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Bernardeau A, Bauer T, Moussa MK, Valentin E, Lopes R, Hardy A. Return to sport and satisfaction after arthroscopic anatomic reconstruction of the lateral ligaments of the ankle in athletes. Orthop Traumatol Surg Res 2025:104221. [PMID: 40074075 DOI: 10.1016/j.otsr.2025.104221] [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: 04/08/2024] [Revised: 11/27/2024] [Accepted: 03/07/2025] [Indexed: 03/14/2025]
Abstract
INTRODUCTION Ankle sprains, one of the most frequent accidental injuries in traumatology, can lead to chronic instability. Although arthroscopic anatomic ankle ligament reconstruction seems to provide good results, very few studies have specifically examined the outcomes of this procedure. The main goal of this study was to evaluate the rate of and delay to return to sport (RTS) at the preinjury level after anatomic ligament reconstruction and the predictive factors of a RTS in an athletic population. The secondary objectives were to report postoperative satisfaction and functional and psychological scores. MATERIAL AND METHODS This retrospective multicenter study included 92 athletes who underwent ankle ligament reconstruction between 2015 and 2022 at three different centers with a minimum follow-up of one year. The primary outcome measurement was the percentage, quality and time to RTS. Secondary outcome measurements included the ALR-RSI, FAAM functional scores, satisfaction, and complications rates at the final follow-up. The effect of different variables (age, sex, preoperative level of play, circumstances of the first accident) on RTS was assessed. RESULTS Forty-six men (50%) and 46 women (50%), mean age 36.6 years old (SD = 12), were included. Mean follow-up was 37.5 (SD = 23.9) months. At the final follow-up, 85.9% patients had RTS. The analysis did not reveal any factors significantly associated with a RTS at the preinjury level of play except for a trend towards a higher percentage of RTS at the preinjury level in patients with a higher preoperative level of sports activity (p = 0.052). The mean ALR-RSI score at the final follow-up was 67.7% (SD = 24.1), the FAAM sport score was 79.9% (SD = 26.2) and the FAAM adl score was 89.6% (SD = 16.9). Nine patients had postoperative complications, usually discomfort on the endobutton, requiring removal. CONCLUSION This study shows that arthroscopic anatomic ankle ligament reconstruction is associated with high rate of RTS (85.9%) after a mean 7.5 (6.9) months as well as a high rate of satisfaction. Although this study did not identify any predictive factors for the RTS, the preoperative level of sports might play a role. In addition, this study once again confirms that functional and psychological scores are practical tools to assess a patient's postoperative readiness to RTS. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Anaïs Bernardeau
- Clinique du Sport, 28 Boulevard Saint Marcel, 75005 Paris, France.
| | - Thomas Bauer
- Hôpital Ambroise Paré, 9 Avenue Charles de Gaulle, 92100 Boulogne Billancourt, France
| | - Mohamad K Moussa
- Clinique du Sport, 28 Boulevard Saint Marcel, 75005 Paris, France
| | - Eugénie Valentin
- Clinique du Sport, 28 Boulevard Saint Marcel, 75005 Paris, France
| | - Ronny Lopes
- Centre Pied Cheville Nantes Atlantique, Avenue Claude Bernard, 44800 Saint-Herblain, France
| | - Alexandre Hardy
- Clinique du Sport, 28 Boulevard Saint Marcel, 75005 Paris, France
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2
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Kamin K, Mäder M, Marx C, Rammelt S. [Injuries to the lateral ankle ligaments]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2025; 128:47-58. [PMID: 39656242 DOI: 10.1007/s00113-024-01503-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/24/2024] [Indexed: 01/16/2025]
Abstract
Acute sprains and ruptures of the lateral ankle ligaments are the most common injuries of the ankle joint. They are often related to sporting activity and predominantly affect individuals under 40 years old. Lateral ligament injuries occur due to supination trauma. The anterior talofibular ligament is most commonly affected often in combination with the calcaneofibular ligament. In contrast, ruptures of all three lateral ankle ligaments (luxatio pedis supinatoria) or complete ruptures of the medial and lateral ligaments (luxatio pedis cum talo) are extremely rare. The clinical diagnostics have a high sensitivity and specificity and X-ray images are used to exclude fractures and other accompanying injuries. In cases of acute injuries conservative treatment in an orthosis for 5-6 weeks to prevent supination is the method of choice. Surgical treatment is reserved for exceptional indications. For both operative and conservative forms of treatment the functional treatment with initial movement exercises in a semi-rigid orthosis and the following proprioceptive training are crucial for the success of treatment and show superior results compared to immobilization in a surgical cast.
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Affiliation(s)
- Konrad Kamin
- UniversitätsCentrum für Orthopädie und Unfall- und Plastische Chirurgie, Am Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - Marcel Mäder
- UniversitätsCentrum für Orthopädie und Unfall- und Plastische Chirurgie, Am Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Christine Marx
- UniversitätsCentrum für Orthopädie und Unfall- und Plastische Chirurgie, Am Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Stefan Rammelt
- UniversitätsCentrum für Orthopädie und Unfall- und Plastische Chirurgie, Am Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
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Dallaudière B, Dalmau-Pastor M, Pesquer L, Boudahmane S, Cordier G. Ultrasound of Postoperative Ankle Instability: How to Manage with Arthroscopic Reparation or Anatomical Reconstruction of Lateral Ankle Ligaments. Semin Musculoskelet Radiol 2024; 28:758-770. [PMID: 39561757 DOI: 10.1055/s-0044-1791493] [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: 11/21/2024]
Abstract
Surgical repair or reconstruction of lateral ankle ligaments is indicated in patients with persistent ankle instability, with arthroscopic/endoscopic treatment becoming more frequent. Although presurgical imaging of the ankle is always standard procedure, more is needed to understand the evolution of the repaired ligament or the tendinous graft to help improve length of postoperative time and functional results. This review describes the normal ultrasound aspects and possible complications of repaired/reconstructed ankle ligaments after an all-inside endoscopic repair/reconstruction of the anterior talofibular ligament and the calcaneofibular ligament.
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Affiliation(s)
- Benjamin Dallaudière
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS, Université de Bordeaux, Bordeaux, France
- Centre d'Imagerie Ostéo-articulaire, Clinique du Sport de Bordeaux-Mérignac 2, Mérignac, France
- Département d'Imagerie Musculo-squelettique, Centre Hospitalier Universitaire Pellegrin, Place Amélie Léon Rabat, Bordeaux, France
| | - Miki Dalmau-Pastor
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Mérignac, France
| | - Lionel Pesquer
- Département d'Imagerie Musculo-squelettique, Centre Hospitalier Universitaire Pellegrin, Place Amélie Léon Rabat, Bordeaux, France
| | - Sofiane Boudahmane
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS, Université de Bordeaux, Bordeaux, France
| | - Guillaume Cordier
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Mérignac, France
- Service de Chirurgie orthopédique, Clinique du Sport de Bordeaux-Mérignac, Mérignac, France
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McCann RS, Ohrnberger E, Kosik KB, Gribble PA. Prediction of Recurrent Lateral Ankle Sprain and Ankle Pain Using Applied Care Strategies and Patient-Reported Outcomes. J Athl Train 2024; 59:1070-1076. [PMID: 38779882 PMCID: PMC11611370 DOI: 10.4085/1062-6050-0054.24] [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] [Indexed: 05/25/2024]
Abstract
CONTEXT Patients with lateral ankle sprains (LASs) often have deficient patient-reported outcomes (PROs) at return to activity (RTA), potentially increasing risk for recurrent LAS and ankle pain. Additionally, applied care strategies are known to correct impairments, but their ability to mitigate risk for long-term consequences remains unknown. OBJECTIVE To determine if applied care strategies and PRO scores at RTA and 6 months after RTA predict recurrent LAS and ankle pain 12 months after an acute LAS. DESIGN Prospective cohort study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS We enrolled 63 individuals within 1 week of sustaining an acute LAS. MAIN OUTCOME MEASURE(S) Participants completed online surveys about their health history and recent LAS. At RTA and 6 months after RTA, participants completed online surveys regarding demographics, applied care strategies, and PROs, including the Foot and Ankle Disability Index (FADI), Identification of Functional Ankle Instability, Godin Leisure-Time Exercise Questionnaire, and Short Form-8 (SF8). At 12 months post-RTA, we asked participants if they sustained recurrent LASs. Chi-square analyses determined if recurrent LAS and ankle pain at 12 months were related to applied care strategies or ankle pain at RTA. Independent t tests compared demographics and PROs at RTA and 6 months between participants with and without a recurrent LAS or ankle pain at 12 months. Logistic regression and area under the receiver operating characteristic analyses determined if demographics, applied care strategies, ankle pain at RTA, and PRO scores at RTA and 6 months predicted recurrent LAS and ankle pain at 12 months. RESULTS Participants with a recurrent LAS had a lower walking boot use (P = .05) and were taller than those without (P = .03). Increased height and lack of walking boot use were predictive of recurrent LAS (P < .01, R2 = 0.33, area under the receiver operating characteristic = 0.81 [0.68, 0.95]). CONCLUSIONS Individuals with LAS who are taller and do not use a walking boot might have greater risk for a recurrent LAS withing 12 months of RTA.
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Affiliation(s)
- Ryan S McCann
- School of Rehabilitation Sciences, Old Dominion University, Norfolk, VA
| | - Elisabeth Ohrnberger
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington
| | - Kyle B Kosik
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington
| | - Phillip A Gribble
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington
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Mercan N, Yurteri A, Dere Y. Do lateral ankle ligaments contribute to syndesmotic stability: a finite element analysis study. Comput Methods Biomech Biomed Engin 2024; 27:1768-1780. [PMID: 37728074 DOI: 10.1080/10255842.2023.2258251] [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: 07/27/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
Whether the lateral ankle ligaments contribute to syndesmotic stability is still controversial and has been the subject of frequent research recently. In our study, we tried to elucidate this situation using the finite element analysis method. Intact model and thirteen different injury models were created to simulate injuries of the lateral ankle ligaments (ATFL, CFL, PTFL), injuries of the syndesmotic ligaments (AITFL, IOL, PITFL) and their combined injuries. The models were compared in terms of LFT, PFT and EFR. It was observed that 0.537 mm LFT, 0.626 mm PFT and 1.25° EFR occurred in the intact model (M#1), 0.539 mm LFT, 0.761 mm PFT and 2.31° EFR occurred in the isolated ATFL injury (M#2), 0.547 mm LFT, 0.791 mm PFT and 2.50° EFR occurred in the isolated AITFL injury (M#8). The LFT, PFT and EFR amounts were higher in the both M#2 and M#8 compared to the M#1. LFT, PFT and EFR amounts in M#2 and M#8 were found to be extremely close. In terms of LFT and PFT, when we compare models with (LFT: 0.650 mm, PFT: 1.104) and without (LFT: 0.457 mm, PFT: 1.150) IOL injury, it is seen that the amount of LFT increases and the amount of PFT decreases with IOL injury. We also observed that injuries to the CFL, PTFL and PITFL did not cause significant changes in fibular translations and PFT and EFR values show an almost linear correlation. Our results suggest that ATFL injury plays a crucial role in syndesmotic stability.
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Affiliation(s)
- Numan Mercan
- Department of Orthopaedic and Traumatology, Kahramanmaras Necip Fazıl City Hospital, Kahramanmaras, Turkey
| | - Ahmet Yurteri
- Department of Orthopaedic and Traumatology, Konya Sehir Hastanesi, Konya, Turkey
| | - Yunus Dere
- Department of Civil Engineering, Necmettin Erbakan University, Meram, Turkey
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Michels F, Dewyn T, Bogaerts K, De Waele C, Hamers D. The evolution of patient-reported outcome measures after a first lateral ankle sprain: A prospective study. Foot Ankle Surg 2024; 30:568-575. [PMID: 38714452 DOI: 10.1016/j.fas.2024.04.012] [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: 08/26/2023] [Revised: 04/03/2024] [Accepted: 04/28/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE A lateral ankle sprain is the most common musculoskeletal injury in the physically active population. However, it is unclear how the clinical condition evolves during the period after the injury and what proportion of patients develops chronic symptoms. Therefore, the purpose of this study is to assess the evolution of patient-reported outcome measures after a first time lateral ankle sprain. METHODS A prospective clinical study assessed the patient-reported outcome measures (PROMs) of a consecutive group of 100 patients during 1 year after a first lateral ankle sprain. The Karlsson score and Foot and Ankle Outcome Score (FAOS) were assessed at 6 weeks, 3 months, 6 months, 9 months and 1 year. The Cumberland Ankle Instability Tool (CAIT)-score was assessed at 6 months, 9 months and 1 year. The difference between the time points of all scores was analysed using the positive change over time (binomial test versus 50%) and the difference in score (signed rank test). The time to sustained excellent level was also assessed overall and in several subgroups: age, gender, degree of injury (2 or 3), avulsion fracture, use of crutches, use of cast. Differences between subgroups were assessed by a generalized log-rank test. RESULTS All clinical scores demonstrated an improvement up to 12 months after the sprain. The median Karlsson score (interquartile range) improved from 62 (50-80) at 6 weeks to 90 (72-100) at 3 months, to 97 (82-100) at 6 months to 100 (90-100) at 9 months, to 100 (100-100) at 1 year. The analysis of positive change over time demonstrated a significant positive change (P-value <.0005) between all time points except between 6 weeks and 12 weeks when using the FAOS quality score. The difference in score demonstrated a significant change (P-value <.01) between all time points except between 36 weeks and 48 weeks when using the FAOS pain and FAOS sports score. Age and presence of an avulsion fracture were correlated with a slower recovery and worse results. At 1 year, in total 13 patients (13%) had a worse outcome corresponding to a Karlsson score < 81 or CAIT score < 24. CONCLUSION The clinical condition after a first ankle sprain demonstrated a significant improvement in PROMs between the different time points in the first year. Twelve months after a first lateral ankle sprain 13% had a fair or poor outcome. Higher age and presence of an avulsion fracture were correlated with a slower recovery and worse results. This information is useful in clinical practice to predict further progression and inform patients. Moreover, it is valuable to improve treatment strategies. LEVEL OF EVIDENCE Level II (prospective cohort study).
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Affiliation(s)
- Frederick Michels
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium; MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France; Department of Development and Regeneration, Faculty of Medicine, University of Leuven campus Kortrijk, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium.
| | - Tim Dewyn
- Department of Emergency and Sports Medicine, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium.
| | - Kris Bogaerts
- KU Leuven, Department of public health and critical care, I-BioStat, Leuven, Belgium; UHasselt, I-BioStat, Hasselt, Belgium.
| | - Camille De Waele
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium.
| | - Delphine Hamers
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium.
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Murata K, Sakakida T, Kawabata S, Yokoyama M, Morishita Y, Kita S, Kubota K, Kano T, Kojima T, Terada H, Takasu C, Kanemura N. The effect of orthosis management on joint instability in knee joint disease: A systematic review. Prosthet Orthot Int 2024; 48:400-411. [PMID: 37708343 DOI: 10.1097/pxr.0000000000000289] [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: 11/21/2022] [Accepted: 07/20/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Joint instability is a common finding of clinical importance in patients with knee disease. This literature review aimed to examine the evidence regarding the effect of orthosis management on joint instability in knee joint disease. METHODS The detailed protocol for this study was published in the International Prospective Register of Systematic Reviews in the field of health and social welfare (CRD 42022335360). A literature search was conducted on May 2023, using the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Physiotherapy Evidence Database (PEDro), and Institute of Electrical and Electronics Engineers (IEEE) Xplore. A secondary search was manually conducted using Google Scholar to address publication bias. Each database search strategy was described, and the search was conducted by independent reviewers. RESULTS A total of 281 studies were retrieved, 11 articles were included in the systematic review. Of the 11 articles selected, the number of included diseases was 2 for osteoarthritis, 7 for anterior cruciate ligament injuries, and 3 for posterior cruciate ligament injuries. In result, orthosis management may improve self-reported instability and functional assessment in patients with osteoarthritis, anterior cruciate ligament injury, and posterior cruciate ligament injury. However, an objective evaluation of anatomical instability did not indicate an improvement in joint instability. CONCLUSION The effects of orthosis management on knee instability might improve physical function and self-reported instability.
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Affiliation(s)
- Kenji Murata
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan
| | - Takuma Sakakida
- Department of Rehabilitation, Izumi Rehabilitation Hospital, Chiba, Japan
| | - Sora Kawabata
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Moeka Yokoyama
- Sportology Center, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yuri Morishita
- Department of Rehabilitation, Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan
| | - Shunsuke Kita
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Keisuke Kubota
- Research Development Center, Saitama Prefectural University, Saitama, Japan
| | - Takuma Kano
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Takuma Kojima
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Hidenobu Terada
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Chiharu Takasu
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Naohiko Kanemura
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan
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Chen Z, Zhao Y, Xue X, Gu X, Hua Y. Outcomes comparison of elastic bandage versus lower-leg cast immobilization after anterior talofibular ligament repair. BMC Musculoskelet Disord 2024; 25:469. [PMID: 38879465 PMCID: PMC11179373 DOI: 10.1186/s12891-024-07584-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/10/2024] [Indexed: 06/19/2024] Open
Abstract
PURPOSE The aim of this study was to compare the clinical outcomes between patients with chronic ankle instability (CAI) undergoing arthroscopic anterior talofibular ligament (ATFL) repair who received elastic bandage treatment and those who received lower-leg cast immobilization. METHODS CAI patients with isolated ATFL injury undergoing arthroscopic ATFL repair from January 2017 and August 2019 were included in the study. The visual analogue scale (VAS) at rest and during activities, American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (Karlsson score), and time of returning to walk, walk normally, work and sports were evaluated preoperatively, and at 6 months and 12 months follow-up. RESULTS A total of 41 patients were included in this study. Among them, 24 patients accepted lower-leg cast fixation, and the other 17 patients were immobilized with elastic bandage. Compared to patients with lower-leg immobilization, patients with elastic bandage fixation had significantly lower VAS during activities (P = 0.021) and higher AOFAS score (P = 0.015) at 12 months follow-up. The Karlsson score at 6 months follow-up were significantly higher in elastic bandage group than those in lower-leg group (P = 0.011). However, no significant difference was observed in time of returning to walk, work and sports between the two groups. CONCLUSION Elastic bandage treatment was better than lower-leg cast immobilization in terms of eliminating pain symptom at 12 months follow-up, and improving ankle functional outcome at 6 months follow-up. Moreover, the present study emphasized that lower-leg cast immobilization offered no advantages in arthroscopic ATFL repair postoperative immobilization. STUDY DESIGN Cohort study; Level of evidence, 3.
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Affiliation(s)
- Ziyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yujie Zhao
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoao Xue
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xicheng Gu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.
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Dhillon MS, Patel S, Baburaj V. Ankle Sprain and Chronic Lateral Ankle Instability: Optimizing Conservative Treatment. Foot Ankle Clin 2023; 28:297-307. [PMID: 37137624 DOI: 10.1016/j.fcl.2022.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The management protocol for each case of ankle sprain should be individualized and optimized in order to reduce the likelihood of development of chronic instability. Initial treatment aims to address pain, swelling, and inflammation and facilitates regaining pain-free joint motion. Short-term joint immobilization is indicated in severe cases. Subsequently, muscle strengthening, balance training, and targeted activities to develop proprioception are added. Gradually, sports-related activities are added with the ultimate goal of bringing the individual back to preinjury level of activity. This protocol of conservative treatment should always be offered before considering any surgical intervention.
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Affiliation(s)
| | - Sandeep Patel
- Department of Orthopedic Surgery, PGIMER Chandigarh.
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Bak J, Thorborg K, Clausen MB, Johannsen FE, Kirk JW, Bandholm T. Using the app "Injurymap" to provide exercise rehabilitation for people with acute lateral ankle sprains seen at the Hospital Emergency Department-A mixed-method pilot study. PLOS DIGITAL HEALTH 2023; 2:e0000221. [PMID: 37186574 PMCID: PMC10184914 DOI: 10.1371/journal.pdig.0000221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/27/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Acute lateral ankle sprains (LAS) account for 4-5% of all Emergency Department (ED) visits. Few patients receive the recommended care of exercise rehabilitation. A simple solution is an exercise app for mobile devices, which can deliver tailored and real-time adaptive exercise programs. PURPOSE The purpose of this pilot study was to investigate the use and preliminary effect of an app-based exercise program in patients with LAS seen in the Emergency Department at a public hospital. MATERIALS AND METHODS We used an app that delivers evidence-based exercise rehabilitation for LAS using algorithm-controlled progression. Participants were recruited from the ED and followed for four months. Data on app-use and preliminary effect were collected continuously through the exercise app and weekly text-messages. Baseline and follow-up data were collected though an online questionnaire. Semi-structured interviews were performed after participants stopped using the app. Results: Health care professionals provided 485 patients with study information and exercise equipment. Of those, 60 participants chose to enroll in the study and 43 became active users. The active users completed a median of 7 exercise sessions. Most of the active users were very satisfied or satisfied (79%-93%) with the app and 95.7% would recommend it to others. The interviews showed that ankle sprains were considered an innocuous injury that would recover by itself. Several app users expressed they felt insufficiently informed from the ED health care professionals. Only 39% felt recovered when they stopped exercising, and 33% experienced a recurrent sprain in the study period. Conclusion: In this study, only few patients with LAS became active app users after receiving information in the ED about a free app-based rehabilitation program. We speculate the reason for this could be the perception that LAS is an innocuous injury. Most of the patients starting training were satisfied with the app, although few completed enough exercise sessions to realistically impact clinical recovery. Interestingly more than half of the participants did not feel fully recovered when they stopped exercising and one third experienced a recurrent sprain. TRIAL-IDENTIFIERS https://clinicaltrials.gov/ct2/show/NCT03550274, preprint (open access): https://www.medrxiv.org/content/10.1101/2022.01.31.22269313v1.
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Affiliation(s)
- Jonas Bak
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
| | - Kristian Thorborg
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital, Amager and Hvidovre, Denmark
| | - Mikkel Bek Clausen
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen N, Denmark
| | - Finn Elkjær Johannsen
- Institute of Sports Medicine Copenhagen, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Injurymap Aps, Copenhagen N, Denmark
| | - Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Thomas Bandholm
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital, Amager and Hvidovre, Denmark
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11
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Kawabata S, Murata K, Iijima H, Nakao K, Kawabata R, Terada H, Kojima T, Takasu C, Kano T, Kanemura N. Ankle instability as a prognostic factor associated with the recurrence of ankle sprain: A systematic review. Foot (Edinb) 2023; 54:101963. [PMID: 36709590 DOI: 10.1016/j.foot.2023.101963] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
DESIGN Systematic review using PRISMA guidelines. PURPOSE To explore Relationship between ankle instability and ankle sprain recurrence in preventing recurrence of ankle sprains and to provide appropriate treatment. METHODS MEDLINE (the Cochrane Library) and the Physiotherapy Evidence Database (PEDro) were explored using key words related to ankle instability and ankle sprains in for April 2022. According to the inclusion criteria, studies that 1) targeted patients with ankle sprains, 2) assessed ankle instability, and 3) investigated ankle sprain recurrence rates, were extracted. The author names, publication year, patient characteristics, comparison groups, intervention methods, and outcome data (ankle instability and recurrence) were extracted. A correlation analysis between recurrence rate and ankle instability was conducted. In addition, A meta-analysis was performed on the correlation coefficients within each article. RESULTS Eight studies were extracted from 149 studies. A correlation analysis was conducted on five studies and meta-analysis was on three studies with the same post-intervention follow-up period and the same assessment methods for ankle instability and recurrence rate. Strong positive correlations were found for the same follow-up periods (r = 0.95: 95%CI [0.62-0.99]; 3-month, r = 0.97: 95%CI [0.75-0.10]; 1 year, p < .05). The correlation became stronger as the follow-up period increased. Furthermore, the meta-analysis showed that ankle instability as well as the main symptoms of sprain, such as pain and swelling, tended to be positively correlated with the recurrent rate of ankle sprains. These results suggest that ankle instability is strongly related to recurrence, and the longer the time since onset, the stronger the relationship. CONCLUSIONS Ankle instability was a prognostic factor associated with recurrence of ankle sprains in patients with ankle sprains. Therefore, ankle instability is one of important factor in preventing recurrence of ankle sprains.
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Affiliation(s)
- Sora Kawabata
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Kenji Murata
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan.
| | - Hirotaka Iijima
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan; Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kouki Nakao
- Department of Rehabilitation, Amakusa Rehabilitation Hospital, Saitama, Japan
| | - Riku Kawabata
- Department of Rehabilitation, Minami-Koshigaya Hospital, Saitama, Japan
| | - Hidenobu Terada
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Takuma Kojima
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Chiharu Takasu
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Takuma Kano
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Naohiko Kanemura
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan
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12
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Michels F, Wastyn H, Pottel H, Stockmans F, Vereecke E, Matricali G. The presence of persistent symptoms 12 months following a first lateral ankle sprain: A systematic review and meta-analysis. Foot Ankle Surg 2022; 28:817-826. [PMID: 34961654 DOI: 10.1016/j.fas.2021.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/02/2021] [Accepted: 12/06/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND A lateral ankle sprain (LAS) is the most common musculoskeletal injury in the physically active population. It is uncertain what percentage of these patients develop persisting symptoms including pain, recurrent sprains and subjective instability. This systematic review was conducted to assess the presence and duration of persistent symptoms after a first LAS. METHODS A systematic review of the Medline, Web of Sciences, Embase, CINAHL and Pedro databases was performed to identify peer-reviewed articles concerning the occurrence and duration of remaining symptoms after a first LAS. Inclusion criteria focused on selection of patients without previous ankle injuries and study quality. One of the following outcomes had to be described: subjective instability, resprains, remaining symptoms. RESULTS In total, 15 studies were included. The occurrence of patients with subjective instability decreased from 37.9% (95%CI [6.0-69.7]) at 3 months to 16.1% (95%CI [7.8-24.3]) at 6 months and 8.1% (95%CI [3.3-13.3]) at 12 months. The occurrence of patients with a recurrent LAS was 15.8% (95%CI [6.3-25.3]) at 12 months. The occurrence of patients with residual pain decreased from 48.6% (95%CI [23.6-73.5]) at 3 months, to 21.5% (95%CI [2.8-40.2]) at 6 months and 6.7% (95%CI [3.2-10.1]) at 12 months. CONCLUSION This study offers new insights in the presence of remaining symptoms after a first LAS and the development of chronic ankle instability. Twelve months following an initial LAS, a significant number of patients may still have symptoms. The incidence of subjective instability, and pain, continues to decrease until 12 months post-injury. This new information may suggest that a longer period of non-operative treatment may be warranted before recommending surgical intervention in patients with a first LAS.
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Affiliation(s)
- Frederick Michels
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium; MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France; ESSKA-AFAS Ankle Instability Group, Luxembourg.
| | - Heline Wastyn
- Department of Orthopaedics, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - Hans Pottel
- Department of Public Health and Primary Care, Catholic University Leuven, Kortrijk, Belgium.
| | - Filip Stockmans
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium; Dept. Development and Regeneration, Faculty of Medicine, University of Leuven campus Kortrijk, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium.
| | - Evie Vereecke
- Dept. Development and Regeneration, Faculty of Medicine, University of Leuven campus Kortrijk, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium.
| | - Giovanni Matricali
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium; Institute of Orthopaedic Research and Training, KU Leuven, Leuven, Belgium.
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13
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Toyoshima Y, Akagi R, Nabeshima K. Isometric exercise during immobilization reduces the time to return to play after lateral ankle sprain. Phys Ther Sport 2021; 52:168-172. [PMID: 34547600 DOI: 10.1016/j.ptsp.2021.09.002] [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: 06/16/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
[Objectives] Immobilization reduces symptoms after lateral ankle sprain but may worsen the range of motion (ROM) of the ankle and delay return to play (RTP). We aimed to elucidate the correlation between ankle ROM and time to RTP following immobilization for lateral ankle sprain and investigated if isometric exercise during immobilization would increase ROM and shorten the time to RTP. [Participants and outcome measures] Eighty-two patients with acute lateral ankle sprain were treated by a short-leg cast with or without isometric exercise and electrical muscle stimulation (EMS); intervention group or control group, respectively. The correlation between ankle ROM at cast removal and time to RTP was analyzed. The total and side-to-side ankle ROM and the time to RTP were compared between the two groups. [Results] Side-to-side difference in total ankle ROM significantly correlated with time to RTP (r = 0.38, p = 0.02). The intervention reduced the side-to-side difference in total ROM (20° versus 31°, p = 0.01) and time to RTP (46 versus 65 days, p = 0.01) compared to the control group. [Conclusion] Increased deficiency in ankle ROM led to a longer time to RTP, and isometric exercise combined with EMS during immobilization increased the total ankle ROM and shortened the time to RTP.
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Affiliation(s)
- Yasunao Toyoshima
- Health and Sports Association Nabeshima Orthopaedic Clinic, 4-23-2 Matsunami, Chuo-ku, Chiba, Chiba, 260-0044, Japan
| | - Ryuichiro Akagi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan; Sportsmedics Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.
| | - Kazuo Nabeshima
- Health and Sports Association Nabeshima Orthopaedic Clinic, 4-23-2 Matsunami, Chuo-ku, Chiba, Chiba, 260-0044, Japan
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14
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Miranda JP, Silva WT, Silva HJ, Mascarenhas RO, Oliveira VC. Effectiveness of cryotherapy on pain intensity, swelling, range of motion, function and recurrence in acute ankle sprain: A systematic review of randomized controlled trials. Phys Ther Sport 2021; 49:243-249. [PMID: 33813154 DOI: 10.1016/j.ptsp.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/17/2021] [Accepted: 03/21/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Investigate effectiveness of cryotherapy on pain intensity, swelling, range of motion, function and recurrence in acute ankle sprain. METHODS Searches were conducted on six databases for randomized or quasi-randomized controlled trials (RCTs) evaluating effectiveness of cryotherapy for pain intensity, swelling, range of motion, function and recurrence in acute ankle sprain. Selection of trials, data extraction and methodological quality assessment of included trials were conducted independently by two reviewers with discrepancies resolved by a third reviewer. Estimates were presented as mean differences (MDs) with 95% confidence intervals (CIs). The quality of the evidence was assessed using the Grading of Recommendations Assessment (GRADE) approach. RESULTS Two RCTs with high risk of bias were included. Both evaluated the additional effects of cryotherapy, comparing cryotherapy combined with other intervention versus other intervention stand-alone. Uncertain evidence shows that cryotherapy does not enhance effects of other intervention on swelling (MD = 6.0; 95%CI: 0.5 to 12.5), pain intensity (MD = -0.03; 95%CI: 0.34 to 0.28) and range of motion (p > 0.05). CONCLUSIONS Current literature lacks evidence supporting the use of cryotherapy on management of acute ankle sprain. There is an urgent call for larger high-quality randomized controlled trials.
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Affiliation(s)
- Júlio Pascoal Miranda
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil.
| | - Whesley Tanor Silva
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil.
| | - Hytalo Jesus Silva
- Postgraduate Program in Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
| | - Rodrigo Oliveira Mascarenhas
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil.
| | - Vinícius Cunha Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Postgraduate Program in Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil.
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15
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Halabchi F, Hassabi M. Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World J Orthop 2020; 11:534-558. [PMID: 33362991 PMCID: PMC7745493 DOI: 10.5312/wjo.v11.i12.534] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/04/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023] Open
Abstract
Acute ankle sprain is the most common lower limb injury in athletes and accounts for 16%-40% of all sports-related injuries. It is especially common in basketball, American football, and soccer. The majority of sprains affect the lateral ligaments, particularly the anterior talofibular ligament. Despite its high prevalence, a high proportion of patients experience persistent residual symptoms and injury recurrence. A detailed history and proper physical examination are diagnostic cornerstones. Imaging is not indicated for the majority of ankle sprain cases and should be requested according to the Ottawa ankle rules. Several interventions have been recommended in the management of acute ankle sprains including rest, ice, compression, and elevation, analgesic and anti-inflammatory medications, bracing and immobilization, early weight-bearing and walking aids, foot orthoses, manual therapy, exercise therapy, electrophysical modalities and surgery (only in selected refractory cases). Among these interventions, exercise and bracing have been recommended with a higher level of evidence and should be incorporated in the rehabilitation process. An exercise program should be comprehensive and progressive including the range of motion, stretching, strengthening, neuromuscular, proprioceptive, and sport-specific exercises. Decision-making regarding return to the sport in athletes may be challenging and a sports physician should determine this based on the self-reported variables, manual tests for stability, and functional performance testing. There are some common myths and mistakes in the management of ankle sprains, which all clinicians should be aware of and avoid. These include excessive imaging, unwarranted non-weight-bearing, unjustified immobilization, delay in functional movements, and inadequate rehabilitation. The application of an evidence-based algorithmic approach considering the individual characteristics is helpful and should be recommended.
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Affiliation(s)
- Farzin Halabchi
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran 14167-53955, Iran
| | - Mohammad Hassabi
- Department of Sports and Exercise Medicine, Shahid Beheshti University of Medical Sciences, Tehran 19979-64151, Iran
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16
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Cupler ZA, Alrwaily M, Polakowski E, Mathers KS, Schneider MJ. Taping for conditions of the musculoskeletal system: an evidence map review. Chiropr Man Therap 2020; 28:52. [PMID: 32928244 PMCID: PMC7491123 DOI: 10.1186/s12998-020-00337-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/12/2020] [Indexed: 12/14/2022] Open
Abstract
Background Taping is a common treatment modality used by many rehabilitation providers. Several types of tapes and taping methods are used in the treatment of musculoskeletal dysfunction and pain. Purpose To summarize and map the evidence related to taping methods used for various joints and conditions of the musculoskeletal system, and to provide clinicians and researchers with a user-friendly reference with organized evidence tables. Data sources The PEDro, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register for Controlled Trials, PubMed, and PROSPERO databases were searched from inception through October 31, 2019. Study selection Eligible studies were selected by two independent reviewers and included either systematic reviews (SRs) or randomized controlled trials (RCTs) and included a musculoskeletal complaint using a clinical outcome measure. Data extraction Data was extracted by two investigators independently. Risk of bias and quality were assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) for SRs or the Physiotherapy Evidence Database (PEDro) scale for RCTs. The protocol was registered with PROSPERO (CRD42019122857). Data synthesis Twenty-five musculoskeletal conditions were summarized from forty-one SRs and 127 RCTs. There were 6 SRs and 49 RCTs for spinal conditions. Kinesio tape was the most common type of tape considered. Four evidence tables representing the synthesized SRs and RCTs were produced and organized by body region per condition. Limitations Inclusion of only English language studies. Also, the heterogeneous nature of the included studies prevented a meta-analysis. Conclusions There is mixed quality evidence of effectiveness for the different types of taping methods for different body regions and conditions. All of the SRs and RCTs found during our search of the taping literature have been organized into a series of appendices. A synthesis of the results have been placed in evidence tables that may serve as a useful guide to clinicians and researchers.
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Affiliation(s)
- Zachary A Cupler
- Physical Medicine & Rehabilitation Services, Butler VA Healthcare System, 353 N. Duffy Road, Butler, Pennsylvania, USA.
| | - Muhammad Alrwaily
- Division of Physical Therapy, School of Medicine, West Virginia University, Morgantown, West Virginia, USA.,Department of Physical Therapy, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Emily Polakowski
- Private Practice, Independence Physical Therapy, Mystic, Connecticut, USA
| | - Kevin S Mathers
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Michael J Schneider
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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17
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Kaneguchi A, Ozawa J, Minamimoto K, Yamaoka K. Three-week joint immobilization increases anterior-posterior laxity without alterations in mechanical properties of the anterior cruciate ligament in the rat knee. Clin Biomech (Bristol, Avon) 2020; 75:104993. [PMID: 32298871 DOI: 10.1016/j.clinbiomech.2020.104993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/20/2020] [Accepted: 02/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although knee immobilization may deteriorate the mechanical parameters of the anterior cruciate ligament, such as stiffness and failure strength, it is unknown whether it induces laxity in the whole joint. We examined the effects of immobilization on anterior-posterior joint laxity and mechanical properties of the anterior cruciate ligament, as well as histological and gene expression profiles of the joint capsule in rat knee joints. METHODS Unilateral rat knees were immobilized using an external fixator. Non-immobilized contralateral knees were used as controls. After 3 weeks, anterior-posterior laxity in the whole joint (i.e., a complex of bones, ligaments, and capsule) and stiffness and failure strength in the anterior cruciate ligament were examined using a universal testing machine. Moreover, the knee joint capsule was histologically analyzed, and the expression levels of genes related to collagen turnover in the posterior joint capsule were examined. FINDINGS Joint immobilization slightly but significantly increased anterior-posterior laxity compared with the contralateral side. Unexpectedly, the stiffness and failure strength of the anterior cruciate ligament were not altered by immobilization. There was no correlation found between anterior cruciate ligament stiffness and anterior-posterior joint laxity. In the posterior joint capsule, thinning of the collagen fiber bundles accompanied by a decrease in COL3A1 gene expression was observed after immobilization. INTERPRETATION These results suggest that 3 weeks of joint immobilization alters the biomechanical integrity in the knee joint without altering the mechanical properties of the anterior cruciate ligament. Changes in the joint capsule may contribute to the immobilization-induced increase in anterior-posterior laxity.
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Affiliation(s)
- Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan.
| | - Kengo Minamimoto
- Major in Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Kaoru Yamaoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
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18
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Canton S, Anderst W, Hogan MV. In Vivo Ankle Kinematics Revealed Through Biplane Radiography: Current Concepts, Recent Literature, and Future Directions. Curr Rev Musculoskelet Med 2020; 13:77-85. [PMID: 31989528 PMCID: PMC7083983 DOI: 10.1007/s12178-020-09601-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW Lateral ligament repair, specifically the modified Broström-Gould (BG) procedure, has been described for patients with chronic ankle instability (CAI) after failure of nonoperative management. However, there is minimal data about native in vivo ankle bone kinematics and how repairs such as the BG procedure affect the kinematics. The objective of this review is to appraise existing literature that used biplane radiography to measure in vivo kinematics of the ankle in healthy, CAI, and BG populations. RECENT FINDINGS Results showed that the tibiotalar joint contributes more to dorsi/plantarflexion, the subtalar joint contributes more to inversion/eversion and internal/external rotation, and that both joints are capable of complex three-dimensional (3D) motion. Preliminary data suggests that demanding activities (as opposed to walking) are necessary to elicit kinematic differences between healthy and CAI populations. Results also indicate that the BG procedure restores static kinematics and range of motion. All but one of the studies identified in this review collected static, quasi-stance, or partial gait capture data. The strength of our current knowledge is low given the small sample sizes, exploratory nature of previous work, and lack of rigorous experimental design in previous studies. Future directions include development of an improved protocol for establishing coordinate systems in the ankle bones, continued development of a database of normal kinematics during a variety of activities, and large-scale, longitudinal studies of CAI and BG patients.
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Affiliation(s)
- Stephen Canton
- The University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA
| | - William Anderst
- The University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA.
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, 15213, USA.
| | - MaCalus V Hogan
- The University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, 15213, USA
- The Foot and Ankle Injury [F.A.I.R] Group, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, 15213, USA
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19
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Green T, Willson G, Martin D, Fallon K. What is the quality of clinical practice guidelines for the treatment of acute lateral ankle ligament sprains in adults? A systematic review. BMC Musculoskelet Disord 2019; 20:394. [PMID: 31470826 PMCID: PMC6717337 DOI: 10.1186/s12891-019-2750-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/02/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Acute lateral ankle ligament sprains (LALS) are a common injury seen by many different clinicians. Knowledge translation advocates that clinicians use Clinical Practice Guidelines (CPGs) to aid clinical decision making and apply evidence-based treatment. The quality and consistency of recommendations from these CPGs are currently unknown. The aims of this systematic review are to find and critically appraise CPGs for the acute treatment of LALS in adults. METHODS Several medical databases were searched. Two authors independently applied inclusion and exclusion criteria. The content of each CPG was critically appraised independently, by three authors, using the Appraisal of Guidelines for REsearch and Evaluation (AGREE II) instrument online version called My AGREE PLUS. Data related to recommendations for the treatment of acute LALS were abstracted independently by two reviewers. RESULTS This study found CPGs for physicians and physical therapists (Netherlands), physical therapists, athletic trainers, physicians, and nurses (USA) and nurses (Canada and Australia). Seven CPGs underwent a full AGREE II critical appraisal. None of the CPGs scored highly in all domains. The lowest domain score was for domain 5, applicability (discussion of facilitators and barriers to application, provides advice for practical use, consideration of resource implications, and monitoring/auditing criteria) achieving an exceptionally low joint total score of 9% for all CPGs. The five most recent CPGs scored a zero for applicability. Other areas of weakness were in rigour of development and editorial independence. CONCLUSIONS The overall quality of the existing LALS CPGs is poor and majority are out of date. The interpretation of the evidence between the CPG development groups is clearly not consistent. Lack of consistent methodology of CPGs is a barrier to implementation. SYSTEMATIC REVIEW Systematic review registered with PROSPERO ( CRD42015025478 ).
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Affiliation(s)
- Toni Green
- ANU Medical School, College of Health and Medicine, Australian National University, ACT, Acton, Australia
- Discipline of Physiotherapy, University of Canberra, ACT, Bruce, 2617 Australia
| | - Grant Willson
- Discipline of Physiotherapy, University of Canberra, ACT, Bruce, 2617 Australia
| | - Donna Martin
- Elite Rehab and Sports Physiotherapy, Deakin, Canberra, Australia
| | - Kieran Fallon
- ANU Medical School, College of Health and Medicine, Australian National University, ACT, Acton, Australia
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20
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Wikstrom EA, Hubbard-Turner T, Duncan A, Cline J, Turner MJ. Prolonged Rest, Long-Term Dynamic Balance, and Gait in a Mouse Ankle-Sprain Model. J Athl Train 2019; 54:801-807. [PMID: 31343261 DOI: 10.4085/1062-6050-38-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Lateral ankle sprains (LASs) result in short- and long-term adaptations in the sensorimotor system that are thought to contribute to the development of chronic ankle instability and posttraumatic ankle osteoarthritis. Debate continues as to the appropriateness of rapid return to sport after LASs given the prevalence of long-term consequences. OBJECTIVE To examine the short- and long-term effects of prolonged rest, as a model of immobilization, on dynamic balance and gait outcomes after a severe LAS in a mouse model. DESIGN Controlled laboratory study. SETTING Research laboratory. INTERVENTION(S) At 7 weeks of age, 18 male mice (CBA/J) had their right anterior talofibular and calcaneofibular ligaments transected. Mice were then randomized to 1 of 3 groups representing when access to a running wheel postsurgery was gained: at 3 days, 1 week, and 2 weeks. MAIN OUTCOME MEASURE(S) Dynamic balance and spatial gait characteristics were quantified before surgery (baseline) and at 3 days and 1, 2, 4, 6, 12, 18, 24, 30, 36, 42, 48, and 54 weeks postinjury. RESULTS Relative to prolonged rest, resting for only 3 days resulted in worse dynamic balance during the later assessment points (42-54 weeks postinjury, P < .01). Mice that underwent a prolonged rest period of 2 weeks crossed the balance beam faster than the group that rested for only 3 days when averaged across all time points (P < .012). Spatial gait characteristics did not differ among the groups (P > .05). CONCLUSIONS Relative to 3 days of rest, prolonged rest (1 and 2 weeks) after a severe LAS in mice positively affected balance. The apparent benefit of prolonged rest was noted on both dynamic-balance outcomes and performance. Stride length was not altered by the duration of rest after a surgically induced severe LAS in mice. Future research is needed to determine if these results translate to a human model.
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Affiliation(s)
- Erik A Wikstrom
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
| | - Tricia Hubbard-Turner
- Department of Kinesiology, University of North Carolina at Charlotte.,Center for Biomedical Engineering & Science, University of North Carolina at Charlotte
| | | | - Jason Cline
- Department of Kinesiology, University of North Carolina at Charlotte
| | - Michael J Turner
- Department of Kinesiology, University of North Carolina at Charlotte
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21
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Al Bimani SA, Gates LS, Warner M, Bowen C. Factors influencing return to play following conservatively treated ankle sprain: a systematic review. PHYSICIAN SPORTSMED 2019; 47:31-46. [PMID: 30324860 DOI: 10.1080/00913847.2018.1533392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ankle sprain is a very common injury, yet uncertainty exists in what is appropriate time to return to play (RTP). Such guidance may inform treatment pathways and effective practice. OBJECTIVES To determine if consensus exist about potential influencing factors for time to RTP in conservatively treated ankle sprain. METHODS We searched AMED, CINAHL Plus, Cochrane library, EMBASE, MEDLINE (EBSCO), SPOERDiscus, PsycINFO, PEDro, Scopus, unpublished literature and ongoing trials and Google Scholar from inception until April 2017. The quality of the eligible papers was assessed using the Downs and Black tool for randomized controlled trials (RCTs) and Critical Appraisal Skills Program (CASP) for observational studies. RESULTS The initial search identified 1885 articles. After screening, 14 articles were included. Of these, 11 were RCTs and 3 were prospective observational studies. Individual treatment methods that resulted in a shorter time to RTP were functional treatment, compression stockings, anteroposterior joint mobilization, hyaluronic acid injection (HA), Jump Stretch Flex Band programme (JSFB) and diclofenac medication. Prognostic factors for determining time to RTP in the included prospective observational studies were measures of Global function, SF 36PF, athlete's ambulation status, weight-bearing activity scores and self-reported athletic ability. CONCLUSION To our knowledge, this is the first review to report influencing factors for time to RTP following conservatively treated ankle sprain. Findings from this review identified factors that influence time to RTP. However, caution should be taken in generalizing these results due to the heterogeneity of studies and inability to clearly define and list the criteria for safe RTP. The inclusion of factors such as age, sex, BMI, level of sport, injury related factors in future studies might help to understand the course of injury and therefore assist in constructing safer criteria.
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Affiliation(s)
- Saed A Al Bimani
- a Faculty of Health Sciences , University of Southampton , Southampton , UK.,b Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Southampton , Southampton , UK.,c Department of Physiotherapy , College of Health Sciences , Muscat , Oman
| | - Lucy S Gates
- a Faculty of Health Sciences , University of Southampton , Southampton , UK.,b Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Southampton , Southampton , UK
| | - Martin Warner
- a Faculty of Health Sciences , University of Southampton , Southampton , UK.,b Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Southampton , Southampton , UK
| | - Catherine Bowen
- a Faculty of Health Sciences , University of Southampton , Southampton , UK.,b Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Southampton , Southampton , UK
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Crombé A, Borghol S, Guillo S, Pesquer L, Dallaudiere B. Arthroscopic reconstruction of the lateral ankle ligaments: Radiological evaluation and short-term clinical outcome. Diagn Interv Imaging 2018; 100:117-125. [PMID: 30446413 DOI: 10.1016/j.diii.2018.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/27/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE The purpose of this study was to describe the positioning of bone tunnels of arthroscopic anatomical reconstruction of lateral ankle ligaments (AAR-LAL) and identify radiological measurements associated with short-term clinical outcome one year after surgery. MATERIALS AND METHODS A total of 61 patients were included in this IRB-approved retrospective study. There were 52 men and 9 women, with a mean age of 36.3 ± 10.8 (SD) years. AAR-LAL was performed to treat chronic instability secondary to strain sequelae after failure of conservative treatment. Good short-term clinical outcome was defined by Karlsson-score≥80 (n=40) one year after surgery. Sixteen radiological measurements were studied to characterize the positionings of fibular, talar and calcaneal tunnels (FT, TT and CT, respectively). Feasibility and inter-observer agreement were calculated for each measurement. Receiver operating characteristic curves were used to identify optimal thresholds for measurements associated with outcome at univariate analysis. A binary logistic regression was used to identify independent predictors. RESULTS Two measurements were associated with good outcome: distance from the proximal FT entrance to the distal end of the fibula on anteroposterior (AP) view (called 'AP distal FT', P=0.005), and the ratio between the distance from TT entrance to the talo-navicular joint and the talus length on lateral view (P=0.009). Optimal thresholds were of >35mm and<0.445, respectively. At multivariate anlysis, only 'AP distal FT'>35mm remained independent predictor of good outcome (P=0.002). CONCLUSION Radiological evaluation of bone tunnels following AAR-LAL is feasible, reproducible, and helps predict short-term outcome after reconstruction of lateral ankle ligaments.
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Affiliation(s)
- A Crombé
- Musculoskeletal Imaging Center, Bordeaux-Mérignac Sport Clinic, 2, rue Georges Negrevergne, 33700 Mérignac, France; Department of Radiology, Institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France.
| | - S Borghol
- Musculoskeletal Imaging Center, Bordeaux-Mérignac Sport Clinic, 2, rue Georges Negrevergne, 33700 Mérignac, France
| | - S Guillo
- Orthopedic Department, Bordeaux-Mérignac Sport Clinic, 2, rue Georges Negrevergne, 33700 Mérignac, France
| | - L Pesquer
- Musculoskeletal Imaging Center, Bordeaux-Mérignac Sport Clinic, 2, rue Georges Negrevergne, 33700 Mérignac, France
| | - B Dallaudiere
- Musculoskeletal Imaging Center, Bordeaux-Mérignac Sport Clinic, 2, rue Georges Negrevergne, 33700 Mérignac, France; Department of Musculoskeletal Radiology, Hôpital Pellegrin, Bordeaux University, 2, place Amélie Raba-Leon, 33000 Bordeaux, France
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Řezaninová J, Hrazdira L, Moc Králová D, Svoboda Z, Benaroya A. Advanced conservative treatment of complete acute rupture of the lateral ankle ligaments: Verifying by stabilometry. Foot Ankle Surg 2018; 24:65-70. [PMID: 29413777 DOI: 10.1016/j.fas.2016.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/03/2016] [Accepted: 12/05/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to investigate the result of the specific conservative treatment of acute lateral ankle ligaments rupture and verify the effect of this therapy by stabilometry. METHODS 17 young athletes were examined after acute lateral ankle sprain (grade III). Diagnosis was based on musculoskeletal ultrasound examinations. Pressure plate evaluated postural stability after conservative treatment at regular intervals during 1year. RESULTS There were no significant differences in postural stability in double-leg stance between limbs. In single-leg stance, COP confidence ellipse (p=0,011) and COP excursion in sagittal plane (p=0,000) were significantly higher for the injured leg when compared with the uninjured leg only one week after removing the cast. CONCLUSIONS After conservative treatment of grade III injuries with STABHA, immobilization with full weight bearing on the injured leg for 6 weeks and rehabilitation, stabilometry results showed that none of the patients had impaired postural stability or were at risk of functional ankle instability in the monitored period.
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Affiliation(s)
- Jana Řezaninová
- Faculty of Sports Studies, Masaryk University, Brno, Czechia.
| | - Luboš Hrazdira
- Faculty of Sports Studies, Masaryk University, Brno, Czechia
| | | | - Zdeněk Svoboda
- Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czechia
| | - Azriel Benaroya
- Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Stirling AM, McBride JM, Merritt EK, Needle AR. Nervous system excitability and joint stiffness following short-term dynamic ankle immobilization. Gait Posture 2018; 59:46-52. [PMID: 28987766 DOI: 10.1016/j.gaitpost.2017.09.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 09/18/2017] [Accepted: 09/22/2017] [Indexed: 02/02/2023]
Abstract
Joint immobilization has been demonstrated to modify neural excitability in subsets of healthy populations, leading to disinhibition of cortical and reflexive pathways. However, these findings may have limited clinical application as most models have investigated casting and rigid immobilization, while many musculoskeletal injuries often utilize dynamic immobilization devices such as boot immobilizers and pneumatic splints that allow for modified ambulation. We therefore aimed to determine the short-term effects of ambulation in ankle immobilization devices on nervous system excitability and stiffness in able-bodied individuals. A repeated-measures design was implemented where 12 healthy individuals were tested for cortical excitability to the ankle musculature using transcranial magnetic stimulation, reflexive excitability using the Hoffmann reflex, and ankle joint stiffness using arthrometry before and after 30min of ambulation with a boot immobilizer, pneumatic leg splint, or barefoot. Motor evoked potential (MEP), cortical silent period (CSP), Hmax to Mmax ratio, and ankle joint displacement were extracted as dependent variables. Results indicated that despite the novel motor demands of walking in immobilization devices, no significant changes in cortical excitability (F≥0.335, P≥0.169), reflexive excitability (F≥0.027, P≥0.083), or joint stiffness (F≥0.558, P≥0.169) occurred. These findings indicate that short-term ambulation in dynamic immobilization devices does not modify neural excitability despite forced constraints on the sensorimotor system. We may therefore conclude that modifications to neural excitability in previous immobilization models are mediated by long-term nervous system plasticity rather than acute mechanisms, and there appear to be no robust changes in corticomotor or spinal excitability acutely posed by ambulation with immobilization devices.
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Affiliation(s)
- Alyssa M Stirling
- Department of Health & Exercise Science, Appalachian State University, Boone, NC, USA
| | - Jeffrey M McBride
- Department of Health & Exercise Science, Appalachian State University, Boone, NC, USA
| | - Edward K Merritt
- Department of Kinesiology, Southwestern University, Georgetown, TX, USA
| | - Alan R Needle
- Department of Health & Exercise Science, Appalachian State University, Boone, NC, USA.
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Brison RJ, Day AG, Pelland L, Pickett W, Johnson AP, Aiken A, Pichora DR, Brouwer B. Effect of early supervised physiotherapy on recovery from acute ankle sprain: randomised controlled trial. BMJ 2016; 355:i5650. [PMID: 27852621 PMCID: PMC5112179 DOI: 10.1136/bmj.i5650] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess the efficacy of a programme of supervised physiotherapy on the recovery of simple grade 1 and 2 ankle sprains. DESIGN A randomised controlled trial of 503 participants followed for six months. SETTING Participants were recruited from two tertiary acute care settings in Kingston, ON, Canada. PARTICIPANTS The broad inclusion criteria were patients aged ≥16 presenting for acute medical assessment and treatment of a simple grade 1 or 2 ankle sprain. Exclusions were patients with multiple injuries, other conditions limiting mobility, and ankle injuries that required immobilisation and those unable to accommodate the time intensive study protocol. INTERVENTION Participants received either usual care, consisting of written instructions regarding protection, rest, cryotherapy, compression, elevation, and graduated weight bearing activities, or usual care enhanced with a supervised programme of physiotherapy. MAIN OUTCOME MEASURES The primary outcome of efficacy was the proportion of participants reporting excellent recovery assessed with the foot and ankle outcome score (FAOS). Excellent recovery was defined as a score ≥450/500 at three months. A difference of at least 15% increase in the absolute proportion of participants with excellent recovery was deemed clinically important. Secondary analyses included the assessment of excellent recovery at one and six months; change from baseline using continuous scores at one, three, and six months; and clinical and biomechanical measures of ankle function, assessed at one, three, and six months. RESULTS The absolute proportion of patients achieving excellent recovery at three months was not significantly different between the physiotherapy (98/229, 43%) and usual care (79/214, 37%) arms (absolute difference 6%, 95% confidence interval -3% to 15%). The observed trend towards benefit with physiotherapy did not increase in the per protocol analysis and was in the opposite direction by six months. These trends remained similar and were never statistically or clinically important when the FAOS was analysed as a continuous change score. CONCLUSIONS In a general population of patients seeking hospital based acute care for simple ankle sprains, there is no evidence to support a clinically important improvement in outcome with the addition of supervised physiotherapy to usual care, as provided in this protocol.Trial registration ISRCTN 74033088 (www.isrctn.com/ISRCTN74033088).
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Affiliation(s)
- Robert J Brison
- Queen's University Department of Emergency Medicine, Kingston, ON, Canada
- Kingston General Hospital Research Institute, Kingston, ON, Canada
- Queen's University Department of Public Health Sciences, Kingston, ON, Canada
| | - Andrew G Day
- Kingston General Hospital Research Institute, Kingston, ON, Canada
- Queen's University Department of Public Health Sciences, Kingston, ON, Canada
| | - Lucie Pelland
- Queen's University School of Rehabilitation Therapy, Kingston, ON, Canada
- The Human Mobility Research Centre, Kingston General Hospital and Queen's University, Kingston, ON, Canada
| | - William Pickett
- Queen's University Department of Emergency Medicine, Kingston, ON, Canada
- Queen's University Department of Public Health Sciences, Kingston, ON, Canada
| | - Ana P Johnson
- Queen's University Department of Public Health Sciences, Kingston, ON, Canada
| | - Alice Aiken
- Queen's University School of Rehabilitation Therapy, Kingston, ON, Canada
| | - David R Pichora
- The Human Mobility Research Centre, Kingston General Hospital and Queen's University, Kingston, ON, Canada
- Queen's University Division of Orthopaedics, Kingston, ON, Canada
| | - Brenda Brouwer
- Queen's University School of Rehabilitation Therapy, Kingston, ON, Canada
- The Human Mobility Research Centre, Kingston General Hospital and Queen's University, Kingston, ON, Canada
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Yi J, Cha JG, Lee YK, Lee BR, Jeon CH. MRI of the anterior talofibular ligament, talar cartilage and os subfibulare: Comparison of isotropic resolution 3D and conventional 2D T2-weighted fast spin-echo sequences at 3.0 T. Skeletal Radiol 2016; 45:899-908. [PMID: 26992909 DOI: 10.1007/s00256-016-2367-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the accuracy of a three-dimensional (3D) T2-weighted fast spin-echo (FSE) magnetic resonance (MR) sequence compared with two-dimensional (2D) sequence for diagnosing anterior talofibular ligament (ATFL) tears, chondral lesion of the talus (CLT) and os subfibulare/avulsion fracture of the distal fibula (OSF). MATERIALS AND METHODS Thirty-five patients were included, who had undergone ankle MRI with 3D T2-weighted FSE and 2D T2-weighted FSE sequences, as well as subsequent ankle arthroscopy, between November 2013 and July 2014. Each MR imaging sequence was independently scored by two readers retrospectively for the presence of ATFL tears, CLT and OSF. The area under the receiver operating curve (AUC) was compared to determine the discriminatory power of the two image sequences. Interobserver agreement was expressed as unweighted kappa value. RESULTS Arthroscopic findings confirmed 21 complete tears of the ATFL, 14 partial tears of the ATFL, 17 CLTs and 7 OSFs. There were no significant differences in the diagnoses of ATFL tears (p = 0.074-0.501), CLT (p = 0.090-0.450) and OSF (p = 0.317) obtained from the 2D and 3D sequences by either reader. The interobserver agreement rates between two readers using the 3D T2-weighted FSE sequence versus those obtained with the 2D sequence were substantial (κ = 0.659) versus moderate (κ = 0.553) for ATFL tears, moderate (κ = 0.499) versus substantial (κ = 0.676) for CLT and substantial (κ = 0.621) versus substantial (κ = 0.689) for OSF. CONCLUSION Three-dimensional isotropic T2-weighted FSE MRI of the ankle resulted in no statistically significant difference in diagnostic performance compared to two-dimensional T2-weighted FSE MRI in the evaluation of ATFL tears, CLTs and OSFs.
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Affiliation(s)
- Jisook Yi
- Department of Radiology, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, 14584, Korea
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, 14584, Korea.
| | - Young Koo Lee
- Department of Orthopedics, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, 14584, Korea
| | - Bo Ra Lee
- Department of Biomedical Statistics, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, 14584, Korea
| | - Chan Hong Jeon
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, 14584, Korea
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Bae JY, Park KS, Seon JK, Jeon I. Analysis of the Effects of Normal Walking on Ankle Joint Contact Characteristics After Acute Inversion Ankle Sprain. Ann Biomed Eng 2015; 43:3015-24. [DOI: 10.1007/s10439-015-1360-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 06/09/2015] [Indexed: 12/26/2022]
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Jeong BO, Kim MS, Song WJ, SooHoo NF. Feasibility and outcome of inferior extensor retinaculum reinforcement in modified Broström procedures. Foot Ankle Int 2014; 35:1137-42. [PMID: 25037711 DOI: 10.1177/1071100714543645] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to assess the feasibility of inferior extensor retinaculum (IER) reinforcement and analyze differences in clinical and radiographic outcomes based on whether or not IER reinforcement was performed in modified Broström procedures. METHODS Forty-one patients (41 ankles) who underwent ankle reconstruction with either a Broström procedure or modified Broström with IER reinforcement were included in this prospective study. During Broström procedures, feasibility of IER reinforcement was recorded. Clinical and radiographic outcomes were analyzed between modified Broström procedures (MBP group) in which IER reinforcement was feasible and Broström procedures (BP group) in which IER reinforcement was not feasible. RESULTS IER reinforcement was feasible in 31 cases (75.6%) and not feasible in 10 cases (24.4%) due to anatomic variations. The American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved in the MBP group from a preoperative mean of 66.3 to a postoperative mean of 89.4. In the BP group, the score increased from 71.3 to 89.8. The radiographic outcomes assessed by stress radiographs demonstrated that talar anterior translation and talar tilt improved from 6.3 mm to 4.6 mm and from 9.0 degrees to 5.0 degrees, respectively, in the MBP group. In the BP group, talar anterior translation improved from 6.9 mm to 4.9 mm and talar tilt, from 9.5 degrees to 4.9 degrees. No statistically significant difference was observed between the 2 groups. CONCLUSION IER reinforcement was feasible in 75.6% of patients in whom modified Broström procedures had been planned. Postoperative clinical and radiographic outcomes were not significantly different based on whether or not IER reinforcement was performed. These findings suggest that isolated ligament reconstruction without IER may be sufficient to restore ankle stability. LEVEL OF EVIDENCE Level II, cohort study.
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Affiliation(s)
- Bi O Jeong
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Myung Seo Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Wook Jae Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Nelson F SooHoo
- Department of Orthopaedic Surgery, UCLA School of Medicine, Los Angeles, CA, USA
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Guillo S, Bauer T, Lee JW, Takao M, Kong SW, Stone JW, Mangone PG, Molloy A, Perera A, Pearce CJ, Michels F, Tourné Y, Ghorbani A, Calder J. Consensus in chronic ankle instability: aetiology, assessment, surgical indications and place for arthroscopy. Orthop Traumatol Surg Res 2013; 99:S411-9. [PMID: 24268842 DOI: 10.1016/j.otsr.2013.10.009] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/09/2013] [Indexed: 02/02/2023]
Abstract
Ankle sprains are the most common injuries sustained during sports activities. Most ankle sprains recover fully with non-operative treatment but 20-30% develop chronic ankle instability. Predicting which patients who sustain an ankle sprain will develop instability is difficult. This paper summarises a consensus on identifying which patients may require surgery, the optimal surgical intervention along with treatment of concomitant pathology given the evidence available today. It also discusses the role of arthroscopic treatment and the anatomical basis for individual procedures.
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Affiliation(s)
- S Guillo
- Clinique du Sport, 33300 Mérignac, France
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Wainright WB, Spritzer CE, Lee JY, Easley ME, DeOrio JK, Nunley JA, DeFrate LE. The effect of modified Broström-Gould repair for lateral ankle instability on in vivo tibiotalar kinematics. Am J Sports Med 2012; 40:2099-104. [PMID: 22886690 PMCID: PMC3535340 DOI: 10.1177/0363546512454840] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lateral ankle instability leads to an increased risk of tibiotalar joint osteoarthritis. Previous studies have found abnormal tibiotalar joint motions with lateral ankle instability that may contribute to this increased incidence of osteoarthritis, including increased anterior translation and internal rotation of the talus under weightbearing loading. Surgical repairs for lateral ankle instability have shown good clinical results, but the effects of repair on in vivo ankle motion are not well understood. HYPOTHESIS The modified Broström-Gould lateral ligament reconstruction decreases anterior translation and internal rotation of the talus under in vivo weightbearing loading conditions. STUDY DESIGN Controlled laboratory study. METHODS Seven patients underwent modified Broström-Gould repair for unilateral lateral ankle instability. Ankle joint kinematics as a function of increasing body weight was studied with magnetic resonance imaging and biplanar fluoroscopy. Tibiotalar kinematics was measured in unstable ankles preoperatively and postoperatively at a mean follow-up of 12 months as well as in the uninjured contralateral ankles of the same patients. RESULTS Surgical repair resulted in statistically significant decreases (expressed as mean ± standard error of the mean) in anterior translation of the talus (0.9 ± 0.3 mm; P = .018) at 100% body weight and internal rotation of the talus at 75% (2.6° ± 0.8°; P = .019) and 100% (2.7° ± 0.8°; P = .013) body weight compared with ankle kinematics measured before repair. No statistically significant differences were detected between repaired ankles and contralateral normal ankles. CONCLUSION The modified Broström-Gould repair improved the abnormal joint motion observed in patients with lateral ankle instability, decreasing anterior translation and internal rotation of the talus. CLINICAL RELEVANCE Altered kinematics may contribute to the tibiotalar joint degeneration that occurs with chronic lateral ankle instability. The findings of the current study support the efficacy of this repair in improving the abnormal ankle motion observed in these patients.
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Affiliation(s)
| | | | - Jun Young Lee
- Department of Orthopaedic Surgery, Duke University Medical Center
| | - Mark E. Easley
- Department of Orthopaedic Surgery, Duke University Medical Center
| | - James K. DeOrio
- Department of Orthopaedic Surgery, Duke University Medical Center
| | - James A. Nunley
- Department of Orthopaedic Surgery, Duke University Medical Center
| | - Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University Medical Center,Corresponding Author: Louis E. DeFrate, PhD, Orthopaedic Bioengineering Laboratory, Box 3093, Duke University Medical Center, Durham NC 27710
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Polzer H, Kanz KG, Prall WC, Haasters F, Ockert B, Mutschler W, Grote S. Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthop Rev (Pavia) 2012; 4:e5. [PMID: 22577506 PMCID: PMC3348693 DOI: 10.4081/or.2012.e5] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 11/12/2011] [Indexed: 02/06/2023] Open
Abstract
Acute ankle injuries are among the most common injuries in emergency departments. However, there are still no standardized examination procedures or evidence-based treatment. Therefore, the aim of this study was to systematically search the current literature, classify the evidence, and develop an algorithm for the diagnosis and treatment of acute ankle injuries. We systematically searched PubMed and the Cochrane Database for randomized controlled trials, meta-analyses, systematic reviews or, if applicable, observational studies and classified them according to their level of evidence. According to the currently available literature, the following recommendations have been formulated: i) the Ottawa Ankle/Foot Rule should be applied in order to rule out fractures; ii) physical examination is sufficient for diagnosing injuries to the lateral ligament complex; iii) classification into stable and unstable injuries is applicable and of clinical importance; iv) the squeeze-, crossed leg- and external rotation test are indicative for injuries of the syndesmosis; v) magnetic resonance imaging is recommended to verify injuries of the syndesmosis; vi) stable ankle sprains have a good prognosis while for unstable ankle sprains, conservative treatment is at least as effective as operative treatment without the related possible complications; vii) early functional treatment leads to the fastest recovery and the least rate of reinjury; viii) supervised rehabilitation reduces residual symptoms and re-injuries. Taken these recommendations into account, we present an applicable and evidence-based, step by step, decision pathway for the diagnosis and treatment of acute ankle injuries, which can be implemented in any emergency department or doctor's practice. It provides quality assurance for the patient and promotes confidence in the attending physician.
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Affiliation(s)
- Hans Polzer
- Munich University Hospital, Dept. Trauma Surgery - Innenstadt Campus, Ludwig-Maximilians-University, Munich, Germany
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LaBella CR. Common Acute Sports-Related Lower Extremity Injuries in Children and Adolescents. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2007. [DOI: 10.1016/j.cpem.2007.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
There are approximately 35 million children participating in organized sports in the United States. With this increasing participation, we have seen an overall increase in sports-related injuries in young athletes over the past 20 years. Young athletes suffer both acute and chronic, or overuse, injuries. They are susceptible to many of the same injuries as their adult counterparts, but due to the effects of growth on the musculoskeletal system, they are at risk for injuries to the growth plate, apophysis, and joint surface. Common acute and overuse injuries seen in young athletes are discussed here.
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Affiliation(s)
- Joyce V Soprano
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, PO Box 581289, Salt Lake City, UT 84158, USA.
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Abstract
Orthopedic injuries are common reasons for visits to primary care physicians. Careful history and physical examination with intelligent use of imaging technology will arrive at the correct diagnosis in most patients. Many conditions may be definitively managed by the office internist. Others maybe initially stabilized and referred to orthopedic surgeons for definitive care. Nondisplaced fractures, tendon injuries, sprains, and overuse syndromes are entities within the purview of the primary care physician. Familiarity and confidence with diagnosis and management of these conditions in the office is optimal for the care of the adult patient.
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Affiliation(s)
- Laura Pimentel
- Division of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
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Abstract
Based on the recent evidence, ankle bracing and taping do appear to have positive effects on ankle support. For example, both bracing and taping restrict inversion range of motion, with tape and stirrup-style braces providing the best support. Although exercise reduces this restriction, the range remains consistent with levels considered to be within the normal range. Ankle supports also appear to improve the strength of the muscular response to perturbation, potentially providing a stronger muscular contraction. In contrast, ankle supports fail to improve the neuromuscular response time to unexpected perturbations. Thus, it appears that the stronger response may occur too slowly to protect the joint. This slowness of the neuromuscular response, however, may be offset by the support's ability to slow the inversion motion. The slowing of inversion appears to allow the neuromuscular system to respond at or before the point of ligament damage. Finally, ankle supports appear to improve balance only in individuals with previously injured ankles. This suggests that supports may have a selective effect in protecting injured but not uninjured individuals. Despite these positive effects, some cautions should be emphasized. First, most of the studies cited have been performed in the laboratory setting with joint velocities and loads much below what are encountered in the athletic and daily activities. Whether tape and braces can maintain their effectiveness under the more extreme conditions of functional activities remains unclear. Additionally, some evidence suggests that ankle supports may transfer loads to other joints putting them at risk for injury. Thus, further study is needed to determine the risk-to-benefit ratio of ankle supports. Finally, much of the research presented has been done only on uninjured ankles. Based on the current evidence, it seems possible that the effectiveness of ankle supports may differ depending on the population, and it seems clinically important to know whether we can expect the same results for injured and uninjured ankles. Proper and early rehabilitation is important in preventing residual ankle symptoms. Reports indicate that up to 73% of people who sustain a lateral ankle sprain have recurrent sprains, but it is unknown how many of these participants partake in rehabilitation. Proper immobilization and acute care of the injured ankle is imperative. An immobilization boot or strapping that can be removed during early non-weight bearing exercises seems to be most effective. Strength and balance training of the uninjured contralateral limb can be used to assist reaching full recovery in a shorter period of time. Functional exercises can also be performed earlier in the rehabilitation process by reducing the gravitational forces so patients can perform in a pain-free range and still receive the benefits of early activity. Evidence shows that daily ankle disk training assists in preventing ankle sprains, and is a relatively inexpensive and easy alternative to traditional rehabilitation protocols.
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Affiliation(s)
- Brent L Arnold
- Sports Medicine Research Laboratory, Department of Exercise Science, Virginia Commonwealth University, PO Box 842037, Richmond, VA 23284-2037, USA.
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