In Different Gender Groups, What Is the Impact of the Fibular Notch on The Severity of High Ankle Sprain: A Retrospective Study of 240 Cases

Background: The function of the distal tibiofibular ligament on the ankle in the occurrence of high ankle sprain (HAS) has been widely studied. Then, in different genders, the effect of the anatomical morphology of fibular notch (FN) on HAS is unclear. Therefore, on the basis of excluding the anatomical differences caused by gender, we explore the impact of different types of FN on the severity of HAS.Methods: We selected 120 patients and further classified these 120 patients into four HAS groups according to FN depth with deep concave type FN ≥ four mm and shallow flat type FN < four mm. A further 120 normal individuals were served as a control group. FN morphological indicators, tibiofibular distance (TFD), and ankle mortise indexes were measured and compared between patients and control groups.Results: In males with shallow flat type, the Anterior tibiofibular distance (aTFD), Middle tibiofibular distance (mTFD), Posterior tibiofibular distance (pTFD), Front tibial width (FTiW), Middle tibial width (MTiW), Posterior tibial width (PTiW) and Depth of ankle mortise (DOAM) of HAS group were higher than those in normal group (P < 0.05). In males with deep concave type, the aTFD, mTFD and DOAM of patients were significantly higher (P < 0.05). Among females with shallow flat type, the aTFD, mTFD, pTFD, FTiW and MTiW in HAS group were greater than those in normal group (P < 0.05). Among the females with deep concave type, the mTFD and pTFD of patients were higher (P < 0.05).Conclusions: After analyzing the morphological indicators of FN, it is found that in both males and females, HAS patients have significant differences in TFD and certain ankle mortise indexes compared with normal people. But more importantly, the above abnormalities are often more common in HAS patients with shallow flat FN, indicating that shallow flat FN may be related to more serious distal tibiofibular ligament injury and ankle mortise widening, resulting in a worse prognosis.Level of evidence: Level III, retrospective comparative study.

The Effect of “High-ankle Sprain” Taping on Ankle Syndesmosis Congruity: A Cadaveric Study

Background: Different treatment options exist for dynamically unstable purely ligamentous syndesmotic injury, including surgery, walking boot, brace and taping. Objective: The main purpose of this study was to evaluate the effect of high-ankle sprain taping (ring taping) on syndesmotic stability in various ligament conditions when axial loading is applied. Methods: This controlled cadaveric laboratory study included ten cadaveric specimens installed in a custom-made device applying 750N of axial loading in order to simulate weight-bearing. Sectioning of syndesmotic ligaments, AiTFL and IOL, was done sequentially and CT scan images were taken with and without high-ankle sprain taping. A validated measurement system consisting of 3 lengths and 1 angle was used. Results were compared with Wilcoxon tests for paired samples and non-parametric data. Results: In every ligament condition (intact vs. cut), no statistically significant difference was observed between specimens, with or without high-ankle sprain taping and with or without axial loading. When the data from ankles with AiTFL and IOL ruptures were compared, the mean for length “b” without axial loading was 7.19 (±2.17), compared to 7.20 (±1.98) with axial loading (p-value = 0.905). With taping and the leg still in axial loading, the value was 7.17 (±2.09) (p-value = 0.721), which is not statistically significant. Conclusion: It is impossible to conclude regarding high-ankle sprain taping’s capacity to maintain syndesmosis congruity because no significant difference was observed, regardless of condition. The most important finding is that high-ankle sprain taping did not cause malreduction of the injured syndesmosis. Level of Evidence: Level V cadaveric study

The Diagnostic Value of MRI for High Ankle Sprains with an Unstable Syndesmosis: Time to Scan Matters

Category: Ankle, Arthroscopy, Sports, Trauma Introduction/Purpose: Early clinical examination combined with MRI following a high ankle sprain allows accurate diagnosis of syndesmosis instability. However, patients often present late, and for chronic injuries clinical assessment is less reliable. The aims of the current study were to describe MRI characteristics associated with diagnosed syndesmosis instability, and to assess if MRI characteristics change as the injury becomes chronic. Methods: Patients with a high ankle sprain and proven syndesmosis instability at arthroscopy were retrospectively identified from the logbooks of two fellowship trained foot and ankle surgeons over a five-year period. Patients were excluded if they had a distal fibula fracture or absence of an MRI report by a consultant radiologist. Associations between MRI characteristics and time from injury to MRI scan, categorised as acute (< 6 weeks), intermediate (6-12 weeks) and chronic (> 12 weeks) were examined using the Pearson’s chi-squared or Fisher’s exact tests (significance set at p<0.05). Results: Of the 164 patients, 108 had an MRI scan in the acute period, 32 were classified as intermediate and 24 as chronic. A posterior syndesmosis injury was detected in 93.5% of acute patients, 87.5% of intermediate patients and 54.2% of chronic patients. In the acute group, PITFL injury was detected in 78.7% of patients, posterior malleolus bone oedema in 60.2% and posterior malleolus fracture in 15.7%. The proportion of patients with injury to the PITFL in intermediate patients was 59.4% and 29.2% in chronic patients which was significantly lower than in acute patients (p<0.001). Twenty eight patients with posterior malleolus bone oedema had an apparently normal PITFL. The proportion of patients with posterior malleolus bone oedema or fracture were not significantly different between groups. Conclusion: The most important finding of the current study is that in acute high ankle sprains with syndesmosis instability, MRI detected a posterior syndesmosis injury in 93.5% of patients. Posterior malleolus bone oedema appears to be a marker of an unstable syndesmosis injury, regardless of time from injury to the MRI scan. The ability of MRI to detect a posterior syndesmosis injury reduces significantly if delayed more than 12 weeks. If suspicious of a high ankle sprain, we advocate early MRI assessment to help determine stable versus unstable injuries, as the ability of MRI to detect posterior injuries reduces over time.

High Ankle Sprains in Professional Ice Hockey Players: Prognosis and Correlation Between Magnetic Resonance Imaging Patterns of Injury and Return to Play

Background: Hockey players sustain a greater incidence of ankle syndesmosis injuries than other athletes. These injuries have a higher morbidity and more unpredictable recovery than lateral ankle sprains. Magnetic resonance imaging (MRI) has been used to establish the diagnosis but has not been evaluated for its ability to predict return to play. Hypothesis: We hypothesized that patterns of injury defined on MRI could be used to predict return to play in a cohort of professional hockey players with syndesmosis sprains. Study Design: Cohort study; Level of evidence, 3. Methods: A prospectively collected National Hockey League (NHL) database was analyzed from the 2006-2007 to 2011-2012 seasons to assess return to play after an injury. A separate retrospective review of ankle MRI scans from professional hockey players with a documented high ankle sprain sustained between 2007 and 2012 was performed. Injuries were classified on MRI as complete or partial tears of the anterior-inferior tibiofibular ligament (AITFL), posterior-inferior tibiofibular ligament (PITFL), anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), calcaneofibular ligament (CFL), and deltoid ligament. Fractures, bone contusions, and osteochondral lesions were also recorded. Results: A total of 105 NHL athletes sustained high ankle sprains over the 5 seasons studied. Of these athletes, 85 were unable to play and missed a median of 8 games (range, 0-65 games). A retrospective MRI evaluation of 21 scans identified complete AITFL tears in 13 (62%) and high-grade partial tears in 5 (24%) cases. In contrast, the PITFL was partially torn in 9 (43%) and normal in 12 (57%) cases. Bone contusions were seen in 71% of cases and lacked a consistent pattern. The most commonly associated ligamentous injury was of the ATFL, which was injured in 52% of cases (11/21; 3 complete and 8 partial). There was no difference in the mean number of days lost when players were stratified by patterns of injury (incomplete/complete AITFL tear ± additional ligamentous injury, bone contusion, syndesmosis width). Conclusion: A high ankle sprain resulted in significant variations in time of recovery among professional hockey players. A torn AITFL and bone bruising were the most common patterns of injury. Although MRI can be used to confirm the diagnosis of a syndesmosis injury, it did not predict return to play in this population.

The Epidemiology of High Ankle Sprains in National Collegiate Athletic Association Sports

Background: Ankle sprains are among the most common injuries experienced by collegiate athletes. The type of ankle sprain is rarely differentiated in epidemiological studies. This differentiation is necessary, as each ankle sprain type has a unique injury mechanism and recovery period. High ankle sprains commonly result in long recovery periods. Thus, a further examination of the epidemiology of high ankle sprains is warranted. Purpose: To describe the epidemiology of high ankle sprains in National Collegiate Athletic Association (NCAA) sports during the 2009/2010-2014/2015 academic years. Study Design: Descriptive epidemiology study. Methods: NCAA Injury Surveillance Program high ankle sprain data and athlete-exposures (AEs) from 25 sports were evaluated. Certified athletic trainers recorded sport-related injury, event, and AE data during team-sanctioned events. High ankle sprain injury rates per 10,000 AEs were calculated. Percentage distributions were calculated for the amount of time lost from sport and percentage of recurrent injuries. Injury rate ratios (RRs) and 95% CIs compared injury rates by event type, participation restriction time, and sex. 95% CIs not containing 1.00 were considered statistically significant. Results: The overall high ankle sprain injury rate was 1.00 per 10,000 AEs. Overall, 56.7% of high ankle sprain injuries occurred during competitions, and 9.8% of high ankle sprain injuries were recurrent. Men’s football (2.42/10,000 AEs), wrestling (2.11/10,000 AEs), and ice hockey (1.19/10,000 AEs) had the highest high ankle sprain injury rates. In sex-comparable sports, men had higher injury rates (RR, 1.77; 95% CI, 1.28-2.44). Player contact was the most common injury mechanism (60.4%), and 69.0% of injuries resulted in ≥1 day of participation restriction, with 47.1% resulting in ≥7 days of participation restriction and 15.8% resulting in >21 days of participation restriction. Conclusion: High ankle sprains resulted in significant participation restriction time from sport participation. The majority of high ankle sprain injuries resulted from player contact and were observed in contact/collision sports. The large proportion of high ankle sprains resulting from player contact, specifically in male contact sports, is worthy of further investigation. Clinical Relevance: The enhanced understanding of the epidemiology of high ankle sprains provided in our study will aid clinicians in developing targeted injury prevention strategies to mitigate the negative consequences of these injuries.

Patient with an Ankle Sprain

Ankle sprains are a very common injury, suffered by approximately 25,000 patients per year, and affect all age groups, including children, athletes, and the elderly. The recognition of the type of ankle sprain (medial, lateral, syndesmotic) affects early and late management of ankle sprains. Also discussed are the acute diagnosis and treatment of ankle sprains, as well as the consequences of chronic ankle instability, which may include serious conditions such as complex regional pain syndrome and chronic ankle instability. Surgical and nonsurgical treatment, evaluation, prognosis, and prevention are also discussed. Key words: ankle pain, ankle sprain, chronic ankle instability, complex regional pain syndrome, cryoneuroablation, high ankle sprain, lateral ankle sprain, medial ankle sprain,