Arthrogenic Muscle Inhibition in the Leg Muscles of Subjects Exhibiting Functional Ankle Instability

2005 ◽  
Vol 26 (12) ◽  
pp. 1055-1061 ◽  
Author(s):  
Eric D. McVey ◽  
Riann M. Palmieri ◽  
Carrie L. Docherty ◽  
Steven M. Zinder ◽  
Christopher D. Ingersoll
Keyword(s):  
Tibialis Anterior ◽  
Ankle Instability ◽  
H Reflex ◽  
Functional Ankle Instability ◽  
Injured Limb ◽  
Lateral Ankle ◽  
M Wave ◽  
Muscle Inhibition ◽  
Lateral Ankle Ligaments ◽  
Arthrogenic Muscle Inhibition

Background: Functional ankle instability or a subjective report of “giving way” at the ankle may be present in up to 40% of patients after a lateral ankle sprain. Damage to mechanoreceptors within the lateral ankle ligaments after injury is hypothesized to interrupt neurologic feedback mechanisms resulting in functional ankle instability. The altered input can lead to weakness of muscles surrounding a joint, or arthrogenic muscle inhibition. Arthrogenic muscle inhibition may be the underlying cause of functional ankle instability. Establishing the involvement of arthrogenic muscle inhibition in functional ankle instability is critical to understanding the underlying mechanisms or chronic ankle instability. The purpose of this investigation was to determine if arthrogenic muscle inhibition is present in the ankle joint musculature of patients exhibiting unilateral functional ankle instability. Methods: Twenty-nine subjects, 15 with unilateral functional ankle instability and 14 healthy control subjects, consented to participate. Bilateral soleus, peroneal, and tibialis anterior H-reflex and M-wave recruitment curves were obtained. Maximal H-reflex and maximal M-wave values were identified and the H:M ratios were calculated for data analysis. Separate 1 × 2 ANOVA were done for both the functional ankle instability and control groups to evaluate differences between limbs on the H:M ratios. Bonferroni multiple comparison procedures were used for post hoc comparisons ( p ≤ 0.05). Results: The soleus and peroneal H:M ratios for subjects with functional ankle instability were smaller in the injured limb when compared with the uninjured limb (p < 0.05). No limb difference was detected for the tibialis anterior H:M ratio in the functional ankle instability group ( p = 0.904). No side-to-side differences were detected for the H:M ratios in patients reporting no history of ankle injury ( p > 0.05). Conclusions: Depressed H:M ratios in the injured limb suggest that arthrogenic muscle inhibition is present in the ankle musculature of patients exhibiting functional ankle instability. Establishing and using therapeutic techniques to reverse arthrogenic muscle inhibition may reduce the incidence of functional ankle instability.

Peroneal Activation Deficits in Persons with Functional Ankle Instability

2009 ◽  
Vol 37 (5) ◽  
pp. 982-988 ◽  
Author(s):  
Riann M. Palmieri-Smith ◽  
J. Ty Hopkins ◽  
Tyler N. Brown
Keyword(s):  
Ankle Sprain ◽  
Muscle Activation ◽  
Ankle Instability ◽  
Cross Sectional Study ◽  
Functional Ankle Instability ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Emg Amplitude ◽  
Muscle Inhibition ◽  
Arthrogenic Muscle Inhibition

Background Functional ankle instability (FAI) may be prevalent in as many as 40% of patients after acute lateral ankle sprain. Altered afference resulting from damaged mechanoreceptors after an ankle sprain may lead to reflex inhibition of surrounding joint musculature. This activation deficit, referred to as arthrogenic muscle inhibition (AMI), may be the underlying cause of FAI. Incomplete activation could prevent adequate control of the ankle joint, leading to repeated episodes of instability. Hypothesis Arthrogenic muscle inhibition is present in the peroneal musculature of functionally unstable ankles and is related to dynamic peroneal muscle activity. Study Design Cross-sectional study; Level of evidence, 3. Methods Twenty-one (18 female, 3 male) patients with unilateral FAI and 21 (18 female, 3 male) uninjured, matched controls participated in this study. Peroneal maximum H-reflexes and M-waves were recorded bilaterally to establish the presence or absence of AMI, while electromyography (EMG) recorded as patients underwent a sudden ankle inversion perturbation during walking was used to quantify dynamic activation. The H:M ratio and average EMG amplitudes were calculated and used in data analyses. Two-way analyses of variance were used to compare limbs and groups. A regression analysis was conducted to examine the association between the H:M ratio and the EMG amplitudes. Results The FAI patients had larger peroneal H:M ratios in their nonpathological ankle (0.399 ± 0.185) than in their pathological ankle (0.323 ± 0.161) (P = .036), while no differences were noted between the ankles of the controls (0.442 ± 0.176 and 0.425 ± 0.180). The FAI patients also exhibited lower EMG after inversion perturbation in their pathological ankle (1.7 ± 1.3) than in their uninjured ankle (EMG, 3.3 ± 3.1) (P < .001), while no differences between legs were noted for controls (P > .05). No significant relationship was found between the peroneal H:M ratio and peroneal EMG (P > .05). Conclusion Arthrogenic muscle inhibition is present in the peroneal musculature of persons with FAI but is not related to dynamic muscle activation as measured by peroneal EMG amplitude. Reversing AMI may not assist in protecting the ankle from further episodes of instability; however dynamic muscle activation (as measured by peroneal EMG amplitude) should be restored to maximize ankle stabilization. Dynamic peroneal activity is impaired in functionally unstable ankles, which may contribute to recurrent joint instability and may leave the ankle vulnerable to injurious loads.

Ultrasound Analysis of Lateral Ankle Ligaments in Functional Ankle Instability

2020 ◽  
Vol 46 (12) ◽  
pp. 3228-3238
Author(s):  
Susanne Rein ◽  
Khosrow Siamak Houschyar ◽  
Thorben Sterling-Hauf
Keyword(s):  
Ankle Instability ◽  
Functional Ankle Instability ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Lateral Ankle Ligaments

In Vivo Kinematics of Functional Ankle Instability Patients and Lateral Ankle Sprain Copers During Stair Descent

2019 ◽  
Vol 37 (8) ◽  
pp. 1860-1867 ◽  
Author(s):  
Shengxuan Cao ◽  
Chen Wang ◽  
Xin Ma ◽  
Xu Wang ◽  
Jiazhang Huang ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Ankle Instability ◽  
Functional Ankle Instability ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
In Vivo Kinematics ◽  
Stair Descent

Talar Anchor Placement for Modified Brostrom Lateral Ankle Stabilization Procedure

2008 ◽  
Vol 98 (6) ◽  
pp. 473-476 ◽  
Author(s):  
Arush K. Angirasa ◽  
Michael J. Barrett
Keyword(s):  
Research Study ◽  
Ankle Instability ◽  
Suture Technique ◽  
Anatomic Reconstruction ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Lateral Ankle Instability ◽  
Stabilization Procedure ◽  
Lateral Ankle Ligaments ◽  
Modified Broström Procedure

The modified Brostrom procedure has been a proven procedure with excellent utility in the treatment of lateral ankle instability within limitation. Multiple variations of the original technique have been described in the literature to date. Included in these variations are differences in anchor placement, suture technique, or both. In this research study, we propose placing a bone screw anchor into the lateral shoulder of the talus rather than the typical placement at the lateral malleolus for anatomic reconstruction of the lateral ankle ligaments. (J Am Podiatr Med Assoc 98(6): 473–476, 2008)

scholarly journals Surgical Management of Lateral Ankle Instability in Athletes

2019 ◽  
Vol 54 (6) ◽  
pp. 639-649 ◽  
Author(s):  
Luis D. Camacho ◽  
Zachary T. Roward ◽  
Yu Deng ◽  
L. Daniel Latt
Keyword(s):  
Surgical Management ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Anatomic Reconstruction ◽  
Ankle Sprains ◽  
Functional Rehabilitation ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Initial Surgery ◽  
Lateral Ankle Ligaments

Ankle sprains are common injuries involving the lateral ankle ligaments and affect athletes of all levels. Most patients heal uneventfully, but those with symptoms persisting past 3 months should be evaluated for chronic ankle instability and its associated conditions as well as for the presence of varus malalignment. Chronic ankle instability is initially treated nonoperatively, with surgical management reserved for those who have failed to improve after 3 to 6 months of bracing and functional rehabilitation. Anatomic repair using a modification of the Broström procedure is the preferred technique for initial surgery. Anatomic reconstruction with tendon graft should be considered when repair is not possible, as it maintains physiological joint kinematics. Nonanatomic reconstructions are seldom indicated. Arthroscopic repair or reconstruction of the lateral ankle ligaments is a promising new technique with results similar to those of open surgery.

scholarly journals Motor-Neuron Pool Excitability of the Lower Leg Muscles After Acute Lateral Ankle Sprain

2011 ◽  
Vol 46 (3) ◽  
pp. 263-269 ◽  
Author(s):  
Lindsey W. Klykken ◽  
Brian G. Pietrosimone ◽  
Kyung-Min Kim ◽  
Christopher D. Ingersoll ◽  
Jay Hertel
Keyword(s):  
Motor Neuron ◽  
Ankle Sprain ◽  
Tibialis Anterior ◽  
Ankle Instability ◽  
Ankle Sprains ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Leg Muscles ◽  
Motor Neuron Pool ◽  
Neuron Pool

Context: Neuromuscular deficits in leg muscles that are associated with arthrogenic muscle inhibition have been reported in people with chronic ankle instability, yet whether these neuromuscular alterations are present in individuals with acute sprains is unknown. Objective: To compare the effect of acute lateral ankle sprain on the motor-neuron pool excitability (MNPE) of injured leg muscles with that of uninjured contralateral leg muscles and the leg muscles of healthy controls. Design: Case-control study. Setting: Laboratory. Patients or Other Participants: Ten individuals with acute ankle sprains (6 females, 4 males; age = 19.2 ± 3.8 years, height = 169.4 ± 8.5 cm, mass = 66.3 ±11.6 kg) and 10 healthy individuals (6 females, 4 males; age = 20.6 ± 4.0 years, height = 169.9 ± 10.6 cm, mass = 66.3 ± 10.2 kg) participated. Intervention(s): The independent variables were group (acute ankle sprain, healthy) and limb (injured, uninjured). Separate dependent t tests were used to determine differences in MNPE between legs. Main Outcome Measure(s): The MNPE of the soleus, fibularis longus, and tibialis anterior was measured by the maximal Hoffmann reflex (Hmax) and maximal muscle response (Mmax) and was then normalized using the Hmax:Mmax ratio. Results: The soleus MNPE in the ankle-sprain group was higher in the injured limb (Hmax:Mmax = 0.63; 95% confidence interval [CI], 0.46, 0.80) than in the uninjured limb (Hmax:Mmax = 0.47; 95% CI, 0.08, 0.93) (t6 = 3.62, P = .01). In the acute ankle-sprain group, tibialis anterior MNPE tended to be lower in the injured ankle (Hmax:Mmax = 0.06; 95% CI, 0.01, 0.10) than in the uninjured ankle (Hmax:Mmax = 0.22; 95% CI, 0.09, 0.35), but this finding was not different (t9 = −2.01, P = .07). No differences were detected between injured (0.22; 95% CI, 0.14, 0.29) and uninjured (0.25; 95% CI, 0.12, 0.38) ankles for the fibularis longus in the ankle-sprain group (t9 = −0.739, P = .48). We found no side-to-side differences in any muscle among the healthy group. Conclusions: Facilitated MNPE was present in the involved soleus muscle of patients with acute ankle sprains, but no differences were found in the fibularis longus or tibialis anterior muscles.

scholarly journals There is No Difference in Post-operative Complication Rates between Single and Multiple Incision Approaches to Lateral Ligament Repair for Chronic Ankle Instability

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Ashish Shah ◽  
Brent Cone ◽  
Cesar de Cesar Netto ◽  
Ibukunoluwa Araoye ◽  
Parke Hudson ◽  
...  
Keyword(s):  
Single Incision ◽  
Ankle Instability ◽  
Demographic Data ◽  
Lateral Ligament ◽  
Complication Rates ◽  
Ligament Repair ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Significant Difference ◽  
Lateral Ankle Ligaments

Category: Ankle Introduction/Purpose: Ankle sprains are common orthopaedic injuries. Some patients may develop chronic instability, requiring ligament reconstruction surgery. While laxity of the lateral ankle ligaments most commonly contributes to ankle instability, there may be other associated factors such as peroneal pathology or misalignment of the hindfoot that must be addressed. Classically, a small curvilinear incision is made to access the lateral ankle ligaments, and separate incisions are made to address the peroneals, or to perform a calcaneal osteotomy if needed. A more recent method involves making a single longitudinal incision that allows access the lateral ankle ligaments, the peroneals and calcaneus without the need for further incisions. This study evaluates the post-operative complication rates between the single and multiple incision approach for patients undergoing lateral ligament repair. Methods: This is a retrospective review of patients who underwent ligament reconstruction for lateral ankle instability from 2011 to 2015. A total of 231 patient records were reviewed. Records with insufficient data, patients with history of prior ligament repair and insufficient follow-up (< 1 year) were excluded. A total of 187 patients met inclusion criteria. Complications including chronic pain, sural neuritis, and skin infections were recorded during the follow up period. Demographic data and complication rates between the two groups were compared using chi-squared test. Results: Of the 187 patients, 160 were in the single incision group and 27 in the multiple incision group. Women comprised 69.0 (90/148) percent of the total patient population. There was no significant difference in demographic data between the two groups. There was also no significant difference in the rate of complications between the single incision and multiple incision groups (p= 0.808). The single incision group had a complication rate of 24% (39/160), while the multiple incision group had a complication rate of 22% (6/27). The most frequent complication in both groups was sural neuritis with it comprising 31% (12/39) and 50% (3/6) of the complications in the single and multiple incision groups respectively. Conclusion: Performing a single longitudinal incision for lateral ligament repair, as well as access to the peroneal tendons and calcaneus does not have increased rates of post-operative complications compared to a multiple incision approach. A longitudinal single incision may be performed without concern for increased rates of post-operative complications in lateral ligament repair surgery for chronic ankle instability.

The improvement of postural control in patients with mechanical ankle instability after lateral ankle ligaments reconstruction

2015 ◽  
Vol 24 (4) ◽  
pp. 1081-1085 ◽  
Author(s):  
Hong-Yun Li ◽  
Jie-Jiao Zheng ◽  
Jian Zhang ◽  
Ye-Hua Cai ◽  
Ying-Hui Hua ◽  
...  
Keyword(s):  
Postural Control ◽  
Ankle Instability ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Lateral Ankle Ligaments

Reconstruction of the Lateral Ankle Ligaments Using an Inferior Extensor Retinaculum Flap

1997 ◽  
Vol 18 (11) ◽  
pp. 723-728 ◽  
Author(s):  
D. Saragaglia ◽  
F. Fontanel ◽  
E. Montbarbon ◽  
Y. Tourné ◽  
F. Picard ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
X Rays ◽  
Extensor Retinaculum ◽  
Sports Activity ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Functional Instability ◽  
Lateral Ankle Ligaments ◽  
Inferior Extensor Retinaculum

The aim of this study was to assess the results of 32 cases of chronic ankle instability. These were treated by ligament shortening and reinforced with an inferior extensor retinaculum flap. All patients complained of persistent functional instability unrelieved with proprioceptive exercises. Results were assessed clinically (pain, instability, recovery of sports activity, mobility) and radiologically (correction of laxity on stress x-rays). This enabled us to draw up a revision score on a scale of 100 points. We obtained a mean score of 86.7 points (45–100 points), and subjective results showed that 88% of the patients were satisfied with the surgery.

scholarly journals Neuromuscular Alterations After Ankle Sprains: An Animal Model to Establish Causal Links After Injury

2016 ◽  
Vol 51 (10) ◽  
pp. 797-805 ◽  
Author(s):  
Lindsey K. Lepley ◽  
Patrick O. McKeon ◽  
Shane G. Fitzpatrick ◽  
Catherine L. Beckemeyer ◽  
Timothy L. Uhl ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Muscle Activity ◽  
Tibialis Anterior ◽  
Vastus Lateralis ◽  
Onset Time ◽  
Biceps Femoris ◽  
Sample Entropy ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Lateral Ankle Ligaments

Context: The mechanisms that contribute to the development of chronic ankle instability are not understood. Investigators have developed a hypothetical model in which neuromuscular alterations that stem from damaged ankle ligaments are thought to affect periarticular and proximal muscle activity. However, the retrospective nature of these studies does not allow a causal link to be established. Objective: To assess temporal alterations in the activity of 2 periarticular muscles of the rat ankle and 2 proximal muscles of the rat hind limb after an ankle sprain. Design: Controlled laboratory study. Setting: Laboratory. Patients or Other Participants: Five healthy adult male Long Evans rats (age = 16 weeks, mass = 400.0 ± 13.5 g). Intervention(s): Indwelling fine-wire electromyography (EMG) electrodes were implanted surgically into the biceps femoris, medial gastrocnemius, vastus lateralis, and tibialis anterior muscles of the rats. We recorded baseline EMG measurements while the rats walked on a motor-driven treadmill and then induced a closed lateral ankle sprain by overextending the lateral ankle ligaments. After ankle sprain, the rats were placed on the treadmill every 24 hours for 7 days, and we recorded postsprain EMG data. Main Outcome Measure(s): Onset time of muscle activity, phase duration, sample entropy, and minimal detectable change (MDC) were assessed and compared with baseline using 2-tailed dependent t tests. Results: Compared with baseline, delayed onset time of muscle activity was exhibited in the biceps femoris (baseline = −16.7 ± 54.0 milliseconds [ms]) on day 0 (5.2 ± 64.1 ms; t4 = −4.655, P = .043) and tibialis anterior (baseline = 307.0 ± 64.2 ms) muscles on day 3 (362.5 ± 55.9 ms; t4 = −5.427, P = .03) and day 6 (357.3 ± 39.6 ms; t4 = −3.802, P = .02). Longer phase durations were observed for the vastus lateralis (baseline = 321.9 ± 92.6 ms) on day 3 (401.3 ± 101.2 ms; t3 = −4.001, P = .03), day 4 (404.1 ± 93.0 ms; t3 = −3.320, P = .048), and day 5 (364.6 ± 105.2 ms; t3 = −3.963, P = .03) and for the tibialis anterior (baseline = 103.9 ± 16.4 ms) on day 4 (154.9 ± 7.8 ms; t3 = −4.331, P = .050) and day 6 (141.9 ± 16.2 ms; t3 = −3.441, P = .03). After sprain, greater sample entropy was found for the vastus lateralis (baseline = 0.7 ± 0.3) on day 6 (0.9 ± 0.4; t4 = −3.481, P = .03) and day 7 (0.9 ± 0.3; t4 = −2.637, P = .050) and for the tibialis anterior (baseline = 0.6 ± 0.4) on day 4 (0.9 ± 0.5; t4 = −3.224, P = .03). The MDC analysis revealed increased sample entropy values for the vastus lateralis and tibialis anterior. Conclusions: Manually inducing an ankle sprain in a rat by overextending the lateral ankle ligaments altered the complexity of muscle-activation patterns, and the alterations exceeded the MDC of the baseline data.

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