A systematic review on ankle injury and ankle sprain in sports

Orthopaedic sport biomechanics - a new paradigm

This article proposes a new paradigm, "Orthopaedic sport biomechanics", for the understanding of the role of biomechanics in preventing and managing sports injury. Biomechanics has three main roles in this paradigm: (1) injury prevention, (2) immediate evaluation of treatment, and (3) long-term outcome evaluation. Related previous studies showing the approach in preventing and managing anterior cruciate ligament rupture and anterior talofibular ligament tear are highlighted. Orthopaedics and biomechanics specialists are encouraged to understand what they could contribute to the current and future practice of sports medicine.

Ankle: isotropic MR imaging with 3D-FSE-cube--initial experience in healthy volunteers

The purpose of this prospective study was to compare a new isotropic three-dimensional (3D) fast spin-echo (FSE) pulse sequence with parallel imaging and extended echo train acquisition (3D-FSE-Cube) with a conventional two-dimensional (2D) FSE sequence for magnetic resonance (MR) imaging of the ankle. After institutional review board approval and informed consent were obtained and in accordance with HIPAA privacy guidelines, MR imaging was performed in the ankles of 10 healthy volunteers (four men, six women; age range, 25-41 years). Imaging with the 3D-FSE-Cube sequence was performed at 3.0 T by using both one-dimensional- and 2D-accelerated autocalibrated parallel imaging to decrease imaging time. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) with 3D-FSE-Cube were compared with those of the standard 2D FSE sequence. Cartilage, muscle, and fluid SNRs were significantly higher with the 3D-FSE-Cube sequence (P < .01 for all). Fluid-cartilage CNR was similar for both techniques. The two sequences were also compared for overall image quality, blurring, and artifacts. No significant difference for overall image quality and artifacts was demonstrated between the 2D FSE and 3D-FSE-Cube sequences, although the section thickness in 3D-FSE-Cube imaging was much thinner (0.6 mm). However, blurring was significantly greater on the 3D-FSE-Cube images (P < .04). The 3D-FSE-Cube sequence with isotropic resolution is a promising new MR imaging sequence for viewing complex joint anatomy.

The epidemiology of ankle injuries in professional rugby union players

BACKGROUND

Ankle injuries represent a considerable proportion of injuries to professional rugby union players; however, there is a scarcity of detailed epidemiology about these injuries.

PURPOSE

To describe the epidemiology and assess the risk factors associated with ankle injuries sustained by a cohort of professional rugby union players.

STUDY DESIGN

Descriptive epidemiology study.

METHOD

Medical personnel prospectively reported time-loss injuries in professional rugby union in England, and the ankle injuries were evaluated.

RESULTS

Lateral ankle ligament injuries were the most common injury reported during matches and training, and together with Achilles tendon injuries, they accounted for more than half of the absence due to injury. The incidence rate of injuries was highest in second-row forwards. More than a quarter of injuries were recurrences.

CONCLUSION

Lateral ankle ligament injuries and Achilles tendon injuries should be a focus of injury prevention, treatment, and rehabilitation strategies in professional rugby union players.

Sport-related ankle injuries attending an accident and emergency department

INTRODUCTION

This study investigated the sport-related ankle injuries attending an accident and emergency (A&E) department during a 1-year period.

METHODS

A total of 1715 sports injuries cases attending an A&E department from 1 January 2005 to 31 December 2005 were prospectively recorded. Details of each classified case were recorded in a computerised record system by the triage nurse. At the end of the study period, all sport-related ankle injury cases were analysed.

RESULTS

A total of 240 sport-related ankle injury cases were reported. Most cases were sustained from basketball (32.9%), soccer (31.7%) and hiking (5.8%) sports. The majority of the cases was ligamentous sprains (81.3%) and fractures (10.4%). The mean age of all patients was 24.6 years (S.D. = 12.3). Four fifths (80.4%) were male patients. All cases were not life threatening. Most cases (99.2%) were referred to orthopedics specialty. Radiography was routinely employed in 99.2% of the cases. Ligamentous sprains were mostly sustained in basketball (37.4%) and soccer (28.7%), and were often treated with bandaging (60.0%) and analgesics (48.7%). Most cases were discharged with or without referral to physiotherapy and specialty clinic (95.4%). Fractures were mostly sustained in soccer (52.0%), basketball (20.0%) and hiking (16.0%), and were very often admitted to hospital wards (84.0%). The estimated A&E attendance rate for all sports injuries, ankle injuries, ligamentous sprains and fractures were 1.68, 0.24, 0.19 and 0.02/1000 person-year.

CONCLUSIONS

The results of this study together with the previous study on ankle sprain epidemiology suggested the following sports ankle injury pattern in Hong Kong-major and serious ankle ligamentous sprains and fractures were sustained from basketball, soccer and hiking, leading to A&E attendance, while minor sprains were sustained in running and jogging and racquet sports. We suggested that the Sports medicine specialists in Hong Kong should emphasise the ankle injury prevention strategies in these sports.

Interventions for the prevention of first time and recurrent ankle sprains

The uses of external support and balance/coordination training have demonstrated to be effective interventions for the prevention of ankle sprains, especially in those who have a history of ankle sprain. The purpose of this article is to identify areas where evidence has been established to support the use of these interventions for the prevention and enhancement of outcomes of lateral ankle sprain. In addition, areas of deficiency in the evidence are discussed related to these interventions. Finally, future directions for clinicians and researchers as per the use of these interventions are discussed.

Individuals with mechanical ankle instability exhibit different motion patterns than those with functional ankle instability and ankle sprain copers

BACKGROUND

Chronic ankle instability commonly develops after lateral ankle sprain, but differences in movement patterns between subtypes of ankle instability have not been determined. We hypothesized mechanically and functionally unstable ankle subjects would demonstrate different kinematics and kinetics compared to a group of ankle sprain injury "copers".

METHODS

Sixty-three recreational athletes, 21 in each of 3 groups (11 males, 10 females) matched for gender, age, height, mass, and limb dominance were tested. Knee and ankle sagittal and frontal plane motion, peak ground reaction forces, and time to peak ground reaction forces were measured during 5 tasks (walk, step down, run, drop jump, and stop jump).

FINDINGS

Using 5 one-way Analyses of Variance with Tukey post hoc testing at alpha=0.05, the mechanically unstable group displayed at least one difference in sagittal and/or frontal plane ankle motion at initial contact, maximum, and/or in displacement than the functionally unstable and coper groups in each task except the run (P<0.05). The greatest number of differences occurred in the drop jump and stop jump tasks. The mechanically unstable group exhibited greater frontal plane displacement and maximum eversion, and decreased sagittal plane displacement and maximum plantar flexion in several tasks.

INTERPRETATION

The mechanically unstable group demonstrated altered ankle motion patterns when compared to functionally unstable and coper groups. The landing pattern may help avoid ankle sprains, but may also increase risk of ankle joint degeneration. Unstable ankle groups exhibit different movement patterns and may require different treatment regimens.