronic Ankle Instability (CAI). Literature searches were conducted in multiple databases including China National Knowledge Infrastructure (CNKI), VIP, Wanfang, China Biology Medicine disc (CBM), PubMed, EBSCO (Medline, CINAHL, SPORTDiscus, and Rehabilitation & Sports Medicine Source), Embase, ScienceDirect, ProQuest, Cochrane Library, and Web of Science for randomized controlled trials assessing the effects of Proprioceptive Neuromuscular Facilitation interventions on patients with Chronic Ankle Instability. The publication timeframe spanned from the inception of each database until April 10, 2024. Meta-analysis was performed using STATA 12 software on the included studies. ① A total of 12 randomized controlled trials were included, encompassing 405 patients with Chronic Ankle Instability, demonstrating a generally high methodological quality of the literature.② Meta-analysis results indicate that compared to the control group, Proprioceptive Neuromuscular Facilitation (PNF) significantly enhanced the balance ability of patients with Chronic Ankle Instability as measured by the Y Balance Test (YBT) (Weighted Mean Difference (WMD) = 3.61, 95% CI [2.65, 4.56], z = 7.42, P<0.001) and the Star Excursion Balance Test (SEBT) (WMD = 5.50, 95% CI [3.80, 7.19], z = 6.36, P<0.001), with improvement in all eight directions of SEBT balance ability surpassing that of the control group (P<0.05); muscle strength around the ankle (SMD) = 0.19, 95% CI [0.03, 0.36], z = 2.26, P = 0.024), with both Plantar flexion and Dorsal flexion muscle strength improvements exceeding those of the control group (P<0.05); Visual Analog Scale (VAS) (WMD = -1.39, 95% CI [-1.72, -1.06], z = 8.23, P<0.001); Ankle instability questionnaire (WMD = 2.91, 95% CI [1.92, 3.89], z = 5.78, P<0.001).③Descriptive analysis results showed that the differences in Inversion Joint Position Sense and Dorsiflexion range of motion between the PNF and control groups were not statistically significant (P>0.05), however, the effects of PNF training persisted for a certain period even after cessation of treatment. Proprioceptive Neuromuscular Facilitation (PNF) can significantly improve balance, muscle strength, and pain in patients with Chronic Ankle Instability (CAI). While PNF has shown improvements in joint position sense and dorsiflexion range of motion for CAI patients, with effects that remain for a period thereafter, these improvements were not significantly different when compared to the control group. Further research is required to substantiate these specific effects.

Muscle mechanics and energetics in chronic ankle instability and copers during landing: Strategies for adaptive adjustments in locomotion pattern

Muscle mechanics and energetics in chronic ankle instability and copers during landing: Strategies for adaptive adjustments in locomotion pattern

Indicators of Return to Sports at Preinjury Levels Following Surgery for Chronic Ankle Instability: Comparison of ALR-RSI, AOFAS, and Karlsson Scores.

While there are several scales for measuring patients' outcomes after chronic ankle instability (CAI) surgery, a study comparing the predictive ability of these scores with regard to return to sports (RTS) at the preinjury level is lacking. The purpose of this study was to compare the Ankle Ligament Reconstruction-Return to Sport After Injury (ALR-RSI), American Orthopaedic Foot and Ankle Society (AOFAS), and Karlsson scores in predicting 2-year RTS outcomes after arthroscopic treatment of CAI. It was hypothesized that ALR-RSI would be superior in predicting 2-year RTS outcomes after CAI surgery and that a quantifiable increase in this score would significantly improve RTS outcomes. Cohort study; Level of evidence, 2. This prospective cohort study analyzed patients who underwent surgery for CAI at a sports surgery center between 2016 and 2018. The inclusion criteria focused on adult patients undergoing their first surgery for CAI with a minimum 2-year follow-up. The primary outcome was RTS at 2 years. The study evaluated 3 scores at 1 year postoperatively to predict RTS at the same level as the preinjury level at 2 years-ALR-RSI, AOFAS Ankle-Hindfoot Scale, and Karlsson score. The most predictive score, with its corresponding optimal threshold, was determined using the receiver operating characteristic (ROC) curve. This threshold signifies the score value above which the likelihood of RTS at the preinjury level is significantly increased. Once identified, the secondary outcome evaluated the impact of a 10-point increase in this score on RTS, after adjusting for confounding factors. A total of 159 patients (age, 35.7 ± 11.4 years) were included. Two years after surgery, 40.25% of patients returned to their preinjury level of sports. ROC curve analysis of the tested scores at 1-year postoperatively showed the ALR-RSI score had the best predictive ability for RTS (area under the curve [AUC], 0.70 [95% CI, 0.6-0.77]), whereas Karlsson and AOFAS scores were less predictive (AUC, 0.53 [95% CI, 0.43-0.63] and 0.61 [95% CI, 0.52-0.70], respectively). The optimal threshold for the ALR-RSI score was identified at 83 (Youden index = 0.35, sensitivity = 63%, and specificity = 71%). Confounder identification revealed earlier surgery and arthroscopic techniques were associated with higher RTS rates. A 10-point increase in the ALR-RSI score correlated with increased odds of RTS (1.27 [95% CI, 1.12-1.46]; P = .0004) in univariate analysis and (1.29 [95% CI, 1.06- 1.61]; P = .01) in multivariate analysis. This study showed that none of the scores were great predictors of RTS after surgery for CAI. The ALR-RSI score was a stronger predictor of RTS to the same preinjury level after CAI surgery than AOFAS and Karlsson scores. The ALR-RSI optimal threshold identified was 83. A 10-point increase in the ALR-RSI score boosted the odds of RTS by 1.29 times.

Anatomical study of the posterior talofibular ligament: A descriptive analysis of its dual-bundle structure.

The lateral ankle ligament complex, consisting of the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL), is essential for ankle stability. While the ATFL and CFL are frequently studied, the PTFL's role remains less explored. Twelve fresh-frozen ankle specimens were dissected to analyze the PTFL's origin, trajectory, and talar insertion, focusing on its bundles and anatomical relationships. All specimens exhibited a consistent PTFL origin at the lateral malleolar fossa. Two distinct bundles were identified: the pars superficialis (PS) and pars profunda (PP). The PS attached to the posterolateral talus, while the PP attached separately to the posterior aspect of the lateral talar process. The PTFL comprises two distinct bundles with separate talar insertions. This finding challenges the traditional view of a single-bundled PTFL and may influence understanding of lateral ankle instability as well as its treatment. IV.

Ankle injury due to supination trauma: Potential factors worsening patient outcome

PurposeSupination trauma is a common sports injury, and often leads to chronic ankle instability. This study analyses whether indications of healing can be detected 2 weeks after supination trauma. MethodsThis prospective, monocentric study at a German Medical Center examined patients with acute supination trauma. Only patients with severity levels 2-3 were included in the study, and were advised to wear an orthosis for 5 weeks starting in the emergency room. The follow-up period was two weeks after trauma (follow-up examination 1/FE1: swelling of the ankle joint, tenderness over the lateral ligament complex and the syndesmosis, questionnaire). Nine months after injury (follow-up examination 2/FE2), these patients were interviewed by telephone using a questionnaire surveying current complaints in everyday life, sports, and work, as well as the general healing process. ResultsForty-one patients aged 35.1 years (±10.5) were included in the study. The presence of hematoma two weeks post-injury (n=6) correlated significantly with inability to work (p=0.02). Calcaneofibular ligament (CFL) tenderness was seen in 36 patients, posterior talofibular ligament (PTFL) tenderness in 29 patients, and syndesmosis tenderness in 9 patients. All patients who reported pressure pain at the anterior talofibular ligament (ATFL) at FE1 were significantly more likely to experience feelings of instability at FE2 (p=0.011). All patients who reported instability at FE1 had significantly greater problems climbing stairs at FE2 (p=0.003). All patients with hematoma and instability two weeks post-injury had a persistent feeling of instability at FE2. Patients with hematoma and pressure pain at the ATFL at FE1 had persistent pain through FE2. ConclusionsPersistent hematoma, pressure pain at the ATFL or feelings of instability two weeks after ankle sprain increase the likelihood of symptoms persisting for up to nine months post-injury. Physicians and patients should be well informed about the treatment guidelines and not underestimate this injury. In general, further studies are necessary to clarify why acute ankle sprains often lead to persistent complaints.

Bilateral alterations in sensorimotor function and altered sensory strategy in individuals with unilateral chronic ankle instability.

This study aimed to evaluate bilateral sensorimotor function in patients with unilateral CAI. Furthermore, sensory reweighting ability and vestibular modulation were assessed. Twenty individuals with unilateral CAI and twenty healthy controls participated in this study. All participants executed ankle proprioception, plantar sensation, unilateral stance, Y balance, motor control test (MCT) and sensory organisation test (SOT) assessments. Proprioception assessment included joint position sense and force sense (FS), and plantar sensation evaluation consisted of light-touch, vibration and two-point discrimination (TPD) thresholds at the heel, head of the first metatarsal (1MF), base of the fifth metatarsal (5MF), centre of foot and forefoot. MCT and SOT tests were conducted using NeuroCom Balance Manager System. Except for SOT, all tests evaluated bilateral limbs, and the order of limbs was randomly selected. 2 (group)×2 (limb) mixed model analyses of variance were performed for outcome measures of unilateral stance, Y balance and MCT, and independent t-test was used to analyse the outcomes of SOT between two groups. Mann-Whitney U and Wilcoxon test were applied to examine the differences in plantar sensation between groups and limbs. For plantar sensation, increased light-touch threshold at heel and 1MF and the TPD threshold at 1MF were observed bilaterally in CAI group (p<0.05). No differences were observed in joint position sense (JPS), but bilateral deficit was found in plantarflexor FS with moderate effect size (uninjured side: ES=0.67; injured side: ES=0.61) in CAI group. For unilateral stance with eyes closed, moderate postural instability was displayed bilaterally in the anteroposterior direction (uninjured side: ES=0.71; injured side: ES=0.86). The delayed latency of MCT with medium-backward translation was also observed in both sides of unilateral CAI (uninjured: ES=0.74; injured: ES=0.92). Compared with healthy controls, higher visual reliance was shown moderately in the injured and uninjured sides of unilateral CAI (uninjured: ES=0.78; injured: ES=0.91). Sensory analysis of SOT displayed decreased use of visual (p=0.001) and vestibular information (p<0.000) in CAI group. Unilateral CAI presented impaired plantar sensation and ankle proprioception on both sides. Higher visual reliance, delayed motor response and postural instability under unreliable visual clues were also displayed bilaterally. Except for bilateral sensorimotor alterations, reduced ability of sensory reweighting and fixed sensory strategy also presented in CAI group, but the somatosensory clue still served as the main sensory source in CAI.

Assessment of chronic ankle instability: are functional scores relevant enough?

Assessment of chronic ankle instability: are functional scores relevant enough?

High-Density Surface Electromyography Feedback Enhances Fibularis Longus Recruitment in Chronic Ankle Instability.

This study aimed to determine whether individuals with chronic ankle instability (CAI) can activate the fibularis longus compartments with high-density surface electromyography (HD-sEMG) biofeedback to the same extent as those without CAI, and to analyze the effect of ankle position on compartment activation in individuals with CAI using HD-sEMG feedback. There were 16 volunteers per group (CAI and No-CAI). The sEMG amplitude at each compartment (anterior and posterior) and the barycenter of the spatial sEMG amplitude distribution of the fibularis longus were recorded during eversion in neutral and plantar flexion positions at 30% and 70% of maximum voluntary contraction force, both with and without visual feedback on the spatial sEMG amplitude distribution. sEMG amplitude of the posterior compartment of the fibularis longus in the CAI group trained with HD-sEMG feedback during eversion at 70% maximum voluntary contraction (in plantar flexion) was significantly higher than without HD-sEMG feedback (95% CI = 3.75-34.50% root mean square) and was similar to the activation of the No-CAI group (95% CI = -14.34% to 34.20% root mean square). Furthermore, individuals with CAI who underwent training with HD-sEMG feedback in plantar flexion exhibited a posterior displacement of the barycenter (95% CI = 0.56-2.84 mm). Utilizing HD-sEMG feedback during eversion in plantar flexion position increases activation of the fibularis longus posterior compartment in individuals with CAI to the same extent as healthy people. HD-sEMG-based topographic maps can serve as effective feedback training to restore motor control of the ankle. Long-term efficacy for improving motor function requires investigation through longitudinal studies.

Postural control strategies in individuals with and without chronic ankle instability during the reach phase of the posteromedial direction of the star excursion balance test.

To compare center of mass (COM) and center of pressure (COP) displacement, joint angles, and muscle activity for the ankle, knee, and hip during the posteromedial (PM) reach direction of the Star Excursion Balance Test between individuals with chronic ankle instability (CAI) and healthy individuals. Cross-sectional Study. Biomechanics laboratory. Fifteen individuals with CAI (age: 20.0±1.2y) and 20 healthy individuals (age: 20.6±0.8y). The maximum reach distance (MRD). The COM and COP displacement, and ankle, knee, and hip joint angles of the stance limb during the PM reach task measured via a 3D motion analysis system. Electromyography (EMG) was also recorded during the task from the tibialis anterior (TA), soleus, peroneus longus, vastus medialis (VM), biceps femoris, and gluteus medius muscles. MRD of the CAI group was shorter than the healthy group (P=0.005). The CAI group showed higher COM positioning (P=0.007), less knee flexion (P=0.009), and lower muscle activity in TA (P=0.04), and VM (P=0.007) during performance of the PM reach as compared to the healthy group. These findings suggest that individuals with CAI demonstrate altered postural control strategies during PM reach performance, likely contributing to a shorter MRD.

Effects of kinesio taping on lower limb biomechanical characteristics during dynamic postural control tasks in individuals with chronic ankle instability.

Previous studies have demonstrated significant biomechanical differences between individuals with chronic ankle instability (CAI) and healthy controls during the Y-balance test. This study aimed to examine the effects of kinesio taping (KT) on lower limb biomechanical characteristics during the Y-balance anterior reach task in individuals with CAI. A total of 30 participants were recruited, comprising 15 individuals with CAI and 15 healthy controls. All participants were randomly assigned three taping conditions: no taping (NT), placebo taping (PT), and KT, followed by the Y-balance anterior reach task. Each condition was separated by one-week intervals. Kinematic and kinetic data of the lower limbs during the movement phase were collected using the Vicon motion capture system (Vicon, T40, 200 Hz) and two Kistler force platforms (Kistler, 1000 Hz). KT significantly improved the Y-balance anterior reach distance (P = 0.003) and peak ankle eversion angle (P = 0.019) compared to NT. Additionally, KT resulted in increased peak knee flexion angle (P = 0.002, P = 0.011) and peak ankle dorsiflexion angle (P <0.001, P = 0.005) relative to both NT and PT. KT also significantly reduced mediolateral center of pressure (COP) displacement (P = 0.001) and average velocity of mediolateral COP displacement (P = 0.033) in comparison to NT. Furthermore, KT decreased mediolateral center of gravity displacement (P = 0.002, P = 0.003) relative to both NT and PT. KT significantly improved abnormal ankle posture by promoting greater ankle dorsiflexion and eversion angles. Additionally, KT reduced mediolateral COP displacement and average velocity to improve postural stability. These changes may contribute to reduced risk of ankle sprains. Therefore, KT may serve as an effective tool for managing recurrent ankle sprains in individuals with CAI.

Biomechanical assessment of ligament maturation after arthroscopic ligament reconstruction of the anterior talofibular ligament.

Many techniques have been described for lateral ankle ligament reconstruction. Although the biomechanical properties of gracilis tendons are different from those of ligaments, the use of a gracilis tendon autograft is a popular option for anatomical reconstruction. Graft maturation and the biomechanical processes over time remain unclear. This study describes changes in graft stiffness following anterior talofibular ligament (ATFL) reconstruction and graft reaction to varus stress. The reconstruction would be stiffer than the native ATFL, but would decrease during follow-up. Twenty patients were prospectively included after arthroscopic reconstruction of the ATFL and calcaneofibular ligament for ankle stabilization. All patients were followed up 3, 6, and 12 months after surgery to assess graft stiffness by shear wave elastography (SWE) at different angles of varus in the ankle. At one year the EFAS and AOFAS functional scores were obtained. A control group of twenty healthy subjects were included to compare graft stiffness to that of a native ATFL. The stiffness of the native ATFL in the control group was 12.8 +/- 2.4 kPa in neutral position, 18.4 +/- 4.8 kPa at 15 ° of varus, 31.9 +/- 6.6 kPa at 30 ° of varus. One year after surgery, graft stiffness was statistically higher and averaged 56 +/- 9 kPa, 70.2 +/- 11.6 kPa and 84.9 +/- 10.5 kPa, respectively. Postoperative graft stiffness at three, six, and twelve months was not correlated with any of these scores, reflecting patient satisfaction and good function at one year. Graft stiffness decreases over time but remains four times stiffer than that of a native ATFL at one year in the neutral position. ATFL graft stiffness at one year during varus stress appears to be different from that of a native ATFL. III.