The medial ligaments of the ankle are injured more often than generally believed. Complete deltoid ligament tears are occasionally seen in association with lateral malleolar fractures or bimalleolar fractures. Chronic deltoid ligament insufficiency can be seen in several conditions, including posterior tibial tendon disorder, trauma- and sports-related deltoid disruptions, and valgus talar tilting in patients who have a history of triple arthrodesis or total ankle arthroplasty. This article focuses on the anatomy and function of the medial ligaments of the ankle and establishes a rationale for the diagnosis and treatment of incompetent deltoid ligament.
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"The anterior drawer test and the talar tilt test were the two common tests to assess the integrity of the anterior talofibular ligament, and could be useful in diagnosing the grading of the tear of the ligament [39,102]. To test the medial ligament, mainly the deltoid ligament at the medial aspect of the ankle, the eversion stress test was commonly performed . This could be tested by the external rotation test and the squeeze test . "
[Show abstract][Hide abstract] ABSTRACT: This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL) which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing - a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms). Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60-90 ms). The failure supination or inversion torque is about 41-45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative. Immobilization should not be used as it results in joint stiffness, muscle atrophy and loss of proprioception. Traditional Chinese medicine such as herbs, massage and acupuncture were well applied in China in managing sports injuries, and was reported to be effective in relieving pain, reducing swelling and edema, and restoring normal ankle function. Finally, the best practice of sports medicine would be to prevent the injury. Different previous approaches, including designing prophylactice devices, introducing functional interventions, as well as change of games rules were highlighted. This paper allows the readers to catch up with the previous researches on ankle sprain injury, and facilitate the future research idea on sport-related ankle sprain injury.
Sports Medicine Arthroscopy Rehabilitation Therapy & Technology 08/2009; 1(1):14. DOI:10.1186/1758-2555-1-14
[Show abstract][Hide abstract] ABSTRACT: Total ankle replacement is a possible treatment for ankle arthritis; however, participation in sports after this procedure has not yet been analyzed.
There is a significant increase of sports activity after total ankle replacement in patients with arthritis. There is a significant correlation between sports activity and American Orthopaedic Foot and Ankle Society hindfoot score in patients after total ankle replacement.
Case series; Level of evidence, 4.
A clinical evaluation was performed preoperatively and at follow-up after total ankle replacement in 147 patients (152 ankles) with ankle arthritis (mean age, 59.6 years; range, 28-86 years). Ankle arthritis origin, patient satisfaction, range of motion, American Orthopaedic Foot and Ankle Society hindfoot score, radiologic assessment, and rate, level, and type of sports activity were documented at both evaluations. The mean follow-up was 2.8 years (range, 2-4 years).
Preoperative diagnosis was posttraumatic osteoarthritis in 115 cases (76%). At total ankle replacement follow-up, excellent and good outcomes were reported in 126 cases (83%); 105 cases (69%) were pain free. The mean range of motion pre-operatively was 21 degrees (range, 0 degrees -45 degrees ); after total ankle replacement, it was 35 degrees (range, 10 degrees -55 degrees ; P < .05). The preoperative American Orthopaedic Foot and Ankle Society score was 36 points; after total ankle replacement, it was 84 points (P < .001). Before surgery, 36% of the patients were active in sports; after surgery, this percentage rose to 56% (P < .001). After total ankle replacement, sports-active patients showed a significantly higher hindfoot score than did patients not active in sports: 88 versus 79 points (P < .001). The 3 most frequent sports activities were hiking, biking, and swimming.
There was a significant increase of sports activity by treating ankle arthritis patients with total ankle replacement. Sports-active total ankle replacement patients showed better functional results than did inactive ones.
The American Journal of Sports Medicine 06/2006; 34(6):993-9. DOI:10.1177/0363546505284189 · 4.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In patients with asymmetric (varus or valgus) ankle osteoarthritis, realignment surgery is an alternative treatment to fusion or total ankle replacement in selected cases. To determine whether realignment surgery in asymmetric ankle osteoarthritis relieved pain and improved function, we clinically and radiographically followed 35 consecutive patients with posttraumatic ankle osteoarthritis treated with lower leg and hindfoot realignment surgery. We further questioned if outcome correlated with achieved alignment. The average patient age was 43 years (range, 26-68 years). We used a standardized clinical and radiographic protocol. Besides distal tibial osteotomies, additional bony and soft tissue procedures were performed in 32 patients (91%). At mean followup of 5 years (range, 3-10.5 years), pain decreased by an average of 4 points on a visual analog scale; range of ankle motion increased by an average of 5 degrees . Walking ability and the functional parts of the American Foot and Ankle Society score increased by an average of 10 and 21 points, respectively, and correlated with achieved reversal of tibiotalar tilt and the score of Takakura et al. Revision surgery was performed in 10 ankles (29%), of which three ankles (9%) were converted to total ankle replacement. We believe the data support realignment surgery for patients with asymmetric ankle osteoarthritis.
Clinical Orthopaedics and Related Research 10/2007; 462(462):156-68. DOI:10.1097/BLO.0b013e318124a462 · 2.77 Impact Factor