Validation of the Indonesian version of the foot and ankle score in patients with chronic lateral ankle instability

Abstract Background This study aimed to examine the psychometric performance of the Foot and Ankle Outcome Score (FAOS) used in Indonesian patients with chronic lateral ankle instability (CLAI). Methods The FAOS was translated into Indonesian through standardized procedures. Among 224 patients with unilateral CLAI recruited from 14 physical therapy clinics during a 1-year period, reliabilities, construct validities, and responsiveness levels of the FAOS were examined. Active and passive range of motion of ankle dorsiflexion or plantiflexion, figure-of-eight, numeric pain rating scale (NPRS), and Short Form (SF)-36 were used to test the construct validities. Results The five subscales indicated adequate internal consistency (Cronbach’s alpha, 0.74 ~ 0.96) and interrater test-retest reliabilities (interclass correlation coefficients, 0.80 ~ 0.94). Subscales of the FAOS moderately converged with those selected measures with similar constructs ($$r$$ r values, 0.32 ~ 0.53), with the exception of the correlation of pain with the NPRS ($$r$$ r , -0.06). Results of the principal component analysis showed that the five-factor structure of the FAOS was appropriate for the Indonesian data, although six items (four in the pain and two in the other symptoms (OSs) subscales) did not perfectly fit their original subscales. Guyatt’s responsiveness index for the FAOS’s subscales changed in the SF-36’s physical function over a 1-month period and ranged 0.37 to 1.27. Conclusions The Indonesian version of the FAOS demonstrated acceptable reliabilities and responsiveness, and fair construct validities among CLAI patients, although certain items in the pain and OSs subscales may need to be further explored and improved.

Download Full-text

Validation of the Indonesian Version of the Foot and Ankle Outcome Score in Patients with Chronic Lateral Ankle Instability

10.21203/rs.3.rs-184175/v1 ◽

2021 ◽

Author(s):

I Putu Gde Surya Adhitya ◽

Wen-Yu Yu ◽

Putu Ayu Sita Saraswati ◽

I Made Niko Winaya ◽

Mau-Roung Lin

Keyword(s):

Rating Scale ◽

Ankle Instability ◽

Short Form ◽

Principal Component ◽

Foot And Ankle ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Outcome Score ◽

Sf 36 ◽

Lateral Ankle Instability

Abstract Background: This study aimed to examine the psychometric performance of the Foot and Ankle Outcome Score (FAOS) used in Indonesian patients with chronic lateral ankle instability (CLAI).Methods: The FAOS was translated into Indonesian through standardized procedures. Among 224 patients with unilateral CLAI recruited from 14 physical therapy clinics during a 1-year period, reliabilities, construct validities, and responsiveness levels of the FAOS were examined. Active and passive range of motion of ankle dorsiflexion or plantiflexion, figure-of-eight, numeric pain rating scale (NPRS), and Short Form (SF)-36 were used to test the construct validities.Results: The five subscales indicated adequate internal consistency (Cronbach’s alpha, 0.74~0.96) and interrater test-retest reliabilities (interclass correlation coefficients, 0.80~0.94). Subscales of the FAOS moderately converged with those selected measures with similar constructs (r values, 0.32~0.53), with the exception of the correlation of pain with the NPRS (r, -0.06). Results of the principal component analysis showed that the five-factor structure of the FAOS was appropriate for the Indonesian data, although six items (four in the pain and two in the other symptoms (OSs) subscales) did not perfectly fit their original subscales. Guyatt’s responsiveness index for the FAOS’s subscales changed in the SF-36’s physical function over a 1-month period and ranged 0.37 to 1.27.Conclusions: The Indonesian version of the FAOS demonstrated acceptable reliabilities and responsiveness, and fair construct validities among CLAI patients, although certain items in the pain and OSs subscales may need to be further explored and improved.

Download Full-text

Chronic Lateral Ankle Instability: Results of Anatomic Repair with Polyester Tape Augmentation

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0013.9781 ◽

2020 ◽

Vol 22 (1) ◽

pp. 27-33

Author(s):

Islam Sarhan ◽

Islam Mubark ◽

Ahmed Waly

Keyword(s):

Ankle Sprain ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

High Rate ◽

Anatomic Reconstruction ◽

Foot And Ankle ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Anatomic Repair ◽

Lateral Ankle Instability

Background. Ankle sprains are one of the most common injuries in both athletes and the general population. A major problem accompanying ankle injury is the high rate of recurrence, with about 20% of acute ankle sprain patients developing chronic ankle instability. Unlike acute ankle sprain, chronic ankle instability usually needs surgical intervention. Various anatomic reconstruction techniques using the ruptured ends of the ligaments to restore stability have gained popularity. The purpose of this study was to evaluate the functional results of the treatment of chronic lateral ankle instability with anatomic repair of the injured ligaments and reinforcement with polyester tape. Material and methods. A prospective study of 30 consecutive patients who underwent anatomic reconstruction of the lateral ligaments using transosseous suturing and augmentation using a polyester tape done at a single centre by a single surgeon from 2016 to 2017. All patients were assessed preoperatively and postoperatively at 6 weeks, 3, 6 and 12 months. The American Orthopaedic Foot and Ankle Score (AOFAS) and Free Online Foot and Ankle Ability Measure (FAAM) were recorded and used for results analysis. Results. At 12 months’ follow-up, the AOFAS had improved from mean 52.47 ± 2.06 to 91.0 ± 6.03 (p< 0.001) .The FAAM mean score had improved from mean 55.21± 1.9 to 90.43 ± 4.02 Conclusion. The ankle ligament reconstruction with additional polyester tape augmentation is an effective technique in treating chronic ankle instability with a satisfactory surgical outcome.

Download Full-text

No Differences in Clinical Outcomes of Suture Tape Augmented Repair Versus Broström Repair Surgery for Chronic Lateral Ankle Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120948491 ◽

2020 ◽

Vol 8 (9) ◽

pp. 232596712094849

Author(s):

Hong Li ◽

Yujie Zhao ◽

Wenbo Chen ◽

Hongyun Li ◽

Yinghui Hua

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Complication Rate ◽

Ankle Instability ◽

Foot And Ankle ◽

Recurrent Instability ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Lateral Ankle Instability ◽

Suture Tape

Background: Suture tape (ST) augmented repair, an alternative to traditional Broström repair (BR), may protect the repaired anterior talofibular ligament during ligament healing. No systematic review of cohort studies has been conducted to compare traditional BR with ST-augmented repair for chronic lateral ankle instability. Purpose: To review the current evidence in the literature to ascertain whether ST-augmented repair is superior to traditional BR in managing chronic lateral ankle instability. Study Design: Systematic review; Level of evidence, 3. Methods: A literature search was performed to identify relevant articles published in PubMed, Embase, and Cochrane Library databases in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search included cohort studies comparing the efficacy of BR and ST-augmented repair procedures in terms of incidence of instability recurrence, functional scores, talar tilt angle (TTA), anterior talar translation (ATT), and complication rate. Methodological quality was assessed using the Jadad scale for randomized studies and the Newcastle-Ottawa Scale for nonrandomized studies. Results: A total of 4 clinical trials with 254 patients were included. No significant differences were detected between BR and ST-augmented repair procedures in terms of incidence of recurrent instability, American Orthopaedic Foot & Ankle Society score, Foot and Ankle Outcome Score, Foot and Ankle Ability Measure, TTA, ATT, or complication rate. The ST group appeared to have a shorter operation time compared with the BR group. Conclusion: No significant differences were found between ST-augmented repair and BR surgery regarding incidence of recurrent instability, functional outcome scores, or complication rates. Although technically challenging, the ST-augmented repair procedure appears to be a safe and fast option.

Download Full-text

Consistency and Reliability of Ankle Stress Radiography in Patients With Chronic Lateral Ankle Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211004099 ◽

2021 ◽

Vol 9 (5) ◽

pp. 232596712110040

Author(s):

Ji Hye Choi ◽

Kug Jin Choi ◽

Chin Youb Chung ◽

Moon Seok Park ◽

Ki Hyuk Sung ◽

...

Keyword(s):

Standard Deviation ◽

Tilt Angle ◽

Ankle Instability ◽

Interobserver Reliability ◽

Initial Presentation ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Stress Radiographs ◽

Lateral Ankle Instability

Background: Ankle stress radiographs are important tools for evaluating chronic lateral ankle instability. The consistency of a patient’s ankle condition as it affects the reliability of ankle stress radiographs has never been evaluated. Purpose: To investigate the consistency and reliability of ankle stress radiographs in patients with chronic lateral ankle instability without an ankle injury during the study period. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Included were patients with chronic lateral ankle instability who underwent 2 repeated ankle stress radiographs between January 2014 and July 2019; those with an ankle injury during the study period were excluded. The tibiotalar tilt angle on varus stress radiographs and anterior translation of the talus on anterior drawer stress radiographs were measured at initial presentation and final follow-up examination. Interobserver reliability and consistency of ankle stress radiographs were analyzed using the intraclass correlation coefficient (ICC). Results: A total of 45 patients (mean ± standard deviation age, 36.4 ± 13.4 years; 18 men and 27 women; follow-up duration, 9.1 ± 3.2 months) were included. The mean ± standard deviation tibiotalar tilt angle and anterior talar translation at initial presentation were 10.8° ± 5.2° and 6.9 ± 2.7 mm, respectively. The interobserver reliabilities of the tibiotalar tilt angle and anterior talar translation were excellent (ICC = 0.926 [95% CI, 0.874-0.959] and 0.911 [95% CI, 0.766-0.961], respectively). The consistency between the initial and final radiographs was good for tibiotalar tilt angle (ICC = 0.763 [95% CI, 0.607-0.862]) and poor for anterior talar translation (ICC = 0.456 [95% CI, 0.187-0.660]). Conclusion: Although the interobserver reliability of the radiographic measurements was excellent, the consistency of the ankle stress radiographs was not as acceptable. Surgeons need to be cautious when deciding whether to operate on a patient with chronic lateral ankle instability based on a single ankle stress radiograph.

Download Full-text

Demographic Predictors of Concomitant Osteochondral Lesion of the Talus in Patients With Chronic Lateral Ankle Instability

Foot & Ankle Orthopaedics ◽

10.1177/24730114211013344 ◽

2021 ◽

Vol 6 (2) ◽

pp. 247301142110133

Author(s):

Yong Sang Kim ◽

Tae Yong Kim ◽

Yong Gon Koh

Keyword(s):

Tilt Angle ◽

Ankle Instability ◽

Osteochondral Lesion ◽

Case Series ◽

Level Of Evidence ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Female Patients ◽

Lateral Ankle Instability ◽

Talar Tilt

Background: Osteochondral lesion of the talus (OLT) is commonly found as a concomitant pathologic lesion in a large proportion of patients with chronic lateral ankle instability (CLAI). This study investigated which characteristics in a patient with CLAI increase the risk for OLT. Methods: Three hundred sixty-four patients who underwent a modified Broström operation for their CLAI were reviewed retrospectively. The characteristics of each patient and variables associated with OLTs were investigated. Statistical analyses were performed to determine the effect of each potential predictor on the incidence of OLT, and to evaluate the associations between the patient characteristics and variables associated with OLTs. Results: Patients with OLTs were more frequently female (female vs male: 63.1% vs 43.9%, P = .003). In addition, the lesion sizes were larger in female patients (female vs male: 113.9 ± 24.9 mm2 vs 100.7 ± 18.0 mm2, P = .002), and medial lesions were more common in female patients (female vs male; 93.3% vs 81.8%, P = .036). The lesion sizes were larger in patients with a wider talar tilt angle ( P < .001), and patients with a medial OLT showed a wider talar tilt angle (12.0 ± 2.0 degrees vs 10.3 ± 2.2 degrees, P = .002). Conclusion: In this CLAI patient cohort, we found female patients to be at greater risk for OLTs than male patients. Furthermore, CLAI female patients with concomitant OLT had on average a larger lesion size, more frequent OLT medial position, and were associated with wider talar tilt angles, suggesting that females had more intrinsic ankle instability than males. Level of Evidence: Level IV, retrospective case series.

Download Full-text

Magnetic Resonance Imaging T2* Mapping of the Talar Dome and Subtalar Joint Cartilage 3 Years After Anterior Talofibular Ligament Repair or Reconstruction in Chronic Lateral Ankle Instability

The American Journal of Sports Medicine ◽

10.1177/0363546520982240 ◽

2021 ◽

Vol 49 (3) ◽

pp. 737-746

Author(s):

Yiwen Hu ◽

Yuyang Zhang ◽

Qianru Li ◽

Yuxue Xie ◽

Rong Lu ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Ankle Instability ◽

Anterior Talofibular Ligament ◽

Resonance Imaging ◽

Talar Dome ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Lateral Ankle Instability

Background: Cartilage degeneration is a common issue in patients with chronic lateral ankle instability. However, there are limited studies regarding the effectiveness of lateral ligament surgery on preventing talar and subtalar joint cartilage from further degenerative changes. Purpose: To longitudinally evaluate talar and subtalar cartilage compositional changes using magnetic resonance imaging T2* mapping in anatomic anterior talofibular ligament (ATFL)–repaired and ATFL-reconstructed ankles and to compare them with measures in asymptomatic controls. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2015 and December 2016, patients with chronic lateral ankle instability who underwent anatomic ATFL repair (n = 19) and reconstruction (n = 20) were prospectively recruited. Patients underwent 3.0-T magnetic resonance imaging at baseline and 3-year follow-up. As asymptomatic controls, 21 healthy volunteers were recruited and underwent imaging at baseline. Talar dome cartilage was divided into (1) medial anterior, central, and posterior and (2) lateral anterior, central, and posterior. Posterior subtalar cartilage was divided into (1) central talus and calcaneus and (2) lateral talus and calcaneus. Ankle function was assessed using the American Orthopaedic Foot & Ankle Society scores. Results: There were significant increases in T2* values in medial and lateral posterior and central talus cartilage from baseline to 3-year follow-up in patients who underwent repair. T2* values were significantly higher in ATFL-repaired ankles at follow-up for all cartilage regions of interest, except medial and lateral anterior and lateral central, compared with those in healthy controls. From baseline to 3-year follow-up, ATFL-reconstructed ankles had a significant increase in T2* values in lateral central and posterior cartilage. T2* values in ATFL-reconstructed ankles at follow-up were elevated in all cartilage regions of interest, except medial and lateral anterior, compared with those in healthy controls. ATFL-repaired ankles showed a greater decrease of T2* values from baseline to follow-up in lateral calcaneus cartilage than did ATFL-reconstructed ankles ( P = .031). No significant differences in American Orthopaedic Foot & Ankle Society score were found between repair and reconstruction procedures (mean ± SD, 19.11 ± 7.45 vs 16.85 ± 6.24; P = .311). Conclusion: Neither anatomic ATFL repair nor reconstruction could prevent the progression of talar dome and posterior subtalar cartilage degeneration; however, ankle function and activity levels were not affected over a short period. Patients who underwent ATFL repair exhibited lower T2* values in the lateral calcaneus cartilage than did those who underwent reconstruction.

Download Full-text