Treatment of Chronic Ankle Instability in the Military Population: A Systematic Review

2022 ◽  
pp. 193864002110682
Author(s):  
Ezra Goodrich ◽  
Bryan Vopat ◽  
Ashley Herda
Keyword(s):  
Patient Population ◽  
Military Service ◽  
English Language ◽  
Ankle Instability ◽  
Case Reports ◽  
Treatment Strategies ◽  
Chronic Ankle Instability ◽  
Lateral Ligament ◽  
Military Population ◽  
The Military

Background The high incidence of ankle sprain within the military sets the stage for prevalent chronic ankle instability. The purpose of this review was to compare and evaluate chronic ankle instability treatment strategies in the military population. Methods Electronic databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews guidelines for English-language, human studies with a military patient population that had been diagnosed with and treated for chronic ankle instability. Exclusion criteria were animal, cadaver, and review studies and case reports. Results Eight studies met the inclusion criteria, representing 695 military service members—625 males (89.9%) and 70 females (10.1%)—and 4 treatment strategies: Broström-related procedures, modified Watson-Jones procedure, Colville’s technique, and anatomic lateral ligament reconstruction using semitendinosus tendon allograft. The percentage of satisfactory outcomes was 100% for Colville’s technique, and ranged from 73.2% to 94.7% for Broström-related procedures and 72% to 80% for the modified Watson-Jones procedure. Mean American Orthopaedic Foot and Ankle Society scores, anterior drawer displacement, talar tilt, and visual analogue scale scores were also reported. Conclusion This review demonstrates that the Bröstrom procedure has consistently satisfactory outcomes within the military population, and Colville’s technique is another promising option for this patient population but would require additional studies to support this claim. Levels of Evidence: Level IV

scholarly journals Prevalence of Chronic Ankle Instability in French Paratroopers

2019 ◽  
Vol 185 (3-4) ◽  
pp. 477-485
Author(s):  
Marion Schmitt ◽  
Joffrey Marchi ◽  
Arnaud Jouvion ◽  
Thomas Trappier ◽  
Lisa Reyes-Rivet ◽  
...  
Keyword(s):  
General Population ◽  
Ankle Sprain ◽  
Sports Injuries ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Military Population ◽  
Physically Active ◽  
Active Population ◽  
The Military ◽  
The Impact

Abstract Introduction Ankle sprain is the most common musculoskeletal injury in the physically active population (up to 50% of sports injuries) and is common in the general population with about one ankle sprain per 10 000 person-days worldwide. It is an even more frequent pathology in the military population with a prevalence of five to eight times higher than in the civilian population. In the general population, 20 to 74% of sprains are complicated by chronic ankle instability. No studies estimate this prevalence in a French military population. The main objective of our study was, therefore, to estimate the prevalence of chronic ankle instability in French paratroopers. Materials and Methods The study was carried out in a French parachute regiment over a period of 1 year during periodic medical examinations. To diagnose chronic ankle instability, we used the criteria defined by the International Ankle Consortium in 2013 and two questionnaires that this consortium recommended (FAAM and IdFAI). Results Chronic ankle instability has a prevalence of 43.1% after an ankle sprain with a total of 2.3% among paratroopers, which is comparable to data in the literature. After their first sprain, 23.1% of subjects did not consult a health professional and 47.6% of subjects did not receive physiotherapy. Conclusions Physiotherapy is the basis of care, both for prevention and treatment of chronic ankle instability. It is necessary to raise awareness of this injury among the military and to encourage their adherence to treatment in order to preserve the operational capabilities of combat units. Subsequently, further studies are needed to expand the study population to provide a more comprehensive view of the impact of this injury on the military. Studies concerning the management of chronic ankle instability adapted to the military population would also be relevant.

Infertility and the Military Male

2019 ◽  
Vol 37 (01) ◽  
pp. 005-011
Author(s):  
Amanda B. Reed-Maldonado ◽  
Kristin C. Madden
Keyword(s):  
Male Infertility ◽  
Military Service ◽  
Clinical Investigation ◽  
Male Factor Infertility ◽  
Military Population ◽  
Male Factor ◽  
Scientific Publications ◽  
Military Service Members ◽  
Infertile Couples ◽  
The Military

AbstractMale infertility is a condition that affects approximately 50% of infertile couples and about 30% of those couples have only male factor infertility identified. There has been speculation that male military service members may have an even greater lifetime prevalence of infertility as compared to the general population, but very few scientific publications focus on male factor infertility in the military population specifically. This review will discuss many of the unique considerations regarding male infertility in the military and highlight future opportunities for research. The military/federal health system has the potential to serve as a leader in both the delivery of health care for male factor infertility and in the clinical investigation into the etiologies of and treatments for male factor infertility.

Fair evidence consistently supports open surgical treatment for chronic ankle instability: a systematic review

2019 ◽  
Vol 4 (5) ◽  
pp. 254-269
Author(s):  
Chad Alexander Purcell ◽  
James Calder ◽  
Kentaro Matsui ◽  
Pontus Andersson ◽  
Jón Karlsson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Systematic Evaluation ◽  
Anatomical Reconstruction ◽  
Lateral Ligament ◽  
Anterior Talofibular Ligament ◽  
Reconstruction Technique ◽  
Operative Techniques ◽  
Level Of Evidence

ImportancePatients with chronic ankle instability (CAI) who have failed non-operative treatments are most commonly treated with open ankle repair or reconstruction of the anterior talofibular ligament and/or calcaneofibular ligament. Over 50 operative techniques have been described for the treatment of CAI. However, there is no current systematic evaluation of currently used open operative techniques for the treatment of CAI.Aim/ObjectiveThe primary objective of this study is to provide evidence-based treatment recommendations for CAI in adults based on a comprehensive systematic review of the literature.Evidence reviewThe literature review of PubMed, EMBASE, Cochrane and Web of Science databases was completed on 22 February 2017. Search terms included two concepts: lateral ligament of the ankle (patients) and open reconstructive or repair procedures (intervention). All published clinical studies with English translation were included. Biomechanical, cadaveric, review articles, minimally invasive procedures and arthroscopic procedures were excluded. Open operative procedures from included articles were classified as anatomical or non-anatomical and repair or reconstructive. Articles were then assigned a level of evidence (I-V) to denote quality of the research methods. Articles were reviewed collectively to provide a grade of recommendation (A-C or I) in support for or against the operative intervention in treatment of CAI.FindingsSeventy one of 1635 identified articles were included for review. There is fair evidence (Grade B) in support of anatomical repair, anatomical reconstruction and non-anatomical reconstruction procedures. There was insufficient evidence available to grade internal brace and non-anatomical repair procedures.Conclusions and relevanceAlthough only fair-quality evidence exists in support of open operative treatment of CAI, this systematic review helps reassure clinicians of their current practices. The literature reaffirms support for open anatomical repair and anatomical reconstruction technique for CAI.Level of evidenceLevel II, systematic review.

Arthroscopic Findings in Patients with Chronic Ankle Instability

2002 ◽  
Vol 30 (3) ◽  
pp. 402-409 ◽  
Author(s):  
Beat Hintermann ◽  
Andreas Boss ◽  
Dirk Schäfer
Keyword(s):  
Structural Changes ◽  
Ankle Instability ◽  
Cartilage Damage ◽  
Case Series ◽  
Chronic Ankle Instability ◽  
Ankle Arthroscopy ◽  
Lateral Ligament ◽  
Deltoid Ligament ◽  
Anterior Talofibular Ligament ◽  
Ligament Injuries

Background There are little objective data on structural changes of the chronically unstable ankle. Such knowledge could help with preoperative planning. Hypothesis Preoperative ankle arthroscopy provides important insights into the causes and mechanisms of ankle instability and the resulting disability. Study Design Case series. Methods From 1993 to 1999, arthroscopic examination was performed in the ankles of 148 patients with symptomatic chronic ankle instability that had lasted 6 months or more. All structural changes were recorded and compared with the clinical diagnosis. Results A rupture or elongation of the anterior talofibular ligament was noted in 86% of ankles, of the calcaneofibular ligament in 64%, and of the deltoid ligament in 40%. Cartilage damage was noted in 66% of ankles with lateral ligament injuries, whereas 98% of the ankles with deltoid ligament injuries had cartilage damage. Although lateral instability could be verified arthroscopically in 127 patients, medial instability was presumed clinically in 38 patients but was actually detected in 54 patients arthroscopically. Conclusion Preoperative ankle arthroscopy revealed an essential amount of information that would otherwise have been undetected. For instance, the ligaments showed typical abnormalities corresponding to different entities of ankle instability and different intra-articular pathologic conditions.

scholarly journals Arthroscopic Lateral Ligament Repair Through Two Portals in Chronic Ankle Instability

2017 ◽  
Vol 11 (1) ◽  
pp. 617-632 ◽  
Author(s):  
Jorge Pablo Batista ◽  
Jorge Javier del Vecchio ◽  
Luciano Patthauer ◽  
Manuel Ocampo
Keyword(s):  
Ankle Instability ◽  
Medical Condition ◽  
Surgical Techniques ◽  
Clinical Success Rate ◽  
Chronic Ankle Instability ◽  
Tilt Test ◽  
Lateral Ligament ◽  
Return To Sports ◽  
Ligament Repair

Objectives:Injury to the lateral ligament complex of the ankle is one of the most common sports-related injury.Usually lateral ankle evolves with excellent clinical recovery with non surgical treatment, however, near about 30% develop a lateral chronic instability sequela.Several open and arthroscopic surgical techniques have been described to treat this medical condition.Material and Methods:Of the 22 patients who were treated; 18 males and 4 females, and aged from 17-42 years (mean 28 years).All patients presented a history of more than three ankle sprains in the last two years and presented positive anterior drawer and talar tilt test of the ankle in the physical examination.We perform an anterior arthroscopy of the ankle in order to treat asociated disease and then we performed“All inside¨lateral ligament repair through two portals (anteromedial and anterolateral) using an anchor knotless suture.Results:Clinical outcome evaluations were performed at a mean follow up of 25 months. (R: 17-31).Overall results has been shown by means of the American Orthopaedic Foot and Ankle Society (AOFAS). Mean AOFAS scores improved from 63 points (range 52–77) preoperatively to 90 points (range 73–100) at final follow up.No recurrences of ankle instability were found in the cases presented.Conclusion:Several surgical procedures have been described during the last years in order to treat chronic ankle instability.¨All inside¨lateral ligament reconstruction presents lower local morbidity than open procedures with few complications. Moreover, it is a reproductible technique, with high clinical success rate, few complications and relatively quick return to sports activities. A high knowledge of the anatomic landmarks should be essential to avoid unwated injuries.

An Interdisciplinary Treatment Approach for Soldiers With TBI/PTSD: Issues and Outcomes

2009 ◽  
Vol 19 (2) ◽  
pp. 36-46 ◽  
Author(s):  
Sandra L. Schneider ◽  
Lisa Haack ◽  
Jenny Owens ◽  
Dominique P. Herrington ◽  
Anita Zelek
Keyword(s):  
Brain Injury ◽  
Treatment Strategies ◽  
Interdisciplinary Approach ◽  
Interdisciplinary Treatment ◽  
Post Traumatic Stress ◽  
Military Population ◽  
Evidence Based Practices ◽  
Co Morbidity ◽  
Complex Population ◽  
The Military

Abstract Purpose: While the co-morbidity of symptoms associated with traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) in the injured military population is currently being discussed and researched, those of us in the rehabilitation fields need to be ready now to serve this complex population. We are challenged to provide the best services with limited research and evidence-based practices to guide us. This article presents an interdisciplinary approach to treatment for soldiers with TBI. Method: We compare and contrast the blast-induced brain injury acquired in the military population, designated as the “signature injury of this war,” to “typical” TBI populations. Results and conclusions: We share what we have learned by serving this population and present each discipline's assessments, treatment strategies, outcome measures, and suggestions for navigating the military “mindset” of the soldiers being served.

Effect of Balance Training on Postural Stability in Subjects With Chronic Ankle Instability

2013 ◽  
Vol 22 (2) ◽  
pp. 143-149 ◽  
Author(s):  
Maraike Alice Wortmann ◽  
Carrie L. Docherty
Keyword(s):  
Exercise Training ◽  
Postural Stability ◽  
Ankle Instability ◽  
Balance Training ◽  
Chronic Ankle Instability ◽  
Lateral Ligament ◽  
Common Component ◽  
Moderate Evidence ◽  
Balance Exercise ◽  
Dynamic Postural Stability

The lateral ligament complex of the ankle is a frequently injured structure in sports and recreational activities, which often results in chronic ankle instability (CAI). Balance exercise training has become a common component of clinical rehabilitation for CAI to address postural deficits. To determine the effect of balance training on postural stability, this critically appraised topic presents a summary and analysis of 4 relevant studies that address the effectiveness of balance training in subjects with CAI. Information about the methods and sources used in the article is provided. The findings imply that there is moderate evidence that 4–6 wk of balance training can enhance static and dynamic postural stability in subjects with CAI.

scholarly journals Early Functional and Patient Reported Outcomes following Suture Tape Augmented Brostrom

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0034
Author(s):  
Kevin D. Martin ◽  
Jeannie Huh ◽  
William Robinson ◽  
Kevin D. Martin
Keyword(s):  
Patient Reported Outcomes ◽  
Ankle Instability ◽  
Active Duty ◽  
Lateral Ligament ◽  
Anterior Talofibular Ligament ◽  
Foot And Ankle ◽  
Military Population ◽  
Functional Rehabilitation ◽  
Patient Reported ◽  
Suture Tape

Category: Ankle Introduction/Purpose: Immediately following a lateral ligament reconstruction the strength of the repair is far less than the native anterior talofibular ligament (ATFL). With early functional rehabilitation the repair has shown increased laxity. We hypothesized that a Brostrom augmented with a suture-tape construct would allow early functional rehabilitation while maintaining patient reported outcomes within a military population. Methods: This study is a retrospective cohort of 90 consecutive patients with chronic lateral ankle instability were treated with a Brostrom procedure augmented with a suture-tape construct. All had a preoperative MRI demonstrating ligament insufficiency, and was examined by an orthopaedic foot and ankle surgeon. Subjects were evaluated at 2, 6 and 12 weeks postoperatively. Demographics including Foot and Ankle Disability Index (FADI), Visual Analog Scale (VAS), and clinical measures including single- leg hop and single-leg heel raise were recorded. The population included (14 women [18%], 76 men [84%] mean age of 29.47, BMI 27.3) active duty service members. Results: The mean FADI score pre-operatively (67) improved to 86 and 89 at 6 and 12 weeks. The VAS scores pre-operatively (4.8) improved to 1.4 and 1.3 at 6 and 12 weeks respectively. 95.5% (86/90) of patients were able to complete a single-leg hop and single-leg heel raise at 6 and 12 weeks. Conclusion: Our results suggest that a Brostrom augmented with suture-tape can allow for early functional rehabilitation in an active duty Military population.

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