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Liu Z, Yamaguchi R, Fu S, Zhao H, Li Y, Kobayashi Y, Gong Y, Kumai T. Epidemiology of ankle sprain and chronic ankle instability in elite adolescent dancesport athletes. PHYSICIAN SPORTSMED 2025; 53:119-128. [PMID: 39412831 DOI: 10.1080/00913847.2024.2418283] [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: 07/01/2024] [Accepted: 10/15/2024] [Indexed: 10/22/2024]
Abstract
BACKGROUND Dancesport is performed in high-heeled shoes. Dancesport athletes may have a higher prevalence and incidence of ankle sprains, which can affect their performance. However, the occurrence of ankle sprains among dancesport athletes remains unclear. This study aimed to determine the prevalence and incidence of ankle sprains among elite dancesport athletes and to investigate the related information. METHOD We conducted a mixed descriptive epidemiological study (cross-sectional and longitudinal) involving 198 elite adolescent dancesport athletes, using past medical records and questionnaires administered to the participants. Data on the occurrence of ankle sprains among all participants were compiled using medical records and information on injury mechanisms, missed days, severity types, and countermeasures for ankle sprains were collected. The prevalence of chronic ankle instability (CAI) among the participants was assessed using a questionnaire. Following the initial survey, we conducted a one-year follow-up study to investigate the incidence of ankle sprains, incidence rate per 1000 exposure hours, and recurrence of ankle sprains. RESULT The cross-sectional study and longitudinal study included 198 participants and 92 elite dancesport athletes, respectively. The prevalence of ankle sprains and CAI was 49.5% and 45.1%, respectively. Of all ankle sprains, 88% were medial injuries. The most common injury mechanisms were turning (46.9%) and jumping (46.9%). The average number of missed days due to ankle sprains was 11.2 days. Most injuries were managed with rest, and only one male athlete underwent surgery due to an ankle sprain sustained during dancing. During the one-year follow-up, the incidence of ankle sprains, incidence rate per 1000 exposure hours, and recurrence rate of ankle sprains were 46.6% (male, 41.2%; female, 48.8%), 0.65 ankle sprains/1000 h, and 35.3%, respectively. No sex-related differences were observed. CONCLUSION It is crucial to focus on the occurrence of ankle sprains and CAI in dancesport athletes with high heels. Future research should clarify the impact of ankle sprains on dancesport performance and develop preventive measures to reduce the incidence and recurrence of these associated injuries.
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Affiliation(s)
- Zijian Liu
- Graduate School of Sport Sciences, Waseda university, Saitama, Japan
| | - Ryusei Yamaguchi
- Graduate School of Sport Sciences, Waseda university, Saitama, Japan
| | - Siyang Fu
- Graduate School of Sport Sciences, Waseda university, Saitama, Japan
| | - Hanye Zhao
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Yanshu Li
- Graduate School of Human Sciences, Waseda University, Saitama, Japan
| | - Yusuke Kobayashi
- Graduate School of Sport Sciences, Waseda university, Saitama, Japan
| | - Yining Gong
- Graduate School of economics, Osaka University of Economics and Law, Osaka, Japan
| | - Tsukasa Kumai
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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Kim YC, Lee MS, Oh BH, Heo YM, Kim TG, Yoo SJ, Yoo HJ. Factors Associated with Driving Ability and Changes After Immobilization of the Right Lower Limb: A Driving Simulator Study. J Clin Med 2025; 14:1396. [PMID: 40004926 PMCID: PMC11856806 DOI: 10.3390/jcm14041396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Revised: 02/12/2025] [Accepted: 02/16/2025] [Indexed: 02/27/2025] Open
Abstract
Introduction: Patients with orthopedic injuries often require cast immobilization therapy using casts. Driving with a cast on the right lower limb restricts many things. This study aimed to investigate the factors associated with driving capacity after orthopedic fixation of the right lower limb in healthy adult volunteers. This study's hypothesis was that the orthopedic splint immobilization would have delayed reaction when in a driving simulation. Materials and Methods: We carried out an experimental study between 17 April 2023 and 19 May 2023. We set up the study in two phases: a driving simulation experiment without immobilization with a cast on the right lower limb and a driving simulation experiment with immobilization with a cast on the right lower limb. The data collected through the questionnaire were then analyzed in R version 4.2.2. Results: A total of 47 individuals participated in the study with a mean height of 167.68, of which 68.09% were females. Overall, 78.7% of the study participants could not drive after immobilization with a cast on the right lower limb. There was a significant difference between participants who could drive and those who could not drive by height (p = 0.04), age (p = 0.038), and body type (p = 0.046). Conclusions: Our study demonstrates that an individual's height, age, and body type are associated with an individual's driving ability after orthopedic immobilization of the right lower limb. Our findings suggest that regulations regarding the ability to drive after orthopedic immobilization of the right lower limb must be reconsidered.
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Affiliation(s)
- Young Cheol Kim
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon 35365, Republic of Korea; (Y.C.K.); (B.H.O.); (Y.M.H.); (T.G.K.)
| | - Moo Sik Lee
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon 35365, Republic of Korea;
| | - Byung Hak Oh
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon 35365, Republic of Korea; (Y.C.K.); (B.H.O.); (Y.M.H.); (T.G.K.)
| | - Youn Moo Heo
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon 35365, Republic of Korea; (Y.C.K.); (B.H.O.); (Y.M.H.); (T.G.K.)
| | - Tae Gyun Kim
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon 35365, Republic of Korea; (Y.C.K.); (B.H.O.); (Y.M.H.); (T.G.K.)
| | - Se Jong Yoo
- Department of Radiological Science, Konyang University, Daejeon 35365, Republic of Korea
| | - Hyun Jin Yoo
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon 35365, Republic of Korea; (Y.C.K.); (B.H.O.); (Y.M.H.); (T.G.K.)
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Vignaraja V, Lewis TL, Franklin S, Ferreira GF, Nunes GA, Aljabi Y, Lam P, Ray R. Clinical outcomes of all-inside arthroscopic lateral ankle ligament reconstruction for chronic lateral ankle instability: A prospective series with minimum 12 month outcomes. Foot Ankle Surg 2025:S1268-7731(25)00039-6. [PMID: 39979204 DOI: 10.1016/j.fas.2025.02.008] [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: 07/31/2024] [Revised: 01/19/2025] [Accepted: 02/10/2025] [Indexed: 02/22/2025]
Abstract
BACKGROUND Chronic lateral ankle instability (CAI) is a common condition that can be effectively treated with lateral ankle ligament reconstruction to restore ankle stability and function. The aim was to assess the functional outcomes of arthroscopic lateral ligament reconstruction using the Manchester-Oxford Foot Questionnaire (MOXFQ), Visual Analog Score (VAS) and Euroqol-5D-5L (EQ-5D) patient-reported outcome measures (PROMs). METHODS This prospective series included 36 consecutive patients who underwent isolated arthroscopic lateral ligament reconstruction for CAI between November 2020 and November 2022 with minimum 12-month follow up. All patients completed the MOXFQ, VAS, and EQ5D PROMs preoperatively, and a minimum of 12 months postoperatively. The MOXFQ is a foot and ankle-specific PROM that assesses foot and ankle function, the VAS measures pain and the EQ5D evaluates general health-related quality of life. RESULTS Patients were followed up for 12-25 months. In all patients, there was significant improvement in all postoperative PROMs (p < 0.05). The MOXFQ index decreased from 59.1 ± 19.2-13.5 ± 18.1 (p < 0.01), EQ-5D index increased from 0.607 ± 0.224-0.854 ± 0.175 (p < 0.01) and VAS pain decreased from 36.6 ± 22.3-13.6 ± 18.4 (p < 0.01).A total of 6 patients(16.3 %) were lost to follow up and mean follow-up time was 1.63 ± 0.54 years. CONCLUSION Arthroscopic lateral ankle ligament reconstruction is an effective treatment for chronic ankle instability, with significant improvements in clinical and health-related quality of life outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Thomas L Lewis
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, UK
| | - Samuel Franklin
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, UK
| | - Gabriel Ferraz Ferreira
- Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil
| | | | | | - Peter Lam
- Orthopaedic and Arthritis Specialist Centre, Chatswood, Sydney, Australia
| | - Robbie Ray
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, UK
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Bravo-Aguilar M, Abuín-Porras V, Blanco-Morales M, Romero Morales C, Almazán-Polo J, Villafañe JH, Canosa-Carro L. Beyond support: exploring the dynamic and static biomechanical changes induced by preventive ankle taping: a novel cross-sectional study. PeerJ 2025; 13:e18472. [PMID: 39886021 PMCID: PMC11781261 DOI: 10.7717/peerj.18472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 10/15/2024] [Indexed: 02/01/2025] Open
Abstract
Introduction In sports, 80% of all ankle injuries are sprains of the external compartment. Functional bandages are usually used preventively, specially in individuals with a history of lateral ankle injuries. To this day, the actual benefits of such taping remain unknown as important modifications are introduced in the ankle biomechanics. Objective The aim of the present study is to describe the biomechanical processes underlying these effects, such as modification during stance times, balance, contact surface and maximum and average pressures in the rearfoot, forefoot and midfoot, using a sprain preventive taping for the external ankle compartment. Methods An observational, analytic, cross-sectional study was designed. Data from static and dynamic plantar pressures with a pressure platform and balance data assessed with the Y Balance Test (YBT) were analysed in 50 participants (age = 21.00 ± 2.34 years, weight = 71.11 ± 13.12 kg, height = 1.75 ± 00.9 m, BMI = 22.94 ± 2.50 kg/m2, foot size = 41.60 ± 3.00) with and without preventive functional taping for lateral ankle sprain (LAS). Results A statistically significant decrease in YBT was observed in the taped participants toward anterior (p = 0.001) and posterolateral (p = 0.005) motion. On the static measures at the pressure platform, an increase in peak pressure at the midfoot (p = 0.001), a decrease in the maximum pressure in the forefoot (p = 0.003) and a decrease in the contact surface in the rearfoot (p = 0.003) were recorded. Dynamic measures at the pressure platform analysis showed a statistically significant decrease in contact surface at the rearfoot (p = 0.001), an increase in mean pressure in both the midfoot (p = 0.044) and forefoot (p = 0.001) and a significant decrease in velocity in the forefoot (p = 0.003). Conclusions In conclusion, we observed that ankle taping led to increased peak pressures in the midfoot and decreased maximum pressures in the forefoot, indicating a shift in load distribution within the plantar surface. Simultaneously, a significant reduction in the velocity at the forefoot during dynamic tasks suggests that taping may alter natural gait dynamics, potentially affecting movement efficiency and stride characteristics. In addition, the application of ankle taping significantly altered balance, as evidenced by a decrease of YBT scores anterior and posterolateral directions. Prophylactic taping in patients with no prior history of LAS is not recommended.
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Affiliation(s)
- María Bravo-Aguilar
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Vanesa Abuín-Porras
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
| | - María Blanco-Morales
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Carlos Romero Morales
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Jaime Almazán-Polo
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Jorge Hugo Villafañe
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Lorena Canosa-Carro
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
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Takao M, Iwashita K, Miura T, Sivasamy P, Inagawa M, Watanabe T, Jujo Y. Ultrasound Imaging for the Evaluation of Anterior Talofibular Ligament Remnants in 547 Ankles With Chronic Lateral Ankle Instability. Foot Ankle Int 2024; 45:1372-1379. [PMID: 39513689 DOI: 10.1177/10711007241284016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2024]
Abstract
BACKGROUND There are few reports on the intra- and interobserver agreement and parameters for the diagnostic accuracy of ultrasound (US) imaging for chronic lateral ankle instability (LAI). The purpose of this study was to investigate the reliability and validity of US imaging for identifying anterior talofibular ligament (ATFL) remnants in patients with LAI. METHODS A total of 547 ankles from 406 patients underwent surgery for LAI between 2019 and 2022. If ligament fibers remained in US images, they were evaluated as positive. If the ligament was not visualized, it was evaluated as negative. Two observers performed repeated measurements. Arthroscopic findings were considered the "gold standard" for validity and diagnostic test accuracy purposes. The intra- and interobserver agreements and parameters for diagnostic accuracy, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of preoperative US imaging as intraoperative arthroscopic findings were used as reference standards. RESULTS The intraobserver agreement was substantial, with an agreement of 98.54% and a kappa coefficient of 0.76. The interobserver agreement was also substantial, with an agreement of 98.72% and a kappa coefficient of 0.75. The sensitivity, specificity, and accuracy of preoperative US imaging were 98.7%, 100%, and 98.7%, respectively. The PPV and NPV of US imaging were 100% and 61.1%, respectively. In the arthroscopic evaluation of the 7 cases in which US imaging showed false negative results, the ATFL ruptured at the fibular attachment and ran in contact with the talus. CONCLUSION A US examination finding of an intact ATFL is highly likely to be correct. An US examination finding of a ruptured ATFL can be false and may require arthroscopic confirmation.
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Affiliation(s)
- Masato Takao
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, Kisarazu, Chiba, Japan
| | | | - Taihei Miura
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, Kisarazu, Chiba, Japan
| | - Parthiban Sivasamy
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, Kisarazu, Chiba, Japan
- School of Medicine, KPJ University, Negeri Sembilan, Malaysia
- Department of Orthopaedic, KPJ Seremban Specialist Hospital, Negeri Sembilan, Malaysia
| | - Miyu Inagawa
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Japan
| | - Takashi Watanabe
- Department of Hospital Medicine, JCHO Sendai Hospital, Sendai, Japan
| | - Yasuyuki Jujo
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, Kisarazu, Chiba, Japan
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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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Abstract
Despite the high frequency of ankle sprains, the ideal management is controversial, and a significant percentage of patients sustaining an ankle sprain never fully recover. There is strong evidence that residual disability of ankle joint injury is often caused by an inadequate rehabilitation and training program and early return to sports. Therefore, the athlete should start their criteria-based rehabilitation and gradually progress through the programmed activities, including cryotherapy, edema relief, optimal weight-bearing management, range of motion exercises for ankle dorsiflexion improvement, triceps surae stretching, isometric exercises and peroneus muscles strengthening, balance and proprioception training, and bracing/taping.
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Affiliation(s)
- Theodorakys Marín Fermín
- Aspetar Orthopaedic and Sports Medicine Hospital, Inside Aspire Zone, Sports City Street, Al Buwairda St, Doha 29222, Qatar.
| | - Ayyoub A Al-Dolaymi
- Aspetar Orthopaedic and Sports Medicine Hospital, Inside Aspire Zone, Sports City Street, Al Buwairda St, Doha 29222, Qatar
| | - Pieter D'Hooghe
- Aspetar Orthopaedic and Sports Medicine Hospital, Inside Aspire Zone, Sports City Street, Al Buwairda St, Doha 29222, Qatar
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8
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Dias S, Lewis TL, Alkhalfan Y, Ahluwalia R, Ray R. Current concepts in the surgical management of chronic ankle lateral ligament instability. J Orthop 2022; 33:87-94. [PMID: 35874042 PMCID: PMC9305620 DOI: 10.1016/j.jor.2022.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022] Open
Abstract
Background/aims Ankle sprains are common injuries which can lead to chronic lateral ankle ligament instability (CAI). Methods The aim of this review is to provide a comprehensive overview of the epidemiology, pathophysiology, investigation, surgical management and rehabilitation of CAI. Results Investigation of CAI is based on history, clinical examination, and imaging. Surgical management of CAI can be defined as anatomic reconstruction, anatomic and non anatomic repair of ATFL and/or CFL. Anatomic repair has been shown to have better functional outcomes and less secondary osteoarthritis when compared to non anatomic repair. Non-anatomic methods do not replicate the normal anatomical course of ATFL/CFL and may lead to stiffness. The most common surgical treatment for CAI is the open modified Broström repair augmented with the Gould modification. There are arthroscopic techniques being developed which have reported promising clinical results. However, there are considerable areas of further research which should be carried out to improve understanding and effectiveness of current treatment options. Standardised validated patient reported outcome measures and evidence-based protocols in the rehabilitation periods are crucial for positive and reproducible outcomes. Conclusion Surgical repair has proven to show excellent outcomes for patients suffering from CAI, however larger prospective studies should be carried out to evaluate the use of newer surgical techniques.
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Affiliation(s)
- Shiluka Dias
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Thomas L. Lewis
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Raju Ahluwalia
- King's College Hospital MTC, London; King's College Hospital Diabetic Foot Unit & King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Robbie Ray
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
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Gaddi D, Mosca A, Piatti M, Munegato D, Catalano M, Di Lorenzo G, Turati M, Zanchi N, Piscitelli D, Chui K, Zatti G, Bigoni M. Acute Ankle Sprain Management: An Umbrella Review of Systematic Reviews. Front Med (Lausanne) 2022; 9:868474. [PMID: 35872766 PMCID: PMC9301067 DOI: 10.3389/fmed.2022.868474] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/27/2022] [Indexed: 12/26/2022] Open
Abstract
Even though ankle sprains are among the most frequent musculoskeletal injuries seen in emergency departments, management of these injuries continues to lack standardization. Our objective was to carry out an umbrella review of systematic reviews to collect the most effective evidence-based treatments and to point out the state-of-the-art management for this injury. PubMed, Scopus, Web of Science, and the Cochrane library were searched from January 2000 to September 2020. After removing duplicates and applying the eligibility criteria, based on titles and abstracts, 32 studies were screened. At the end of the process, 24 articles were included in this umbrella review with a mean score of 7.7/11 on the AMSTAR quality assessment tool. We found evidence supporting the effectiveness of non-surgical treatment in managing acute ankle sprain; moreover, functional treatment seems to be preferable to immobilization. We also found evidence supporting the use of paracetamol or opioids as effective alternatives to non-steroidal anti-inflammatory drugs to reduce pain. Furthermore, we found evidence supporting the effectiveness of manipulative and supervised exercise therapy to prevent re-injury and restore ankle dorsiflexion.
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Affiliation(s)
- Diego Gaddi
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Angelo Mosca
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Massimiliano Piatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Daniele Munegato
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Marcello Catalano
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giorgia Di Lorenzo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Turati
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Paediatric Orthopedic Surgery, University Hospital Grenoble-Alpes, University Grenoble-Alpes, Grenoble, France
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Hospital Couple Enfant, Grenoble, France
- *Correspondence: Marco Turati
| | - Nicolò Zanchi
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Daniele Piscitelli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States
| | - Kevin Chui
- Department of Physical Therapy, Waldron College of Health and Human Services, Radford University, Roanoke, VA, United States
| | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Hospital Couple Enfant, Grenoble, France
| | - Marco Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Hospital Couple Enfant, Grenoble, France
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In Patients with Grade I and II Ankle Sprains, Dynamic Taping Seems to Be Helpful during Certain Tasks, Exercises and Tests in Selected Phases of the Rehabilitation Process: A Preliminary Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095291. [PMID: 35564686 PMCID: PMC9100756 DOI: 10.3390/ijerph19095291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 12/26/2022]
Abstract
We aimed to investigate changes in postural stability on a stable surface after the application of dynamic tape for patients with inversion ankle sprains. This study enrolled 30 patients (age 25.5 ± 8.0 years) with grade I and II ankle sprains, which occurred 7−21 days before enrolment. Postural stability (balance, coordination, feedback) was assessed before and after the application of dynamic tape using a stabilographic platform. Three 32-s exercises were performed on the stabilographic platform, one with eyes open, one with eyes closed and one with visual feedback. After the application of dynamic tape, an improvement was observed in terms of the mean radius of sway (4.2 ± 1.3 mm vs. 3.4 ± 0.9 mm; p = 0.012) and coordination (48.8 ± 19.2% vs. 59.3 ± 5.8%; p = 0.021). Selected balance parameters did not improve significantly in the tests with open and closed eyes. Asymmetric load improved for all tests, but significant differences were only observed with eyes closed (34.9 ± 24.4 vs. 41.7 ± 30.5; p < 0.01). We concluded that the use of dynamic tape after an ankle sprain significantly improved balance and coordination on a stable surface. The benefits were shown in terms of a significant improvement in the asymmetric load of the injured limb in comparison to the healthy limb during the test with closed eyes and a considerable improvement in the asymmetric load that was evaluated with visual feedback on a stable surface.
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Du M, Li J, Jiao C, Guo Q, Hu Y, Jiang D. Distal insertion rupture of lateral ankle ligament as a predictor of weakened and delayed sports recovery after acute ligament repair: mid-term outcomes of 117 cases. BMC Musculoskelet Disord 2022; 23:294. [PMID: 35346150 PMCID: PMC8961918 DOI: 10.1186/s12891-022-05260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background For lateral ankle ligament rupture, surgical repair has been considered for patients requiring return to high-demanding sports. However, there is a lack of systematic research regarding arthroscopic treatment followed by ligament repair for severe acute ankle sprain. The purpose of this study was to analyze the mid-term outcomes of arthroscopy followed by open anatomic lateral ankle ligament repair surgery for acute lateral ankle sprain and the impact of ligament rupture site on the outcomes. Methods Professional or amateur athletes with clinically- and radiologically-confirmed grade III acute lateral ankle ligament injuries undergoing ankle arthroscopy followed by open anatomic ligament repair between June 2007 and May 2017 were reviewed. Intra-articular lesions and the location of rupture were first examined under arthroscopy. Simple suture repair was performed for mid- substance ligament rupture (middle group), while suture repair with anchors were used for the ruptures near the ligament attachment site on the fibular (proximal group), talar or the calcaneal side (distal group). Outcomes were evaluated at final follow-up, including visual analog scale (VAS) pain score, American Orthopaedic Foot & Ankle Society (AOFAS) score, Tegner score, time to return to sports, resumption of pre-injury sports level, sprain recurrence and range of motion (ROM). Results A total of 117 patients were included for analysis, with a mean follow-up duration of 46.4 ± 16.1 months. There were 48 (41%) cases in the proximal group, 41 (35%) cases in the middle group and 28 (24%) cases in the distal group respectively. At final follow-up, all of the VAS score, AOFAS score and the Tegner score were significantly improved from the pre-operative level (p < 0.001). 12 (10%) patients complained of sprain recurrence during follow-up. 14 (12%) patients reported mild ROM restriction and 7 (6%) patients experienced transient skin numbness. The average time to return to pre-injury sports was 4.34 ± 1.11 months. The smallest proportion (86% ± 13%) of resumption of pre-injury sports level was reported from the distal group, compared with 93% ± 12% for the proximal group and 89% ± 14% for the middle group (p = 0.037). Time to return to sports was significantly longer for the distal group, with an average of 4.59 ± 1.27 months compared to 3.99 ± 1.09 months for the proximal group and 4.58 ± 0.90 months for the middle group (p = 0.009). Conclusions Ankle arthroscopy followed by open anatomic ligament repair is a reliable procedure for patients requiring return to high demanding sports after severe acute ankle sprains. Distal rupture near the talar or calcaneal end was associated with delayed return-to-sport and inferior performance in resuming pre-injury sports level.
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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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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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Conservative Treatment for Acute Ankle Sprain: A Systematic Review. J Clin Med 2020; 9:jcm9103128. [PMID: 32992655 PMCID: PMC7599579 DOI: 10.3390/jcm9103128] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/14/2020] [Accepted: 09/25/2020] [Indexed: 12/13/2022] Open
Abstract
The aim was to identify conservative treatments available for acute ankle sprain and to evaluate their effectiveness with respect to pain relief and short-term recovery of functional capacity. A systematic review of the relevant literature was conducted via a data search of the PROSPERO, PubMed, Scopus, CINAHL, PyscINFO and SPORTDiscus databases, from inception until December 2019, focusing on randomised control trial studies. Two of the authors independently assessed the quality of each study located and extracted the relevant data. The quality of each paper was assessed using the Cochrane risk of bias tool included in RevMan 5. In all, 20 studies met the inclusion criteria. In terms of absence of bias, only nine papers were classed as “high quality”. Studies (75%) were of low quality in terms of the blinding of participants and personnel and uncertainty in blinding of outcome assessment and all presented one or more other forms of bias. Despite the generally low quality of the studies considered, it can be concluded that conservative treatment for acute ankle sprain normally achieves pain relief and rapidly improved functionality. Research based on higher-quality study designs and procedures would enable more definitive conclusions to be drawn.
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Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis. Sports Med 2020; 49:601-619. [PMID: 30747379 DOI: 10.1007/s40279-019-01071-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this systematic review was to identify prospective studies that used a criteria-based return to sport (RTS) decision-making process for patients with lateral ankle sprain (LAS) injury. DESIGN Systematic review and narrative synthesis. DATA SOURCES The PubMed (MEDLINE), Web of Science, PEDro, Cochrane Library, SPORTDiscus (EBSCO), ScienceDirect, and Scopus databases were searched to 23 November 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were included if they prospectively applied a criteria-based RTS decision-making process for patients with LAS injury, but were excluded if they merely gathered outcome measures at the RTS time point. Studies were also excluded if patients were recovering from ankle fracture, high ankle sprain, medial ankle sprain, chronic ankle instability or complex ankle injury. RESULTS No studies were identified that used a criteria-based RTS decision-making process for patients with LAS injury. We were unable to conduct a quantitative synthesis or meta-analysis, therefore we provide a narrative synthesis of relevant questionnaires, as well as clinical and functional assessments commonly used in studies retrieved in the search. CONCLUSION There are currently no published evidence-based criteria to inform RTS decisions for patients with an LAS injury. Based on our narrative synthesis, we propose a number of variables that could be used to develop a criteria-based RTS decision paradigm. Future research should aim to reach consensus on these variables and apply them to actual RTS decisions within prospective study designs. Furthermore, we suggest that complex systems theory and the RTS continuum could be used to inform the development of an RTS decision-making paradigm for athletes with LAS injury.
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Stanek JM, Pieczynski AE. Effectiveness of clinician- and patient-applied mobilisation with movement technique to increase ankle dorsiflexion range of motion. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2018.0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background/aims Restricted ankle dorsiflexion has the potential to cause acute and chronic injuries. One method for increasing dorsiflexion range of motion is the application of joint mobilisation with movement. An alternative to clinician-applied mobilisation with movement is self-applied mobilisation with movement; however, this technique has not been previously studied. The objective of this study was to evaluate the effectiveness of self-applied and clinician-applied mobilisation with movement technique for improving dorsiflexion range of motion in participants with ≤34° of dorsiflexion. Methods A total of 42 typically healthy participants qualified and were randomly assigned to the control, self-applied, or clinician-applied mobilisation with movement group. Closed chain ankle dorsiflexion range of motion was assessed using a modified weight-bearing lunge test. Results Both mobilisation groups showed significant increases in standing and kneeling dorsiflexion range of motion when compared to the control group, with no differences between treatment groups. Conclusions These findings suggest clinicians can teach patients to apply mobilisation with movement and receive similar benefits to a clinician-applied mobilisation with movement treatment.
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Clanton TO, Mullens J, Backus J, Waldrop N, Robinson A. Ankle Sprains, Ankle Instability, and Syndesmosis Injuries. BAXTER'S THE FOOT AND ANKLE IN SPORT 2020:255-274. [DOI: 10.1016/b978-0-323-54942-4.00015-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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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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Matherne T, Cooke J, McMorris M, Gross M. Delayed conservative treatment of an acute lateral ankle sprain in a non-athlete female following walking boot immobilisation. BMJ Case Rep 2019; 12:12/7/e229625. [PMID: 31352385 DOI: 10.1136/bcr-2019-229625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Lateral ankle sprains are a common injury with an estimated occurrence rate of 23 000 per day in the USA. Prolonged immobilisation and delayed referral to physical therapy are associated with poorer outcomes. The patient was a 49-year-old woman working as a surgical technologist. She sustained an inversion injury to her left ankle while descending from a stool. Her primary care physician examined her, issued a Controlled Ankle Movement (CAM) walking boot and immobilised her ankle for 6 weeks. Patients with grade I and II lateral ankle sprains who are treated with early mobilisation and referral to physical therapy have demonstrated earlier return to function compared with patients who are treated with prolonged immobilisation and delayed referral. Nevertheless, it remains common for individuals who have sustained a lateral ankle sprain to be immobilised. This case study highlights the importance of early mobilisation and early physical therapy referral for patients with lateral ankle sprains.
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Affiliation(s)
- Tyler Matherne
- Department of Physical Therapy, University of North Carolina System, Chapel Hill, North Carolina, USA
| | - Jennifer Cooke
- Department of Physical Therapy, University of North Carolina System, Chapel Hill, North Carolina, USA
| | - Michael McMorris
- Department of Physical Therapy, University of North Carolina System, Chapel Hill, North Carolina, USA
| | - Michael Gross
- Department of Physical Therapy, University of North Carolina System, Chapel Hill, North Carolina, USA
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Dearlove DJ, Newman E, Zasada M. The time-course effects of talus taping on ankle dorsiflexion range of motion. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2017.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Talus taping may be an effective physiotherapeutic treatment for equinus (passive dorsiflexion range of motion <10°). However, the time-course effects of this intervention are unknown. The aims of this study were to identify the effect that the application of talus tape for 48 hours during normal functional activities has on dorsiflexion range of motion, and to determine whether any changes in dorsiflexion range of motion persisted until 5 days after removal (study day 7). Methods A total of 16 healthy participants (mean age 28.3 ± 8 years) were recruited. Participants' were randomly assigned to control and intervention conditions. Baseline measures of dorsiflexion range of motion were taken in both ankles using the weight-bearing lunge test. The intervention ankle had talus tape applied, which remained in place for 48 hours during normal functional activities. To determine the time-course effects, dorsiflexion range of motion was reassessed in the control and intervention ankles immediately following removal of the tape (at 48 hours) and again 5 days later, on day 7. Findings Dorsiflexion range of motion in the taped intervention ankle increased significantly between the baseline and 48-hour measures. However, when reassessed at day 7, participants' dorsiflexion range of motion had returned to baseline levels. There were no significant differences in the control ankle across all three measures. Conclusions Applying talus tape for 48 hours during normal functional activities results in immediate but not long-lasting changes in dorsiflexion range of motion.
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Affiliation(s)
- David J Dearlove
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Ellesse Newman
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Matt Zasada
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
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21
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Active Ankle Circumduction to Identify Mobility Deficits in Subacute Ankle Sprain Patients. J Appl Biomech 2018; 34:1-6. [PMID: 28771113 DOI: 10.1123/jab.2016-0321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Assessment of ankle mobility is complex and of clinical relevance after an ankle sprain. This study develops and tests a biomechanical model to assess active ankle circumduction and its reliability. The model was then applied to compare individuals' ankle mobility between injured and noninjured ankles after a sprain episode. Twenty patients with subacute unilateral ankle sprain were assessed at 4 weeks and 10 weeks after the injury. They underwent a clinical exam and an ankle circumduction test during which the kinematics were recorded with an optoelectronic device. A biomechanical model was applied to explore ankle kinematics. Reliability of the ankle circumduction tests were good to excellent (ICC of 0.55-0.89). Comparison between noninjured and injured ankles showed a mobility deficit of the injured ankle (dorsiflexion = -27.4%, plantar flexion = -25.9%, eversion = -27.2%, and inversion = -11.6%). The model allows a graphical representation of these deficits in 4 quadrants. Active ankle circumduction movement can be reliably assessed with this model. In addition, the graphical representation allows an easy understanding of the mobility deficits which were present in all 4 quadrants in our cohort of patients with subacute ankle sprain.
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22
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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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Stanek J, Sullivan T, Davis S. Comparison of Compressive Myofascial Release and the Graston Technique for Improving Ankle-Dorsiflexion Range of Motion. J Athl Train 2018; 53:160-167. [PMID: 29373060 DOI: 10.4085/1062-6050-386-16] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Restricted dorsiflexion (DF) at the ankle joint can cause acute and chronic injuries at the ankle and knee. Myofascial release and instrument-assisted soft tissue mobilization (IASTM) techniques have been used to increase range of motion (ROM); however, evidence directly comparing their effectiveness is limited. OBJECTIVE To compare the effects of a single session of compressive myofascial release (CMR) or IASTM using the Graston Technique (GT) on closed chain ankle-DF ROM. DESIGN Randomized controlled trial. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Participants were 44 physically active people (53 limbs) with less than 30° of DF. INTERVENTION(S) Limbs were randomly assigned to 1 of 3 groups: control, CMR, or GT. Both treatment groups received one 5-minute treatment that included scanning the area and treating specific restrictions. The control group sat for 5 minutes before measurements were retaken. MAIN OUTCOME MEASURE(S) Standing and kneeling ankle DF were measured before and immediately after treatment. Change scores were calculated for both positions, and two 1-way analyses of variance were conducted. RESULTS A difference between groups was found in the standing ( F2,52 = 13.78, P = .001) and kneeling ( F2,52 = 5.85, P = .01) positions. Post hoc testing showed DF improvements in the standing position after CMR compared with the GT and control groups (both P = .001). In the kneeling position, DF improved after CMR compared with the control group ( P = .005). CONCLUSIONS Compressive myofascial release increased ankle DF after a single treatment in participants with DF ROM deficits. Clinicians should consider adding CMR as a treatment intervention for patients with DF deficits.
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Affiliation(s)
- Justin Stanek
- School of Kinesiology & Recreation, Illinois State University, Normal
| | | | - Samantha Davis
- School of Kinesiology & Recreation, Illinois State University, Normal
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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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25
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Hudson R, Baker RT, May J, Reordan D, Nasypany A. Novel treatment of lateral ankle sprains using the Mulligan concept: an exploratory case series analysis. J Man Manip Ther 2017; 25:251-259. [PMID: 29449767 DOI: 10.1080/10669817.2017.1332557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective The purpose of this study was to examine the effect of the Mulligan Concept (MC) Mobilization with movement (MWM) in the treatment of clinically diagnosed acute lateral ankle sprains in competitive athletes. Methods A prospective case series of 5 adolescent patients, ages ranging from 14 to 18 years (mean = 15.8 ± 1.64), that suffered an acute lateral ankle sprain (LAS). Patients were treated with the MC lateral ankle MWM. Mobilization was directed at the distal fibula or, using a modified MWM, 2-3 inches proximal to the distal fibula. Using paired t-tests and descriptive statistics (mean and standard deviation) results were analyzed. Results Treatment lasted an average of 9 days (mean = 9.2, ±SD 3.96) from intake to discharge. During that time frame, patients reported decreases in pain on the numeric pain rating scale (NRS), disability on the Disablement in the Physically Active (DPA) scale and an increase in function on the patient-specific functional scale (PSFS); and an immediate decrease in pain on the NRS within the first treatment. The minimal detectable change for the PSFS and NRS were exceeded from intake to discharge. Additionally, the minimally clinical important differences were exceeded on the NRS and DPA scale. Discussion The evidence presented in this Level-4 case series supports the use of the MC lateral ankle MWM to treat patients diagnosed with acute grade II LAS. Patients in this case series reported immediate decreases in pain and immediate increases in function. Therefore, further investigation of the MC lateral ankle MWM is warranted.
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Affiliation(s)
- Robinetta Hudson
- Department of Sports Medicine, Concordia Lutheran High School, Tomball, TX, USA
| | - Russell T Baker
- Department of Movement Sciences, University of Idaho, Moscow, ID, USA
| | - James May
- Department of Movement Sciences, University of Idaho, Moscow, ID, USA
| | - Don Reordan
- Orthopedic Department, Jacksonville Physical Therapy, Jacksonville, OR, USA
| | - Alan Nasypany
- Department of Movement Sciences, University of Idaho, Moscow, ID, USA
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Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med 2016; 51:113-125. [PMID: 28053200 DOI: 10.1136/bjsports-2016-096178] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ankle sprains are highly prevalent with high risk of recurrence. Consequently, there are a significant number of research reports examining strategies for treating and preventing acute and recurrent sprains (otherwise known as chronic ankle instability (CAI)), with a coinciding proliferation of review articles summarising these reports. OBJECTIVE To provide a systematic overview of the systematic reviews evaluating treatment strategies for acute ankle sprain and CAI. DESIGN Overview of intervention systematic reviews. PARTICIPANTS Individuals with acute ankle sprain/CAI. MAIN OUTCOME MEASUREMENTS The primary outcomes were injury/reinjury incidence and function. RESULTS 46 papers were included in this systematic review. The reviews had a mean score of 6.5/11 on the AMSTAR quality assessment tool. There was strong evidence for bracing and moderate evidence for neuromuscular training in preventing recurrence of an ankle sprain. For the combined outcomes of pain, swelling and function after an acute sprain, there was strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques. There was conflicting evidence regarding the efficacy of surgery and acupuncture for the treatment of acute ankle sprains. There was insufficient evidence to support the use of ultrasound in the treatment of acute ankle sprains. CONCLUSIONS For the treatment of acute ankle sprain, there is strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques, for pain, swelling and function. Exercise therapy and bracing are supported in the prevention of CAI.
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Affiliation(s)
- Cailbhe Doherty
- Insight Centre for Data Analytics, O'Brien Centre for Science, University College Dublin, Dublin, Ireland
| | - Chris Bleakley
- Sport and Exercise Sciences Research Institute, Ulster Sports Academy, University of Ulster, Newtownabbey, UK
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Institute for Sport and Health, University College Dublin, Dublin, Ireland
| | - Sinead Holden
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Abstract
Participation in sports-related activities increases the risk for acute injury to soft tissues. In adults, the sites most often affected include the ankle, knee, and wrist joint structures, along with the muscles of the back and extremities. The subsequent inflammatory response to tissue damage results in pain and swelling, which limits mobility. A thorough patient assessment is required for accurate diagnosis and provides a guide for appropriate treatment. Initial management is based on the principles of basic first aid: rest, ice, compression, and elevation. Pharmacological therapy can also be used to achieve pain relief and improve mobility. There are few well-controlled studies addressing the pharmacotherapy of acute soft tissue injury, but clinical experience with nonsteroidal anti-inflammatory drugs is extensive. Both traditional and nontraditional therapeutic approaches are discussed.
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Affiliation(s)
- Nayahmka McGriff-Lee
- Department of Pharmacy Practice, Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, 600 South 43rd Street, Box 8, Philadelphia, PA 19104-4495,
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Nery C, Raduan F, Baumfeld D. Foot and Ankle Injuries in Professional Soccer Players: Diagnosis, Treatment, and Expectations. Foot Ankle Clin 2016; 21:391-403. [PMID: 27261812 DOI: 10.1016/j.fcl.2016.01.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Soccer is one of the most popular sports in the world. It has undergone many changes in recent years, mainly because of increased physical demands, and this has led to an increased injury risk. Direct contact accounts for half of all injuries in both indoor and outdoor soccer and ankle sprains are the most common foot and ankle injury. There is a spectrum of foot and ankle injuries and their treatment should be individualized in these high-demand patients. An injury prevention program is also important and should the players, the trainer, responsible physician, and physical therapists.
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Affiliation(s)
- Caio Nery
- Foot and Ankle Clinic, UNIFESP - Escola Paulista de Medicina, São Paulo, São Paulo, Brazil.
| | - Fernando Raduan
- UNIFESP - Escola Paulista de Medicina, São Paulo, São Paulo, Brazil
| | - Daniel Baumfeld
- UFMG - Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Best R, Böhle C, Mauch F, Brüggemann PG. Preventive lateral ligament tester (PLLT): a novel method to evaluate mechanical properties of lateral ankle joint ligaments in the intact ankle. Knee Surg Sports Traumatol Arthrosc 2016; 24:963-70. [PMID: 25059338 DOI: 10.1007/s00167-014-3190-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 07/14/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE To construct and evaluate an ankle arthrometer that registers inversion joint deflection at standardized inversion loads and that, moreover, allows conclusions about the mechanical strain of intact ankle joint ligaments at these loads. METHODS Twelve healthy ankles and 12 lower limb cadaver specimens were tested in a self-developed measuring device monitoring passive ankle inversion movement (Inv-ROM) at standardized application of inversion loads of 5, 10 and 15 N. To adjust in vivo and in vitro conditions, the muscular inactivity of the evertor muscles was assured by EMG in vivo. Preliminary, test-retest and trial-to-trial reliabilities were tested in vivo. To detect lateral ligament strain, the cadaveric calcaneofibular ligament was instrumented with a buckle transducer. After post-test harvesting of the ligament with its bony attachments, previously obtained resistance strain gauge results were then transferred to tensile loads, mounting the specimens with their buckle transducers into a hydraulic material testing machine. RESULTS ICC reliability considering the Inv-ROM and torsional stiffness varied between 0.80 and 0.90. Inv-ROM ranged from 15.3° (±7.3°) at 5 N to 28.3° (±7.6) at 15 N. The different tests revealed a CFL tensile load of 31.9 (±14.0) N at 5 N, 51.0 (±15.8) at 10 N and 75.4 (±21.3) N at 15 N inversion load. CONCLUSIONS A highly reliable arthrometer was constructed allowing not only the accurate detection of passive joint deflections at standardized inversion loads but also reveals some objective conclusions of the intact CFL properties in correlation with the individual inversion deflections. The detection of individual joint deflections at predefined loads in correlation with the knowledge of tensile ligament loads in the future could enable more individual preventive measures, e.g., in high-level athletes.
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Affiliation(s)
- Raymond Best
- Department of Orthopedic and Sports Trauma Surgery, Sportklinik Stuttgart GmbH, Taubenheimstrasse 8, 70372, Stuttgart, Germany.
| | - Caroline Böhle
- Department of Orthopedics and Biomechanics, German Sports University Cologne, Cologne, Germany
| | - Frieder Mauch
- Department of Orthopedic and Sports Trauma Surgery, Sportklinik Stuttgart GmbH, Taubenheimstrasse 8, 70372, Stuttgart, Germany
| | - Peter G Brüggemann
- Department of Orthopedics and Biomechanics, German Sports University Cologne, Cologne, Germany
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30
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Abstract
The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected structures should be obtained through history and objective assessment. From this information, an individualized evidence-based intervention plan can be developed to enable recovery while decreasing the risk of reinjury. An appropriate evaluation is needed not only to determine the correct diagnosis but also to allow for grading and determining the prognosis of the injury in those with an acute lateral ankle sprain. Examination should include an assessment of impairments as well as a measure of activity and participation. Evidence-based interventions for those with an acute lateral ankle sprain should include weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy. For those with chronic ankle instability (CAI), interventions should include manual therapy and a comprehensive rehabilitation program. It is essential to understand the normal clinical course for athletes who sustain a lateral ankle sprain as well as risk factors for an acute injury and CAI. Risk factors for both an acute lateral ankle sprain and CAI include not using an external support and not participating in an appropriate exercise program. Incorporating the latest evidence-based rehabilitation techniques provides the best course of treatment for athletes with an acute ankle sprain or CAI.
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Affiliation(s)
- Ryan P McGovern
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA
| | - RobRoy L Martin
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA; Centers for Sports Medicine - University of Pittsburgh, Pittsburgh, PA, USA
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Uslu M, Inanmaz ME, Ozsahin M, Isık C, Arıcan M, Gecer Y. Cohesive taping and short-leg casting in acute low-type ankle sprains in physically active patients. J Am Podiatr Med Assoc 2015; 105:307-12. [PMID: 25216243 DOI: 10.7547/13-130.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cohesive taping is commonly used for the prevention or treatment of ankle sprain injuries. Short-leg cast immobilization or splinting is another treatment option in such cases. To determine the clinical efficacy and antiedema effects of cohesive taping and short-leg cast immobilization in acute low-type ankle sprains of physically active patients, we performed a preliminary clinical study to assess objective evidence for edema and functional patient American Orthopaedic Foot and Ankle Society (AOFAS) scores with these alternative treatments. METHODS Fifty-nine physically active patients were included: 32 in the taping group and 27 in the short-leg cast group within a year. If a sprain was moderate (grade II) or mild (grade I), we used functional taping or short-leg cast immobilization for 10 days. We evaluated the edema and the functional scores of the injured ankle using the AOFAS Clinical Rating System on days 1, 10, and 100. RESULTS In each group, edema significantly decreased and AOFAS scores increased indicating that both treatment methods were effective. With the numbers available, no statistically significant difference could be detected. CONCLUSIONS Each treatment method was effective in decreasing the edema and increasing the functional scores of the ankle. At the beginning of treatment, not only the level of edema but also the initial functional scores of the ankle and examinations are important in making decisions regarding the optimal treatment option.
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Affiliation(s)
- Mustafa Uslu
- Department of Orthopedics and Traumatology, Düzce University, Düzce, Turkey
| | - Mustafa E. Inanmaz
- Department of Orthopaedics and Traumatology, Sakarya University, Sakarya, Turkey
| | - Mustafa Ozsahin
- Department of Physical Treatment and Rehabilitation, Duzce University, Düzce, Turkey
| | - Cengiz Isık
- Department of Orthopaedics and Traumatology, Izzet Baysal University, Bolu, Turkey
| | - Mehmet Arıcan
- Department of Orthopedics and Traumatology, Düzce University, Düzce, Turkey
| | - Yavuz Gecer
- Department of Orthopedics and Traumatology, Düzce University, Düzce, Turkey
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Kemler E, van de Port I, Schmikli S, Huisstede B, Hoes A, Backx F. Effects of soft bracing or taping on a lateral ankle sprain: a non-randomised controlled trial evaluating recurrence rates and residual symptoms at one year. J Foot Ankle Res 2015; 8:13. [PMID: 25897326 PMCID: PMC4404115 DOI: 10.1186/s13047-015-0069-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 03/11/2015] [Indexed: 12/31/2022] Open
Abstract
Background After sustaining an ankle sprain, taping is often the standard treatment in primary care. Ankle braces are sometimes used as an alternative. This study aimed to compare the effects of four weeks of soft bracing or taping following acute lateral ankle ligamentous sprain (ALALS) on sprain recurrence rates and residual symptoms at one year. Methods In this pragmatic, non-randomised controlled trial, 157 adult participants with an ALALS caused by an inversion trauma were alternately allocated to a four week treatment with a soft brace (intervention group) or a four week treatment with ankle tape (control group) in order of presentation. The primary outcome was the 1-year incidence of the self-reported recurrence of ALALS. The secondary outcome was the occurrence of residual symptoms. Results Baseline characteristics did not differ appreciably between the treatment groups. Thirteen patients (17%) in the brace group reported a re-injury versus 11 patients (14%) treated with tape, corresponding to a risk difference of 3.1% (relative risk 1.2, 95% CI 0.6 to 2.6). Cox regression analysis showed a hazard ratio of self-reported ankle sprain recurrence within 52 weeks in the brace group compared to the tape group of 0.9 (95% CI 0.4 to 1.9). After one year, patients in the brace group had poorer scores on the manual anterior ankle test, corresponding to a risk difference of 15.4% (RR 2.4, 95% CI 1.1 to 5.0). Conclusion ALALS recurrences and residual symptoms appear to be similar at one year when an ALALS is treated with four weeks of soft bracing or taping. Trial registration ISRCTN92030205
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Affiliation(s)
- Ellen Kemler
- Department of Rehabilitation, Nursing Science and Sport, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, PO Box 85500, 3508 GA The Netherlands ; Consumer Safety Institute, Amsterdam, The Netherlands
| | - Ingrid van de Port
- Department of Rehabilitation, Nursing Science and Sport, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, PO Box 85500, 3508 GA The Netherlands ; Revant Rehabilitation Centre, Breda, The Netherlands
| | - Sandor Schmikli
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Bionka Huisstede
- Department of Rehabilitation, Nursing Science and Sport, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, PO Box 85500, 3508 GA The Netherlands
| | - Arno Hoes
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Frank Backx
- Department of Rehabilitation, Nursing Science and Sport, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, PO Box 85500, 3508 GA The Netherlands
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Hershkovich O, Tenenbaum S, Gordon B, Bruck N, Thein R, Derazne E, Tzur D, Shamiss A, Afek A. A large-scale study on epidemiology and risk factors for chronic ankle instability in young adults. J Foot Ankle Surg 2014; 54:183-7. [PMID: 25135102 DOI: 10.1053/j.jfas.2014.06.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Indexed: 02/03/2023]
Abstract
Up to 40% of ankle sprains can result in chronic ankle instability (CAI). The prevalence of CAI and its association with body mass index (BMI) and height in the general young adult population has not been reported. The database records of young adults before recruitment into mandatory military service were studied. Information on the disability codes associated with CAI was retrieved. Logistic regression models were used to assess the association between the BMI and body height with various grades of CAI severity. The study cohort included 829,791 subjects (470,125 males and 359,666 females). The prevalence was 0.7% for mild CAI and 0.4% for severe instability in males and 0.3% and 0.4%, respectively, for females (p < .001). An increased BMI was associated with ankle instability in males (overweight, odds ratio [OR] 1.249, p < .001; obese, OR 1.418, p < .001) and females (overweight, OR 1.989 p < .001; obese, OR 2.754, p < .001). The body height was associated with an increased risk of CAI when the highest height quintile was compared with the lowest height quintile in both males (OR 2.443, p < .001) and females (OR 1.436, p < .001) for all levels of instability severity. The present study has shown a greater prevalence of CAI among males than females in a general healthy young adult population. CAI was associated with an increased BMI and greater body height for all grades of instability severity.
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Affiliation(s)
- Oded Hershkovich
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel HaShomer, Israel; Medical Corps, Israeli Defense Forces, Tel HaShomer, Israel
| | - Shay Tenenbaum
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel HaShomer, Israel.
| | - Barak Gordon
- Medical Corps, Israeli Defense Forces, Tel HaShomer, Israel; Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Nathan Bruck
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Ran Thein
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Estela Derazne
- Medical Corps, Israeli Defense Forces, Tel HaShomer, Israel; Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Dorit Tzur
- Medical Corps, Israeli Defense Forces, Tel HaShomer, Israel
| | - Ari Shamiss
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel; Central Management, Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Arnon Afek
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
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Musumeci G, Castrogiovanni P, Leonardi R, Trovato FM, Szychlinska MA, Di Giunta A, Loreto C, Castorina S. New perspectives for articular cartilage repair treatment through tissue engineering: A contemporary review. World J Orthop 2014; 5:80-88. [PMID: 24829869 PMCID: PMC4017310 DOI: 10.5312/wjo.v5.i2.80] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/20/2014] [Indexed: 02/06/2023] Open
Abstract
In this paper review we describe benefits and disadvantages of the established methods of cartilage regeneration that seem to have a better long-term effectiveness. We illustrated the anatomical aspect of the knee joint cartilage, the current state of cartilage tissue engineering, through mesenchymal stem cells and biomaterials, and in conclusion we provide a short overview on the rehabilitation after articular cartilage repair procedures. Adult articular cartilage has low capacity to repair itself, and thus even minor injuries may lead to progressive damage and osteoarthritic joint degeneration, resulting in significant pain and disability. Numerous efforts have been made to develop tissue-engineered grafts or patches to repair focal chondral and osteochondral defects, and to date several researchers aim to implement clinical application of cell-based therapies for cartilage repair. A literature review was conducted on PubMed, Scopus and Google Scholar using appropriate keywords, examining the current literature on the well-known tissue engineering methods for the treatment of knee osteoarthritis.
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Assessment of functional treatment versus plaster of Paris in the treatment of grade 1 and 2 lateral ankle sprains. J Orthop Traumatol 2014; 16:41-6. [PMID: 24671488 PMCID: PMC4348498 DOI: 10.1007/s10195-014-0289-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 03/03/2014] [Indexed: 12/29/2022] Open
Abstract
Background Despite the common occurrence of ankle sprains, no treatment is considered to be the gold standard for the management of such sprains. We assessed functional treatment versus plaster of Paris (POP) for the treatment of lateral ankle sprains, with pain and function employed as the outcome measures. Materials and methods 126 Patients were eligible for inclusion. They were assigned to either the functional treatment Tubigrip (TG) group or the POP group after applying block randomization. Characteristics such as age, dominant ankle, and gender were assessed at baseline. Pain and functional assessments were done using the visual analog scale (VAS) and the Karlsson score (KS) at baseline (at the start of the study) and during the 2nd and 6th weeks, respectively. Data on other subjective parameters, such as the number of painkillers used, the number of days taken off work, and the number of sleepless nights, were requested from the patients at the end of the study. SPSS version 16 was used for analysis, and p < 0.05 was taken to indicate significance. Results 60 Patients completed the trial in each group. The mean ages were 28.77 ± 6.72 in the TG group and 29.83 ± 6.30 in the POP group (p = 0.034). There was a slight female predominance. Right and left ankles were equally involved in the TG group, while left ankles were mainly involved in the POP group. Mean differences in VAS and KS between the two groups were statistically significant at the end of the study. The mean number of painkillers used by the patients in the TG group was higher than the number used in the POP group (p < 0.001). The mean number of days taken off work was 4.18 ± 1.73 days in the TG group, and 6.25 ± 2.73 days in the POP group (p < 0.001). The mean number of sleepless nights was higher in the POP group. Conclusion The results of our study indicate that functional treatment provides better functional support and pain reduction than a below-knee POP cast. Level of evidence Level I.
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Kovaleski JE, Heitman RJ, Gurchiek LR, Hollis JM, Liu W, Pearsall AW. Joint stability characteristics of the ankle complex in female athletes with histories of lateral ankle sprain, part II: clinical experience using arthrometric measurement. J Athl Train 2014; 49:198-203. [PMID: 24568223 DOI: 10.4085/1062-6050-49.2.08] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT This is part II of a 2-part series discussing stability characteristics of the ankle complex. In part I, we used a cadaver model to examine the effects of sectioning the lateral ankle ligaments on anterior and inversion motion and stiffness of the ankle complex. In part II, we wanted to build on and apply these findings to the clinical assessment of ankle-complex motion and stiffness in a group of athletes with a history of unilateral ankle sprain. OBJECTIVE To examine ankle-complex motion and stiffness in a group of athletes with reported history of lateral ankle sprain. DESIGN Cross-sectional study. SETTING University research laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-five female college athletes (age = 19.4 ± 1.4 years, height = 170.2 ± 7.4 cm, mass = 67.3 ± 10.0 kg) with histories of unilateral ankle sprain. INTERVENTION(S) All ankles underwent loading with an ankle arthrometer. Ankles were tested bilaterally. MAIN OUTCOME MEASURE(S) The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness. RESULTS Anterior displacement of the ankle complex did not differ between the uninjured and sprained ankles (P = .37), whereas ankle-complex rotation was greater for the sprained ankles (P = .03). The sprained ankles had less anterior and inversion end-range stiffness than the uninjured ankles (P < .01). CONCLUSIONS Changes in ankle-complex laxity and end-range stiffness were detected in ankles with histories of sprain. These results indicate the presence of altered mechanical characteristics in the soft tissues of the sprained ankles.
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Affiliation(s)
- John E Kovaleski
- Department of Health, Physical Education, and Leisure Studies, University of South Alabama, Mobile
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Needle AR, Baumeister J, Kaminski TW, Higginson JS, Farquhar WB, Swanik CB. Neuromechanical coupling in the regulation of muscle tone and joint stiffness. Scand J Med Sci Sports 2014; 24:737-48. [DOI: 10.1111/sms.12181] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- A. R. Needle
- Department of Health and Exercise Science; Appalachian State University; Boone North Carolina USA
| | - J. Baumeister
- Department of Health and Exercise Science; Appalachian State University; Boone North Carolina USA
| | - T. W. Kaminski
- Department of Health and Exercise Science; Appalachian State University; Boone North Carolina USA
| | - J. S. Higginson
- Department of Health and Exercise Science; Appalachian State University; Boone North Carolina USA
| | - W. B. Farquhar
- Department of Health and Exercise Science; Appalachian State University; Boone North Carolina USA
| | - C. B. Swanik
- Department of Health and Exercise Science; Appalachian State University; Boone North Carolina USA
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Terada M, Pietrosimone BG, Gribble PA. Therapeutic interventions for increasing ankle dorsiflexion after ankle sprain: a systematic review. J Athl Train 2013; 48:696-709. [PMID: 23914912 DOI: 10.4085/1062-6050-48.4.11] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Clinicians perform therapeutic interventions, such as stretching, manual therapy, electrotherapy, ultrasound, and exercises, to increase ankle dorsiflexion. However, authors of previous studies have not determined which intervention or combination of interventions is most effective. OBJECTIVE To determine the magnitude of therapeutic intervention effects on and the most effective therapeutic interventions for restoring normal ankle dorsiflexion after ankle sprain. DATA SOURCES We performed a comprehensive literature search in Web of Science and EBSCO HOST from 1965 to May 29, 2011, with 19 search terms related to ankle sprain, dorsiflexion, and intervention and by cross-referencing pertinent articles. STUDY SELECTION Eligible studies had to be written in English and include the means and standard deviations of both pretreatment and posttreatment in patients with acute, subacute, or chronic ankle sprains. Outcomes of interest included various joint mobilizations, stretching, local vibration, hyperbaric oxygen therapy, electrical stimulation, and mental-relaxation interventions. DATA EXTRACTION We extracted data on dorsiflexion improvements among various therapeutic applications by calculating Cohen d effect sizes with associated 95% confidence intervals (CIs) and evaluated the methodologic quality using the Physiotherapy Evidence Database (PEDro) scale. DATA SYNTHESIS In total, 9 studies (PEDro score = 5.22 ± 1.92) met the inclusion criteria. Static-stretching interventions with a home exercise program had the strongest effects on increasing dorsiflexion in patients 2 weeks after acute ankle sprains (Cohen d = 1.06; 95% CI = 0.12, 2.42). The range of effect sizes for movement with mobilization on ankle dorsiflexion among individuals with recurrent ankle sprains was small (Cohen d range = 0.14 to 0.39). CONCLUSIONS Static-stretching intervention as a part of standardized care yielded the strongest effects on dorsiflexion after acute ankle sprains. The existing evidence suggests that clinicians need to consider what may be the limiting factor of ankle dorsiflexion to select the most appropriate treatments and interventions. Investigators should examine the relationship between improvements in dorsiflexion and patient progress using measures of patient self-reported functional outcome after therapeutic interventions to determine the most appropriate forms of therapeutic interventions to address ankle-dorsiflexion limitation.
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Affiliation(s)
- Masafumi Terada
- Musculoskeletal Health and Movement Science Laboratory, University of Toledo, OH
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Kerkhoffs GMMJ, Van Dijk CN. Acute lateral ankle ligament ruptures in the athlete: the role of surgery. Foot Ankle Clin 2013; 18:215-8. [PMID: 23707174 DOI: 10.1016/j.fcl.2013.02.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
High-level athletes have significantly greater load and demand on their ankle joints than the average population. Therefore, treatment of acute lateral ankle ligament ruptures in the high-demanding athlete is a challenge. This article reviews the treatment of acute lateral ankle ruptures in athletes, with special emphasis on the role of surgical treatment.
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Affiliation(s)
- Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands.
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Anterior fibrous bundle: a cause of residual pain and restrictive plantar flexion following ankle sprain. Knee Surg Sports Traumatol Arthrosc 2013; 21:1385-9. [PMID: 22622780 DOI: 10.1007/s00167-012-2053-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 05/10/2012] [Indexed: 12/26/2022]
Abstract
PURPOSE To describe anterior fibrous bundle as an intra-articular residual disorder following ankle sprain. METHODS Between January 1998 and January 2009, we performed arthroscopy on 10 patients (7 males, 3 females; median age, 25 years; age range, 17-43 years) who had the uncommon problem of anterior ankle pain accompanied by restriction of plantar flexion following an ankle sprain. Pre-operative magnetic resonance imaging revealed osteochondral lesions (OCLs) of the talar dome in 3 patients, but no other findings that could explain restricted plantar flexion. All patients underwent arthroscopy for investigation and treatment of the cause of symptoms, and the 3 patients with OCL underwent additional arthroscopic drilling. Outcome was measured using the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score, Visual Analogue Scale (VAS) for pain and active plantar flexion angle. RESULTS In all patients, an anterior fibrous bundle was confirmed under arthroscopic investigation as the cause of symptoms and was resected arthroscopically. Median AOFAS and VAS scores improved significantly from 65 (range 61-82) and 70 (range 50-85) pre-operatively to 95 (range 84-100) and 4 (range 0-15) at final follow-up, respectively (p < 0.001). In addition, median active plantar flexion angle improved significantly from 40° (range 35-40) pre-operatively to 55° (range 45-55), (p < 0.01). CONCLUSIONS An anterior fibrous bundle is one of the intra-articular residual disorders after ankle sprain that can cause restriction of plantar flexion.
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Kerkhoffs GMMJ, Rowe BH, Assendelft WJJ, Kelly KD, Struijs PAA, van Dijk CN. WITHDRAWN: Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. Cochrane Database Syst Rev 2013; 2013:CD003762. [PMID: 23543522 PMCID: PMC10680425 DOI: 10.1002/14651858.cd003762.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Acute lateral ankle ligament injuries (ankle sprains) are common problems in acute medical care. The treatment variation observed for the acutely injured lateral ankle ligament complex suggests a lack of evidence-based management strategies for this problem. OBJECTIVES The objective of this review was to assess the effectiveness of methods of immobilisation for acute lateral ankle ligament injuries and to compare immobilisation with functional treatment methods. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group specialised register (December 2001); the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), MEDLINE (1966-May 2000), EMBASE (1988-May 2000), reference lists of articles, and contacted organisations and researchers in the field. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing either different types of immobilisation or immobilisation versus functional treatments for injuries to the lateral ligament complex of the ankle in adults were included. Trials which investigated the treatment of chronic instability or post-surgical treatment were excluded. DATA COLLECTION AND ANALYSIS Data were independently extracted by two authors. Where appropriate, results of comparable studies were pooled using fixed effects models. Individual and pooled statistics were reported as relative risks with 95% confidence intervals for dichotomous outcomes and weighted (WMD) or standardised (SMD) mean differences and 95% confidence intervals for continuous outcome measures. Heterogeneity between trials was tested using a standard chi-squared test. MAIN RESULTS Twenty-one trials involving 2184 participants were included. The mean validity score of the included trials increased from 9.1 (SD 3.0) to 10 (SD 2.9) after retrieving further information (maximum 18 points). Statistically significant differences in favour of functional treatment when compared with immobilisation were found for seven outcome measures: more patients returned to sport in the long term (relative risk (RR) 1.86, 95% confidence interval (CI) 1.22 to 2.86); the time taken to return to sport was shorter (WMD 4.88 (days), 95% CI 1.50 to 8.25); more patients had returned to work at short term follow-up (RR 5.75, 95% CI 1.01 to 32.71); the time taken to return to work was shorter (WMD 8.23 days, 95% CI 6.31 to 10.16); fewer patients suffered from persistent swelling at short term follow-up (RR 1.74, 95% CI 1.17 to 2.59); fewer patients suffered from objective instability as tested by stress X-ray (WMD 2.60, 95% CI 1.24 to 3.96); and patients treated functionally were more satisfied with their treatment (RR 1.83, 95% CI 1.09 to 3.07). A separate analysis of trials that scored 50 per cent or more in quality assessment found a similar result for time to return to work only (WMD (days) 12.89, 95% CI 7.10 to 18.67). No significant differences between varying types of immobilisation, immobilisation and physiotherapy or no treatment were found, apart from one trial where patients returned to work sooner after treatment with a soft cast. In all analyses performed, no results were significantly in favour of immobilisation. AUTHORS' CONCLUSIONS Functional treatment appears to be the favourable strategy for treating acute ankle sprains when compared with immobilisation. However, these results should be interpreted with caution, as most of the differences are not significant after exclusion of the low quality trials. Many trials were poorly reported and there was variety amongst the functional treatments evaluated.
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Affiliation(s)
- Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, Netherlands.
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Rekonstruktion des Außenbandapparats mittels Kniebeugesehnentransplantat bei chronischer Außenbandinstabilität des OSG. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2012; 24:50-60. [DOI: 10.1007/s00064-011-0126-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Morelli F, Perugia D, Vadalà A, Serlorenzi P, Ferretti A. Modified Watson-Jones technique for chronic lateral ankle instability in athletes: clinical and radiological mid- to long-term follow-up. Foot Ankle Surg 2011; 17:247-51. [PMID: 22017895 DOI: 10.1016/j.fas.2010.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 08/17/2010] [Accepted: 08/21/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND We clinically and radiologically assessed mid- to long-term follow-up of a group of patients treated with a modified Watson-Jones technique for chronic ankle instability. METHODS Fourteen athletes were retrospectively evaluated with physical examination, and Tegner, Good and AOFAS scales; moreover, a 2-view stress, side-to-side X-ray, was performed. RESULTS All patients were followed-up at a mean of 10.8 years. No one reported further ankle sprains. Mean Good scale value decreased from 3.7 to 1.6, while the Tegner scale decreased from 6.8 to 5.1; the mean AOFAS score was 92.2. Mean sagittal-plane ROM was 62.3° (4.9° S/S difference), while mean coronal-plane ROM was 25.5° (3.8° S/S difference). Mean X-ray talar tilt angle was 4.5° (0.1° S/S difference), while mean anterior drawer test angle was 5.4 mm (0.5 mm S/S difference). CONCLUSIONS The modified Watson-Jones procedure seems to be a reliable technique in providing satisfactory mid- to long-term clinical and radiological results.
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Affiliation(s)
- Federico Morelli
- Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, S. Andrea Hospital, University of Rome Sapienza, Via Grottarossa, 1035 Rome, Italy
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Kemler E, van de Port I, Backx F, van Dijk CN. A systematic review on the treatment of acute ankle sprain: brace versus other functional treatment types. Sports Med 2011; 41:185-97. [PMID: 21395362 DOI: 10.2165/11584370-000000000-00000] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Ankle injuries, especially ankle sprains, are a common problem in sports and medical care. Ankle sprains result in pain and absenteeism from work and/or sports participation, and can lead to physical restrictions such as ankle instability. Nowadays, treatment of ankle injury basically consists of taping the ankle. The purpose of this review is to evaluate the effectiveness of ankle braces as a treatment for acute ankle sprains compared with other types of functional treatments such as ankle tape and elastic bandages. A computerized literature search was conducted using PubMed, EMBASE, CINAHL and the Cochrane Clinical Trial Register. This review includes randomized controlled trials in English, German and Dutch, published between 1990 and April 2009 that compared ankle braces as a treatment for lateral ankle sprains with other functional treatments. The inclusion criteria for this systematic review were (i) individuals (sports participants as well as non-sports participants) with an acute injury of the ankle (acute ankle sprains); (ii) use of an ankle brace as primary treatment for acute ankle sprains; (iii) control interventions including any other type of functional treatment (e.g. Tubigrip™, elastic wrap or ankle tape); and (iv) one of the following reported outcome measures: re-injuries, symptoms (pain, swelling, instability), functional outcomes and/or time to resumption of sports, daily activities and/or work. Eight studies met all inclusion criteria. Differences in outcome measures, intervention types and patient characteristics precluded pooling of the results, so best evidence syntheses were conducted. A few individual studies reported positive outcomes after treatment with an ankle brace compared with other functional methods, but our best evidence syntheses only demonstrated a better treatment result in terms of functional outcome. Other studies have suggested that ankle brace treatment is a more cost-effective method, so the use of braces after acute ankle sprains should be considered. Further research should focus on economic evaluation and on different types of ankle brace, to examine the strengths and weaknesses of ankle braces for the treatment of acute ankle sprains.
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Affiliation(s)
- Ellen Kemler
- Rudolf Magnus Institute of Neuroscience, Department of Rehabilitation, Nursing Science and Sport, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Fotiadis E, Kenanidis E, Samoladas E, Chytas A, Lyrtzis C, Koimtzis M, Chalidis B. Are venotonic drugs effective for decreasing acute posttraumatic oedema following ankle sprain? A prospective randomized clinical trial. Arch Orthop Trauma Surg 2011; 131:389-392. [PMID: 21274547 DOI: 10.1007/s00402-011-1266-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Lower leg oedema after trauma may cause various degrees of pain, disability and delay in patient recovery. In this prospective randomized study, we hypothesized that venotonic drugs had no effect in clinical outcome of patients with ankle sprain. PATIENTS AND METHODS Eighty-one patients with type II and III ankle sprain were screened and randomly assigned for receiving standard conservative treatment alone (control group, 39 patients) or with oral intake of a venotonic drug (micronized purified flavonoid fraction, Daflon 1,000 mg × 3) for 20 days (study group, 42 patients). Measurement of the circumference of ankle region in two different locations and assessment of pain intensity with the Visual Analogue Score were performed at the time of patients' admission and during the 7th and 20th posttraumatic day. RESULTS Patients demographics were comparable in both groups. There were no significant differences between the two groups regarding the values of perimeter of ankle joint or pain intensity at all the examined time points. CONCLUSIONS Venotonic drugs seem not to decrease the posttraumatic oedema or pain in patients who suffer from moderate or severe ankle sprain.
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Affiliation(s)
- Elias Fotiadis
- Orthopaedic Department, General Hospital of Veria, Verias-Asomaton street, 59100, Veria, Greece.
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Audenaert A, Prims J, Reniers GLL, Weyns D, Mahieu P, Audenaert E. Evaluation and economic impact analysis of different treatment options for ankle distortions in occupational accidents. J Eval Clin Pract 2010; 16:933-9. [PMID: 20586846 DOI: 10.1111/j.1365-2753.2009.01231.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Appropriate use of diagnostic and treatment modalities are essential for rational use of resources. The aim of this study is to evaluate the use of diagnostic modalities and different treatment options and their economic impacts following an acute ankle distortion resulting from an occupational accident. We evaluated the type-of-treatment impact on the victims' course of recovery as well as its impact on the associated accident costs. Research was carried out in Belgium. METHODS An ankle distortion victims' database consisting of 200 cases of (Belgian) occupational accidents during the period 2005-2007 was analysed. RESULTS Patients who were prescribed immobilization or the use of adjuvant support or physical therapy (118 cases) were not employed during a period of 37 days on average, with a mean total cost of 3140.14 Euros caused by the ankle sprain. Patients without any adjuvant therapy (82 cases) were characterized by an unemployment rate of 15 days on average, and a total cost of 1077.86 Euros. Cast immobilization, although its application is not supported by evidence-based literature, was still applied in 36% of the population studied and resulted in the longest average absence of work of 42 days with an obvious significant increase in medical and total costs. CONCLUSIONS Our results show a high rate of inappropriate use of cast immobilizations for ankle distortions. From an economic point of view and for the same clinical endpoint (being full resumption of the occupational activities), simple conventional treatment, consisting of rest, ice, compression and elevation at diagnosis with allowance of early weight bearing in the further clinical course, leads to the quickest full resumption of activities in combination with the lowest medical costs, if compared with any other kind of treatment.
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Affiliation(s)
- Amaryllis Audenaert
- Department of Applied Engineering & Technology: Construction, Artesis University College of Antwerp, Paardenmarkt, Antwerp, Belgium.
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Kim E, Kim T, Kang H, Lee J, Childers MK. Aquatic versus land-based exercises as early functional rehabilitation for elite athletes with acute lower extremity ligament injury: a pilot study. PM R 2010; 2:703-12. [PMID: 20598958 DOI: 10.1016/j.pmrj.2010.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 01/25/2010] [Accepted: 03/05/2010] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To compare outcomes between aquatic and land-based exercises during early-phase recovery from acute lower extremity ligament injuries in elite athletes. DESIGN A single-blinded, covariate adaptive randomized, controlled study. SETTING National training center for elite athletes. PARTICIPANTS Twenty-two athletes with isolated grade I or II ligament injury in ankles or knees were randomized into either an aquatic or land-based exercise group. INTERVENTIONS Early functional rehabilitation program (ranging, strengthening, proprioceptive training, and functional exercises) was performed in both groups. All exercises were identical except for the training environment. MAIN OUTCOME MEASUREMENTS Data were collected at baseline and at 2 and 4 weeks using a visual analog scale (VAS) for pain; static stability (overall stability index [OSI] level 5 and 3); dynamic stability (TCT), and percentage single-limb support time (%SLST). RESULTS Both groups showed decreases in VAS, OSI 5 and 3, and TCT, with a concomitant increase in %SLST at 2 and 4 weeks (P < .05). No significant differences were detected between the 2 groups in any of the outcome measures. However, the line graphs for VAS, OSI 3, TCT, and %SLST in the aquatic exercise group were steeper than those in the land-based exercise group indicating significant group by time interactions (P < .05). These data indicate that the aquatic exercise group improved more rapidly than the land-based exercise group. CONCLUSIONS For elite athletes with acute ligament sprains in the lower limb, aquatic exercises may provide advantages over standard land-based therapy for rapid return to athletic activities. Consequently, aquatic exercise could be recommended for the initial phase of a rehabilitation program.
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Affiliation(s)
- Eunkuk Kim
- Department of Sports Medicine and Science, National Training Center of Korea Olympic Committee, Seoul, Korea.
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