Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021

Background: Anatomic lateral ankle ligament reconstruction has been proposed for patients with chronic ankle instability. A reliable approach is a reconstruction technique using an allograft and 2 fibular tunnels. A recently introduced approach that entails 1–fibular tunnel reconstruction might reduce the risk of intraoperative complications and ultimately improve patient outcome. Hypothesis: We hypothesized that both reconstruction techniques show similar ankle stability (joint laxity and stiffness) and are similar to the intact joint condition. Study Design: Controlled laboratory study. Methods: A total of 10 Thiel-conserved cadaveric ankles were divided into 2 groups and tested in 3 stages—intact, transected, and reconstructed lateral ankle ligaments—using either the 1– or the 2–fibular tunnel technique. To quantify stability in each stage, anterior drawer and talar tilt tests were performed in 0°, 10°, and 20° of plantarflexion (anterior drawer test) or dorsiflexion (talar tilt test). Bone displacements were measured using motion capture, from which laxity and stiffness were calculated together with applied forces. Finally, reconstructed ligaments were tested to failure in neutral position with a maximal applicable torque in inversion. A mixed linear model was used to describe and compare the outcomes. Results: When ankle stability of intact and reconstructed ligaments was compared, no significant difference was found between reconstruction techniques for any flexion angle. Also, no significant difference was found when the maximal applicable torque of the 1-tunnel technique (9.1 ± 4.4 N·m) was compared with the 2-tunnel technique (8.9 ± 4.8 N·m). Conclusion: Lateral ankle ligament reconstruction with an allograft using 1 fibular tunnel demonstrated similar biomechanical stability to the 2-tunnel approach. Clinical Relevance: Demonstrating similar stability in a cadaveric study and given the potential to reduce intraoperative complications, the 1–fibular tunnel approach should be considered a viable option for the surgical therapy of chronic ankle instability. Clinical randomized prospective trials are needed to determine the clinical outcome of the 1-tunnel approach.

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Review of Variability in Rehabilitation Protocols after Lateral Ankle Ligament Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00246 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0024

Author(s):

Christina Hermanns ◽

Reed Coda ◽

Sana Cheema ◽

Matthew Vopat ◽

Megan Bechtold ◽

...

Keyword(s):

Return To Sport ◽

Ankle Sprains ◽

Inclusion Criteria ◽

Lateral Ankle ◽

Ankle Stability ◽

Ankle Ligament ◽

Rehabilitation Protocols ◽

Lateral Ankle Ligament ◽

Leg Exercise ◽

Suture Tape

Category: Ankle; Sports Introduction/Purpose: Ankle sprains are one of the most common athletic injuries. If a patient fails to improve through conservative management, surgery is an option to restore ankle stability. The purpose of this study is to analyze the variability across rehabilitation for patients undergoing lateral ankle ligament repair, reconstruction, or suture tape augmentation. Methods: 26 protocols were found. Inclusion criteria was protocols for ankle ligament surgery. Protocols for nonoperative care were excluded. A rubric was created to analyze weightbearing, range of motion (ROM), immobilization, single leg exercises, return to running, and return to sport (RTS). Results: There was variability especially in recommendations for immobilizing brace, partial and full weigh bearing, specific ROM movements of the ankle, and return to single leg exercise and running. For repair and reconstruction, none of these categories had greater than 60% agreement. 100% (12/12) of repair and 86% (12/14) of reconstruction protocols recommended no ROM postoperatively, and 86% (6/7) repair and 78% (11/14) reconstruction recommended no weightbearing postoperatively, making postoperative ROM and weightbearing status the most consistent aspects across protocols. Suture tape augmentation protocols generally allowed rehabilitation on a quicker timeline with full weightbearing by week 4-6 in 100% (3/3) of protocols and full ROM by week 8-10 in 66% (2/3). RTS was consistent in repair protocols (100% at week 12-16). Conclusion: ROM was variable across protocols and did not always match up with supporting literature. Return to sport was likely to correlate between protocols and the literature. Weightbearing was consistent between protocols. The variability between programs demonstrated the need for standardization of rehabilitation.

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Ankle Stability in Simulated Lateral Ankle Ligament Injuries

Foot & Ankle International ◽

10.3113/fai.2010.0531 ◽

2010 ◽

Vol 31 (6) ◽

pp. 531-537 ◽

Cited By ~ 11

Author(s):

Tadashi Fujii ◽

Harold B. Kitaoka ◽

Kota Watanabe ◽

Zong-Ping Luo ◽

Kai-Nan An

Keyword(s):

Ligament Injuries ◽

Lateral Ankle ◽

Ankle Stability ◽

Ankle Ligament ◽

Lateral Ankle Ligament

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Review of Variability in Rehabilitation Protocols after Lateral Ankle Ligament Surgery

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2020.12.153 ◽

2021 ◽

Vol 37 (1) ◽

pp. e74-e75

Author(s):

Christina Hermanns ◽

Reed Coda ◽

Sana Cheema ◽

Matthew Vopat ◽

Megan Bechtold ◽

...

Keyword(s):

Lateral Ankle ◽

Ankle Ligament ◽

Rehabilitation Protocols ◽

Lateral Ankle Ligament

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Reconstruction of the Lateral Ankle Ligament With a Long Extensor Tendon Graft of the Fourth Toe

The American Journal of Sports Medicine ◽

10.1177/0363546510388882 ◽

2011 ◽

Vol 39 (3) ◽

pp. 637-644 ◽

Cited By ~ 35

Author(s):

Jae Hoon Ahn ◽

Won-Sik Choy ◽

Ha-Yong Kim

Keyword(s):

Extensor Tendon ◽

Tendon Graft ◽

Lateral Ankle ◽

Ankle Ligament ◽

Lateral Ankle Ligament

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Early Repair of the Lateral Ankle Ligament in Young Patients.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.43.369 ◽

1994 ◽

Vol 43 (1) ◽

pp. 369-371

Author(s):

Takao Tsuruta ◽

Tetsuo Nakano ◽

Kazuki Miyazono ◽

Hideo Nishikawa ◽

Satoshi Kudo

Keyword(s):

Young Patients ◽

Lateral Ankle ◽

Early Repair ◽

Ankle Ligament ◽

Lateral Ankle Ligament

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Predisposing factors to lateral ankle injury in male comrades marathon runners

South African Journal of Physiotherapy ◽

10.4102/sajp.v65i1.75 ◽

2009 ◽

Vol 65 (1) ◽

Cited By ~ 1

Author(s):

J. Hiemstra ◽

N. Naidoo

Keyword(s):

Correlation Coefficient ◽

Undergraduate Research ◽

The United States ◽

Ankle Injury ◽

Ankle Injuries ◽

Distance Runners ◽

Marathon Runners ◽

Lateral Ankle ◽

Ankle Ligament ◽

Lateral Ankle Ligament

Introduction: More than two million people experience ankle ligament traumaeach year in the United States. Half of these are severe ligament sprains, however verylittle is known about the factors that predispose individuals to these injuries. The purpose of this study, (which was conducted as an undergraduate research project),was to find a correlation between the characteristics of height, weight and limbdominance and lateral ankle ligament injuries. Method: A retrospective study was conducted on 114 ultra distance runners whoparticipated in the 2006 Comrades Marathon. During race registration, the runners’ height and weight were measuredafter answering a questionnaire regarding their training. Results: 114 runners responded to the questionnaire. From this cohort, 38 (33.3%) had sustained previous lateral ankle injuries. Of these 38 injuries, 47.4% of the injuries occurred on the runner’s dominant limb and 36.8% occurred on thenon-dominant side. 15.8% of the runners sustained previous ankle injuries to both ankles. There was a low negative correlation coefficient of 0.24 with regards to weight as a risk factor. This indicated that the power of the correlationwas 5.93%. The study demonstrates that there is no correlation between an increase in weight and an increase in theincidence of ankle injury. The correlation coefficient indicated a low correlation between an increase in height and the incidence of ankle injury. However, the power of the correlation at 18.37% makes inaccurate any attempt to predict the height at which a runner would be at most risk for lateral ankle injury. Conclusion: Height and weight are not risk factors predisposing subjects to lateral ankle injury. In addition, the studyillustrated that there was no effect of limb dominance on the incidence of lateral ankle injury.

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