Corrigendum to “Neuromuscular control of the ankle during pre-landing in athletes with chronic ankle instability: Insights from statistical parametric mapping and muscle co-contraction analysis” [Physical Therapy in Sport 47 (2021) 46–52]

Category: Ankle; Sports Introduction/Purpose: Augmentation of the Broström procedure with FiberTape device has been described for the treatment of chronic ankle instability. However, it has yet to be determined if the cost of the implant is negated by the benefits to the patient. The purpose of this study was to perform a comprehensive cost analysis by comparing the cost of surgical procedure, physical therapy visits, time off work, and any costs related to revision surgery between the Broström reconstruction with suture anchors alone versus augmentation with a FiberTape device. Methods: 166 patients undergoing lateral ankle ligament repair were analyzed retrospectively. Patients underwent either a modified Broström ligament repair with two suture anchors or Broström ligament repair with FiberTape augmentation. All patients followed the same post-operative protocol for early weight bearing and initiation of physical therapy once the wound was healed. Timing of return to work and the total number of visits of physical therapy before discharge were recorded. Implant costs, facility charges and professional fees were obtained from billing records. Lost income for missed days of work was based on the Pennsylvania Bureau of Labor Statistics. Complications requiring return to the operating room were recorded. Patients were followed out to one year. Results: Aggregate cost in the modified Broström group was $2,219 more expensive than when augmenting with FiberTape ($20,970 vs. $18,751) despite an increased implant cost of $900. This difference was the result of a greater number of therapy visits and days out of work in the modified Broström group versus the augmentation group (14.9 vs 12.4) as well as a significantly higher amount of days out of work in the modified Broström group versus augmentation (63.3 vs. 53.8 days respectively). No statistically significant difference was found for operation time between groups, and failure rates were similar; 2.0% (1/49) for FiberTape and 3.4% (4/117) for modified Broström. Conclusion: The aim of this study was to explore the cost comparison of the modified Broström procedure for chronic ankle instability versus the FiberTape augmentation. Despite an upfront increase in implant costs, the average cost per procedure was lower for the augmentation group. The majority of cost savings occurred in decreases in the number of physical therapy visits and faster return to work times. The results of this study suggest that the use of FiberTape to augment modified Broström repair may have a financial benefit and cost savings to patients and the healthcare system.

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Alterations in Neuromuscular Control at the Knee in Individuals With Chronic Ankle Instability

Journal of Athletic Training ◽

10.4085/1062-6050-49.3.28 ◽

2014 ◽

Vol 49 (5) ◽

pp. 599-607 ◽

Cited By ~ 17

Author(s):

Masafumi Terada ◽

Brian G. Pietrosimone ◽

Phillip A. Gribble

Keyword(s):

Confidence Interval ◽

Effect Size ◽

Muscle Activation ◽

Sagittal Plane ◽

Ankle Instability ◽

Force Plate ◽

Neuromuscular Control ◽

Chronic Ankle Instability ◽

Electromyographic Activity ◽

Vastus Medialis

Context: Few authors have assessed neuromuscular knee-stabilization strategies in individuals with chronic ankle instability (CAI) during functional activities. Objective: To investigate the influence of CAI on neuromuscular characteristics around the knee during a stop-jump task. Design: Case-control study. Setting: Research laboratory. Participants or Other Participants: A total of 19 participants with self-reported unilateral CAI and 19 healthy control participants volunteered for this study. Intervention(s): Participants performed double-legged, vertical stop-jump tasks onto a force plate, and we measured muscle activation around the knee of each limb. Main Outcome Measure(s): We calculated the integrated electromyography for the vastus medialis oblique, vastus lateralis, medial hamstrings, and lateral hamstrings muscles during the 100 ms before and after initial foot contacts with the force plate and normalized by the ensemble peak electromyographic value. Knee sagittal-plane kinematics were also analyzed during a stop-jump task. Results: Compared with control participants, the CAI group demonstrated greater prelanding integrated electromyographic activity of the vastus medialis oblique (CAI = 52.28 ± 11.25%·ms, control = 43.90 ± 10.13%·ms, t36 = 2.41, P = .021, effect size = 0.78, 95% confidence interval = 0.11, 1.43) and less knee-flexion angle at the point of initial foot contact (CAI = 7.81° ± 8.27°, control = 14.09° ± 8.7°, t36 = −2.28, P = .029, effect size = −0.74, 95% confidence interval = −1.38, −0.07) and at 100 ms post–initial foot contact (CAI = 51.36° ± 5.29°, control = 58.66° ± 7.66°, t36 = −3.42, P = .002, effect size = −1.11, 95% confidence interval = −1.77, −0.40). No significant results were noted for the other electromyographic measures. Conclusions: We found altered feed-forward patterns of the vastus medialis oblique and altered postlanding knee sagittal-plane kinematics in the CAI group. These observations may provide insight regarding sensorimotor characteristics that may be associated with CAI.

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Neuromuscular Control Training Does Not Improve Gait Biomechanics in Those With Chronic Ankle Instability: A Critically Appraised Topic

International Journal of Athletic Therapy & Training ◽

10.1123/ijatt.2019-0014 ◽

2020 ◽

Vol 25 (4) ◽

pp. 165-169

Author(s):

Kimmery Migel ◽

Erik Wikstrom

Keyword(s):

Ankle Instability ◽

Balance Training ◽

Neuromuscular Control ◽

Chronic Ankle Instability ◽

Program Completion ◽

Ankle Sprains ◽

Bottom Line ◽

Gait Biomechanics ◽

Rehabilitation Programs ◽

Evidence Grade

Introduction/Clinical Scenario: Ankle sprains are highly common within the population and can lead to chronic ankle instability (CAI). Individuals with CAI have both functional and mechanical impairments, which are thought to contribute to maladaptive gait biomechanics. Neuromuscular control and balance training are frequently incorporated into rehabilitation programs, however the effect of balance training on gait biomechanics remains unknown. Focused Clinical Question: Does balance or neuromuscular training improve gait biomechanics in individuals with CAI? Summary of Key Findings: Three studies assessed 4–6 weeks of progressive neuromuscular control training and found no improvements in gait biomechanics. One study found a worsening of eversion position at midstance upon program completion. However, when training was augmented with destabilizing shoes, improvements in dorsiflexion were noted. Clinical Bottom Line: Cumulative findings suggest that neuromuscular control training does not improve gait biomechanics in those with CAI. However, augmentation of programs may be beneficial. Strength of Recommendation: There is high-quality evidence(Grade B) that balance training does not alter gait biomechanics in patients with CAI.

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Taping Benefits Ankle Joint Landing Kinematics in Subjects With Chronic Ankle Instability

Journal of Sport Rehabilitation ◽

10.1123/jsr.2018-0234 ◽

2020 ◽

Vol 29 (2) ◽

pp. 162-167

Author(s):

Roel De Ridder ◽

Tine Willems ◽

Jos Vanrenterghem ◽

Ruth Verrelst ◽

Cedric De Blaiser ◽

...

Keyword(s):

Angular Velocity ◽

Ankle Joint ◽

Ankle Instability ◽

Statistical Parametric Mapping ◽

Frontal Plane ◽

Chronic Ankle Instability ◽

Joint Kinematics ◽

Repeated Measure ◽

Inverted Position ◽

Jump Landing

Context: Although taping has been proven effective in reducing ankle sprain events in individuals with chronic ankle instability, insight into the precise working mechanism remains limited. Objectives: To evaluate whether the use of taping changes ankle joint kinematics during a sagittal and frontal plane landing task in subjects with chronic ankle instability. Design: Repeated measure design. Setting: Laboratory setting. Participants: A total of 28 participants with chronic ankle instability performed a forward and side jump landing task in a nontaped and taped condition. The taping procedure consisted of a double “figure of 6” and a medial heel lock. Main Outcome Measures: 3D ankle joint kinematics was registered. Statistical parametric mapping was used to assess taping effect on mean ankle joint angles and angular velocity over the landing phase. Results: For both the forward and side jump, a less plantar flexed and a less inverted position of the ankle joint were found in the preparatory phase till around touchdown (TD) in the taped condition (P < .05). In addition, for both jump landing protocols, a decreased dorsiflexion angular velocity was found after TD (P < .05). During the side jump protocol, a brief period of increased inversion angular velocity was registered after TD (P < .05). Conclusions: Taping is capable of altering ankle joint kinematics prior to TD, placing the ankle joint in a less vulnerable position at TD.

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Neuromuscular control in individuals with chronic ankle instability: A comparison of unexpected and expected ankle inversion perturbations during a single leg drop-landing

Human Movement Science ◽

10.1016/j.humov.2019.01.013 ◽

2019 ◽

Vol 64 ◽

pp. 133-141 ◽

Cited By ~ 4

Author(s):

Jeffrey D. Simpson ◽

Ethan M. Stewart ◽

Alana J. Turner ◽

David M. Macias ◽

Samuel J. Wilson ◽

...

Keyword(s):

Ankle Instability ◽

Neuromuscular Control ◽

Chronic Ankle Instability ◽

Ankle Inversion ◽

Drop Landing

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Effects of Dry Needling on Neuromuscular Control of Ankle Stabilizer Muscles and Center of Pressure Displacement in Basketball Players with Chronic Ankle Instability: A Single-Blinded Randomized Controlled Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18042092 ◽

2021 ◽

Vol 18 (4) ◽

pp. 2092

Author(s):

Luis López-González ◽

Deborah Falla ◽

Irene Lázaro-Navas ◽

Cristina Lorenzo-Sánchez-Aguilera ◽

Isabel Rodríguez-Costa ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Postural Control ◽

Center Of Pressure ◽

Ankle Instability ◽

Controlled Trial ◽

Neuromuscular Control ◽

Chronic Ankle Instability ◽

Dry Needling ◽

Basketball Players ◽

Randomized Controlled

This study aimed to compare the effects of dry needling (DN) versus placebo DN applied to the peroneus longus (PL) and tibialis anterior (TA) on neuromuscular control and static postural control in basketball players with chronic ankle instability (CAI). A single-blinded randomized controlled trial was conducted. Thirty-two male and female basketball players with CAI were randomly assigned to receive either DN (n = 16) or placebo DN (n = 16). Pre-activation amplitudes of PL and TA were assessed with surface electromyography (EMG) during a dynamic landing test. Center of pressure (CoP) displacement and sway variability in anterior-posterior (AP) and medio-lateral (ML) directions were measured with a force platform during a single leg balance test (SLBT). Measures were obtained prior to a single DN intervention, immediately after, at 48 h, and 1 month after. The DN group displayed a significant increase in PL and TA pre-activation values, which were maintained 1 month later. Significant reductions in the ML and AP displacements and sway variability of CoP were found for the DN group. These results showed improvements in feedback/feed-forward strategies following DN, including enhanced neuromuscular control and static postural control, with the potential to become a convenient and accessible preventive treatment in CAI subjects.

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Does Strength Training for Chronic Ankle Instability Improve Balance and Patient-Reported Outcomes and by Clinically Detectable Amounts? A Systematic Review and Meta-Analysis

Physical Therapy ◽

10.1093/ptj/pzab046 ◽

2021 ◽

Author(s):

Lijiang Luan ◽

Roger Adams ◽

Jeremy Witchalls ◽

Charlotte Ganderton ◽

Jia Han

Keyword(s):

Strength Training ◽

Evaluation System ◽

Ankle Instability ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Neuromuscular Control ◽

Chronic Ankle Instability ◽

Cochrane Library ◽

Minimal Detectable Change ◽

Patient Reported

Abstract Objective Strength training as a form of exercise therapy has long been used to maintain or promote strength, but its effectiveness as a treatment intervention in chronic ankle instability is not fully understood. The purpose of this study was to evaluate the effects of strength training compared to no exercise and neuromuscular control training on balance and self-reported function in people with chronic ankle instability (CAI). Methods Eight databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, PEDro, CNKI, and WanFang) were searched in June 2020. Randomized controlled trials involving strength training conducted on individuals with CAI were included. Data were extracted by 2 independent reviewers using a standardized form. Methodological quality and risk of bias were assessed by using the PEDro scale. In addition, the evaluation system (Grading of Recommendations Assessment, Development and Evaluation [GRADE]) was used to determine the strength of evidence. A total of 554 studies were initially screened, resulting in a final selection of 11 RCTs involving 428 participants, and 8 RCTs were included in the final meta-analysis. Compared with no exercise, strength training demonstrated some benefits in the Star Excursion Balance Test (SEBT) (anterior: weighted mean difference [WMD] = 2.39, 95% CI = 0.60–4.18; posteromedial: WMD = 3.30, 95% CI = 0.24–6.35; posterolateral: WMD = 2.97, 95% CI = 0.37–5.57), but these intervention results did not reach the minimal detectable change values. Conclusions Available evidence showed that, compared with controls, strength training did not produce any minimal detectable changes on SEBT or Foot and Ankle Ability Measure scores in individuals with CAI. Clinicians should use strength training cautiously for improving balance and symptoms in CAI.

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