The Ratio of Stress to Nonstress Anterior Talofibular Ligament Length on Ultrasonography: Normative Values

Background: Stress ultrasonography (US) has been shown to be a valid procedure for evaluating chronic anterior talofibular ligament (ATFL) injury. The ratio of stress/nonstress ATFL length (ATFL ratio) as measured on US is clinically useful; however, there are no published normative data concerning this ratio. Purpose: To report a normative value of the ATFL ratio on US and evaluate the relationships between sex, generalized joint laxity (GJL), and the grade of anterior drawer test (ADT). Study Design: Cross-sectional study; Level of evidence, 3. Methods: The ATFL lengths were prospectively measured in the stress and nonstress positions (manual maximal anterior drawer position) for participants with noninjured ankles from March 2020 to March 2021. GJL was defined as a Beighton score ≥4. A manual ADT was also performed. The ATFL ratio was calculated, and the relationships between sex, GJL, and ADT grade were evaluated. Results: A total of 333 ankles in 184 participants (mean age, 24.5 ± 2.7 years; range, 20-33 years) were eligible for the analysis. GJL was found in 69 ankles (20.7%). The mean ATFL ratio was 1.08 ± 0.04 (95% CI, 1.08-1.09; range, 1.01-1.24), and there was a significant difference between male (1.07 ± 0.04; 95% CI, 1.07-1.08; range, 1.02-1.23) and female (1.09 ± 0.04; 95% CI, 1.08-1.10; range, 1.01-1.24) ankles ( P = .001). In male ankles, the ATFL ratio was significantly greater in participants with GJL (1.11 ± 0.06 vs 1.07 ± 0.03; P = .02) or a higher grade of ADT (grade 2 vs grade 1: 1.11 ± 0.06 vs 1.07 ± 0.03, P = .002). These findings were not observed in female ankles. Conclusion: The normative value of the ATFL ratio on stress US was 1.07 ± 0.04 in men and 1.09 ± 0.04 in women. The ATFL ratio was affected by the presence of GJL in men but not in women. These findings will be useful for future studies seeking to establish the cutoff value of the ATFL ratio for diagnosing chronic lateral ankle stability on stress US.

Current Approaches to Improve Balance in Down Syndrome Population-A Systematic Review

Down syndrome is one of the most common chromosomal disorders in pediatrics characterized by variable intellectual disability, generalized joint laxity, and hypotonia that compromises their function and causes a delay in developing gross motor skills, poor balance, and coordination. Thus, this study aims to determine the current yet effective treatment approaches to improve balance in the Down syndrome population. The studies were explored across seven electronic databases that include MEDLINE, PubMed, Cochrane Library, Google Scholar, Scopus, PEDro, and Web of Science from inception till October 2020 comprised of experimental studies published in English language investigating the effects on balance in children and adults diagnosed with DS considering different interventions. A total of 1,570 records were retrieved from seven electronic databases published between the year's tenure of 2013-2020. 144 full-text papers were extracted to be reviewed, of which only 18 experimental studies were selected on the basis of inclusion criteria that involved 493 Down syndrome patients, investigated the effects of therapeutic exercises, manual therapy techniques, and patient-related instructions on standardized balance scales/tests. It was concluded that all the included trials demonstrated significantly profound effects in improving the static and dynamic balance of Down syndrome patients. Therefore, none of the interventions is declared as superior to another in terms of obtained results. Furthermore, these diverse interventions need to be investigated more for better understating and generalizability of outcomes.

The Results of Orthopaedic Medical Examinations in Adolescent Amateur Weightlifters

Background: Several studies have reported injuries and physical characteristics in adult elite weightlifters. However, few studies have evaluated such issues in adolescent amateur weightlifters. The purpose of this study was (1) to show the results of orthopaedic medical examinations in adolescent amateur weightlifters and (2) to evaluate the sexual differences in the obtained findings. Methods: The orthopaedic medical examinations had been performed cross-sectionally from 2012 to 2019, and the findings in young weightlifters were retrospectively evaluated. The orthopaedic medical examination included six assessments (physical examinations, generalized joint laxity, muscle and joint tightness, static alignment, muscle volume of the lower extremities, and medial longitudinal arch of the foot). A questionnaire survey regarding pain in the spine and lower extremities was also performed. Results: A total of 99 adolescent weightlifters were included (71 males and 28 females; mean age, 16.2 ± 0.2 years). A total of 9.1% of adolescent amateur weightlifters had received orthopaedic treatments, with spine injuries the most prevalent. Of the adolescent weightlifters who had not received orthopaedic treatments, 31.1% had pain in the spine or lower extremities (for > 4 weeks), accompanied with positive findings on physical examinations. There were no significant sexual differences in the incidence of pain or positive findings of physical examinations. Female weightlifters had a more reduced dorsiflexion of the ankle joint than male weightlifters (9.4 ± 1.9° vs. 14.7 ± 1.1°, p = 0.02). Male weightlifters had a significantly lower flexibility of the quadriceps than female weightlifters.Conclusions: More than one-third of adolescent competitive weightlifters had pain or positive findings of physical examinations in the spine or lower extremities. The results of orthopaedic medical examinations in this study may help clinicians and young weightlifters to prevent injuries in competitive weightlifting.

Increased rate of joint hypermobility in autism and related neurodevelopmental conditions is linked to dysautonomia and pain

Objective: Autism, attention deficit hyperactivity disorder (ADHD), and tic disorder (Tourette syndrome; TS) are neurodevelopmental conditions that frequently co-occur and impact psychological, social and emotional functioning. Vulnerability to chronic physical symptoms, including fatigue and pain, are also recognised. The expression of joint hypermobility, reflecting a constitutional variant in connective tissue, predicts vulnerability to psychological symptoms alongside recognised physical symptoms. Here, we tested for increased rates of joint hypermobility, autonomic dysfunction and pain in 109 adults with neurodevelopmental diagnoses. Method: Rates of generalized joint laxity in those individuals with neurodevelopmental conditions were compared to those in the general population in UK. Levels of orthostatic intolerance and musculoskeletal symptoms were compared to a neurotypical control group. Results: Adults with neurodevelopmental diagnoses manifest elevated rates of joint hypermobility (50%) compared to the general population rate of 20% and a matched control population of 10%. Odds ratio for hypermobility in individuals with neurodevelopmental diagnoses, compared to the general population was 4.51 (95%CI 2.17-9.37), with greater odds in females rather than males. Neurodevelopmental patients reported significantly more symptoms of orthostatic intolerance and musculoskeletal skeletal pain than controls Conclusions: In adults with neurodevelopmental conditions, there is a strong link between the expression of joint hypermobility, autonomic dysfunction and pain, more so than in healthy controls. Increased awareness and understanding of this association may enhance the management of core symptoms and allied difficulties including comorbid stress-sensitive physical symptoms.

Risk Factors Influencing the Incidence of Ankle Sprain Among Elite Football and Basketball Players: A Prospective Study

Introduction. The objective of the present study was to investigate whether certain intrinsic factors (foot hyperpronation, generalized joint laxity) and clinical tests (anterior drawer and talar tilt tests, single-leg balance test and star excursion balance test, ankle and first metatarsophalangeal range of motion) could predict the incidence of lateral ankle sprains among elite football and basketball players during a full year. Method. In a prospective cohort study, 106 elite basketball and football players were recruited. During the preseason period, players underwent baseline measurements. Team physicians in following year reported occurrence of new ankle sprains. Results. Ankle sprain was more frequent among basketball players ( P = .01). The history of recurrent ( P = .001) and acute ankle sprain ( P = .01) and each 5-year increase in age ( P = .039) were predictive factors for ankle sprain. No evidence for relationship between other risk factors and occurrence of ankle sprain were achieved. Conclusion. In our study, the history of recurrent and acute ankle sprain was the strongest predictor for ankle injuries. Considering the limitations of this study, it seems mandatory to conduct more prospective studies with a larger sample size and longer follow-up period. Levels of Evidence: Level II: Prognostic