scholarly journals Evaluation of the Anterior Talofibular Ligament by Stress Ultrasound for Assessing Generalized Joint Hypermobility

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0045
Author(s):  
Jaehwang Song ◽  
Chan Kang ◽  
Je Hyung Jeon ◽  
Chang Uk Ham
Keyword(s):  
Ankle Joint ◽  
Ankle Instability ◽  
Plantar Flexion ◽  
Joint Hypermobility ◽  
Anterior Talofibular Ligament ◽  
Specific Method ◽  
Ultrasound Images ◽  
Beighton Score ◽  
Generalized Joint Hypermobility ◽  
Ultrasound Parameters

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: Chronic ankle instability with generalized joint hypermobility (GJH) is considered a relative contraindication for the modified Bröstrom procedure. Most clinicians use the Beighton score to assess GJH. However, the Beighton score itself does not involve investigation of the ankle joint. In our experience, resting, longitudinal ultrasound images of the uninjured, intact ATFL frequently show a loose, wavy pattern in patients with high Beighton scores. We evaluated anterior talofibular ligament (ATFL) status according to Beighton score and the manual anterior drawer test (ADT). It was hypothesized that the value of ultrasound for ATFL would be significantly different between participants with GJH (Beighton score >= 5) and without GJH and show a correlation with participant’s Beighton scores and manual ADT grades. Methods: Forty-four healthy young patients (44 ankles) aged 20 to 40 years and without a history of ankle trauma or disease were included in the study. To assess GJH and ankle instability, Beighton scores and manual ADT grades were evaluated, respectively. For the investigation of ATFL, resting and stress ultrasonography were performed to assess its length, height, and thickness. Ultrasound images were taken in resting position and during maximal plantar-flexion and inversion (Figure: Ultrasound images of the ATFL in (a) the resting position and (b) stress position in a 21-year-old woman with Beighton score of 9. Dotted red line: Length, Yellow line: Height, Green double-headed arrow: Thickness). Beighton scores, manual ADT grades, and ultrasound parameters of participants with and without GJH were compared and the correlation coefficients among Beighton scores, manual ADT grades, and the length, height, and thickness of resting and stress ATFLs were analyzed. Results: The participants were divided into two groups, those without GJH (24 ankles) and with GJH (20 ankles). Mean Beighton scores and manual ADT grades were significantly different between the two groups (P < .05). The mean length, height of resting, stress ATFL and mean difference in height between resting and stress ATFL were significantly different between the two groups (P < .05). The resting and stress ATFL length, height, and difference in height between resting and stress ATFL showed a moderately positive linear relationship with Beighton scores and manual ADT grades (P < .05). Among the ATFL parameters, resting ATFL height showed the strongest relationship with the Beighton score (r = 0.763, P < .001) and ADT grade (r = 0.763, P < .001). Conclusion: The ATFL stress ultrasound parameters showed significant differences between participants with high and low Beighton scores and were correlated with Beighton scores and manual ADT grades. We believe that this ankle joint specific method might provide significant, quantitative parameters for assessing GJH in addition to the Beighton score.

Contact patterns in the ankle joint after lateral ligamentous injury during internal rotation: A computational study

2020 ◽  
Vol 235 (1) ◽  
pp. 82-88
Author(s):  
G Marta ◽  
C Quental ◽  
J Folgado ◽  
F Guerra-Pinto
Keyword(s):  
Finite Element ◽  
Contact Mechanics ◽  
Internal Rotation ◽  
Ankle Joint ◽  
Ankle Instability ◽  
Computational Study ◽  
Rotational Instability ◽  
Anterior Talofibular Ligament ◽  
Maximum Contact ◽  
Contact Pressures

Lateral ankle instability, resulting from the inability of ankle ligaments to heal after injury, is believed to cause a change in the articular contact mechanics that may promote cartilage degeneration. Considering that lateral ligaments’ insufficiency has been related to rotational instability of the talus, and that few studies have addressed the contact mechanics under this condition, the aim of this work was to evaluate if a purely rotational ankle instability could cause non-physiological changes in contact pressures in the ankle joint cartilages using the finite element method. A finite element model of a healthy ankle joint, including bones, cartilages and nine ligaments, was developed. Pure internal talus rotations of 3.67°, 9.6° and 13.43°, measured experimentally for three ligamentous configurations, were applied. The ligamentous configurations consisted in a healthy condition, an injured condition in which the anterior talofibular ligament was cut, and an injured condition in which the anterior talofibular and calcaneofibular ligaments were cut. For all simulations, the contact areas and maximum contact pressures were evaluated for each cartilage. The results showed not only an increase of the maximum contact pressures in the ankle cartilages, but also novel contact regions at the anteromedial and posterolateral sections of the talar cartilage with increasing internal rotation. The anteromedial and posterolateral contact regions observed due to pathological internal rotations of the talus are a computational evidence that supports the link between a pure rotational instability and the pattern of pathological cartilaginous load seen in patients with long-term lateral chronic ankle instability.

scholarly journals Characteristics and predictors of muscle strength deficit in mechanical ankle instability

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Zong-chen Hou ◽  
Xin Miao ◽  
Ying-fang Ao ◽  
Yue-lin Hu ◽  
Chen Jiao ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Strength Training ◽  
Ankle Instability ◽  
Plantar Flexion ◽  
Ligament Injury ◽  
Osteochondral Lesions ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Unaffected Side ◽  
Affected Side

Abstract Purpose Muscle strength training is a common strategy for treating chronic ankle instability (CAI), but the effectiveness decreases for mechanical ankle instability (MAI) patients with initial severe ligament injuries. The purpose of this study was to investigate the characteristics and the potential predictors of muscle strength deficit in MAI patients, with a view to proposing a more targeted muscle strength training strategy. Methods A total of 220 MAI patients with confirmed initial lateral ankle ligament rupture and a postinjury duration of more than 6 months were included. All patients underwent a Biodex isokinetic examination of the ankle joints of both the affected and unaffected sides. Then, the associations between the limb symmetry index (LSI) (mean peak torque of the injury side divided by that of the healthy side) and the patients’ sex, body mass index, postinjury duration, presence of intra-articular osteochondral lesions, presence of osteophytes and ligament injury pattern (i.e., isolated anterior talofibular ligament (ATFL) injury or combined with calcaneofibular ligament injury) were analysed. Results There was significantly weaker muscle strength on the affected side than on the unaffected side in all directions (p < 0.05). The LSI in plantar flexion was significantly lower than that in dorsiflexion at 60°/s (0.87 vs 0.98, p < 0.001). A lower LSI in eversion was significantly correlated with female sex (0.82 vs 0.94, p = 0.016) and isolated ATFL injury (0.86 vs 0.95, p = 0.012). No other factors were found to be associated with muscle strength deficits. Conclusion MAI patients showed significant muscle strength deficits on the affected side, especially in plantar flexion. There were greater strength deficits in eversion in females and individuals with an isolated ATFL injury. Thus, a muscle strength training programme for MAI patients was proposed that focused more on plantar flexion training and eversion training for females and those with an isolated ATFL injury.

scholarly journals Generalized Joint Hypermobility among School-going children in Majmaah region, Saudi Arabia

2019 ◽  
Author(s):  
Mohamed Sherif Sirajudeen ◽  
Mohamed Waly ◽  
Mazen Alqahtani ◽  
Msaad Alzhrani ◽  
Hariraja Muthusamy ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
School Children ◽  
Personal Characteristics ◽  
Joint Hypermobility ◽  
Primary School Children ◽  
Cutoff Score ◽  
Score Distribution ◽  
Beighton Score ◽  
Cross Sectional ◽  
Generalized Joint Hypermobility

Abstract Background Generalized Joint Hypermobility (GJH) is common among schoolchildren and usually benign. However, progressively may lead to joint pain and developmental delay. Identifying the GJH at the school-age would facilitate to monitor early changes and to plan for early rehabilitative intervention. Hence, we aimed to determine the prevalence, pattern, and factors associated with the GJH among school-going children in the Majmaah region, Saudi Arabia. Methods The school children of both genders aged 8 to 14 years from the Majmaah region of Saudi Arabia participated in this cross-sectional study. The Beighton’s score was used to assess the joint hypermobility. Personal characteristics like age, height, weight, Body mass index (BMI), and handedness was also collected. Descriptive statistics were produced for personal characteristics, the point prevalence of hypermobility, frequency of Beighton score distribution, and prevalence of GJH. The association between specific factors and the presence of GJH was analyzed using Chi-square tests and logistic regression measures. Results The occurrence of GJH as defined by Beighton cutoff score ≥ 4 in the 303 participated primary school children was 15.2%. The prevalence of GJH was high among females (16.8%) compared to males (13.4%), but this difference is not statistically significant. Younger male children (age 8 to 11 years) were 16.7 times more probable to develop hypermobility (adjusted OR 0.06 [95% CI 0.01 – 0.56]) compared to older male children (age 12 to 14 years). No associations were observed among female children. Conclusion The prevalence rate reported in this study among school-going children was in the lower range in comparison with the rates reported across the globe. Beighton score of ≥4 was adequate for use in identifying GJH among children in Saudi Arabia.

The Role of Calcaneofibular Ligament Injury in Ankle Instability: Implications for Surgical Management

2018 ◽  
Vol 47 (2) ◽  
pp. 431-437 ◽  
Author(s):  
Kenneth J. Hunt ◽  
Helder Pereira ◽  
Judas Kelley ◽  
Nicholas Anderson ◽  
Richard Fuld ◽  
...  
Keyword(s):  
Contact Mechanics ◽  
Ankle Joint ◽  
Contact Area ◽  
Ankle Instability ◽  
Peak Torque ◽  
Ligament Injury ◽  
Lateral Ligament ◽  
Anterior Talofibular Ligament ◽  
Ankle Sprains ◽  
Calcaneofibular Ligament

Background: Acute inversion ankle sprains are among the most common musculoskeletal injuries. Higher grade sprains, including anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) injury, can be particularly challenging. The precise effect of CFL injury on ankle instability is unclear. Hypothesis: CFL injury will result in decreased stiffness, decreased peak torque, and increased talar and calcaneal motion and will alter ankle contact mechanics when compared with the uninjured ankle and the ATFL-only injured ankle in a cadaveric model. Study Design: Descriptive laboratory study. Methods: Ten matched pairs of cadaver specimens with a pressure sensor in the ankle joint and motion trackers on the fibula, talus, and calcaneus were mounted on a material testing system with 20° of ankle plantarflexion and 15° of internal rotation. Intact specimens were axially loaded to body weight and then underwent inversion along the anatomic axis of the ankle from 0° to 20°. The ATFL and CFL were sequentially sectioned and underwent inversion testing for each condition. Linear mixed models were used to determine significance for stiffness, peak torque, peak pressure, contact area, and inversion angles of the talus and calcaneus relative to the fibula across the 3 conditions. Results: Stiffness and peak torque did not significantly decrease after sectioning of the ATFL but decreased significantly after sectioning of the CFL. Peak pressures in the tibiotalar joint decreased and mean contact area increased significantly after CFL release. Significantly more inversion of the talus and calcaneus as well as calcaneal medial displacement was seen with weightbearing inversion after sectioning of the CFL. Conclusion: The CFL contributes considerably to lateral ankle instability. Higher grade sprains that include CFL injury result in significant decreases in rotation stiffness and peak torque, substantial alteration of contact mechanics at the ankle joint, increased inversion of the talus and calcaneus, and increased medial displacement of the calcaneus. Clinical Relevance: Repair of an injured CFL should be considered during lateral ligament reconstruction, and there may be a role for early repair in high-grade injuries to avoid intermediate and long-term consequences of a loose or incompetent CFL.

Modified Broström Procedure for Chronic Ankle Instability With Generalized Joint Hypermobility

2016 ◽  
Vol 44 (4) ◽  
pp. 1011-1016 ◽  
Author(s):  
Bingzhe Huang ◽  
Yong Tae Kim ◽  
Jung Uk Kim ◽  
Jung Hoon Shin ◽  
Yong Wook Park ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Joint Hypermobility ◽  
Generalized Joint Hypermobility ◽  
Modified Broström Procedure

scholarly journals Characteristics and predictors of muscle strength deficit in mechanical ankle instability

2020 ◽  
Author(s):  
Zong-chen Hou ◽  
Xin Miao ◽  
Ying-fang Ao ◽  
Yue-lin Hu ◽  
Chen Jiao ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Strength Training ◽  
Ankle Instability ◽  
Plantar Flexion ◽  
Ligament Injury ◽  
Osteochondral Lesions ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Unaffected Side ◽  
Affected Side

Abstract Purpose: Muscle strength training is a common strategy for treating chronic ankle instability (CAI), but the effectiveness decreases for mechanical ankle instability (MAI) patients with initial severe ligament injuries. The purpose of this study was to investigate the characteristics and the potential predictors of muscle strength deficit in MAI patients, with a view to proposing a more targeted muscle strength training strategy.Methods: A total of 220 MAI patients with confirmed initial lateral ankle ligament rupture and a postinjury duration of more than 6 months were included. All patients underwent a Biodex isokinetic examination of the ankle joints of both the affected and unaffected sides. Then, the associations between the limb symmetry index (LSI) (mean peak torque of the injury side divided by that of the healthy side) and the patients’ sex, body mass index, postinjury duration, presence of intra-articular osteochondral lesions, presence of osteophytes and ligament injury pattern (i.e., isolated anterior talofibular ligament (ATFL) injury or combined with calcaneofibular ligament injury) were analysed.Results: There was significantly weaker muscle strength on the affected side than on the unaffected side in all directions (p<0.05). The LSI in plantar flexion was significantly lower than that in dorsiflexion at 60°/s (0.87 vs 0.98, p<0.001). A lower LSI in eversion was significantly correlated with female sex (0.82 vs 0.94, p=0.016) and isolated ATFL injury (0.86 vs 0.95, p=0.012). No other factors were found to be associated with muscle strength deficits.Conclusion: MAI patients showed significant muscle strength deficits on the affected side, especially in plantar flexion. There were greater strength deficits in eversion in females and individuals with an isolated ATFL injury. Thus, a muscle strength training programme for MAI patients was proposed that focused more on plantar flexion training and eversion training for females and those with an isolated ATFL injury.

Influence of the Interosseous Talocalcaneal Ligament Injury on Stability of the Ankle-Subtalar Joint Complex — a Cadaveric Experimental Study

2000 ◽  
Vol 21 (6) ◽  
pp. 486-491 ◽  
Author(s):  
Yuki Tochigi ◽  
Kazuhisa Takahashi ◽  
Masatsune Yamagata ◽  
Tamotsu Tamaki
Keyword(s):  
Ankle Joint ◽  
Subtalar Joint ◽  
Plantar Flexion ◽  
Three Dimensional ◽  
Axial Loading ◽  
Mechanical Tests ◽  
Ligament Injury ◽  
Anterior Talofibular Ligament ◽  
Ankle Ligaments ◽  
Lateral Ankle Ligaments

The present study aims to clarify the influence of the interosseous talocalcaneal ligament (ITCL) injury associated with injury to the lateral ankle ligaments on the ankle-subtalar joint complex motion under conditions of physiologic loading. We conducted mechanical tests using five fresh cadaveric lower extremities. Each specimen was mounted in the loading device and an axial cyclic load from 9.8 to 686 N was applied. Three-dimensional rotations of the ankle and the subtalar joint were measured simultaneously by a linkage electric goniometer. Mechanical tests were repeated after sectioning of the anterior talofibular ligament (ATFL), and again after additional sectioning of the ITCL. In the intact condition, the ankle and the subtalar joints rotated consistently with increase of the load. The predominant rotations were plantar flexion and adduction at the ankle joint, with some eversion demonstrated at the subtalar joint. Although ATFL sectioning did not significantly change the motion of the two joints, additional sectioning of the ITCL significantly increased adduction and total rotation of the ankle joint. The present study demonstrated that a combined injury of the ATFL and the ITCL can induce anterolateral rotatory instability of the ankle joint under conditions of axial loading.

No Effect of Generalized Joint Hypermobility on Injury Risk in Elite Female Soccer Players: A Prospective Cohort Study

2016 ◽  
Vol 45 (2) ◽  
pp. 286-293 ◽  
Author(s):  
Donna Blokland ◽  
Karin M. Thijs ◽  
Frank J.G. Backx ◽  
Edwin A. Goedhart ◽  
Bionka M.A. Huisstede
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Joint Hypermobility ◽  
Ankle Injuries ◽  
Soccer Players ◽  
Injury Incidence ◽  
Beighton Score ◽  
Generalized Joint Hypermobility ◽  
Significant Difference ◽  
Cutoff Points

Background: Although it has been suggested that generalized joint hypermobility (GJH) is a risk factor for injury in soccer players, it remains unclear whether this applies to elite female soccer players. Purpose: To investigate whether GJH is a risk factor for injury in elite female soccer players. Study Design: Cohort study; Level of evidence, 2. Methods: Elite female soccer players in the Netherlands were screened at the start of the 2014-2015 competitive season. GJH was assessed using the Beighton score. Soccer injuries and soccer exposure were registered throughout the entire season. Poisson regression was performed to calculate incidence risk ratios (IRRs) using different cutoff points of the Beighton score (≥3, ≥4, and ≥5) to indicate GJH. Results: Of the 114 players included in the study, 20 were classified as hypermobile (Beighton score ≥4). The mean (±SD) injury incidence per player was 8.40 ± 9.17 injuries/1000 hours of soccer, with no significant difference between hypermobile and nonhypermobile players. GJH was not a risk factor for injuries when using Beighton score cutoff points of ≥3 (IRR = 1.06 [95% CI, 0.74-1.50]; P = .762), ≥4 (IRR = 1.10 [95% CI, 0.72-1.68]; P = .662), or ≥5 (IRR = 1.15 [95% CI, 0.68-1.95]; P = .602). Similarly, GJH was not a significant risk factor for thigh, knee, or ankle injuries evaluated separately. Conclusion: This study indicates that GJH is not a risk factor for injuries in elite female soccer players, irrespective of Beighton score cutoff point. Hypermobile players at this elite level might have improved their active stability and/or used braces to compensate for joint laxity.

scholarly journals Generalized joint hypermobility among school-aged children in Majmaah region, Saudi Arabia

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e9682
Author(s):  
Mohamed Sherif Sirajudeen ◽  
Mohamed Waly ◽  
Mazen Alqahtani ◽  
Msaad Alzhrani ◽  
Fahad Aldhafiri ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Personal Characteristics ◽  
Epidemiological Studies ◽  
Joint Hypermobility ◽  
Score Distribution ◽  
Gulf Region ◽  
Beighton Score ◽  
Cross Sectional ◽  
School Aged Children ◽  
Generalized Joint Hypermobility

Generalized joint hypermobility (GJH) is common among schoolchildren and usually benign. However, it may progressively lead to joint pain and developmental delay. Identifying GJH in school-aged children would facilitate the monitoring of early changes and planning for early rehabilitative intervention. Epidemiological studies addressing the prevalence of GJH among children in the Gulf region and Arab ethnicity are lacking. Hence, we aimed to determine the prevalence, pattern, and factors associated with GJH among school-aged children in the Majmaah region, Saudi Arabia. Male and female school-aged children 8–14 years of age from the Majmaah region of Saudi Arabia participated in this cross-sectional study. Beighton score was used to assess GJH. Personal characteristics such as age, height, weight, body mass index, and handedness were also collected. Descriptive statistics were obtained for personal characteristics, the point prevalence of hypermobility, frequency of Beighton score distribution, and prevalence of GJH. The associations between specific factors and the presence of GJH were analyzed using chi-square and Mann-whitney tests. Using the Beighton score cutoff ≥ 4 and ≥ 6, 15.2% and 7.6% of the school children in our study were diagnosed with GJH respectively. The prevalence of GJH was higher among females (16.8%) than among males (13.4%), but the difference was not statistically significant. The elbow joints (17.2%) were the most common hypermobile joints and the trunk (0.7%) was the least involved. The children with GJH were younger and had lesser BMI compared to children without GJH (P < 0.05). The prevalence reported in this study among school-aged children was comparable with those reported worldwide.

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