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Abstract

Ankle sprain has been studied in athletic cohorts, but little is known of its epidemiology in the general population. A longitudinal, prospective epidemiological database was used to determine the incidence and demographic risk factors for ankle sprains presenting to emergency departments in the United States. It was our hypothesis that ankle sprain is influenced by sex, race, age, and involvement in athletics. The National Electronic Injury Surveillance System (NEISS) was queried for all ankle sprain injuries presenting to emergency departments between 2002 and 2006. Incidence rate ratios were then calculated with respect to age, sex, and race. During the study period, an estimated 3,140,132 ankle sprains occurred among an at-risk population of 1,461,379,599 person-years for an incidence rate of 2.15 per 1000 person-years in the United States. The peak incidence of ankle sprain occurred between fifteen and nineteen years of age (7.2 per 1000 person-years). Males, compared with females, did not demonstrate an overall increased incidence rate ratio for ankle sprain (incidence rate ratio, 1.04; 95% confidence interval, 1.00 to 1.09). However, males between fifteen and twenty-four years old had a substantially higher incidence of ankle sprain than their female counterparts (incidence rate ratio, 1.53; 95% confidence interval, 1.41 to 1.66), whereas females over thirty years old had a higher incidence compared with their male counterparts (incidence rate ratio, 2.03; 95% confidence interval, 1.65 to 2.65). Compared with the Hispanic race, the black and white races were associated with substantially higher rates of ankle sprain (incidence rate ratio, 3.55 [95% confidence interval, 1.01 to 6.09] and 2.49 [95% confidence interval, 1.01 to 3.97], respectively). Nearly half of all ankle sprains (49.3%) occurred during athletic activity, with basketball (41.1%), football (9.3%), and soccer (7.9%) being associated with the highest percentage of ankle sprains during athletics. An age of ten to nineteen years old is associated with higher rates of ankle sprain. Males between fifteen and twenty-four years old have higher rates of ankle sprain than their female counterparts, whereas females over thirty years old have higher rates than their male counterparts. Half of all ankle sprains occur during athletic activity.

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... The most common cases treated by orthopedic surgeons are patients with acute ankle injuries (1). About 18% of all fractures are ankle fractures (2,3). ...
... But the syndesmotic injuries with concomitant fractures should be treated surgically (11,12). Two surgical options are primarily used for the management of syndesmotic injuries: (1) direct open reduction with posterior to anterior fixation or (2) indirect reduction with anterior to posterior fixation with lag screws (13). The last one is preferred as the surgeon is familiar with the approach and the supine positioning of the patient (14,15). ...
... Our inclusion criteria were: (1) the age of the patients range from twenty to sixty years, (2) patients who suffered from closed fracture, and (3) patients who are fit for surgery. On the other hand, our exclusion criteria were: (1) patients who had open fractures, (2) vascular injuries, (3) uncontrolled diabetes mellitus, (4) nonunited and mal-united fractures, or (5) rheumatoid patients. ...
Article
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Background: About 18% of all fractures are ankle fractures. Injury of the ankle with syndesmotic ligaments usually causes instability and may require specific intervention beyond the fixation of the fracture. The syndesmotic injuries, that are isolated without displacement, are not treated surgically. But those with concomitant fractures should be treated surgically. Aim of the study: To assess the outcomes of dynamic fixation by tightrope and static fixation by conventional 3.5 mm cortical screw in patients with acute syndesmosis injuries. Patients and methods: this is a clinical trial conducted on 40 patients with acute syndesmosis injuries recruited from January 2018 to September 2020. Patients were divided into two groups according to the type of treatment. The first group were treated with a conventional 3.5 mm conventional cortical screw (Group A) and the other group were treated by ORIF using an Arthrex tightrope (group B). Results: The average age of the included patients was 26.8±4.67 in Group A and 28.2±6.3 in Group B. The overall AOFAS score was significantly higher in patients in Group B than patients in Group A after 3 months of follow-up (64.75±10.9 versus 58.5±12.9, respectively) P=0.05 and at 24 weeks follow-up (94.15±5.35 versus 86.95±11.45, respectively) P=0.005.
... Women are more often affected after the age of 30 years, which may be due to the improper selection of shoes. It has also been shown that 50% of ankle sprains occur during sports activities [2]. In the US, between 2002 and 2006, the annual reports from emergency departments recorded that 2 of 12 2/1000 patients had ankle injuries [2]. ...
... It has also been shown that 50% of ankle sprains occur during sports activities [2]. In the US, between 2002 and 2006, the annual reports from emergency departments recorded that 2 of 12 2/1000 patients had ankle injuries [2]. These facts show that ankle sprains are a global health problem that has a multifactorial background, which often develops into a chronic form and leads to a reduction in the quality of life for all age groups. ...
... Dynamic taping is an improved version of kinesiology taping that is currently recommended in physiotherapy practice [8], but there is still limited evidence for its effectiveness in the literature. Within this context, the use of dynamic taping for dysfunctions of the ankle complex seems to be important due to the high prevalence of these injuries [1,2]. ...
We aimed to investigate changes in postural stability on a stable surface after the application of dynamic tape for patients with inversion ankle sprains. This study enrolled 30 patients (age 25.5 ± 8.0 years) with grade I and II ankle sprains, which occurred 7-21 days before enrolment. Postural stability (balance, coordination, feedback) was assessed before and after the application of dynamic tape using a stabilographic platform. Three 32-s exercises were performed on the stabilographic platform, one with eyes open, one with eyes closed and one with visual feedback. After the application of dynamic tape, an improvement was observed in terms of the mean radius of sway (4.2 ± 1.3 mm vs. 3.4 ± 0.9 mm; p = 0.012) and coordination (48.8 ± 19.2% vs. 59.3 ± 5.8%; p = 0.021). Selected balance parameters did not improve significantly in the tests with open and closed eyes. Asymmetric load improved for all tests, but significant differences were only observed with eyes closed (34.9 ± 24.4 vs. 41.7 ± 30.5; p < 0.01). We concluded that the use of dynamic tape after an ankle sprain significantly improved balance and coordination on a stable surface. The benefits were shown in terms of a significant improvement in the asymmetric load of the injured limb in comparison to the healthy limb during the test with closed eyes and a considerable improvement in the asymmetric load that was evaluated with visual feedback on a stable surface.
... An age of 10-19 years old is associated with higher rates of ankle sprain in male and female. Between 15-24year-old have higher rate of ankle sprain in male than female, whereas over thirty-year-old have higher rate in female than male [13]. Numerous treatment facilities available in CAI to improve balance. ...
... Vol. 13 ...
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This is an Open Access Journal / article distributed under the terms of the Creative Commons Attribution License (CC BY-NC-ND 3.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. All rights reserved. Chronic ankle instability (CAI) is define as, the tendency toward repeated ankle sprain and improper treatment, recurring symptoms like pain, weakness, giving way feel. CAI classified into mechanical ankle instability and functional ankle instability. Balance is most commonly affected in CAI due to loss of proprioception. To find out the effectiveness of virtual reality based training (VRBT) and proprioception training in CAI for improving dynamic balance. 30 CAI subjects were selected by talar tilt and anterior drawer test and 15 consist in Group A-VRBT and 15 in Group B-proprioception training for 10 weeks. Pre-Post-test measure by star excursion balance test (SEBT) and foot and ankle disability index and Sport modules (FADI-S). Group A and Group B had improvement in dynamic balance and functional activity. Group A shows significant difference from group B in all outcome measures. The independence sample t-test in anterior p-value .000 less than .05, in P-L p-value .017 less than .05, in P-M p-value .038 is less than .05, and in FADI-S p-value .000 less than .05. Proprioception improved in both group as well as feedback, reaction time also increase in VRBT group. It was concluded that virtual reality based training is more effective than proprioception training for improving dynamic balance in chronic ankle instability.
... This is not always due to decreased incidence of partial tears or ligamentous sprain, but it is rather due to decreased number of patients presenting with those injuries as they considered a milder injury that could be treated conservatively from the patient's point of view. So, in this study, there is decreased prevalence of partial tears and ankle sprains, but this was in contradiction to another study which conducted in USA [12] . The percentage of Tenosynovitis was 14% and this could confirm the fact that tenosynovitis requires time to develop and most of the presenting cases were acute injuries, similar findings were found in a parallel study conducted in Korea showing ATFL injury in ninety percent of patients [13] . ...
Article
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Background: Ankle injuries occur frequently and represent around 10% of all emergency department admissions. The preferred diagnostic modality for evaluating ankle injuries is Magnetic resonance imaging, because of its better soft tissue contrast; noninvasive imaging, as well as its scanning capability in several planes. Aims: This study aimed to highlight the importance of MRI in the assessment of patients with Ankle pain as a result of a traumatic injury in Taif, Saudi Arabia. Methods and materials: a retrospective study was carried out at King Abdulaziz Specialist Hospital in Taif, from October 2021 to February 2022. 56 traumatic patients were enrolled in the study. All images were evaluated by two expert radiologists. Results: Out of 56 patients; 31 (55%) were males and only 25 (45%) were females, the mean age was found to be 34. ± 12. Acute onset of pain was (82%) and (18%) was chronic. 44 (79%) of the respondents had joint effusion and 37 (66%) had ATFL Anterior Talofibular Ligament injuries. Regarding tendons injury, the most reported injury was tenosynovitis (14.3%). Deltoid ligament injury is significantly associated with age (P-value = .005), since those 35 years old or less are more frequently prone to have deltoid ligament injury (44%) than those more than 35 years old (9%). Conclusion: The MRI is the perfect modality of choice in the assessment of traumatic ankle injuries because it has higher sensitivity detection when compared to other modalities.
... Ankle sprain is a common sports injury [1] that usually occurs during jump and landing activities [2][3][4][5] in a foot-inversion position [6,7] and may lead to chronic ankle instability (CAI) [8]. Proprioception is fundamental for neuromuscular control in ankle injury, and can be defined as the ability of an individual to integrate sensory signals from mechanoreceptors to perceive the location and spatial movement of body parts [9]. ...
Article
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Proprioception is essential for neuromuscular control in relation to sport injury and performance. The effect of landing heights and loads on ankle inversion proprioceptive performance in individuals with or without chronic ankle instability (CAI) may be important but are still unclear. Forty-three participants (21 CAI and 22 non-CAI) volunteered for this study. The Ankle Inversion Discrimination Apparatus for Landing (AIDAL), with one foot landing on a horizontal surface and the test foot landing on an angled surface (10°, 12°, 14°, 16°), was utilized to assess ankle proprioception during landing. All participants performed the task from a landing height of 10 cm and 20 cm with 100% and 110% body weight loading. The four testing conditions were randomized. A repeated measures ANOVA was used for data analysis. The result showed that individuals with CAI performed significantly worse across the four testing conditions (p = 0.018). In addition, an increased landing height (p = 0.010), not loading (p > 0.05), significantly impaired ankle inversion discrimination sensitivity. In conclusion, compared to non-CAI, individuals with CAI showed significantly worse ankle inversion proprioceptive performance during landing. An increased landing height, not loading, resulted in decreased ankle proprioceptive sensitivity. These findings suggest that landing from a higher platform may increase the uncertainty of judging ankle positions in space, which may increase the risk of ankle injury.
... Ankle ligament sprain is one of the most common joint injuries in daily life and sport activities. An epidemiological study has revealed that the estimated incidence rate of ankle sprains in the general population presenting to emergency departments in the United States is 2.15 per 1000 person-years, and nearly half of all ankle sprains occur during athletic activity [38]. Up to 40% of patients with acute ankle sprain are likely to develop chronic ankle instability (CAI) [9]. ...
Article
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Background: This study aims to explore the relationship between surgically-induced ankle instability and posttrau-matic osteoarthritis (PTOA) in a mouse model, and to provide reference for clinical practice. Results: Ligamentectomy was performed on 24 eight-week-old male C57BL/6 J mice, which were divided into three groups. Both the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) were severed in the CFL + ATFL group, while only the CFL was removed in the CFL group. The SHAM group was set as the blank control group. A wheel-running device was used to accelerate the development of ankle osteoarthritis (OA). Balance measurement, footprint analysis, and histological analysis were used to assess the degree of ankle instability and OA. According to the balance test results, the CFL + ATFL group demonstrated the highest number of slips and the longest crossing beam time at 8 weeks postoperatively. The results of gait analysis exhibited that the CFL + ATFL group had the most significant asymmetry in stride length, stance length, and foot base width compared to the CFL and SHAM groups. The OARSI score of the CFL + ATFL group (16.7 ± 2.18) was also much higher than those of the CFL group (5.1 ± 0.96) and the SHAM group (1.6 ± 1.14). Conclusion: Based on the mouse model, the findings indicate that severe ankle instability has nearly three times the chance to develop into ankle OA compared to moderate ankle instability.
... Ankle sprains were investigated in three studies. [124][125][126] The studies were published between 1994 and 2010 and contained data ending in the years between 1990 and 2006. All three studies were included in the pooled incidence of 429.4 (95% CI 243.0 to 759.0) per 100,000 person-years. ...
Article
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Aims The aim of this systematic review and meta-analysis was to gather epidemiological information on selected musculoskeletal injuries and to provide pooled injury-specific incidence rates. Methods PubMed (National Library of Medicine) and Scopus (Elsevier) databases were searched. Articles were eligible for inclusion if they reported incidence rate (or count with population at risk), contained data on adult population, and were written in English language. The number of cases and population at risk were collected, and the pooled incidence rates (per 100,000 person-years) with 95% confidence intervals (CIs) were calculated by using either a fixed or random effects model. Results The screening of titles yielded 206 articles eligible for inclusion in the study. Of these, 173 (84%) articles provided sufficient information to be included in the pooled incidence rates. Incidences of fractures were investigated in 154 studies, and the most common fractures in the whole adult population based on the pooled incidence rates were distal radius fractures (212.0, 95% CI 178.1 to 252.4 per 100,000 person-years), finger fractures (117.1, 95% CI 105.3 to 130.2 per 100,000 person-years), and hip fractures (112.9, 95% CI 82.2 to 154.9 per 100,000 person-years). The most common sprains and dislocations were ankle sprains (429.4, 95% CI 243.0 to 759.0 per 100,000 person-years) and first-time patellar dislocations (32.8, 95% CI 21.6 to 49.7 per 100,000 person-years). The most common injuries were anterior cruciate ligament (17.5, 95% CI 6.0 to 50.2 per 100,000 person-years) and Achilles (13.7, 95% CI 9.6 to 19.5 per 100,000 person-years) ruptures. Conclusion The presented pooled incidence estimates serve as important references in assessing the global economic and social burden of musculoskeletal injuries.
... Hintergrund Die Sprunggelenksdistorsion ist die häufigste muskuloskelettale Verletzung bei körperlich aktiven Menschen [1]. In deren Anschluss kann eine chronische Sprunggelenksinstabilität (CSI) entstehen [2]. ...
Poster
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Hintergrund: In der nicht-operativen Behandlung der chronischen Instabilität des Sprunggelenks (CSI) konnten in der Vergangenheit funktionelle Verbesserungen durch manuelle Gelenkmobilisationen und -manipulationen am Sprunggelenk festgestellt werden. Bisher wurden die beiden manualtherapeutischen Techniken hinsichtlich ihrer akuten Wirksamkeit in der Therapie von CSI jedoch noch nicht miteinander verglichen. Zielstellung: Das Ziel dieser Studie war zu untersuchen, welchen kurzfristigen Einfluss eine einmalige manuelle talocrurale Gelenkmobilisierung im Vergleich zu einer Gelenkmanipulation auf das Bewegungsausmaß, die statische und dynamische posturale Kontrolle sowie das Instabilitätsempfinden bei Sportlern mit CSI hat. Methodik: In dieser doppelt verblindeten, randomisierten, vergleichenden Pilotstudie wurden die Teilnehmer anhand der Kriterien des International Ankle Consortiums rekrutiert. Zwölf Teilnehmer*innen mit CSI [fünf Frauen, sieben Männer; Alter (MW ± SD): 23,17 ± 5,44 Jahre; Größe: 182,00 ± 9,16 cm; Gewicht: 81,42 ± 19,46 kg] wurden randomisiert in zwei Gruppen (sechs pro Gruppe) eingeteilt. Beide Gruppen erhielten eine kurze manualtherapeutische Behandlung, entweder eine Mobilisation (G1) oder eine Manipulation (G2), am Sprunggelenk. Hinsichtlich der Behandlungszuteilungen wurden die Patienten verblinded. Bezüglich der erhobenen Messwerte wurde der Behandler verblinded. Im Rahmen der Ein- und Ausgangsmessungen wurden das Bewegungsausmaß mithilfe des Weight-bearing Lunge Tests (WBTL), die statische posturale Kontrolle durch das Balance Error Scoring System (BESS) und die dynamische posturale Kontrolle mittels Star Excursion Balance Test (SEBT) in anteriore, posteromediale und posterolaterale Richtung unmittelbar vor und nach der Behandlung gemessen. Zur Ermittlung der Ausprägung des Instabilitätsgefühls bei CSI wurde der Fragebogen Cumberland Ankle Instability Tool (CAIT) vor und im Follow-Up eine Woche nach der Behandlung ausgefüllt. Ergebnisse: Signifikante Unterschiede in der Gesamtgruppe ergaben sich zwischen beiden Messzeitpunkten beim WBLT (p = 0,005), BESS (p = 0,009), SEBT in anteriore Richtung (p = 0,014) und CAIT (p = 0,008). Im Vergleich zwischen beiden Interventionen (Gruppen) gab es keinen statistisch signifikanten Unterschied in allen Outcomes. Schlussfolgerung: Unabhängig von der manuellen Behandlungstechnik in Form einer talocruralen Gelenkmobilisierung oder –manipulation, scheinen Sportler*innen mit CSI kurzfristige funktionelle Verbesserungen zu erfahren, die sich positiv auf das individuelle Stabilitätsempfinden am betroffenen Sprunggelenk auswirken können. Die Relevanz und die Generalisierbarkeit der Ergebnisse für die Population von Sportler*innen mit CSI kann aus den Ergebnissen der vorliegenden Studie nicht abgeleitet werden. Eine randomisierte kontrollierte Studie mit größerer Fallzahl sollte folgen.
... [1] Ankle sprains cause pain and restricted range of motion; it can lead to functional deficits or disability, post-traumatic osteoarthritis, and chronic ankle instability. [2][3][4] These signs can appear in 44% of patients with a sprain one year after the injury. [5] It is known that aspects such as foot type (supinated, neutral, or pronated), general joint laxity, or gender are not risk factors. ...
Article
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Background: The lateral sprain of the ankle is a very frequent injury in the population in general, appearing in the emergency services frequently. The general objective was to review the current clinical practice guidelines (CPGs) on management and treatment of ankle sprains, assess their quality, analyze the levels of evidence and summarize the grades of recommendation. Methods: A systematic search of the literature in relevant databases with the search terms "ankle," "sprain," "practice guideline," and "guideline" was carried out. There were included those guidelines that had the system of grades of recommendation and level of evidence concerning to management and treatment of ankle sprain. The quality of the guides was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Results: Seven clinical practice guides were included in this review. The AGREE II scores ranged from 42% to 100%, with only six CPGs explicitly declaring the use of a systematic methodology. Seventeen recommendations were extracted and summarized. Discussion: Six of the recommendations analyzed present enough evidence to be applied in clinical practice and are highly recommended for ankle sprain management: Ottawa rules, manual therapy, cryotherapy, functional supports, early ambulation, short term NSAIDs and rehabilitation.
... Waterman ve ark. (16) yaptığı çalışmada hastaların yaklaşık yarısında atletik aktivite sırasında yaralanmanın meydana geldiği saptanmıştır. Hølmer ve ark. ...
... The incidence rate of ankle sprains is 2 to 7 per 1000 person-years in the general population, and lateral ankle ligament injury accounts for up to 80% of the ankle sprains. 16,29,37 Acute injury can be treated using conservative treatment modalities such as ankle bracing, ice packing, and subsequent physical therapy. Approximately 30% of patients who do not respond to nonoperative management can develop chronic lateral ankle instability (CLAI). ...
Article
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Background: Roughly 30% of patients with chronic lateral ankle instability (CLAI) have long-lasting painful instability requiring surgical intervention. Ligament reconstruction with the traditional open method and using tendon allografts can provide sufficient mechanical stability for severe CLAI. Arthroscopic ligament reconstruction with tendon allograft has recently been introduced to treat CLAI. Purpose: In this study, we describe an arthroscopic ligament reconstruction procedure involving the use of the tendon allograft for patients with CLAI, and we compare the efficacy of this procedure with open ligament reconstruction with tendon allograft. Study design: Cohort study; Level of evidence, 3. Methods: We enrolled 10 patients (4 men and 6 women) with CLAI (mean age, 37.3 years; range, 16-57 years) who underwent arthroscopic ligament reconstruction with tendon allografting between November 2017 and June 2019. The control group consisted of 10 patients who received open tendon allograft reconstruction. Preoperative and 2-year postoperative functional outcomes were evaluated using the American Orthopaedic Foot & Ankle Society ankle-hindfoot scale (AOFAS), Karlsson Ankle Functional Score (KAFS), pain visual analog scale (VAS), 12-Item Short Form Health Survey (SF-12), and Tegner activity score (TAS). Results: The mean operative time was 118 and 110 minutes in the arthroscopic and open groups, respectively. At 2-year follow-up, scores on the AOFAS improved significantly compared with preoperatively, from 71.3 to 96.4 (P = .006) in the arthroscopic group, and from 68.6 to 96.7 (P = .005) in the open group. The postoperative AOFAS, VAS, KAFS, and SF-12 scores did not differ significantly between the 2 groups; however, the TAS score was significantly higher in the arthroscopic reconstruction group compared with in the open group (7 vs 6.1, respectively; P = .01). Conclusion: Arthroscopic ligament reconstruction with tendon allografting resulted in sufficient ankle stability and no donor-site morbidity. This procedure can yield similar functional outcomes to open reconstruction technique and may be an option for the management of CLAI.
... Although it is a nondisabling condition, ankle sprain has persisting consequences, which finally precipitate a chronic health problem. Previous literature revealed that the incidence of ankle sprains in the United States is 2.15 per 1000 participants per year (58.4 sprains for every1000 individuals per year) in armed forces, constituting a financial burden of $4.5 billion each year [4]. Optimum balance is a crucial determinant of accomplishing reasonable lower extremity function [5]. ...
Article
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Aim. To explore whether the eccentric muscle strength of both hip abductors and external rotators differ in participants with subacute lateral ankle sprain and healthy population, and to compare the Biodex balance measures as well. Material and methods. Thirty males diagnosed as a second degree ankle sprain enrolled in this study, while twenty-nine healthy volunteers considered as controls. The study measured both the peak eccentric torque for both hip abductors and external rotators using Biodex isokinetic dynamometer. All participants examined for bilateral and unilateral balance ability using Biodex balance system from erect position to determine total stability index (SI), anteroposterior index (API), and mediolateral index (MLI). Results. A detected signi icant negative correlation was obvious between peak eccentric isokinetic testing for hip external rotators torque; and total SI, API, and MLI of all the Biodex balance system measures for bilateral stance and API in unilateral stance. While, a moderate signi icant positive correlation found for peak eccentric isokinetic torques between both hip external rotators and abductors. Conclusion. Decreased hip muscle strength can increase the vulnerability of ankle ligaments via minimizing the postural control during weight-bearing activities, which, in turn, stimulates the compensatory neuromuscular mechanisms. Streszczenie Cel. Zbadanie, czy ekscentryczna siła mięsńi zarówno mięsńi odwodzących bioder, jak i rotatorów zewnętrznych rózṅi się u pacjentów z podostrym bocznym skręceniem stawu skokowego i u osób zdrowych, a takzė porównanie miar równowagi Biodex. Materiał i metody. Trzydziestu męzċzyzn ze zdiagnozowanym skręceniem stawu skokowego drugiego stopnia wzięło udział w badaniu, podczas gdy dwudziestu dziewięciu zdrowych ochotników uznano za grupę kontrolną. W badaniu mierzono zarówno szczytowy ekscentryczny moment obrotowy zarówno dla mięsńi odwodzących bioder, jak i rotatorów zewnętrznych za pomocą izokinetycznego dynamometru Biodex. Wszystkim uczestnikom zbadano dwustronną i jednostronną zdolnosć́ do utrzymywania równowagi przy uzẏciu systemu równowagi Biodex z pozycji wyprostowanej w celu okresĺenia wskazńika całkowitej stabilnosći (SI), wskazńika przednio-tylnego (API) i wskazńika sŕodkowo-bocznego (MLI). Wyniki. Wykryta istotna ujemna korelacja była oczywista między szczytowymi ekscentrycznymi testami izokinetycznymi dla momentu obrotowego zewnętrznych rotatorów stawu biodrowego; oraz całkowite SI, API i MLI wszystkich miar systemu bilansowego Biodex dla pozycji dwustronnej i API dla pozycji jednostronnej. Stwierdzono umiarkowaną istotną dodatnią korelację dla szczytowych ekscentrycznych izokinetycznych momentów obrotowych między zewnętrznymi rotatorami stawu biodrowego i mięsńiami odwodzącymi. Wniosek. Zmniejszona siła mięsńi bioder mozė zwiększyć wrazliwosć́ więzadeł stawu skokowego poprzez zminimalizowanie kontroli postawy podczas cẃiczeń z obciązėniem, co z kolei stymuluje kompensacyjne mechanizmy nerwowo-mięsńiowe. Słowa kluczowe System równowagi Biodex, szczytowy moment izokinetyczny, podostre skręcenie stawu skokowego, osłabienie mięsńia biodrowego i wskazńik stabilnosći równowagi
... Ankle sprains are known to be the most common musculoskeletal ankle injury. 24 Cavus foot structure is a predisposing condition. Concurrently with a lateral ankle sprain, the peroneus longus tendon is often injured. ...
Article
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Current biomechanical theory of foot and ankle movement has been in transition over the last 25 years. A clear explanation of current status and the impact on foot orthosis therapy is provided.
... incidence rates of ankle sprain in men and women were 2.20 and 2.10 per 1000 person-years, respectively (NS) [29]. Similar findings were observed in young male and female athletes [30]. ...
Article
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Background A number of studies have evaluated risk factors for lateral ankle sprain (LAS) or chronic lateral ankle instability (CLAI). However, the definitive risk factors for LAS or CLAI remain controversial. The purpose of this study was to evaluate whether the contralateral healthy ankles of subjects with ipsilateral mechanical lateral ankle laxity (group I) show greater lateral ankle laxity in comparison to the healthy ankles of bilateral healthy controls (group B). Methods From March 2020, anterior talofibular ligament (ATFL) lengths of young adult volunteers were cross-sectionally measured in non-stress and stress positions using a previously reported stress ultrasonography (US) procedure. The ATFL ratio (the ratio of stress ATFL/non-stress ATFL length) was calculated as an indicator of lateral ankle laxity. The manual anterior drawer test (ADT) was also performed. The US findings of healthy ankles from groups I and B were compared. Results A total of 154 subjects in group B (mean age, 24.5 ± 2.8 years; male/female, 84/70) and 40 subjects in group I (mean age, 24.4 ± 2.3 years; male/female, 26/14) were included in the study. There was no significant difference in the ADT between the groups. There were no significant differences in the non-stress ATFL length (19.4 ± 1.8 vs. 19.3 ± 1.9, p = 0.84), stress ATFL length (20.8 ± 1.8 vs. 20.9 ± 1.9, p = 0.66), length change (1.5 ± 0.6 vs. 1.6 ± 0.6, p = 0.12) and ATFL ratio (1.08 ± 0.03 vs. 1.08 ± 0.03, p = 0.13) between the groups. Conclusion No significant difference was detected between the contralateral healthy ankles of subjects with ipsilateral mechanical lateral ankle laxity and those of bilateral healthy controls.
... Ankle sprains have consistently remained one of the most common musculoskeletal injuries in the United States. It was estimated two million ankle sprains occurred each year in the United States, which account for 20% of all sports injuries (26). However, this number is most likely an underestimation because many injured people may not understand the severity and do not seek medical attention (10). ...
Article
Ankle sprains account for about 20% of all sports injuries in the United States. About 5-10 minutes of general warm-up is recommended to enhance performance and reduce injuries. However, its immediate impact on single-leg balance is unclear. The purpose of the study was to examine if different warm-up protocols could impact single-leg balance in individuals with and without functional ankle instability. Thirty volunteers (aged 19-29 years) participated in the study. The Cumberland Ankle Instability Tool was used to examine functional ankle stability and the Athletic Single-leg Stability Test of the Biodex Balance System was used to examine single-leg balance. Subjects were examined in three separate sessions (no warm-up, 5-minute warm-up, or 10-minute warm-up) with one week apart. Results show warm-up conditions had a significant impact on single-leg balance (p = .021). Pairwise comparisons showed the balance after the 5-minute warm-up was significantly worse than the no warm-up condition (p = .000). It is possible that warm-up makes the tissues surrounding lower extremity joints more flexible, therefore making single-leg balance control more challenging. In addition, subjects with functional ankle instability exhibited significantly worse single-leg balance than those without functional ankle instability (p = .003). However, the immediate effect of warm-up on balance control was similar between individuals with and without functional ankle instability. Clinicians should consider implementing single-leg balance testing and training for those who are identified as having functional ankle instability. Despite its known benefits of enhancing performance and reducing injuries, general warm-up activities may have an immediately negative effect on single-leg balance control.
... An ankle sprain is one of the most common injuries in athletes, typically involving the lateral ankle ligaments. 6,15,19,32 In most cases, lateral ankle ligament injuries respond well to nonoperative therapies such as external immobilization and physical therapy, which provide satisfactory therapeutic outcomes. 11,14 However, approximately 20% of patients develop chronic lateral ankle instability (CLAI), leading to repeated sprains and, in some cases, the development of osteoarthritis. ...
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Background Although the minimal invasiveness of arthroscopic ankle lateral ligament repair (ALLR) means that an early return to sporting activities can be anticipated, studies have described postoperative cast immobilization and the avoidance of weightbearing for a certain period. Accelerated rehabilitation may be helpful for an early return to sport. Purpose To investigate clinical outcomes of ALLR and accelerated rehabilitation with a minimum duration of postoperative ankle immobilization and proactive early weightbearing. Study Design Case series; Level of evidence, 4. Methods This study investigated 23 ankles of 22 patients (11 men, 11 women; mean age, 38.7 years) who underwent ALLR for chronic lateral ankle instability. Postoperative management included the avoidance of weightbearing until postoperative day 3, after which full weightbearing walking with a brace was permitted. The objective was to return to competitive sport 8 weeks after surgery. The following were evaluated: pre- and postoperative instability and pain symptoms, ankle range of motion, anterior drawer distance on stress radiograph, anterior translation measured with a capacitance-type strain sensor, the Ankle-Hindfoot Scale from the Japanese Society for Surgery of the Foot, and the SAFE-Q (Self-Administered Foot Evaluation Questionnaire). Results Two male patients dropped out and were excluded from analysis. Postoperatively, instability and pain resolved or improved in all patients. There was no significant postoperative change in range of motion. There were significant pre- to postoperative improvements in talar tilt angle (from 12.2°-5.6°, P < .01), anterior drawer distance (8.2-4.4 mm, P < .01), and anterior translation (10.5-4.6 mm, P < .01) as well as the Ankle-Hindfoot Scale score (68.8-96.8, P < .01) and all subscales of the SAFE-Q ( P ≤ .01 for all). Complete return to sport was achieved by 75% of the patients at 8 weeks postoperatively. Conclusion When accelerated rehabilitation with proactive weightbearing exercises was implemented from postoperative day 3 without ankle immobilization after ALLR, there were significant improvements in objective assessments of ankle stability and clinical scores, and as many as 75% of the patients were able to make a complete return to sport within 8 weeks.
... Ankle sprains involving the lateral ligament are the most frequently occurring injuries in sports and physical activities [1,2]. Most of them are treated conservatively, but in some cases, there may be residual symptoms, such as pain and instability during exercise and daily activity, which may progress to chronic ankle instability [3][4][5]. ...
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Background The manual traditional anterior drawer test (ADT) is essential for deciding the treatment for chronic ankle instability, but it has been shown to have a comparatively low reproducibility and accuracy, especially in less experienced hands. To clarify the inter-examiner reproducibility, we compared the actual distance of anterior translation between junior and senior examiners in ADT. We also evaluated the diagnostic abilities of traditional ADT, and a novel modified ADT (fixed ADT). Methods Thirty ankles were included in this study, and ankle instability was defined using stress radiography. All subjects underwent two methods of manual ADT by junior and senior examiners, and ankle instability was judged in a blinded fashion. The anterior drawer distance was calculated from the lengthening measured using a capacitance-type sensor device. Results The degree of anterior translation determined by the junior examiner was significantly lower than that determined by the senior examiner when traditional ADT was performed (3.3 vs. 4.5 mm, P=0.016), but there was no significant difference in anterior translation between the two examiners when fixed ADT was performed (4.6 vs. 4.1 mm, P=0.168). The inter-examiner reliability of fixed ADT was higher than that of traditional ADT. For the junior examiner, the diagnostic accuracy of fixed ADT was higher than that of traditional ADT (sensitivity, 0.40 vs. 0.80; specificity, 0.75 vs. 0.80). Conclusion Fixed ADT may have the advantage of being a simple manual test of ankle instability with less error between examiners.
... Ankle sprains are among the most commonly reported sports injuries, and up to 18% of ankle sprains involve the syndesmotic ligament complex [1,20,22,41]. Colloquially referred to as a high ankle sprain, the most critical aspect of initial assessment is distinguishing stable from unstable injuries. High ankle sprains are especially caused by a forced external rotation injury, which may result in sequential injury to the anterior inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), and posterior inferior tibiofibular ligament (PITFL) [14,24,37]. ...
Article
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Purpose Portable ultrasonography (P-US) is increasingly used to diagnose syndesmotic instability. The aim of this study was to evaluate syndesmotic instability by measuring the distal tibiofibular clear space (TFCS) in a cadaveric model using P-US with progressive stages of syndesmotic ligamentous transection under external rotation stress. Methods Ten fresh lower leg cadaveric specimens amputated above the proximal tibiofibular joint were used. Using P-US, the TFCS was evaluated in the intact stage and after progressive sectioning of the (1) anterior–inferior tibiofibular ligament (AITFL), (2) interosseous ligament (IOL), and (3) posterior–inferior tibiofibular ligament (PITFL). The TFCS was measured in both the unstressed (0 Nm) state and with 4.5, 6.0, 7.5, and 9.0 Nm of external rotation stress using a bone hook placed on the first metatarsal bone at each stage of ligamentous transection stage using both P-US and fluoroscopy. Results When assessed with P-US, partial syndesmotic injury encompassing the AITFL and IOL resulted in significant TFCS widening at 4.5 Nm of external rotation torque when compared to intact state with a TFCS-opening of 2.6 ± 2 mm, p = 0.01. In contrast, no significant differences in TFCS were detected using fluoroscopy. Only a moderate correlation was found between P-US and fluoroscopy. Conclusion P-US is a useful tool in diagnosing syndesmotic instability during external rotation stress examination. TFCS-opening increased as additional ligaments of the syndesmosis were transected, and application of 4.5 Nm torque was sufficient to detect a difference of 2.6 mm after the IOL cut.
... Ankle sprains are one of the most prevalent musculoskeletal injuries, with athletes in the United States reporting ankle sprain accounting for 15% of total injuries [1]. More than 70% of individuals that experience initial lateral ankle sprain (LAS) develop chronic ankle instability (CAI) [2] that leads to compromised joint capsule, ligament, tendon, and muscle integrity. ...
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More than 70% of people with ankle sprain experience chronic ankle instability. However, some people are well adapted to this damage (copers) and do not suffer from chronic ankle instability (CAI). This cross-sectional study involved 34 female athletes, who were classified into three groups (athletes with CAI, copers, and healthy athletes) and tested on a Biodex Balance System. Surface electromyography (EMG) and balance scores were monitored. The coper and healthy group exhibited higher medial gastrocnemius (MG) EMG activity during unstable balance conditions. The rectus abdominus (RA) in the coper group and rectus femoris (RF) in the healthy group showed greater EMG activity compared to CAI during unstable conditions. During stable conditions, the coper group showed greater RA EMG activity compared to CAI, as well as higher tibialis anterior (TA) EMG activity compared to the healthy group. Additionally, balance error scores were higher in the CAI group than those in the healthy group under unstable conditions. In conclusion, decreased EMG activity of the MG, RF, and RA in CAI athletes may contribute to impaired balance in these individuals. The increased EMG activity of the MG, TA, and RA in copers might result in more trunk and ankle stability.
... In the general population [10][11][12][13][14][15][16][17][18][19] year olds are at the greatest risk of acute ankle sprain. 8 Severe ankle injuries predispose children to ongoing mechanical and functional instability, with children who engage in dance being more likely to sustain functional instability. 44 ...
Article
Background/aims Ankle sprains are common injuries which can lead to chronic lateral ankle ligament instability (CAI). Methods The aim of this review is to provide a comprehensive overview of the epidemiology, pathophysiology, investigation, surgical management and rehabilitation of CAI. Results Investigation of CAI is based on history, clinical examination, and imaging. Surgical management of CAI can be defined as anatomic reconstruction, anatomic and non anatomic repair of ATFL and/or CFL. Anatomic repair has been shown to have better functional outcomes and less secondary osteoarthritis when compared to non anatomic repair. Non-anatomic methods do not replicate the normal anatomical course of ATFL/CFL and may lead to stiffness. The most common surgical treatment for CAI is the open modified Broström repair augmented with the Gould modification. There are arthroscopic techniques being developed which have reported promising clinical results. However, there are considerable areas of further research which should be carried out to improve understanding and effectiveness of current treatment options. Standardised validated patient reported outcome measures and evidence-based protocols in the rehabilitation periods are crucial for positive and reproducible outcomes. Conclusion Surgical repair has proven to show excellent outcomes for patients suffering from CAI, however larger prospective studies should be carried out to evaluate the use of newer surgical techniques.
... Ankle sprains represent the most common musculoskeletal injury in sports (Fong et al., 2007;Waterman et al., 2010) and have a high rate of re-injury, ranging between 12 and 47% according to the sport specificity (Herzog et al., 2019). It is well-established that impairment of postural control is one of the most important risk factors (Delahunt and Remus, 2019). ...
Article
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Background: Ankle sprain is one of themost common injuries in sport, and hip abductor muscle weakness has recently been reported as a predisposing factor. Currently, the influence of hip abductor muscle fatigue on ankle joint control has not been elucidated during an ankle disturbed balance exercise. This study aimed to determine the influence of hip abductor muscle fatigue on ankle joint control during a disturbed balance task, and to consider inter-individual variability in the kinematic and neuromuscular reorganizations implemented. Methods: Twenty-six healthy subjects (13 males; 13 females) performed a unipedal postural balance task with eyes closed before and after a fatiguing exercise (up to a 50% decrease in strength) of the hip abductor muscles. Subjects completed balance task while equipped with an ankle destabilization device that allows inversion/eversion movements. Electromyographic (EMG) activity of the gastrocnemius lateralis (GastL), peroneus longus (PL) and brevis, tibialis anterior, and gluteus medius were recorded during task. Kinematics (e.g., frontal foot angulation) of the ankle complex were determined using inertial measurement units. Results: In the overall group, no significant time, sex or interaction effect was observed for kinematic and EMG variables. However, when considering individual responses to hip fatigue, 14 subjects decreased the standard deviation of frontal angulation (−30%) suggesting enhancement of ankle joint control, while 12 subjects increased it (+46%). Normalized EMG for PL and GastL muscles changed with fatigue for both these groups. However, variations were significantly different between groups (p = 0.027 for PL and p = 0.006 for GastL). Indeed, the contribution of ankle muscles increased for the enhanced-stability group while no change for the impaired-stability group. Conclusion: These results highlight that subject adopt different neuromuscular and kinematic ankle strategies to control ankle destabilization in response to hip abductor muscle fatigue. Frontal foot angulation variability seemed to be a valuable marker to detect the type of strategy employed. The strategy adopted by the impaired-stability group might have important implications when analyzing risk factors for ankle sprains. Further studies should consider individual responses to fatigue, to understand which factor could predispose athletes to use of one or other strategy.
... The nature of injuries occurring at the ankle include sprains, fractures, dislocations, and ruptures [17]. Sprains have been recorded at two million occurrences per year in the United States, where half (49.3%) are attributed to athletic activities [18]. In sporting populations specifically, ankle sprains are responsible for 15% of all diagnosed injuries [19]. ...
Article
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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 seventeen 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 twenty categories of risk factors investigated for ankle sprain association across seventeen 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.
... Ankle injuries are among the most frequently observed musculoskeletal injuries sustained during physical activity. [10][11][12]19,27 In the National Football League (NFL), lower extremity injuries, including ankle sprains and fractures, account for up to 60% of total injuries during a competitive season. 16 Furthermore, previous literature has demonstrated that ankle injuries are the most common injuries that occur in football players, with only knee injuries found to be more common in certain analyses. ...
Article
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Background Traumatic ankle injuries are commonly complicated by persistent symptoms and the development of chronic ankle instability. Purpose To describe the epidemiology of ankle injuries in the National Football League (NFL) and investigate the effects that ankle injuries have on performance metrics in the years after injury. Study Design Descriptive epidemiologic study. Methods Ankle injuries sustained by NFL players during the 2015-2016, 2016-2017, and 2017-2018 seasons were identified using the Pro Football Reference database. Cumulative incidence was calculated, and demographic identifiers were collected for each injury. The return-to-play (RTP) rate was also recorded. For each player who met inclusion for the performance analysis, power rating (PR) was calculated for the preinjury season (Y–1) and 2 postinjury seasons (Y+1 and Y+2) as follows: PR = ( offensive yards/10) + ( total touchdowns × 6) + ( combined tackles) + ( sacks × 2) + ( interceptions × 2). Mean PRs were calculated for each season as well as the percentage change and mean difference in PR between Y–1 and Y+1 (ΔPR 1 %, ΔPR 1 ) and between Y–1 and Y+2 (ΔPR 2 %, ΔPR 2 ). Subgroup analyses of PR were performed by player position, injury type, and years of experience. Results Overall, 668 ankle injuries were identified, with an average cumulative incidence across the 3 seasons of 11.2% and RTP rate of 91%. Of those injuries, 159 met inclusion criteria for the PR analysis. The mean overall PR (96.95 in Y–1) declined 22% in Y+1 to 76.10 (–20.85 [95% CI, –13.82 to –27.89]; P < .001) and 27% in Y+2 to 70.93 (–26.02 [95% CI, –18.04 to –34.00]; P < .001). The mean PR per game played (6.70 in Y–1) decreased 14% in Y+1 to 5.75 (–0.95 [95% CI, –0.56 to –1.34]; P < .001) and 17% in Y+2 to 5.54 (–1.16 [95% CI, –0.63 to –1.62]; P < .001). Conclusion It was found that ankle injuries hampered the performance of NFL players, even multiple years after the injury occurred, despite a relatively high RTP rate. There was a decrease in total games played after ankle injuries as well as a decreased performance output per game played.
... A lateral ankle sprain is one of the most prevalent orthopedic and sports injuries that can lead to long-term complications (Waterman et al., 2010;Wallace et al., 2011). Following an initial sprain, many individuals experience lingering residual symptoms such as frequent episodes of ankle giving way and recurrent ankle sprains (Hertel, 2002). ...
Article
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Purpose An investigation of the ankle dynamics in a motor task may generate insights into the etiology of chronic ankle instability (CAI). This study presents a novel application of recurrence quantification analysis (RQA) to examine the ankle dynamics during walking. We hypothesized that CAI is associated with changes in the ankle dynamics as assessed by measures of determinism and laminarity using RQA. Methods We recorded and analyzed the ankle position trajectories in the frontal and sagittal planes from 12 participants with CAI and 12 healthy controls during treadmill walking. We used time-delay embedding to reconstruct the position trajectories to a phase space that represents the states of the ankle dynamics. Based on the phase space trajectory, a recurrence plot was constructed and two RQA variables, the percent determinism (%DET) and the percent laminarity (%LAM), were derived from the recurrence plot to quantify the ankle dynamics. Results In the frontal plane, the %LAM in the CAI group was significantly lower than that in the control group ( p < 0.05. effect size = 0.86). This indicated that the ankle dynamics in individuals with CAI is less likely to remain in the same state. No significant results were found in the %DET or in the sagittal plane. Conclusion A lower frontal-plane %LAM may reflect more frequent switching between different patterns of neuromuscular control states due to the instabilities associated with CAI. With further study and development, %LAM may have the potential to become a useful biomarker for CAI.
... With a peak ankle incident rate between the ages of ten and nineteen, high school athletes are specifically susceptible to ankle sprains, accounting for 22.6% of all sports related musculoskeletal injuries. 1,2 The highest incidence in high school sports of ankle sprains occurs in boys basketball (7.74 per 10,000 exposures), followed by girls basketball (6.93 per 10,000 exposures) and boys' football (6.52 per 10,000 exposures). 2 Approximately 85% of ankle injuries occur after excessive inversion and plantarflexion of the foot combined with external rotation of the distal leg, which results in damage to the lateral ligament complex. 3 Of the three lateral ligaments, the anterior talofibular ligament (ATFL) is the weakest and is more frequently involved in ankle sprains than the calcaneofibular ligament or the posterior talofibular ligament. ...
Article
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Ankle injuries are common among high school athletics with the highest incidence rates in boys and girls basketball and boys football. Novel treatment paradigms like the Mulligan Mobilization with Movement (MWM) in conjunction with fibular repositioning tape have shown promising results in reducing pain, disability and time lost due to lateral ankle sprains. However, research focusing on the Mulligan treatment strategies and ankle swelling following a lateral ankle sprain is limited. Therefore, the purpose of this case series was to evaluate the combined effects of the MWM and fibular repositioning taping on swelling, function, and pain in high school patients with an acute grade 1 LAS. A convenience sample of seven (4 females, 3 males, 5 right ankle, 2 left ankle injuries) consecutive high school patients (15.9± 1.4 years of age; range = 14-18 years) were evaluated following an acute lateral ankle sprain and treated with the Mulligan MWM and fibular repositioning tape. Subjective evaluation of pain, self-report function and disability were assessed throughout the treatment process utilizing PROMs. Specifically, the Numeric Pain Rating Scale, Disablement in the Physically Active scale, Foot and Ankle Ability Measure and the Foot and Ankle Ability Measure Sport Subscale were included throughout the treatment protocol along with the figure-of-eight ankle girth measurement to assess the amount of swelling following each treatment session. All seven patients returned to unrestricted participation following an average of 2.9±0.8 treatments (range 2-4 treatments) and presented an average decrease in ankle girth of 24.7±13.7mm from baseline to return to participation. Overall, the Mulligan MWM and fibular repositioning tape produce an immediate change in pain, disability, function and swelling following an acute grade 1 LAS.
... And epidemiological studies reported that one ankle sprain occurs per 10000 people per day in the world. Waterman et al. reported that there were 3,140,132 ankle sprains from 2002 to 2006 (an average of 628,026 cases per year) in the 1.46 billion high-risk population and further estimated that the incidence of ankle sprains in the United States is 2.15 cases per 1,000 people per year [2]. Although most acute ankle sprains can be successfully treated by conservative methods, the epidemiological studies reported that 5-20% of ankle sprains will develop into chronic ankle instability (CAI) [3]. ...
Article
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Background: This study is aimed at exploring the prognostic value of preoperative lymphocyte-to-monocyte ratio (LMR), an index of systemic inflammation before operation, in ankle lateral ligament repair (ALLR). Methods: A total of 213 I-III degrees injuries of lateral ankle ligament patients received ALLR and were followed up for more than 2 years. Univariate and multivariable linear regression analysis was used to determine the relationship between preoperative LMR and postoperative recovery. The evaluations of postoperative recovery include American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson-Peter ankle score (KPAS), Cumberland Ankle Instability Tool (CAIT) score, Visual Analog Scale (VAS) score, and range of motion (ROM). The prognostic value of preoperative LMR was measured by receiver operating characteristic (ROC) curve. Results: 178 patients (178 ankles) were followed up successfully, with a follow-up of 2.82 ± 1.54 years. Overall, the mean AOFAS, KPAS, CAIT and VAS scores, and ankle varus angle were significantly improved at the final follow-up. Univariate and multiple linear regression analysis showed that preoperative LMR was the only independent factor associated with postoperative function, ROM, and pain. The preoperative LMR of patients with poor recovery was significantly lower than that of patients with good recovery. Based on the ROC analysis, the cutoff value of preoperative LMR was 3.824. The clinical outcomes of patients with preoperative LMR < 3.824 were significantly lower than that of patients with preoperative LMR ≥ 3.824. The corresponding specificity and sensitivity were 84.6% and 71.4%. Conclusion: The clinical outcomes of open or arthroscopic repair for ATFL injury are satisfactory. As a marker of systemic inflammation, preoperative LMR can be used as a prognostic indicator for ALLR.
... Within sports-related injuries, supination ankle sprains with subsequent injury to the lateral ankle ligaments range among the most common musculoskeletal injuries, with a risk-profile dependent incidence of 2-58 per 1000 person years, accounting for 10-30% of all sports injuries [10,45]. A growing body of evidence demonstrates that a surgical repair of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) via the Broström procedure [1] and its modifications [13,24,35] reliably produces favorable outcomes in cases of recurrent/chronic instability [18,23,31,34,47]. ...
Article
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Purpose To evaluate clinical outcomes as well as return to sports (RTS) and return to work (RTW) rates following anatomic lateral ankle ligament reconstruction with a tendon autograft for chronic lateral ankle instability (CLAI) in a high-risk population, and to compare these outcome parameters between patients having received a gracilis tendon autograft (GT) and free split peroneus brevis tendon (PBT) autograft. Methods Twenty-eight consecutive patients, who were diagnosed with CLAI, presenting with ≥ 1 risk factor (ligamentous hyperlaxity, insufficient substance of native ligament and/or high-demand athlete), who underwent ankle ligament reconstruction with a tendon autograft between January 2011 and December 2018, were included in this retrospective study. At 63.7 ± 28.0 months (24–112), 23 patients with a mean age of 29.7 ± 10.9 years were available for follow-up. The Karlsson Score, the Foot and Ankle Outcome Score (FAOS), the Tegner Activity Scale and the visual analog scale (VAS) for pain were collected at a minimum follow-up of 24 months. RTS and RTW were evaluated by questionnaire. A subgroup analysis with regard to the graft used for ankle ligament reconstruction (GT versus PBT) was performed. Results Patients reported a Karlsson score of 82.1 ± 17.5 (37–100), a FAOS score of 87.8 ± 8.4 (73–99), a median Tegner activity scale of 5.0 (IQR 4–6) and a VAS for pain of 0.5 ± 0.9 (0–4) at rest and of 2.0 ± 2.1 (0–7) during activities at final follow-up. Postoperatively, 96% of patients had returned to sports after 8.3 ± 6.2 months. All patients (100%) had returned to work at 3.5 ± 5.7 (0–24) months, with 87% reporting an equal or improved working ability compared to that preoperatively. Postoperatively, exercise hours per week were significantly reduced compared to preoperatively in patients with a split PBT ( n = 12; 13.0 ± 12.9 to 5.6 ± 6.4 h, p = 0.038) autograft as opposed to patients with a GT autograft ( n = 11; 13.1 ± 8.7 to 12.4 ± 7.1 h, n.s.). No other group differences were observed. Conclusion Good patient-reported outcomes as well as excellent RTS and RTW rates can be achieved in high-risk patients undergoing ankle ligament reconstruction with a tendon autograft for CLAI. These results may be helpful in preoperatively managing patients’ expectations regarding sports- and work-related outcomes and provide tangible data on the expectable time frame of the individual return to sports and work trajectory. Level of evidence IV.
... Football is a popular sport globally, with active participation by many countries and individuals. In football players, due to the frequent physical contact and dynamic movements, ankle sprains are the most common sports injuries [1][2][3]. ...
Article
Football is a sport involving dynamic movements, and ankle sprains are common sports injuries experienced by football players. Ankle sprains exhibit a high recurrence rate, and rehabilitation training is effective; however, expert-supervised rehabilitation (SVR) at training centers is difficult due to the recent COVID-19 pandemic. This study investigated the effects of mobile-based rehabilitation (MBR) performed at home by high school football players. Sixty players (SVR: 30 and MBR: 30) with recurrent ankle sprains were analyzed. The rehabilitation program consisted of strength and balance training, and the training intensity was gradually increased from week 1 to week 8. The SVR group underwent training at the center with experts, and the BMR group were provided with programs and feedback using mobile devices. Ankle muscle strength was evaluated by measuring isometric eversion, inversion, plantarflexion, and dorsiflexion contraction using a hand-held dynamometer, and dynamic balance was assessed using the Y-balance test (YBT; anterior, posteromedial, and posterolateral); the Foot and Ankle Outcome Score (FAOS) was used for the subjective evaluation. Measurements were conducted at weeks 1, 4, and 8. The patients visited the clinic within 1 week after the injury, and the first test was conducted after consent to participate in the research. Patients underwent the second test at an average of 3.2 weeks after the first test, and the last test at an average of 4.4 weeks after the second test. Although only the SVR group exhibited improvement in strength (eversion and dorsiflexion), YBT and subjective satisfaction at week 4, these measurements improved in both the SVR and MBR groups at week 8. Therefore, mobile-based rehabilitation could be a suitable alternative for high school athletes with ankle sprains who cannot undergo supervised rehabilitation.
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Purpose: Joint deafferentation after post-ankle sprain ligament healing can disrupt sensory input from the ankle and induce maladaptive neuroplasticity, especially in the cerebellum. This study aimed to determine whether the regional homogeneity of intrinsic cerebellar activity differs between patients with ankle instability and healthy controls without a history of ankle injury. Methods: The current study used a primary data set of 18 patients and 22 healthy controls and an external UK Biobank data set of 16 patients with ankle instability and 69 healthy controls for a cross-database, cross-sectional investigation. All participants underwent resting-state functional magnetic resonance imaging to calculate their regional homogeneity (ReHo) value. Between-group comparisons of the sensorimotor-related subregions of the cerebellum were first performed in the primary data set to identify low cerebellar ReHo in patients with multiple comparison corrections, and the surviving subregions were then externally validated in the UK Biobank data set. Correlation analyses between the ReHo values and clinical features were also performed. Results: The ReHo value of cerebellar lobule VIIIb was significantly lower in the ankle instability group than in the controls (0.170 ± 0.016 vs 0.184 ± 0.019 in the primary data set, 0.157 ± 0.026 vs 0.180 ± 0.042 in the UK Biobank data set). The ReHo values of this subregion showed a significant positive correlation with the Cumberland Ankle Instability Tool scores in the ankle instability group (r = 0.553, P-corrected = 0.0348). Conclusions: Patients with ankle instability had lower intraregional coherence in cerebellar lobule VIIIb than that of controls, which was also positively correlated with the intensity of self-reported ankle instability.
Article
Résumé De l’enfant au sénior, toutes les tranches d’âge sont touchées par l’instabilité de cheville. Peu de publications s’intéressent aux particularités de la prise en charge diagnostique et thérapeutique de l’instabilité de cheville selon l’âge des patients. En distinguant 3 périodes de vie (l’enfant et l’adolescent, l’adulte jeune et le sujet de plus de 50 ans), nous détaillons dans cet article les spécificités de la prise en charge de l’instabilité de cheville dans chacune de ces tranches d’âge.
Article
The medial ankle ligamentous complex, which includes the deltoid, talocalcaneal, and calcaneonavicular ligaments, functions to provide stability to the medial ankle. Injuries to the deltoid ligament can lead to medial-sided ankle pain, subsequent instability, and posttraumatic osteoarthritis given the altered biomechanics of the ankle joint. After completing a thorough physical examination, imaging modalities such as stress radiographs and magnetic resonance imaging can be used to confirm the diagnosis. Acute injuries to the deltoid ligament should be managed conservatively with a short course of immobilization. For patients with continued pain and instability following a regimen of nonoperative management, surgical intervention can be considered. Primary repair using suture anchor fixation to the medial malleolus can be utilized if sufficient tissue remains. However, if reconstruction is necessitated, autograft or allograft can be utilized in several described techniques. Levels of Evidence: Therapeutic
Article
Ankle syndesmosis injuries include isolated ligamentous rupture, as well as fractures with ligamentous injury. These injuries can significantly affect athletes in all sports, and lead to prolonged recovery and return to sport. Adequate evaluation and diagnosis of these injuries are imperative for treatment and return to play. Many can be treated nonoperatively, but operative treatment is indicated in fractures with syndesmosis disruption and ligamentous injuries with instability. Anatomic reduction and fixation of these injuries will allow functional rehab and return to sport.
Chapter
Ankle sprains are one of the most common injuries encountered by orthopedic providers, and a large percentage of patients go on to develop recurrent ankle instability. In a subset of patients, mechanical alignment contributes to recurrent instability. In particular, patients with subtle cavovarus alignment are at risk for recurrent sprains and may go underrecognized. Thorough physical examination, including assessment of hindfoot alignment, Coleman block testing, Silfverskiöld testing, and neurologic examination, should be performed in patients with recurrent instability and cavovarus alignment. Imaging studies in the form of weight-bearing ankle radiographs and hindfoot radiographs should be performed; MRI and CT can be considered in indicated cases. Understanding if the deformity is forefoot or hindfoot driven is paramount to appropriate management. Nonoperative treatment in the form of physical therapy, orthotics, and bracing is generally first-line treatment. In patients who fail conservative management, operative treatment in the setting of recurrent ankle instability and cavovarus alignment should address the fixed deformity in the hindfoot and/or forefoot as well as the ligamentous insufficiency. Lateralizing calcaneal osteotomy is indicated to address hindfoot-driven varus, while first-ray dorsiflexion osteotomy is indicated in forefoot-driven varus. Lateral ligament reconstruction can be performed with these procedures, and adjunct procedures to address intra-articular pathology, peroneal tendon pathology, and gastrocnemius contracture should also be considered. When recognized and addressed, patients with cavovarus alignment and recurrent ankle instability can have excellent surgical outcomes and return to a high level of activity.KeywordsAnkle instabilityCavovarus footAlignmentOsteotomyLigamentRecurrent injuryAthlete
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Chronic ankle instability (CAI) can develop in a percentage of patients who have suffered recurrent lateral ankle sprains. Patients with CAI typically describe a sensation of the ankle “giving way” although patients may or may not exhibit pathological laxity on exam. Such chronic instability can result from functional or mechanical instability. Diagnosis is established by obtaining a thorough history of symptoms combined with physical exam to assess for laxity and various imaging techniques. The preferred initial treatment includes nonoperative modalities such as pain control, activity restriction, bracing or taping, and functional rehabilitation. Physical therapy focuses on proprioception and balance control to improve functional stability. Patients who fail conservative management are candidates for surgery to improve mechanical stability, of which anatomic surgical approaches such as the modified Broström tend to be preferred as they recreate the ankle’s native biomechanics. This chapter provides a review of chronic lateral ankle instability including anatomy, evaluation, treatment approach, and outcomes.KeywordsChronic ankle instabilityLateral ankle ligamentsAnkle sprainsMechanical instabilityFunctional instabilityFunctional rehabilitationAnterior talofibular ligamentCalcaneofibular ligament
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Acute ankle sprains are considered to be one of the most commonly occurring musculoskeletal injuries, and this incidence seems to be particularly high in physically active individuals. Sprains of the lateral ligament complex are the most commonly occurring sprains in the ankle. The epidemiological statistics available might not even be accurate enough since not all individuals sustaining an acute ankle sprain might present to an emergency department or even seek medical care. The incidence of these injuries might vary slightly from the general population to the athletic population and indeed might even vary more in sport-specific activities. These injuries and more so the complications or long-term sequelae associated with them might pose a significant socioeconomic burden on the society. It appears that acute, first time, and recurrent ankle sprains all play a role in the incidence rates of this injury, and consequently, these factors should be taken into consideration when planning injury prevention intervention protocols. In spite of these facts, the initial management of acute ankle sprains is still not yet scientifically validated or proven. Early and staged functional rehabilitation exercises and programs have been shown to be of great value. Generally, the ultimate management goal should be to control the inflammatory process, regain full range of motion (ROM), and improve muscle strength and power while maintaining and improving proprioceptive abilities.KeywordsAcute ankle sprainLateral ankle sprainManagement of sprain ankleRehabilitation for sprain ankleTreatment of sprain ankle
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Objective To introduce the surgical technique and clinical outcomes of arthroscopic anterior talofibular ligament (ATFL) repair using the Internal Brace and lasso-loop technique for chronic ankle lateral instability.MethodsA retrospective study was performed on 29 patients who underwent all-arthroscopic ATFL repair with the Internal Brace and lasso-loop technique from January to August 2020. The patients included 24 males and five females, with a mean age of 30.17 years. Through the accessory anterolateral (AAL) portal, we drilled the bone tunnels and fixed the tape with 4.75 mm and 3.5 mm “SwiveLock” anchors and reattached the torn ligament by the lasso-loop technique.ResultsAll 29 patients underwent all-arthroscopic procedures smoothly without serious complications, such as infection and important nerve or vessel injuries. There were eight cases of lateral malleolar avulsion fractures and ten cases of talus cartilage injury. The visual analog scale (VAS), Karlsson-Peterson, Tegner, and American Orthopedic Foot and Ankle Society (AOFAS) scores were used to evaluate the clinical consequences. All the patients were followed up for 18.66 ± 4.85 months on average. The average pre-operative VAS score was 4.69 ± 1.04, which was significantly higher than the average post-operative VAS score of 1.14 ± 1.56. At the final follow-up appointments, the averages of Karlsson-Peterson, AOFAS, and Tenger scores were 75.83 ± 9.44, 88.31 ± 6.81, and 6.93 ± 1.79, respectively, which was significantly higher than that before the operation.Conclusion This arthroscopic anterior talofibular ligament repair with the Internal Brace and lasso-loop technique achieves satisfactory clinical outcomes with the benefits of high safety and reliability for chronic ankle lateral instability.
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Posterior tibial tendon dysfunction (PTTD) and tarsal tunnel syndrome (TTS) are debilitating conditions reported to occur after ankle sprain due to their proximity to the ankle complex. The objective of this study was to investigate the incidence of PTTD and TTS in the 2 years following an ankle sprain and which variables are associated with its onset. In total, 22,966 individuals in the Military Health System diagnosed with ankle sprain between 2010 and 2011 were followed for 2 years. The incidence of PTTD and TTS after ankle sprain was identified. Binary logistic regression was used to identify potential demographic or medical history factors associated with PTTD or TTS. In total, 617 (2.7%) received a PTTD diagnosis and 127 (0.6%) received a TTS diagnosis. Active-duty status (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.70–2.79), increasing age (OR 1.03, 95% CI 1.02–1.04), female sex (OR 1.58, 95% CI 1.28–1.95), and if the sprain location was specified by the diagnosis (versus unspecified location) and did not include a fracture contributed to significantly higher (p < 0.001) risk of developing PTTD. Greater age (OR 1.06, 95% CI 1.03–1.09), female sex (OR 2.73, 95% CI 1.74–4.29), history of metabolic syndrome (OR 1.73, 95% CI 1.03–2.89), and active-duty status (OR 2.28, 95% CI 1.38–3.77) also significantly increased the odds of developing TTS, while sustaining a concurrent ankle fracture with the initial ankle sprain (OR 0.45, 95% CI 0.28–0.70) significantly decreased the odds. PTTD and TTS were not common after ankle sprain. However, they still merit consideration as postinjury sequelae, especially in patients with persistent symptoms. Increasing age, type of sprain, female sex, metabolic syndrome, and active-duty status were all significantly associated with the development of one or both subsequent injuries. This work provides normative data for incidence rates of these subsequent injuries and can help increase awareness of these conditions, leading to improved management of refractory ankle sprain injuries.
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Ankle inversion injuries are common and most patients will have complete resolution of symptoms with nonoperative treatment. Some patients will develop chronic ankle instability and may develop associated pathology such as peroneal tendonitis, osteochondral lesions, ankle synovitis, and ankle impingement. A careful physical examination is imperative to evaluate for ankle instability as well as concomitant pathology. Imaging begins with standard radiographs and advanced imaging is used to evaluate for osteochondral lesions, ligament integrity, tendinitis, and other soft tissue lesions. Nonoperative treatment consists of immobilization, bracing, and physical therapy. Surgical treatment is reserved for patients who have symptoms despite nonoperative treatment and often involves imbrication of the lateral ankle ligament complex. Outcomes are typically favorable and most patients can expect to return to athletic activity.
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Background: Acute ankle injuries are one of the most common injuries in orthopaedic department. However, there is still lack of standardized evidence-based treatment. Therefore, the aim of our study was to compare and evaluate the functional outcome of Partial And Complete Immobilization Methods. Comparative evaluation of Functional outcome in ankleObjective: sprain patient treated with partial and complete immobilization and to identify factors affecting the functional outcome in patients with ankle sprain. Methodology- A prospective comparative study was designed from 1st jan 21 to 30th oct 21 49 patients fromMaterials and Methods: orthopedic OPD was selected whom were presented with the ankle sprain and ready to give consent irrespective of their gender. Lower Extremity Functional Scale(LEFS) and visual analogue scale (VAS) were observed at pre-treatment and post treatment at 1st ,3rd and 6th week were compared in both category. in the present study 35 patients were treated with partial immombilization method and 14 were treatedResult- with complete immobilization. Most of patients were belong to age group of 18-25. 67.3 % patients were male and 32.7% were female. 51% having left side injury while 49% have right side a Lower Extremity Functional Scale(LEFS) and visual analogue scale (VAS) were observed at pretreatment post treatment at 1st ,3rd and 6th week. - From our prospective study, we conclude that conservative management ofConclusion- ankle ligament injuries (grade I, II) is a safe and effective method of treatment. And partial immobilization is better than the complete mobilization.
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Objective The purpose of this study was to compare Functional and Kinetic Treatment with Rehabilitation (FAKTR) combined with cryotherapy to cryotherapy alone in the treatment of acute grade I or II inversion ankle sprains. Methods This prospective, randomized clinical trial of adult (18-40 years of age) participants (n = 40) with acute grade I or II inversion ankle sprain of less than 3 weeks, who were randomly allocated into a FAKTR and cryotherapy group (n = 20) or a cryotherapy only group (n = 20). The participants had 3 treatments (inclusive of the initial consultation), with a fourth as a measurement follow-up (2 weeks after the third treatment). Measurement procedures were completed at the outset of the first to third consultations and the fourth measurement only consultation. Clinical measures taken by a blinded research assistant included the Numerical Pain Rating Scale, Foot function index, algometer, digital inclinometer for ankle dorsiflexion range of motion measures, the figure-of-8 maneuver measured swelling, and the Stork-Balance-Stand Test. Results Significant intergroup differences were observed for pain rating (P ≤ .01; 95% confidence interval [CI] –4.74 to 0.86), pain pressure threshold (P ≤ .05; 95% CI –1.06 to 1.52), balance and proprioception (P ≤ .01; 95% CI –5.28 to –1.39), and foot function index (P ≤ .01; 95% CI –30.12 to 4.83). No significant intergroup differences were observed in ankle dorsiflexion range of motion (P = .242; 95% CI –3.17 to 1.20) and edema measurements (P = .602; 95% CI 0.41-1.46). Conclusion The FAKTR instrument assisted soft tissue mobilization treatment combined with cryotherapy indicated a trend toward greater clinical effectiveness than cryotherapy for measures of pain, pain pressure threshold, balance and proprioception, and foot function index; however, these outcomes were not reflected for ankle dorsiflexion range of motion and edema measurements.
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Objective: The aim of the present study was to measure the immediate effect of a thrust manipulation on the length of the anterior talofibular and calcaneofibular ligaments in healthy patients. Methods: A convenience sample of 47 healthy patients were recruited for this quasi-experimental study. The patients had an age range from 22 to 54 years, with a mean age of 30.36 years. There were 23 female patients and 24 male patients. Musculoskeletal ultrasound imaging was used to measure the length of the anterior talofibular and calcaneofibular ligaments before and immediately after a high-velocity long-axis thrust manipulation of the talocrural joint during various validated test positions. Results: A single long-axis thrust manipulation did not result in a significant change in the length of the anterior talofibular ligament (P = .325). Additionally, there was no significant difference in calcaneofibular length after a long-axis thrust manipulation (P = .26). Conclusion: The results indicate that the length of the anterior talofibular and calcaneofibular ligament did not significantly change after a single long-axis thrust manipulation of the talocrural joint in healthy patients. It appears that the joint capsule of the talocrural joint reached end-range during the manipulation before the ligament undergoes plastic length changes; thus, the increase in joint range of motion after a thrust manipulation was probably not due to increased plastic length changes of the anterior talofibular and calcaneofibular ligaments.
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Résumé Introduction L’entorse latérale de cheville est la blessure la plus fréquente. La fatigue semble jouer un rôle dans ce traumatisme car c’est aussi en fin de match (football, rugby, …) qu’elle se produit le plus souvent. L’objectif de cette étude est d’évaluer la reproductibilité d’un test de résistance à la fatigue et de comparer les scores entre des sujets sains et des sujets ayant une instabilité chronique de cheville (Chronic Ankle Instability). Méthode Un total de 19 sujets sains et 11 sujets CAI ont réalisé un test de résistance à la fatigue en appui unipodal avec une chaussure de déstabilisation. Les sujets devaient réaliser un nombre maximal de répétitions d’inversion lente et d’éversion rapide. Ce test a été réalisé à deux reprises à une semaine d’intervalle. Résultats La reproductibilité relative était très bonne pour les sujets sains (ICC = 0,95) et modérée pour les sujets CAI (ICC = 0,58). L’erreur de mesure reste cependant relativement variable et élevée (SEM = 2,06–4,10 et MDC = 5,70–11,4). Les sujets sains ont été significativement plus résistants à la fatigue que les sujets CAI (p = 0,02). Conclusion Le test de résistance à la fatigue est reproductible. Toutefois, il est probable que l’arrêt du test puisse être parfois lié à une incapacité motrice sans lien avec la fatigue. Les sujets instables chroniques présentent une résistance à la fatigue significativement plus faible que les sujets sains démontrant l’intérêt du test en pratique clinique. Un seuil ≤ 8 répétitions est proposé comme limite pour identifier un déficit.
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Ankle sprains are a common injury among physically active populations and occur with an incidence of around 2.15 per 1000 person-years. This article discusses various surgical procedures used to treat chronic lateral ankle instability, including direct ligament repair, anatomic reconstruction, and nonanatomic reconstruction. We focus our discussion on the most common and challenging complications of ankle stabilization, both in our experience and as supported by the existing literature, including recurrent instability, superficial peroneal nerve injury, and unaddressed pathology that continues to cause symptoms and limit function. We offer possible methods to manage these conditions as well as available outcome data.
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The ankle tendons are subjected to tremendous functional demands during daily living that predispose them to a wide spectrum of acute and chronic injuries. They are among the most common injuries sustained by athletes. Despite their prevalence in society, ankle injuries still remain a difficult diagnosis and therapeutic challenge especially in the athlete and as in society in general.
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Background The modified Broström-Gould (MBG) procedure is the gold standard for patients with chronic ankle instability (CAI), but it is relatively contraindicated for patients with higher body weight or generalized ligamentous laxity (GLL). The use of the ligament augmentation reconstruction system (LARS) is an alternative. Hypothesis It was hypothesized that clinical outcomes would be similar in patients with increased body weight (>90 kg) or GLL, relative to controls. Study Design Cohort study; Level of evidence, 2. Methods A total of 66 patients satisfying the inclusion criteria were invited to participate and were divided into 3 groups: controls (no risk factors for inferior clinical outcome), patients with body weight >90 kg, and patients with GLL (Beighton score, ≥5 of 9). All patients underwent imbrication of the lateral collateral ligament complex augmented with the LARS. Primary outcomes of interest were Tegner activity scale (TAS) and Foot and Ankle Outcome Score (FAOS) subscale scores. Secondary outcomes were recurrence of ankle instability, the need for further surgery, and/or complications. Patients were reviewed at 2 and 5 years postoperatively, and outcomes between groups were compared using repeated-measures analysis of variance. Results Complete data were available for 63 patients (21 patients in each group). TAS improved in all groups from preoperatively to 2 years and 5 years postoperatively ( P < .001 for all). Relative to the controls, the TAS scores were lower in the >90-kg group at 2 years and 5 years ( P < .001 for both periods), while the GLL group had similar scores to controls at both postoperative periods. Both the >90-kg and the GLL groups showed no significant difference in improvement on any FAOS subscale scores relative to the controls, at both 2 and 5 years postoperatively. There were no recurrences, repeat surgeries, or major complications. Conclusion Relative to controls, patients with body weight >90 kg or GLL had similar FAOSs, and TAS scores were lower in the >90-kg group, at 2 and 5 years, after the use of the LARS to augment lateral collateral ligament imbrication for CAI. Use of the LARS in this manner is a viable option in patients for whom the MBG procedure is relatively contraindicated.
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Background In cases of large osteochondral lesions of the talus (OLTs), fresh structural or bulk osteochondral allograft transplantation has yielded favorable outcomes in several retrospective and few prospective case series. The purpose of this study was to prospectively evaluate patients who received fresh structural allograft transplantation of the talar shoulder. Methods A prospective evaluation of patients who received a fresh structural allograft of an OLT was performed. Preoperative imaging included magnetic resonance imaging (MRI) and/or computed tomography (CT) with plain radiographs. The following patient-reported outcomes questionnaires were administered preoperatively and yearly after surgery: 36-Item Short-Form Health Survey (SF-36), visual analog scale (VAS) for pain, and the Short Musculoskeletal Functional Assessment (SMFA). Preoperative and postoperative imaging were evaluated for allograft assimilation, evidence of arthritic changes, or functional range of motion abnormalities. Results Thirty-one patients with a mean age of 41.4 years (±14.1, range 18-69) underwent structural fresh osteochondral allograft transplantation to the talar shoulder and were included in this study. The mean follow-up was 56.2 months (±36.1, range 24-142). The majority of patients were female (n=17, 54.8%), reported some history of prior ankle trauma (n=21, 67.7%), and underwent prior ankle surgery (n=23, 74.2%). The mean lesion size on CT scan was 1879 mm ³ (n = 27) compared to the mean lesion size of 3877 mm ³ (n = 21) on MRI. There was a significant improvement in the mean preoperative VAS score ( P < .0001), SF-36 score ( P < .0005), SMFA bother index ( P < .0015), and the SMFA function index ( P < .0001) at final follow-up. A total of 15 (48.4%) patients underwent an additional surgery following their osteochondral allograft transplant, most commonly arthroscopic debridement or removal of hardware, performed at an average of 25.2 (±13.0) from their index procedure. There was one failure that required a total ankle replacement. The overall graft survival rate was 96.8%. Conclusion Fresh, structural allograft transplantation resulted in significant improvement in patient-reported postoperative pain and function in patients suffering from OLTs. The graft survival rate was 96.8% at a mean of 56.2 months follow-up, with half of patients requiring a second procedure. Level of Evidence Level IV, prospective case series.
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Ankle sprains have been reported as one of the most common injuries sustained by members of the US Armed Services. However, little is known about the incidence rate and injury patterns associated with ankle sprains in this population. To examine the incidence of ankle sprains among active-duty members of the US Armed Services from 1998 through 2006. A secondary objective was to describe the sex, age, and service-specific injury patterns in this young, physically active population. Cohort study. All active-duty service members from the day they enter military service until the day they leave military service and US Army Reserve and National Guard service members during periods of active duty and mobilization. Injury data were extracted from the Defense Medical Epidemiological Database from 1998 through 2006. All data for ankle sprains, coded according to the International Classification of Diseases (9th revision), were included. Cases were limited to those injuries reported as first occurrences. Incidence rates (IRs) were calculated per 1000 person-years by sex, age, and service. Incidence rate ratios (IRRs) and 95% confidence intervals (95% CIs) were used to assess the strength of association between the incidence of ankle sprain and the independent variables of sex, age, and service. From 1998 through 2006, 423 581 service members sustained ankle sprains and 12 118 863 person-years at risk to injury were documented in this population. The incidence rate was 34.95 (95% CI = 34.85, 35.06) per 1000 person-years at risk. Females were 21% more likely (IRR = 1.21, 95% CI = 1.21, 1.23) to sustain an ankle sprain than males. Sex-specific IR varied by age and service. Differences in the rate of ankle sprains were also noted by age and service. The incidence of ankle sprains among US service members was 5 times greater than that previously reported in civilian population studies. Sex, age, and branch of military service are important factors related to the incidence of ankle sprains in this population.
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In a prospective study of risk factors for lateral ankle sprain among 390 male Israeli infantry recruits, a 18% incidence of lateral ankle sprains was found in basic training. There was no statistically significant difference in the incidence of lateral ankle sprains between recruits who trained in modified basketball shoes or standard lightweight infantry boots. By multivariate stepwise logistic regression a statistically significant relationship was found between body weight x height (a magnitude which is proportional to the mass moment of inertia of the body around a horizontal axis through the ankle), a previous history of ankle sprain, and the incidence of lateral ankle sprains. Recruits who were taller and heavier and thus had larger mass moments of inertia (P = 0.004), and those with a prior history of ankle sprain (P = 0.01) had higher lateral ankle sprain morbidity in basic training.
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Physical training-related injuries are common among army recruits and other vigorously active populations, but little is known about their causation. To identify intrinsic risk factors, we prospectively measured 391 army trainees. For 8 weeks of basic training, 124 men and 186 women (79.3%) were studied. They answered questionnaires on past activities and sports participation, and were measured for height, weight, and body fat percentage; 71% of the subjects took an initial army physical training test. Women had a significantly higher incidence of time-loss injuries than men, 44.6% compared with 29.0%. During training, more time-loss injuries occurred among the 50% of the men who were slower on the mile run, 29.0% versus 0.0%. Slower women were likewise at greater risk than faster ones, 38.2% versus 18.5%. Men with histories of inactivity and with higher body mass index were at greater injury risk than other men, as were the shortest women. We conclude that female gender and low aerobic fitness measured by run times are risk factors for training injuries in army trainees, and that other factors such as prior activity levels and stature may affect men and women differently.
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To determine whether associations exist between body fatness and injury rates in high school football linemen. Prospective, injury surveillance study during a 2-week preseason and 10-week regular season. 10 public high schools in Texas. Two hundred fifteen varsity and junior varsity high school football linemen. Injury rates (injuries per 1000 hours of playing time) for groups of players above a given body fat level and at or below a given body fat level. Rates were computed as the number of injuries per group divided by the group's aggregate playing time (practice + game time). The null hypothesis was that there is no difference in injury rates between players above a given level of body fat and those at or below that level of body fat. Body fat was determined from chest, abdomen, and thigh skinfold measurements using standard conversion equations. Body mass index (BMI) (kg/m2) was also calculated for each player. The overall injury rate was 5.66 injuries per 1000 hours of playing time. Percent body fat ranged from 9.3% to 40.2%. BMI ranged from 19.9 to 46.6 kg/m2. Sixty-seven players sustained 86 injuries, the most common of which were ankle sprains and medial collateral ligament sprains. No difference in overall injury rates between higher and lower fat groups was seen at any body fat level. Players in higher body fat groups, however, had significantly greater lower extremity injury rates than did players in lower fat groups between 18% and 27% body fat and again 32% to 33%, but not at intermediate levels or >33%. Players in higher BMI groups had significantly greater lower extremity injury rates than did players in lower BMI groups throughout the range from 24 to 36 kg/m2, except at 34 kg/m2. Both higher body fatness and BMI were associated with increased rates of lower extremity injury among high school football linemen. BMI appears to be associated more consistently with increased lower extremity injury rates than is body fat.
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Injuries are the leading health problem in the military services. Sports and physical training activities are an area in which a substantial number of injuries can occur. Although athletic injuries are not often investigated in military populations, the Armed Forces database provides a unique opportunity to investigate sports injuries. An Army database of all hospital admissions for active duty Army personnel in the 1989-1994 period was used to study injuries resulting from sports and Army physical training. For the 6-year time period reviewed, there were 13,861 hospital admissions for injuries resulting from sports or Army physical training: 94% (13,020) of these admissions were men and 6% (841) were women. The rates of sports injuries were 38 and 18 per 10,000 person-years for men and women, respectively. Sports injuries accounted for an average of 29,435 lost duty days each year: Men lost an average of 13 days per injury and women lost an average of 11 days per injury. Acute musculoskeletal injuries in the categories of fractures, sprains/strains, and dislocations accounted for 82% of all injuries. The knee was the most often injured body area in both genders, with the anterior cruciate ligament (ACL) identified as the most frequently injured body part overall. The top seven injuries were virtually identical for men and women, with only slight variations in order. Although the rates of all hospitalized sports injuries were higher for men than women, women had a higher proportion of ACL injuries from basketball and softball, ankle fractures from softball and head injuries from basketball. For men, football and basketball contributed to the highest rates of injuries. The highest injury rates for women were from Army physical training and basketball. For both men and women, Army physical training was the leading cause of lumbosacral strains. Sports and Army physical training injuries account for a significant amount of lost duty time and impact military readiness.
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To estimate the incidence of ankle sprains and severe ankle sprains attending accident and emergency (A&E) units; to describe current practice for severe ankle sprains in A&E units in the United Kingdom. Crude age and sex specific incidence rates were calculated for four health districts from cases ascertained from data on seven A&E clinical information systems. Case records of patients with ankle sprains at an A&E unit in another health district were audited and the proportion of severe ankle sprains calculated. UK A&E units were surveyed about their usual treatment of patients with severe ankle sprains. The estimate of the crude incidence rate of ankle sprains was a minimum of 52.7 per 10 000, rising to 60.9 (95% CI 59.4 to 62.4) when figures were adjusted for the proportion of patients without a diagnostic code (13.7%). There were important age-sex differences with unadjusted rates observed from 127.8 per 10 000 (CI 115.5 to 140.0) in girls aged 10-14 years to 8.2 (CI 4.2 to 12.3) in men aged 70-74 years. As 14% of ankle sprains attending A&E were classed as severe, this would equate to 42 000 severe ankle sprains per year in the UK. In the UK wide survey, there was a response rate of 79% (211 of 266). Among the responders, Tubigrip was used routinely in 55%, below knee casts in 3%, and braces in 2%. Boots were not used routinely in any unit. While there is considerable variation in severe ankle sprain management in UK A&E units, most are treated with the minimal mechanical support of Tubigrip.
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In a previous study, we noted a possible connection between an athlete's weight and risk of ankle sprain. A high body mass index and a history of a previous ankle sprain increase the risk of a subsequent noncontact sprain. Cohort study; Level of evidence, 2. One hundred fifty-two athletes from 4 football teams were observed (2 varsity and 2 junior varsity). Two teams were observed for 3 seasons, and 2 teams were observed for 1 season. Before each season, body mass, height, history of previous ankle sprains, and ankle tape or brace use were recorded. There were 24 ankle sprains, of which 15 were noncontact inversion sprains (11 grade I, 3 grade II, 1 grade III; incidence, 1.08 per 1000 athlete-exposures). Injury incidence was higher in athletes with previous ankle injuries (2.60 vs 0.39; P < .001). Body mass index was also a risk factor (P < .05): injury incidence was 0.52 for players with a normal body mass index, 1.05 for players at risk of overweight, and 2.03 for overweight players. Injury incidence was 0.22 for normal-weight players with no previous ankle sprain compared with 4.27 for overweight players who had a previous sprain. An overweight player who had a previous ankle sprain was 19 times more likely to sustain a noncontact ankle sprain than was a normal-weight player with no previous ankle sprain. Ankle sprain prevention strategies should be targeted at football players with a high body mass index and a history of previous ankle sprains.
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The prevalence of overweight in children and adolescents and obesity in adults in the United States has increased over several decades. To provide current estimates of the prevalence and trends of overweight in children and adolescents and obesity in adults. Analysis of height and weight measurements from 3958 children and adolescents aged 2 to 19 years and 4431 adults aged 20 years or older obtained in 2003-2004 as part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US population. Data from the NHANES obtained in 1999-2000 and in 2001-2002 were compared with data from 2003-2004. Estimates of the prevalence of overweight in children and adolescents and obesity in adults. Overweight among children and adolescents was defined as at or above the 95th percentile of the sex-specific body mass index (BMI) for age growth charts. Obesity among adults was defined as a BMI of 30 or higher; extreme obesity was defined as a BMI of 40 or higher. In 2003-2004, 17.1% of US children and adolescents were overweight and 32.2% of adults were obese. Tests for trend were significant for male and female children and adolescents, indicating an increase in the prevalence of overweight in female children and adolescents from 13.8% in 1999-2000 to 16.0% in 2003-2004 and an increase in the prevalence of overweight in male children and adolescents from 14.0% to 18.2%. Among men, the prevalence of obesity increased significantly between 1999-2000 (27.5%) and 2003-2004 (31.1%). Among women, no significant increase in obesity was observed between 1999-2000 (33.4%) and 2003-2004 (33.2%). The prevalence of extreme obesity (body mass index > or =40) in 2003-2004 was 2.8% in men and 6.9% in women. In 2003-2004, significant differences in obesity prevalence remained by race/ethnicity and by age. Approximately 30% of non-Hispanic white adults were obese as were 45.0% of non-Hispanic black adults and 36.8% of Mexican Americans. Among adults aged 20 to 39 years, 28.5% were obese while 36.8% of adults aged 40 to 59 years and 31.0% of those aged 60 years or older were obese in 2003-2004. The prevalence of overweight among children and adolescents and obesity among men increased significantly during the 6-year period from 1999 to 2004; among women, no overall increases in the prevalence of obesity were observed. These estimates were based on a 6-year period and suggest that the increases in body weight are continuing in men and in children and adolescents while they may be leveling off in women.
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This article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201,600 patients were included, with 32,509 ankle injuries. Ankle injury information was available from 14,098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports.
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Although a rare event, the prevalence of major tendon rupture has increased in recent decades. Identification of risk factors is important for prevention purposes. Race is a risk factor for major tendon ruptures. Cohort study (prevalence); Level of evidence, 2. All patients admitted for surgical management of a rupture of a major tendon at Womack Army Medical Center, Fort Bragg, North Carolina, in 1995 and 1996 were identified and evaluated for risk factors. The authors identified 52 major tendon ruptures: 29 Achilles, 12 patellar, 7 pectoralis major, and 4 quadriceps tendon ruptures. All patients were active-duty soldiers, and 1 was a female soldier. Forty-one tendon ruptures occurred among black soldiers, 8 occurred among white soldiers, and 3 occurred among Latino soldiers. The population at risk included 93,224 exposures during the 2-year period, of which 67.1% were white, 24.5% were black, and 8.4% were self-classified as other race. The rate ratio for tendon rupture, adjusted for gender and age, was 13.3 (95% confidence interval, 6.2-28.5) between blacks and whites and 2.9 (95% confidence interval, 0.8-10.9) between Latinos and whites. The rate of major tendon rupture was 13 times greater for black men in this study population when compared with whites. Interventions among those at a higher risk for injury should be considered.
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To summarize 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for 15 sports and to identify potential modifiable risk factors to target for injury prevention initiatives. In 1982, the NCAA began collecting standardized injury and exposure data for collegiate sports through its Injury Surveillance System (ISS). This special issue reviews 182 000 injuries and slightly more than 1 million exposure records captured over a 16-year time period (1988-1989 through 2003-2004). Game and practice injuries that required medical attention and resulted in at least 1 day of time loss were included. An exposure was defined as 1 athlete participating in 1 practice or game and is expressed as an athlete-exposure (A-E). Combining data for all sports, injury rates were statistically significantly higher in games (13.8 injuries per 1000 A-Es) than in practices (4.0 injuries per 1000 A-Es), and preseason practice injury rates (6.6 injuries per 1000 A-Es) were significantly higher than both in-season (2.3 injuries per 1000 A-Es) and postseason (1.4 injuries per 1000 A-Es) practice rates. No significant change in game or practice injury rates was noted over the 16 years. More than 50% of all injuries were to the lower extremity. Ankle ligament sprains were the most common injury over all sports, accounting for 15% of all reported injuries. Rates of concussions and anterior cruciate ligament injuries increased significantly (average annual increases of 7.0% and 1.3%, respectively) over the sample period. These trends may reflect improvements in identification of these injuries, especially for concussion, over time. Football had the highest injury rates for both practices (9.6 injuries per 1000 A-Es) and games (35.9 injuries per 1000 A-Es), whereas men's baseball had the lowest rate in practice (1.9 injuries per 1000 A-Es) and women's softball had the lowest rate in games (4.3 injuries per 1000 A-Es). In general, participation in college athletics is safe, but these data indicate modifiable factors that, if addressed through injury prevention initiatives, may contribute to lower injury rates in collegiate sports.
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The literature has shown that anterior cruciate ligament (ACL) tear rates vary by gender, by sport, and in response to injury-reduction training programs. However, there is no consensus as to the magnitudes of these tear rates or their variations as a function of these variables. For example, the female-male ACL tear ratio has been reported to be as high as 9:1. Our purpose was to apply meta-analysis to the entire applicable literature to generate accurate estimates of the true incidences of ACL tear as a function of gender, sport, and injury-reduction training. A PubMed literature search was done to identify all studies dealing with ACL tear incidence. Bibliographic cross-referencing was done to identify additional articles. Meta-analytic principles were applied to generate ACL incidences as a function of gender, sport, and prior injury-reduction training. Female-male ACL tear incidences ratios were as follows: basketball, 3.5; soccer, 2.67; lacrosse, 1.18; and Alpine skiing, 1.0. The collegiate soccer tear rate was 0.32 for female subjects and 0.12 for male subjects. For basketball, the rates were 0.29 and 0.08, respectively. The rate for recreational Alpine skiers was 0.63, and that for experts was 0.03, with no gender variance. The two volleyball studies had no ACL tears. Training reduced the ACL tear incidence in soccer by 0.24 but did not reduce it at all in basketball. Female subjects had a roughly 3 times greater incidence of ACL tears in soccer and basketball versus male subjects. Injury-reduction programs were effective for soccer but not basketball. Recreational Alpine skiers had the highest incidences of ACL tear, whereas expert Alpine skiers had the lowest incidences. Volleyball may in fact be a low-risk sport rather than a high-risk sport. Alpine skiers and lacrosse players had no gender difference for ACL tear rate. Year-round female athletes who play soccer and basketball have an ACL tear rate of approximately 5%. Level IV, therapeutic case series.
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The epidemiology of sports injuries in children and youth is an important area of research that has been largely overlooked in the medical and sport science literature. This article presents an overview of the analytic aspects of pediatric sports injury epidemiology, focusing on injury risk factors and preventive measures. The review indicates that few modifiable injury risk factors have been statistically evaluated, and not many studies have been designed to determine the effect of injury prevention measures in pediatric sports. However, initial results are promising. Specific directions for further analytic research are presented.
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Ankle sprain is a common injury in athletic populations that results in significant time lost to injury. The incidence rates (IRs) of ankle ligament sprains are influenced by gender, height, weight, body mass index (BMI), physical conditioning, level of competition, type of sport, and athlete exposure to sport. Cohort study; Level of evidence, 2. A longitudinal cohort study was performed to determine the effect of risk factors for ankle sprain at the United States Military Academy between 2005 and 2007. A total 614 cadets sustained new ankle sprains during 10 511 person-years at risk, resulting in an overall IR of 58.4 per 1000 person-years. Women (96.4), compared with men (52.7), had a significantly increased rate ratio (IRR) for ankle sprain of 1.83 (95% confidence interval [CI], 1.52-2.20). Men with ankle sprains had higher mean height, weight, and BMI than uninjured men (P <.001). Men with ankle sprains had higher average scores in push-ups, sit-ups, and run time than uninjured men (P <.001). Ankle sprain occurred most commonly during athletics (64.1%). Ankle sprain IR did not significantly differ between intercollegiate and intramural athletic competition after controlling for athlete-exposure (IRR, 1.05; 95% CI, 0.81-1.37). The ankle sprain IRR of female compared with male intercollegiate athletes was 0.93 (95% CI, 0.67-1.32) per 1000 person-years and 1.04 (95% CI, 0.74-1.47) per 1000 athlete-exposures. The intercollegiate sports of men's rugby, women's cheerleading, and men's/women's basketball, soccer, and lacrosse had the highest ankle sprain IR. Higher mean height and weight in men, increased BMI in men, greater physical conditioning in men, and athlete exposure to selected sports were all risk factors for ankle sprain.
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Little is known of the incidence of shoulder instability, despite some evidence that it may be a common injury in young, athletic individuals. The goal of this study was to determine the incidence of shoulder dislocation in United States military personnel, as well as to identify the demographic risk factors for injury. We performed a query of the Defense Medical Epidemiology Database with the code from the International Classification of Diseases, Ninth Revision, for acute shoulder dislocation for the years 1998 through 2006. An overall injury incidence was calculated, in addition to multivariate analysis, to determine independent risk factors among the following demographic considerations: sex, race, branch of military service, rank, and age. The overall incidence rate was 1.69 dislocations per 1000 person-years. Significant demographic risk factors were male sex, white race, service in the Army, junior enlisted rank, and an age of less than thirty years (p<0.0001). The incidence of shoulder instability among U.S. military personnel (1.69 per 1000 person-years) is considerably higher than previous reports for the general U.S. population (0.08 per 1000 person-years). Male sex, white race, and an age of less than thirty years were significant independent risk factors for injury.
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The prevalence of foot and ankle conditions varies among different ethnic groups. It is not known if this difference is due to any distinctive skeletal morphological characteristics of the foot. The purpose of this study was to determine if ethnic differences exist in the morphometric measurements on radiographs of the weightbearing foot. A morphometric study of weightbearing radiographs of feet was performed prospectively. Radiographic parameters were measured on digital monitors using digital tools. These were the hallux valgus angle (HVA), intermetatarsal angle (IMA), talonavicular angle (TNA), talonavicular coverage angle (TNCovA), metatarsal span (MS) on anteroposterior (AP) radiographs and talo-first metatarsal angle (T-1(st)MTA), calcaneal pitch (CP), and lateral talocalcaneal angle (LTCA) on lateral radiographs. A total of 237 feet in 126 patients (45 African Americans, 59 Caucasians, and 22 Hispanics) were studied. Statistically significant differences were found in the CP, LTCA, and MS. African Americans have significantly lower CP than Caucasians (p < 0.0001). African Americans have significantly lower CP than Hispanics (p < 0.0016). Caucasians have significantly higher TCA than African Americans (p < 0.0004). Males have a larger MS than females (p < 0.0001). There are differences in the radiographic morphology of feet among different ethnic groups. A larger prospective community-based study of morphological differences is needed for better understanding of the genetic and environmental factors influencing the prevalence of foot and ankle conditions. The clinical relevance between having a lower CP angle and a higher incidence of flat feet in African Americans warrants further investigation. It is not known if there is a relationship between posterior tibialis insufficiency and low CP.
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This is a study of the physical performance and injury rate for seven classes of women midshipmen at the United States Naval Academy. Women comprise only 6.2% of the brigade of midshipmen, but men and women live in the same dormitory, undergo the same physical training and fitness tests, study the same academic curriculum, and live in an environment where performance and activities can be constantly moni tored. The required number of hours of physical edu cation are the same for men and women. The conclusions from this study are: (1) women midshipmen continue to improve their fitness level more rapidly than men; (2) while some disparities in perform ance are correctly attributed to physiological differ ences, many of the present disparities should be attrib uted to societal conditions; (3) should physical perform ance requirements ever become the same, women will have to work harder than men to achieve the same standards because of the physiological differences; (4) women continue to seek medical attention for stress- related problems (i.e., shin splints, stress fractures) more often than men, but do so less often as they become acclimated to the active life of the Naval Acad emy ; (5) women midshipmen have the same number of serious injuries as men, and in some sports are more susceptible to certain types of injuries.
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Ankle sprain is a common sports injury and is often regarded as trivial by athletes and coaches. This epidemiological study was conducted among three categories of Hong Kong Chinese athletes: national teams, competitive athletes and recreational athletes. This study shows that as much as 73% of all athletes had recurrent ankle sprain and 59% of these athletes had significant disability and residual symptoms which led to impairment of their athletic performance. This study indicates that a proper approach towards injury prevention and a comprehensive rehabilitation programme are required.
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The epidemiology of sprains in the lateral ankle and foot was investigated in a prospective study at the casualty ward at Hillerød County Hospital. During one year, 766 patients were registered. The overall sprain incidence was 7/1000 person-years. The incidence was highest for young males. After the age of 40 years, the incidence was higher for women than for men. Most sprains were sustained during sport, but, with increasing age, other activities became dominant. Sixty-one percent of the lesions were located around the lateral ankle, and 24% were located on the lateral midfoot.
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Women's participation in intercollegiate athletics has increased dramatically in recent years. Greater participation has increased awareness of health and medical issues specific to the female athlete. Some reports have noted a higher susceptibility to knee injury, specifically injuries to the anterior cruciate ligament, in female athletes as compared with their male counterparts. We performed a 5-year evaluation of anterior cruciate ligament injuries in collegiate men's and women's soccer and basketball programs using the National College Athletic Association Injury Surveillance System. Results showed significantly higher anterior cruciate ligament injury rates in both female sports compared with the male sports. Noncontact mechanisms were the primary cause of anterior cruciate ligament injury in both female sports. Possible causative factors for this increase in anterior cruciate ligament injuries among women may be extrinsic (body movement, muscular strength, shoe-surface interface, and skill level) or intrinsic (joint laxity, limb alignment, notch dimensions, and ligament size).
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This report describes ambulatory care visits in the United States across three ambulatory care settings-physician offices, hospital outpatient departments, and hospital emergency departments. Statistics are presented on selected patient and visit characteristics for aggregated ambulatory care visits and for each setting. The data presented in this report were collected by means of the 1995 National Ambulatory Medical Care Survey (NAMCS) and the 1995 National Hospital Ambulatory Medical Care Survey (NHAMCS). These surveys are part of the ambulatory care component of the National Health Care Survey that measures health care utilization across a variety of providers. The NAMCS and NHAMCS are national probability sample surveys of visits to office-based physicians (NAMCS) and visits to the outpatient departments and emergency departments of non-Federal, short-stay and general hospitals (NHAMCS) in the United States. Sample data are weighted to produce annual estimates. During 1995 an estimated 860.9 million visits were made to physician offices, hospital outpatient departments, and hospital emergency departments in the United States, an overall rate of 3.3 visits per person. Visits to office-based physicians accounted for 81.0 percent of ambulatory care utilization, followed by visits to emergency departments (11.2 percent) and outpatient departments (7.8 percent). Persons 75 years and over had the highest rate of ambulatory care visits. Females had significantly higher rates of visits to physician offices and hospital outpatient departments than males did. Less than two-thirds of ambulatory care visits by black persons were to physician offices. There were an estimated 126.1 million injury-related ambulatory care visits during 1995, or 48.2 visits per 100 persons.
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The purpose of this study was to examine a young athletic population to update the data regarding epidemiology and disability associated with ankle injuries. At the United States Military Academy, all cadets presenting with ankle injuries during a 2-month period were included in this prospective observational study. The initial evaluation included an extensive questionnaire, physical examination, and radiographs. Ankle sprain treatment included a supervised rehabilitation program. Subjects were reevaluated at 6 weeks and 6 months with subjective assessment, physical examination, and functional testing. The mean age for all subjects was 20 years (range, 17-24 years). There were 104 ankle injuries accounting for 23% of all injuries seen. There were 96 sprains, 7 fractures, and 1 contusion. Of the 96 sprains, 4 were predominately medial injuries, 76 were lateral, and 16 were syndesmosis sprains. Ninety-five percent had returned to sports activities by 6 weeks; however, 55% of these subjects reported loss of function or presence of intermittent pain, and 23% had a decrement of >20% in the lateral hop test when compared with the uninjured side. At 6 months, all subjects had returned to full activity; however, 40% reported residual symptoms and 2.5% had a decrement of >20% on the lateral hop test. Neither previous injury nor ligament laxity was predictive of chronic symptomatology. Furthermore, chronic dysfunction could not be predicted by the grade of sprain (grade I vs. II). The factor most predictive of residual symptoms was a syndesmosis sprain, regardless of grade. Syndesmosis sprains were most prevalent in collision sports. This study demonstrates that even though our knowledge and understanding of ankle sprains and rehabilitation of these injuries have progressed in the last 20 years, chronic ankle dysfunction continues to be a prevalent problem. The early return to sports occurs after almost every ankle sprain; however, dysfunction persists in 40% of patients for as long as 6 months after injury. Syndesmosis sprains are more common than previously thought, and this confirms that syndesmosis sprains are associated with prolonged disability.
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Injury is a major cause of morbidity and mortality in the United States. Although the National Vital Statistics System provides data on injury-related deaths, a national surveillance system is needed for timely identification of emerging nonfatal injury problems and continuous monitoring of severe nonfatal injuries. This work assesses the feasibility of expanding the National Electronic Injury Surveillance System (NEISS) to monitor all types and causes of nonfatal injuries treated in US hospital emergency departments and reports national estimates generated by a pilot study of this system. At a stratified sample of US hospital EDs, persons receiving first-time treatment for an injury were monitored from May 1 through July 31, 1997. National estimates of the annual number and rate of ED-treated injuries overall, by patient characteristics, injury diagnosis, and external cause of injury were generated, and the sensitivity of the system for detecting ED-treated injuries was assessed. An estimated 29. 1 million injuries were treated in US EDs in 1997 (rate of 108.6/1, 000 population). The leading causes of injury were falls, being struck by or striking against an object or person, cutting or piercing, and motor vehicle traffic. Of 593 cases of injury detected by investigators from the Centers for Disease Control and Prevention during visits to 6 of the 21 NEISS hospitals in the study, 490 were also detected by NEISS coders for an overall sensitivity of 82.6%. Expanding the NEISS is a feasible means of timely and continuous monitoring of all types and causes of nonfatal injuries treated in US hospital EDs.
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A total of 865 members of the U.S. military underwent repair of Achilles tendon ruptures at U.S. military hospitals during calendar years 1994, 1995, and 1996. The discharge summaries of these patients were analyzed for patient demographic information, including age, race, and causative activity. Patients were then stratified by age, race, and cause of injury. Blacks were at increased risk for undergoing repair of the Achilles tendon compared with nonblacks (overall relative risk = 4.15, 95% confidence interval [CI] = 3.63, 4.74; summary odds ratio controlling for age = 3.69, CI = 3.25, 4.19). Participation in the game of basketball accounted for 64.9% of all injuries in black patients and 34.0% of all injuries in nonblack patients. Among those injured, blacks had a significantly increased risk for injury related to playing basketball than nonblacks (relative risk = 1.82, CI = 1.58, 2.10). This finding suggests that there may be other predisposing factor(s) that result in a higher risk of Achilles tendon ruptures in black individuals.
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This report describes ambulatory care visits in the United States across three ambulatory care settings--physician offices, hospital outpatient departments, and hospital emergency departments. Statistics are presented on selected patient and visit characteristics for all ambulatory care visits and separately for each setting. The data presented in this report are from the 1997 National Ambulatory Medical Care Survey (NAMCS) and the 1997 National Hospital Ambulatory Medical Care Survey (NHAMCS). These surveys are part of the ambulatory care component of the National Health Care Survey that measures health care utilization across a variety of health care providers. NAMCS and NHAMCS are national probability sample surveys of visits to office-based physicians (NAMCS) and visits to the outpatient departments and emergency departments of non-Federal, short-stay and general hospitals (NHAMCS) in the United States. Sample data are weighted to produce annual estimates. During 1997, an estimated 959.3 million visits were made to physician offices, hospital outpatient departments, and hospital emergency departments in the United States, an overall rate of 3.6 visits per person. Visits to office-based physicians accounted for 82.1 percent of ambulatory care utilization, followed by visits to emergency departments (9.9 percent) and outpatient departments (8.0 percent). Utilization varied by patient age, sex, and race. Persons 75 years and over had the highest rate of ambulatory care visits. Females had significantly higher rates of visits to physician offices and hospital outpatient departments than males did. White persons utilized physician offices at a higher rate compared with black persons. There were an estimated 123.8 million injury-related ambulatory care visits during 1997, or 46.4 visits per 100 persons.
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The purpose of this study was to evaluate the relative risk of anterior cruciate ligament injury in female versus male midshipmen at the United States Naval Academy. From 1991 to 1997, we recorded the incidence of anterior cruciate ligament injury during intercollegiate athletics, intramural athletics, and military training. The subjects were male and female varsity athletes, coed intramural athletes, and participants in military training consisting of the obstacle course and instructional wrestling. All patient data were collected at the time of injury. Records filed at the intramural sports office, along with a questionnaire completed by coaches and trainers, were used to estimate midshipmen exposures. Results showed that in intercollegiate soccer, basketball, and rugby, women had a relative injury risk of 3.96 compared with men. In coed soccer, basketball, softball, and volleyball, the women's relative injury risk was 1.40 compared with men. In military training, women had a relative injury risk of 9.74 compared with men. In comparing overall annual anterior cruciate ligament injury rates among midshipmen, we found that women had a relative injury risk of 2.44 compared with men. We concluded that female midshipmen have an increased relative risk of anterior cruciate ligament injury as compared with men in intercollegiate athletics, basic military training, and throughout their service academy career. This increase was not statistically significant at the intramural level of athletics.
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Studies suggest that women are at greater risk than men for sports and training injuries. This study investigated the association between gender and risk of exercise-related injuries among Army basic trainees while controlling for physical fitness and demographics. Eight hundred and sixty-one trainees were followed during their 8-week basic training course. Demographic characteristics, body composition, and physical fitness were measured at the beginning of training. Physical fitness measures were taken again at the end of training. Multivariate logistic regression analysis was used to evaluate the association between gender and