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.     

Dynamic joint stiffness of the ankle in chronic ankle instability patients

BackgroundWhile Individuals with chronic ankle instability (CAI) exhibit altered ankle joint movement and moments during stance phase of gait, the interaction or dynamic joint stiffness (DJS) between these is not fully understood. Little attention has been placed on DJS during gait, limiting our understanding of how the most common dynamic task during daily life could affect cartilage loading.Research questionDo Individuals with CAI exhibit altered ankle DJS and mechanical energy exerted at the ankle joint during stance phase of gait?MethodsEighty-four physically active individuals, consisting of 42 individuals with CAI (12 M and 30 F) and 42 control (12 M and 30 F) participants were recruited in this study. Three-dimensional gait analysis was conducted. The sagittal ankle joint angle and moment during stance phase of walking gait were obtained. Stance phase was divided into three sub-phases: controlled plantarflexion, controlled dorsiflexion, and powered plantarflexion. Ankle DJS was represented by the slope of the joint moment plotted as a function of the joint angle. The coefficient of determination was calculated to determine how accurately data fit a linear model. Net work was calculated by the difference between work produced and absorbed. Further, sex specific exploratory analyses of DJS and work between individuals with and without CAI were conducted.ResultsLower DJS during the controlled plantarflexion (CPF) sub-phase, work produced, and net work was found in the CAI group. Males with CAI exhibited lower ankle moment changes during controlled dorsiflexion (CDF) sub-phase and work absorbed. Females with CAI exhibited lower ankle moment changes during CPF and CDF sub-phases, lower DJS during the CPF sub-phase, and lower net work.SignificanceIndividuals with CAI have alterations in DJS and work relative to uninjured controls. Females with CAI showed greater DJS related alterations, relative to controls, than their male CAI counterparts.     

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.     

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.     

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.     

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.     

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.     

Copers adopt an altered dynamic postural control compared to individuals with chronic ankle instability and controls in unanticipated single-leg landing

BackgroundSeveral prior studies involving “expected” single-leg landings have not succeeded in establishing a difference between copers and a control group.Research questionDoes expected and unanticipated single-leg landing affect dynamic postural stability in lateral ankle sprain individuals with chronic ankle instability (CAI), copers, and controls?MethodsIn this prospective cross-sectional study, physically active adults with CAI (n = 12), copers (n = 12), and controls (n = 12) were included. Participants performed expected single-leg landing by stepping off a 30-cm box. They also performed unanticipated landings including side-step cutting, side-step cutting at 60°, single-leg landing, and forward stepping. The expected and unanticipated conditions of each groups were compared in terms of time to stabilization (TTS) and center of pressure (COP) for the anterior-posterior (AP) and medial-lateral (ML) conditions. To analyze the data, a mixed-model one-way analysis of variance and a Tukey-Kramer post hoc test were performed.ResultsA significant condition × group interaction was observed in only TTS ML, with the CAI group demonstrating a significantly longer TTS ML than the coper (p < 0.001) and control (p < 0.001) groups during unanticipated trials. In addition, group interaction effects were observed for COP AP and TTS AP. The coper group demonstrated significantly longer COP AP and TTS AP than the control group (p < 0.001).SignificanceThe CAI group demonstrated a significantly longer TTS ML than the coper and control groups during the unanticipated condition, and the coper group demonstrated significantly longer TTS AP and COP AP than the control group. Thus, longer COP AP and TTS AP sway time in the coper group may be a protection mechanism, allowing greater freedom in the AP plane while quickly controlling ML sway and preventing lateral ankle sprains. These findings can help in the prevention of lateral ankle sprains and assessment of dynamic postural control.     

Hip and knee muscle torque and its relationship with dynamic balance in chronic ankle instability,copers and controls

ObjectivesWe compared hip and knee isometric muscle torque between individuals with chronic ankle instability (CAI), those who have sustained one ankle sprain with no ongoing problems (copers) and healthy controls. Our secondary objective was to compare balance between groups and investigate the relationship between muscle torque and balance.DesignCross-sectional study.Methods22 CAI, 20 copers and 22 uninjured participants were tested. Isometric torque (normalised to body mass (Nm/kg)) was measured using a rigidly-fixated hand-held dynamometer. Balance was assessed with the Y-balance test.ResultsKnee and hip flexor and extensor, and hip adductor and abductor muscle torque was less in individuals with CAI compared to controls (standardised mean difference (SMD) >1.2). Hip and knee flexor and extensor muscle torque was less in CAI participants than copers (SMD: 0.69–1.1). Hip external and internal rotator torque did not differ between groups. There was no difference in hip or knee muscle torque between controls and copers (SMD: 0.01–0. 54). Balance was impaired in CAI participants compared to copers and controls in all directions. There was a strong positive correlation between posterolateral Y-balance test performance and torque of the hip adductors (r = 0.53), flexors (r = 0.52) and extensors (r = 0.50).ConclusionsIndividuals with CAI have weak knee and hip muscles compared to copers and controls. Hip strength was shown to be related to posterolateral balance performance. Future studies may investigate the effect of hip and knee strengthening exercise on ongoing ankle problems, such as episodic giving way in individuals with CAI.     

Neuromuscular control of the ankle during pre-landing in athletes with chronic ankle instability: Insights from statistical parametric mapping and muscle co-contraction analysis

ObjectiveThe present study aimed to compare the neuromuscular control of the muscles around the ankle between athletes with CAI and without history of any ankle sprain (Non-CAI) by using statistic parametric mapping (SPM) and co-contraction analyses.DesignCross-sectional study; Setting: Laboratory; Participants: 40 athletes (20 CAI, 20 Non-CAI) were pair-matched for age and gender.Main outcome measuresNeuromuscular control was examined using surface electromyography (EMG) amplitude and muscle co-contraction 200 ms before foot-contact with the ground during a jump-landing task.ResultsThe EMG amplitude of tibialis anterior, peroneus longus, and gastrocnemius medialis were analyzed using statistic parametric mapping. The CAI group exhibited decreased EMG amplitude of peroneus longus during preparation for foot-contact. There were no significant co-contraction differences between groups.ConclusionsOur findings demonstrate that SPM combined with the co-contraction provides a comprehensive EMG analysis to detect the differences of neuromuscular control between athletes with and without chronic ankle instability. Additionally, this finding indicates that CAI contributed to altered neuromuscular control during the pre-landing phase, which may contribute to re-injury mechanisms.     

Muscle activations during functional tasks in individuals with chronic ankle instability: a systematic review of electromyographical studies

BackgroundIt has been reported that individuals with chronic ankle instability (CAI) show motor control abnormalities. The study of muscle activations by means of surface electromyography (sEMG) plays a key role in understanding some of the features of movement abnormalities.Research questionDo common sEMG activation abnormalities and strategies exists across different functional movements?MethodsLiterature review was conducted on PubMed, Web-of-Science and Cochrane databases. Studies published between 2000 and 2020 that assessed muscle activations by means of sEMG during any type of functional task in individuals with CAI, and used healthy individuals as controls, were included. Methodological quality was assessed using the modified Downs&Black checklist. Since the methodologies of different studies were heterogeneous, no meta-analysis was conducted.ResultsA total of 63 articles investigating muscle activations during gait, running, responses to perturbations, landing and hopping, cutting and turning; single-limb stance, star excursion balance task, forward lunges, ball-kicking, y-balance test and single-limb squatting were considered. Individuals with CAI showed a delayed activation of the peroneus longus in response to sudden inversion perturbations, in transitions between double- and single-limb stance, and in landing on unstable surfaces. Apparently, while walking on ground there are no differences between CAI and controls, walking on a treadmill increases the variability of muscles activations, probably as a “safety strategy” to avoid ankle inversion. An abnormal activation of the tibialis anterior was observed during a number of tasks. Finally, hip/spine muscles were activated before ankle muscles in CAI compared to controls.ConclusionThough the methodology of the studies herein considered is heterogeneous, this review shows that the peroneal and tibialis anterior muscles have an abnormal activation in CAI individuals. These individuals also show a proximal muscle activation strategy during the performance of balance challenging tasks. Future studies should investigate whole-body muscle activation abnormalities in CAI individuals.     

Diagnostic accuracy of clinical tests assessing ligamentous injury of the ankle syndesmosis: A systematic review with meta-analysis

ObjectiveTo summarise and evaluate research on the diagnostic accuracy of clinical tests for ligamentous injury of the ankle syndesmosis.MethodsCINAHL, Embase, and MEDLINE were searched from inception to February 12, 2021. Studies comparing clinical examination to arthroscopy, magnetic resonance imaging, or ultrasound were considered eligible. Meta-analysis was based on random effect modelling and limited to studies fulfilling all QUADAS-2 criteria. Sensitivity (SN), specificity (SP) and likelihood ratios determined diagnostic accuracy, all with 95% confidence intervals (CI).ResultsSix studies were included (512 participants; 13 clinical tests; 29% median prevalence). No individual test was associated with both high sensitivity and high specificity. Tests with the highest sensitivity were: palpation [SN 92% (95%CI 79–98)] and dorsiflexion lunge [SN 75% (95% CI 64–84%); n = 2 studies]. Tests with the highest specificity were: squeeze test [SP 85% (95% CI 81–89%); n = 4 studies] and external rotation [SP 78% (95% CI 73–82%); n = 4 studies].ConclusionsClinical examination should involve initial clustering of tests with high sensitivity (palpation; dorsiflexion lunge), followed by a test with high specificity (squeeze). However, as these tests cannot definitively stratify syndesmotic injuries into stable vs unstable, decisions on optimal management (conservative vs surgery) require additional imaging or arthroscopy.     

The effect of sensory-targeted ankle rehabilitation strategies on single-leg center of pressure elements in those with chronic ankle instability: A randomized clinical trial

Objectives

To determine the effects of sensory-targeted ankle rehabilitation strategies on laboratory-oriented measures of single-leg balance in those with chronic ankle instability.

The influence of foot position on lower leg muscle activity during a heel raise exercise measured with fine-wire and surface EMG

ObjectiveExercises for lower leg muscles are important to improve function. To examine the influence of foot position on lower leg muscle activity during heel raises.DesignCross-sectional laboratory study.SettingLaboratory.ParticipantsFourteen healthy men participated in this study.Main outcome measuresThe muscle activity levels of the tibialis posterior (TP), peroneus longus (PL), flexor digitorum longus (FDL) and medial gastrocnemius (MG) were measured. The heel raises consisted of three foot positions: 1) neutral, 2) 30° abduction, and 3) 30° adduction. The EMG data for five repetitions of each foot position were normalized to maximum voluntary contraction. One-way repeated measure ANOVA was employed for statistical analysis.ResultsThe muscle activity level of TP, PL and FDL was significantly different between the three foot positions during the heel raises. TP and FDL showed the highest activity level in 30° foot adduction while PL demonstrated the highest activity level in 30° foot abduction.ConclusionsHeel raises with 30° foot adduction and abduction positions can change lower leg muscle activity; These findings suggest that altering foot posture during the heel raise exercise may benefit patients with impaired TP, PL or FDL function.     

The effect of an ankle brace on the 3-dimensional kinematics and tibio-talar contact condition for lateral ankle sprains

Ten fresh-frozen cadaveric ankles were studied to investigate the effect of an ankle brace (Air-Stirrup) on the three-dimensional (3-D) motion and contact-pressure distribution of the talo-tibial joint with lateral ligamentous injury. Three-dimensional motion and contact-pressure distribution were simultaneously measured under dynamic conditions employing a direct linear-transformation technique and a dynamic-pressure sensor, respectively. Inversion increased significantly upon severing of the anterior talo-fibular (ATF) ligament and calcaneo-fibular (CF) ligaments; however, restoration to the intact level was observed following application of the ankle brace. Internal rotation also increased upon severing of the lateral ligaments in the plantar flexion; however, this difference was not altered by using the ankle brace. The contact area on the articular surface of the talus shifted from posterior to anterior between plantar flexion and dorsal flexion; additionally, a high pressure area was evident in the medial aspect of the talus following severing of the lateral ligaments. Upon application of the ankle brace, however, no significant changes were apparent in the contact condition. The results of this study suggest that stabilization against inversion is the major function of braces in terms of protection of ankle sprains. Ankle sprains, however, often occur in combinations of inversion, plantar flexion and internal rotation; therefore, restriction of plantar flexion and internal rotation may also be an important function of the ankle brace.     

The effect of ankle supports on lower limb biomechanics during functional tasks: A systematic review with meta-analysis

ObjectivesTo systematically review the literature on the effects of ankle supports on lower extremity biomechanics during functional tasks.DesignSystematic review with meta-analysis.MethodsEight electronic databases were searched from inception to July 2019. Studies of biomechanical outcomes during functional tasks that used a within-participant (repeated measures) design were included. Two independent reviewers screened studies, extracted data, assessed the methodological quality of the included studies and rated the quality of evidence. Meta-analysis was performed and reported as standardised mean differences and 95% confidence intervals.ResultsA total of 8350 studies were identified in the electronic search and 42 studies involving a total of 761 participants were included in the review (21 studies included for qualitative reporting and 21 studies in the meta-analysis). Most individual studies and the meta-analyses demonstrated no effect of ankle supports on ground reaction force or ankle inversion angle. However, there was high quality evidence that ankle taping decreased plantarflexion angle at initial contact during landing from a height (P = 0.0009, standerdised mean differences = 0.72, 95% confidence intervals = 1.15, 0.03, I ² = 3%). The effect of ankle supports on transverse plane ankle biomechanics has not been adequately investigated.ConclusionsAnkle taping only decreased plantarflexion angle at initial contact during landing from a jump. Ankle supports did not affect inversion angle or forces in linear and multiplanar tasks. There was insufficient evidence on the effect of ankle supports on ankle transverse plane biomechanics.     

Effectiveness of cryotherapy on pain intensity,swelling, range of motion,function and recurrence in acute ankle sprain: A systematic review of randomized controlled trials

ObjectiveInvestigate effectiveness of cryotherapy on pain intensity, swelling, range of motion, function and recurrence in acute ankle sprain.MethodsSearches were conducted on six databases for randomized or quasi-randomized controlled trials (RCTs) evaluating effectiveness of cryotherapy for pain intensity, swelling, range of motion, function and recurrence in acute ankle sprain. Selection of trials, data extraction and methodological quality assessment of included trials were conducted independently by two reviewers with discrepancies resolved by a third reviewer. Estimates were presented as mean differences (MDs) with 95% confidence intervals (CIs). The quality of the evidence was assessed using the Grading of Recommendations Assessment (GRADE) approach.ResultsTwo RCTs with high risk of bias were included. Both evaluated the additional effects of cryotherapy, comparing cryotherapy combined with other intervention versus other intervention stand-alone. Uncertain evidence shows that cryotherapy does not enhance effects of other intervention on swelling (MD = 6.0; 95%CI: 0.5 to 12.5), pain intensity (MD = −0.03; 95%CI: 0.34 to 0.28) and range of motion (p > 0.05).ConclusionsCurrent literature lacks evidence supporting the use of cryotherapy on management of acute ankle sprain. There is an urgent call for larger high-quality randomized controlled trials.     

Effects of elastic ankle support on running ankle kinematics in individuals with chronic ankle instability and healthy controls

BackgroundIndividuals with chronic ankle instability (CAI) have an increased risk for recurrent injuries. The preventive effects of external ankle supports are not fully understood. This study aimed to examine the effect of elastic ankle support on running ankle kinematics.Methods3D running gait analysis of individuals with and without CAI was conducted at three-minute-running trials at 2.78 m/s with and without elastic ankle support in a randomised order. Ankle kinematics and intra-individual standard deviations (variability) were calculated at each percent of the running gait cycle. Group and ankle support effects were calculated using statistical parameter mapping.ResultsTwenty-seven individuals were analysed (CAI: n = 14, controls: n = 13). When wearing ankle support, CAI individuals showed significantly decreased plantarflexion angles at 43–47 % (p = 0.033) and 49–51 % (p = 0.043) of the running gait cycle compared to normal running. In healthy controls, no differences in ankle angles between both conditions were found. Comparisons between CAI individuals and healthy controls showed statistically significant differences in the plantar-/dorsiflexion angles at 38–41 % (p = 0.044) with ankle support and at 34–46 % (p = 0.004) without ankle support. Significant ankle angle variability differences were found for ankle in-/eversion between CAI individuals and healthy controls (p = 0.041) at 32–33 % of the running gait cycle.ConclusionsElastic ankle support reduces the range of sagittal plane running ankle kinematics of CAI individuals but not of healthy controls. Further research is needed to evaluate the association between ankle support effects and the risk for recurrent ankle sprains.     

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.     

Efficacy of non-surgical interventions on dynamic balance in patients with ankle instability: A network meta-analysis

Objectives

To identify non-surgical treatments which were deemed to be more effective in improving dynamic postural control in patients with chronic ankle instability (CAI).