The role of ankle bracing for prevention of ankle sprain injuries

Lateral ankle sprains are one of the most common injuries incurred in recreational and competitive athletics. These injuries have a significant impact in terms of cost, athletic participation, and activities of daily living. Prophylactic ankle braces are often used to reduce the risk of injury recurrence when individuals return to athletic participation. The purpose of this clinical commentary is to review the literature and provide our own experience relative to the use of prophylactic ankle bracing. Relatively high incidence rates of ankle sprain injury have been reported for basketball and soccer athletes, military trainees, and individuals with a previous history of ankle sprain injury. Semirigid and laced ankle braces have significantly reduced the incidence of initial and recurrent ankle sprain injuries in athletic and military samples. With few exceptions, these braces do not appear to affect functional performance adversely. The prophylactic use of semirigid ankle braces appears warranted to reduce the incidence of initial and, in particular, recurrent ankle sprain injuries for individuals who participate in activities that have the highest risk for these injuries. Additional research is needed to evaluate the many new braces that are available and in use and their influence on the incidence of ankle sprain injury and functional performance.     

Editorial Commentary: Early Anterior Cruciate Ligament Reconstruction Decreases the Risk of Developing Irreparable Meniscus Tears in Female Athletes

There has been a substantial increase in the participation of women in sports since the passage of Title IX in 1972. With increased participation has come a rise in athletic injuries, including anterior cruciate ligament (ACL) tears. Numerous factors (modifiable and nonmodifiable) contribute to the 2 to 8 times increased risk of ACL tears in female compared with male athletes. The sports with the greatest risk of ACL injury include cutting sports such as soccer (1.1% per season), basketball (0.9% per season), volleyball, and lacrosse. In addition, female patients have a 33.7% greater risk of a subsequent contralateral ACL tear. Approximately 70% of ACL tears are the result of noncontact injuries. Numerous factors contribute to the increased risk of ACL tears in female athletes, including nonmodifiable (hormonal fluctuations, sex differences in knee geometry) and modifiable risk factors (neuromuscular control). Injury-prevention programs focus on modifiable risk factors and have been shown to be incredibly effective, decreasing the risk of ACL tears up to 50%. ACL tears commonly are associated with meniscus tears, including medial meniscus ramp and lateral posterior root lesions; therefore, thorough assessment is critical to identify this pathology. Early ACL reconstruction (i.e., <12 months following injury) increases the likelihood of being able to repair meniscus tears. Given the much greater risk of ACL tears and lower rate of return to sport in female athletes, this group warrants special attention to identify and treat these injuries earlier and subsequently improve overall outcomes.     

Anterior cruciate ligament injuries in the female athlete. Potential risk factors

In the general population, an estimated one in 3000 individuals sustains an anterior cruciate ligament injury per year in the United States, corresponding to an overall injury rate of approximately 100,000 injuries annually. This national estimate is low for women because anterior cruciate ligament injury rates are reported to be two to eight times higher in women than in men participating in the same sports, presenting a sizable health problem. With the growing participation of women in athletics and the debilitating nature of anterior cruciate ligament injuries, a better understanding of mechanisms of injury in women sustaining anterior cruciate ligament injuries is essential. Published studies strongly support noncontact mechanisms for anterior cruciate ligament tears in women, which make these injuries even more perplexing. Speculation on the possible etiology of anterior cruciate ligament injuries in women has centered on anatomic differences, joint laxity, hormones, and training techniques. Investigators have not agreed on causal factors for this injury, but they have started to profile the type of athlete who is at risk. In the current study the most recent scientific studies of intrinsic and extrinsic risk factors thought to be contributing to the high rate of female anterior cruciate ligament injuries will be reviewed, important differences will be highlighted, and recommendations proposed to alleviate or minimize these risk factors among female athletes will be reported where appropriate.     

Lateral collateral ligament ankle injuries in young athletic individuals.

1. Eleven cases of surgical repair of acute tears of the capsule, anterior talo-fibular, and calcaneo-fibular ligaments of the ankle in young athletic individuals are reported. 2. Diagnosis was made by clinical examination and stress X-rays and confirmed by arthrography in selected cases. All of the ligament ruptures were visualized at surgery. 3. Post-surgery, all of the patients had a stable ankle and were able to return to vigorous athletic endeavors without disability. 4. This study lends support to the impression that surgical repair of severe lateral collateral ankle ligament injuries in young athletic individuals leads to a functionally and mechanically stable ankle able to withstand severe stress without disability.     

Swedish research in sports traumatology

With long-established traditions in both sports medicine and trauma in Sweden, investigations are in progress on prevention, diagnosis, treatment, and rehabilitation, with special emphasis on soft-tissue injuries. The following subjects are of current interest: injuries to the ankle ligaments, compartment syndromes, knee ligament and meniscus injuries, thigh and groin muscle injuries, shoulder dislocation, lateral epicondylitis, and rupture of the ulnar collateral ligament of the thumb. Skiing injuries and the prevention of trauma in soccer players represent important unsolved problems.     

A 7-year review of men’s and women’s ice hockey injuries in the NCAA

BackgroundIce hockey is a high-speed collision sport with recognized injury potential. Body checking, identified as a primary cause of injury, is allowed in men’s hockey but is not allowed at any level for female players. The injury patterns in collegiate hockey should reflect this fundamental difference in how the game is played. In this study, we reviewed the injuries sustained by National Collegiate Athletic Association (NCAA) hockey players over a 7-year period.MethodsWe conducted a retrospective database review of injuries and exposures reported to the Injury Surveillance System to determine rates of injury or differences in the pattern of injury between the sexes.ResultsThe rate of injury during games for men (18.69/1000 athlete-exposures [AEs]) and women (12.10/1000 AEs) was significantly higher than the rate of injury during practice. The rate of concussion was 0.72/1000 AEs for men and 0.82/1000 AEs for women, and the rate remained stable over the study period. Player contact was the cause of concussions in game situations for 41% of women and 72% of men.ConclusionBoth men and women had increased rates of practice-related injuries that resulted in time loss during the study period. In addition, there were high rates of concussions from player contact. The concussion rate in women was higher than expected. A more detailed examination with focused data collection may impact these findings.     

Risk factors for ankle fracture requiring operative fixation

BACKGROUND: Ankle fractures are common and expensive injuries, particularly the injuries that require operative intervention. However, epidemiological research on the causative factors is sparse. This study aims to identify the groups at risk of ankle fracture requiring operative fixation, and to suggest directions for further study. METHODS: The clinical data on 336 patients with ankle fractures admitted to an urban hospital in New Zealand in 1994 were reviewed. Statistical analysis was carried out on the 252 patients with ankle fractures requiring operative fixation. RESULTS: Those at highest risk of ankle fracture are young male rugby players and middle-aged women who sustain injury while walking. Young males have a similar incidence of AO Type B and C fractures, while Type B fractures predominate strongly in older women. CONCLUSIONS: The groups at risk of ankle fracture requiring operative fixation, and the activities predisposing these groups to injury have been identified. More work is required to define the specific risk factors and biomechanical mechanisms that lead to these debilitating injuries.     

成人踝关节损伤的流行病学分析

目的：分析成人踝关节损伤患者性别年龄分布、致伤原因及分型等流行病学特点。方法利用PACS及病案查询系统,整理2011年1月至2011年12月新疆地区5所医院705例（714侧）成人踝关节损伤患者的临床资料,统计并分析其性别、年龄、Lauge-Hansen分型和AO分型特点。结果705例踝关节损伤患者中,男性（67.5%,476/705）多于女性（32.5%,229/705）;31～40岁年龄组患者最多（27.0%,190/705）;低能量损伤（跌倒和扭伤）致伤占68.1%（480/705）;714侧踝关节损伤均可按AO分型划分,但有10.1%（72/714）的踝关节损伤未能按Lauge-Hansen分型划分。结论成年踝关节损伤患者以青壮年男性常见,多由低能量损伤所致, Lauge-Hansen分型不能包含所有的踝关节损伤。     

Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention

Syndesmosis injuries are rare, but very debilitating and frequently misdiagnosed. The purpose of this clinical commentary is to review the mechanisms of syndesmotic injuries, clinical examination methods, diagnosis, and management of the injuries. Cadaveric studies of the syndesmosis and deltoid ligaments are also reviewed for further understanding of stress transmission and the roles of different structures in stabilizing the distal syndesmosis. External rotation and excessive dorsiflexion of the foot on the leg have been reported as the most common mechanisms of injury. The injury is most often incurred by individuals who participate in skiing, football, soccer, and other sport activities played on turf. The external rotation and squeeze tests are reliable tests to detect this injury. The ability of imaging studies to assist in an accurate diagnosis may depend on the severity of the injury. The results of cadaveric studies indicate the importance of the deltoid ligament in maintaining stability of the distal tibiofibular syndesmosis and the congruency of the ankle mortise. Intervention programs with early rigid immobilization and pain relief strategies, followed by strengthening and balance training are recommended. Heel lift and posterior splint intervention can be used to avoid separation of the distal syndesmosis induced by excessive dorsiflexion of the ankle joint. Application of a rigid external device should be used with caution to prevent medial-lateral compression of the leg superior to the ankle mortise, thereby inducing separation of the distal syndesmosis articulation. Surgical intervention is an option when a complete tear of the syndesmotic ligaments is present or when fractures are observed.     

Psychological Factors as Predictors of Injuries Among Senior Soccer Players. A Prospective Study

It is reported that between 65-91% of elite soccer players in Sweden have at least one injury per year. Several studies define different physiological and psychological factors affecting athletic injury-risk. A number of models contain proposals that specify relationships between psychological factors and an increased athletic injury-risk. Examples include Williams and Andersen’s stress-injury model and Johnson and Ivarsson’s empirical model of injury risk factors which proposes that factors such as trait anxiety and ineffective coping skills are influential. The purpose of this study was to examine the relationship between (a) personality factors, b) coping variables, and (c) stress and injury risk. Participants were 48 male soccer players from 3 Swedish teams ranging in age from 16 to 36 years (M = 22 years). Participants completed 5 questionnaires: Football Worry Scale, Swedish universities Scales of Personality, Life Events Survey for Collegiate Athletes, Daily Hassle Scale and Brief COPE. Information on injuries was collected by athletic trainers of the teams over 3-months. Results suggest injury was significantly predicted by 4 personality trait predictors: somatic trait anxiety, psychic trait anxiety, stress susceptibility, and trait irritability. Collectively, the predictors self-blame and acceptance could explain 14.6% of injury occurrence. More injuries were reported among players who score high in daily hassles. These results support previous findings. Recommendations are given for both the athletes and the trainers on working to prevent sport injuries.

Key points

• A number of psychological factors, such as high stress levels and ineffective coping could increase the injury risk among athletes.
• The two coping factors, self - blame and acceptance could together explain 14.6 % of injury occurrence.
• Results of the current study suggest that the factors; somatic trait anxiety, psychic trait anxiety, stress susceptibility and trait irritability could increase injury risk among soccer players.
• Suggestion for future research is to investigate how daily hassles affects injury risk among soccer players in larger samples and on premiership levels. Moreover, to investigate the effects of a preventive intervention designs for a representative sample of soccer players.

Key words: Coping strategies, daily hassles, personality, psychological predictors, sport injury     

Does the FIFA 11+ Injury Prevention Program Reduce the Incidence of ACL Injury in Male Soccer Players?

Background

The FIFA 11+ injury prevention program has been shown to decrease the risk of soccer injuries in men and women. The program has also been shown to decrease time loss resulting from injury. However, previous studies have not specifically investigated how the program might impact the rate of anterior cruciate ligament (ACL) injury in male soccer players.

Questions/purposes

The purpose of this study was to examine if the FIFA 11+ injury prevention program can (1) reduce the overall number of ACL injuries in men who play competitive college soccer and whether any potential reduction in rate of ACL injuries differed based on (2) game versus practice setting; (3) player position; (4) level of play (Division I or II); or (5) field type.

Methods

This study was a prospective cluster randomized controlled trial, which was conducted in 61 Division I and Division II National Collegiate Athletic Association men’s soccer teams over the course of one competitive soccer season. The FIFA 11+ is a 15- to 20-minute on-the-field dynamic warm-up program used before training and games and was utilized as the intervention throughout the entire competitive season. Sixty-five teams were randomized: 34 to the control group (850 players) and 31 to the intervention group (675 players). Four intervention teams did not complete the study and did not submit their data, noting insufficient time to complete the program, reducing the number for per-protocol analysis to 61. Compliance to the FIFA 11+ program, athletic exposures, specific injuries, ACL injuries, and time loss resulting from injury were collected and recorded using a secure Internet-based system. At the end of the season, the data in the injury surveillance system were crosshatched with each individual institution’s internal database. At that time, the certified athletic trainer signed off on the injury collection data to confirm their accuracy and completeness.

Results

A lower proportion of athletes in the intervention group experienced knee injuries (25% [34 of 136]) compared with the control group (75% [102 of 136]; relative risk [RR], 0.42; 95% confidence interval [CI], 0.29-0.61; p < 0.001). When the data were stratified for ACL injury, fewer ACL injuries were reported in the intervention group (16% [three of 19]) compared with the control group (84% [16 of 19]), accounting for a 4.25-fold reduction in the likelihood of incurring ACL injury (RR, 0.236; 95% CI, 0.193–0.93; number needed to treat = 70; p < 0.001). With the numbers available, there was no difference between the ACL injury rate within the FIFA 11+ group and the control group with respect to game and practice sessions (games—intervention: 1.055% [three of 15] versus control: 1.80% [12 of 15]; RR, 0.31; 95% CI, 0.09–1.11; p = 0.073 and practices—intervention: 0% [zero of four] versus control: 0.60% [four of four]; RR, 0.14; 95% CI, 0.01–2.59; p = 0.186). With the data that were available, there were no differences in incidence rate (IR) or injury by player position for forwards (IR control = 0.339 versus IR intervention = 0), midfielders (IR control = 0.54 versus IR intervention = 0.227), defenders (IR control = 0.339 versus IR intervention = 0.085), and goalkeepers (IR control = 0.0 versus IR intervention = 0.0) (p = 0.327). There were no differences in the number of ACL injuries for the Division I intervention group (0.70% [two of nine]) compared with the control group (1.05% [seven of nine]; RR, 0.30; CI, 0.06–1.45; p = 0.136). However, there were fewer ACL injuries incurred in the Division II intervention group (0.35% [one of 10]) compared with the control group (1.35% [nine of 10]; RR, 0.12; CI, 0.02–0.93; p = 0.042). There was no difference between the number of ACL injuries in the control group versus in the intervention group that occurred on grass versus turf (Wald chi square [1] = 0.473, b = 0.147, SE = 0.21, p = 0.492). However, there were more ACL injuries that occurred on artificial turf identified in the control group (1.35% [nine of 10]) versus the intervention group (0.35% [one of 10]; RR, 0.14; 95% CI, 0.02–1.10; p = 0.049).

Conclusions

This program, if implemented correctly, has the potential to decrease the rate of ACL injury in competitive soccer players. In addition, this may also enhance the development and dissemination of injury prevention protocols and may mitigate risk to athletes who utilize the program consistently. Further studies are necessary to analyze the cost-effectiveness of the program implementation and to analyze the efficacy of the FIFA 11+ in the female collegiate soccer cohort.

Level of Evidence

Level I, therapeutic study.

     

Efficacy of plantar loading parameters during gait in terms of reliability, variability, effect of gender and relationship between contact area and plantar pressure

BACKGROUND: The purpose of this study was to determine plantar pressure and contact areas of the foot inside the athletic shoe during activity. The objectives were to determine if plantar pressure and contact area measurements collected on multiple trials from the same subject were reliable, to determine the variability of measurements between subjects as compared to that found between steps within a single subject, to determine the relationship between contact area and plantar pressure, and to ascertain whether there were any systematic gender differences in these measurements. METHODS: Sixteen healthy adults volunteered for participation in the first part of the study that was designed to determine reliability and variability of the testing methodology. A separate group of fifty healthy high school and collegiate athletes participating in soccer, field hockey, basketball, and lacrosse comprised the second part of the study that was designed to investigate gender differences in terms of normalized midfoot plantar pressure and contact area, and the interrelationship between the two measurements. Data were collected during the midstance phase of gait, using the Pedar in-shoe measurement system (Novel GMBH, St. Paul, MN). Athletes wore their own athletic shoes and performed walking trials on a surface similar to that used in their sport. The foot was divided into four regions based on radiographic measurements. RESULTS: The midfoot region demonstrated excellent reliability across multiple trials of the same subject in contact area and plantar pressure, and the variability between steps within a single subject was small when compared to that between subjects. Normalized midfoot contact area and plantar pressure values were highly correlated with r values of 0.862 on the left foot and .912 on the right foot. No significant differences were found in normalized midfoot contact area or plantar pressure values between males and females. CONCLUSIONS: The Pedar in-shoe pressure measurement system can be used reliably to quantify contact area and plantar pressure beneath the midfoot region during the midstance phase of gait. This measurement technique can now be used in risk factor studies designed to identify individuals at risk for injury to the foot, ankle, and other lower extremity structures.     

Head injuries in men's and women's lacrosse: a 10 year analysis of the NEISS database. National Electronic Injury Surveillance System

INTRODUCTION: Although protective headgear is required in men's lacrosse, women's lacrosse is viewed as non-contact, and use of helmets and faceguards is prohibited. Yet, women remain at risk for injury to the head and face region from contact with the ball and stick. This study was designed to examine differences in lacrosse-related injuries between genders and amongst various age groups. METHODS: Data on lacrosse-related injuries maintained through the Consumer Product Safety Commission's National Electronic Injury Surveillance System, In-depth Investigation File, and Injuries/Potential Injuries File were analysed over a 10-year period (January 1990-April 2000). RESULTS: A total of 1727 cases of lacrosse-related trauma, mean age 16.9 years, range 4-59 years, were recorded. Males accounted for 80.5% of cases. The head and face region was the most common area injured (20.4%). Injuries to the head and face were significantly more prevalent among females (30.1% of all injuries) than males (18.0% of all injuries), p < 0.001, and often resulted from contact with the ball (33.6% of incidents). Children aged 4-11 years experienced the highest percentage of injuries to the head and face. Closed head injuries represented 5.6% of all lacrosse-related injuries and were slightly more prevalent among females. CONCLUSIONS: Women and children lacrosse players are at risk of serious injury to the head and face region. The use of protective head/face gear should be encouraged.     

Acute flexor hallucis longus and fibular tendinopathies during sport activities. MRI findings and clinical impact in a prospective study

Objectives

To evaluate, with magnetic resonance imaging (MRI), the occurrence of acute tendinopathy in athletes with ankle trauma during sports activities having normal radiographs and referred to the orthopedic department as “ankle sprains??

Methods

This is a prospective study of 54 patients. Clinical examination and MR imaging were done in order to have an accurate diagnosis and point out the incidence of bone, ligament and tendon injuries.

Results

Nearly half of the patients were found to have no ligament injury on MRI. Out of 20 (37%) acute tendon injuries, nine (45%, 16.5% overall injuries) concerned the Flexor Hallucis Longus (FHL) tendon and eight (40%, 14.8% overall injuries) the fibular tendons.

Conclusions

This study reveals that acute tendon injuries and are not infrequent in “benign??ankle trauma. MRI findings were the basis for a case by case and patient centered management. Conservative treatment was effective in all patients but one who was operated on. Surgical treatment is indicated mainly for complete tendon tears.     

Trends in operative ankle ligament surgery in Finland between 1986 and 2018

BackgroundAnkle sprains are common musculoskeletal injuries. Until the 1990s, ankle ligament injuries were often treated operatively. The aim of this registry study was to determine how the change in treatment practice has affected the number of acute and elective ankle ligament surgeries in Finland.MaterialThe data of ankle ligament injury patients operated between 1 January 1986 and 31 December 2018 was collected from the Finnish National Hospital Discharge Register.ResultsA total of 33,770 ankle ligament injuries were repaired. The incidence of acute ankle ligament injury repair surgery has decreased nearly 80% over the last three decades. No increase in the number of late-stage ankle ligament injury repairs was found.ConclusionThe number of acute and elective ankle ligament surgeries has remained low in the 2000s. This suggests that the occurrence of clinical instability after ankle sprains has not increased, even though acute-phase treatment has become conservative.     

Prospective Epidemiological Study of Basketball Injuries During One Competitive Season: Ankle Sprains and Overuse Knee Injuries

This prospective cohort study aims to assess the overall incidence of acute and overuse basketball injuries and identifies risk factors associated with ankle sprains and knee overuse injuries. In total, 164 senior players (23.7 years ± 7.0) of all levels of play, and including both men and women, participated voluntarily during one season. A total of 139 acute and 87 overuse injuries were reported, resulting in an overall injury incidence of 9.8 (8.5 to 11.1) per 1,000 hours. The incidence of acute injuries was 6.0/1,000 hours. Ankle sprains (n = 34) accounted for most acute injuries, and 52.9% of all players with ankle sprains reported a previous ankle sprain. Relative Risks (RR) and Odds Ratio (OR) with their 95% Confidence Intervals (CI) were calculated to determine significant differences. Landing on an opponent’s foot was the major inciting event, significantly more so than non contact mechanisms (RR=2.1 [95% CI: 1.0-4.2]). Acute knee injuries resulted in the highest playing absence (7 weeks 2 days ± 9 weeks 1 day). Overuse injury incidence was 3.8/1,000 hours. The knee (1.5/1,000 hours) was the most common site. Forward players sustained less knee overuse injuries than players of all other playing positions, and significantly less than center players (OR=0.5 [95% CI: 0.2-0.9]). This study showed that ankle sprains and overuse knee injuries are the most common injuries in basketball, both accounting for 14.8%. Injury prevention programmes however should not concentrate on those injuries only, but might one to consider that acute knee injuries, in spite of the fact that they occur less frequently, also merit further research.

Key points

• Ankle sprains are the most common acute injuries in basketball with the inciting event being landing on an opponent’s foot or changing direction.
• Anterior knee pain is the most common overuse injury. Etiologic factors are well described in literature, but prevention strategies are lacking.
• Acute knee injuries account for the highest inactivity and should therefore also be prevented.
• Most of the injuries are due to contact mechanisms and therefore the definition of basketball as a non contact sport is questionable.
• Highest injury risks are found in women and in the lower levels.

Key Words: Aetiology, ankle sprain, injury cause, injury mechanism, overuse knee injury     

Lack of effect of a knee ligament injury prevention program on the incidence of noncontact anterior cruciate ligament injury

BACKGROUND: Studies have suggested that exercise programs can reduce the incidence of noncontact injuries of the anterior cruciate ligament in female athletes. We conducted a two-year prospective study to assess the effects of a knee ligament injury prevention exercise program on the incidence of noncontact anterior cruciate ligament injuries in high-school female athletes. METHODS: A prospective cohort design was used to study high-school female athletes (playing soccer, basketball, and volleyball) from fifteen schools (112 teams) for two consecutive seasons. The schools were divided into treatment and control groups. The treatment group participated in a plyometric-based exercise program twice a week throughout the season. Practice and game exposures and compliance with the exercise program were recorded on a weekly basis. Suspected noncontact anterior cruciate ligament injuries were confirmed on the basis of the history as well as at the time of surgery and/or with magnetic resonance imaging. RESULTS: A total of 1439 athletes (862 in the control group and 577 in the treatment group) were monitored. There were six confirmed noncontact anterior cruciate ligament injuries: three in the treatment group, and three in the control group. The incidence of noncontact anterior cruciate ligament injuries per 1000 exposures was 0.167 in the treatment group and 0.078 in the control group, yielding an odds ratio of 2.05, which was not significant (p > 0.05). CONCLUSIONS: Our results suggest that a twenty-minute plyometric-based exercise program that focuses on the mechanics of landing from a jump and deceleration when running performed twice a week throughout the season will not reduce the rate of noncontact anterior cruciate ligament injuries in high-school female athletes.     

Deficiencies of MRI in the diagnosis of chronic symptomatic lateral ankle ligament injuries

BackgroundStress radiography and more recently magnetic resonance imaging have been used to study the integrity of lateral ankle ligaments in chronic symptomatic instability after injury.AimOur aim was to see if magnetic resonance imaging was as good as examination under anaesthesia and stress radiography, for diagnosing injury to the lateral ankle ligaments.MethodologyFifty eight patients, 47 men and 11 women, who were athletes or military personnel, with symptomatic instability of their ankle were included in the study. This cohort of patients had MRI scans, stress radiography and arthroscopy of their ankle. Integrity of the calcaneo-fibular ligament (CFL) was recorded arthroscopically.The sensitivity, specificity, positive and negative predictive value of MRI and stress views, in assessing integrity of the CFL, were compared against arthroscopic findings.ResultsStress radiography under anaesthesia and MRI had sensitivity of 94% and 47% respectively and specificity of 98% and 83% respectively, for diagnosing injury to the CFL. Stress radiography has a higher accuracy in diagnosing CFL injuries as compared to MRI.ConclusionThe results of this study casts doubt on the efficacy of MRI in the diagnosis of serious ankle ligament injuries.     

Penetrating trauma in urban women: patterns of injury and violence

Background

Penetrating trauma is known to occur with less frequency in women than in men, and this difference has resulted in a lack of characterization of penetrating injury patterns involving women. We hypothesized that the nature of penetrating injury differs significantly by gender and that these injuries in women are associated with important psychosocial and environmental factors.

Materials and methods

A level 1 urban trauma center registry was queried for all patients with penetrating injuries from 2002–2010. Patient and injury variables (demographics and mechanism of injury) were abstracted and compared between genders; additional social and psychiatric histories and perpetrator information were collected from the records of admitted female patients.

Results

Injured women were more likely to be Caucasian, suffer stab wounds instead of gunshot wounds, and present with a higher blood alcohol level than men. Compared with women with gunshot wounds, those with stab wounds were three times more likely to report a psychiatric or intimate partner violence history. Women with self-inflicted injuries had a significantly greater incidence of prior penetrating injury and psychiatric and criminal history. Male perpetrators outnumbered female perpetrators; patients frequently not only knew their perpetrator but also were their intimate partners. Intimate partner violence and random cross-fire incidents each accounted for about a quarter of injuries observed.

Conclusions

Penetrating injuries in women represent a nonnegligible subset of injuries seen in urban trauma centers. Psychiatric and social risk factors for violence play important roles in these cases, particularly when self-infliction is suspected. Resources allocated for urban violence prevention should proportionately reflect the particular patterns of violence observed in injured women.     

Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies

An estimated 80,000 anterior cruciate ligament (ACL) tears occur annually in the United States. The highest incidence is in individuals 15 to 25 years old who participate in pivoting sports. With an estimated cost for these injuries of almost a billion dollars per year, the ability to identify risk factors and develop prevention strategies has widespread health and fiscal importance. Seventy percent of ACL injuries occur in noncontact situations. The risk factors for non-contact ACL injuries fall into four distinct categories: environmental, anatomic, hormonal, and biomechanical. Early data on existing neuromuscular training programs suggest that enhancing body control may decrease ACL injuries in women. Further investigation is needed prior to instituting prevention programs related to the other risk factors.