Individuals with chronic ankle instability exhibit altered ankle kinematics and neuromuscular control compared to copers during inversion single-leg landing

ObjectivesThis study compares the ankle kinematics and muscle activities of the individuals with chronic ankle instability (CAI), coper, and control groups in normal and inversion single-leg landings.Designcross-sectional study;SettingBiomechanics laboratory.ParticipantsPhysically active adults with CAI (N = 12); and coper (N = 12) and control (N = 12) groups.Main outcome measuresThe participants performed normal and inversion single-leg landing. The muscle activity 200 ms before and after landing of the tibialis anterior, the medial gastrocnemius, and the fibularis longus (FL) were recorded. The FL latency, sagittal and frontal co-contraction indexes (CCI), ankle inversion angle at the initial contact, and the maximum inversion angle were recorded.ResultsSignificantly longer FL latency, decreased FL muscle activity, frontal CCI, and an increased maximum inversion angle at post-landing were discovered during inversion single-leg landing in the CAI group compared to the coper and control groups. However, no significant difference was observed among the CAI and coper groups during normal single-leg landing.ConclusionThese results suggest prolonged FL latency and altered ankle kinematics suggest an increased risk of recurrent lateral ankle sprains in CAI with inversion single-leg landing.     

Arthrography of the ankle joint in chronic instability

Papers on arthrography of injuries of the lateral ligaments of the ankle relate mainly to recent distortion of the joint. Arthrography performed at a later stage after injury generally is considered useless. In fact, changes in chronic instability are observed; they are subtle and consist either of small recesses adjacent to the lateral malleolus or communication of the joint with the peroneal tendon sheaths. Arthrography was assessed in 61 cases of recurrent lateral sprains of the ankle more than 2 weeks after acute injury; 38 were considered as positive. Twenty-five patients had operative evaluation, with four false negative and one false positive results. Small recesses adjacent to the lateral malleolus or opacification of the peroneal tendon sheaths are sequelae of an acute sprain with tear of the anterior talofibular and/or the calcaneofibular ligaments. Although false negative results occur, arthrography is useful in the preoperative assessment of chronic ankle instability.     

Effects of an ankle brace on the in vivo kinematics of patients with chronic ankle instability during walking on an inversion platform

BackgroundAs in vivo tibiotalar and subtalar joint kinematics are not currently known following the application of an ankle brace, an investigation of these kinematics may provide insight into the mechanisms of ankle braces.Research questionThis study aimed to determine the effect of an ankle brace on in vivo kinematics of patients with chronic ankle instability.MethodsEleven patients with chronic ankle instability were recruited in this study. A dual fluoroscopic imaging system and a solid modeling software were utilized to calculate the joint positions of the participants as they walked barefooted on a level platform, walked barefooted on a 15° inversion platform, and walked with an ankle brace on a 15° inversion platform. The joint positions during the three walking conditions were compared.ResultsTibiotalar joints were more inverted (pose 2, p = .004), and subtalar joints were more anteriorly translated (pose 2–6, p = .003), more plantarflexed (pose 2, p = .008; pose 3, p = .013; pose 5, p = .008; pose 6, p = .016) and more inverted (pose 1–5, p = .003; pose 6, p = .013) during barefooted walking on the inversion platform than during walking on the level platform. The inversion of subtalar joints was decreased after the brace application (pose 2–4, p = .003; pose 5, p = .004; pose 7, p = .016).SignificanceBrace application reduced the increased subtalar inversion induced by the inversion platform. Nevertheless, increased subtalar anterior translation and plantarflexion persisted after brace application. The ankle brace might be beneficial for clinical populations with increased subtalar inversion.     

The reliability,and discriminative ability of the identification of functional ankle instability questionnaire,Japanese version

ObjectiveTo assess the discriminability as well as the reliability, and internal consistency of the Identification of Functional Ankle Instability questionnaire translated into Japanese (IdFAI-J).DesignCross-sectional study.SettingCollegiate athletic training/sports medicine clinic.ParticipantsTwenty bilingual and sixty-five collegiate athletes including participants with and without functional instability (FI).Main outcome measuresThe sensitivity, specificity, test retest reliability, and internal consistency of IdFAI-J.ResultsThe optimal cutoff score between the FI and non-FI participants was >10, with an area under the curve of 0.92. We calculated high sensitivity (0.94) and specificity (0.77) at the cutoff point. For the test-retest reliability, the intraclass correlation coefficient value of the IdFAI-J was 0.96; the standard error of measurement and minimal detectable change value was 1.69 and 3.60, respectively. Cronbach's α was 0.87; there was no improvement when a particular item was deleted from the scale.ConclusionsThe IdFAI-J has excellent discriminability, test-retest reliability, and internal consistency. Hence, the IdFAI-J significantly contribute to clinical practice and future research related to ankle instability in Japan.     

Individuals with chronic ankle instability exhibit decreased postural sway while kicking in a single-leg stance

Individuals with chronic ankle instability (CAI) usually experience deficits in balance control, which increase displacement in the body's center of pressure (COP) when they balance on a single leg. Little is known, however, about whether or not these individuals use the strategies of postural adjustment properly, especially during functional tasks that may predispose them to ankle sprain. The aim of this study was to investigate anticipatory (APA) and compensatory (CPA) postural adjustments in individuals with and without CAI as they kick a ball while standing in a single-leg stance with their ankle in neutral and supinated positions. COP displacements were calculated and their magnitudes (range) analyzed during APA and CPA intervals and over the duration of the whole task, represented by the COP area of sway and mean velocity. The CAI group exhibited a significant decrease in CPA and area of sway over the whole task, relative to controls. These results suggest that the decreased balance sway could be caused by the need for further stabilization of the ankle in more unstable postures to prevent recurrent sprain. Our findings could help clinicians to better understand the strategies of postural adjustments in individuals with CAI, and may assist and motivate new investigations into balance control interventions in such individuals, as well as proactively address recurrent ankle sprain conditions.     

Effect of chronic ankle instability on lower extremity kinematics,dynamic postural stability,and muscle activity during unilateral jump-landing tasks: A systematic review and meta-analysis

ObjectiveTo determine if individuals with chronic ankle instability (CAI) demonstrate altered landing kinematics, muscle activity, and impaired dynamic postural stability during a unilateral jump-landing task.Methods21 studies were included from PubMed, MEDLINE, Embase and CINAHL searched on September 26, 2021. Mean differences in joint angles and muscle activity between CAI and controls were analysed as continuous variables and pooled using a random-effects model to obtain standardised mean differences and 95% confidence intervals. Dynamic postural stability measured using time to stabilisation (TTS) was assessed qualitatively.ResultsWe found greater plantarflexion (pooled SMD = 0.33, 95%CI [0.02,0.65]), reduced knee flexion (pooled SMD = −0.67, 95%CI [−0.97, −0.37]), and reduced hip flexion (pooled SMD = −0.52, 95%CI [−0.96, −0.07]) in CAI after landing. Regarding muscle activity, we observed reduced peroneus longus muscle activation (pooled SMD = −0.77, 95% CI [−1.17, −0.36]) in CAI prior to landing.ConclusionOur study provides preliminary evidence of altered landing kinematics in the sagittal plane and reduced peroneus muscle activity in CAI during a dynamic jump-landing task. These results may have clinical implications in the development of more effective and targeted rehabilitation programmes for patients with CAI.     

Applicability of cutoff scores of Chinese Cumberland Ankle Instability Tool and Foot and Ankle Ability Measure as inclusion criteria for study of chronic ankle instability in Chinese individuals

ObjectiveTo examine the applicability of Chinese Cumberland Ankle Instability Tool (CAIT-C) and Foot and Ankle Ability Measure (FAAM-C) as inclusion criteria recommended by the International Ankle Consortium (IAC) for study of chronic ankle instability in the Chinese individuals.DesignCross-sectional comparative design with known groups.SettingResearch laboratory.Participants145 participants with chronic ankle instability (CAI) and 66 participants without injury.Main outcome measuresCAIT-C and FAAM-C Activities of Daily Living (FAAM-C-ADL) and FAAM-C Sports (FAAM-C-Sports).ResultsThe CAIT-C scores (18.2 ± 5.6), FAAM-C-ADL scores (97.0 ± 4.3) and FAAM-C-Sports scores (92.2 ± 10.3) of the CAI group were all lower than the CAIT-C scores (27.4 ± 3.1), FAAM-ADL scores (99.0 ± 2.1) and FAAM-Sports scores (98.4 ± 3.1) (P < 0.01) of the uninjured group. The recommended cutoff score of CAIT-C<24 by the IAC for identifying CAI had a sensitivity of 80.7% and a specificity of 84.9%. If the recommended cutoff scores of FAAM-ADL<90,FAAM-Sports<80 by the IAC as inclusion criteria for the study of CAI were applied, 97% of participants with CAI in this sample would be excluded.ConclusionThe results support the recommended cutoff score of CAIT-C<24 by the IAC to identify Chinese individuals with CAI for study. However, the recommended cutoff scores of FAAM-ADL<90 and FAAM-Sports<80 will exclude most Chinese individuals with CAI having only mild functional impairments.     

下伸肌支持带移位加强联合关节囊紧缩术治疗慢性踝关节外侧不稳的疗效

 目的 探讨下伸肌支持带移位加强联合关节囊紧缩术治疗不同残余程度距腓前韧带损伤导致慢性踝关节外侧不稳的临床疗效。方法 选取2015-06至2019-08在武警特色医学中心骨科行下伸肌支持带移位加强联合关节囊紧缩术的58例慢性踝关节外侧不稳患者,年龄18～50岁,平均(25.3±8.6)岁,随访12～26(18.1±5.5)个月,所有患者术前均对距腓前韧带残留物损伤程度进行超声、磁共振评估,术中进一步明确评估结果,术后采用足踝功能评分(foot and ankle outcome score, FAOS)随访,评估术后踝关节功能,比较不同残余程度距腓前韧带损伤的修复疗效差异。结果 58例中,术前超声检查48例可见距腓前韧带(auterjor tolofitular ligament,ATFL)残余,42例在MRI检查中可见ATFL残余,根据Cardone BW等按形态诊断ATFL损伤分级:19例韧带变薄,形态正常;10例韧带形态不规整; 29例断端萎缩或缺失。58例采用下伸肌支持带移位加强联合关节囊紧缩术治疗,术中见ATFL残余17例,缺失41例。58例均获得随访,术后患肢功能恢复满意,术后FAOS各独立分量中结果差异无统计学意义。结论 对于不同残余程度距腓前韧带损伤的慢性外踝关节不稳患者,中-短期临床随访结果表明,下伸肌支持带移位加强联合关节囊紧缩术临床疗效良好。     

Plausible mechanisms of and techniques to assess ankle joint degeneration following lateral ankle sprains: a narrative review

Lateral ankle sprain (LAS) is the most common lower extremity musculoskeletal injury sustained during daily life and sport. The cascade of events that starts with ligamentous trauma leads to clinical manifestations such as recurrent sprains and giving way episodes, hallmark characteristics of chronic ankle instability (CAI). The sequelae of lateral ankle sprains and CAI appear to contribute to aberrant biomechanics. Combined, joint trauma and aberrant biomechanics appear to directly and/or indirectly play a role in talar cartilage degeneration. Up to 80% of all cases of ankle osteoarthritis (OA) are post-traumatic in nature and common etiologies for ankle post-traumatic osteoarthritis (PTOA) are histories of a single and recurrent ankle sprains. Despite known links between LAS, CAI, and PTOA and evidence demonstrating the burden of LAS and its sequelae, early pathoetiological changes of ankle PTOA and how they can be assessed are poorly understood. Therefore, the purpose of this paper is to review the plausible mechanistic links among LAS and its sequelae of CAI and PTOA as well as review non-surgical techniques that can quantify talar cartilage health. Understanding the pathway from ligamentous ankle injury to ankle PTOA is vital to developing theoretically sound therapeutic interventions aimed at slowing ankle PTOA progression. Further, directly assessing talar cartilage health non-surgically provides opportunities to quantify if current and novel intervention strategies are able to slow the progression of ankle PTOA.     

Arthroscopic assessment of the chronic unstable ankle joint

The purpose of this study was to evaluate prospectively the findings during arthroscopy in patients with chronic instability of the ankle joint. One hundred and ten consecutive patients who had suffered at least two ankle sprains and were symptomatic for at least 6 months were included in this study. A complete rupture of the anterior talofibular ligament was found in 64%, of the calcancofibular ligament in 41% and of the deltoid ligament in 6%. Cartilage lesions of the talus were seen in 54% of the joints, more of them medial (56%) than lateral (15%) or ventral (20%). Other frequently observed findings were synovialitis (38%), rupture of the syndesmosis (7%), and ventral scarring (6%). While cartilage damage was found independently of the lateral ligament injuries, all complete tears of the deltoid ligament were associated with cartilage injury of the talus. Medial instability was assessed in five ankles clinically and found arthroscopically in 23 ankle joints. Our arthroscopic findings show that chronic instability of the ankle joint is associated with various pathological conditions of ligaments, capsule and cartilage. It can therefore give essential information about the status of the chronic unstable joint with regard to the choice of operative or conservative treatment.     

Alterations of lower extremity function,health-related quality of life,and spatiotemporal gait parameters among individuals with chronic ankle instability

ObjectiveTo identify differences in patient-reported outcome questionnaires and spatiotemporal gait parameters during walking between individuals with and without chronic ankle instability (CAI) and to identify relationships between patient-oriented outcome and spatiotemporal gait parameters.ParticipantsTwenty-four individuals with CAI and 24 controls were included in this study.Main outcome measuresAll participants completed the Foot and Ankle Ability Measure including the Activities of Daily Living and Sport Subscales, the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), the Lower Extremity Functional Scale, and the Korean version of the EuroQol 5-Dimension (KEQ-5D). Participants walked in a laboratory setting to collect spatiotemporal gait parameter data.ResultsAll questionnaire scores from the male CAI group were lower than those from the control group. The female group yielded lower questionnaire scores than the controls, with an exception for KEQ-5D. The differences between the female CAI and female control groups in temporal gait parameters were significant. Correlations were observed between the WOMAC scores of the male participants and spatiotemporal gait parameters. In females, there were correlations between the patient-reported outcomes and spatiotemporal gait parameters.ConclusionsCAI patients need treatment not only for ankle function but also lower extremity function and gait performance.     

慢性踝关节外侧不稳定的治疗

目的 回顾慢性踝关节外侧不稳定的治疗,对其结果进行分析和评价.方法 74例患者,其中男43例,女31例;年龄15～63岁,平均39岁.患者至少有半年以上的病史,有两次以上的反复扭伤史.所有患者均行6周以上的保守治疗.41例患者行手术治疗,改良的Brostrom术12例,Myerson法8例,Chrisman-Snook法21例.对其他并发的病理问题需同时处:其中腓骨肌腱滑脱加固术6例,跟腱挛缩延长术9例,跟内翻截骨外移术8例,距骨骨软骨损伤清理打孔13例.结果 本组74例患者,通过术前的保守治疗,21例功能性不稳定的患者症状缓解,53例合并功能性不稳定和机械性不稳定的患者中,10例症状缓解,2例不愿意手术治疗,41例行手术治疗.手术治疗的患者在术后的随访中,有随访资料的39例;33例未手术的患者中,有随访资料的28例.共随访6～91个月,采用Roos功能结果评分法进行结果评判.术后踝关节功能评分的平均值为86.24,保守治疗的患者踝关节功能评分的平均值为97.34.结论 本组74例患者,通过术前的保守治疗,21例功能性不稳定的患者症状缓解,53例合并功能性不稳定和机械性不稳定的患者中,10例症状缓解,2例不愿意手术治疗,41例行手术治疗.手术治疗的患者在术后的随访中,有随访资料的39例;33例未手术的患者中,有随访资料的28例.共随访6～91个月,采用Roos功能结果评分法进行结果评判.术后踝关节功能评分的平均值为86.24,保守治疗的患者踝关节功能评分的平均值为97.34.     

Short-term and long-term effects of ankle joint taping and bandaging on balance,proprioception and vertical jump among volleyball players with chronic ankle instability

ObjectiveThis study hypothesized that the prolonged use of taping during athletic activities produces more significant increases in proprioception, balance, and vertical jump among volleyball players with CAI.DesignA randomized controlled study.ParticipantsOne-hundred participants with chronic ankle instability (CAI) participated in this study. Participants were distributed into 3-groups: taping group, bandaging group, and control group.Primary outcome measuresProprioception (ankle range of motion absolute error), balance(Y-balance test), and vertical jump (vertical jump tester).InterventionsThree interventions were performed: ankle rigid taping, ankle bandaging, and placebo taping. The measurements were performed at baseline, immediately, 2-weeks and 2-months after support.ResultsImmediately after supports, there were non-significant differences between all groups for proprioception, balance (P < .05). There was a significant difference between banding and control groups, and taping and control groups for the vertical jump (P < .05). After 2-weeks and 2-months, there were significant differences between bandaging and control groups, and taping and control groups for proprioception, balance, and vertical jump (P < .05). There were non-significant differences between taping and bandaging groups (P < .05) during all assessments.ConclusionThis study indicated that ankle taping and bandaging immediately improve vertical jump only; while they improve proprioception, balance, and vertical jump after 2-weeks and 2-months.     

In vivo kinematics of functional ankle instability patients during the stance phase of walking

BackgroundPrevious studies showed functional ankle instability (FAI) patients have morphological ligamentous abnormality, despite having no apparent joint laxity.Research questionWhether tibiotalar and subtalar joints hypermobility exists in FAI patients during stance phase of walking, remains controversial.MethodsTen unilateral FAI patients, ten unilateral lateral ankle sprain (LAS) copers and ten healthy controls were included. A dual fluoroscopy imaging system was utilized to capture the fluoroscopic images of tibiotalar and subtalar joint during the stance phase of walking. Kinematic data from six degrees of freedom were calculated utilizing a solid modeling software. The range of motion and joint excursions about six degrees of freedom were compared among the three groups. The correlations between range of motion and Cumberland Ankle Instability Tool (CAIT) scores were assessed utilizing the Spearman’s correlation coefficient (r).ResultsDuring the stance phase, the FAI patients and LAS copers showed larger tibiotalar anterior/posterior translation than the healthy controls (FAI patients, p = .013; LAS copers, p = .002). The FAI patients also showed significantly larger lateral/medial translation (p = .035) and inversion/eversion rotation (p = .003) of subtalar joints than healthy controls. By contrast, the subtalar joints of the LAS copers were not different from those of the healthy controls in the lateral/medial translation (p = .459) and inversion/eversion rotation (p = .091). CAIT scores were negatively correlated with range of motion.SignificanceDuring the stance phase of walking, FAI patients showed significantly larger hypermobility of subtalar joints than healthy controls, contrary to the LAS copers. These findings justify the utilization of dual fluoroscopy imaging system to detect joint hypermobility in FAI patients. Treatment for FAI patients may require stabilization of the subtalar joint.     

半腱肌移植重建踝关节外侧副韧带及踝关节不稳

目的 探讨半腱肌移植修复陈旧性踝关节外侧副韧带损伤及踝关节不稳的有效性.方法 选择陈旧性踝关节外侧副韧带损伤患者2例,其中男1例,女1例;男25岁,女17岁.左侧1例,右侧1例.患者入院前均有2年以上反复踝部旋后位扭伤的病史.踝部损伤为Ⅲ度(美国足踝外科学院分度);前抽屉试验及距骨倾斜试验阳性.应力X线片显示距骨倾斜平均21°,且在侧位片显示距骨前脱位.2例均采用同侧自体半腱肌肌腱移植重建踝关节外侧副韧带.结果 2例平均随访8个月.患足局部无肿痛,行走正常,踝关节主动活动与被动活动良好,患足前抽屉试验及距骨倾斜试验阴性,应力X线片检查显示距骨无前脱位,距骨倾斜角＜5°.根据Mazur疗效评分标准,优1例,良1例.患者对踝关节功能主观满意.结论 (1)踝关节外侧副韧带损伤是导致慢性踝关节不稳,甚至踝关节骨性关节炎的常见原因;(2)Brostr(o)m法仍不失为修复新鲜踝关节外侧副韧带损伤的有效方法,但对陈旧性损伤无效.(3)采用自体半腱肌肌腱修复重建陈旧性踝关节外侧副韧带的方法简单,有效,对于治疗踝关节不稳、防止踝关节骨性关节炎的发生具有重要的作用.     

Fibular taping does not influence ankle dorsiflexion range of motion or balance measures in individuals with chronic ankle instability

ObjectivesTo determine the effects of fibular taping on ankle dorsiflexion range of motion (ROM) and dynamic balance in individuals with chronic ankle instability (CAI).DesignSingle-blind, randomized crossover.MethodsTwenty-three individuals (age = 23.4 ± 2.5 years, height = 171.6 ± 12.4 cm, mass = 71.5 ± 13.1 kg) with CAI were allocated to either a fibular taping intervention or sham taping intervention (tape applied without tension) over the course of two visits. Weight-bearing ankle dorsiflexion ROM and components of the Star Excursion Balance Test (SEBT) were measured before and after intervention.ResultsThere was not a significant change in ankle dorsiflexion ROM when comparing the taping interventions (F_1,43 = 1.03, P = .32), but both interventions resulted in a small increase (F_1,43 = 8.07, P = .007) in dorsiflexion ROM (pre = 36.7° ± 6.9°, post = 37.7° ± 6.2°). This increase in ROM did not exceed the established minimal detectable change for dorsiflexion ROM. Fibular taping with tension produced an increase (F_1,41 = 5.84, P = .02) (pre = 69.0 ± 9.1%, post = 70.6 ± 8.6%) in posterolateral reach distance when compared to taping without tension (pre = 72.7 ± 11.0%, post = 71.4 ± 9.6%), but this increase did not exceed the established minimal detectable change. There was not a significant change in dynamic balance between groups for the anterior (F_1,41 = 2.33, P = .14) and posteromedial (F_1,41 = .41, P = .53) reach directions.ConclusionsAlthough small changes in ankle dorsiflexion ROM and posterolateral reach distances were observed, these changes did not exceed established minimal detectable change values for these measures. These results suggest that the benefits of fibular taping are not related to an increase in ankle dorsiflexion ROM or dynamic balance.     

Early range of motion training after ligament reconstruction of the ankle joint

Early range of motion training after ligament reconstruction of the ankle ligaments for chronic ankle joint instability was evaluated. Forty patients were operated on with anatomic reconstruction of the lateral ankle ligaments, i.e. shortening, imbrication and reinsertion. The patients were randomized postoperatively between two groups: (1) immobilization for 6 weeks in a plaster cast and (2) early range of motion training, in a Walker-Boot. Both groups underwent an identical rehabilitation program. with peroneal strengthening and co-ordination training after 6 weeks. The functional results were evaluated using a scoring scale and the mechanical stability with standardized stress radiographs. The minimum follow-up was 2 years. The functional results were satisfactory in 16 (80%) of the patients in group I, and 19 (95%) in group II. The mean values of anterior talar translation and talar tilt were not significantly different between the groups preoperatively nor at follow-up. The mean time period for sick leave was significantly shorter for group II, 6.5±1.6 weeks compared with 8.5±1.8 weeks for group I. The mean time period for return to sports activity was significantly shorter for group II, 9.5±2.2 weeks, compared with 12.5±2.6 weeks for group I. Early range of motion training is recommended after ligament reconstruction of the ankle, as it will enable earlier return to sports activities, shorter sick leave and preserved mechanical stability.     

Anatomical repair of lateral ligaments in patients with chronic ankle instability

In a prospective study, 19 patients with chronic ankle instability underwent clinical and radiographic reexaminations 36 months after anatomical reconstruction. In addition, dynamic pedography was conducted and peroneal reaction time measured on a tilting platform for an evaluation of functional aspects. Prior to this examination, 32 patients had been asked to fill in a questionnaire and make a detailed subjective evaluation of current discomfort, stability, flexibility and sporting abilities. Eighty-eight percent of the patients reported satisfactory results; only 3% complained of persistent instability. In 71% the ability to take part in sports had improved after surgery, and 85% of the patients reported unrestricted walking abilities. Supination ability was impaired in 5% of the patients at the follow-up. The radiographic examination showed restored ankle stability with a significant reduction of talar tilt and talar translation; a postoperative increase in signs and symptoms of arthrosis was not observed. Dynamic pedography showed a large degree of symmetry of plantar pressure distribution after surgery. There were no significant differences in peroneal reaction time in the repaired and intact ankles. The results of the study show that it is possible to restore ankle stability with anatomical reconstruction without impairing the range of movement in the ankle joint complex. Progressive osteoarthrosis can be prevented.     

The prevalence of chronic ankle instability and its relationship to foot arch characteristics in female collegiate athletes

ObjectiveTo determine the prevalence of chronic ankle instability (CAI) and to investigate its relationship to the foot arch in collegiate female athletes by each sports event.DesignCross-sectional study.SettingUniversity setting.Participants138 collegiate female athletes.Main outcome measuresAll subjects were asked about previous ankle sprains, and the arch height index (AHI) was calculated. Athletes with a previous sprain history were evaluated based on the criteria by the International Ankle Consortium (IAC), the severity of ankle instability (CAIT), and foot and ankle function (FAAM). The prevalence of CAI and the relationship between the AHI and ankle instability were analyzed by each sports event.ResultsOf 106 athletes with a previous ankle sprain, 10 (9.4%) met the IAC criteria below the cut-off value of the CAIT, and only 1 athlete (0.9%) was below the FAAM cut-off value. The AHI was not significantly different in athletes with CAI. The AHI was significantly lower in swimmers than in track and field (sprint) athletes.ConclusionMost female athletes with CAI were aware of the severity of ankle instability, but they did not feel dysfunction of the ankle during sports. Additionally, the AHI may depend on the characteristics of sports events.     

Subgroup characteristics of patients with chronic ankle instability in primary care

ObjectivesTo examine clinical and radiological characteristics of participants with an ankle sprain in general practice, classified into subgroups of a previously described chronic ankle instability (CAI) model.DesignCross-sectional study.Methods206 participants, who visited their general practitioner with a lateral ankle sprain 6–12 months before inclusion, completed a questionnaire, physical examination, radiography and magnetic resonance imaging. They were classified into three subgroups of the previously described CAI-model: mechanical instability (MI), perceived instability (PI) and recurrent sprains (RS). Regression analyses were applied to evaluate differences in subgroup characteristics.ResultsA total of 192 participants were eligible to be classified into the model. Of these participants, 153 participants were classified into the subgroups and 39 could not be classified. With overlap between the subgroups and patients falling into more than one subgroup, 59 were classified having MI, 145 having PI and 30 having RS. Participants with RS and PI were more often sports participants (OR 6.83;95%CI 1.35–34.56 and OR 4.44;95%CI1.06–18.63 respectively) than participants without RS and PI. Participants with MI more often had a tenderness on palpation of the anterior talofibular ligament (OR 4.09;95%CI 1.91–8.72) and a KL-score ≥ 1 in the talonavicular joint on X-ray (OR 2.24;95%CI 1.09–4.58), compared to participants without MI.ConclusionsSports participation, tenderness on palpation of the anterior talofibular ligament and early signs of osteoarthritis were variables that discriminated between subgroups of CAI. However, further research is mandatory in order to examine the usefulness of the CAI model in relation to prognosis and suitable intervention.