A Dynamic Ultrasound Examination for the Diagnosis of Ankle Syndesmotic Injury in Professional Athletes

2009 ◽  
Vol 37 (5) ◽  
pp. 1009-1016 ◽  
Author(s):  
Omer Mei-Dan ◽  
Eugene Kots ◽  
Vidal Barchilon ◽  
Sabri Massarwe ◽  
Meir Nyska ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Cutoff Point ◽  
Control Group ◽  
Study Group ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Clear Space ◽  
Specificity And Sensitivity ◽  
Dynamic Ultrasound ◽  
History Of

Background Syndesmotic ankle injuries are not easy to recognize when an associated fracture or frank diastasis is not present. There is a need for a simple, fast, inexpensive, and easily reproducible diagnostic tool to assess the integrity of the distal tibiofibular synedesmosis. Hypothesis Dynamic ultrasound (US) examination can accurately diagnose anteroinferior tibiofibular ligament (AITFL) rupture. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods We evaluated 3 groups: 9 consecutive professional athletes with recent AITFL rupture, a control group of 18 subjects without a history of ankle injury, and 20 patients with lateral ankle sprain. The dynamic US examination was performed in neutral (N), forced internal rotation (IR), and external rotation (ER) of the foot for measuring the tibiofibular clear space on the anterior aspect of the ankle, at the level of the AITFL, 1 cm proximal to the joint line. Results The mean age of the study group was 27 years (range, 16-32). Magnetic resonance imaging (MRI) confirmed the diagnosis of AITFL rupture in all cases. Differences between the injured and control group were statistically significant for the N, IR, and ER positions (P < .001) and for the measured Δ between the AITFL in the ER and N positions (P < .01). The difference in the tibiofibular clear space between the 2 ankles of the injured athletes was significantly different compared with the control athletes for all 3 positions (P < .001). The measured difference between the ER and N positions for both sides of the study group showed a specificity and sensitivity of 100% (P < .001; cutoff point of 0.9 mm and 0.7 mm, respectively). The Δ (Δ = ER — N) of the injured side showed a specificity and sensitivity of only 89% (P < .001; cutoff point of 0.4 mm). Additionally, the third group with the history of lateral ankle sprain showed, as expected, that this type of injury does not correlate with AITFL injury on dynamic US examination. Conclusion We conclude that dynamic US examination can be used to accurately diagnose an AITFL rupture. This preliminary study has found the described method to be a simple, inexpensive, and easily reproducible examination.

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

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.

Effects of Inversion Perturbation After Step-Down on the Latency of the Peroneus Longus and Peroneus Brevis

2011 ◽  
Vol 27 (4) ◽  
pp. 283-290 ◽  
Author(s):  
Adam C. Knight ◽  
Wendi H. Weimar
Keyword(s):  
Ankle Sprain ◽  
Ankle Sprains ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Peroneus Longus ◽  
Significant Difference ◽  
History Of ◽  
Step Down ◽  
Peroneus Brevis ◽  
High Ankle Sprain

The purpose of this investigation was to determine the effect of different types of ankle sprains on the response latency of the peroneus longus and peroneus brevis to an inversion perturbation, as well as the time to complete the perturbation (time to maximum inversion). To create a forced inversion moment of the ankle, an outer sole with fulcrum was used to cause 25 degrees of inversion at the ankle upon landing from a 27 cm step-down task. Forty participants completed the study: 15 participants had no history of any ankle sprain, 15 participants had a history of a lateral ankle sprain, and 10 participants had a history of a high ankle sprain. There was not a significant difference between the injury groups for the latency measurements or the time to maximum inversion. These findings indicate that a previous lateral ankle sprain or high ankle sprain does not affect the latency of the peroneal muscles or the time to complete the inversion range of motion.

scholarly journals Using Balance Tests to Discriminate Between Participants With a Recent Index Lateral Ankle Sprain and Healthy Control Participants: A Cross-Sectional Study

2016 ◽  
Vol 51 (3) ◽  
pp. 213-222 ◽  
Author(s):  
Fereshteh Pourkazemi ◽  
Claire Hiller ◽  
Jacqueline Raymond ◽  
Deborah Black ◽  
Elizabeth Nightingale ◽  
...  
Keyword(s):  
Discriminant Analysis ◽  
Ankle Sprain ◽  
Control Group ◽  
Stepwise Discriminant Analysis ◽  
Ankle Sprains ◽  
Balance Test ◽  
Cross Sectional ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Star Excursion Balance Test

The first step to identifying factors that increase the risk of recurrent ankle sprains is to identify impairments after a first sprain and compare performance with individuals who have never sustained a sprain. Few researchers have restricted recruitment to a homogeneous group of patients with first sprains, thereby introducing the potential for confounding.Context: To identify impairments that differ in participants with a recent index lateral ankle sprain versus participants with no history of ankle sprain.Objective: Cross-sectional study.Design: We recruited a sample of convenience from May 2010 to April 2013 that included 70 volunteers (age = 27.4 ± 8.3 years, height = 168.7 ± 9.5 cm, mass = 65.0 ± 12.5 kg) serving as controls and 30 volunteers (age = 31.1 ± 13.3 years, height = 168.3 ± 9.1 cm, mass = 67.3 ± 13.7 kg) with index ankle sprains.Patients or Other Participants: We collected demographic and physical performance variables, including ankle-joint range of motion, balance (time to balance after perturbation, Star Excursion Balance Test, foot lifts during single-legged stance, demi-pointe balance test), proprioception, motor planning, inversion-eversion peak power, and timed stair tests. Discriminant analysis was conducted to determine the relationship between explanatory variables and sprain status. Sequential discriminant analysis was performed to identify the most relevant variables that explained the greatest variance.Main Outcome Measure(s): The average time since the sprain was 3.5 ± 1.5 months. The model, including all variables, correctly predicted a sprain status of 77% (n = 23) of the sprain group and 80% (n = 56) of the control group and explained 40% of the variance between groups ( = 42.16, P = .03). Backward stepwise discriminant analysis revealed associations between sprain status and only 2 tests: Star Excursion Balance Test in the anterior direction and foot lifts during single-legged stance ( = 15.2, P = .001). These 2 tests explained 15% of the between-groups variance and correctly predicted group membership of 63% (n = 19) of the sprain group and 69% (n = 48) of the control group.Results: Balance impairments were associated with a recent first ankle sprain, but proprioception, motor control, power, and function were not.Conclusions:

scholarly journals The Effect of Ankle Bracing on Kinematics in Simulated Sprain and Drop Landings: A Double-Blind, Placebo-Controlled Study

2019 ◽  
Vol 47 (6) ◽  
pp. 1480-1487
Author(s):  
Alison N. Agres ◽  
Marios Chrysanthou ◽  
Peter C. Raffalt
Keyword(s):  
Ankle Sprain ◽  
Sagittal Plane ◽  
Ankle Instability ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Ankle Inversion ◽  
Ankle Kinematics ◽  
Ankle Brace ◽  
History Of ◽  
Drop Landings

Background: The efficacy of external ankle braces to protect against sudden inversion sprain has yet to be determined while taking into account the possible placebo effect of brace application. Purpose: To assess the protective effect of an external ankle brace on ankle kinematics during simulated inversion sprain and single-legged drop landings among individuals with a history of unilateral lateral ankle sprain. Hypothesis: The primary hypothesis was that active and placebo external braces would reduce inversion angle during simulated inversion sprain. Study Design: Controlled laboratory study. Methods: Sixteen participants with ankle instability and previous sprain performed single-legged drop landings and sudden inversion tilt perturbations. Kinematics of the affected limb were assessed in 3 conditions (active bracing, passive placebo bracing, and unbraced) across 2 measurement days. Participators and investigators were blinded to the brace type tested. The effect of bracing on kinematics was assessed with repeated measures analysis of variance with statistical parametric mapping, with post hoc tests performed for significant interactions. Results: Only active bracing reduced inversion angles during a sudden ankle inversion when compared with the unbraced condition. This reduction was apparent between 65 and 140 milliseconds after the initial fall. No significant differences in inversion angle were found between the passive placebo brace and unbraced conditions during sudden ankle inversion. Furthermore, no significant differences were found among all tested conditions in the sagittal plane kinematics at the knee and ankle. Conclusion: During an inversion sprain, only the actively protecting ankle brace limited inversion angles among participants. These results do not indicate a placebo effect of external bracing for patients with ankle instability and a history of unilateral ankle sprain. Furthermore, sagittal plane knee kinematics appear to remain unaffected by bracing during single-legged landing, owing to the limited effects of bracing on sagittal ankle kinematics. These results highlight the role of brace design on biomechanical function during sports-related and injury-prone movements. Clinical Relevance: Athletes prone to reinjury after lateral ankle sprain may benefit from brace designs that allow for full sagittal range of motion but restrict only frontal plane motion.

scholarly journals Laboratory Measures of Postural Control During the Star Excursion Balance Test After Acute First-Time Lateral Ankle Sprain

2015 ◽  
Vol 50 (6) ◽  
pp. 651-664 ◽  
Author(s):  
Cailbhe Doherty ◽  
Chris M. Bleakley ◽  
Jay Hertel ◽  
Brian Caulfield ◽  
John Ryan ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Postural Control ◽  
Ankle Sprain ◽  
Control Group ◽  
Injured Limb ◽  
Balance Test ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Star Excursion Balance Test ◽  
First Time

Context No researchers, to our knowledge, have investigated the immediate postinjury-movement strategies associated with acute first-time lateral ankle sprain (LAS) as quantified by center of pressure (COP) and kinematic analyses during performance of the Star Excursion Balance Test (SEBT). Objective To analyze the kinematic and COP patterns of a group with acute first-time LAS and a noninjured control group during performance of the SEBT. Design Case-control study. Setting University biomechanics laboratory. Patients or Other Participants A total of 81 participants with acute first-time LAS (53 men, 28 women; age = 23.22 ± 4.93 years, height = 1.73 ± 0.09 m, mass = 75.72 ± 13.86 kg) and 19 noninjured controls (15 men, 4 women; age = 22.53 ± 1.68 years, height = 1.74 ± 0.08 m, mass = 71.55 ± 11.31 kg). Intervention Participants performed the anterior (ANT), posterolateral (PL), and posteromedial (PM) reach directions of the SEBT. Main Outcome Measure(s) We assessed 3-dimensional kinematics of the lower extremity joints and associated fractal dimension (FD) of the COP path during performance of the SEBT. Results The LAS group had decreased normalized reach distances in the ANT, PL, and PM directions when compared with the control group on their injured (ANT: 58.16% ± 6.86% versus 64.86% ± 5.99%; PL: 85.64% ± 10.62% versus 101.14% ± 8.39%; PM: 94.89% ± 9.26% versus 107.29 ± 6.02%) and noninjured (ANT: 60.98% ± 6.74% versus 64.76% ± 5.02%; PL: 88.95% ± 11.45% versus 102.36% ± 8.53%; PM: 97.13% ± 8.76% versus 106.62% ± 5.78%) limbs (P &lt; .01). This observation was associated with altered temporal sagittal-plane kinematic profiles throughout each reach attempt and at the point of maximum reach (P &lt; .05). This result was associated with a reduced FD of the COP path for each reach direction on the injured limb only (P &lt; .05). Conclusions Acute first-time LAS was associated with bilateral deficits in postural control, as evidenced by the bilateral reduction in angular displacement of the lower extremity joints and reduced reach distances and FD of the COP path on the injured limb during performance of the SEBT.

scholarly journals Joint Stability Characteristics of the Ankle Complex in Female Athletes With Histories of Lateral Ankle Sprain, Part II: Clinical Experience Using Arthrometric Measurement

2014 ◽  
Vol 49 (2) ◽  
pp. 198-203 ◽  
Author(s):  
John E. Kovaleski ◽  
Robert J. Heitman ◽  
Larry R. Gurchiek ◽  
J. M. Hollis ◽  
Wei Liu ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Soft Tissues ◽  
Complex Motion ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Anterior Displacement ◽  
History Of ◽  
Ankle Complex ◽  
And Inversion ◽  
Lateral Ankle Ligaments

Context: This is part II of a 2-part series discussing stability characteristics of the ankle complex. In part I, we used a cadaver model to examine the effects of sectioning the lateral ankle ligaments on anterior and inversion motion and stiffness of the ankle complex. In part II, we wanted to build on and apply these findings to the clinical assessment of ankle-complex motion and stiffness in a group of athletes with a history of unilateral ankle sprain. Objective: To examine ankle-complex motion and stiffness in a group of athletes with reported history of lateral ankle sprain. Design: Cross-sectional study. Setting: University research laboratory. Patients or Other Participants: Twenty-five female college athletes (age = 19.4 ± 1.4 years, height = 170.2 ± 7.4 cm, mass = 67.3 ± 10.0 kg) with histories of unilateral ankle sprain. Intervention(s): All ankles underwent loading with an ankle arthrometer. Ankles were tested bilaterally. Main Outcome Measure(s): The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness. Results: Anterior displacement of the ankle complex did not differ between the uninjured and sprained ankles (P = .37), whereas ankle-complex rotation was greater for the sprained ankles (P = .03). The sprained ankles had less anterior and inversion end-range stiffness than the uninjured ankles (P &lt; .01). Conclusions: Changes in ankle-complex laxity and end-range stiffness were detected in ankles with histories of sprain. These results indicate the presence of altered mechanical characteristics in the soft tissues of the sprained ankles.

scholarly journals Lateral Ankle Sprain and Subsequent Ankle Sprain Risk: A Systematic Review

2021 ◽  
Vol 56 (6) ◽  
pp. 578-585
Author(s):  
Erik A. Wikstrom ◽  
Mary Spencer Cain ◽  
Avinash Chandran ◽  
Kyeongtak Song ◽  
Tasha Regan ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Data Extraction ◽  
Design Parameters ◽  
Data Synthesis ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Assessment Scores ◽  
Study Selection ◽  
History Of

Objective To evaluate the evidence regarding the association between lateral ankle sprain (LAS) history and the subsequent LAS risk, as well as sex differences in the observed associations. Data Sources PubMed, CINAHL, and SPORTDiscus were searched through July 2020 for articles on LAS history and incidence during the study period. Study Selection Studies were included if they were prospective in nature and the authors reported the number of participants with and those without a history of LAS at study initiation as well as the number of participants in each group who sustained an LAS during the investigation. Data Extraction Data were study design parameters as well as the number of participants with and those without an LAS history and the number of subsequent LASs that occurred in both groups. Risk ratios (RRs) with 95% CIs compared the risk of LAS during the study period between those with and those without an LAS history for each investigation. Data Synthesis A total of 19 studies involving 6567 patients were included. The follow-up periods ranged from 14 weeks to 2 years. Assessment scores indicated the studies were of moderate to high quality. A significantly higher risk of LAS during the study period was observed among those with a history of LAS in 10 of 15 studies (RR range = 1.29–6.06). Similar associations were seen in 4 of 6 studies of all-male samples (RR range = 1.38–8.65) and 1 of 4 studies with an all-female sample (RR = 4.28). Conclusions Strong evidence indicates that a previous LAS increased the risk of a subsequent LAS injury. Men with a history of LAS appeared to be at a higher risk of sustaining a subsequent LAS, but women were not. However, further data are needed to draw definitive conclusions from the limited number of sex-specific studies.

scholarly journals Effect of Ultrasound Therapy and Cryotherapy over Taping Technique in Patients with Acute Lateral Ankle Sprain

2021 ◽  
Vol 11 (4) ◽  
Author(s):  
Ramamurthy Dr. ◽  
Paul Dr. Jibi ◽  
Sharmil Dr. Hepsibah ◽  
P Dr. Sathya
Keyword(s):  
Ankle Sprain ◽  
Rank Test ◽  
Ultrasound Therapy ◽  
Study Group ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Group A ◽  
Student’S T ◽  
Group B ◽  
Taping Technique

The sudden twisting of ankle which overstretches the ligaments to torn or sprain around the ankle joint can lead to pain and swelling. Pain and swelling is one of the major causes of concern in patients with acute lateral ankle sprain while performing physical and daily activity. The study aim was to find the effect of ultrasound therapy and cryotherapy over taping technique among patients with acute lateral ankle sprain. A total of 30 subjects with acute lateral ankle sprain participated in this study. Group A was given ultrasound therapy with cryotherapy for 30 minutes; Group B was given taping technique additional to ultrasound and cryotherapy. Pre and post test was done after 10 sessions of treatment. The outcome was measured for the participants by VAS score. Student’s t-test, Mann Whitney test, Wilcoxon signed rank test were used to analyze data in this study. Group A and B have shown significant improvement after treatment. Comparative study found Group B, had significant changes by ultrasound therapy, cryotherapy and ankle taping technique over the Group A with P<0.001, on reducing pain, swelling and improving earlier active performance. On the basis of the result, the study concluded that treatment with cryotherapy, ultrasound therapy and taping technique is better compared with cryotherapy and ultrasound therapy, and has more effect in reducing pain, swelling and improving earlier active physical performance.

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