Morphological and Functional Characteristics of the Peroneus Muscles in Patients with Lateral Ankle Sprain: An Ultrasound-Based Study

Background and Objectives: The effectiveness of multiple ultrasound evaluations of the peroneus muscles morphology, including muscle cross-sectional area (CSA) and connective tissue, after lateral ankle sprain (LAS) is unknown. This study aimed to measure the peroneus muscles after LAS at three points, adding distal 75% to the conventional measurement points, in order to obtain a detailed understanding of the post-injury morphology and to propose a new evaluation index of the peroneus muscles for multiple LAS. Materials and Methods: Participants with and without LAS (LAS and control groups, 16 each) were recruited. The muscle cross-sectional area (CSA) and muscle echogenicity were measured using a B-mode ultrasound system at 25%, 50%, and 75% proximal to the line connecting the fibular head to the lateral malleolus. The ankle evertor strength was measured using a handheld dynamometer. Simultaneously, the peroneus longus (PL) and peroneus brevis (PB) muscle activities were measured using surface electromyography. Measurements for the LAS side, non-LAS side, and control leg were performed separately. Results: The CSA was significantly higher at 75% on the LAS side than on the non-LAS side and in the control leg. Muscle echogenicity of the LAS side at 75% was significantly lower than that of the non-LAS side and the control leg. Muscle activity of the PL was significantly lower and the PB was higher on the LAS side than on the non-LAS side and in the control leg. Conclusions: The PL was less active than the PB, while the PB was found to be overactive, suggesting that PB hypertrophy occurs due to an increase in the percentage of muscle fibers and a decrease in the connective tissue. Therefore, it is necessary to evaluate the condition of the PL and PB separately after LAS.

Botchu-Beale accessory ligament of lateral ankle

Variations in anatomy of the tendons and ligaments are not uncommon and cause a diagnostic dilemma. We describe a novel ligament encountered in the ankle extending from posterior inferior tibiofibular ligament to calcaneum. Awareness of normal variant is essential during evaluation of a study.

Tertiary rehabilitation in acute ankle sprain caused by sports training

BACKGROUND: An ankle sprain is a common joint sprain in sports injury, which is closely related to its physiological position and anatomical characteristics, and may progress into chronic ankle instability after improper early treatment or premature exercise. OBJECTIVE: To analyze the tertiary rehabilitation effect of acute lateral ankle sprain caused by sports training. METHOD: Ninety-six athletes with acute lateral ankle sprain diagnosed from January 2019 to June 2020 were included and divided into the control group and the rehabilitation group using the random number table grouping method, with 48 cases in each group. The two groups received standardized treatment, and the rehabilitation group additionally received tertiary rehabilitation. The American Orthopedic Foot and Ankle Society (AOFAS ) scores, degree of ankle swelling, pain, and re-injury rate were compared between the two groups. RESULTS: The AOFAS scores of the two groups increased after treatment (P< 0.05). The degree of swelling in both groups after treatment was improved (P< 0.05). The Visual Analogue Scale (VAS) scores in both groups declined two weeks after treatment, with lower results observed in the rehabilitation group The two groups showed similar results of the follow-up visit (P< 0.05). CONCLUSION: Rehabilitation exercise on acute lateral ankle sprain effectively relieves ankle swelling and pain.

Distal Insertion Rupture of Lateral Ankle Ligament as a Predictor of Weakened and Delayed Sports Recovery after Acute Ligament Repair: Mid- to Long-Term Outcomes of 148 Cases

Background Surgical repair has been considered for ankle sprain patients with high sports demanding to achieve stronger ankle stability and allow for an earlier return to sports. However, there is a lack of systematic research regarding arthroscopic treatment followed by ligament repair for severe acute ankle sprain. The purpose of this study was to analyze the mid- to long-term outcome of arthroscopy followed by open anatomic lateral ankle ligament repair surgery for acute lateral ankle sprain and the impact of ligament rupture site on the outcome. Methods 166 professional or semi-professional athletes with clinically- and radiologically-confirmed grade III acute lateral ankle ligament injuries underwent ankle arthroscopy followed by open anatomic ligament repair. Intra-articular lesions and rupture site of the lateral ankle ligament were treated and explored under arthroscopy. Simple suture repair was performed for mid- substance ligament rupture (middle group), while suture repair with anchors were used for the ruptures near the ligament attachment site on the fibular (proximal group), talar or the calcaneal side (distal group). The evaluation parameters included VAS score, AOFAS score, Tegner score, time to return to sports and resumption of pre-injury sports level at final follow-up, sprain recurrence and range of motion (ROM). Results The mean follow-up duration was 64.5 (range, 37–132 months) months and 148 (89.2%) patients were evaluated at final follow-up. Intra-articular lesions were treated under arthroscopy in 63 (43%) patients. The average time to return to pre-injury sports activity was 4.37 ± 1.10 months and 17 (11.5%) patients complaint sprain recurrence after operation. There were 71 (48%) cases in the proximal group, 46 (31%) cases in the middle group and 31 (21%) cases in the distal group respectively. The proximal group achieved shortest time to return to sports (4.14 ± 1.09 months) and highest resumption proportion of pre-injury sports level (94% ± 11%) at final follow-up, followed by middle group (89% ± 15%, 4.61 ± 0.93 months, respectively) and distal group (87% ± 13%, 4.53 ± 1.29 months, respectively) (p =0.008, p =0.04, respectively). At final follow-up, all of the VAS score, AOFAS score and the Tegner score were significantly improved from the pre-operative level (p < 0.001). 18 (12%) patients reported mild ROM restriction and 7 (4.7%) patients experienced transient skin numbness. Conclusions Ankle arthroscopy followed by open anatomic ligament repair is a reliable procedure for patients with high sports demands after severe acute ankle sprains. Rupture near the talar or calcaneal side weakened the sports resumption and delayed about 2 weeks of sports recovery.

Lateral Instability in Total Ankle Arthroplasty: A Comparison Between the Brostrom-Gould and Anatomic Lateral Ankle Stabilization (ATLAS)

Background Lateral ankle instability is not uncommon after osseous cuts and soft tissue releases are performed during Total Ankle Arthroplasty (TAA), particularly with varus malalignment. The purpose of the present study was to compare the outcomes of ankles that underwent TAA with concurrent Brostrom-Gould (BG) or Anatomic Lateral Ankle Stabilization (ATLAS) at a minimum of 1-year follow-up. Methods Thirty-eight TAAs underwent BG (21 INFINITY, 4 CADENCE) or ATLAS (13 INBONE-2) between August 2015 and February 2019 at a single institution and were at least 1 year postoperative (mean 18.3 months, range: 12-40). Baseline patient demographics, characteristics, and operative factors were assessed via medical record and chart reviews. Radiographs parameters were measured preoperatively, at 6 weeks postoperative, and during the latest follow-up. Revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al and Glazebrook et al, respectively. Univariate and multivariate analyses were performed. Results Survivorship for TAA with concurrent BG/ATLAS was 97%. Overall, TAA with concurrent BG had higher incidences of early TAA revision (4%), recurrent instability (4%), reoperation (16%), and complications (29%) compared to ATLAS. Postoperative coronal and sagittal tibiotalar alignment changes were significant for both groups (P < .001, P = .014); however, the differences were greater for ATLAS (P = .045, P < .001). Conclusion The present study is the first to compare outcomes between techniques for addressing ankle instability in the TAA population. At short-term follow-up, anatomic reconstruction produced better outcomes than the traditional BG procedure. Additional comparative studies between techniques to address instability in the TAA population are warranted. Level of Evidence: Level III: Retrospective cohort study