scholarly journals Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

2011 ◽  
Vol 4 (1) ◽  
pp. 5 ◽  
Author(s):  
Hans Polzer ◽  
Karl Georg Kanz ◽  
Wolf Christian Prall ◽  
Florian Haasters ◽  
Ben Ockert ◽  
...  
Keyword(s):  
External Rotation ◽  
Clinical Importance ◽  
Complex Iii ◽  
Ankle Injuries ◽  
Diagnosis And Treatment ◽  
Lateral Ligament ◽  
Evidence Based ◽  
Ankle Sprains ◽  
Level Of Evidence ◽  
Residual Symptoms

Acute ankle injuries are among the most common injuries in emergency departments. However, there are still no standardized examination procedures or evidence-based treatment. Therefore, the aim of this study was to systematically search the current literature, classify the evidence, and develop an algorithm for the diagnosis and treatment of acute ankle injuries. We systematically searched PubMed and the Cochrane Database for randomized controlled trials, meta-analyses, systematic reviews or, if applicable, observational studies and classified them according to their level of evidence. According to the currently available literature, the following recommendations have been formulated: i) the Ottawa Ankle/Foot Rule should be applied in order to rule out fractures; ii) physical examination is sufficient for diagnosing injuries to the lateral ligament complex; iii) classification into stable and unstable injuries is applicable and of clinical importance; iv) the squeeze-, crossed leg- and external rotation test are indicative for injuries of the syndesmosis; v) magnetic resonance imaging is recommended to verify injuries of the syndesmosis; vi) stable ankle sprains have a good prognosis while for unstable ankle sprains, conservative treatment is at least as effective as operative treatment without the related possible complications; vii) early functional treatment leads to the fastest recovery and the least rate of reinjury; viii) supervised rehabilitation reduces residual symptoms and re-injuries. Taken these recommendations into account, we present an applicable and evidence-based, step by step, decision pathway for the diagnosis and treatment of acute ankle injuries, which can be implemented in any emergency department or doctor’s practice. It provides quality assurance for the patient and promotes confidence in the attending physician

scholarly journals Characterization of Ankle Kinematics and Constraint Following Ligament Rupture in a Cadaveric Model

2019 ◽  
Vol 141 (11) ◽  
Author(s):  
Bardiya Akhbari ◽  
Matthew H. Dickinson ◽  
Ednah G. Louie ◽  
Sami Shalhoub ◽  
Lorin P. Maletsky
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Training Data ◽  
Ankle Injuries ◽  
Ankle Sprains ◽  
Ligament Rupture ◽  
Ankle Kinematics ◽  
Posterior Translation ◽  
Ankle Mobility ◽  
And Inversion

Ankle sprains are a common injury that may need reconstruction and extensive physical therapy. The purpose of this study was to provide a description of the biomechanics of the ankle joint complex (AJC) after anterior talofibular (ATFL) and calcaneofibular (CFL) ligament rupture to better understand severe ankle injuries. The envelope of motion of ten cadaveric ankles was examined by manual manipulations that served as training data for a radial basis function used to interpolate ankle mobility at flexion angles under load and torque combinations. Moreover, ankle kinematics were examined, while tendons were loaded to identify how their performance is altered by ligament rupture. The increased force required to plantarflex the ankle following ligament rupture was measured by calculating the load through the Achilles. Following ATFL injury, the largest changes were internal rotation (5 deg) in deep plantarflexion and anterior translation (1.5 mm) in early plantarflexion. The combined ATFL and CFL rupture changed the internal/external rotation (3 deg), anterior/posterior translation (1 mm), and inversion (5 deg) throughout flexion relative to the isolated ATFL rupture. Moreover, the Achilles' load increased by 24% after the rupture of ligaments indicating a reduction in its efficiency. This study suggests that if patients demonstrate primarily an increased laxity in internal rotation, the damage has solely occurred to the ATFL; however, if the constraint is reduced across multiple motions, there is likely damage to both ligaments. Higher loads in the Achilles suggest that it is overloaded after the injury; hence, targeting the calf muscles in rehabilitation exercises may reduce patients' pain.

Persistent Disability Associated with Ankle Sprains: A Prospective Examination of an Athletic Population

1998 ◽  
Vol 19 (10) ◽  
pp. 653-660 ◽  
Author(s):  
J. Parry Gerber ◽  
Glenn N. Williams ◽  
Charles R. Scoville ◽  
Robert A. Arciero ◽  
Dean C. Taylor
Keyword(s):  
Physical Examination ◽  
Ankle Sprain ◽  
The United States ◽  
Ankle Injuries ◽  
Return To Sports ◽  
Ankle Sprains ◽  
Residual Symptoms ◽  
Athletic Population ◽  
Early Return ◽  
Hop Test

The purpose of this study was to examine a young athletic population to update the data regarding epidemiology and disability associated with ankle injuries. At the United States Military Academy, all cadets presenting with ankle injuries during a 2-month period were included in this prospective observational study. The initial evaluation included an extensive questionnaire, physical examination, and radiographs. Ankle sprain treatment included a supervised rehabilitation program. Subjects were reevaluated at 6 weeks and 6 months with subjective assessment, physical examination, and functional testing. The mean age for all subjects was 20 years (range, 17–24 years). There were 104 ankle injuries accounting for 23% of all injuries seen. There were 96 sprains, 7 fractures, and 1 contusion. Of the 96 sprains, 4 were predominately medial injuries, 76 were lateral, and 16 were syndesmosis sprains. Ninety-five percent had returned to sports activities by 6 weeks; however, 55% of these subjects reported loss of function or presence of intermittent pain, and 23% had a decrement of >20% in the lateral hop test when compared with the uninjured side. At 6 months, all subjects had returned to full activity; however, 40% reported residual symptoms and 2.5% had a decrement of >20% on the lateral hop test. Neither previous injury nor ligament laxity was predictive of chronic symptomatology. Furthermore, chronic dysfunction could not be predicted by the grade of sprain (grade I vs. II). The factor most predictive of residual symptoms was a syndesmosis sprain, regardless of grade. Syndesmosis sprains were most prevalent in collision sports. This study demonstrates that even though our knowledge and understanding of ankle sprains and rehabilitation of these injuries have progressed in the last 20 years, chronic ankle dysfunction continues to be a prevalent problem. The early return to sports occurs after almost every ankle sprain; however, dysfunction persists in 40% of patients for as long as 6 months after injury. Syndesmosis sprains are more common than previously thought, and this confirms that syndesmosis sprains are associated with prolonged disability.

External Rotation Ankle Injuries: Investigating Ligamentous Rupture

2009 ◽  
Author(s):  
Mark R. Villwock ◽  
Eric G. Meyer ◽  
John W. Powell ◽  
Roger C. Haut
Keyword(s):  
High Frequency ◽  
Failure Load ◽  
Sports Injuries ◽  
External Rotation ◽  
Experimental Studies ◽  
Soft Tissue Injuries ◽  
Ankle Injuries ◽  
Ankle Sprains ◽  
Severity Of Injury ◽  
Ankle Complex

Ankle sprains are one of the most common sports injuries [1], accounting for 10% to 15% of these injuries [2]. The severity of injury varies greatly and the player’s recovery time is related to the structures involved and their degree of damage. In contrast to the soft tissue injuries reported in many clinical studies on the ankle, experimental studies have typically generated a high frequency of bone fracture when the foot/ankle complex is externally rotated [3–5]. In a majority of these manuscripts, the cadaveric test specimens are of advanced or unknown age. These variables may substantially affect both the failure load and the mode of failure in the joint, since most ankle sprains occur in people under the age of 35 years [6].

scholarly journals Conservative Management for Stable High Ankle Injuries in Professional Football Players

2017 ◽  
Vol 10 (1) ◽  
pp. 80-84 ◽  
Author(s):  
Derrick M. Knapik ◽  
Anthony Trem ◽  
Joseph Sheehan ◽  
Michael J. Salata ◽  
James E. Voos
Keyword(s):  
Conservative Management ◽  
American Football ◽  
Ankle Injuries ◽  
Football Players ◽  
Ankle Sprains ◽  
Level Of Evidence ◽  
Flow Restriction ◽  
Recovery Times ◽  
Prolonged Recovery ◽  
Level 3

Context: High ankle “syndesmosis” injuries are common in American football players relative to the general population. At the professional level, syndesmotic sprains represent a challenging and unique injury lacking a standardized rehabilitation protocol during conservative management. Evidence Acquisition: PubMed, Biosis Preview, SPORTDiscus, PEDro, and EMBASE databases were searched using the terms syndesmotic injuries, American football, conservative management, and rehabilitation. Study Design: Clinical review. Level of Evidence: Level 3. Results: When compared with lateral ankle sprains, syndesmosis injuries result in significantly prolonged recovery times and games lost. For stable syndesmotic injuries, conservative management features a brief period of immobilization and protected weightbearing followed by progressive strengthening exercises and running, and athletes can expect to return to competition in 2 to 6 weeks. Further research investigating the efficacy of dry needling and blood flow restriction therapy is necessary to evaluate the benefit of these techniques in the rehabilitation process. Conclusion: Successful conservative management of stable syndesmotic injuries in professional American football athletes requires a thorough understanding of the anatomy, injury mechanisms, diagnosis, and rehabilitation strategies utilized in elite athletes.

scholarly journals Ten-Year Epidemiology of Ankle Injuries in Men's and Women's Collegiate Soccer Players

2019 ◽  
Vol 54 (8) ◽  
pp. 881-888
Author(s):  
Matthew Gulbrandsen ◽  
David E. Hartigan ◽  
Karan A. Patel ◽  
Justin L Makovicka ◽  
Sailesh V Tummala ◽  
...  
Keyword(s):  
National Collegiate Athletic Association ◽  
Injury Rate ◽  
Injury Surveillance ◽  
Ankle Injuries ◽  
Soccer Players ◽  
Lateral Ligament ◽  
Deltoid Ligament ◽  
Surveillance Program ◽  
Ankle Sprains ◽  
Injury Rates

Context Data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) have indicated that ankle injuries are the most common injuries among NCAA soccer players. Objective To review 10 years of NCAA-ISP data for soccer players' ankle injuries to understand how the time period (2004–2005 through 2008–2009 versus 2009–2010 through 2013–2014), anatomical structure injured, and sex of the athlete affected the injury rate, mechanism, and prognosis. Design Descriptive epidemiology study. Setting Online injury surveillance. Main Outcome Measure(s) The NCAA-ISP was queried for men's and women's soccer ankle data from 2004 to 2014. Ankle-injury rates were calculated on the basis of injuries per 1000 athlete-exposures. Rate ratios (RRs) were used to compare injury rates. Injury proportion ratios (IPRs) were used to compare injury characteristics. Results When compared with the 2004–2005 through 2008–2009 seasons, the 2009–2010 through 2013–2014 seasons showed a similar rate of injuries (RR = 0.94, 95% confidence interval [CI] = 0.85, 1.04) but fewer days missed (P < .001) and fewer recurrent injuries (IPR = 0.55, 95% CI = 0.41, 0.74). The 4 most common ankle injuries, which accounted for 95% of ankle injuries, were lateral ligament complex tears (65.67%), tibiofibular ligament (high ankle) sprains (10.3%), contusions (10.1%), and medial (deltoid) ligament tears (9.77%). Of these injuries, high ankle sprains were most likely to cause athletes to miss ≥30 days (IPR = 1.9, 95% CI = 1.24, 2.90). Men and women had similar injury rates (RR = 1.02, 95% CI = 0.94, 1.11). Men had more contact injuries (IPR = 1.28, 95% CI = 1.16, 1.41) and contusion injuries (IPR = 1.34, CI = 1.03, 1.73) but fewer noncontact injuries (IPR = 0.86, 95% CI = 0.78, 0.95) and lateral ligamentous complex injuries (IPR = 0.92, 95% CI = 0.86, 0.98). Conclusions Although the rate of ankle injuries did not change between the 2004–2005 through 2008–2009 seasons and the 2009–2010 through 2013–2014 seasons, the prognoses improved. Among the 4 most common ankle injuries, high ankle sprains resulted in the worst prognosis. Overall, male and female NCAA soccer players injured their ankles at similar rates; however, men were more likely to sustain contact injuries.

Prophylactic Bracing Decreases Ankle Injuries in Collegiate Female Volleyball Players

2007 ◽  
Vol 36 (2) ◽  
pp. 324-327 ◽  
Author(s):  
David I. Pedowitz ◽  
Sudheer Reddy ◽  
Selene G. Parekh ◽  
G. Russell Huffman ◽  
Brian J. Sennett
Keyword(s):  
National Collegiate Athletic Association ◽  
Case Series ◽  
Injury Rate ◽  
Ankle Injury ◽  
Ankle Injuries ◽  
Ankle Sprains ◽  
Level Of Evidence ◽  
Injury Data ◽  
Ankle Brace ◽  
Volleyball Players

Background Ankle injuries account for the highest percentage of injuries among female collegiate volleyball players. Since 1998, all female volleyball players at the authors’ institution have worn bilateral double-upright padded ankle braces at all times. Purpose To review the authors’ experience with this brace in preventing ankle injuries that result in a loss of play. Study Design Case series; Level of evidence, 4. Methods Injury data, preparticipation medical histories, and total exposure data were collected prospectively on all female volleyball players at the authors’ institution from 1998 to 2005. Injuries and exposures were defined based on established National Collegiate Athletic Association Injury Surveillance System criteria. Injury rate was calculated as the number of injuries per 1000 exposures. The National Collegiate Athletic Association female volleyball injury data from 1998 to 2005 were used for comparison. Results During the study period, there were a total of 13 500 exposures and 1 injury in our group yielding an injury rate of 0.07 per 1000 exposures. Nearly half of our athletes had a preparticipation history of ankle sprains, yet only 1 ankle injury occurred during all of our braced exposures. Conclusion There were 811 710 exposures and 797 injuries in the National Collegiate Athletic Association comparison group with an increased injury rate of 0.98 per 1000 exposures ( P = .001). Prophylactic use of a double-upright ankle brace significantly reduced the ankle injury rate compared with that reported by the National Collegiate Athletic Association. From these data, it appears that the use of such a brace is an effective way to decrease the incidence of ankle injuries in this active but vulnerable group of athletes.

Knotless Modified Arthroscopic-Broström Technique for Ankle Instability

2019 ◽  
Vol 40 (4) ◽  
pp. 475-483 ◽  
Author(s):  
Manuel J. Pellegrini ◽  
Jesus Sevillano ◽  
Cristian Ortiz ◽  
Eric Giza ◽  
Giovanni Carcuro
Keyword(s):  
Ankle Instability ◽  
Standard Procedure ◽  
Functional Results ◽  
Nonoperative Treatment ◽  
Lateral Ligament ◽  
Ankle Sprains ◽  
Arthroscopic Technique ◽  
Distal Fibula ◽  
Level Of Evidence ◽  
Inferior Extensor Retinaculum

Instability is a common sequela after repeated ankle sprains. When nonoperative treatment fails, open lateral ligament complex repair and reinforcement with the inferior extensor retinaculum has been the gold standard procedure. The recent advancements in arthroscopic techniques have created comparable biomechanical and functional results to open procedures. The authors’ modification to the standard arthroscopic technique permits ligament approximation to the distal fibula over a larger surface area, using knotless anchors to avoid the need of an accessory portal and limit potential suture knot–related complications. Level of Evidence: Level V, expert opinion.

Syndesmotic Ankle Sprains in Athletes

2007 ◽  
Vol 35 (7) ◽  
pp. 1197-1207 ◽  
Author(s):  
Glenn N. Williams ◽  
Morgan H. Jones ◽  
Annunziato Amendola
Keyword(s):  
Sports Medicine ◽  
Imaging Modality ◽  
Nonoperative Treatment ◽  
Diagnosis And Treatment ◽  
Return To Play ◽  
Future Research ◽  
Ankle Sprains ◽  
Level Of Evidence ◽  
Severity Of Injury ◽  
High Incidence

Ankle sprains are among the most common athletic injuries and represent a significant source of persistent pain and disability. Despite the high incidence of ankle sprains in athletes, syndesmosis injuries have historically been underdiagnosed, and assessment in terms of severity and optimal treatment has not been determined. More recently, a heightened awareness in sports medicine has resulted in more frequent diagnoses of syndesmosis injuries. However, there is a low level of evidence and a paucity of literature on this topic compared with lateral ankle sprains. As a result, no clear guidelines are available to help the clinician assess the severity of injury, choose an imaging modality to visualize the injury, make a decision in terms of operative versus nonoperative treatment, or decide when the athlete may return to play. Increased knowledge and understanding of these injuries by clinicians and researchers are essential to improve the prevention, diagnosis, and treatment of this significant condition. This review will discuss the anatomy, mechanism of injury, diagnosis, and treatment of syndesmosis sprains of the ankle while identifying controversies in management and topics for future research.

Effect of Shoe Stiffness on Injury Produced Under External Rotation of the Foot in Human Cadavers

2013 ◽  
Author(s):  
Keith D. Button ◽  
Mark A. Davison ◽  
Jerrod E. Braman ◽  
Maureen C. Schaefer ◽  
Roger C. Haut
Keyword(s):  
Ankle Sprain ◽  
External Rotation ◽  
Ankle Injuries ◽  
Upper Body ◽  
Deltoid Ligament ◽  
Ankle Sprains ◽  
Interosseous Ligament ◽  
Lateral Ankle ◽  
Human Cadavers ◽  
Anterior Deltoid

Ankle sprain is a common occurrence in sports, accounting for 10–30% of injuries 9. Injury to the lateral ligamentous complex occurs under excessive foot inversion and is known as a “lateral ankle sprain” 1. Injury to the anterior deltoid ligament (ADL), which consists of the tibionavicular ligament (TiNL) and the anterior tibiotalar ligament (ATiTL), is known as a “medial ankle sprain” 13. High ankle sprains occur in the distal tibiofibular syndesmosis, which is comprised of the anterior and posterior tibiofibular ligaments (ATiFL and PTiFL) and the interosseous ligament (IOL) 2. While approximately 85% of ankle sprains are lateral ankle injuries, syndesmotic (high) and medial injuries typically result in more time off the field. The mechanism of both high and medial ankle sprain is commonly ascribed to excessive internal rotation of the upper body, while the foot is planted on the playing surface.

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