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Vermorel PH, Testa R, Neri T, Lelonge Y, Lintz F, Ronat M, Tourne Y, Philippot R. Importance of observer experience in clinical assessment of ankle and subtalar joint laxity: Validation of a multidirectional 3D opto-electronic motion analysis protocol. Foot Ankle Surg 2025:S1268-7731(25)00081-5. [PMID: 40148179 DOI: 10.1016/j.fas.2025.03.002] [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: 01/13/2025] [Revised: 03/01/2025] [Accepted: 03/18/2025] [Indexed: 03/29/2025]
Abstract
BACKGROUND Role of ankle and subtalar ligaments remains poorly understood due to inconsistent literature. This study validates a protocol for analyzing multidirectional foot and ankle motions and assesses the impact of experience on clinical evaluations of ankle and subtalar instability. METHODS Five cadaveric feet were tested using a 3D opto-electronic system to measure talus, tibia, and calcaneus motions under varying ligament conditions. Anterior Drawer Test (ADT), varus talar tilt test in neutral flexion (VTTT), and in dorsiflexion (VTTTF) were tested by one experienced and one inexperienced observer. The system measured multidirectional angular rotations. RESULTS Intra-observer ICC exceeded 0.97. For ADT, flexion/extension and internal/external rotation correlated significantly with laxity scores for both observers (p < 0.05). For VTTT, varus/valgus correlations were stronger for the experienced observer, VTTTF correlations were significant only for the experienced observer. CONCLUSION 3D opto-electronic is reliable for foot and ankle multidirectional motion analysis. Experience improves subtalar instability assessment accuracy. LEVEL OF EVIDENCE Level 5 (cadaveric study).
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Affiliation(s)
- Pierre-Henri Vermorel
- Inter-university Laboratory of Human Movement Science, University Lyon - University Jean-Monnet Saint-Étienne, Saint-Étienne, France; Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne EA 7424, France; Duke University School of Medicine, Orthopedics Department, Foot and Ankle Division, Durham, NC, USA.
| | - Rodolphe Testa
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne EA 7424, France
| | - Thomas Neri
- Inter-university Laboratory of Human Movement Science, University Lyon - University Jean-Monnet Saint-Étienne, Saint-Étienne, France; Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne EA 7424, France
| | - Yann Lelonge
- Laboratory of Human Anatomy, Faculty of Medicine, University of Saint-Etienne, Saint-Étienne, France
| | - François Lintz
- Duke University School of Medicine, Orthopedics Department, Foot and Ankle Division, Durham, NC, USA
| | - Margot Ronat
- Inter-university Laboratory of Human Movement Science, University Lyon - University Jean-Monnet Saint-Étienne, Saint-Étienne, France; ISTP - Higher Institute of Advanced Performance Techniques, Saint-Etienne, France
| | - Yves Tourne
- SOS Pied Cheville, Department of Orthopaedic Surgery, Clinique du Sport, Bordeaux Mérignac, France
| | - Rémi Philippot
- Inter-university Laboratory of Human Movement Science, University Lyon - University Jean-Monnet Saint-Étienne, Saint-Étienne, France; Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne EA 7424, France
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Mohamad H, Koh D, Socklingam R, Chandrakumara D, Moo IH, Kon C. Clinical Outcomes After Arthroscopic Broström-Gould Procedure for Chronic Lateral Ankle Instability. Cureus 2025. [DOI: 10.7759/cureus.81025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2025] Open
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Gundtoft PH, Pedersen AB, Viberg B. Incidence, treatment, and mortality of ankle fractures: a Danish population-based cohort study. Acta Orthop 2025; 96:203-208. [PMID: 40029096 PMCID: PMC11868812 DOI: 10.2340/17453674.2025.43006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 01/21/2025] [Indexed: 03/05/2025] Open
Abstract
BACKGROUND AND PURPOSE Previous studies have shown large variation in the incidence of ankle fractures. Nationwide data covering longer periods is necessary to gain knowledge of the current trends. The aim of this study was to describe the trends in incidence, treatment, and mortality of ankle fracture during a 20-year period. METHODS Ankle fractures in patients ≥ 18 years old were identified in the Danish National Patient Register using the validated diagnosis and surgical procedure codes for ankle fractures. Incidence rates per 100,000 and incidence rate ratio (IRR) are reported with 95% confidence intervals (CI). RESULTS We identified 155,740 ankle fractures. The overall mean incidence rate during the period 1997-2018 was 164 (CI 163-165) per 100,000 person-years, being 154 (CI 152-155) for men and 203 (CI 202-205) for women. The incidence rate increased from 155 (CI 131-179) during 1997-2006 to 173 (CI 147-199) during 2007-2018, corresponding to an IRR of 1.12 (CI 1.10-1.12). This increase was primarily driven by an increase in women, with an IRR of 1.21 (CI 1.20-1.23) and for patients above 50 years, with an IRR of 1.22 (CI 1.08-1.10). The proportion of patients surgically treated increased from 21% in 1997-2006 to 25% in 2007-2018. The 1-year mortality risk was higher for patients above 65 years with an ankle fracture compared with the general population of the same age, with an IRR of 1.47 (CI 1.42-1.53). CONCLUSION The incidence of ankle fracture increased from 1997 to 2018, primarily due to an increased incidence in women and in the elderly population. The proportion of surgically treated patients increased from 21% to 26%. Excess mortality after ankle fracture in patients above 65 years was observed.
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Affiliation(s)
- Per H Gundtoft
- Orthopedic Department, Aarhus University Hospital; Department of Orthopedic Surgery, Kolding Hospital, Denmark.
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Medicine, Aarhus University, Denmark
| | - Bjarke Viberg
- Department of Orthopedic Surgery, Kolding Hospital; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Clinical Research, University of Southern Denmark, Denmark
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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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Zhong C, Luo X, Gao H, Zhang T, Zhu X, Huang X, Shen P. Effects of dual-task paradigm on the injury potential during landing among individuals with chronic ankle instability. Front Physiol 2024; 15:1473844. [PMID: 39668841 PMCID: PMC11634839 DOI: 10.3389/fphys.2024.1473844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 11/07/2024] [Indexed: 12/14/2024] Open
Abstract
Purpose Chronic ankle instability (CAI) causes maladaptive neuroplastic changes in the central nervous system, which may lead to high injury potential under dual-task conditions. This study aims to explore the effects of dual-task paradigm on the injury potential during landing among individuals with CAI. Methods Twenty participants with CAI (4 female and 16 male, 12 were affected with their right limbs and 8 were affected with their left limbs, 20.4 ± 1.7 years, 176.9 ± 5.0 cm, and 72.0 ± 11.1 kg) and eighteen without CAI (6 female and 12 male, 20.2 ± 1.5 years, 173.5 ± 7.0 cm, and 70.3 ± 10.8 kg) were recruited. They drop-landed on a trap-door device, with their affected or matched limbs on a flippable platform, under single- (drop-landing only) and dual-task (drop-landing while subtracting of serial threes) conditions. A twelve-camera motion capture system was used to capture the kinematic data. Two-way ANOVA with mixed design (CAI vs non-CAI groups by single-vs dual-task conditions) was used to analyze the data. Results Significant group-by-condition interactions were detected in the ankle inversion angle (P = 0.040, η 2 p = 0.012) and ankle inversion angular velocity (P = 0.038, η 2 p = 0.114). Both indicators decreased among individuals without CAI from single-to dual-task conditions, while remained unchanged among those with CAI; and they were higher among individuals with CAI under both single- and dual-task conditions, compared to those without CAI. Conclusion Individuals with CAI have a reduced ability to limit ankle inversion compared to those without CAI. Under dual-task conditions, individuals without CAI limited their ankle inversion, while those with CAI did not. Drop-landing, especially under dual-task conditions, poses a high risk of excessive ankle inversion for individuals with CAI.
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Affiliation(s)
- Cheng Zhong
- Graduate School, Shandong Sport University, Jinan, China
| | - Xin Luo
- Graduate School, Shandong Sport University, Jinan, China
| | - He Gao
- Graduate School, Shandong Sport University, Jinan, China
| | - Teng Zhang
- College of Sports and health, Shandong Sport University, Jinan, China
| | - Xiaoxue Zhu
- Graduate School, Shandong Sport University, Jinan, China
| | - Xueke Huang
- Graduate School, Shandong Sport University, Jinan, China
| | - Peixin Shen
- College of Sports and health, Shandong Sport University, Jinan, China
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Gengatharan D, Wong WSY, Png W, Rikhraj IS, Cher EWL. Concomitant osteochondral lesion of the talus in ankle instability: Utilizing clinical presentation to guide imaging decision. J Foot Ankle Surg 2024:S1067-2516(24)00278-3. [PMID: 39486788 DOI: 10.1053/j.jfas.2024.10.011] [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: 07/03/2024] [Revised: 10/14/2024] [Accepted: 10/26/2024] [Indexed: 11/04/2024]
Abstract
Low ankle sprains are a prevalent issue, often involving the anterior talofibular ligament. While there is increased attention placed on ligamentous injuries in ankle sprains, concomitant cartilaginous injuries are frequently overlooked. This article aims to (Park et al., 2021) evaluate the significance of magnetic resonance imaging in anterior talofibular ligament injuries to detect concurrent osteochondral lesions of the talus as well as other associated ligamentous injuries; (Hølmer et al., 1994) determine the importance of clinical presentation and its association with the risk of concomitant osteochondral lesions in anterior talofibular ligament injuries. We conducted a retrospective analysis of 129 patients who underwent anterior talofibular ligament reconstruction, reviewing patient data to assess the incidence of osteochondral lesions of the talus and associated ligamentous injuries. Clinical presentations were then reviewed to identify signs and symptoms associated with the occurrence of osteochondral lesions of the talus. The results indicated that calcaneofibular ligament was most injured in association with anterior talofibular ligament injuries (69.52 %; n = 73). Furthermore. 31.78 % (n = 41) of patients with anterior talofibular ligament injuries had concurrent osteochondral lesion of the talus. Analysis on clinical presentation revealed statistical significance (p < .001) between patients that had ankle joint line tenderness lasting for more than 6 weeks and the occurrence of osteochondral lesions of the talus. This study concludes that magnetic resonance imaging could be beneficial in anterior talofibular ligament injuries with patients exhibiting persistent joint line tenderness to evaluate for osteochondral lesions to ensure a comprehensive pre-operative assessment.
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Affiliation(s)
- Dhivakaran Gengatharan
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore.
| | - Walter Soon Yaw Wong
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore
| | - Wenxian Png
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme 20 College Road, Academia Level 4 Singapore 169865, Singapore
| | - Inderjeet Singh Rikhraj
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme 20 College Road, Academia Level 4 Singapore 169865, Singapore
| | - Eric Wei Liang Cher
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme 20 College Road, Academia Level 4 Singapore 169865, Singapore
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Gutiérrez-Guisado J, Calvo-Sotelo AE, Hernández-Blasco L, Fidalgo Á, Gómez-Cuervo C, López-Ruiz A, Aibar J, Verhamme P, Meireles J, Monreal M. Venous thromboembolism (VTE) developing after ankle sprain. Comparison with VTE after knee arthroplasty. Thromb Res 2024; 237:94-99. [PMID: 38574519 DOI: 10.1016/j.thromres.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/09/2024] [Accepted: 03/17/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a critical complication after non-major trauma or surgery. While the risk and severity of VTE following major orthopedic surgery is well-documented, there is significant knowledge gap regarding, non-major trauma such as ankle sprains. METHODS We analyzed data from the RIETE registry to assess the clinical characteristics, VTE prophylaxis usage, and outcomes in patients with VTE following ankle sprain versus those post elective knee arthroplasty. We aimed to assess the risk and severity of VTE in a population traditionally considered at lower risk. Risk stratification was performed using the TRiP(cast) score. RESULTS Among 1,250 patients with VTE, those with ankle sprain (n = 459) were much younger than those post knee arthroplasty (n = 791), less often female, had fewer comorbidities, and received VTE prophylaxis less often (27% vs. 93 %). During anticoagulation, 26 patients developed recurrent VTE, 31 had major bleeding, and 12 died (fatal PE 3, fatal bleeding 2). There were no differences between the two groups in the rates of VTE recurrences (rate ratio (RR): 1.65; 95%CI: 0.69-3.88) or death (RR: 1.12; 95%CI: 0.33-3.46), but patients with VTE after ankle sprain had a lower rate of major bleeding (RR: 0.39; 95%CI: 0.13-0.99). CONCLUSIONS Ankle sprain patients are often undertreated for VTE prophylaxis and have similar severity of VTE than those undergoing elective knee surgery, indicating the need for a more customized approach to VTE management.
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Affiliation(s)
- Javier Gutiérrez-Guisado
- Department of Internal Medicine, Hospital ASEPEYO Coslada, Universidad Francisco de Vitoria, Madrid, Spain.
| | - Alejo Erice Calvo-Sotelo
- Department of Internal Medicine, Hospital ASEPEYO Coslada, Universidad Francisco de Vitoria, Madrid, Spain
| | - Luis Hernández-Blasco
- Pneumology Department of Clinical Medicine, Miguel Hernandez University, ISABIAL, Dr. Balmis University General Hospital, Alicante. Spain
| | - Ángeles Fidalgo
- Department of Internal Medicine, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | - Antonio López-Ruiz
- Department of Internal Medicine, Hospital Comarcal de Axarquía, Málaga, Spain
| | - Jesús Aibar
- Department of Internal Medicine, Hospital Clínic, Barcelona, Spain
| | - Peter Verhamme
- Vascular Medicine and Haemostasis, University of Leuven, Leuven, Belgium
| | - José Meireles
- Department of Internal Medicine, Centro Hospitalar de Entre o Douro e Vouga, Santa María da Feira, Portugal
| | - Manuel Monreal
- Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Spain, CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Dolan P, Kenny I, Glynn L, Campbell M, Warrington GD, Cahalan R, Harrison A, Lyons M, Comyns T. Risk factors for acute ankle sprains in field-based, team contact sports: a systematic review of prospective etiological studies. PHYSICIAN SPORTSMED 2023; 51:517-530. [PMID: 35757862 DOI: 10.1080/00913847.2022.2093618] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The aim of this systematic review was to identify prospectively measured ankle sprain risk factors in field-based team contact sports. METHODS Eight databases including SPORTDiscus, CINAHL Complete, MEDLINE (EBSCO), Education Source, Web of Science, Scopus, Embase, and Pubmed were searched using specific Boolean terms. A modified-CASP diagnostic test assessed the quality of the included studies. Extensive data extraction included but was not limited to injury definition, protocols for injury diagnosis and recording, and outcomes associated with ankle sprain. RESULTS 4012 records were returned from the online search and 17 studies met the inclusion criteria for this review. Twelve different risk factors including anatomic alignment of the foot and ankle, joint laxity, height, mass, BMI (body mass index), age, ankle strength, hip strength, single leg landing performance (ground reaction force, pelvic internal rotation, and knee varus), and single leg reach were all found to be associated with ankle sprain incidence. Injury definitions and methods of diagnosis and recording varied across the 17 studies. CONCLUSION This review updates the literature on prospective risk factors for ankle sprain in a specific population rather than heterogeneous cohorts previously studied. From more than 20 categories of risk factors investigated for ankle sprain association across 17 studies in field-based team contact sports, 12 variables were found to be associated with increased incidence of ankle sprain. In order to reduce the risk of ankle sprain, BMI, ankle plantar and dorsiflexion strength, hip strength, and single leg landing performance should be factored in to athlete assessment and subsequent program design. More studies utilizing standardized definitions and methods of recording and reporting are needed. Future prospective etiological studies will allow strength and conditioning coaches, physiotherapists, and physicians to apply specific training principles to reduce the risk and occurrence of ankle sprain injuries.
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Affiliation(s)
- Patrick Dolan
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ian Kenny
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- School of Medicine, University of Limerick, Limerick, Ireland
- HRB Primary Care Clinical Trials Network Ireland, Ireland
| | - Mark Campbell
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
- Lero, The Irish Software Research Centre, University of Limerick, Limerick, Ireland
| | - Giles D Warrington
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
| | - Roisin Cahalan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, University of Limerick, Limerick, Ireland
| | - Andrew Harrison
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
| | - Mark Lyons
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
| | - Thomas Comyns
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
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Koh D, Chandrakumara D, Kon Kam King C. Incidence of Injuries Associated With Anterior Talofibular Ligament Injury Based on the Reporting of Magnetic Resonance Imaging. Cureus 2023; 15:e41738. [PMID: 37575750 PMCID: PMC10415230 DOI: 10.7759/cureus.41738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction This paper aims to report the incidence of ligamentous, tendon, and other structural injuries associated with an anterior talofibular ligament (ATFL) injury based on magnetic resonance imaging (MRI) findings. Methods The reports of all patients who underwent surgical treatment for ATFL injury between 2021 and 2022 at Changi General Hospital and had preoperative MRI ankle scans performed were analyzed in this retrospective study. Patients who had a preoperative MRI ankle scan performed with specific reporting of the ATFL, calcaneofibular ligament (CFL), deltoid ligaments, peroneal tendons, and the presence of an osteochondral defect (OCD) were included in this study. Patients who underwent surgery but did not have a preoperative MRI ankle scan done or had ankle fractures or systemic conditions affecting the same ankle were excluded. Results Eighty-six patients were included in this study, of which 59 were males and 27 were females. About 73.3% (63 of 86) of patients had sustained injuries in association with ATFL injury, and 58.1% (50 of 86) of patients suffered an associated injury to the calcaneofibular ligament (CFL). There were injuries to the superficial and deep deltoid ligaments in 29.1% (25 of 86) and 44.2% (38 of 86) of patients, respectively. The peroneal tendons were also injured in 17.4% (15 of 86) of patients. Lastly, there were also associated OCDs found in 19.8% (17 of 86) of patients. Conclusion There is a high incidence of injuries associated with an ATFL injury. The CFL and deltoid ligament complex are the most commonly injured structures in association with the ATFL. One in five patients will also have an associated OCD. The ATFL tends to be the only structure that is commonly addressed during surgery. Repair of the ATFL only may thus lead to poorer outcomes and persistent pain, if the underlying cause is due to the other concurrent injuries. Clinical evaluation of the other structures should thus be thoroughly performed to allow the addressing of any concurrent injuries in the same surgical setting to achieve better outcomes.
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Affiliation(s)
- Don Koh
- Orthopaedics, Changi General Hospital, Singapore, SGP
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Maricot A, Dick E, Walravens A, Pluym B, Lathouwers E, De Pauw K, Verschueren J, Roelands B, Meeusen R, Tassignon B. Brain Neuroplasticity Related to Lateral Ankle Ligamentous Injuries: A Systematic Review. Sports Med 2023; 53:1423-1443. [PMID: 37155129 DOI: 10.1007/s40279-023-01834-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Lateral ankle sprains are the most common ankle injuries in sports and have the highest recurrence rates. Almost half of the patients experiencing lateral ankle sprains develop chronic ankle instability. Patients with chronic ankle instability experience persistent ankle dysfunctions and detrimental long-term sequelae. Changes at the brain level are put forward to explain these undesirable consequences and high recurrence rates partially. However, an overview of possible brain adaptations related to lateral ankle sprains and chronic ankle instability is currently lacking. OBJECTIVE The primary purpose of this systematic review is to provide a comprehensive overview of the literature on structural and functional brain adaptations related to lateral ankle sprains and in patients with chronic ankle instability. METHODS PubMed, Web of Science, Scopus, Embase, EBSCO-SPORTDiscus and Cochrane Central Register of Controlled Trials were systematically searched until 14 December, 2022. Meta-analyses, systematic reviews and narrative reviews were excluded. Included studies investigated functional or structural brain adaptations in patients who experienced a lateral ankle sprain or with chronic ankle instability and who were at least 18 years of age. Lateral ankle sprains and chronic ankle instability were defined following the recommendation of the International Ankle Consortium. Three authors independently extracted the data. They extracted the authors' name, publication year, study design, inclusion criteria, participant characteristics, the sample size of the intervention and control groups, methods of neuroplasticity testing, as well as all means and standard deviations of primary and secondary neuroplasticity outcomes from each study. Data reported on copers were considered as part of the control group. The quality assessment tool for observational and cross-sectional studies was used for the risk of bias assessment. This study is registered on PROSPERO, number CRD42021281956. RESULTS Twenty articles were included, of which only one investigated individuals who experienced a lateral ankle sprain. In all studies combined, 356 patients with chronic ankle instability, 10 who experienced a lateral ankle sprain and 46 copers were included. White matter microstructure changes in the cerebellum have been related to lateral ankle sprains. Fifteen studies reported functional brain adaptations in patients with chronic ankle instability, and five articles found structural brain outcomes. Alterations in the sensorimotor network (precentral gyrus and supplementary motor area, postcentral gyrus and middle frontal gyrus) and dorsal anterior cingulate cortex were mainly found in patients with chronic ankle instability. DISCUSSION The included studies demonstrated structural and functional brain adaptations related to lateral ankle sprains and chronic ankle instability compared to healthy individuals or copers. These adaptations correlate with clinical outcomes (e.g. patients' self-reported function and different clinical assessments) and might contribute to the persisting dysfunctions, increased re-injury risk and long-term sequelae seen in these patients. Thus, rehabilitation programmes should integrate sensorimotor and motor control strategies to cope with neuroplasticity related to ligamentous ankle injuries.
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Affiliation(s)
- Alexandre Maricot
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Emilie Dick
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Annemiek Walravens
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Bert Pluym
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Elke Lathouwers
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Kevin De Pauw
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
- Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Jo Verschueren
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Bart Roelands
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Romain Meeusen
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
- Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Bruno Tassignon
- Faculty of Physical Education and Physiotherapy, Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium.
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11
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Tennler J, Raeder C, Praetorius A, Ohmann T, Schoepp C. Effectiveness of the SMART training intervention on ankle joint function in patients with first-time acute lateral ankle sprain: study protocol for a randomized controlled trial. Trials 2023; 24:162. [PMID: 36869403 PMCID: PMC9985260 DOI: 10.1186/s13063-023-07195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND The lateral ankle sprain (LAS) is the most common injury in the field of everyday and sports-related activities. There is a high rate of patients with LAS who will develop chronic ankle instability (CAI). A possible explanation for this high rate is an insufficient rehabilitation and/or a premature return to intense exercise and workloads. Currently, there are general rehabilitation guidelines for LAS but there is a lack of standardized evidenced-based rehabilitation concepts for LAS, which effectively reduce the high CAI rate. The primary aim of the study is to investigate the effectiveness of a 6-week sensorimotor training intervention (SMART-Treatment, SMART) in contrast to standard therapy (Normal Treatment, NORMT) after an acute LAS on perceived ankle joint function. METHODS This study will be a prospective, single-center, interventional randomized controlled trial with an active control group. Patients (14-41 years) with an acute LAS and a MRI confirmed lesion or rupture of at least one ankle ligament will be included. Exclusion criteria are acute concomitant injuries of the ankle, pre-injuries of the ankle, serious lower-extremity injuries of the last 6 months, lower-extremity surgery, and neurological diseases. The primary outcome measure will be the Cumberland Ankle Instability Tool (CAIT). Secondary outcomes include the Foot and Ankle Ability Measurement (FAAM), isokinetic and isometric strength diagnostics, joint repositioning sense, range of motion, measurements of postural control, gait and run analysis, and jump analysis. This protocol will follow the SPIRIT guidance. DISCUSSION Current management of LAS rehabilitation lacks since there is a high rate of patients developing a CAI. It has been shown that exercise therapy improves ankle function in acute LAS as well as in patients with CAI. It is further recommended to address specific impairment domains in ankle rehabilitation. However, empirical data for such a holistic treatment algorithm is missing. Therefore, this study has the potential to improve the healthcare for LAS patients and might be used for a future standardized evidence-based rehabilitation concept. TRIAL REGISTRATION "Prospectively registered" ISRCTN - ISRCTN13640422 17/11/2021; DRKS (German Clinical Trials Register) - DRKS00026049.
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Affiliation(s)
- Janina Tennler
- Department for Arthroscopic Surgery, Sports Traumatology & Sports Medicine, BG Klinikum Duisburg, Duisburg, Germany.
| | - Christian Raeder
- Department for Arthroscopic Surgery, Sports Traumatology & Sports Medicine, BG Klinikum Duisburg, Duisburg, Germany
| | - Arthur Praetorius
- Department for Arthroscopic Surgery, Sports Traumatology & Sports Medicine, BG Klinikum Duisburg, Duisburg, Germany
| | - Tobias Ohmann
- Research Department, BG Klinikum Duisburg, Duisburg, Germany
| | - Christian Schoepp
- Department for Arthroscopic Surgery, Sports Traumatology & Sports Medicine, BG Klinikum Duisburg, Duisburg, Germany.,Department of Trauma and Reconstructive Surgery, University Hospital, Essen, Germany
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12
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Picot B, Hardy A, Terrier R, Tassignon B, Lopes R, Fourchet F. Which Functional Tests and Self-Reported Questionnaires Can Help Clinicians Make Valid Return to Sport Decisions in Patients With Chronic Ankle Instability? A Narrative Review and Expert Opinion. Front Sports Act Living 2022; 4:902886. [PMID: 35721875 PMCID: PMC9204606 DOI: 10.3389/fspor.2022.902886] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/04/2022] [Indexed: 12/26/2022] Open
Abstract
Lateral ankle sprain is the most common injury in sports, with up to 40% of patients developing chronic ankle instability (CAI). One possible cause underlying this high rate of recurrence or feeling of giving way may be a premature return to sport (RTS). Indeed, except for time-based parameters, there are no specific criteria to guide clinicians in their RTS decisions in patients with CAI. A recent international consensus highlighted the relevance and importance of including patient-reported ankle function questionnaires combined with functional tests targeting ankle impairments in this population. Thus, the aim of this narrative review and expert opinion was to identify the most relevant functional performance tests and self-reported questionnaires to help clinicians in their RTS decision-making process following recurrent ankle sprains or surgical ankle stabilization. The PubMed (MEDLINE), PEDro, Cochrane Library and ScienceDirect databases were searched to identify published articles. Results showed that the single leg stance test on firm surfaces, the modified version of the star excursion balance test, the side hop test and the figure-of-8 test appeared to be the most relevant functional performance tests to target ankle impairments in patients with CAI. A combination of the Foot and Ankle Ability Measure (FAAM) and the Ankle Ligament Reconstruction-Return to Sport after Injury (ALR-RSI) questionnaires were the most relevant self-reported questionnaires to assess patient function in the context of CAI. Although these functional tests and questionnaires provide a solid foundation for clinicians to validate their RTS decisions in patient with CAI, objective scientific criteria with cut-off scores are still lacking. In addition to the proposed test cluster, an analysis of the context, in particular characteristics related to sports (e.g., fatigue, cognitive constraints), to obtain more information about the patient's risk of recurrent injury could be of added value when making a RTS decision in patients with CAI. In order to evaluate the strength of evertors under ecological conditions, it would also be interesting to assess the ability to control weight-bearing ankle inversion in a unipodal stance. Further studies are needed to assess the relevance of this proposed test cluster in RTS decision-making following lateral ankle sprain injury and CAI.
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Affiliation(s)
- Brice Picot
- French Handball Federation, Creteil, France
- French Society of Sports Physical Therapist (SFMKS Lab), Pierrefitte-sur-Seine, France
- Inter-University Laboratory of Human Movement Biology (LIBM), Savoie Mont-Blanc University, Chambéry, France
- *Correspondence: Brice Picot
| | | | - Romain Terrier
- French Society of Sports Physical Therapist (SFMKS Lab), Pierrefitte-sur-Seine, France
- Inter-University Laboratory of Human Movement Biology (LIBM), Savoie Mont-Blanc University, Chambéry, France
- SARL Whergo, Savoie Technolac (BP 80218), La Motte-Servolex, France
| | - Bruno Tassignon
- Human Physiology and Sports Physiotherapy Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ronny Lopes
- Santé Atlantique, Pied Cheville Nantes Atlantique, Nantes, France
| | - François Fourchet
- French Society of Sports Physical Therapist (SFMKS Lab), Pierrefitte-sur-Seine, France
- Motion Analysis Lab, Physiotherapy Department, La Tour Hospital, Swiss Olympic Medical Center, Meyrin, Switzerland
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13
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Pflüger P, Wurm M, Biberthaler P, Pförringer D, Crönlein M. [Analysis of 6851 foot and ankle injuries from 2010-2017 in an emergency department]. Unfallchirurg 2021; 125:801-810. [PMID: 34591136 PMCID: PMC9515139 DOI: 10.1007/s00113-021-01081-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund Sprunggelenk- und Fußverletzungen gehören zu den häufigsten Krankheitsbildern in der Traumatologie. Ziel dieser Studie war es, die demografischen Veränderungen von Patienten mit Fuß- und Sprunggelenkverletzungen, das zeitliche Auftreten und die Entwicklung über die Jahre in einer Notaufnahme zu untersuchen. Material und Methoden Retrospektive Datenauswertung von Patienten, welche aufgrund einer Fuß- und Sprunggelenkverletzung in der Notaufnahme im Zeitraum von 2010 bis 2017 behandelt wurden. Die Patienten wurden mittels ICD-Codes identifiziert und die demografischen Veränderungen, das zeitliche Auftreten und die Entwicklung über die Jahre analysiert. Mittels Quantil-Quantil-Diagramm wurden kontinuierliche Variablen auf Normalverteilung getestet und, falls zutreffend, mittels t‑Test oder nichtparametrischem Mann-Whitney-U-Test auf Signifikanz überprüft. Ergebnisse Insgesamt wurden 6581 Fuß- und Sprunggelenkverletzungen in die Analyse eingeschlossen. Das mittlere Alter von Patienten mit einer Fußfraktur war 39 ± 17,4 Jahre und mit einer Sprunggelenkfraktur 47 ± 19,2 Jahre (p < 0,001). Ligamentäre Verletzungen des Sprunggelenks traten insbesondere bei jüngeren Patienten in den Sommermonaten auf. Die Altersverteilung bei Sprunggelenkfrakturen zeigte für Männer einen Häufigkeitsgipfel zwischen dem 30. und 39. Lebensjahr und bei Frauen ein vermehrtes Auftreten ab dem 50. Lebensjahr. In der Altersgruppe zwischen 65 und 75 Jahren stellten Trimalleolarfrakturen die zweithäufigste Sprunggelenkfraktur dar. Frakturen des Fußes betrafen am häufigsten Patienten im Alter von 20 bis 29 Jahren, wobei bei Frauen ein 2. Häufigkeitsgipfel zwischen dem 50. und 59. Lebensjahr zu beobachten war. Schlussfolgerung Ligamentäre Verletzungen des Sprunggelenks sind häufige Krankheitsbilder in der Notaufnahme und betreffen v. a. jüngere Patienten. Sprunggelenkfrakturen zeigten für Frauen eine bimodale Altersverteilung, und insbesondere Bi- und Trimalleolarfrakturen waren vermehrt bei Frauen ab dem 65. Lebensjahr zu beobachten. Aufgrund der erhöhten Prävalenz von Fuß- und Sprunggelenkfrakturen bei älteren Frauen sollte in diesem Patientenkollektiv eine weitere Osteoporoseabklärung veranlasst werden.
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Affiliation(s)
- Patrick Pflüger
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
| | - Markus Wurm
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Peter Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Dominik Pförringer
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Moritz Crönlein
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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14
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Abstract
Direct-type cavus foot deformities are most commonly encountered and are primarily sagittal plane deformities. Direct deformities should be delineated from rarer triplane pes cavovarus deformities. The lateral weight-bearing radiograph is the cornerstone of imaging evaluation of direct pes cavus foot deformity. The apex of Meary talo-first metatarsal angle on the lateral radiograph represents the pinnacle of the cavus deformity and assists in subclassification of the deformity. With routine application, ancillary radiographic imaging techniques, such as the modified Saltzman view or the modified Coleman block test, can give valuable insight into deformity assessment and surgical planning.
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Affiliation(s)
- Lawrence Osher
- Radiology, Division of Podiatric and General Medicine, Kent State University College of Podiatric Medicine, 6000 Rockside Woods Blvd. N, Independence, OH 44131, USA.
| | - Jeffrey E Shook
- Adjunct Faculty, St. Vincent Charity Medical Center, Cleveland, OH, USA
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15
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Pogliacomi F, De Filippo M, Casalini D, Longhi A, Tacci F, Perotta R, Pagnini F, Tocco S, Ceccarelli F. Acute syndesmotic injuries in ankle fractures: From diagnosis to treatment and current concepts. World J Orthop 2021; 12:270-291. [PMID: 34055585 PMCID: PMC8152437 DOI: 10.5312/wjo.v12.i5.270] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/14/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023] Open
Abstract
A stable and precise articulation of the distal tibiofibular syndesmosis maintains the tibiofibular relationship, and it is essential for normal motion of the ankle joint. The disruption of this joint is frequently accompanied by rotational ankle fracture, such as pronation-external rotation, and rarely occurs without ankle fracture. The diagnosis is not simple, and ideal management of the various presentations of syndesmotic injury remains controversial to this day. Anatomical restoration and stabilization of the disrupted tibiofibular syndesmosis is essential to improve functional outcomes. In such an injury, including inadequately treated, misdiagnosed and correctly diagnosed cases, a chronic pattern characterized by persistent ankle pain, function disability and early osteoarthritis can result. This paper reviews anatomical and biomechanical characteristics of this syndesmosis, the mechanism of its acute injury associated to fractures, radiological and arthroscopic diagnosis and surgical treatment.
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Affiliation(s)
| | - Massimo De Filippo
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Daniele Casalini
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Alberto Longhi
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Fabrizio Tacci
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Rocco Perotta
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Francesco Pagnini
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Silvio Tocco
- Centro Riabilitativo della Mano e Arto Superiore, Parma 43121, Italy
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16
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Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. J Orthop Sports Phys Ther 2021; 51:CPG1-CPG80. [PMID: 33789434 DOI: 10.2519/jospt.2021.0302] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This revised clinical practice guideline (CPG) addresses the distinct but related lower extremity impairments of those with a first-time lateral ankle sprain (LAS) and those with chronic ankle instability (CAI). Depending on many factors, impairments may continue following injury. While most individuals experience resolution of symptoms, complaints of instability may continue and are defined as CAI. The aims of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. J Orthop Sports Phys Ther 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302.
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17
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Mechanical characterisation of the lateral collateral ligament complex of the ankle at realistic sprain-like strain rates. J Mech Behav Biomed Mater 2020; 102:103473. [DOI: 10.1016/j.jmbbm.2019.103473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/02/2019] [Accepted: 10/02/2019] [Indexed: 11/19/2022]
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18
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Abstract
OBJECTIVE To provide a focused overview of the existing literature on the epidemiology of acute ankle sprains (lateral, medial, and high/syndesmotic) with an emphasis on incidence studies from the United States. In addition, we provide a brief overview of chronic ankle instability (CAI), posttraumatic osteoarthritis, and injury prevention to contribute to our understanding of the epidemiology of these injuries and the current state of the science on ankle sprains and ankle instability in sports medicine. BACKGROUND Acute ankle sprains are one of the most common musculoskeletal injuries, with a high incidence among physically active individuals. Additionally, acute ankle sprains have a high recurrence rate, which is associated with the development of CAI. Understanding the epidemiology of these injuries is important for improving patients' musculoskeletal health and reducing the burden of lower limb musculoskeletal conditions. DESCRIPTION Acute ankle-sprain incidence rates are summarized among the general population, as well as among physically active populations, including organized athletics and military personnel, with a focus on incidence in the United States. The link between a prior ankle sprain and a future acute ankle sprain is described. We also discuss the association between the incident ankle sprain and adverse, long-term outcomes such as CAI and posttraumatic osteoarthritis. Finally, we summarize injury-prevention successes and future directions for research and prevention. CLINICAL APPLICATIONS This information is useful for health care providers to understand the expected incidence rates of acute ankle sprains, be aware of the association between ankle sprains and negative short- and long-term outcomes, and be familiar with existing injury-prevention programs.
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Affiliation(s)
- Mackenzie M. Herzog
- Department of
Epidemiology, University of North Carolina at Chapel Hill
- Real-World Analytics Solutions, IQVIA, Research Triangle Park, NC
- University of North Carolina Injury Prevention Research Center, Chapel Hill
| | - Zachary Y. Kerr
- Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Stephen W. Marshall
- Department of
Epidemiology, University of North Carolina at Chapel Hill
- University of North Carolina Injury Prevention Research Center, Chapel Hill
| | - Erik A. Wikstrom
- Exercise and Sport Science, University of North Carolina at Chapel Hill
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19
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Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA. Epidemiology of Ankle Sprains and Chronic Ankle Instability. J Athl Train 2019. [PMID: 31135209 DOI: 10.4085/1062-6050-447-17.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To provide a focused overview of the existing literature on the epidemiology of acute ankle sprains (lateral, medial, and high/syndesmotic) with an emphasis on incidence studies from the United States. In addition, we provide a brief overview of chronic ankle instability (CAI), posttraumatic osteoarthritis, and injury prevention to contribute to our understanding of the epidemiology of these injuries and the current state of the science on ankle sprains and ankle instability in sports medicine. BACKGROUND Acute ankle sprains are one of the most common musculoskeletal injuries, with a high incidence among physically active individuals. Additionally, acute ankle sprains have a high recurrence rate, which is associated with the development of CAI. Understanding the epidemiology of these injuries is important for improving patients' musculoskeletal health and reducing the burden of lower limb musculoskeletal conditions. DESCRIPTION Acute ankle-sprain incidence rates are summarized among the general population, as well as among physically active populations, including organized athletics and military personnel, with a focus on incidence in the United States. The link between a prior ankle sprain and a future acute ankle sprain is described. We also discuss the association between the incident ankle sprain and adverse, long-term outcomes such as CAI and posttraumatic osteoarthritis. Finally, we summarize injury-prevention successes and future directions for research and prevention. CLINICAL APPLICATIONS This information is useful for health care providers to understand the expected incidence rates of acute ankle sprains, be aware of the association between ankle sprains and negative short- and long-term outcomes, and be familiar with existing injury-prevention programs.
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Affiliation(s)
- Mackenzie M Herzog
- Department of * Epidemiology, University of North Carolina at Chapel Hill.,Real-World Analytics Solutions, IQVIA, Research Triangle Park, NC.,University of North Carolina Injury Prevention Research Center, Chapel Hill
| | - Zachary Y Kerr
- Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Stephen W Marshall
- Department of * Epidemiology, University of North Carolina at Chapel Hill.,University of North Carolina Injury Prevention Research Center, Chapel Hill
| | - Erik A Wikstrom
- Exercise and Sport Science, University of North Carolina at Chapel Hill
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20
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Harriss J, Khan A, Song K, Register-Mihalik JK, Wikstrom EA. Clinical movement assessments do not differ between collegiate athletes with and without chronic ankle instability. Phys Ther Sport 2019; 36:22-27. [PMID: 30611027 DOI: 10.1016/j.ptsp.2018.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
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21
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Pogliacomi F, Artoni C, Riccoboni S, Calderazzi F, Vaienti E, Ceccarelli F. The management of syndesmotic screw in ankle fractures. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 90:146-149. [PMID: 30715014 PMCID: PMC6503419 DOI: 10.23750/abm.v90i1-s.8015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM There is a wide debate about the number, diameter and length of the syndesmotic screw and necessity and timing for its removal. The aim of this study is to determine whether functional and radiological outcomes differ in patients operated for Weber type B and C ankle fractures who had syndesmotic screws removed (group 1) compared to those who did not (group 2). Furthermore, authors want to define if it is really necessary to remove this device and its correct timing. MATERIALS AND METHODS 90 patients were eligible for the study. The functional outcomes were analyzed 1 year after surgery using OMAS and AOFAS scores. Radiographic evaluation assessed the tibiofibular distance immediately and 12 months after surgery and fracture's healing. RESULTS Clinical and x-rays results were similar in both groups at follow-up. DISCUSSION Fractures with interruption of syndesmosis are lesions that, if not well treated, are complicated by joint stiffness, residual pain and post-traumatic osteoarthritis. Syndesmotic screw removal is not routinely performed, thus accepting the risk of rupture but avoiding a new surgery. CONCLUSIONS Results observed suggest that syndesmotic screw removal is not necessary. If surgeon decide to remove this device correct timing is mandatory in order to obtain satisfactory long-term results.
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Affiliation(s)
- Francesco Pogliacomi
- PARMA UNIVERSITY DEPARTMENT OF SURGICAL SCIENCES ORTHOPAEDIC AND TRAUMATOLOGY SECTION.
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22
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Kemler E, Blokland D, Backx F, Huisstede B. Differences in injury risk and characteristics of injuries between novice and experienced runners over a 4-year period. PHYSICIAN SPORTSMED 2018; 46:485-491. [PMID: 30071170 DOI: 10.1080/00913847.2018.1507410] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Running is increasingly popular, but also carries a high injury risk, especially in novice runners. This study investigates differences in incidence and characteristics of running-related injuries (RRIs) between novice and experienced runners in the open population, in order to adapt to more specific needs for future prevention programs. METHODS Data were obtained from Injuries and Physical Activity in the Netherlands (IPAN), a Dutch questionnaire on injuries, physical activity, and sports. A representative sample of runners (n = 4621) from IPAN, including 1405 novice runners, was used to assess injury incidence rates, anatomical site, onset and need for medical attention of RRIs. Participants who started running during the past 12 months were defined as 'novice' runners. 'Experienced' runners are participants who had been running for more than 1 year. RESULTS Of the 4621 runners, 41,8% were female. The average age was 34.2 years. From 2010 to 2013, a total of 416 injuries were reported. The incidence of RRIs was significantly higher in novice runners compared with experienced runners: 8.78 (8.59-8.96) vs. 4.24 (4.11-4.37) per 1000 h running. In both novice and experienced runners, most RRIs were located at the knee (30.5%) and lower leg (17.8%), with the Achilles' tendon less frequently injured in novice runners (2.3% vs. 8.4%, p = 0.031). Novice runners sustained more medical attention injuries (36.8%) than experienced runners (29.2%) (p > 0.132). CONCLUSIONS In total, over 30% of all (novice and experienced) runners, suffered from RRI within 1 year. Novice runners reported more injuries per 1000 h of running in comparison to experienced runners. A tendency toward receiving medical attention more frequently was found in novice runners compared to experienced runners. In view of this higher injury incidence of RRIs and healthcare consumption in novice runners, more studies are needed to develop effective injury prevention programs for novice runners.
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Affiliation(s)
- Ellen Kemler
- a Dutch Consumer Safety Institute , Amsterdam , the Netherlands
| | - Donna Blokland
- b Department of Rehabilitation, Physical Therapy Science and Sport , Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht University , Utrecht , the Netherlands
| | - Frank Backx
- b Department of Rehabilitation, Physical Therapy Science and Sport , Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht University , Utrecht , the Netherlands
| | - Bionka Huisstede
- b Department of Rehabilitation, Physical Therapy Science and Sport , Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht University , Utrecht , the Netherlands
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23
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Hall EA, Chomistek AK, Kingma JJ, Docherty CL. Balance- and Strength-Training Protocols to Improve Chronic Ankle Instability Deficits, Part I: Assessing Clinical Outcome Measures. J Athl Train 2018; 53:568-577. [PMID: 29975573 DOI: 10.4085/1062-6050-385-16] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Functional rehabilitation may improve the deficits associated with chronic ankle instability (CAI). OBJECTIVE To determine if balance- and strength-training protocols improve the balance, strength, and functional performance deficits associated with CAI. DESIGN Randomized controlled clinical trial. SETTING Athletic training research laboratory. PATIENTS OR OTHER PARTICIPANTS Participants were 39 volunteers with CAI, which was determined using the Identification of Functional Ankle Instability Questionnaire. They were randomly assigned to 1 of 3 groups: balance-training protocol (7 males, 6 females; age = 23.5 ± 6.5 years, height = 175.0 ± 8.5 cm, mass = 72.8 ± 10.9 kg), strength-training protocol (8 males, 5 females; age = 24.6 ± 7.7 years, height = 173.2 ± 9.0 cm, mass = 76.0 ± 16.2 kg), or control (6 males, 7 females; age = 24.8 ± 9.0 years, height = 175.5 ± 8.4 cm, mass = 79.1 ± 16.8 kg). INTERVENTION(S) Each group participated in a 20-minute session, 3 times per week, for 6 weeks. The control group completed a mild to moderately strenuous bicycle workout. MAIN OUTCOME MEASURE(S) Participants completed baseline testing of eccentric and concentric isokinetic strength in each ankle direction (inversion, eversion, plantar flexion, and dorsiflexion) and the Balance Error Scoring System (BESS), Star Excursion Balance Test (SEBT), and side-hop functional performance test. The same variables were tested again at 6 weeks after the intervention. Two multivariate repeated-measures analyses of variance with follow-up univariate analyses were conducted. The α level was set a priori at .05. RESULTS We observed time-by-group interactions in concentric ( P = .02) and eccentric ( P = .01) inversion, eccentric eversion ( P = .01), concentric ( P = .001) and eccentric ( P = .03) plantar flexion, BESS ( P = .01), SEBT ( P = .02), and side hop ( P = .004). With pairwise comparisons, we found improvements in the balance- and strength-training protocol groups in concentric and eccentric inversion and concentric and eccentric plantar flexion and the BESS, SEBT, and side hop (all P values = .001). Only the strength-training protocol group improved in eccentric eversion. The control group did not improve in any dependent variable. CONCLUSIONS Both training protocols improved strength, balance, and functional performance. More clinicians should incorporate hop-to-stabilization exercises into their rehabilitation protocols to improve the deficits associated with CAI.
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Affiliation(s)
- Emily A Hall
- Department of Orthopaedics and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa; Departments of
| | | | - Jackie J Kingma
- Kinesiology, School of Public Health, Indiana University, Bloomington
| | - Carrie L Docherty
- Kinesiology, School of Public Health, Indiana University, Bloomington
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Wynkoop A, Ndubaku O, Walter N, Atkinson T. Temporal Variation in Ankle Fractures and Orthopedic Resident Program Planning in an Urban Level 1 Trauma Center. J Foot Ankle Surg 2018. [PMID: 28633767 DOI: 10.1053/j.jfas.2017.01.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Previous studies have described the mechanism of ankle fractures, their seasonal variation, and fracture patterns but never in conjunction. In addition, the cohorts previously studied were either not from trauma centers or were often dominated by low-energy mechanisms. The present study aimed to describe the epidemiology of ankle fractures presenting to an urban level 1 trauma center. The records from an urban level 1 trauma center located in the Midwestern United States were retrospectively reviewed, and the injury mechanism and energy, time of injury, day of week, month, and patient characteristics (age, gender, comorbidities, smoking status) were collected. The fractures were classified using the AO (Arbeitsgemeinschaft für Osteosynthesefragen), Lauge-Hansen, and Danis-Weber systems. Of these systems, the Lauge-Hansen classification system resulted in the greatest number of "unclassifiable" cases. Most ankle fractures were due to high-energy mechanisms, with motor vehicle collisions the most common high-energy mechanism. The review found that most ankle fractures were malleolar fractures, regardless of the mechanism of injury. The ankle fracture patients had greater rates of obesity, diabetes, and smoking than present in the region where the hospital is located. The fractures were most likely to occur in the afternoon, with more fractures presenting on the weekend than earlier in the week and more fractures in the fall and winter than in the spring and summer. The temporal variation of these fractures should be considered for health services planning, in particular, in regard to resident physician staffing at urban level 1 trauma centers.
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Elsoe R, Ostgaard SE, Larsen P. Population-based epidemiology of 9767 ankle fractures. Foot Ankle Surg 2018; 24:34-39. [PMID: 29413771 DOI: 10.1016/j.fas.2016.11.002] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/27/2016] [Accepted: 11/07/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose was to provide up-to-date information concerning the incidence of ankle fractures in a large and complete population including all age groups, spanning a decade, and report the distribution of fractures, trauma mechanism and patient baseline demographics. METHODS Population-based epidemiological study of all patients treated for an ankle fracture in a 10-year period from 2005 to 2014. RESULTS A total of 9767 patients with ankle fractures were treated between 2005 and 2014. The mean age at time of fracture was 41.4 (24.3 SD) years. The mean incidence of ankle fractures between 2005 and 2014 was 168.7/100,000/year. Years with cold winters showed increased incidences compared with years with normal winters. For males, the incidence was 157.1/100,000/year, and for females, 179.5/100,000/year. The incidence shows a peak incidence among adolescents in both genders with a male predominance. After the age of 19 the male incidence declines with age, which is in contrast to females, who experience an increasing incidence. The most common fracture type in all age groups was a fracture of the lateral malleolus representing 55% of all fractures. The predominant mode of injury was falls (61%) followed by sports (22%). CONCLUSION This study shows an incidence of 168.7/100,000/year spanning a decade. The most common fracture type in all age groups was a fracture of the lateral malleolus representing 55% of all fractures. The predominant mode of injury was falls (61%) followed by sports (22%).
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Affiliation(s)
- Rasmus Elsoe
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
| | - Svend E Ostgaard
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Larsen
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
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Thompson JY, Byrne C, Williams MA, Keene DJ, Schlussel MM, Lamb SE. Prognostic factors for recovery following acute lateral ankle ligament sprain: a systematic review. BMC Musculoskelet Disord 2017; 18:421. [PMID: 29061135 PMCID: PMC5654104 DOI: 10.1186/s12891-017-1777-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 10/10/2017] [Indexed: 12/17/2022] Open
Abstract
Background One-third of individuals who sustain an acute lateral ankle ligament sprain suffer significant disability due to pain, functional instability, mechanical instability or recurrent sprain after recovery plateaus at 1 to 5 years post injury. The identification of early prognostic factors associated with poor recovery may provide an opportunity for early-targeted intervention and improve outcome. Methods We performed a comprehensive search of AMED, EMBASE, Psych Info, CINAHL, SportDiscus, PubMed, CENTRAL, PEDro, OpenGrey, abstracts and conference proceedings from inception to September 2016. Prospective studies investigating the association between baseline prognostic factors and recovery over time were included. Two independent assessors performed the study selection, data extraction and quality assessment of the studies. A narrative synthesis is presented due to inability to meta-analyse results due to clinical and statistical heterogeneity. Results The search strategy yielded 3396 titles/abstracts after duplicates were removed. Thirty-six full text articles were then assessed, nine of which met the study inclusion criteria. Six were prospective cohorts, and three were secondary analyses of randomised controlled trials. Results are presented for nine studies that presented baseline prognostic factors for recovery after an acute ankle sprain. Age, female gender, swelling, restricted range of motion, limited weight bearing ability, pain (at the medial joint line and on weight-bearing dorsi-flexion at 4 weeks, and pain at rest at 3 months), higher injury severity rating, palpation/stress score, non-inversion mechanism injury, lower self-reported recovery, re-sprain within 3 months, MRI determined number of sprained ligaments, severity and bone bruise were found to be independent predictors of poor recovery. Age was one prognostic factor that demonstrated a consistent association with outcome in three studies, however cautious interpretation is advised. Conclusions The associations between prognostic factors and poor recovery after an acute lateral ankle sprain are largely inconclusive. At present, there is insufficient evidence to recommend any factor as an independent predictor of outcome. There is a need for well-conducted prospective cohort studies with adequate sample size and long-term follow-up to provide robust evidence on prognostic factors of recovery following an acute lateral ankle sprain. Trial registration Prospero registration: CRD42014014471 Electronic supplementary material The online version of this article (10.1186/s12891-017-1777-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jacqueline Yewande Thompson
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Christopher Byrne
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,School of Health Professions, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Mark A Williams
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
| | - David J Keene
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Micheal Maia Schlussel
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Walley KC, Hofmann KJ, Velasco BT, Kwon JY. Removal of Hardware After Syndesmotic Screw Fixation: A Systematic Literature Review. Foot Ankle Spec 2017; 10:252-257. [PMID: 28027655 DOI: 10.1177/1938640016685153] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND While trans-syndesmotic fixation with metal screws is considered the gold standard in treating syndesmotic injuries, controversy exists regarding the need and timing of postoperative screw removal. Formal recommendations have not been well established in the literature and clinical practice is highly variable in this regard. The purpose of this systematic review is to critically examine the most recent literature regarding syndesmotic screw removal in order to provide surgeons an evidence-based approach to management of these injuries. METHODS The Cochrane Library and PubMed Medline databases were explored using search terms for syndesmosis and screw removal between October 1, 2010 and June 1, 2016. RESULTS A total of 9 studies (1 randomized controlled trial and 8 retrospective cohort studies) were found that described the outcomes of either retained or removed syndesmotic screws. Overall, there was no difference in functional, clinical or radiographic outcomes in patients who had their syndesmotic screw removed. There was a higher likelihood of recurrent syndesmotic diastasis when screws were removed between 6 and 8 weeks. There was a higher rate of postoperative infections when syndesmotic screws were removed without administering preoperative antibiotics. CONCLUSION Removal of syndesmotic screws is advisable mainly in cases of patient complaints related to the other implanted perimalleolar hardware or malreduction of the syndesmosis after at least 8 weeks postoperatively. Broken or loose screws should not be removed routinely unless causing symptoms. Antibiotic prophylaxis is recommended on removal. Radiographs should be routinely obtained immediately prior to removal and formal discussions should be had with patients prior to surgery to discuss management options if a broken screw is unexpectedly encountered intraoperatively. Radiographs and/or computed tomography imaging should be obtained after syndesmotic screw removal when indicated for known syndesmotic malreduction. LEVELS OF EVIDENCE Level IV: Systematic review.
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Affiliation(s)
- Kempland C Walley
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kurt J Hofmann
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Brian T Velasco
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - John Y Kwon
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Gribble PA, Bleakley CM, Caulfield BM, Docherty CL, Fourchet F, Fong DTP, Hertel J, Hiller CE, Kaminski TW, McKeon PO, Refshauge KM, Verhagen EA, Vicenzino BT, Wikstrom EA, Delahunt E. Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med 2016; 50:1496-1505. [PMID: 27259753 DOI: 10.1136/bjsports-2016-096189] [Citation(s) in RCA: 366] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2016] [Indexed: 02/06/2023]
Abstract
Lateral ankle sprains (LASs) are the most prevalent musculoskeletal injury in physically active populations. They also have a high prevalence in the general population and pose a substantial healthcare burden. The recurrence rates of LASs are high, leading to a large percentage of patients with LAS developing chronic ankle instability. This chronicity is associated with decreased physical activity levels and quality of life and associates with increasing rates of post-traumatic ankle osteoarthritis, all of which generate financial costs that are larger than many have realised. The literature review that follows expands this paradigm and introduces emerging areas that should be prioritised for continued research, supporting a companion position statement paper that proposes recommendations for using this summary of information, and needs for specific future research.
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Affiliation(s)
- Phillip A Gribble
- University of Kentucky, College of Health Sciences, Lexington, Kentucky, USA
| | - Chris M Bleakley
- Department of Life and Health Sciences, Ulster University, Jordanstown, Carrickfergus, UK
| | - Brian M Caulfield
- University College Dublin, Insight Centre for Data Analytics, Dublin, Ireland
| | - Carrie L Docherty
- Indiana University, School of Public Health, Bloomington, Indiana, USA
| | | | - Daniel Tik-Pui Fong
- National Centre for Sport and Exercise Medicine-East Midlands, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Jay Hertel
- Departments of Kinesiology and Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Claire E Hiller
- University of Sydney, College of Health, Sydney, New South Wales, Australia
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Patrick O McKeon
- Department of Exercise and Sport Sciences, Ithaca College, Ithaca, New York, USA
| | | | - Evert A Verhagen
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Bill T Vicenzino
- University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy, Brisbane, Queensland, Australia
| | - Erik A Wikstrom
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eamonn Delahunt
- University College Dublin, School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
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Andersen MR, Frihagen F, Madsen JE, Figved W. High complication rate after syndesmotic screw removal. Injury 2015; 46:2283-7. [PMID: 26319204 DOI: 10.1016/j.injury.2015.08.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/04/2015] [Accepted: 08/11/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to determine the rate of complications after routine syndesmotic screw removal. MATERIALS AND METHODS All patients who underwent syndesmotic screw removal at our hospital between 2007 and 2012 were included in the study. Patient demographics, surgical characteristics, radiographic evaluation and complications were recorded from the patients' charts. Questionnaires were sent by postal mail to all patients, to measure patient satisfaction and pain (VAS scales). RESULTS 161 patients were included in the trial. A wound infection was found in 8 (5%) patients. 3 were regarded as serious infections requiring hospitalisation and intravenous antibiotics, 2 of those required surgical revisions. 5 patients were treated by oral antibiotics. Staphylococcus aureus was identified as the causing organism in all (6/8) cases with a positive culture. The patients with postoperative infection reported more pain (5.3 vs. 2.3; p=0.02) and were less satisfied (4.7 vs. 7.6; p=0.014) with their ankle compared to those without infection (T-test for independent samples). CONCLUSION There were 5% wound infections after routine syndesmotic screw removal. Routine antibiotic prophylaxis effective against S. aureus should be administered when removing syndesmotic screws. In our institution we now use one single dose Cefalotin of 2g intravenously 30-60min before screw removal.
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Affiliation(s)
| | - Frede Frihagen
- Department of Orthopaedic Surgery, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
| | - Jan Erik Madsen
- Department of Orthopaedic Surgery, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
| | - Wender Figved
- Department of Orthopaedic Surgery, Baerum Hospital, Drammen, Norway.
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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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