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Tengler SM, Lenz M, Hofmann GO, Rosenthal M, Roth KE, Mohr L, Waizy H, Klos K. [Online resources for ankle sprains : A German language web analysis]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2025; 128:201-208. [PMID: 39820584 PMCID: PMC11850430 DOI: 10.1007/s00113-024-01526-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2024] [Indexed: 01/19/2025]
Abstract
BACKGROUND With the Internet as the main source of information for health content, the quality of websites with medical information is of high importance. OBJECTIVE This study analysed 250 websites on acute ankle sprain (ASD), one of the most common musculoskeletal disorders, for their quality and readability. Based on the results, a guide for patients was created. METHOD The quality of the websites was assessed using a 25-item content score and the EQIP36 score for medical information material. The reading level could be determined using the Flesch-Kincaid index and the calculated readability. The best three websites were evaluated in a user survey. RESULTS Of the 250 websites recorded 77 were included in the study. The quality of these varied significantly, with none achieving the maximum score. Sources in the healthcare system showed higher quality, while commercially influenced sites were below average in terms of completeness of content. Only 14% of the websites reached the recommended reading level. A significant negative correlation was found between completeness of content and readability. The user survey showed a mixed level of satisfaction and participants with previous medical knowledge were more critical than laypersons. CONCLUSION Online resources about ASD are suboptimal and differ considerably. Deficiencies in content, readability and structure were identified, which limit the effective use by patients. Health information publishers should work harder to improve the comprehensibility and quality of the information provided.
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Affiliation(s)
- Sophie Maria Tengler
- Klinik für Unfall‑, Hand und Wiederherstellungschirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland.
- Friedrich-Schiller-Universität Jena, 07743, Jena, Deutschland.
| | - Mark Lenz
- Klinik für Unfall‑, Hand und Wiederherstellungschirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland
- Friedrich-Schiller-Universität Jena, 07743, Jena, Deutschland
| | - Gunther O Hofmann
- Klinik für Unfall‑, Hand und Wiederherstellungschirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland
- Friedrich-Schiller-Universität Jena, 07743, Jena, Deutschland
| | - Marianne Rosenthal
- Klinik für Unfall‑, Hand und Wiederherstellungschirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland
- Friedrich-Schiller-Universität Jena, 07743, Jena, Deutschland
| | - Klaus E Roth
- Meliva Gelenkzentrum Rhein-Main, 65239, Hochheim, Deutschland
| | - Lena Mohr
- Universitätsmedizin Mainz, 55131, Mainz, Deutschland
| | | | - Kajetan Klos
- Klinik für Unfall‑, Hand und Wiederherstellungschirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland
- Meliva Gelenkzentrum Rhein-Main, 65239, Hochheim, Deutschland
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Kim YC, Lee MS, Oh BH, Heo YM, Kim TG, Yoo SJ, Yoo HJ. Factors Associated with Driving Ability and Changes After Immobilization of the Right Lower Limb: A Driving Simulator Study. J Clin Med 2025; 14:1396. [PMID: 40004926 PMCID: PMC11856806 DOI: 10.3390/jcm14041396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Revised: 02/12/2025] [Accepted: 02/16/2025] [Indexed: 02/27/2025] Open
Abstract
Introduction: Patients with orthopedic injuries often require cast immobilization therapy using casts. Driving with a cast on the right lower limb restricts many things. This study aimed to investigate the factors associated with driving capacity after orthopedic fixation of the right lower limb in healthy adult volunteers. This study's hypothesis was that the orthopedic splint immobilization would have delayed reaction when in a driving simulation. Materials and Methods: We carried out an experimental study between 17 April 2023 and 19 May 2023. We set up the study in two phases: a driving simulation experiment without immobilization with a cast on the right lower limb and a driving simulation experiment with immobilization with a cast on the right lower limb. The data collected through the questionnaire were then analyzed in R version 4.2.2. Results: A total of 47 individuals participated in the study with a mean height of 167.68, of which 68.09% were females. Overall, 78.7% of the study participants could not drive after immobilization with a cast on the right lower limb. There was a significant difference between participants who could drive and those who could not drive by height (p = 0.04), age (p = 0.038), and body type (p = 0.046). Conclusions: Our study demonstrates that an individual's height, age, and body type are associated with an individual's driving ability after orthopedic immobilization of the right lower limb. Our findings suggest that regulations regarding the ability to drive after orthopedic immobilization of the right lower limb must be reconsidered.
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Affiliation(s)
- Young Cheol Kim
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon 35365, Republic of Korea; (Y.C.K.); (B.H.O.); (Y.M.H.); (T.G.K.)
| | - Moo Sik Lee
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon 35365, Republic of Korea;
| | - Byung Hak Oh
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon 35365, Republic of Korea; (Y.C.K.); (B.H.O.); (Y.M.H.); (T.G.K.)
| | - Youn Moo Heo
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon 35365, Republic of Korea; (Y.C.K.); (B.H.O.); (Y.M.H.); (T.G.K.)
| | - Tae Gyun Kim
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon 35365, Republic of Korea; (Y.C.K.); (B.H.O.); (Y.M.H.); (T.G.K.)
| | - Se Jong Yoo
- Department of Radiological Science, Konyang University, Daejeon 35365, Republic of Korea
| | - Hyun Jin Yoo
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon 35365, Republic of Korea; (Y.C.K.); (B.H.O.); (Y.M.H.); (T.G.K.)
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Hu D, Sun H, Wang S, Wang H, Zheng X, Tang H, Hou H. Treatment and prevention of chronic ankle instability: An umbrella review of meta-analyses. Foot Ankle Surg 2025; 31:111-125. [PMID: 39107216 DOI: 10.1016/j.fas.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/13/2024] [Accepted: 07/26/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Chronic ankle instability (CAI) is a common and highly disabling condition. Although several studies have evaluated and analyzed prevention and treatment strategies for CAI, an unbiased and systematic synthesis of evidence is required to provide the most powerful and comprehensive evidence-based measures for the its prevention and treatment of CAI. This study aimed to synthesize evidence from the existing literature addressing the treatment and prevention of CAI. METHODS The PubMed, Embase, Cochrane, and Web of Science databases were systematically searched for relevant studies from inception to December 12, 2023. Data on effect sizes and corresponding 95 % confidence intervals for selected intervention measures were extracted. Systematic reviews were assessed for quality of included studies using a measurement tool (i.e., "AMSTAR 2"). RESULTS In total, 37 studies were included, among which 21 (57 %) were of high or moderate quality. Strong evidence suggested that lower weight (P < 0.001), lower body mass index (P = 0.002), and non-stability defects (P = 0.04) significantly reduced the risk of developing CAI. Strong evidence supported exercise and moderate evidence supported manual therapy, acupuncture, and surgery for improving CAI. Additionally, external support plays an active role in the treatment process of CAI. CONCLUSION This is the first study synthesizing evidence supporting interventions for the treatment and prevention of CAI. Low body weight and body mass index were effective preventive measures against CAI. Exercise, manual therapy, acupuncture, and surgery can improve ankle function in patients with CAI. Plantar sensory treatment and neuromuscular training may be good therapeutic options for patients with CAI. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Dahai Hu
- Department of Sports Medicine, The First Affiliated Hospital, Guangdong Provincial Key Laboratory of Speed Capability, The Guangzhou Key Laboratory of Precision Orthopedics and Regenerative Medicine, Jinan University, 510630 Guangzhou, China; International School, Jinan University, Guangzhou, Guangdong 510632, China
| | - Hongyan Sun
- The Biomedical Translational Research Institute, Jinan University, Guangzhou 510632, China
| | - Shengli Wang
- The Biomedical Translational Research Institute, Jinan University, Guangzhou 510632, China
| | - Huajun Wang
- Department of Sports Medicine, The First Affiliated Hospital, Guangdong Provincial Key Laboratory of Speed Capability, The Guangzhou Key Laboratory of Precision Orthopedics and Regenerative Medicine, Jinan University, 510630 Guangzhou, China
| | - Xiaofei Zheng
- Department of Sports Medicine, The First Affiliated Hospital, Guangdong Provincial Key Laboratory of Speed Capability, The Guangzhou Key Laboratory of Precision Orthopedics and Regenerative Medicine, Jinan University, 510630 Guangzhou, China.
| | - Hui Tang
- The Clinical Medicine Research Institute, The First Affiliated Hospital of Jinan University, Guangzhou 510632, China; The Clinical Medicine Research Institute, The Fifth Affiliated Hospital of Jinan University, Heyuan 517000, China.
| | - Huige Hou
- Department of Sports Medicine, The First Affiliated Hospital, Guangdong Provincial Key Laboratory of Speed Capability, The Guangzhou Key Laboratory of Precision Orthopedics and Regenerative Medicine, Jinan University, 510630 Guangzhou, China.
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Liu K, Ji X, Su P. Advancements in minimally invasive treatment of deltoid ligament injuries combined with distal tibiofibular syndesmosis injuries. BMC Surg 2025; 25:50. [PMID: 39881270 PMCID: PMC11776317 DOI: 10.1186/s12893-025-02779-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Accepted: 01/13/2025] [Indexed: 01/31/2025] Open
Abstract
The deltoid ligament (medial collateral ligament) and the syndesmosis (a composite ligamentous structure at the distal tibiofibular junction) are critical for maintaining ankle stability. In cases of high-energy ankle fractures, these structures are often injured simultaneously, leading to instability and potential long-term complications such as post-traumatic arthritis. This review aims to explore advancements in minimally invasive techniques for the treatment of combined deltoid ligament and syndesmosis injuries, with a focus on optimizing surgical outcomes and reducing patient morbidity. Current treatment strategies primarily involve cortical screws for syndesmosis stabilization and anchor fixation for deltoid ligament repair. Recent innovations, such as bioabsorbable screws, suture-button devices with elastic micromotion, and syndesmotic plates, have demonstrated potential in improving biomechanical stability while minimizing complications. Furthermore, minimally invasive techniques, including arthroscopic repairs with suture anchors, as well as ligament reconstruction using autografts, allografts, or synthetic ligaments, are becoming increasingly popular. By incorporating these advancements, the field is moving toward more effective and patient-centered approaches to achieve anatomical and functional restoration under minimally invasive principles. Future research should focus on further validating these techniques and identifying the most effective strategies for complex injuries.
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Affiliation(s)
- Kun Liu
- Department of Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiaoyan Ji
- Department of Hand and Foot Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China.
| | - Peng Su
- Department of Hand and Foot Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
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He L, Dai M, Xu Y, Ouyang L, Duan D, Huang Z, Xiang C. The feasibility of diagnosing sprained ankle via 3D MRI reconstructing three-dimensional model of anterior talofibular ligament. Front Sports Act Living 2024; 6:1488082. [PMID: 39749261 PMCID: PMC11693451 DOI: 10.3389/fspor.2024.1488082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 11/18/2024] [Indexed: 01/04/2025] Open
Abstract
Introduction The anterior talofibular ligament (ATFL) is the most vulnerable ligament in ankle sprains. Most patients recover after this injury with conservative treatment, while 20%-40% progress to chronic ankle instability that requires surgical stabilization. Conventional MRI does not provide a comprehensive image of the ATFL. We aimed to evaluate the feasibility of using 3D MRI to facilitate the understanding of ATFL injuries and the operative planning. Methods A total of 21 healthy asymptomatic volunteers with 30 normally functioning ankles and 13 patients with 18 sprained ankles were studied. MRI scans were divided into two groups: Group 1 (normal ankle) and Group 2 (injured ankle). The data of all 48 cases were exported to Mimics and reconstructed into 3D models. The image quality of all 3D models was evaluated using a 5-point subjective scoring system. The length, width, and thickness of the ATFL were measured in the 3D model in Mimics and compared to the 3D MPR image data. Results The image quality score was 4.57 ± 0.32. There was no statistically significant difference between the 3D model and the 3D MPR image of ATFL measurements in both groups (P > 0.05). Discussion We concluded that 3D MRI can be used to reconstruct a 3D model of the ATFL for accurate measurements of the ATFL anatomical structure, which holds potential to improve preoperative planning and intraoperative navigation for young sports medicine doctor, facilitate diagnosis of ATFL injuries and make the decision about the operative method.
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Affiliation(s)
- Lei He
- Department of Orthopaedics, Minda Hospital of Hubei Minzu University, Enshi, China
- Hubei Provincial Key Laboratory of Occurrence and Intervention of Rheumatic Diseases, Hubei Minzu University, Enshi, China
| | - Meng Dai
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yan Xu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liu Ouyang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Deyu Duan
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhaogang Huang
- Department of Joint Surgery, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China
| | - Chenghao Xiang
- Department of Joint Surgery, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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Taghizadeh Delkhoush C, Arzani P, Mirmohammadkhani M, Bagheri R, Norouzi A. The Impact of Ankle Mobilization Techniques on Static Stability in Individuals With Acute Inversion Ankle Sprain: A Randomized Clinical Trial. J Chiropr Med 2024; 23:153-161. [PMID: 39776821 PMCID: PMC11701860 DOI: 10.1016/j.jcm.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/18/2024] [Accepted: 08/20/2024] [Indexed: 01/11/2025] Open
Abstract
Objective The purpose of the study was to compare the impact of the mobilization techniques and mobilization with movement techniques on static balance in individuals with acute inversion ankle sprain. Methods Volunteers with acute inversion ankle sprain (N = 40) were equally and randomly assigned to 2 groups. Participants in intervention group I received the Mulligan mobilization with movement techniques, whereas participants in intervention group II underwent the Maitland mobilization techniques. Each participant received the intervention every other day for 2 consecutive weeks. To assess static balance, participants assumed a single-leg stance on the affected leg at the center of a force plate with eyes open or closed plate for 20 seconds. The displacement, velocity, and area of the center of pressure were recorded 1 day before and after the intervention. Results The velocity of the center of pressure in the anterior-posterior direction was significantly reduced only in group I during eyes open (P = .043) and closed (P = .004). However, the displacement of the center of pressure in the anterior-posterior direction was significantly decreased in both group I (P = .024) and group II (P = .028) with eyes open. No significant changes were found in the area of the center of pressure in either group during eyes open or closed (P > .053). Conclusions Both Mulligan's and Maitland's approaches significantly improved sway displacement. For the individuals with acute inversion ankle sprain who were included in this study, the Mulligan technique were more effective in improving static balance indicators compared to the Maitland technique. Clinical Trial The study was then registered in the Iranian Registry of Clinical Trials (17/02/2019) (IRCT20190108042292N2).
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Affiliation(s)
| | - Parisa Arzani
- Department of Physical Therapy, School of Rehabilitation Sciences, Semnan University of Medical Sciences, Semnan, Iran
| | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Rasool Bagheri
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Adeleh Norouzi
- Department of Physical Therapy, School of Rehabilitation Sciences, Semnan University of Medical Sciences, Semnan, Iran
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Tedeschi R, Ricci V, Tarantino D, Tarallo L, Catani F, Donati D. Rebuilding Stability: Exploring the Best Rehabilitation Methods for Chronic Ankle Instability. Sports (Basel) 2024; 12:282. [PMID: 39453248 PMCID: PMC11510844 DOI: 10.3390/sports12100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 10/08/2024] [Accepted: 10/15/2024] [Indexed: 10/26/2024] Open
Abstract
Background: Chronic Ankle Instability (CAI) is a common condition characterized by repeated episodes of ankle "giving way" and impaired balance, leading to functional limitations. Various rehabilitation techniques, including balance training, proprioceptive exercises, whole-body vibration (WBV), and novel approaches like stroboscopic vision, are used to address these deficits. This review evaluates the effectiveness of different rehabilitation interventions for CAI management. Methods: A review was conducted by analyzing 11 randomized controlled trials that investigated the impact of balance and proprioceptive training programs on CAI. The primary outcomes assessed were the Star Excursion Balance Test (SEBT), Cumberland Ankle Instability Tool (CAIT), and Foot and Ankle Ability Measure (FAAM). Methodological quality was assessed using the PEDro scale, and the risk of bias was evaluated with the ROB 2 tool. Results: All rehabilitation interventions demonstrated significant improvements in SEBT, CAIT, and FAAM scores. However, no single intervention was found to be consistently superior. Traditional balance training, strength exercises, BAPS, and WBV all provided meaningful functional gains. Stroboscopic vision training showed similar effectiveness compared to conventional approaches. The evidence supports a combination of balance and strength training for optimal recovery. Conclusions: Balance and proprioceptive exercises are effective in managing CAI, with improvements in both dynamic stability and subjective outcomes. No intervention stands out as the best, but personalized programs incorporating various methods are recommended. Future research should explore the long-term effects and potential synergies of combined interventions.
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Affiliation(s)
- Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Via Zamboni 33, 40126 Bologna, Italy
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, 20146 Milan, Italy
| | | | - Luigi Tarallo
- Department of Orthopedics and Traumatology, Polyclinic of Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Fabio Catani
- Department of Orthopedics and Traumatology, Polyclinic of Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Danilo Donati
- Physical Therapy and Rehabilitation Unit, Policlinico di Modena, 41124 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy
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Kocsis K, Stubnya B, Váncsa S, Kói T, Kovács N, Hergár L, Hetthéssy J, Holnapy G, Hegyi P, Pap K. Diagnostic accuracy of ultrasonography in acute lateral ankle ligament injury: A systematic review and meta-analysis. Injury 2024; 55 Suppl 3:111730. [PMID: 39300628 DOI: 10.1016/j.injury.2024.111730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 06/10/2024] [Accepted: 07/14/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND The gold standard diagnostic method for acute lateral ankle ligament sprain is magnetic resonance imaging (MRI). However, it is hardly accessible and is time-consuming. Therefore, additional diagnostic methods are warranted. Point-of-care ultrasound, on the other hand, is inexpensive, widely available, time-efficient testing method. PURPOSE Therefore, the aim of this meta-analysis is to determine the diagnostic accuracy of ultrasound for acute ankle ligament injuries compared to MRI. METHODS In our systematic review and meta-analysis, we followed the recommendations of the Cochrane Handbook. We searched the following databases from inception to March 31, 2022: Medline (PubMed), EMBASE, and Cochrane Library. Eligible studies investigated the diagnostic accuracy of US compared to MRI for diagnosing acute lateral ankle ligament injuries. Finally, we calculated pooled sensitivity and specificity with a 95 % confidence interval (CI). RESULTS Eight studies met our eligibility criteria, involving 434 patients. For anterior tibiofibular ligament (ATFL) injury, the summary sensitivity and specificity were Se = 0.97 (CI: 0.89-0.99) and Sp = 0.93 (CI: 0.84-0.97). For calcaneofibular ligament (CFL) injury, the summary sensitivity and specificity were Se.: Se = 0.81 (CI: 0.58-0.93) and Sp = 0.92 [0,81;0,97]. In addition, subgroup analysis based on US performed by different types of investigators was comparable between each other (radiologist group Se = 0.98, CI: 0.24-1, and Sp = 0.91, CI: 0.74-0.97, and the orthopedic/ emergency department group Se = 0.96, CI: 0-1, and Sp = 0.97, CI: 0-1). CONCLUSION Ultrasound showed high diagnostic accuracy for acute lateral ankle ligament injury, irrespective of the investigator. Therefore, based on the current available data, it could be used in primary diagnostics of acute lateral ankle ligament injury.
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Affiliation(s)
- Koppány Kocsis
- Department of Orthopedics and Traumatology, Uzsoki Hospital, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Bence Stubnya
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Institute for Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Tamás Kói
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Stochastics, Institute of Mathematics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Norbert Kovács
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Luca Hergár
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Judit Hetthéssy
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Gergely Holnapy
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Institute for Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Károly Pap
- Department of Orthopedics and Traumatology, Uzsoki Hospital, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Traumatology, Semmelweis University, Budapest, Hungary.
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Zhuang T, Vandal N, Dehghani B, Alqazzaz A, Humbyrd CJ. Medicaid Insurance is Associated With Decreased MRI Use for Ankle Sprains Compared With Private Insurance: A Retrospective Large-database Analysis. Clin Orthop Relat Res 2024; 482:1394-1402. [PMID: 38060239 PMCID: PMC11272272 DOI: 10.1097/corr.0000000000002943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/08/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Advanced imaging modalities are expensive, and access to advanced imaging services may vary by socioeconomic factors, creating the potential for unwarranted variations in care. Ankle sprains are a common injury for which variations in MRI use can occur, both via underuse of indicated MRIs (appropriate use) and overuse of nonindicated MRIs (inappropriate use). High-value, equitable healthcare would decrease inappropriate use and increase appropriate use of MRI for this common injury. It is unknown whether socioeconomic factors are associated with underuse of indicated MRIs and overuse of nonindicated MRIs for ankle sprains. QUESTIONS/PURPOSES Using ankle sprains as a paradigm injury, given their high population incidence, we asked: (1) Does MRI use for ankle sprains vary by insurance type? (2) After controlling for relevant confounding variables, did patients who received an MRI have higher odds of undergoing ankle surgery? METHODS Between 2011 and 2019, a total of 6,710,223 patients were entered into the PearlDiver Mariner Patient Records Database with a diagnosis of ankle sprain. We considered patients with continuous enrollment in the database for at least 1 year before and 2 years after the diagnosis as potentially eligible. Based on that, 68% (4,567,106) were eligible; a further 20% (1,372,478) were excluded because of age younger than 18 years, age at least 65 years with Medicaid insurance, or age < 65 years with Medicare insurance. Another 0.1% (9169) had incomplete data, leaving 47% (3,185,459) for analysis here. Patients with Medicaid insurance differed from patients with Medicare Advantage or private insurance with respect to age, gender, region, and comorbidity burden. The primary outcome was ankle MRI occurring within 12 months after diagnosis. The use of ankle surgery after MRI in each cohort was measured as a secondary outcome. We used multivariable logistic regression models to evaluate the association between insurance type and MRI use while adjusting for age, gender, region, and comorbidity burden. Separate multivariable regression models were created to evaluate the association between receiving an MRI and subsequent ankle surgery for each insurance type, adjusting for age, gender, region, and comorbidity burden. Within 12 months of an ankle sprain diagnosis, 1% (3522 of 339,457) of patients with Medicaid, 2% (44,793 of 2,627,288) of patients with private insurance, and 1% (1660 of 218,714) of patients with Medicare Advantage received an MRI. RESULTS After controlling for age, gender, region, and comorbidity burden, patients with Medicaid had lower odds of receiving an MRI within 12 months after ankle sprain diagnosis than patients with private insurance (odds ratio 0.60 [95% confidence interval 0.57 to 0.62]; p < 0.001). Patients with Medicaid who received an MRI had higher adjusted odds of undergoing subsequent ankle surgery (OR 23 [95% CI 21 to 26]; p < 0.001) than patients with private insurance (OR 12.7 [95% CI 12 to 13]; p < 0.001). CONCLUSION Although absolute MRI use was generally low, there was substantial relative variation by insurance type. Given the high incidence of ankle sprains in the general population, these relative differences can translate to tens of thousands of MRIs. Further studies are needed to evaluate the reasons for decreased appropriate MRI use in patients with Medicaid and overuse of MRI in patients with private insurance. The establishment of clinical practice guidelines by orthopaedic professional societies and more stringent gatekeeping for MRI use by health insurers could reduce unwarranted variations in MRI use. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Thompson Zhuang
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicholas Vandal
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Bijan Dehghani
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Aymen Alqazzaz
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Casey Jo Humbyrd
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Plakoutsis G, Tsepis E, Fousekis K, Paraskevopoulos E, Papandreou M. The Effects of Motor Imagery on Static and Dynamic Balance and on the Fear of Re-Injury in Professional Football Players with Grade II Ankle Sprains. Healthcare (Basel) 2024; 12:1432. [PMID: 39057575 PMCID: PMC11276660 DOI: 10.3390/healthcare12141432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/11/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Lateral ankle sprains are one of the most frequent athletic injuries in football, causing deficits in balance. Motor Imagery (MI) has been successively included in sports rehabilitation as a complementary therapeutic intervention. The aim of the present study was to explore the effects of MI on static and dynamic balance and on the fear of re-injury in professional football players with Grade II ankle sprains. Fifty-eight participants were randomly allocated into two groups: First-MI group (n = 29) and second-Placebo group (n = 29), and they each received six intervention sessions. The first MI group received MI guidance in addition to the balance training program, while the second Placebo group received only relaxation guidance. One-way ANOVA showed statistically significant results for all variables, both before and 4 weeks after the interventions for both groups. The t-test showed statistically significant differences between the two groups for static balance for the right lower extremity (t = 3.25, S (two-tailed) = 0.002, p < 0.05) and also for heart rate (final value) in all time phases. Further research is needed in order to establish MI interventions in sports trauma recovery using stronger MI treatments in combination with psychophysiological factors associated with sports rehabilitation.
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Affiliation(s)
- George Plakoutsis
- Laboratory of Advanced Physiotherapy, Department of Physiotherapy, University of West Attica, 12243 Athens, Greece
| | - Elias Tsepis
- Department of Physiotherapy, University of Patras, 26504 Patra, Greece
| | | | - Eleftherios Paraskevopoulos
- Laboratory of Advanced Physiotherapy, Department of Physiotherapy, University of West Attica, 12243 Athens, Greece
| | - Maria Papandreou
- Laboratory of Advanced Physiotherapy, Department of Physiotherapy, University of West Attica, 12243 Athens, Greece
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11
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Bsoul N, Ning L, Cai L, Mazmanyan D, Porter D. Evidence-based clinical practice guidelines for the management of acute ankle injuries according to: a PRISMA systematic review and quality appraisal with AGREE II. BMC Musculoskelet Disord 2024; 25:523. [PMID: 38978052 PMCID: PMC11229291 DOI: 10.1186/s12891-024-07655-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Acute ankle injuries are commonly seen in emergency rooms, with significant social impact and potentially devastating consequences. While several clinical practice guidelines (CPGs) related to ankle injuries have been developed by various organizations, there is a lack of critical appraisal of them. The purpose of this systematic review is to identify and critically appraise evidence-based clinical practice guidelines (EB-CPGs) related to acute ankle injuries in adults. METHOD We conducted searches in the Cochrane Library, MEDLINE, EMBASE databases, WHO, and reviewed 98 worldwide orthopedic association websites up until early 2023. Two authors independently applied the inclusion and exclusion criteria, and each evidence-based clinical practice guideline (EB-CPG) underwent independent critical appraisal of its content by all four authors using the Appraisal of Guidelines for REsearch and Evaluation (AGREE II) instrument. AGREE II scores for each domain were then calculated. RESULTS This review included five evidence-based clinical practice guidelines. The mean scores for all six domains were as follows: Scope and Purpose (87.8%), Stakeholder Involvement (69.2%), Rigour of Development (72.5%), Clarity of Presentation (86.9%), Applicability (45.6%), and Editorial Independence (53.3%). CONCLUSION The number of EB-CPGs related to ankle injuries are limited and the overall quality of the existing evidence-based clinical practice guidelines (EB-CPGs) for ankle injuries is not strong, with three of them being outdated. However, valuable guidance related to Ottawa rules, manual therapy, cryotherapy, functional supports, early ambulation, and rehabilitation has been highlighted. Challenges remain in areas such as monitoring and/or auditing criteria, consideration of the target population's views and preferences, and ensuring editorial independence. Future guidelines should prioritize improvements in these domains to enhance the quality and relevance of ankle injury management. SYSTEMATIC REVIEW Systematic review.
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Affiliation(s)
- Najeeb Bsoul
- Tsinghua University, Beijing, China
- First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Liang Ning
- Tsinghua University, Beijing, China.
- First Affiliated Hospital of Tsinghua University, Beijing, China.
| | - Leyi Cai
- Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Davit Mazmanyan
- Tsinghua University, Beijing, China
- First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Daniel Porter
- Tsinghua University, Beijing, China
- First Affiliated Hospital of Tsinghua University, Beijing, China
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12
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Picot B, Grimaud O, Rauline G, Haidar I, Moussa MK, Hardy A. Validity and reproducibility of the ARL-RSI score to assess psychological readiness before returning to sport after lateral ankle sprain. J Exp Orthop 2024; 11:e12073. [PMID: 38957229 PMCID: PMC11217666 DOI: 10.1002/jeo2.12073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 07/04/2024] Open
Abstract
Purpose Although multiple scales exist to evaluate psychological readiness before returning to sport post-lateral ankle sprain (LAS), no score has been validated specifically for LAS or chronic ankle instability. The main aim of the study is to evaluate the validity and reproducibility of the ankle ligament reconstruction-return to sport injury (ALR-RSI) scale in assessing psychological readiness after LAS and its ability to identify patients who can return to their preinjury level. Methods A total of 64 patients (35 females and 29 males; 33.8 ± 13.2 years) who recently experienced an acute LAS were included in this study. All patients participated in a predictive validation component of the study and were assessed at 2 and 4 months following an LAS. The ALR-RSI was completed twice by 20 patients at a 7-day interval to evaluate the reliability of the score in patients suffering from LAS. Results The ALR-RSI was significantly (p < 0.001) and positively correlated with the other scores. The correlation was strong with the Foot and Ankle Ability Measure Sports: r = 0.77; 95% confidence interval [CI]: 0.78-0.83) and moderate with the American Orthopaedic Foot and Ankle Society (r = 0.69; 95% CI: 0.60-0.78) and the Foot and Ankle Ability Measure Activities of Daily Living Scores (r = 0.63; 95% CI: 0.51-0.72). Two-month ALR-RSI scores had good ability for predicting nonreturners at 4 months (area under the curve = 0.76; 95% CI: 0.6-0.9; p = 0.005). A Youden index of 0.51 was observed at an ALR-RSI score of 46%, corresponding to a sensitivity of 67% and specificity of 83%. Test-retest reliability of the ALR-RSI was excellent, with an ICC of 0.98 (95% CI: 0.96-0.99), a standard error of measurement of 3.02% and a minimum detectable change of 8.37%. Conclusions The results of the current study validated the ALR-RSI as an important questionnaire to assess psychological readiness to return to sport after LAS. Level of Evidence Level II prospective cohort study.
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Affiliation(s)
- Brice Picot
- Interuniversity Laboratory of Human Movement SciencesSavoie MontBlanc UniversityChambéryFrance
- French Society of Sports Physical Therapist (SFMKS Lab)Pierrefitte‐surSeineFrance
| | | | | | - Ibrahim Haidar
- Department of Orthopedic SurgeryEmirates HospitalDubaiUnited Arab Emirates
| | - Mohamad K. Moussa
- Department of Orthopedic SurgeryGroup Hospitalier Sélestat‐ObernaiSélestatFrance
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13
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Lichte P, Weber C, Otto M, Bläsius F, Gutteck N, Hildebrand F, Arbab D. [Current diagnostics and treatment of ankle sprains in German]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:449-456. [PMID: 38634870 PMCID: PMC11133181 DOI: 10.1007/s00113-024-01428-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Ankle sprains are one of the most frequent injuries of the musculoskeletal system. The injury pattern determines the treatment and are crucial for the outcome. Nonoperative treatment is commonly recommended for isolated injuries of the lateral ligaments but no standard strategy exists in combined ankle ligament injuries. The goal of this national survey was to achieve an overview about the current diagnostic strategies and common treatment concepts in Germany. MATERIAL AND METHODS All members of the German Society for Orthopaedics and Trauma Surgery (DGOU) were invited to participate in an anonymous survey about the diagnostic and therapeutic approach in cases of ankle sprains. The online survey consisted of 20 questions. Besides questions about the speciality and scope of activities the participants were ask to depict their diagnostic and therapeutic strategy. RESULTS A total of 806 participants completed the survey. Most of them were orthopedic trauma surgeons and worked in a hospital. During the first presentation the anterior drawer test (89.5%) and the inversion/eversion test (81.6%) were most commonly used, 88.1% always make an X‑ray examination and 26.5% an ultrasonography examination. Isolated injuries of the anterior fibulotalar ligament (LFTA) were treated nonoperatively by 99.7% of the participants, 78.8% recommend full weight bearing in an orthesis, 78.8% treat the complete rupture of the lateral ligaments without operation whereas 30.1% stated that they would treat a combined lateral ligaments rupture with an injury of the syndesmosis nonoperatively. DISCUSSION Due to the heterogeneity of injury patterns after ankle sprain no consistent recommendations for diagnostics and treatment exist. The Ottawa ankle rules and ultrasonography were not often utilized despite of the good evidence. The isolated rupture of the LFTA is diagnosed and treated according to the national guidelines by most of the participants. In cases of combined injuries of the lateral and medial ankle ligaments the majority choose a nonoperative treatment strategy which is justified by the guidelines with a low level of evidence. Combined injuries of the syndesmosis and the lateral ankle ligaments were treated operatively, which also correlates with the recommendations in the literature. The standard care of ankle sprain in Germany is in accordance with the recommendations from the current literature.
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Affiliation(s)
- Philipp Lichte
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - Christian Weber
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Michael Otto
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Felix Bläsius
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Natalia Gutteck
- Klinik für Orthopädie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Frank Hildebrand
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Dariusch Arbab
- Klinik für Orthopädie/Unfallchirurgie, St. Elisabeth-Hospital Herten, Mitglied der Medizinischen Fakultät der Universität Witten/Herdecke, Herten, Deutschland
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14
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Nishikawa DRC, Saito GH, Mendes AAM, Marangon A, Tardini CH, de Oliveira Junior AS, Duarte FA, Prado MP. Functional outcomes and rates of return to sport activities in a non-athlete population after the open Brostrom-Gould repair: a seven-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1957-1962. [PMID: 38472435 DOI: 10.1007/s00590-024-03882-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION After an ankle sprain, up to 20% of patients may develop chronic lateral ankle instability (CLAI) requiring surgical treatment. The objective of this study was to investigate the functional outcomes and rates of return to sport activities in a cohort of non-athlete patients with chronic lateral ankle instability (CLAI) who underwent the opened Brostrom-Gould technique (BGT). MATERIALS AND METHODS Seventy-nine patients (seventy-nine feet) from three different centers undergoing BGT were reviewed. For clinical and functional analysis, the AOFAS ankle-hindfoot scale was applied and rates of return to sport activities were assessed. Correlation of Δ-AOFAS and rates of return to sport activities with all variables analyzed was performed. RESULTS Mean AOFAS score improved from 64.6 to 97.2 (p < 0.001). Sixty-one (77.2%) returned to preinjury activities and 18 (22.8%) changed to a lower-level modality. Symptoms of instability were related to Δ-AOFAS (p = 0.020). Change in the sport activity was related to pain and symptoms of instability (p = 0.41 and p < 0.001). CONCLUSION Recreational athlete patients who underwent the BGT demonstrated excellent functional outcomes after a mean follow-up of 7 years. Residual pain and symptoms of instability after surgery were the main complaints associated with limitations in physical activities.
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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Department of Orthopaedic Surgery, Hospital Alemão Oswaldo Cruz, 94, São Joaquim Street, Liberdade, São Paulo, SP, CEP: 01508-000, Brazil.
| | - Guilherme Honda Saito
- Department of Orthopaedic Surgery, Hospital Sírio-Libanês, 91, Dona Adma Jafet Street, Bela Vista, São Paulo, SP, CEP:01308-050, Brazil
| | - Alberto Abussamra Moreira Mendes
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
| | - Alberto Marangon
- Department of Orthopaedic Surgery, Clinica San Francesco, 21/B, Monte Ortigara Street, 37127, Verona, VR, Italy
| | - Carlos Henrique Tardini
- Department of Orthopaedic Surgery, Instituto Prata de Ortopedia, 161, Paineiras Street, Jardim, Santo André, SP, CEP 09090-521, Brazil
| | - Adilson Sanches de Oliveira Junior
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
| | - Fernando Aires Duarte
- Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, São Paulo, SP, CEP: 05078-000, Brazil
| | - Marcelo Pires Prado
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
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15
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Maria PA, Vuurberg G, Kerkhoffs GMMJ. Exploring influences and risk of bias of studies on return to sport and work after lateral ankle sprain: A systematic review and meta-analysis. World J Meta-Anal 2024; 12:87026. [DOI: 10.13105/wjma.v12.i1.87026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/26/2023] [Accepted: 01/02/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Lateral ankle sprains are the most common traumatic musculoskeletal injuries of the lower extremity, with an incidence rate of 15%-20%. The high incidence and prevalence highlights the economic impact of this injury. Ankle sprains lead to a high socioeconomic burden due to the combination of the high injury incidence and high medical expenses. Up to 40% of patients who suffer from an ankle sprain develop chronic ankle instability. Chronic instability can lead to prolonged periods of pain, immobility and injury recurrence. Identification of factors that influence return to work (RTW) and return to sports (RTS) after a lateral ankle sprain (LAS) may help seriously reduce healthcare costs.
AIM To explore which factors may potentially affect RTW and RTS after sustaining an LAS.
METHODS EMBASE and PubMed were systematically searched for relevant studies published until June 2023. Inclusion criteria were as follows: (1) Injury including LAS or chronic ankle instability; (2) Described any form of treatment; (3) Assessment of RTW or RTS; (4) Studies published in English; and (5) Study designs including randomized controlled clinical trials, clinical trials or cohort studies. Exclusion criteria were: (1) Studies involving children (age < 16 year); or (2) Patients with concomitant ankle injury besides lateral ankle ligament damage. A quality assessment was performed for each of the included studies using established risk of bias tools. Additionally quality of evidence was assessed using the GRADEpro tool in cases where outcomes were included in the quantitative analysis. A best evidence synthesis was performed in cases of qualitative outcome analysis. For all studied outcomes suitable for quantitative analysis a forest plot was created to calculate the effect on RTW and RTS.
RESULTS A total of 8904 patients were included in 21 studies, 10 randomized controlled trials, 7 retrospective cohort studies and 4 prospective cohort studies. Fifteen studies were eligible for meta-analysis. The overall RTS rate ranged were 80% and 83% in the all treatments pool and surgical treatments pool, respectively. The pooled mean days to RTS ranged from 23-93 d. The overall RTW rate was 89%. The pooled mean time to RTW ranged from 5.8-8.1 d. For patients with chronic ankle instability, higher preoperative motivation was the sole factor significantly and independently (P = 0.001) associated with the rate of and time to RTS following ligament repair or reconstruction. Higher body mass index was identified as a significant factor (P = 0.04) linked to not resuming sports or returning at a lower level (median 24, range 20-37), compared to those who resumed at the same or higher level (median 23, range 17-38). Patients with a history of psychological illness or brain injury, experienced a delay in their rehabilitation process for sprains with fractures and unspecified sprains. The extent of the delayed rehabilitation was directly proportional to the increased likelihood of experiencing a recurrence of the ankle sprain and the number of ankle-related medical visits. We also observed that 10% of athletes who did return to sport after lateral ankle sprain without fractures described non-ankle-related reasons for not returning.
CONCLUSION All treatments yielded comparable results, with each treatment potentially offering unique advantages or benefits. Preoperative motivation may influence rehabilitation after LAS. Grading which factor had a greater impact was not possible due to the lack of comparability among the included patients.
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Affiliation(s)
- Priscilla A Maria
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC-Location AMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Academic Center for Evidence-based Sports medicine, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Faculty of Medicine, University of Amsterdam, Amsterdam 1105 AZ, Netherlands
| | - Gwendolyn Vuurberg
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC-Location AMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Academic Center for Evidence-based Sports medicine, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Department of Radiology and Nuclear Medicine, Rijnstate Arnhem, Arnhem 6815AD, Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
| | - Gino MMJ Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC-Location AMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Academic Center for Evidence-based Sports medicine, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Faculty of Medicine, University of Amsterdam, Amsterdam, 1105 AZ, Netherlands
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Mellado-Romero MÁ, Guerra-Pinto F, Ojeda-Thies C, Arroyo-Hernández M, Abarquero-Diezhandino A, Ramos-Pascua L, Vilá-Rico J. Comparison of Direct Repair Versus Anatomic Graft Reconstruction of the Anterior Talofibular Ligament: A Biomechanical Cadaveric Study. J Foot Ankle Surg 2024; 63:36-41. [PMID: 37633486 DOI: 10.1053/j.jfas.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023]
Abstract
The goal of our study is to compare the stability of the anatomic reconstruction of the anterior talofibular ligament (ATFL) with direct repair of the ATFL, in a cadaver model. We performed the following techniques in 18 cadaveric ankles: the intact ATFL was cut, after which a direct repair using 2 anchors was performed. The repair was sectioned, and anatomic reconstruction was then performed with a tendon autograft. We measured angular displacement in 3 anatomic planes (axial, coronal, sagittal) for each situation in response to the anterior drawer test (ADT), talar tilt test (TTT) and pivot test (PT), using a specifically constructed arthrometer. The sectioned ATFL was inferior to the intact ATFL in the axial plane with the ADT (p = .012), in the axial plane with the PT (p = .001) and in the axial and coronal planes with the TTT (p = .013 and p = .016, respectively). Direct anatomic repair was inferior to the intact ATFL in the axial plane upon the PT (p = .009). No differences could be found between anatomic graft reconstructions and the intact ATFL with any manoeuver, nor when comparing anatomic graft reconstruction and direct repair with 2 anchors. We were able to conclude that anatomic graft reconstruction of the ATFL reproduces angular stability of the native ligament in a cadaver model. While we could not detect if anatomic graft reconstruction was superior to direct repair, the latter proved to be less stable in the axial plane upon internal rotation (pivot test) versus the intact ATFL.
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Affiliation(s)
- María Ángela Mellado-Romero
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - Francisco Guerra-Pinto
- Department of Orthopaedics of the Hospital de Sant'Ana, Parede, Portugal; Department of Orthopaedics of the Hospital da Cruz Vermelha, Lisbon, Portugal; NOVA Medical School - Faculdade de Ciências Médicas, Nova University of Lisbon, Lisbon, Portugal
| | - Cristina Ojeda-Thies
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marta Arroyo-Hernández
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Abarquero-Diezhandino
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis Ramos-Pascua
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Jesús Vilá-Rico
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Dolan P, Kenny I, Glynn L, Campbell M, Warrington GD, Cahalan R, Harrison A, Lyons M, Comyns T. Risk factors for acute ankle sprains in field-based, team contact sports: a systematic review of prospective etiological studies. PHYSICIAN SPORTSMED 2023; 51:517-530. [PMID: 35757862 DOI: 10.1080/00913847.2022.2093618] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The aim of this systematic review was to identify prospectively measured ankle sprain risk factors in field-based team contact sports. METHODS Eight databases including SPORTDiscus, CINAHL Complete, MEDLINE (EBSCO), Education Source, Web of Science, Scopus, Embase, and Pubmed were searched using specific Boolean terms. A modified-CASP diagnostic test assessed the quality of the included studies. Extensive data extraction included but was not limited to injury definition, protocols for injury diagnosis and recording, and outcomes associated with ankle sprain. RESULTS 4012 records were returned from the online search and 17 studies met the inclusion criteria for this review. Twelve different risk factors including anatomic alignment of the foot and ankle, joint laxity, height, mass, BMI (body mass index), age, ankle strength, hip strength, single leg landing performance (ground reaction force, pelvic internal rotation, and knee varus), and single leg reach were all found to be associated with ankle sprain incidence. Injury definitions and methods of diagnosis and recording varied across the 17 studies. CONCLUSION This review updates the literature on prospective risk factors for ankle sprain in a specific population rather than heterogeneous cohorts previously studied. From more than 20 categories of risk factors investigated for ankle sprain association across 17 studies in field-based team contact sports, 12 variables were found to be associated with increased incidence of ankle sprain. In order to reduce the risk of ankle sprain, BMI, ankle plantar and dorsiflexion strength, hip strength, and single leg landing performance should be factored in to athlete assessment and subsequent program design. More studies utilizing standardized definitions and methods of recording and reporting are needed. Future prospective etiological studies will allow strength and conditioning coaches, physiotherapists, and physicians to apply specific training principles to reduce the risk and occurrence of ankle sprain injuries.
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Affiliation(s)
- Patrick Dolan
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ian Kenny
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- School of Medicine, University of Limerick, Limerick, Ireland
- HRB Primary Care Clinical Trials Network Ireland, Ireland
| | - Mark Campbell
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
- Lero, The Irish Software Research Centre, University of Limerick, Limerick, Ireland
| | - Giles D Warrington
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
| | - Roisin Cahalan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, University of Limerick, Limerick, Ireland
| | - Andrew Harrison
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
| | - Mark Lyons
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
| | - Thomas Comyns
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
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18
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Wenning M, Schmal H. Chronic Ankle Instability - Mechanical vs. Functional. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:552-562. [PMID: 35158394 DOI: 10.1055/a-1696-2503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Chronic ankle instability arises from three interacting contributing factors: mechanical ankle instability, functional ankle instability, and perceived ankle instability. To decide on the most appropriate individual recommendation for therapeutic options, it is necessary to assess which of the two main aetiologies - functional vs. mechanical - is dominant in causing the perceived impairment. It is essential to perform a thorough analysis and diagnosis, even though quantifying mechanical ankle instability is still a challenge in the clinical approach to this common pathology. When diagnosing mechanical instability, the most established procedure is physical examination, although this unfortunately does not allow the deficit to be quantified. Additional options include stress-ultrasound, 3D stress-MRI (3SAM), ankle arthrometry, marker-based 3D motion analysis, and diagnostic ankle arthroscopy. Of these the latter is considered the gold standard, even though it is an invasive procedure, it may not be performed for diagnostic reasons only, and it also does not allow the mechanical instability to be quantified. For diagnosing functional instability there are non-instrumented tests such as the Star Excursion Balance Test or Y-Balance Test, posturography/stabilometry, and gait and running analysis, possibly combined with EMG acquisition and isokinetic strength testing.To date, the standard of care is conservative management of ankle instability, and the therapy should include sensorimotor training, strength training of the periarticular muscles, balance training, and gait and running exercises on different surfaces. However, it is increasingly clear that a certain degree of mechanical instability cannot be compensated for by functional training. Thus, it is the goal of differential diagnostics to identify those patients and guide them to mechanical therapy, including ankle bracing, taping, and surgical ligament reconstruction.
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Affiliation(s)
- Markus Wenning
- Department of Orthopedic and Trauma Surgery, Albert-Ludwigs-Universität Freiburg Medizinische Fakultät, Freiburg, Deutschland
| | - Hagen Schmal
- Department of Orthopedic and Trauma Surgery, Albert-Ludwigs-Universitat Freiburg Medizinische Fakultat, Freiburg, Deutschland
- Department of Orthopedic Surgery, Odense University Hospital Department of Orthopaedic Surgery, Odense, Denmark
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Maduka GC, Jakusonoka R, Maduka DC, Yusuf N. Conservative Management of Acute Lateral Ligaments of the Ankle Injuries: An Analytical Literature Review. Cureus 2023; 15:e47709. [PMID: 37965420 PMCID: PMC10641652 DOI: 10.7759/cureus.47709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
Injuries to the lateral ligaments of the ankle are among the most frequent sporting injuries. These injuries constitute a significant portion of all sports-related injuries. Nearly all cases involve damage to either the anterior talofibular ligament (ATFL) or the calcaneofibular ligament (CFL). While they are generally considered to be mild injuries, without adequate rehabilitation and treatment, these injuries often result in lingering symptoms for many patients for a period ranging from 6 weeks to 18 months. Subsequently, this analysis seeks to assess the non-surgical, conservative approaches currently employed in managing lateral ligament injuries of the ankle. Therefore, this assessment explores the variations and effectiveness of conservative treatment approaches based on the injury's severity and the mechanisms of trauma. The study conducted an analytical literature review that relied on diverse sources, including orthopedic books, e-books, articles, journals, and internet databases, to accomplish this. The main sources were obtained from reputable databases such as UpToDate, NCBI, and PubMed. Collectively, these sources provide definitions, outlines, evaluations, and discussions related to the topic. As such, they facilitated the formulation of an informed conclusion on the approach to treating lateral ligament injuries of the ankle complex. The reviewed literature shows that early and effective initial treatment involving pain management, prompt resumption of weight-bearing activities, limited immobilisation, and targeted physical therapy yields favorable outcomes for minor-grade sprains and is an effective preventive measure against recurrent injuries. Accordingly, athletes who experience regular ankle sprains should consider prophylactic bracing or taping to lower the risk of re-injury while enhancing their functionality. Notably, the existing functional and conservative management methods demonstrate and yield positive post-treatment outcomes. Nonetheless, the efficiency and effectiveness of these treatments depend on the specific nature of the injury and the unique traits of the individuals who sustain it. Consequently, these factors must be considered for when determining the appropriate treatment approach.
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Affiliation(s)
- Godsfavour C Maduka
- Trauma and Orthopaedics, Lister Hospital, East & North Herts National Health Service (NHS) Trust, Stevenage, GBR
| | | | - Divinegrace C Maduka
- Major Trauma, Queens Medical Centre-Nottingham University Hospitals National Health Service (NHS) Trust, Nottingham, GBR
| | - Naeem Yusuf
- Plastic Surgery, Lister Hospital, East & North Herts National Health Service (NHS) Trust, Stevenage, GBR
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20
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Guyonnet C, Dutra Vieira T, Lopes R. Arthroscopic Double-Row Repair for Acute Proximal Detachment of the Lateral Collateral Ligament in a Complex Ankle Sprain. Arthrosc Tech 2023; 12:e1409-e1416. [PMID: 37654887 PMCID: PMC10466297 DOI: 10.1016/j.eats.2023.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/30/2023] [Accepted: 04/12/2023] [Indexed: 09/02/2023] Open
Abstract
Management of ankle sprains is still being discussed. For athletes, recent studies recommend surgical treatment for acute grade III rupture, because of better long-term ankle stability. The purpose of this technical note is to describe the arthroscopic acute double-row repair for proximal disinsertion of collateral lateral ligament ankle. With the patient in dorsal decubitus under spinal anesthesia, the foot and ankle are extended beyond the edge of the surgical table. The anteromedial portal is created inside the anterior tibial tendon in which the arthroscope is introduced. The anterolateral approach is simulated with a needle under arthroscopic control, in front and under the tip of the lateral malleolus. The anterior talofibular ligament (ATFL) is released from the capsule with a beaver blade. The tip of the lateral malleolus is sharpened, and a soft anchor is impacted there. ATFL is caught with a Mini-Scorpio plier, a Lasso loop is performed to improve tissue grasping. The ligament is pressed against the anchor, with the foot in maximum dorsiflexion and eversion. A knotless anchor is impacted 5 mm above and with the threads of the soft anchor, creating a double-row fixation. The arthroscopic acute double-row repair for proximal desinsertion of collatéral lateral ligament ankle can be done especially for athletes.
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Affiliation(s)
- Clément Guyonnet
- Clinique Brétéché, Nantes, France
- Polyclinique de l’Atlantique, Saint-Herblain, France
| | | | - Ronny Lopes
- Clinique Brétéché, Nantes, France
- Polyclinique de l’Atlantique, Saint-Herblain, France
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Cucchiara J, Thompson J, Zychowicz M, McHone A, Williamson R. Splint Quality Assessment and Improvement Among Emergency Department Staff. Adv Emerg Nurs J 2023; 45:240-247. [PMID: 37501277 DOI: 10.1097/tme.0000000000000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
The purpose of this quality improvement project is to assess and improve the quality of splint application in the emergency department (ED), as well as the splint application confidence level of the ED staff. Consistent and high-quality splint application is critical in fracture stabilization and prevention of further injury. Significantly high turnover and a lack of formal training of ED staff has led to poor splint application, and in some cases, patient injuries related to the splints themselves. These injuries include pain, edema, and skin complications (A. P. Carino, 2017). A random, Likert-based analysis was performed on 20 ED-applied splints. Once analysis was complete, training courses were implemented to improve splint application techniques. Using the same Likert-based tool, applications of 20 posttraining splints were analyzed. In addition, ED staff confidence levels were scored before and after the training courses. Overall, statistically significant improvement was achieved in splint application quality and staff confidence. Correct splint applications increased from 50% to 95% after the educational sessions. Staff confidence in splint application also increased, from 35% to 77.1%. Quality splint application affects all patients. The higher risk population is more likely to suffer the consequences of poor splint application. This project had a positive impact on the region's marginalized patient population. These patients have limited resources, including lack of transportation, financial limitations, and typically are at higher risk for complications due to comorbidities.
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Affiliation(s)
- Jason Cucchiara
- School of Nursing, Duke University, Durham, North Carolina (Drs Cucchiara, Thompson, and Zychowicz); Northern Orthopaedics, Mount Airy, North Carolina (Drs Cucchiara and Williamson); and Mount Airy Emergency Physicians, Mount Airy, North Carolina (Dr McHone)
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Hong CC, Calder J. The Burden of the "Simple Ankle Sprains": A Review of the Epidemiology and Long-Term Impact. Foot Ankle Clin 2023; 28:187-200. [PMID: 37137618 DOI: 10.1016/j.fcl.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Lateral ankle sprain (LAS) is not as simple as it was believed to be as it has substantial negative impacts on the active sporting population. The negative impact on physical function, quality of life (QoL) and economic burden is significant with increased risk of reinjury, development of chronic lateral ankle instability and posttraumatic ankle osteoarthritis resulting in functional deficits, decreased QoL and chronic disabilities. Economic burden from a societal perspective demonstrated notably higher indirect costs from productivity loss. Preventative interventions with early surgery for a selective cohort of active sporting population may be considered to mitigate morbidities associated with LAS.
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Affiliation(s)
- Choon Chiet Hong
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK; Department of Orthopaedic Surgery, National University Hospital of Singapore, 1E, Kent Ridge Road, Singapore 119228, Singapore.
| | - James Calder
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK; Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
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23
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Wang X, Qiu J, Fong DT. The applications of wearable devices in the rehabilitation of ankle injuries: A systematic review and meta-analysis. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2023. [DOI: 10.1016/j.medntd.2023.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Zhang J, Wang C, Li X, Fu S, Gu W, Shi Z. Platelet-rich plasma, a biomaterial, for the treatment of anterior talofibular ligament in lateral ankle sprain. Front Bioeng Biotechnol 2022; 10:1073063. [PMID: 36619392 PMCID: PMC9817145 DOI: 10.3389/fbioe.2022.1073063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Because of the rising prevalence of anterior talofibular ligament (ATFL) damage, there is a considerable interest in developing innovative techniques to improve the biological healing response of ATFL. Platelet-rich plasma (PRP) includes several growth factors linked to a favorable healing response, however none of the studies involved both quality evaluation and clinical results to evaluate this treatment. Purpose: To determine the clinical results of PRP injections into the ATFL in lateral ankle sprain (LAS) patients, as well as the quality of the ATFL based on radiographic outcomes. Methods: Patients with clinically confirmed grade II LAS for the first time (n = 83) were examined. The clinical outcomes of three types of injection methods were evaluated: none, once within 48 h after the sprain, and once more 4 weeks later after first injection. PRP was injected into the tear site of the ATFL using ultrasound guidance, and all ankles were immobilized for 2 weeks. The American Orthopedic Foot and Ankle Score (AOFAS) ankle-hindfoot scale and the Visual Analogue Scale (VAS) were used to assess the results at 2, 6, 8, 24, and 48 weeks of follow-up. The signal/noise ratio (SNR) value of Magnetic Resonance Imaging (MRI)-based ATFL signal intensity can disclose ATFL quality. The ATFL SNR results were then assessed 8, 24 and 48 weeks following the first injection to compare ATFL quality. Results: The PRP injection groups outperformed the control group in terms of clinical outcomes, and the two injections group outperformed other groups in terms of pain reduction and functional outcome at 8 weeks. The clinical results of all groups were comparable at 6 and 12 months follow-up. ATFL SNR findings improved significantly across all groups over time. At the same follow-up time, the PRP injection groups outperformed the control group, and the best SNR result showed in the two injections group at the final follow-up. Conclusion: PRP injection helped relieve early symptoms of LAS, although all patients saw a similar development after 6 months. The two PRP injections group produced considerably better clinical results and quality of the ATFL in short-term follow-up.
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Affiliation(s)
- Jieyuan Zhang
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Cheng Wang
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Xueqian Li
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Shaoling Fu
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Wenqi Gu
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China,Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital East Campus, Shanghai, China,*Correspondence: Wenqi Gu, ; Zhongmin Shi,
| | - Zhongmin Shi
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China,*Correspondence: Wenqi Gu, ; Zhongmin Shi,
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25
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Flore Z, Hambly K, De Coninck K, Welsch G. Time-loss and recurrence of lateral ligament ankle sprains in male elite football: A systematic review and meta-analysis. Scand J Med Sci Sports 2022; 32:1690-1709. [PMID: 35904448 PMCID: PMC9804772 DOI: 10.1111/sms.14217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/07/2022] [Accepted: 07/24/2022] [Indexed: 01/09/2023]
Abstract
A literature search was conducted to systematically review and meta-analyze time-loss and recurrence rate of lateral ankle sprains (LAS) in male professional football players. Six electronic databases (PubMed, Scopus, Web of Science, PEDRO, CINAHL, and Cochrane) were searched independently, separately both for time-loss and recurrence from inception until April 30, 2021. In addition, reference lists were screened manually to find additional literature. Cohort studies, case reports, case-control studies and RCT in English language of male professional football players (aged more than 16 years) for which data on time-loss or recurrence rates of LAS were available were included. A total of 13 (recurrence) and 12 (time-loss) studies met the inclusion criteria. The total sample size of the recurrence studies was 36,201 participants (44,404 overall initial injuries; 7944 initial ankle sprain [AS] injuries, 1193 recurrent AS injuries). 16,442 professional football players (4893 initial AS injuries; 748 recurrent AS injuries) were meta-analyzed. A recurrence rate of 17.11% (95% CI: 13.31-20.92%; df = 12; Q = 19.53; I2 = 38.57%) based on the random-effects model was determined. A total of 7736 participants were part of the time-loss studies (35,888 total injuries; 4848 total ankle injuries; 3370 AS injuries). Out of the 7736 participants, 7337 participants met the inclusion criteria with a total of 3346 AS injuries. The average time-loss was 15 days (weighted mean: 15.92; median: 14.95; min: 9.55; max: 52.9). We determined a priori considerable heterogeneity (CI: 18.15-22.08; df = 11; Q = 158; I2 = 93%), so that the data on time-loss are only presented descriptively. There is an average time-loss of 15 days per LAS and a recurrence rate of 17%. LAS is one of the most common types of injury with higher recurrence rates than ACL injuries (9%-12%) in professional football players. Nevertheless, the focus of research in recent years has been mostly on ACL injuries. However, the high recurrence rates and long-term consequences show the necessity for research in the field of LAS in elite football. Yet, heterogeneous data lead to difficulties concerning the aspect of comparability.
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Affiliation(s)
- Zacharias Flore
- University of Kent, School of Sport and Exercise SciencesCanterburyUK,Hamburger SV, Fußball AGHamburgGermany,University Medical Center Hamburg‐EppendorfUKE‐AthleticumHamburgGermany
| | - Karen Hambly
- University of Kent, School of Sport and Exercise SciencesCanterburyUK
| | - Kyra De Coninck
- University of Kent, School of Sport and Exercise SciencesCanterburyUK
| | - Götz Welsch
- University Medical Center Hamburg‐EppendorfUKE‐AthleticumHamburgGermany,Department of Trauma and Orthopaedic SurgeryUniversity Medical Center Hamburg‐EppendorfHamburgGermany
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Choi YH, Cho SH, Seo J, Ahn JH, Kim YC. Apoptosis Occurs in the Anterior Talofibular Ligament of Patients With Chronic Lateral Ankle Instability: An In Vitro Study. Clin Orthop Relat Res 2022; 480:2420-2429. [PMID: 35973121 PMCID: PMC9653187 DOI: 10.1097/corr.0000000000002337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/06/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chronic lateral ankle instability is treated operatively, whereas most acute ankle sprains associated with acute anterior talofibular ligament injury are usually treated nonoperatively. This treatment strategy is widely accepted and has been validated using a variety of clinical or radiological methods. We suspected that there may be biological differences between chronic and acutely injured ligaments, particularly with respect to apoptosis. Apoptosis is known to cause ligament degeneration. If it could be demonstrated that apoptosis occurs more in the anterior talofibular ligament tissues of patients with chronic lateral ankle instability compared with patients with acute anterior talofibular ligament injury, biological evidence could be supported. QUESTIONS/PURPOSES We sought to (1) elucidate the difference in the extent of apoptosis between patients with chronic lateral ankle instability and those with acute anterior talofibular ligament injury. In addition, we asked: (2) What is the expression level of apoptotic enzymes such as caspases 3, 7, 8, and 9 and cytochrome c in each patient group? (3) Is there a correlation between apoptotic activities and the symptom duration period of chronic lateral ankle instability? METHODS Between March 2019 and February 2021, 50 patients were prospectively enrolled in this study. Anterior talofibular ligament tissues were harvested from patients who were divided into two groups: the chronic lateral ankle instability group and the acute anterior talofibular ligament injury group. Patients with insufficient remaining ligaments were excluded from the chronic lateral ankle instability group, and cases in which the tissue was severely damaged or the quality of collected tissue was insufficient because of severe impingement into the fracture site were excluded from the acute anterior talofibular ligament injury group. Tissues were collected from 21 patients (11 males and 10 females) in the chronic lateral ankle instability group with a mean age of 37 ± 14 years and from 17 patients (6 males and 11 females) in the acute anterior talofibular ligament injury group with a mean age of 49 ± 17 years. To investigate our first purpose, apoptotic cells were counted using a TUNEL assay. To answer our second question, Western blotting for apoptotic enzymes such as caspases 3, 7, 8, and 9 and cytochrome c was performed to investigate apoptotic activity. Immunohistochemistry was also used to detect apoptotic enzymes. To answer our third question, the time elapsed after the first symptom related to chronic lateral ankle instability occurred and the expression level of each enzyme was investigated. RESULTS More apoptotic cells were observed in the chronic lateral ankle instability group than in the acute anterior talofibular ligament injury group in the TUNEL assay. Western blotting revealed that the apoptotic activities of the chronic lateral ankle instability group were higher than those of the acute anterior talofibular ligament injury group: caspase 3 was 117 in the chronic lateral ankle instability group and 59 in the acute anterior talofibular ligament injury group (mean difference 58 [95% confidence interval (CI) 31 to 86]; p < 0.001), caspase 7 was 138 in the chronic lateral ankle instability group and 45 in the acute anterior talofibular ligament injury group (mean difference 93 [95% CI 58 to 128]; p < 0.001), caspase 8 was 126 in the chronic lateral ankle instability group and 68 in the acute anterior talofibular ligament injury group (mean difference 58 [95% CI 29 to 89]; p < 0.001), caspase 9 was 128 in the chronic lateral ankle instability group and 54 in the acute anterior talofibular ligament injury group (mean difference 74 [95% CI 44 to 104]; p < 0.001), and cytochrome c was 139 in the chronic lateral ankle instability group and 51 in the acute anterior talofibular ligament injury group (mean difference 88 [95% CI 46 to 129]; p < 0.001). Immunohistochemistry revealed higher expression of caspases 3, 7, 8, and 9 and cytochrome c in the chronic lateral ankle instability group compared with those in the acute anterior talofibular ligament injury group. Caspases 3, 7, and 9 showed no correlation with duration of chronic lateral ankle instability symptoms: the Pearson correlation coefficient was 0.22 [95% CI -0.25 to 0.69] for caspase 3 (p = 0.36), 0.29 [95% CI -0.16 to 0.74] for caspase 7 (p = 0.23), and 0.29 [95% CI -0.16 to 0.74] for caspase 9 (p = 0.23). CONCLUSION In chronic lateral ankle instability, apoptotic activity in the anterior talofibular ligament was higher than in acute anterior talofibular ligament injury. CLINICAL RELEVANCE Apoptosis occurs more in chronic injured ligaments than in acutely injured ligaments. Although urgent surgical repair is not required for acute anterior talofibular ligament injury, chronic lateral ankle instability may progress if the nonoperative treatment is not successful. Further research should focus not only on timing of apoptotic progression, but also on biological augmentation to reverse or prevent apoptosis within the anterior talofibular ligament.
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Affiliation(s)
- Youn-Ho Choi
- Department of Orthopaedic Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Hyun Cho
- Department of Orthopaedic Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - JeongYong Seo
- Department of Orthopaedic Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Hoon Ahn
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoon-Chung Kim
- Department of Orthopaedic Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Kobayashi T, Wong P, Hu M, Tashiro T, Morikawa M, Maeda N. The effects of the tension of figure-8 straps of a soft ankle orthosis on the ankle joint kinematics while walking in healthy young adults: A pilot study. Gait Posture 2022; 98:210-215. [PMID: 36179411 DOI: 10.1016/j.gaitpost.2022.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/01/2022] [Accepted: 09/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Figure-8 straps are commonly used in ankle orthoses, which are provided to reduce the risks of primary and recurrent sprain by providing functional support. Functional treatment with ankle orthoses can provide better rehabilitation than immobilization for a mild ankle sprain. However, it is not known how much tension should be applied to the straps while donning the orthosis to optimize its effectiveness. RESEARCH QUESTION The aim of this study was to investigate the effects of figure-8 strap tension of a soft ankle orthosis on ankle joint kinematics in the sagittal, coronal, and transverse planes during gait in healthy young adults. METHODS Ten healthy adults (five males and five females) were enrolled in this study. The 3-dimensional motion analysis system was used to evaluate the ankle kinematics of the participants during gait under five conditions: no soft ankle orthosis, soft ankle orthosis with no figure-8 straps tension (lace-up only), 50 N, 80 N, and 110 N tension of the figure-8 straps, respectively. All participants walked in a straight path at a comfortable speed. RESULTS Plantarflexion angles were significantly reduced with 110 N of tension in the figure-8 straps when compared to the lace-up only and a moderate correlation with r = 0.34 (p = 0.03) was observed between the tensions of figure-8 straps and maximum plantarflexion angles at pre-swing of a gait cycle. No significant effects on ankle joint angles were demonstrated in the coronal and transverse planes. SIGNIFICANCE This study showed that increasing the tension of the figure-8 straps could restrict the ankle joint plantarflexion angle during pre-swing in gait. However, it might not affect inversion/eversion or internal/external rotation angles of the ankle joint in individuals without ankle pathologies.
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Affiliation(s)
- Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Puiyui Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Mingyu Hu
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Tsubasa Tashiro
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masanori Morikawa
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Noriaki Maeda
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Ziaei Ziabari E, Haghpanahi M, Razi M, Lubberts B, Ashkani‐Esfahani S, DiGiovanni CW. The Effects of Chronic Ankle Instability on the Biomechanics of the Uninjured, Contralateral Ankle During Gait. Orthop Surg 2022; 14:2238-2244. [PMID: 35852096 PMCID: PMC9483063 DOI: 10.1111/os.13307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To determine whether unilateral chronic ankle instability (CAI) affects the kinematics of the uninjured contralateral ankle. METHODS In this case-control study, 15 adult patients with unilateral CAI and 15 healthy controls were studied. Both the unstable and uninjured ankles in patients with unilateral CAI (CAI group, n = 15) were compared with that of healthy individuals (control group, n = 15). Applying body photo-reflective markers, the participant's motion during gait was measured. Biomechanical variables including overall ankle-toe angle, linear velocity, linear acceleration, angular velocity, angular acceleration, range of motion (RoM) in dorsiplantar flexion, and inversion-eversion at initial contact, loading response, mid-stance, terminal stance, pre-swing, and swing phase of the gait were measured. RESULTS In patients with CAI, the injured and uninjured ankles were significantly different regarding angle-toe angle, inversion-eversion RoM, dorsiplantar flexion in mid-stance, inversion-eversion at initial contact and terminal stance as well as the pre-swing and swing phases (p < 0.01). The uninjured ankles of patients showed lower ankle-toe velocity (p = 0.01) and acceleration (p = 0.01) compared to both the left and right ankles of the controls. In addition, the uninjured ankles of the patients showed decreased ankle dorsiflexion and increased inversion during initial contact, loading response, mid-stance, terminal stance, pre-swing, and swing compared to the control group (p < 0.017). CONCLUSION The results suggest that unilateral CAI can affect gait biomechanics in the contralateral uninjured ankle. Left unaddressed, unilateral CAI may lead to increased morbidity to the contralateral uninjured side. When surgery is not preferred for the management of unilateral CAI, rehabilitation protocols should focus on both sides.
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Affiliation(s)
- Elaheh Ziaei Ziabari
- School of Mechanical EngineeringIran University of Science and TechnologyTehranIran
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Mohammad Haghpanahi
- School of Mechanical EngineeringIran University of Science and TechnologyTehranIran
| | - Mohammad Razi
- Department of Orthopedic Surgery, Rasoul Akram HospitalIran University of Medical SciencesTehranIran
| | - Bart Lubberts
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Soheil Ashkani‐Esfahani
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Foot & Ankle Service, Massachusetts General Hospital, Newton‐Wellesley HospitalHarvard Medical SchoolMassachusetts General Hospital, BostonMassachusettsUSA
| | - Christopher W. DiGiovanni
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Foot & Ankle Service, Massachusetts General Hospital, Newton‐Wellesley HospitalHarvard Medical SchoolMassachusetts General Hospital, BostonMassachusettsUSA
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Relph N, Greaves H, Armstrong R, Prior TD, Spencer S, Griffiths IB, Dey P, Langley B. Running shoes for preventing lower limb running injuries in adults. Cochrane Database Syst Rev 2022; 8:CD013368. [PMID: 35993829 PMCID: PMC9394464 DOI: 10.1002/14651858.cd013368.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Lower-limb running injuries are common. Running shoes have been proposed as one means of reducing injury risk. However, there is uncertainty as to how effective running shoes are for the prevention of injury. It is also unclear how the effects of different characteristics of running shoes prevent injury. OBJECTIVES To assess the effects (benefits and harms) of running shoes for preventing lower-limb running injuries in adult runners. SEARCH METHODS We searched the following databases: CENTRAL, MEDLINE, Embase, AMED, CINAHL Plus and SPORTDiscus plus trial registers WHO ICTRP and ClinicalTrials.gov. We also searched additional sources for published and unpublished trials. The date of the search was June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs involving runners or military personnel in basic training that either compared a) a running shoe with a non-running shoe; b) different types of running shoes (minimalist, neutral/cushioned, motion control, stability, soft midsole, hard midsole); or c) footwear recommended and selected on foot posture versus footwear not recommended and not selected on foot posture for preventing lower-limb running injuries. Our primary outcomes were number of people sustaining a lower-limb running injury and number of lower-limb running injuries. Our secondary outcomes were number of runners who failed to return to running or their previous level of running, runner satisfaction with footwear, adverse events other than musculoskeletal injuries, and number of runners requiring hospital admission or surgery, or both, for musculoskeletal injury or adverse event. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility and performed data extraction and risk of bias assessment. The certainty of the included evidence was assessed using GRADE methodology. MAIN RESULTS We included 12 trials in the analysis which included a total of 11,240 participants, in trials that lasted from 6 to 26 weeks and were carried out in North America, Europe, Australia and South Africa. Most of the evidence was low or very low certainty as it was not possible to blind runners to their allocated running shoe, there was variation in the definition of an injury and characteristics of footwear, and there were too few studies for most comparisons. We did not find any trials that compared running shoes with non-running shoes. Neutral/cushioned versus minimalist (5 studies, 766 participants) Neutral/cushioned shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with minimalist shoes (low-certainty evidence) (risk ratio (RR) 0.77, 95% confidence interval (CI) 0.59 to 1.01). One trial reported that 67% and 92% of runners were satisfied with their neutral/cushioned or minimalist running shoes, respectively (RR 0.73, 95% CI 0.47 to 1.12). Another trial reported mean satisfaction scores ranged from 4.0 to 4.3 in the neutral/ cushioned group and 3.6 to 3.9 in the minimalist running shoe group out of a total of 5. Hence neutral/cushioned running shoes may make little or no difference to runner satisfaction with footwear (low-certainty evidence). Motion control versus neutral / cushioned (2 studies, 421 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral / cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.92, 95% CI 0.30 to 2.81). Soft midsole versus hard midsole (2 studies, 1095 participants) Soft midsole shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with hard midsole shoes (low-certainty of evidence) (RR 0.82, 95% CI 0.61 to 1.10). Stability versus neutral / cushioned (1 study, 57 participants) It is uncertain whether or not stability shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral/cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.49, 95% CI 0.18 to 1.31). Motion control versus stability (1 study, 56 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with stability shoes because the quality of the evidence has been assessed as very low certainty (RR 3.47, 95% CI 1.43 to 8.40). Running shoes prescribed and selected on foot posture (3 studies, 7203 participants) There was no evidence that running shoes prescribed based on static foot posture reduced the number of injuries compared with those who received a shoe not prescribed based on foot posture in military recruits (Rate Ratio 1.03, 95% CI 0.94 to 1.13). Subgroup analysis confirmed these findings were consistent between males and females. Therefore, prescribing running shoes and selecting on foot posture probably makes little or no difference to lower-limb running injuries (moderate-certainty evidence). Data were not available for all other review outcomes. AUTHORS' CONCLUSIONS Most evidence demonstrates no reduction in lower-limb running injuries in adults when comparing different types of running shoes. Overall, the certainty of the evidence determining whether different types of running shoes influence running injury rates was very low to low, and as such we are uncertain as to the true effects of different types of running shoes upon injury rates. There is no evidence that prescribing footwear based on foot type reduces running-related lower-limb injures in adults. The evidence for this comparison was rated as moderate and as such we can have more certainty when interpreting these findings. However, all three trials included in this comparison used military populations and as such the findings may differ in recreational runners. Future researchers should develop a consensus definition of running shoe design to help standardise classification. The definition of a running injury should also be used consistently and confirmed via health practitioners. More researchers should consider a RCT design to increase the evidence in this area. Lastly, future work should look to explore the influence of different types or running shoes upon injury rates in specific subgroups.
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Affiliation(s)
- Nicola Relph
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | | | - Ross Armstrong
- Institute of Health, University of Cumbria, Carlisle, UK
| | - Trevor D Prior
- Podiatric Surgery, Homerton University Hospital, London, UK
| | - Sally Spencer
- Health Research Institute, Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | | | - Paola Dey
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | - Ben Langley
- Department of Sport & Physical Activity, Edge Hill University, Ormskirk, UK
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de Ruvo R, Russo G, Lena F, Giovannico G, Neville C, Turolla A, Torre M, Pellicciari L. The Effect of Manual Therapy Plus Exercise in Patients with Lateral Ankle Sprains: A Critically Appraised Topic with a Meta-Analysis. J Clin Med 2022; 11:4925. [PMID: 36013167 PMCID: PMC9409935 DOI: 10.3390/jcm11164925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/08/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
A high percentage of patients with lateral ankle sprains report poor outcomes and persistent neuromuscular impairment leading to chronic ankle instability and re-injury. Several interventions have been proposed and investigated, but the evidence on manual therapy combined with therapeutic exercise for pain reduction and functional improvement is still uncertain. The purpose was to study the effectiveness of adding manual therapy to therapeutic exercise in patients with lateral ankle sprains through a critically appraised topic. The literature search was performed in PubMed, PEDro, EMBASE and CINAHL databases, and only randomized clinical trials were included according to following criteria: (1) subjects with acute episodes of lateral ankle sprains, (2) administered manual therapy plus therapeutic exercise, (3) comparisons with therapeutic exercise alone and (4) reported outcomes for pain and function. Three randomized clinical trials (for a total of 180 patients) were included in the research. Meta-analyses revealed that manual therapy plus exercise was more effective than only exercises in improving dorsal (MD = 8.79, 95% CI: 6.81, 10.77) and plantar flexion (MD = 8.85, 95% CI 7.07, 10.63), lower limb function (MD = 1.20, 95% CI 0.63, 1.77) and pain (MD = -1.23; 95% IC -1.73, -0.72). Manual therapy can be used with therapeutic exercise to improve clinical outcome in patients with lateral ankle sprains.
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Affiliation(s)
- Rocco de Ruvo
- Fondazione Centri di Riabilitazione “Padre Pio Onlus”, 71013 San Giovanni Rotondo, Italy
| | - Giuseppe Russo
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Francesco Lena
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
- IRCCS INM Neuromed, 86077 Isernia, Italy
| | - Giuseppe Giovannico
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Christoper Neville
- Department of PT Education, Upstate Medical University, Syracuse, NY 13210, USA
| | - Andrea Turolla
- Dipartimento di Scienze Biomediche e Neuromotorie—DIBINEM, Università degli Studi di Bologna, 40126 Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria, 40138 Bologna, Italy
| | - Monica Torre
- Sanstefar Abruzzo Riabilitazione, 65100 Pescara, Italy
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Effect of Ligament Mapping from Different Magnetic Resonance Image Quality on Joint Stability in a Personalized Dynamic Model of the Human Ankle Complex. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12105087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background. Mechanical models of the human ankle complex are used to study the stabilizing role of ligaments. Identification of ligament function may be improved via image-based personalized approach. The aim of this study is to compare the effect of the ligament origin and insertion site definitions obtained with different magnetic resonance imaging (MRI) modalities on the mechanical behaviour of a dynamic model of the ankle complex. Methods. MRI scans, both via 1.5 T and 3.0 T, were performed on a lower-limb specimen, free from anatomical defects, to obtain morphological information on ligament-to-bone attachment sites. This specimen was used previously to develop the dynamic model. A third ligament attachment site mapping scheme was based on anatomical dissection of the scanned specimen. Following morphological comparison of the ligament attachment sites, their effect on the mechanical behaviour of the ankle complex, expressed by three-dimensional load–displacement properties, was assessed through the model. Results. Large differences were observed in the subtalar ligament attachment sites between those obtained through the two MRI scanning modalities. The 3.0 T MRI mapping was more consistent with dissection than the 1.5 T MRI. Load–displacement curves showed similar mechanical behaviours between the three mappings in the frontal plane, but those obtained from the 3.0 T MRI mapping were closer to those obtained from dissection. Conclusions. The state-of-the-art 3.0 T MRI image analysis resulted in more realistic mapping of ligament fibre origin and insertion site definitions; corresponding load–displacement predictions from a subject-specific model of the ankle complex showed a mechanical behaviour more similar to that using direct ligament attachment observations.
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32
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Tee E, Melbourne J, Sattler L, Hing W. Evidence for Rehabilitation Interventions After Acute Lateral Ankle Sprains in Athletes: A Scoping Review. J Sport Rehabil 2022; 31:457-464. [PMID: 34969012 DOI: 10.1123/jsr.2021-0244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/29/2021] [Accepted: 10/10/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Acute lateral ankle sprain (LAS) is a common injury in athletes and is often associated with decreased athletic performance and, if treated poorly, can result in chronic ankle issues, such as instability. Physical performance demands, such as cutting, hopping, and landing, involved with certain sport participation suggests that the rehabilitation needs of an athlete after LAS may differ from those of the general population. OBJECTIVE To review the literature to determine the most effective rehabilitation interventions reported for athletes returning to sport after acute LAS. EVIDENCE ACQUISITION Data Sources: Databases PubMed, Embase, CINAHL, SPORTDiscus, and PEDro were searched to July 2020. STUDY SELECTION A scoping review protocol was developed and followed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews guidelines and registered (https://osf.io/bgek3/). Study selection included published articles on rehabilitation for ankle sprain in an athletic population. DATA EXTRACTION Parameters included athlete and sport type, age, sex, intervention investigated, outcome measures, measurement tool, and follow-up period. DATA SYNTHESIS A qualitative synthesis for all articles was undertaken, and a quantitative subanalysis of randomized controlled trials and critical methodological appraisal was also conducted. EVIDENCE SYNTHESIS A total of 37 articles were included in this review consisting of 5 systematic and 20 narrative reviews, 7 randomized controlled trials, a single-case series, case report, position statement, critically appraised topic, and descriptive study. Randomized controlled trial interventions included early dynamic training, electrotherapy, and hydrotherapy. CONCLUSIONS Early dynamic training after acute LAS in athletes results in a shorter time to return to sport, increased functional performance, and decreased self-reported reinjury. The results of this scoping review support an early functional and dynamic rehabilitation approach when compared to passive interventions for athletes returning to sport after LAS. Despite existing research on rehabilitation of LAS in the general population, a lack of evidence exists related to athletes seeking to return to sport.
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Shukla M, Agrawal SS. A novel synergistic device for joint inflammation - efficacy on ankle sprain cases. J Med Eng Technol 2022; 46:265-269. [PMID: 35212582 DOI: 10.1080/03091902.2022.2039312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Joint inflammation results from soft-tissue injuries and cartilage damage. PRICE is the standard treatment approach for acute soft tissue injuries like ankle sprain. Electrical stimulation, application of orthotic braces, etc. is also effective for this. In a synergistic device all these components are combined and applied simultaneously. This device was developed for joint inflammation and tested for grade I & II acute ankle joint sprain. To test a synergistic - semirigid device, combining PRICE & electrical stimulation for acute ankle sprains of grades I & II for pain, range of motion and swelling is a case series was the objective. Device was developed using novel concept of synergistic applications of PRICE with electrical stimulation. The joint contour of ankle and specific biomechanical bony surface landmarks were considered. Ethical approval was taken from NTCC committee, AIPT. Recordings were taken from eight patients of acute ankle sprain with - in two days of injury, after getting ethical approval. Elevation to the ankle was provided by keeping the part over the pillow and data was recorded with the help of: 1.VAS scale for pain; 2. Measuring tape; 3. Goniometry. t-test was used to find out the significant difference pre and post the application of device. There was a significant reduction in pain (p = 0.006), edema (p = 0.011), dorsi-flexion (p = 0.015), and plantar flexion (p =0.008). The synegistic device has been effective for acute ankle inflammation - grade I & II ankle sprains in 5 sessions; sufficient for the return of function.
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Affiliation(s)
- Mayank Shukla
- Amity Institute of Physiotherapy, Amity University, Noida, India
| | - S S Agrawal
- Faculty of Health & Allied Sciences Amity University, Noida, India
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In Patients with Grade I and II Ankle Sprains, Dynamic Taping Seems to Be Helpful during Certain Tasks, Exercises and Tests in Selected Phases of the Rehabilitation Process: A Preliminary Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095291. [PMID: 35564686 PMCID: PMC9100756 DOI: 10.3390/ijerph19095291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 12/26/2022]
Abstract
We aimed to investigate changes in postural stability on a stable surface after the application of dynamic tape for patients with inversion ankle sprains. This study enrolled 30 patients (age 25.5 ± 8.0 years) with grade I and II ankle sprains, which occurred 7−21 days before enrolment. Postural stability (balance, coordination, feedback) was assessed before and after the application of dynamic tape using a stabilographic platform. Three 32-s exercises were performed on the stabilographic platform, one with eyes open, one with eyes closed and one with visual feedback. After the application of dynamic tape, an improvement was observed in terms of the mean radius of sway (4.2 ± 1.3 mm vs. 3.4 ± 0.9 mm; p = 0.012) and coordination (48.8 ± 19.2% vs. 59.3 ± 5.8%; p = 0.021). Selected balance parameters did not improve significantly in the tests with open and closed eyes. Asymmetric load improved for all tests, but significant differences were only observed with eyes closed (34.9 ± 24.4 vs. 41.7 ± 30.5; p < 0.01). We concluded that the use of dynamic tape after an ankle sprain significantly improved balance and coordination on a stable surface. The benefits were shown in terms of a significant improvement in the asymmetric load of the injured limb in comparison to the healthy limb during the test with closed eyes and a considerable improvement in the asymmetric load that was evaluated with visual feedback on a stable surface.
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Otsuka S, Papadopoulos K, Bampouras TM, Maestroni L. What is the effect of ankle disk training and taping on proprioception deficit after lateral ankle sprains among active populations? – A systematic review. J Bodyw Mov Ther 2022; 31:62-71. [DOI: 10.1016/j.jbmt.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 03/05/2022] [Accepted: 04/02/2022] [Indexed: 11/24/2022]
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Young KL, Morris B, Herda TJ. The Role of Strength and Conditioning in the Prevention and Treatment of Chronic Lateral Ankle Instability. Strength Cond J 2022. [DOI: 10.1519/ssc.0000000000000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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37
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Ismail EE, Al Saffar RA, Motawei K, Hiware SD, Moizuddin K, Shaikh SA, Bayer SB, Al Harbi Y, Aldahhan RA, Daimi SR. Defining the Components of the Deltoid Ligament (DL): A Cadaveric Study. Cureus 2022; 14:e23051. [PMID: 35464563 PMCID: PMC9001815 DOI: 10.7759/cureus.23051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background: The deltoid ligament (DL) is a strong triangle-shaped ligament with a complex fascicular arrangement. Understanding the morphological and/or functional typing of the DL structure is hindered by a paucity of clear, quantitative, and reproducible data and is further complicated by inconsistent terminology use. The aim of this work was to describe different components of the DL using strict identification criteria. Methods: Thirty embalmed cadaveric ankles of both sides were dissected on all sides and studied by using gross examination, micro-dissection, and light microscopy by tracing the fascicular pattern of each under 6X magnification. Results: Six ligamentous bands were identified. The tibiotalocalcaneal ligament (TTC) and the superficial posterior tibiotalar ligament (sPTT) were two superficial variants and the anterior tibiotalar ligament (ATT), the anterior tibiotalonavicular ligament (ATTN), the intermediate tibiotalar ligament (ITT), and the deep posterior tibiotalar ligament (dPTT) were four deep variants. The TTC was identified in all 30 embalmed cadaveric specimens. Five additional ligamentous bands (ITT, sPTT, dPTT, ATT, and ATTN) were variable findings in the current cohort. Conclusion: This study presents six ligamentous bands as a regular finding and five additional ligamentous bands as variable findings in the dissected specimen. This data could assist in the radiological diagnosis of DL injuries and advanced procedures related to its surgical repair and reconstruction.
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38
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Fenech M, Wylie B. Sonographic anatomy and imaging of the dorsal supportive ligaments of the Chopart joint complex. SONOGRAPHY 2022. [DOI: 10.1002/sono.12300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Michelle Fenech
- College of Clinical Sciences, School of Health, Medical and Applied Sciences CQUniversity Rockhampton Queensland Australia
| | - Bridie Wylie
- Qscan Radiology Clinics Brisbane Queensland Australia
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Costa F, Janela D, Molinos M, Lains J, Francisco GE, Bento V, Dias Correia F. Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study. BMC Musculoskelet Disord 2022; 23:29. [PMID: 34983488 PMCID: PMC8728982 DOI: 10.1186/s12891-021-04891-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/18/2021] [Indexed: 12/13/2022] Open
Abstract
Background Acute musculoskeletal (MSK) pain is very common and associated with impaired productivity and high economic burden. Access to timely and personalized, evidence-based care is key to improve outcomes while reducing healthcare expenditure. Digital interventions can facilitate access and ensure care scalability. Objective Present the feasibility and results of a fully remote digital care program (DCP) for acute MSK conditions affecting several body areas. Methods Interventional single-arm study of individuals applying for digital care programs for acute MSK pain. Primary outcome was the mean change between baseline and end-of-program in self-reported Numerical Pain Rating Scale (NPRS) score and secondary outcomes were change in analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI-GH) and engagement. Results Three hundred forty-three patients started the program, of which 300 (87.5%) completed the program. Latent growth curve analysis (LGCA) revealed that changes in NPRS between baseline and end-of-program were both statistically (p < 0.001) and clinically significant: 64.3% reduction (mean − 2.9 points). Marked improvements were also noted in all secondary outcomes: 82% reduction in medication intake, 63% reduction in surgery intent, 40% in fear-avoidance beliefs, 54% in anxiety, 58% in depression and 79% recovery in overall productivity. All outcomes had steeper improvements in the first 4 weeks, which paralleled higher engagement in this period (3.6 vs 3.2 overall weekly sessions, p < 0.001). Mean patient satisfaction score was 8.7/10 (SD 1.26). Strengths and limitations This is the first longitudinal study demonstrating the feasibility of a DCP for patients with acute MSK conditions involving several body areas. Major strengths of this study are the large sample size, the wide range of MSK conditions studied, the breadth of outcomes measured, and the very high retention rate and adherence level. The major limitation regards to the absence of a control group. Conclusions We observed very high completion and engagement rates, as well as clinically relevant changes in all health-related outcomes and productivity recovery. We believe this DCP holds great potential in the delivery of effective and scalable MSK care. Trial registration NCT, NCT04092946. Registered 17/09/2019; Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04891-5.
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Affiliation(s)
| | - Dora Janela
- SWORD Health Technologies, Inc, Draper, UT, USA
| | | | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center McGovern Medical School, and TIRR Memorial Hermann, Houston, TX, USA
| | | | - Fernando Dias Correia
- SWORD Health Technologies, Inc, Draper, UT, USA. .,Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.
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40
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Waldrop NE, Kouk S. Rehabilitation and Return to Play Considerations. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yang H, Su M, Chen Z, Qu R, Yuan Z, Yuan J, He S, Li Z, Liu C, Xiao Z, Liang H, Ouyang J, Dai J. Anatomic Measurement and Variability Analysis of the Anterior Talofibular Ligament and Calcaneofibular Ligament of the Ankle. Orthop J Sports Med 2021; 9:23259671211047269. [PMID: 34820459 PMCID: PMC8607490 DOI: 10.1177/23259671211047269] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/16/2021] [Indexed: 12/26/2022] Open
Abstract
Background: The anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL)
contribute greatly to the overall stability of the ankle joint; however,
ATFL and combined ATFL-CFL sprains are common. Anatomic reconstruction of
the lateral collateral ligament with grafts has been proposed for patients
with poor tissue quality or inadequate local tissue. Anatomic reconstruction
of the lateral ankle ligaments requires a good understanding of their
anatomic location. Purpose: To describe the anatomy of the ATFL and CFL ligaments quantitatively and
qualitatively and explore the relationship of some morphological
parameters. Study Design: Descriptive laboratory study. Methods: A total of 66 adult ankle specimens were analyzed for ATFL band type, origin,
length, width, thickness, and angle between the ATFL and CFL, and 73 adult
ankle specimens were used for measuring the origin of the CFL. The
coefficient of variation was used to describe and compare the respective
variability of angle, length, width, and thickness. The origin of the ATFL
was labeled as point A, and the leading edge of the CFL
intersection with the articular surface of the calcaneus was considered
point B. Results: The ATFL had a variable number of bands. A high degree of variability
(coefficient of variation >0.2) was seen for most morphological
measurements of the ATFL. In addition, the length of distance
AB also varied. The CFL originated at the tip of the
fibula in only 9% of specimens. It was found more commonly at the anterior
border of the lateral malleolus (4.94 ± 1.70 mm from the tip). The angle
between the ATFL and CFL was consistent at 100° to 105º. Conclusion: A fair amount of variability of ATFL length, width, and thickness were found
in our study, with less variability in the ATFL-CFL angle. Most CFLs
attached anterior to the tip of the fibula. Clinical Relevance: Providing relevant anatomic data of ATFL and CFL is important in ensuring
proper surgical treatment of ankle joint injuries.
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Affiliation(s)
- Han Yang
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Minghao Su
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Zhimin Chen
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Rongmei Qu
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Zhirong Yuan
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Jiajie Yuan
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Shanli He
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Zeyu Li
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Chang Liu
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Zhaoming Xiao
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Haibin Liang
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Jun Ouyang
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China.,Investigation performed at the Guangdong Provincial Medical Biomechanical Key Laboratory, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Jingxing Dai
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China.,Investigation performed at the Guangdong Provincial Medical Biomechanical Key Laboratory, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
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Rhon DI, Greenlee TA, Cook CE, Westrick RB, Umlauf JA, Fraser JJ. Fractures and Chronic Recurrence are Commonly Associated with Ankle Sprains: a 5-year Population-level Cohort of Patients Seen in the U.S. Military Health System. Int J Sports Phys Ther 2021; 16:1313-1322. [PMID: 34631252 PMCID: PMC8486414 DOI: 10.26603/001c.27912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/05/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Whereas ankle-foot injuries are ubiquitous and affect ~16% of military service-members, granularity of information pertaining to ankle sprain subgroups and associated variables is lacking. The purpose of this study was to characterize and contextualize the burden of ankle sprain injuries in the U.S. Military Health System. METHODS This was a retrospective cohort study of beneficiaries seeking care for ankle sprains, utilizing data from the Military Health System Data Repository from 2009 to 2013. Diagnosis and procedural codes were used to identify and categorize ankle sprains as isolated lateral, isolated medial, concomitant medial/lateral, unspecified, or concomitant ankle sprain with a malleolar or fibular fracture. Patient characteristics, frequency of recurrence, operative cases, and injury-related healthcare costs were analyzed. RESULTS Of 30,910 patients included, 68.4% were diagnosed with unspecified ankle sprains, 22.8% with concomitant fractures, (6.9%) with isolated lateral sprains, (1.7%) with isolated medial sprains and 0.3% with combined medial/lateral sprains. Pertaining to recurrence, 44.2% had at least one recurrence. Sprains with fractures were ~2-4 times more likely to have surgery within one year following injury (36.2% with fractures; 9.7% with unspecified sprains) and had the highest ankle-related downstream costs. CONCLUSION Fractures were a common comorbidity of ankle sprain (one in five injuries), and operative care occurred in 16.4% of cases. Recurrence in this cohort approximates the 40% previously reported in individuals with first-time ankle sprain who progress to chronic ankle instability. Future epidemiological studies should consider reporting on subcategories of ankle sprain injuries to provide a more granular assessment of the distribution of severity. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Daniel I Rhon
- Military Performance Division, United States Army Research Institute of Environmental Medicine; Department of Rehabilitation Medicine, Brooke Army Medical Center
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Popp D, Weber J, Kerschbaum M, Schicho A, Baumann F, Hilber F, Krutsch W, Alt V, Pfeifer C. Early functional treatment or trivialization? - current treatment strategies in lateral ligament injuries of the ankle. Eur J Sport Sci 2021; 21:1469-1476. [PMID: 33131454 DOI: 10.1080/17461391.2020.1845813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Ankle injuries are common in daily orthopaedic trauma practice, with a high incidence of lateral ligament complex (lat-lig-com) injuries of the ankle joint (AJ). Primarily, these lat-lig-com injuries heal sufficiently, although there is a risk of developing chronic ankle instability. However, there is a lack of knowledge about the clinical application and routine for rehabilitation strategies so as to prevent chronic instability. This study investigates the current rehabilitation concepts in clinical routine after ligament injuries of the AJ. Methods: Rehabilitation protocols, provided by orthopaedic and trauma surgery institutions in German speaking countries, were analysed in terms of weight-bearing, range of motion (ROM), physiotherapy and choice of orthosis. All protocols for operatively and non-operatively (nop) treated ligament ruptures of the AJ were included. Results: 120 of 213 institutions provided protocols of lat-lig-com injuries of the AJ. Regarding the orthosis, the nop-treatment group mainly used ankle braces; in contrast, the operative group preferred the use of an ankle boot. The operative group recommends 6-12 weeks for duration of orthosis in contrast to only 6 weeks in the nop group. Significant differences prevail in ROM, with free ROM in non-operative treatment from the first day after trauma (p<0.001) in contrast to a careful increase in ROM in the first 6 weeks post-operatively. Conclusion: Early functional treatment is clinical standard in rehabilitation after lat-lig-com injuries of the ankle. Regarding current literature the differences of restrictions in ROM and orthosis treatment after lat-lig-com injuries suggest a trivialization of conservative treatment in the first period after trauma compared to post-operative aftercare.
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Affiliation(s)
- Daniel Popp
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Johannes Weber
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Andreas Schicho
- Department of Radiology, University Medical Centre Regensburg, Regensburg, Germany
| | - Florian Baumann
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Franz Hilber
- Spine Center, Schulthess Clinic Zurich, Zurich, Switzerland
| | - Werner Krutsch
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Christian Pfeifer
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
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Correia FD, Molinos M, Neves C, Janela D, Carvalho D, Luis S, Francisco GE, Lains J, Bento V. Digital Rehabilitation for Acute Ankle Sprains: Prospective Longitudinal Cohort Study. JMIR Rehabil Assist Technol 2021; 8:e31247. [PMID: 34499038 PMCID: PMC8517823 DOI: 10.2196/31247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/16/2021] [Accepted: 07/30/2021] [Indexed: 12/21/2022] Open
Abstract
Background Ankle sprains are one of the most prevalent soft-tissue injuries worldwide. Physical therapy, especially progressive exercise, has proven effective in improving function, while preventing recurrence. Objective We aim to present the results of a fully remote and digitally guided rehabilitation program for acute ankle sprains. Methods We performed a prospective longitudinal cohort study of individuals eligible for workers’ compensation, who were referred for digital rehabilitation therapy for a sprained ankle. Therapeutic exercise sessions were to be performed independently by the patient at home using the biofeedback device provided by SWORD Health. Primary endpoints were the change in self-reported Numerical Pain Rating Scale (NPRS) and Foot and Ankle Ability Measure–activities of daily living (FAAM–ADL) and FAAM–Sports scores. Participants were assessed at baseline, end of the program, and 6 months after program completion. Secondary outcomes included digital therapy dosage, pain and fatigue during sessions, and satisfaction. Results In total, 93 (89.4%) patients completed the program and 79 (76.0%) were available for follow-up. Changes in the primary outcomes between baseline and the 6-month follow-up were both significant (P<.001) and clinically meaningful: mean difference of –2.72 points (95% CI –3.31 to –2.13) on the NPRS (49.8% reduction), 21.7 points (95% CI 17.13-26.27) on the FAAM–ADL (41.1% increase), and 37.8 points (95% CI 30.45-45.15) on the FAAM-Sports (151.8% increase). Longer waiting periods between the accident date and treatment initiation were found to negatively impact functional status at baseline and at the end of the program, triggering an extension in the program duration. The total training volume (12.5 hours, SD 10.5 hours) was similar to that of other interventions for ankle sprains, but the dosage per week was much higher (2.4 hours per week, SD 0.87 hours per week). The mean patient satisfaction score was 8.8 (SD 1.57) out of 10. Among program completers, 83.9% attained full recovery and were discharged with no residual disability. Conclusions Being far less demanding in terms of human resources, the digital program presented constituted a viable, clinically effective, and convenient solution for ankle sprain rehabilitation, particularly during the pandemic. This is the first study presenting a fully remote home-based rehabilitation program for acute ankle sprains, with patients achieving sustained long-term results. This was a prospective cohort study and, as such, did not include a control group, but the results appear comparable to those published for face-to-face interventions. Trial Registration ClinicalTrials.gov NCT04819022; https://clinicaltrials.gov/ct2/show/NCT04819022
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Affiliation(s)
- Fernando D Correia
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Escola de Medicina, Universidade do Minho, Braga, Portugal
| | - Maria Molinos
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Carlos Neves
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Dora Janela
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Diana Carvalho
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Sara Luis
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center, Houston, TX, United States.,TIRR Memorial Hermann, Houston, TX, United States
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Virgilio Bento
- SWORD Health Technologies, Inc, Draper, UT, United States
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Shumway JD, Vraa D. Short-Term Effect of Manual Therapy & Taping on Subacute Ankle Sprains with Potential Syndesmotic Sprain: A Case Series. J Man Manip Ther 2021; 30:116-123. [PMID: 34511056 DOI: 10.1080/10669817.2021.1974240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
STUDY DESIGN Case Series. BACKGROUND Syndesmotic ankle sprains can occur in up to 17% of ankle trauma and can lead to long-term disability. This study describes the management of seven patients with subacute, high-grade ankle sprains with concerns of concurrent syndesmotic strain utilizing manual therapy and rigid sports taping. METHODS Seven active duty military members with clinically diagnosed, high-grade ankle sprains and concern for syndesmotic sprain participated in this case series. All patients received multi-modal treatment consisting of manual therapy, rigid sports taping, progressive exercises, and proprioceptive training. Decrease in Numeric Pain Rating Scale (NPRS) following manual therapy and taping treatment, number of sessions before discharge, and the Global Rating of Change (GROC) at discharge were retrospectively reviewed. RESULTS All patients demonstrated an immediate decrease in NPRS following treatment on average of 5 points (range, 3-8 points) with a functional asterisk sign. The improvement in pain and function was maintained until the next treatment session with a mean GROC score of +3. The mean time until recovery was 5.4 weeks (range, 1-8 weeks). DISCUSSION A multimodal approach for patients diagnosed clinically with high-grade ankle sprains and concern for syndesmotic sprain was useful to immediately reduce pain and improve function, and improvements were maintained throughout the duration of care. This study is the first to assess a combination of manual therapy and rigid sports taping for the treatment of suspected syndesmotic ankle sprains, and more stringent research is needed to validate the findings. LEVEL OF EVIDENCE Therapy, 4.
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Affiliation(s)
- Joshua D Shumway
- Operational Medicine Readiness Squadron, Langley AFB, VA, United States.,Tactical Sports and Orthopedic Manual Physical Therapy Fellowship, US Air Force Academy, CO, United States
| | - Derek Vraa
- Tactical Sports and Orthopedic Manual Physical Therapy Fellowship, US Air Force Academy, CO, United States
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46
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O'Brien S. Midtarsal joint sprain: A case report. SONOGRAPHY 2021. [DOI: 10.1002/sono.12284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lee H, Son SJ, Kim H, Han S, Seeley M, Hopkins JT. Submaximal Force Steadiness and Accuracy in Patients With Chronic Ankle Instability. J Athl Train 2021; 56:454-460. [PMID: 33150436 DOI: 10.4085/15-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Patients with chronic ankle instability (CAI) have demonstrated sensorimotor impairments. Submaximal force steadiness and accuracy measure sensory, motor, and visual function via a feedback mechanism, which helps researchers and clinicians comprehend the sensorimotor deficits associated with CAI. OBJECTIVE To determine if participants with CAI experienced deficits in hip and ankle submaximal force steadiness and accuracy compared with healthy control participants. DESIGN Case-control study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-one patients with CAI and 21 uninjured individuals. MAIN OUTCOME MEASURE(S) Maximal voluntary isometric contraction (MVIC) and force steadiness and accuracy (10% and 30% of MVIC) of the ankle evertors and invertors and hip abductors were assessed using the central 10 seconds (20%-87% of the total time) of the 3 trials. RESULTS Relative to the control group, the CAI group demonstrated less accuracy of the invertors (P < .001). Across all motions, the CAI group showed less steadiness (P < .001) and less accuracy (P < .01) than the control group at 10% of MVIC. For MVIC, the CAI group displayed less force output in hip abduction than the uninjured group (P < .0001). CONCLUSIONS Patients with CAI were unable to control ongoing fine force (10% and 30% of MVIC) through a feedback mechanism during an active test. These findings suggested that deficits in sensorimotor control predisposed patients with CAI to injury positions because they had difficulty integrating the peripheral information and correcting their movements in relation to visual information.
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Affiliation(s)
- Hyunwook Lee
- Department of Exercise Sciences, Brigham Young University, Provo, UT
| | - S Jun Son
- Graduate School of Sports Medicine, CHA University, Seongnam-si, Korea
| | - Hyunsoo Kim
- Department of Kinesiology, West Chester University, PA
| | - Seunguk Han
- Department of Exercise Sciences, Brigham Young University, Provo, UT
| | - Matthew Seeley
- Department of Exercise Sciences, Brigham Young University, Provo, UT
| | - J Ty Hopkins
- Department of Exercise Sciences, Brigham Young University, Provo, UT
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Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. J Orthop Sports Phys Ther 2021; 51:CPG1-CPG80. [PMID: 33789434 DOI: 10.2519/jospt.2021.0302] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This revised clinical practice guideline (CPG) addresses the distinct but related lower extremity impairments of those with a first-time lateral ankle sprain (LAS) and those with chronic ankle instability (CAI). Depending on many factors, impairments may continue following injury. While most individuals experience resolution of symptoms, complaints of instability may continue and are defined as CAI. The aims of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. J Orthop Sports Phys Ther 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302.
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The Location of the Fibular Tunnel for Anatomically Accurate Reconstruction of the Lateral Ankle Ligament: A Cadaveric Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5575524. [PMID: 33791364 PMCID: PMC7997753 DOI: 10.1155/2021/5575524] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/08/2021] [Accepted: 03/09/2021] [Indexed: 11/18/2022]
Abstract
We aimed to describe the location of fibular footprint of each anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), as well as their common origin in relation to bony landmarks of the fibula in order to determine the location of the fibular tunnel. In 105 ankle specimens, the center of the footprints of the ATFL and CFL (cATFL and cCFL, respectively) and the intersection point of their origin (intATFL-CFL) were investigated, and the distances from selected bony landmarks (the articular tip (AT) and the inferior tip (IT) of the fibula) were measured. Forty-two (40%) specimens had single-bundle ATFL, and 63 (60%) had double-bundle patterns. The distance between intATFL-CFL and IT was 12.0 ± 2.5 mm, and a significant difference was observed between the two groups (p = 0.001). Moreover, the ratio of the intATFL-CFL location based on the anterior fibular border for all cadavers was 0.386. The present study suggests a reference ratio that can help surgeons locate the fibular tunnel for a more anatomically accurate reconstruction of the lateral ankle ligament. Also, it may be necessary to make a difference in the location of the fibular tunnel according to the number of ATFL bundles during surgery.
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Kim JH, Lee CK, Lee EY, Cho MR, Lee YS, Lee JS. Effects of Dangguixu-san in patients with acute lateral ankle sprain: a randomized controlled trial. Trials 2021; 22:184. [PMID: 33663582 PMCID: PMC7934479 DOI: 10.1186/s13063-021-05135-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dangguixu-san (DS), a herbal extract, is widely used in Korean medicine to treat pain and swelling caused by ankle sprain. However, there is insufficient evidence regarding the effects of DS on ankle sprains. Accordingly, we assessed the efficacy and safety of DS for the treatment of acute lateral ankle sprain (ALAS). METHODS This study was a multicenter (two Korean hospitals), randomized, double-blind, placebo-controlled, parallel-arm clinical trial with a 1:1 allocation ratio that included a per-protocol analysis and sub-analysis based on symptom severity. Forty-eight participants (n = 28 at Semyung University Korean Medicine Hospital in Chungju; n = 20 at DongShin University Gwangju Korean Medicine Hospital) with grade I or II ALAS that occurred within 72 h before enrollment were randomized to a DS (n = 24) or placebo (n = 24) group. Both groups received acupuncture treatment once daily for 5 consecutive days and the trial medication (DS/placebo capsule) three times a day for 7 consecutive days. Primary (visual analog scale [VAS] scores for pain) and secondary (Foot and Ankle Outcome Scores [FAOS], edema, and European Quality of Life Five-Dimension-Five-Level Scale [EQ-5D-5L] scores) outcome measures were recorded at baseline (week 0), the end of the intervention (week 1), and 4 weeks after treatment completion (week 5). RESULTS Forty-six participants completed the trial (n = 23 each). Changes in VAS scores, FAOS Symptom/Rigidity, and FAOS Ache from week 1 to week 5 showed significant differences between the two groups. Sub-analyses showed significant differences in changes of FAOS Ache (week 0 to week 5) and VAS scores, total FAOS, and EQ-5D-5L scores (week 1 to week 5) between the two subgroups (grade II). There were no adverse events and significant negative changes in clinical laboratory parameters in both groups. CONCLUSIONS Overall, the results of this study are in favor of DS combined with acupuncture and suggest that DS combined with acupuncture is a safe treatment with positive long-term effects in terms of pain reduction and symptom alleviation in patients with grade I or II ALAS. TRIAL REGISTRATION Clinical Research Information Service KCT0002374 . Registered on July 11, 2017; retrospectively registered.
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Affiliation(s)
- Jae-Hong Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, DongShin University, Naju City, 58245, Republic of Korea.
| | - Cham-Kyul Lee
- Department of Acupuncture and Moxibustion Medicine, Semyung University Korean Medicine Hospital in Chungju, Chungju, 27429, Republic of Korea
| | - Eun-Yong Lee
- Department of Acupuncture and Moxibustion Medicine, Semyung University Korean Medicine Hospital in Chungju, Chungju, 27429, Republic of Korea
| | - Myoung-Rae Cho
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, DongShin University, Naju City, 58245, Republic of Korea
| | - Young-Su Lee
- Department of Korean Internal Medicine, DongShin University Gwangju Korean Medicine Hospital, 141, Wolsan-ro, Nam-gu, Gwangju City, 61619, Republic of Korea
| | - Jeong-Soon Lee
- Department of Nursing, Christian College of Nursing, Gwangju City, 61662, Republic of Korea
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