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.

Ankle Ligament Injuries Based on Medical Images of Hip-Hop Training and Research on Training Techniques

Ligament loss of the ankle joints is common. If it is not handled properly, it is easy to cause repeated sprains of the ankle joints. Usually, medical image examination will be the first choice for the diagnosis of ligament injury. This paper analyzes the ankle ligament injury of hip-hop training based on medical images and studies the hip-hop training skills, to explore the application method of medical images in ankle injury, and can provide some theoretical and practical references for other sports injuries. In this paper, several medical image-related technologies such as texture feature extraction, main visual feature SAR method, and edge detection method are proposed. These technologies are applied to the study of ankle ligament injury, and an effective medical training therapy is determined by setting up the control group and the treatment group to observe the medical image display of each part of the ankle. Through the statistics of the clinical efficacy judgment standard results of patients in the treatment group and patients in the control group after two weeks of injury, it is found that the experimental results show that the cure rate, significant efficiency, and total effective rate of patients in the treatment group after two weeks are higher than those in the control group, and the total effective rate of the treatment group has reached 92.20%.

A Case Report of Tarsal Navicular Body Fracture with Lateral Ankle Ligament Complex Tear – a New Injury Combination

Introduction: Fractures of tarsal navicular bone are a rare injury. A navicular fracture can occur either in isolation or associated with other bony or ligamentous injuries, depending on the severity and mechanism of trauma at the time of impact. We report a previously undescribed injury combination of navicular fracture with tear of the lateral ankle ligament complex. Case Report: An 18-year-old professional long jump athlete presented with a history of twisting injury immediately before taking off, while attempting a jump. A detailed clinical examination and radiological assessment with computed tomography (CT) and magnetic resonance imaging (MRI) scan were performed. She was diagnosed to have a navicular body fracture with complete rupture of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Acute fixation of navicular body fracture along with primary repair of ATFL and CFL was done. The final outcome of the patient was good with return to unrestricted physical activities after 4 months. Conclusion: A new injury combination of navicular fracture along with lateral ankle ligament complex tear is reported in a professional athlete. A high index of clinical suspicion and early detection using CT and MRI scan can identify this rare injury combination. Surgical treatment can result in favorable outcomes. Keywords: Tarsal navicular bone, fracture, anterior talofibular ligament, calcaneofibular ligament, computed tomography scan, magnetic resonance imaging scan.

Evaluation of the Effects of Tecar Therapy on Acute Symptoms of Athletes Following Lateral Ankle Ligament Sprain

Background and Objectives: Tecar therapy as a modality has been considered due to its reported effects on reducing pain and swelling and finally increasing range of motion and improving function. The aim of this study was to evaluate the effects of tecar therapy on acute symptoms of athletes following lateral ankle ligament sprain in the treatment and control groups between pre-treatment periods, after 6 sessions, and after 12 sessions of treatment. Methods: In this study, 23 patients in each group including athletes with an acute lateral ankle ligament sprain in the acute stage in Tehran. The participant of this study were divided into 2 groups of control with normal treatment and the second group with normal treatment + tecar treatment. Participants were homogenized in terms of age, height, weight, and level of exercise. To evaluate the pain intensity of patients in the two groups and to measure the swelling of the ankle joint, a tape measure (mm) was used. A goniometer was used to measure the degree of ankle motions. The Foot and Ankle Ability Measure (FAAM) questionnaire was also used to collect data. Results: Statistical analyzes showed that the mean numerical visual criterion of pain in both groups was significantly lower after 6 and 12 sessions of treatment (P<0.001). The results of the analysis of variance showed that the mean swelling in the treatment group and in the control group after 6 and 12 sessions of treatment (P<0.001) was significantly lower than the mean swelling before treatment. Also, the mean swelling after 12 sessions of treatment was significantly lower than after 6 sessions of treatment (P<0.001). Regarding daily life activities and the percentage of athlete satisfaction in performing the activity, the test results showed that the athlete’s scores after 6 and 12 sessions of treatment (P<0.001) were significantly higher than before treatment. Also, their scores after 12 sessions of treatment were significantly higher than 6 sessions (P<0.001). The performance scores in both groups after 6 and 12 sessions of treatment (P<0.001) were significantly higher than performance scores before treatment. Also, the performance scores after 12 sessions of treatment were significantly higher than 6 sessions of treatment (P<0.001). Conclusion: The results of the present study showed that tecar therapy in patients with lateral ligament sprain of the ankle joint improves the condition of symptoms after an injury, including swelling, pain, daily life activities, percentage of athlete satisfaction with daily activities, and finally his performance and it can be used as a complementary treatment along with common therapies.

Application of X-ray image measurement in the early diagnosis of sports injury of ankle ligament

Objectives: To study the value of X-ray analysis method of ankle fracture based on injury mechanism to improve the imaging diagnosis level of ankle fracture. Methods: This study was conducted from January 2016 to December 2019. It included 105 cases of fractures caused by sprained ankle joints. Their age was between 21-81 years with an average of 49.5 years, The traditional X-ray analysis method (Group-A) and the injury mechanism-based ankle fracture X-ray analysis method (Group-B) were used to analyze X-ray image data. Group-B also performed Weber classification and Lauge-Hansen classification on cases. Installment. Results: Of the 105 patients with ankle fractures, 97 patients in Group-B were able to make Lauge-Hansen classification. Of these 97 ankle fractures, 137 were found in Group-A, and 158 were found in Group-B. The wrong diagnosis of fracture in Group-A was 18%, and the wrong diagnosis of fracture in Group-B was 0.5%. There was a statistically significant difference between the two groups (P <0.05). Conclusion: The X-ray analysis method of ankle fractures based on injury mechanism can effectively improve the detection rate of hidden ankle fractures and high fibular fractures, and reduce the missed diagnosis, which is superior to the traditional X-ray analysis methods. At the same time, Weber classification, Lauge-Hansen classification and staging can be made for most cases, which is conducive to guiding clinical treatment. doi: https://doi.org/10.12669/pjms.37.6-WIT.4841 How to cite this:Meng S, Tong W, Han S. Application of X-ray image measurement in the early diagnosis of sports injury of ankle ligament. Pak J Med Sci. 2021;37(6):1580-1584. doi: https://doi.org/10.12669/pjms.37.6-WIT.4841 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Volleyball: 2014–2015 Through 2018–2019

Context Women's volleyball is a globally popular sport with widespread participation at the National Collegiate Athletic Association (NCAA) level. Background Routine examinations of NCAA women's volleyball injuries are important for recognizing emerging injury-related patterns in this population. Methods Exposure and injury data collected in the NCAA Injury Surveillance Program during the 2014–2015 through 2018–2019 athletic years were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differences in injury rates. Results The overall injury rate was 6.73 per 1000 athlete-exposures. Knee (14.6%) and ankle (13.8%) injuries accounted for the largest proportion of all reported injuries, and most injuries were attributed to overuse (26.1%) or noncontact (22.7%) mechanisms. Lateral ankle ligament complex tears (11.1%) and concussions (7.3%) were the most commonly reported specific injury. Summary Results indicate an increasing burden of practice-related injuries and the need to further examine overuse injuries. Lower-extremity injury prevention strategies and mechanisms of concussion also warrant further attention.