Symptomatic Ossification of the Tibiofibular Syndesmosis in Professional Football Players: A Sequela of the Syndesmotic Ankle Sprain

1995 ◽  
Vol 16 (5) ◽  
pp. 285-290 ◽  
Author(s):  
Daniel M. Veltri ◽  
Michael J. Pagnani ◽  
Steven J. O'Brien ◽  
Russell F. Warren ◽  
Michael D. Ryan ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Surgical Excision ◽  
Athletic Participation ◽  
Football Players ◽  
Return To Sports ◽  
Ankle Sprains ◽  
Professional Football ◽  
Tibiofibular Syndesmosis ◽  
Ankle Pain ◽  
Lateral Ankle

Ankle syndesmosis sprains are common injuries in collegiate and professional football. Several reports have documented that patients with syndesmosis injuries require a longer time to return to full athletic participation than patients with lateral ankle sprains. Here we present the cases of two professional football players with ankle pain secondary to syndesmosis ossification following documented syndesmosis ankle sprains. Both patients eventually required resection of the heterotopic ossification to allow a pain-free return to football. We conclude that syndesmosis ossification may be symptomatic in some patients, and surgical excision of the ossification may be required to allow an asymptomatic return to sports.

Mechanism of Injury in a High Ankle Sprain: A Simulation Study

2011 ◽  
Author(s):  
Feng Wei ◽  
Jerrod E. Braman ◽  
Eric G. Meyer ◽  
John W. Powell ◽  
Roger C. Haut
Keyword(s):  
Ankle Sprain ◽  
Simulation Study ◽  
External Rotation ◽  
Recovery Period ◽  
Cadaver Study ◽  
Ankle Sprains ◽  
Mechanism Of Injury ◽  
Tibiofibular Syndesmosis ◽  
Lateral Ankle ◽  
High Ankle Sprain

Injury to the tibiofibular syndesmosis ligaments, which bind together the distal ends of the tibia and fibula, is commonly referred to as a high ankle sprain [8]. While lateral ankle sprains are the most common injury, high ankle sprains represent a more disabling problem and require a longer recovery period [1] and different treatment [4]. The mechanism associated with a high ankle sprain is primarily thought to involve external rotation of the foot [1,7]. However, both a cadaver study [6] and a simulation study [5] show that tibiofibular syndesmosis ligaments are not stretched the most during an excessive, pure external foot rotation.

scholarly journals The Role of the Calcaneofibular Ligament in Chronic Ankle Pain Following Severe Ankle Sprains

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0014
Author(s):  
Richard Alvarez ◽  
Randall Marx ◽  
Mark Mizel ◽  
Loren Latta ◽  
Paul Clifford
Keyword(s):  
Ankle Sprain ◽  
Plantar Flexion ◽  
Neutral Position ◽  
Peroneal Tendon ◽  
Ankle Sprains ◽  
Ankle Pain ◽  
Calcaneofibular Ligament ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Peroneal Tendons

Category: Sports Introduction/Purpose: Lateral ankle pain persists in 10%-20% of patients following severe ankle sprains treated non-operatively. The authors hypothesize that the peroneal tendons may become interposed between the ruptured ends of the calcaneofibular ligament (CFL). Though previously visualized and noted in the literature, no studies have evaluated this lesion biomechanically and anatomically. The purpose of this study is to demonstrate that following a severe lateral ankle sprain that the interposition of the peroneal tendons between the ruptured ends of the CFL can occur. Methods: Eight fresh-frozen cadaveric lower extremity specimens (defrosted) were secured by the foot to a wooden board in the method of Lauge-Hansen. A manual inversion force was then applied to the ankle, both with the ankle in plantar flexion and also in a neutral position to approximate a severe ankle sprain. Magnetic resonance imaging (MRI) was then performed on each ankle. Each specimen was then dissected to observe the integrity and relationship of the lateral ankle structures. Results: Four of the eight specimens sustained CFL tears as viewed by MRI and confirmed through anatomic dissection. One of the four specimens with a CFL tear had a mid substance ligament rupture with the proximal half of the ligament positioned superficial to the peroneal tendon complex. This relationship was observed using the MRI. Conclusion: Creating severe lateral ankle sprain produced ruptures of the CFL with interposition of the peroneal tendon complex between the torn ends of the ligament was seen and identified. This phenomenon may prevent primary ligament healing of the CFL and may be a contributing factor in the chronic ankle pain of non-surgically treated lateral ankle sprains. Perhaps surgical intervention should be considered if clinical suspicion exists, such as with a Stener lesion of the hand.

scholarly journals Predictive Factors of Recovery after an Acute Lateral Ankle Sprain: A Longitudinal Study

Sports ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 41
Author(s):  
Philippe Terrier ◽  
Sébastien Piotton ◽  
Ilona M. Punt ◽  
Jean-Luc Ziltener ◽  
Lara Allet
Keyword(s):  
Ankle Sprain ◽  
Strength Function ◽  
Selection Procedure ◽  
Ankle Sprains ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Functional Scores ◽  
Logistic Regressions ◽  
Poor Outcomes ◽  
Clinical Measures

A prominent feature of ankle sprains is their variable clinical course. The difficulty of providing a reliable early prognosis may be responsible for the substantial rate of poor outcomes after an ankle sprain. The aim of the present study was to evaluate the prognostic value of objective clinical measures, pain, and functional scores for ankle sprain recovery. Fifty-two participants suffering from lateral ankle sprain were included. Sprain status was assessed four weeks following injury and included evaluations of ankle range of motion, strength, function, and pain. Seven months following injury, a second assessment classified the patients into recovered and non-recovered groups using ankle ability measures. Following a predictor pre-selection procedure, logistic regressions evaluated the association between the four-week predictors and the seven-month recovery status. Twenty-seven participants (52%) fully recovered and 25 did not (48%). The results of the logistic regressions showed that walking pain was negatively associated with the probability of recovering at seven months (odds ratio: 0.71, 95% CI: 0.53–0.95). Pain four weeks after ankle sprain had relevant predictive value for long-term recovery. Special attention should be paid to patients reporting persistent pain while walking four weeks following sprain to reduce the risk of chronicity.

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 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 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:

The Effectiveness of a Balance Training Intervention in Reducing the Incidence of Noncontact Ankle Sprains in High School Football Players

2007 ◽  
Vol 35 (8) ◽  
pp. 1289-1294 ◽  
Author(s):  
Malachy P. McHugh ◽  
Timothy F. Tyler ◽  
Michael R. Mirabella ◽  
Michael J. Mullaney ◽  
Stephen J. Nicholas
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Ankle Sprain ◽  
Balance Training ◽  
High Body Mass Index ◽  
Football Players ◽  
Injury Incidence ◽  
Ankle Sprains ◽  
High Body ◽  
Increased Risk

Background A high body mass index and previous ankle sprains have been shown to increase the risk of sustaining noncontact inversion ankle sprains in high school football players. Hypothesis Stability pad balance training reduces the incidence of noncontact inversion ankle sprains in football players with increased risk. Study Design Cohort study; Level of evidence, 2. Methods Height, body mass, history of previous ankle sprains, and current ankle brace/tape use were documented at the beginning of preseason training in 2 high school varsity football teams for 3 consecutive years (175 player-seasons). Players were categorized as minimal risk, low risk, moderate risk, and high risk based on the history of previous ankle sprain and body mass index. Players in the low-, moderate-, and high-risk groups (ie, any player with a high body mass index and/or a previous ankle sprain) were placed on a balance training intervention on a foam stability pad. Players balanced for 5 minutes on each leg, 5 days per week, for 4 weeks in preseason and twice per week during the season. Postintervention injury incidence was compared with preintervention incidence (107 players-seasons) for players with increased risk. Results Injury incidence for players with increased risk was 2.2 injuries per 1000 exposures (95% confidence interval, 1.1-3.8) before the intervention and 0.5 (95% confidence interval, 0.2-1.3) after the intervention (P < .01). This represents a 77% reduction in injury incidence (95% confidence interval, 31%-92%). Conclusion The increased risk of a noncontact inversion ankle sprain associated with a high body mass index and a previous ankle sprain was eliminated by the balance training intervention.

scholarly journals Systematic Review of Postural Control and Lateral Ankle Instability, Part I: Can Deficits Be Detected With Instrumented Testing?

2008 ◽  
Vol 43 (3) ◽  
pp. 293-304 ◽  
Author(s):  
Patrick O. McKeon ◽  
Jay Hertel
Keyword(s):  
Postural Control ◽  
Ankle Sprain ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Effect Sizes ◽  
Ankle Sprains ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Increased Risk ◽  
Clinical Questions

Abstract Objective: To answer the following clinical questions: (1) Is poor postural control associated with increased risk of a lateral ankle sprain? (2) Is postural control adversely affected after acute lateral ankle sprain? (3) Is postural control adversely affected in those with chronic ankle instability? Data Sources: PubMed and CINAHL entries from 1966 through October 2006 were searched using the terms ankle sprain, ankle instability, balance, chronic ankle instability, functional ankle instability, postural control, and postural sway. Study Selection: Only studies assessing postural control measures in participants on a stable force plate performing the modified Romberg test were included. To be included, a study had to address at least 1 of the 3 clinical questions stated above and provide adequate results for calculation of effect sizes or odds ratios where applicable. Data Extraction: We calculated odds ratios with 95% confidence intervals for studies assessing postural control as a risk factor for lateral ankle sprains. Effect sizes were estimated with the Cohen d and associated 95% confidence intervals for comparisons of postural control performance between healthy and injured groups, or healthy and injured limbs, respectively. Data Synthesis: Poor postural control is most likely associated with an increased risk of sustaining an acute ankle sprain. Postural control is impaired after acute lateral ankle sprain, with deficits identified in both the injured and uninjured sides compared with controls. Although chronic ankle instability has been purported to be associated with altered postural control, these impairments have not been detected consistently with the use of traditional instrumented measures. Conclusions: Instrumented postural control testing on stable force plates is better at identifying deficits that are associated with an increased risk of ankle sprain and that occur after acute ankle sprains than at detecting deficits related to chronic ankle instability.

Patient with an Ankle Sprain

2016 ◽  
Author(s):  
Andrea Trescot
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Ankle Sprain ◽  
Ankle Instability ◽  
Age Groups ◽  
Pain Syndrome ◽  
The Elderly ◽  
Chronic Ankle Instability ◽  
Ankle Sprains ◽  
Lateral Ankle ◽  
High Ankle Sprain

Ankle sprains are a very common injury, suffered by approximately 25,000 patients per year, and affect all age groups, including children, athletes, and the elderly. The recognition of the type of ankle sprain (medial, lateral, syndesmotic) affects early and late management of ankle sprains. Also discussed are the acute diagnosis and treatment of ankle sprains, as well as the consequences of chronic ankle instability, which may include serious conditions such as complex regional pain syndrome and chronic ankle instability. Surgical and nonsurgical treatment, evaluation, prognosis, and prevention are also discussed. Key words: ankle pain, ankle sprain, chronic ankle instability, complex regional pain syndrome, cryoneuroablation, high ankle sprain, lateral ankle sprain, medial ankle sprain, 

Reinjury after Acute Lateral Ankle Sprains in Elite Track and Field Athletes

2009 ◽  
Vol 37 (9) ◽  
pp. 1755-1761 ◽  
Author(s):  
Nikolaos Malliaropoulos ◽  
Maria Ntessalen ◽  
Emmanuel Papacostas ◽  
Umile Giuseppe Longo ◽  
Nicola Maffulli
Keyword(s):  
Ankle Sprain ◽  
Track And Field ◽  
Low Grade ◽  
Ankle Sprains ◽  
High Grade ◽  
Level Of Evidence ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Grade Ii ◽  
Persistent Disability

Background Lateral ankle sprains can lead to persistent disability in athletes. The authors studied the effect of a lateral ankle sprain on reinjury occurrence in the same region. Hypothesis There will be no difference in reinjury rate between low-grade (grades I and II) and high-grade (IIIA and IIIB) acute lateral ankle sprains. Study Design Cohort study (prognosis); Level of evidence, 1. Methods From 1996 to 2004, the authors managed 202 elite Greek track and field athletes for an acute lateral ankle sprain. Sprains were classified into 4 degrees (I, II, IIIA, and IIIB). The same rehabilitation protocol was prescribed for all the athletes. The rate of a lateral ankle reinjury was recorded in the 24 months following injury. Results At a follow-up of 24 months, 36 of 202 athletes (17.8%) experienced a second lateral ankle sprain. Of the 79 athletes with a grade I injury, 11 (14%) experienced a recurrence during the study period. Of the 81 athletes with a grade II injury, 23 (29%) experienced a recurrence during the study period. Of the 36 athletes with a grade IIIA injury, 2 (5.6%) experienced a recurrence during the study period. Of the 6 athletes with a grade IIIB injury, none experienced a recurrence during the study period. Conclusion Athletes with a grade I or II lateral ankle sprain are at higher risk of experiencing a reinjury. Low-grade acute lateral ankle sprains result in a higher risk of reinjury than high-grade acute lateral ankle sprains.

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