Changes in joint position sense after surgically treated chronic lateral ankle instability

Background: The first aim of this study was to evaluate the side-to-side difference of joint-position sense, peroneal strength, postural control, and functional performance ability in patients with chronic lateral ankle instability. The second aim was to identify the correlation between various components contributing to the functional ankle instability (FAI). Methods: Thirty-five patients to be scheduled for the modified Broström procedure for chronic ankle instability were analyzed. Joint-position sense and peroneal strength were measured with an isokinetic dynamometer. Postural control ability was evaluated using the modified Romberg test. The functional performance test consisted of the 1-leg hop test, 6-meter hop test, and cross 3-m hop test. Spearman’s correlation coefficient ( r) was calculated to determine the linear association between the individual components of the FAI. Results: Except for the 6-m and cross 3-m hop tests, most examination tools for the FAI demonstrated significant side-to-side differences compared with the unaffected ankle. Spearman’s correlation analysis revealed that individual components (joint-position sense, peroneal strength, postural control, and functional performance ability) of the FAI were significantly associated with one another, except between peroneal strength and postural control ability ( r = 0.21, P = .195). Conclusion: Joint-position sense, peroneal strength, postural control ability, and 1-leg hop test demonstrated significant side-to-side differences in patients with chronic lateral ankle instability. Individual components contributing to the FAI were significantly correlated with one another, except between peroneal strength and postural control ability. Postural control evaluation using the modified Romberg test could substitute for dynamometer testing, with convenience and economic advantage. Level of Evidence: Level IV, prospective case series.

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Consistency and Reliability of Ankle Stress Radiography in Patients With Chronic Lateral Ankle Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211004099 ◽

2021 ◽

Vol 9 (5) ◽

pp. 232596712110040

Author(s):

Ji Hye Choi ◽

Kug Jin Choi ◽

Chin Youb Chung ◽

Moon Seok Park ◽

Ki Hyuk Sung ◽

...

Keyword(s):

Standard Deviation ◽

Tilt Angle ◽

Ankle Instability ◽

Interobserver Reliability ◽

Initial Presentation ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Stress Radiographs ◽

Lateral Ankle Instability

Background: Ankle stress radiographs are important tools for evaluating chronic lateral ankle instability. The consistency of a patient’s ankle condition as it affects the reliability of ankle stress radiographs has never been evaluated. Purpose: To investigate the consistency and reliability of ankle stress radiographs in patients with chronic lateral ankle instability without an ankle injury during the study period. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Included were patients with chronic lateral ankle instability who underwent 2 repeated ankle stress radiographs between January 2014 and July 2019; those with an ankle injury during the study period were excluded. The tibiotalar tilt angle on varus stress radiographs and anterior translation of the talus on anterior drawer stress radiographs were measured at initial presentation and final follow-up examination. Interobserver reliability and consistency of ankle stress radiographs were analyzed using the intraclass correlation coefficient (ICC). Results: A total of 45 patients (mean ± standard deviation age, 36.4 ± 13.4 years; 18 men and 27 women; follow-up duration, 9.1 ± 3.2 months) were included. The mean ± standard deviation tibiotalar tilt angle and anterior talar translation at initial presentation were 10.8° ± 5.2° and 6.9 ± 2.7 mm, respectively. The interobserver reliabilities of the tibiotalar tilt angle and anterior talar translation were excellent (ICC = 0.926 [95% CI, 0.874-0.959] and 0.911 [95% CI, 0.766-0.961], respectively). The consistency between the initial and final radiographs was good for tibiotalar tilt angle (ICC = 0.763 [95% CI, 0.607-0.862]) and poor for anterior talar translation (ICC = 0.456 [95% CI, 0.187-0.660]). Conclusion: Although the interobserver reliability of the radiographic measurements was excellent, the consistency of the ankle stress radiographs was not as acceptable. Surgeons need to be cautious when deciding whether to operate on a patient with chronic lateral ankle instability based on a single ankle stress radiograph.

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Muscle Strength Deficit though Intact Proprioception after Lateral Ankle Sprain without Persistent Instability

Physikalische Medizin Rehabilitationsmedizin Kurortmedizin ◽

10.1055/a-1333-3638 ◽

2021 ◽

Author(s):

Adel M. Madkhali ◽

Shibili Nuhmani

Keyword(s):

Ankle Sprain ◽

Peak Torque ◽

Position Sense ◽

Joint Position Sense ◽

Joint Position ◽

Lateral Ankle Sprain ◽

Lateral Ankle ◽

Cohen’S D ◽

History Of ◽

Cohen's D

Abstract Background Lateral ankle sprain is one of the most common injuries in competitive sports. Previous studies which investigated muscle strength and proprioception (joint position sense) focused on subjects who sustained ankle sprain with instability. It is also important to investigate strength deficits and proprioception in subjects with a history of ankle sprain without instability. Therefore the aim of the study is to investigate proprioception and muscle strength deficits in athletes with lateral ankle sprain. Methods Twenty-four male athletes with a history of lateral ankle sprain and 24 age-matched controls (mean age of 22.42±4.13 years, mean height of 173±5.73 cm, and mean weight of 71.20±7.55 Kg) participated in this cross-sectional study. Peak torque and peak torque ratio at speeds of 30 and 120°/s for concentric and eccentric ankle inversion/eversion were evaluated using an isokinetic dynamometer. The joint position sense of the ankle joint was evaluated using an active angle reproduction test. Result Peak torque produced was significantly less in subjects with history of ankle sprain in concentric inversion 30°/s(t(47)=4.11; p=0.000, Cohen’s d=1.29), concentric inversion 120°/s (t(47)=3.01; p=0.006, Cohen’s d=1.13), concentric eversion 30°/s (t(47)=3.85; p=0.001, Cohen’s d=1.24) and concentric eversion 120°/s (t(47)=3.15; p=0.005, Cohen’s d=1.09). At the same time there was no significant difference observed in eccentric eversion peak torque in both speed (eccentric eversion 30°/s p=0.079; eccentric eversion 120°/s p=0.867) between experimental and control group. No significant difference was found in the joint position sense in the maximal active inversion −5° position (p=0.312) and the 15° inversion position (P=0.386) between both group. Conclusion The study’s results reported a significantly less peak torque of invertors and evertors during concentric movements in athletes with history of ankle sprain. At the same time, no significant difference reported in the evertor/invertor peak torque ratio, and active joint position sense between the 2 groups.

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Demographic Predictors of Concomitant Osteochondral Lesion of the Talus in Patients With Chronic Lateral Ankle Instability

Foot & Ankle Orthopaedics ◽

10.1177/24730114211013344 ◽

2021 ◽

Vol 6 (2) ◽

pp. 247301142110133

Author(s):

Yong Sang Kim ◽

Tae Yong Kim ◽

Yong Gon Koh

Keyword(s):

Tilt Angle ◽

Ankle Instability ◽

Osteochondral Lesion ◽

Case Series ◽

Level Of Evidence ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Female Patients ◽

Lateral Ankle Instability ◽

Talar Tilt

Background: Osteochondral lesion of the talus (OLT) is commonly found as a concomitant pathologic lesion in a large proportion of patients with chronic lateral ankle instability (CLAI). This study investigated which characteristics in a patient with CLAI increase the risk for OLT. Methods: Three hundred sixty-four patients who underwent a modified Broström operation for their CLAI were reviewed retrospectively. The characteristics of each patient and variables associated with OLTs were investigated. Statistical analyses were performed to determine the effect of each potential predictor on the incidence of OLT, and to evaluate the associations between the patient characteristics and variables associated with OLTs. Results: Patients with OLTs were more frequently female (female vs male: 63.1% vs 43.9%, P = .003). In addition, the lesion sizes were larger in female patients (female vs male: 113.9 ± 24.9 mm2 vs 100.7 ± 18.0 mm2, P = .002), and medial lesions were more common in female patients (female vs male; 93.3% vs 81.8%, P = .036). The lesion sizes were larger in patients with a wider talar tilt angle ( P < .001), and patients with a medial OLT showed a wider talar tilt angle (12.0 ± 2.0 degrees vs 10.3 ± 2.2 degrees, P = .002). Conclusion: In this CLAI patient cohort, we found female patients to be at greater risk for OLTs than male patients. Furthermore, CLAI female patients with concomitant OLT had on average a larger lesion size, more frequent OLT medial position, and were associated with wider talar tilt angles, suggesting that females had more intrinsic ankle instability than males. Level of Evidence: Level IV, retrospective case series.

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Magnetic Resonance Imaging T2* Mapping of the Talar Dome and Subtalar Joint Cartilage 3 Years After Anterior Talofibular Ligament Repair or Reconstruction in Chronic Lateral Ankle Instability

The American Journal of Sports Medicine ◽

10.1177/0363546520982240 ◽

2021 ◽

Vol 49 (3) ◽

pp. 737-746

Author(s):

Yiwen Hu ◽

Yuyang Zhang ◽

Qianru Li ◽

Yuxue Xie ◽

Rong Lu ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Ankle Instability ◽

Anterior Talofibular Ligament ◽

Resonance Imaging ◽

Talar Dome ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Lateral Ankle Instability

Background: Cartilage degeneration is a common issue in patients with chronic lateral ankle instability. However, there are limited studies regarding the effectiveness of lateral ligament surgery on preventing talar and subtalar joint cartilage from further degenerative changes. Purpose: To longitudinally evaluate talar and subtalar cartilage compositional changes using magnetic resonance imaging T2* mapping in anatomic anterior talofibular ligament (ATFL)–repaired and ATFL-reconstructed ankles and to compare them with measures in asymptomatic controls. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2015 and December 2016, patients with chronic lateral ankle instability who underwent anatomic ATFL repair (n = 19) and reconstruction (n = 20) were prospectively recruited. Patients underwent 3.0-T magnetic resonance imaging at baseline and 3-year follow-up. As asymptomatic controls, 21 healthy volunteers were recruited and underwent imaging at baseline. Talar dome cartilage was divided into (1) medial anterior, central, and posterior and (2) lateral anterior, central, and posterior. Posterior subtalar cartilage was divided into (1) central talus and calcaneus and (2) lateral talus and calcaneus. Ankle function was assessed using the American Orthopaedic Foot & Ankle Society scores. Results: There were significant increases in T2* values in medial and lateral posterior and central talus cartilage from baseline to 3-year follow-up in patients who underwent repair. T2* values were significantly higher in ATFL-repaired ankles at follow-up for all cartilage regions of interest, except medial and lateral anterior and lateral central, compared with those in healthy controls. From baseline to 3-year follow-up, ATFL-reconstructed ankles had a significant increase in T2* values in lateral central and posterior cartilage. T2* values in ATFL-reconstructed ankles at follow-up were elevated in all cartilage regions of interest, except medial and lateral anterior, compared with those in healthy controls. ATFL-repaired ankles showed a greater decrease of T2* values from baseline to follow-up in lateral calcaneus cartilage than did ATFL-reconstructed ankles ( P = .031). No significant differences in American Orthopaedic Foot & Ankle Society score were found between repair and reconstruction procedures (mean ± SD, 19.11 ± 7.45 vs 16.85 ± 6.24; P = .311). Conclusion: Neither anatomic ATFL repair nor reconstruction could prevent the progression of talar dome and posterior subtalar cartilage degeneration; however, ankle function and activity levels were not affected over a short period. Patients who underwent ATFL repair exhibited lower T2* values in the lateral calcaneus cartilage than did those who underwent reconstruction.

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