The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies

The effects and optimal dosage of traditional Chinese exercises on patients with chronic ankle instability: A systematic review and meta-analysis

BACKGROUND

The effectiveness of Traditional Chinese exercises in promoting functional recovery in patients with chronic ankle instability, as well as the potential impact of variables such as intervention type, duration, frequency, and cycle on treatment outcomes, still requires further investigation.

METHODS

Literature searches were conducted in multiple databases including China National Knowledge Infrastructure (CNKI), VIP, Wanfang, China Biomedical Literature Database (CBM), PubMed, EBSCO(Medline、CINAHL、SPORTDiscus), Embase, Cochrane Library, ProQuest, and Web of Science for randomized controlled trials assessing the effects of Traditional Chinese Exercises interventions on patients with Chronic Ankle Instability. The publication timeframe spanned from the inception of each database until January 20, 2025. Meta-analysis was performed using STATA 15 software on the included studies.

RESULTS

Twelve randomized controlled trials (RCTs) involving 323 patients were included in this analysis. Compared with the control group, Traditional Chinese exercises showed the following improvements: CAIT: WMD = 4.02, 95 % CI [3.22, 4.81], z = 9.90, P < 0.001.Balance: ANT: SMD = 0.38, 95 % CI [0.18, 0.59], z = 3.71, P = 0.003.PM: SMD = 0.49, 95 % CI [0.26, 0.70], z = 4.73, P < 0.001.PL: SMD = 0.67, 95 % CI [0.46, 0.88], z = 6.35, P < 0.001.C: SMD = 0.80, 95 % CI [0.35, 1.25], z = 3.51, P < 0.001.JPS:Plantarflexion: SMD = -0.58, 95 % CI [-0.94, -0.21], z = 3.09, P = 0.002.Inversion: SMD = -0.46, 95 % CI [-0.86, -0.06], z = 2.23, P = 0.025.Muscle Strength: Plantarflexion: SMD = 0.81, 95 % CI [0.43, 1.18], z = 4.25, P < 0.001.Inversion: SMD = 0.66, 95 % CI [0.25, 1.07], z = 3.16, P = 0.002.Eversion: SMD = 1.04, 95 % CI [0.62, 1.46], z = 4.82, P < 0.001.Subgroup Analysis: Tai Chi training conducted twice weekly for a 12-week intervention period, with 60-minute sessions, demonstrated the most effective improvements.

LEVEL OF EVIDENCE

The evidence level for the effects of Traditional Chinese exercises on Balance-ANT, Balance-PM, and Balance-PL balance directions in CAI patients is rated as "moderate."

CONCLUSION

Traditional Chinese exercise has been shown to significantly improve balance, muscle strength, and joint position sense in CAI patients. Based on the current findings, Tai Chi training appears to provide greater benefits for CAI patients. It is recommended that CAI patients participate in Tai Chi training twice a week, with each session lasting 60 minutes, over a 12-week period.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO database, CRD42024613359.

Effects of external ankle braces on kinematics and kinetics of the lower limb during the cutting maneuver in healthy females

BACKGROUND

To explore if lace-up ankle brace and hinged ankle brace affect the kinematics and kinetics of the lower limbs during a cutting maneuver.

METHODS

Twenty healthy females performed a 45° cutting maneuver with different ankle braces. Ground reaction force, lower-limb joint angles and moments were compared among different ankle braces.

RESULTS

Wearing hinged ankle brace significantly increased maximal knee valgus angle than lace-up and no brace conditions (0.7° [p = 0.011] and 0.6° [p = 0.029], respectively). Wearing hinged and lace-up ankle braces significantly increased maximal knee internal rotation angle (1.58° [p ≤ 0.001] and 1.30° [p = 0.020], respectively) and decreased maximal ankle inversion angle (3.04° [p ≤ 0.001] and 1.76° [p = 0.013], respectively). A considerable difference in kinetics was observed only in the maximal ankle eversion moment, which was higher in the hinged condition than the lace-up (p = 0.010) or no brace (p = 0.023) condition.

CONCLUSION

Wearing an hinged or lace-up ankle brace may reduce the risk of ankle sprain in females during cutting maneuvers. Ankle brace appears to have upstream effects on the knee, which may have injury implication.

Physiotherapists Approach in Lateral Ankle Sprain Rehabilitation: A Survey Study

BACKGROUND

To investigate how physiotherapists approach lateral ankle sprain (LAS) rehabilitation and their rationale for exercise progression. We also sought to determine typical exercise dosage prescribed and the extent to which they rely on objective outcomes for guiding rehabilitation progression and return-to-sports decisions.

METHODS

We distributed an online survey using Qualtrics. The survey comprised a combination of 23 open and 8 closed questions to capture data on: participant demographics and clinical experience, typical caseload, LAS rehabilitation dosage, with clinical vignettes used to determine the time taken to reach key rehabilitation milestones, use of objective markers to inform rehabilitation progress, and progression to each milestone. Data were analyzed descriptively; open questions were inventoried and categorized. Proportions were then calculated per category.

RESULTS

Ninety-six physiotherapists from Belgium, the Netherlands, and the United Kingdom responded to the survey, of which 23 completed all sections. On average, less than half (46%) of the responding therapists use objective measurements to guide rehabilitation progress. The estimated time to reach key clinical milestones is equivocal among participating physiotherapists. Most physiotherapists use pain and ankle impairments (eg, range of motion and muscle strength) to guide rehabilitation progress.

CONCLUSION

This study indicates that progress in LAS rehabilitation is determined subjectively and that not the entire spectrum of impairments is assessed. Physiotherapists should implement more objective measures throughout LAS rehabilitation.

Epidemiology of ankle sprain and chronic ankle instability in elite adolescent dancesport athletes

BACKGROUND

Dancesport is performed in high-heeled shoes. Dancesport athletes may have a higher prevalence and incidence of ankle sprains, which can affect their performance. However, the occurrence of ankle sprains among dancesport athletes remains unclear. This study aimed to determine the prevalence and incidence of ankle sprains among elite dancesport athletes and to investigate the related information.

METHOD

We conducted a mixed descriptive epidemiological study (cross-sectional and longitudinal) involving 198 elite adolescent dancesport athletes, using past medical records and questionnaires administered to the participants. Data on the occurrence of ankle sprains among all participants were compiled using medical records and information on injury mechanisms, missed days, severity types, and countermeasures for ankle sprains were collected. The prevalence of chronic ankle instability (CAI) among the participants was assessed using a questionnaire. Following the initial survey, we conducted a one-year follow-up study to investigate the incidence of ankle sprains, incidence rate per 1000 exposure hours, and recurrence of ankle sprains.

RESULT

The cross-sectional study and longitudinal study included 198 participants and 92 elite dancesport athletes, respectively. The prevalence of ankle sprains and CAI was 49.5% and 45.1%, respectively. Of all ankle sprains, 88% were medial injuries. The most common injury mechanisms were turning (46.9%) and jumping (46.9%). The average number of missed days due to ankle sprains was 11.2 days. Most injuries were managed with rest, and only one male athlete underwent surgery due to an ankle sprain sustained during dancing. During the one-year follow-up, the incidence of ankle sprains, incidence rate per 1000 exposure hours, and recurrence rate of ankle sprains were 46.6% (male, 41.2%; female, 48.8%), 0.65 ankle sprains/1000 h, and 35.3%, respectively. No sex-related differences were observed.

CONCLUSION

It is crucial to focus on the occurrence of ankle sprains and CAI in dancesport athletes with high heels. Future research should clarify the impact of ankle sprains on dancesport performance and develop preventive measures to reduce the incidence and recurrence of these associated injuries.

Satisfactory patient reported outcomes at five years following primary repair with suture tape augmentation for anterior talofibular ligament injury

The Brostrom technique is widely accepted as the gold standard surgical intervention for the treatment of chronic lateral ankle instability. Concerns with persistent postoperative instability, incomplete restoration of preinjury biomechanical strength, and variable return-to-sport rates have, however, led to growing interest in novel augmentation procedures. Suture tape augmentation, which reinforces the anterior talofibular ligament and acts as a secondary stabilizer, is one such method. This study assesses 5-year patient-reported outcomes of primary repair with suture tape augmentation for anterior talofibular ligament injuries. Seventy-seven patients undergoing anterior talofibular ligament repair with suture tape augmentation were prospectively followed for at least 5-years. The visual analogue scale for pain (VAS), veteran rands 12 (VR-12) score, functional foot index (FFI), and the foot and ankle ability measure sports subscale (FAAM-S) were assessed at baseline, 2-year follow-up and 5-year follow-up. Of the seventy-seven patients initially included, sixty-eight (88.3%) completed follow-up. The median VAS, VR-12, FFI, and FAAM-S scores all demonstrated significant improvement at both 2-year and 5-year follow-up, compared to preoperative baseline. Only the FFI demonstrated improvement between the 2-year and 5-year follow-up timepoints. In conclusion, primary repair with suture tape augmentation for anterior talofibular ligament injury demonstrates satisfactory patient-reported outcomes at a minimum of 5-year follow-up. These results suggest that this technique should be considered as an alternative to conventional Brostrom repair for treatment of lateral ankle instability.

Gender/sex differences: Representation of women in lateral ankle sprain research

BACKGROUND

Women have historically comprised lower percentages of sports science research participants compared to men. Lateral ankle sprains (LAS) are a common musculoskeletal injury that may affect women more than men.

OBJECTIVE

The primary purpose was to assess the representation of women participants in LAS research. The secondary purpose was to analyze the representation of women as authors in this same work.

DESIGN

Observational study.

SETTING

Systematic reviews on LAS in adults published between May 2013 and April 2023.

PARTICIPANTS

Eleven systematic reviews on LAS with 77 unique original research studies (10, 080 participants, 335 authors) met inclusion criteria.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The main outcomes were the proportion of women as participants and in author roles (primary, senior, and overall).

RESULTS

Women were underrepresented as participants (41%, n = 4150). Women were also the minority gender/sex for authors overall (26%, n = 86) as well as primary (32%, n = 23) and senior (29%, n = 19) authors. No clear increase in the inclusion of women as research participants was observed over time (p = .4), nor was there a significant increase in women authors (p = .1). A greater proportion of participants were women when the primary author was a woman (p = .008).

CONCLUSION

Women are underrepresented in LAS research overall, and there is a lack of clear progress in representation over time. Similarly, women are a minority of study authors and data suggest a possible temporal trend of improvement. Efforts should be made to increase the proportion of women included in LAS research in order to support equitable evidence-based care.

Clinical Outcomes of Avulsion Fractures of the Cuboid and Navicular After Supination Trauma

Supination trauma-related avulsion fractures of the foot are seen frequently, with cuboid and navicular fractures being among the most frequent types encountered. Nevertheless, the prognosis of these fractures remains largely unknown. This study was conducted to evaluate the clinical outcomes of the 2 most prevalent avulsion fractures-cuboid and navicular. A retrospective cohort consisting of patients who sustained a cuboid or navicular avulsion fracture after supination trauma between 2017 and 2020 was compiled and baseline characteristics along with retrospective data were collected. To gain data on clinical outcome 2 questionnaires, the Numerical Rating Scale (NRS) for pain and the Foot and Ankle Ability Measure (FAAM), were completed by participants 2 to 5 years after the fracture. Thirty-seven participants consented to participate, 25 experienced a cuboid fracture and 12 a navicular fracture. Cuboid fracture patients had a median week-average NRS score of 0 (range 0-7) and a median FAAM score of 105 (range 62-116), on average 40.8 months (SD 7.74) after treatment. Five out of 25 (21%) patients experienced persisting foot pain (NRS of ≥2). Navicular fracture patients had a median week-average NRS score of 1.5 (range 0-5) and a median FAAM score of 104 (range 55-116), a median 37.25 (range 27-47) months after treatment. Five out of 12 (42%) patients had a persisting NRS score of ≥2. Avulsion fractures of the cuboid and navicular bones generally have a favorable clinical outcome. However, a substantial portion of patients with both fracture types experienced persistent foot pain ≥24 months after the fracture.Levels of Evidence: Level II: Retrospective cohort study with prospective follow-up design.

Participant demographics and research questions from 10-years of chronic ankle instability studies: A scoping review

OBJECTIVES

To determine 'who' and 'what' were studied over the previous 10-years as it relates to individuals with chronic ankle instability.

DESIGN

Scoping review.

METHODS

Web of Science™ was used to identify all studies that referenced the International Ankle Consortium selection criteria guidelines. Original research reports which cited adherence to the guidelines were included. Data related to demographic information and outcome measures were synthesized to form a descriptive analysis.

RESULTS

A total of 377 studies were included which equated to 11,604 participants with chronic ankle instability. The combined average age of participants was 23.9 years. For measures related to ankle sprain history, participants averaged 4.3 ± 3.7 sprains and 6.2 ± 5.9 years since their first ankle sprain. Across the studies, the number of ankle sprains was reported in 42.7 % of studies and time since first ankle sprain was reported in 10.9 % of studies. Nearly 80 % of studies reported information from at least one validated questionnaire related to ankle instability or ankle function. The primary aim of most studies (44 %) was to determine differences in motor-behavioral impairments between individuals with and without chronic ankle instability.

CONCLUSIONS

Although many studies indicated that they adhered to the International Ankle Consortium selection criteria for chronic ankle instability, variables related to demographic information were inconsistently reported, which may inhibit the external validity of studies related to chronic ankle instability. In addition, much of the research related to chronic ankle instability pertained to young-adults and aimed to identify various motor-behavioral impairments.

Effectiveness of FIFA injury prevention programs in reducing ankle injuries among football players: a systematic review

Background

Ankle injuries are some of the most common injuries among footballers and can prevent players from participating in sport. The Fédération Internationale de Football Association (FIFA) developed FIFA injury prevention programs to reduce overall football injuries, but their effectiveness on a particular joint, such as the ankle, was not assessed. Therefore, this project aims to investigate if these FIFA injury prevention programs are particularly effective in reducing ankle injuries.

Method

A systematic review was conducted with the following criteria for study selection: Randomized controlled trials (RTCs) comparing the FIFA programs (FIFA 11 the old version and FIFA 11+) with the usual training for the teams. Other studies that included the number or percentage of ankle injuries as an outcome. Sample: Male and female footballers aged between 13 and 40 years old and without any restriction on particular skill levels. The Physiotherapy Evidence Database scale (PEDro) was used to assess the methodological quality of the included studies.

Results

The search strategy identified five RCTs that used the FIFA programs. The included studies had a good-to-excellent methodological quality according to the PEDro scale (ranging from 5 to 7 out of 10). The pooled data from all the included studies indicated that the FIFA 11 and FIFA 11+ programs were effective in reducing the ankle injury rate by 14%, while pooled results from the studies that used the FIFA 11+ program significantly reduced ankle injury rate by 32%. However, the FIFA 11 program was not effective in reducing the ankle injury rate.

Conclusion

The FIFA programs, and especially the FIFA 11+ program, appear to be more effective than the usual training in preventing ankle injuries among footballers.

[Online resources for ankle sprains : A German language web analysis]

BACKGROUND

With the Internet as the main source of information for health content, the quality of websites with medical information is of high importance.

OBJECTIVE

This study analysed 250 websites on acute ankle sprain (ASD), one of the most common musculoskeletal disorders, for their quality and readability. Based on the results, a guide for patients was created.

METHOD

The quality of the websites was assessed using a 25-item content score and the EQIP36 score for medical information material. The reading level could be determined using the Flesch-Kincaid index and the calculated readability. The best three websites were evaluated in a user survey.

RESULTS

Of the 250 websites recorded 77 were included in the study. The quality of these varied significantly, with none achieving the maximum score. Sources in the healthcare system showed higher quality, while commercially influenced sites were below average in terms of completeness of content. Only 14% of the websites reached the recommended reading level. A significant negative correlation was found between completeness of content and readability. The user survey showed a mixed level of satisfaction and participants with previous medical knowledge were more critical than laypersons.

CONCLUSION

Online resources about ASD are suboptimal and differ considerably. Deficiencies in content, readability and structure were identified, which limit the effective use by patients. Health information publishers should work harder to improve the comprehensibility and quality of the information provided.

Does chronic ankle instability affect side-cutting in female soccer players?

Lateral ankle sprains have a high recurrence rate, often developing into chronic ankle instability (CAI). CAI affects movement strategy during side-cutting maneuvers, with inconsistent results in many studies. This study aimed to clarify the characteristics of movement strategies during side-cutting maneuvers in female soccer players with and without CAI. Thirteen female soccer players with CAI and twelve healthy controls performed 10 successful trials of side-cutting maneuvers in three directions (anterolateral, lateral, and posterolateral) under unanticipated conditions. Compared to the control group, the CAI group displayed an increased stance time in the lateral and posterolateral side-cutting maneuvers (lateral: p=0.021, effect size=0.97, posterolateral: p=0.014, effect size=1.00). In posterolateral side-cutting maneuvers, the CAI group displayed a decreased posterior ground reaction force at 19-30% and 42-54% of the entire stance phase compared with the control group (p=0.001, effect size=1.30-1.42). Female soccer players with CAI may display increased stance time to compensate for self-reported ankle instability and may also exhibit decreased braking and propulsive force when side-cutting to sharper angles. These observations suggest a hypothesis that could help in the assessment of cutting maneuvers under unanticipated conditions after ankle sprains.

Clinical Outcomes After Arthroscopic Broström-Gould Procedure for Chronic Lateral Ankle Instability

Background Chronic lateral ankle sprains are common injuries that are largely sequelae of inversion injuries of the ankle. These injuries are amenable to surgical intervention, namely, Broström-Gould reconstruction, which is commonly performed for the above injury. Many open and arthroscopic variations of the technique have been described. Arthroscopic Broström-Gould has been shown to have comparable outcomes to the open technique. Analysis of 39 patients who underwent arthroscopic Broström-Gould at a tertiary institution showed excellent outcomes from all three functional scores. Methods Thirty-nine patients underwent arthroscopic Broström-Gould in 2021 at a tertiary institution and were followed up for up to one year postoperatively. All patients had failed conservative treatment and reported pain and chronic instability prior to surgical intervention. Outcomes were measured with functional scores, namely, the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), and Karlsson and Peterson Scoring System (K-P). Other demographics such as age, gender, laterality, and body mass index were also recorded. Statistical analysis was performed with GraphPad Prism (GraphPad Software, San Diego, CA). Outcomes were analysed by paired t-test and statistical significance was set at p < 0.05. Results A total of 39 patients with chronic lateral ankle instability (CLAI) who underwent arthroscopic Broström-Gould were followed up for up to one year postoperatively. Demographics were as follows: 22 males and 17 females, 20 right ankles and 19 left ankles, average age of 36.2 years (19.6-64.8 years), and BMI of 27.4 (19.2-40). At follow-up, functional scores were measured as described in the methods section above. Preoperative VAS scores were 5.87 ± 1.92 (1-10) while postoperative VAS scores were 2.0 ± 2.16 (0-7). Preoperative K-P scores were 43.68 ± 13.2 (7-70) while postoperative K-P scores were 69.21 ± 17.86 (37-100). Preoperative AOFAS scores were 62.53 ± 16.05 (29-83) while postoperative AOFAS scores were 83.8 ± 11.49 (59-100). Conclusions Significant improvement of all three functional scores (VAS, K-P, and AOFAS scores) following arthroscopic Broström-Gould was noted. This shows that the arthroscopic Broström-Gould is an effective method to treat CLAI with good outcomes.

Global prevalence and pattern of injuries in basketball players: a systematic review

INTRODUCTION

Basketball, as a widely popular sport, can be associated with a high risk of injury. This study aimed to provide a comprehensive overview of basketball-related injuries in various groups through the utilization of a systematic review methodology.

EVIDENCE ACQUISITION

An extensive search was conducted in the four valid databases using three groups of keywords up to November 2023 based on the PRISMA guidance. Two reviewers independently performed the steps of the study, including study selection, data extraction, and quality assessment. In case of any disagreements, the opinion of a third researcher was sought to achieve agreement in each step. The agreement between the reviewers was examined by computing Cohen's kappa coefficient. The quality assessment of the articles in this study was conducted using the Joanna Briggs Institute (JBI) critical appraisal tools.

EVIDENCE SYNTHESIS

The prevalence range of injuries in these people was between 0.38% and 92.0%. Ankle injuries in 12 out of 28 studies (42.86%), knee injuries in 7 out of 28 studies (25.00%), head and tooth injuries in 3 out of 28 studies (10.71%), and shoulder and hand injuries in three out of 28 studies (10.71%) had the highest prevalence among various injuries. Five out of six studies (83.33%) showed a higher percentage of the injuries in males. Only a study compared the prevalence of injuries between people with various ages.

CONCLUSIONS

These findings emphasize the need for injury prevention and management strategies, particularly targeting vulnerable areas like the ankle and knee.

Epidemiological study of injuries in artistic swimming: a systematic review

Introduction

Artistic swimming is a highly technical sport that requires a large volume of training and forced positions that generate a high risk of injury.

Objective

to compile scientific evidence on the incidence of injuries in artistic swimming. Literature study: PubMed, Web of Science, and SPORTDiscus databases were used to search for studies that analysed the epidemiology of injuries in artistic swimmers of any age and gender until June 2024. Methodology: the methodological quality of the studies was analysed with the Strengthening the Reporting Scale of Observational Studies in Epidemiology (STROBE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) were followed. Synthesis: eleven studies met the inclusion criteria showing a clear trend of joint-ligament or muscle-tendon injuries in the shoulders, back, and knees.

Conclusions

despite the publication of an injury surveillance document and a consensus on data collection and injury surveillance, there are methodological limitations that do not allow firm conclusions to be drawn. More epidemiological studies that follow data collection and injury surveillance guidelines are needed to establish differences by gender, age groups, and test.

Injury differences between youth male and female American football players

OBJECTIVES

American football continues to be a popular and rapidly growing sport among both males and females, with relatively little research concerning injuries for the latter - especially in the youth population. The current study aims to evaluate the differences in the epidemiology of injured body parts and injury diagnoses between youth male and female American football players.

METHODS

Injury data for male and female American football players were collected over a 10- year period from the National Electronic Injury Surveillance System (NEISS) and retrospectively reviewed. Patients between ages 4 and 18 years with a medical injury/condition related to American football were included. Descriptive analyses were performed for all data including injured body parts, injury diagnoses and setting, demographics, and medical disposition. Odds ratio (OR), 95% CI, and p-values (p < 0.05) were used for the statistical significance between the two groups.

RESULTS

A total of 82,174 American football injuries were found in the NEISS dataset, 95.0% of which were male with a mean age of 13.0 ± 2.9 years. The most injured body parts were the head (17.7%), finger (13.8%), knee (9.2%), shoulder (8.7%), and ankle (8.0%). The most prevalent injury diagnoses were fractures (24.5%), sprains/strains (22.7%), contusions/bruises (12.2%), concussions (9.8%), and internal injuries (7.1%). Males were more likely to suffer head (OR = 1.32, p < 0.001), knee (OR = 1.23, p < 0.001) and shoulder (OR = 2.19, p < 0.001) injuries and females suffered more finger (OR = 3.22, p < 0.001) and ankle (OR = 1.25, p < 0.001) injuries. Males were more likely to suffer concussions (OR = 1.50, p < 0.001) whereas females sustained more sprains/strains (OR = 1.32, p < 0.001).

CONCLUSION

Youth male American football players had a greater likelihood of sustaining concussions and head, knee, and shoulder injuries, whereas females were more likely to have sprains/strains, finger, and ankle injuries. Future studies are warranted to further explore how these differences may be attributed to play style and sex-based physiologic and development differences.

Kinesiophobia in Collegiate Athletes and Nonathletes With and Without Chronic Ankle Instability

CONTEXT

Kinesiophobia is a substantial psychological factor that may impact sport performance and activities of daily living for individuals with chronic ankle instability (CAI). The purpose of this study was to determine the levels of kinesiophobia between collegiate athletes and nonathletes with and without CAI using quantitative and qualitative analyses.

DESIGN

Cross-sectional survey.

METHODS

A Qualtrics survey was distributed to college students. Ankle health status was evaluated using the Foot and Ankle Ability Measure Sport subscale, Identification of Functional Ankle Instability, and history questions. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia-11. A 4 × 2 analysis of variance was used to assess differences in athlete status (NCAA Division 1, intramural, club, and nonathlete) and ankle health status (CAI and healthy). An open-ended question was added to understand how kinesiophobia impacts individuals CAI. Data were analyzed via content analysis.

RESULTS

Of the 531 respondents who completed the survey, 140 (116 = CAI and 24 = healthy) met the inclusion criteria for the study. There was a significant main effect for ankle health status for the Foot and Ankle Ability Measure Sport (CAI = 62.68 [15.11]%, healthy = 99.57 [0.01]%), Identification of Functional Ankle Instability (CAI = 21.63 [5.34], healthy = 2.42 [2.93]), and Tampa Scale of Kinesiophobia-11 (CAI = 26.04 [6.22], healthy = 16.75 [5.50]). There were no significant main effects for athlete status or interactions for any variables. Perceptual and behavioral responses were to major categories identified with the qualitative analysis. Fear, pain, and instability were higher order themes within perceptual responses. Activity avoidance and bracing were higher order themes within behavioral responses.

CONCLUSION

This study highlights the significant role of kinesiophobia in individuals with CAI, with those affected reporting higher levels of fear, pain, and instability compared with healthy individuals. Behavioral adaptations such as activity avoidance and bracing were common among qualitative responses. While no differences were observed across athlete statuses, these findings underscore the need for tailored interventions addressing both physical and psychological factors to improve outcomes for individuals with CAI.

The Effects of Kinesio Tape on Acute Ankle Sprain: A Systematic Review

Background: An ankle sprain is a frequent musculoskeletal injury, often leading to chronic instability and an increased risk of post-traumatic osteoarthritis. Kinesio Tape, an elastic adhesive tape, is widely used in rehabilitation for its supposed benefits in reducing pain, controlling edema, and improving ankle function. However, its effectiveness in managing acute ankle sprains remains debated. Methods: This systematic review aims to evaluate the evidence on the impact of Kinesio Taping on pain reduction, edema control, and return to sport in patients with acute ankle sprains. A systematic review was conducted in line with the PRISMA guidelines. The literature from PubMed, MEDLINE, and the Cochrane Library was searched for studies published from 2004 to 2024. Seven studies met the inclusion criteria, involving 247 patients with acute ankle sprains. Data on patient demographics, follow-up duration, Kinesio Taping protocols, and clinical outcomes were extracted and analyzed. Results: The review revealed mixed findings. Some studies reported short-term pain relief and reduced need for analgesics in the Kinesio Taping group, especially when combined with manual therapy. However, no significant differences were found in the edema control compared to bracing or casting. Functional recovery, as assessed by scales like the Karlsson scoring scale, showed no clear advantage for Kinesio Taping over other treatments. Conclusions: Kinesio Taping provides limited benefits for ankle sprain management, particularly in terms of long-term functional recovery and edema reduction. While it may offer short-term pain relief, it should be considered as an adjunctive treatment rather than a primary intervention.

The ankle instability severity score. A simple preoperative score to select patients for ankle ligament repair or reconstruction Surgery

BACKGROUND

Currently, there is no established preoperative clinical tool for determining whether to opt for surgical reconstruction or repair in cases of chronic ankle instability.

HYPOTHESIS

This study aimed to develop a predictive score for the likelihood of instability recurrence after surgical repair.

PATIENTS AND METHODS

A multicenter case-control study was conducted, comparing patients who experienced recurrence of instability after surgical repair of the lateral ankle ligament (ATFL) to those who did not experience recurrence within 2 years post-surgery. Preoperative risk factors associated with instability recurrence at the 2-year mark were identified. Utilizing these datas along with existing literature, the Ankle Instability Severity Score (AISS) for predicting the risk of recurrence after ATFL repair was formulated. Subsequently, this score was calculated for all patients in the study cohort to evaluate its predictive capability.

RESULTS

Gender (p = 0.03), age (p = 0.02), BMI (p = 0.02), and participation in pivot sports (p = 0.04) were identified as risk factors for recurrence. The 9-point AISS score was applied to the patient cohort. When the score was three or lower, the recurrence rate after ATFL repair stood at 10.6% (OR 0.11 [0.04;0.28], p < 0.001). Conversely, if the score exceeded five, the recurrence rate was substantially higher at 80.0% (OR 11.9 [1.67;237.0], p = 0.03). Using ROC analysis, a threshold value of AISS score at 3.5 (sensitivity = 77.4%, specificity = 72.8%, AUC = 0.78) was identified to develop a instability recurrence after surgical repair.

DISCUSSION

This study introduces the AISS score, which relies on straightforward preoperative criteria to assist in deciding whether patients with chronic ankle instability should undergo ligament repair surgery or explore alternative treatment options.

LEVEL OF EVIDENCE

IV; retrospective study.

Primary Ankle Fracture Dislocation Is Not a Negative Prognostic Factor for the Surgical Treatment of Syndesmotic Injury-A Retrospective Analysis of 246 Patients

Background/Objectives: Acute ankle sprains are common injuries that significantly affect both sports and daily activities. Syndesmotic injuries, a specific type of ligamentous damage, can occur as a part of a sprain or alongside fractures, affecting approximately 20% of ankle fractures. The aim of this study was to evaluate negative prognostic factors influencing surgical outcomes in tibiofibular syndesmotic injuries associated with ankle fractures. Methods: Data from 246 patients were analyzed to examine the impact of initial ankle dislocation, fracture type, and fixation method on postoperative complications and reoperation rates. Ankle joint fractures were treated with open reduction and internal fixation using an anatomically contoured plate designed for optimal tibia and fibula fixation. Four methods of syndesmosis fixation were recorded: one three-cortical screw, one four-cortical screw, two screws (either both four-cortex screws or one three-cortex and one four-cortex screw), or one endobutton. Data analysis was performed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results: Key findings reveal no significant association between initial dislocation and the necessity for reoperation (p = 0.613). However, smoking combined with dislocation significantly increases reoperation rates (35% vs. 15.5%, p = 0.026). Fixation type influenced outcomes, with single four-cortex screws linked to pain but fewer infections. Infection was the most common complication (33.3%), predominantly after fixation with a single three-cortex screw. Men had higher rates of fixation destabilization and infections, while women experienced pain persisting beyond six months postoperatively Conclusions: Patient-specific factors influence syndesmotic injury outcomes. Smoking, gender, and fixation type impact complications, emphasizing the need for tailored surgical approaches to enhance recovery and minimize reoperation risks. Future research should aim to corroborate these findings in larger, multicentric cohorts to refine surgical strategies for syndesmotic injury management.

Ligamentous ankle injuries in relation to the morphology of the incisura fibularis: A systematic review

IMPORTANCE

Ligamentous ankle lesions are among the most frequent sports injuries. One of the key intrinsic stabilizers of the ankle joint is the incisura fibularis (IF), as it interlocks the distal tibia and fibula. Despite an abundant amount of studies related to ligamentous ankle injuries, scant attention has been given to the specific role of the IF morphology.

OBJECTIVE

We systematically reviewed all literature focused on the relation between ligamentous ankle lesions and IF morphology.

EVIDENCE REVIEW

A systematic literature search was conducted on PubMed, Embase, and Web of Science according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42021282862). In general, search terms were related to ankle and syndesmosis trauma/instability in combination with morphology parameters of the IF. Studies categorizable as original research (randomized controlled trial or observational) were included. Studies concerning degenerative ankle disease and cadavers were excluded.

FINDINGS

Thirteen studies were confirmed eligible and consisted of a prospective cohort (n ​= ​1), retrospective comparative (n ​= ​10), and observational (n ​= ​2) study design. Several studies have found an increased number of ankle ligament injuries and a higher incidence of chronic ankle instability in association with a shallow IF depth. In addition, statistically significant differences in incisura height and angle were also noted: a shorter incisura and more obtuse angle were more present in patients with ankle ligament injuries.

CONCLUSION AND RELEVANCE

Most studies found distinct characteristics of the IF morphology associated with ligamentous ankle lesions, potentially due to lower osseous resistance against tibiofibular displacement. However, not all studies could identify this association and presented a heterogeneous methodological quality. Therefore, further prospective studies are warranted to clarify the relationship between the IF morphology and ligamentous ankle injuries.

LEVER OF EVIDENCE

Level III, systematic review.

Comparing the Effects of Progressive Balance and Hip Strengthening Rehabilitation in Individuals With Chronic Ankle Instability

CONTEXT

Chronic ankle instability (CAI) is associated with motor-behavioral and sensory-perceptual impairments, including reduced balance performance, hip strength, and ankle function, and increased disablement, and injury-related fear. Progressive balance training (BAL) and hip strengthening (HIP) can both improve balance and function, but their comparative effects are unknown. Our objective was to compare the effects of progressive BAL and HIP on balance, hip strength, and patient-reported outcomes in those with CAI.

METHODS

Forty-five individuals with CAI volunteered for this randomized control study. Participants were randomly allocated to BAL, HIP, and control (CON) groups (n = 15 per group). BAL and HIP each participated in 8-week interventions while CON did not. Participants' involved limbs underwent testing of patient-reported outcomes (Foot and Ankle Ability Measure [FAAM-ADL, FAAM-S], modified Disablement in the Physically Active Scale [mDPA], Tampa Scale of Kinesiophobia-11 [TSK-11], Fear-Avoidance Beliefs Questionnaire [FABQ], and Self-Efficacy of Balance Scale [SEBS]), Star Excursion Balance Test (SEBT), and isometric hip strength (extension [EXT], abduction [ABD], and external rotation [ER]) before and after the intervention. Multiple imputation was used for missing data. Multivariate repeated-measures analyses of variance analyzed effects of the interventions.

RESULTS

A significant group × time interaction existed for psychosocial outcomes (P = .008), but not for balance (P = .159), strength (P = .492), or ankle function and disability (P = .128). Time main effects existed for balance (P = .003), strength (P < .001), function and disability (P < .001), and psychosocial outcomes (P = .006). BAL significantly improved in SEBT, EXT, ABD, and all patient-reported outcomes. HIP significantly improved in EXT, ABD, ER, FAAM-S, mDPA, FABQ, and SEBS.

CONCLUSIONS

Balance training and hip strengthening can both improve motor-behavioral and sensory-perceptual impairments in individuals with CAI; however, balance training remains the most effective option for clinicians.

The Effect of Sex Hormones on Joint Ligament Properties: A Systematic Review and Meta-analysis

BACKGROUND

Sex differences exist in injury rates, and one contributing factor may be sex hormone effects on the musculoskeletal system.

PURPOSE/HYPOTHESIS

The goal of this systematic review and meta-analysis was to understand the effects of sex hormones on ligaments in females as determined by preclinical and clinical studies. The hypothesis was that sex hormones would affect ligament mechanical properties, histological features, cellular function, and clinically measurable outcomes.

STUDY DESIGN

Systematic review and meta-analysis; Level of evidence, 4.

METHODS

A literature search of PubMed, PEDro, CINAHL, and CENTRAL was performed to identify preclinical and clinical studies assessing sex hormone effects on ligament properties. Overall, 2 independent reviewers performed title, abstract, and full-text screening. Rigor and reproducibility were assessed using the ARRIVE guidelines and the modified Downs and Black checklist. Meta-analyses were also performed.

RESULTS

There were 54 articles included in this review. The majority of studies focused on the anterior cruciate ligament (ACL; n = 27), the menstrual cycle (n = 23), and 17β-estradiol (n = 35). Meta-analyses revealed that there was no effect of the menstrual cycle on knee laxity or anterior tibial translation but that 17β-estradiol decreased the production of types I and III procollagen in ACL fibroblasts in vitro. In examining other ligaments, data suggest that sex hormone changes may affect the mechanical and cellular properties of the medial collateral ligament, intrapubic ligaments, hip ligaments, and ligamentum flavum. Additionally, the literature suggests that hormonal shifts that occur with oral contraceptive pill use, pregnancy, and menopause can affect ligament properties. These effects appear to be mediated, at least in part, by the hormone relaxin.

CONCLUSION

Of the sex hormones examined in this body of literature, 17β-estradiol and relaxin appear to have the most effect on both the mechanical and cellular properties of ligaments in females. The ACL, medial collateral ligament, intrapubic ligaments, hip ligaments, and ligamentum flavum may be impacted by changes in sex hormone concentrations. The menstrual cycle does not likely affect ligament laxity in a clinically meaningful way, but pregnancy, oral contraceptive pill use, and menopause may.

Clinical outcomes of arthroscopic modified suture augmentation versus InternalBrace™ reconstruction in the treatment of chronic ankle instability

BACKGROUND

At present, the modified suture augmentation (MSA) repair and the InternalBrace™ (IB) reconstruction techniques are commonly used for the treatment of chronic ankle instability (CAI). This study aimed to evaluate and compare the clinical efficacy of the MSA repair and IB reconstruction techniques, providing a reference for clinical practice.

METHODS

After propensity score matching, 50 patients with CAI between May 2021 and May 2022 were included in this retrospective study. Of these, 26 underwent IB reconstruction surgery and 24 underwent MSA repair surgery. The American Orthopedic Foot and Ankle Society (AOFAS) scores, visual analog scale (VAS) scores, anterior drawer tests, and patient satisfaction were used for clinical efficacy evaluation.

RESULTS

The postoperative AOFAS scores in the MSA group (88.8 ± 3.0) were significantly higher than those in the IB group (84.3 ± 5.4, P = 0.001). However, the patient satisfaction scores in the IB group (7.3 ± 0.8) were higher than those in the MSA group (6.7 ± 0.8, P = 0.02). There were no significant differences between the two groups in the anterior drawer test results and VAS scores (P < 0.05). In addition, regarding postoperative complications, only one patient (4.2%) in the MSA group had joint laxity.

CONCLUSIONS

MSA repair was superior to IB reconstruction in terms of AOFAS scores. However, IB reconstruction was superior in terms of patient satisfaction. These findings highlight the potential of MSA repair and IB reconstruction techniques for the treatment of CAI.

Assessment of chronic ankle instability: are functional scores relevant enough?

INTRODUCTION

A poorly treated acute ankle sprain can rapidly progress to chronic instability, with varying degrees of disability secondary to weakness of the ankle stabilizers. The aim of our study was to evaluate functional scores and physical tests in the assessment of eversion and proprioception deficits after non-surgical treatment of chronic ankle instability. Our hypothesis was that these functional scores and physical tests are suitable and sufficient for assessing the functional aspect of an unstable ankle.

MATERIAL AND METHOD

This was a prospective, single-center study of patients managed for chronic ankle instability between November 2020 and November 2021. An ankle assessment was performed using two functional scores, the Foot Ankle Ability Measurement (FAAM) and the Ankle Ligament Reconstruction - Return to Sport after Injury (ALR-RSI), as well as two validated physical tests (Y-Balance Test and Side Hope Test). An objective (quantified) assessment of stabilizer muscle strength and proprioception was carried out using a connected device (Myolux™ Medik e-volution).

RESULTS

At last recoil, twenty-eight unstable ankles were included. Only the ALR-RSI score correlated strongly with Myolux™ assessment of eversion strength (Rho ()ρ = 0.7; p < 0.001), and proprioception (Rho ()ρ = 0.8; p < 0.001). FAAM and physical tests were not or only very moderately correlated with Myolux™ assessments.

DISCUSSION

In the absence of the Myolux™ test, the ALR-RSI score seemed the most suitable functional assessment of an unstable ankle in contrast to the FAAM score and the physical examinations Y-Balance Test and Side Hope Test.

LEVEL OF EVIDENCE

IV; prospective study.

Effects of kinesio taping on lower limb biomechanical characteristics during dynamic postural control tasks in individuals with chronic ankle instability

PURPOSE

Previous studies have demonstrated significant biomechanical differences between individuals with chronic ankle instability (CAI) and healthy controls during the Y-balance test. This study aimed to examine the effects of kinesio taping (KT) on lower limb biomechanical characteristics during the Y-balance anterior reach task in individuals with CAI.

METHODS

A total of 30 participants were recruited, comprising 15 individuals with CAI and 15 healthy controls. All participants were randomly assigned three taping conditions: no taping (NT), placebo taping (PT), and KT, followed by the Y-balance anterior reach task. Each condition was separated by one-week intervals. Kinematic and kinetic data of the lower limbs during the movement phase were collected using the Vicon motion capture system (Vicon, T40, 200 Hz) and two Kistler force platforms (Kistler, 1000 Hz).

RESULTS

KT significantly improved the Y-balance anterior reach distance (P = 0.003) and peak ankle eversion angle (P = 0.019) compared to NT. Additionally, KT resulted in increased peak knee flexion angle (P = 0.002, P = 0.011) and peak ankle dorsiflexion angle (P <0.001, P = 0.005) relative to both NT and PT. KT also significantly reduced mediolateral center of pressure (COP) displacement (P = 0.001) and average velocity of mediolateral COP displacement (P = 0.033) in comparison to NT. Furthermore, KT decreased mediolateral center of gravity displacement (P = 0.002, P = 0.003) relative to both NT and PT.

CONCLUSION

KT significantly improved abnormal ankle posture by promoting greater ankle dorsiflexion and eversion angles. Additionally, KT reduced mediolateral COP displacement and average velocity to improve postural stability. These changes may contribute to reduced risk of ankle sprains. Therefore, KT may serve as an effective tool for managing recurrent ankle sprains in individuals with CAI.

Effect of proprioceptive neuromuscular facilitation on patients with chronic ankle instability: A systematic review and meta-analysis

OBJECTIVE

This study conducts a rigorous meta-analysis of existing literature to rigorously examine the efficacy of Proprioceptive Neuromuscular Facilitation (PNF) in ameliorating functional deficits associated with Chronic Ankle Instability (CAI).

METHODS

Literature searches were conducted in multiple databases including China National Knowledge Infrastructure (CNKI), VIP, Wanfang, China Biology Medicine disc (CBM), PubMed, EBSCO (Medline, CINAHL, SPORTDiscus, and Rehabilitation & Sports Medicine Source), Embase, ScienceDirect, ProQuest, Cochrane Library, and Web of Science for randomized controlled trials assessing the effects of Proprioceptive Neuromuscular Facilitation interventions on patients with Chronic Ankle Instability. The publication timeframe spanned from the inception of each database until April 10, 2024. Meta-analysis was performed using STATA 12 software on the included studies.

RESULTS

① A total of 12 randomized controlled trials were included, encompassing 405 patients with Chronic Ankle Instability, demonstrating a generally high methodological quality of the literature.② Meta-analysis results indicate that compared to the control group, Proprioceptive Neuromuscular Facilitation (PNF) significantly enhanced the balance ability of patients with Chronic Ankle Instability as measured by the Y Balance Test (YBT) (Weighted Mean Difference (WMD) = 3.61, 95% CI [2.65, 4.56], z = 7.42, P<0.001) and the Star Excursion Balance Test (SEBT) (WMD = 5.50, 95% CI [3.80, 7.19], z = 6.36, P<0.001), with improvement in all eight directions of SEBT balance ability surpassing that of the control group (P<0.05); muscle strength around the ankle (SMD) = 0.19, 95% CI [0.03, 0.36], z = 2.26, P = 0.024), with both Plantar flexion and Dorsal flexion muscle strength improvements exceeding those of the control group (P<0.05); Visual Analog Scale (VAS) (WMD = -1.39, 95% CI [-1.72, -1.06], z = 8.23, P<0.001); Ankle instability questionnaire (WMD = 2.91, 95% CI [1.92, 3.89], z = 5.78, P<0.001).③Descriptive analysis results showed that the differences in Inversion Joint Position Sense and Dorsiflexion range of motion between the PNF and control groups were not statistically significant (P>0.05), however, the effects of PNF training persisted for a certain period even after cessation of treatment.

CONCLUSION

Proprioceptive Neuromuscular Facilitation (PNF) can significantly improve balance, muscle strength, and pain in patients with Chronic Ankle Instability (CAI). While PNF has shown improvements in joint position sense and dorsiflexion range of motion for CAI patients, with effects that remain for a period thereafter, these improvements were not significantly different when compared to the control group. Further research is required to substantiate these specific effects.

Knowledge and attitude towards ankle sprain management among primary care physicians in the department of family medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia

Introduction

Family doctors are the primary care providers for ankle sprains, which are a prevalent condition that they treat with great care. Family physicians' differing management styles and levels of knowledge about established recommendations may have a substantial influence on patient outcomes.

Aims

The current study aimed to assess the level of awareness among family physicians regarding established guidelines for ankle sprain management.

Materials and Methods

A cross-sectional study was conducted targeting all available and accessible primary care physicians within the Department of Family Medicine at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia during the period from 2023 to May 2024. Data were collected using an online questionnaire that was initiated by the study researchers after comprehensive review of similar articles in the literature.

Results

A total of 88 primary care physicians were included. Physicians' ages ranged from 25 to 60 years with a mean age of 33.4 ± 7.4 years old. A total of 47 (53.4%) were males, 29 (33%) were residents, 28 (31.8%) were consultants, 16 (18.2%) were senior Registrar, and 9 (10.2%) were GPs. A total of 41 (46.6%) of the study physicians had an overall good knowledge level about ankle sprain while most of them (53.4%) had poor knowledge level. A total of 55 (62.5%) of the study physicians utilize the Ottawa Ankle Rules to guide the need for X-ray imaging in ankle sprains, and 52 (59.1%) routinely provide information on preventive measures to patients diagnosed with an ankle sprain.

Conclusion

The study found that primary care physicians have average knowledge about ankle sprains, diagnosis, classification, and treatment, with lower knowledge of follow-up plans. They need training and educational programs.

Recent advances in the management of chronic ankle instability

Ankle sprains are the most common lesion of the ankle joint which might result in chronic ankle instability (CAI). Significant strides have been taken to enhance our comprehension of the underlying mechanisms of CAI, as the exploration of novel surgical techniques and the identification of previously unrecognized anatomical components. The present review aims to provide an extensive overview of CAI, encompassing its pathophysiology, epidemiology, clinical assessment, treatment, and rehabilitation. Treatment of CAI requires a multifaceted algorithm, involving historical analysis, clinical evaluations, and diagnostic imaging. Surgical interventions for CAI primarily involve the anatomical and/or non-anatomical reconstruction and/or repair of the anterior talofibular ligament. Anatomical repair has exhibited superior functional outcomes and a reduced risk of secondary osteoarthritis compared to non-anatomical repair. Non-anatomical approaches fall short of replicating the normal biomechanics of the anterior talofibular ligament, potentially leading to postoperative stiffness. This review seeks to academically review and up-to-date literature on this issue, tailored for clinical practice, with the intent of aiding surgeons in staying abreast of this critical subject matter.

Subchondral Bone Degeneration and Pathology 3-15 Years Following Ankle Sprain Injury in Adolescent Sport

BACKGROUND

Sport-related ankle sprains (SASs) are prevalent in adolescents (ages 10-19), increasing the risk of developing posttraumatic osteoarthritis (PTOA). Although early ankle osteoarthritis (OA) is not well defined, OA eventually includes alterations in bone mineral density (BMD), structural changes, and soft tissue pathology. This study examined the impact of SAS sustained in adolescent sport on bone and soft tissue structural outcomes 3-15 years postinjury.

METHODS

Participants (n = 10) with prior unilateral SAS in adolescent sport (HxAI) were compared to age- and sex-matched controls. To assess injury-related pathologies and BMD, 1.5-tesla (T) extremity magnetic resonance imaging (MRI) and computed tomography scans were used. Semiquantitative scores for injury patterns and OA features from MRI scans were summed and compared between groups. The talus, calcaneus, navicular, and 5% distal tibia were segmented, and BMD was measured for each bone.

RESULTS

All HxAI participants exhibited MRI injury pathology (median 2; IQR 1-6), whereas only 1 of 10 controls showed pathology (median 0; IQR 0-0), χ2(1, n = 20) = 16.36, P < .001. Both the injured and uninjured ankles in HxAI displayed injury pattern pathology. Additionally, 3 of 10 injured ankles and 2 of 10 uninjured ankles in the HxAI group (median 0; IQR 0-3), but none of the controls (median 0; IQR 0-0), exhibited OA features. In the HxAI group, talus BMD was lower in the injured ankle (502.4 ± 67.9 g/cm3) compared with the uninjured ankle (515.6 ± 70.1 g/cm3) (F = 13.33, P = .002), with no significant BMD differences at the calcaneus, navicular, or 5% distal tibia. No differences were observed between the ankles of the control group.

CONCLUSION

The presence of injury pattern pathology, structural changes, and reduced talus BMD suggest that degenerative changes may occur in individuals as early as 3-15 years following ankle injury.

Gendered environmental pathways to sports injury: insights from retired athletes in the UK high-performance context

OBJECTIVE

Women remain at increased risk for some sports injuries, such as anterior cruciate ligament rupture and concussion. This study applied a gendered environmental approach to identify modifiable features of women's sport environments that may contribute to the gendered patterning of sports injuries. Our objectives were to identify features of gendered environments that mattered in athletes' lived experiences and to trace pathways connecting these features to injury.

METHODS

We employed a creative methodology combining semi-structured interviews with artefact-elicited storytelling and poetic transcription to actively centre women athletes' voices and communicate their experiences in formats intended to stimulate reflection among sport system stakeholders.

RESULTS

Drawing on insights from 20 recently retired women athletes across 11 UK high-performance sports, our reflexive thematic analysis identified five gendered environmental challenges shaping women's injury experiences, risk and outcomes: (1) stereotypes trivialise injury, (2) physiology is all or nothing, (3) the 'ideal' female athlete, (4) in/visible inequities and (5) uneven power dynamics. Within these gendered environmental challenges, we identified mechanisms through which challenges manifest in the everyday experiences of athletes, highlighting these as potential points to disrupt the gendered environments-to-injury pathway.

CONCLUSION

Our findings provide an evidence-based framework for categorising and addressing gendered environmental challenges in women's sport. Interventions to reconfigure the gendered status quo within sport should be embedded as part of injury prevention strategies.

Reproducibility of dynamic balance and anterior tibiofibular gap measurements in men and women: A menstrual cycle-based longitudinal study

BACKGROUND

The reproducibility of dynamic balance is an essential component of athletic performance and injury prevention, although it is affected by sex differences. This study aimed to confirm the reproducibility of repeated dynamic balance measurements and ultrasonography assessments of the anterior tibiofibular gap that may contribute to changes in dynamic balance for each sex.

METHODS

This was a longitudinal study involving 48 feet, with 12 men and 12 women. Measurements for men were obtained four times, approximately once a week, and for women, once during each of the four periods of the menstrual cycle (menstrual, follicular, ovulation, and luteal phases). The measures included dynamic balance in a single-leg jump with forward landing and the anterior tibiofibular gap measurement in standing and sitting positions; rate of change in the anterior tibiofibular gap was calculated from the values in standing and sitting positions.

RESULTS

The intraclass correlation coefficient for dynamic balance was excellent for men at 0.936 (0.881-0.969) and good for women at 0.843 (0.708-0.925). Regarding the anterior tibiofibular gap, the intraclass correlation coefficient for standing and sitting were 0.999 (0.997-0.999) and 0.998 (0.996-0.999), respectively, in men; and 0.976 (0.955-0.988) and 0.991 (0.984-0.996), respectively, in women, with excellent values for both sexes. Whereas no significant changes in dynamic balance and rate of change in the anterior tibiofibular gap were observed in the four measurements in men (p > 0.05), there was a significant variation in women (p < 0.05).

CONCLUSIONS

While reproducibility of dynamic balance and anterior tibiofibular gap measurements was high overall, it was lower in women than in men. Women exhibited variations in these measurements during each period of the menstrual cycle, peaking during ovulation. Recognizing these fluctuations could inform injury prevention strategies tailored to sex-specific differences in dynamic balance and ligament extensibility.

Osteochondral lesions of talus

Cite this article: Bone Joint Res  2024;13(12):790–792.

Assessment of Muscle Synergies in Chronic Ankle Instability Patients During Unanticipated and Anticipated Landing

Ankle sprains are a common injury among athletes and the general population, with chronic ankle instability (CAI) being a frequent complication. CAI patients often display altered neuromuscular control adaptations. This study analyzed muscle synergy patterns in 20 CAI patients during anticipated and unanticipated landing tasks to understand their neuromuscular adaptation strategies. Using Nesterov non-negative matrix factorization and K-means clustering, the study identified distinct muscle activation patterns. Results indicated that during unanticipated landings, the gluteus maximus and vastus lateralis showed increased activation weight, while the medial gastrocnemius was more active in anticipated landings. This study highlights that CAI patients display unique muscle synergy patterns during unanticipated landings, relying more on proximal muscles such as the gluteus maximus and vastus lateralis. This adaptation reflects the proximal muscle strategy to enhance stability and compensate for impaired ankle function in unpredictable situations.

The clinical effects of pulsed electromagnetic field therapy for the management of chronic ankle instability: a study protocol for a double-blind randomized controlled trial

BACKGROUND

Chronic ankle instability is associated with long-term neuromuscular deficits involving poor postural control and peroneal muscular impairment. Symptoms of chronic ankle instability hinder engagement in physical activity and undermine the patient's quality of life. Despite the existence of various treatment modalities, none has conclusively provided evidence of clinical effectiveness in counteracting neuromuscular deficits, such as arthrogenic muscle inhibition of the peroneal longus (PL). Pulse electromagnetic field therapy employed as an adjunct biophysical therapy can potentially improve stability by mitigating peroneal muscle weakness and by activating the peroneal muscle. We postulate that by combining standard care (muscle strengthening, balance training, and range of motion exercise) with pulse electromagnetic field therapy, postural control stability and peroneal muscle weakness will significantly improve.

METHODS

This is a prospective, randomized, double-blind, placebo-controlled trial. A total of 48 adults with chronic ankle instability will be recruited and randomly allocated into either the intervention or control groups. The intervention group (n = 24) will receive active pulse electromagnetic field therapy and standard exercise training, while the control group (n = 24) will receive sham pulse electromagnetic field therapy and standard exercise training for 8 weeks. Primary and secondary outcomes will be evaluated at baseline, week 4, 8 as well as at 3-, 6-, and 12-month follow-up visits.

DISCUSSION

Chronic ankle instability is a common debilitating condition without a curative conservative treatment. Investigating different treatment modalities will be essential for improving rehabilitation outcomes in this clinical population. This study will investigate the effectiveness of pulsed electromagnetic field therapy on the functional and clinical outcomes in the chronic ankle instability population. This trial may demonstrate this non-invasive biophysical therapy to be an effective measure to help patients with CAI.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05500885. Registered on August 13, 2022.

AFSegNet: few-shot 3D ankle-foot bone segmentation via hierarchical feature distillation and multi-scale attention and fusion

Accurate segmentation of ankle and foot bones from CT scans is essential for morphological analysis. Ankle and foot bone segmentation challenges due to the blurred bone boundaries, narrow inter-bone gaps, gaps in the cortical shell, and uneven spongy bone textures. Our study endeavors to create a deep learning framework that harnesses advantages of 3D deep learning and tackles the hurdles in accurately segmenting ankle and foot bones from clinical CT scans. A few-shot framework AFSegNet is proposed considering the computational cost, which comprises three 3D deep-learning networks adhering to the principles of progressing from simple to complex tasks and network structures. Specifically, a shallow network first over-segments the foreground, and along with the foreground ground truth are used to supervise a subsequent network to detect the over-segmented regions, which are overwhelmingly inter-bone gaps. The foreground and inter-bone gap probability map are then input into a network with multi-scale attentions and feature fusion, a loss function combining region-, boundary-, and topology-based terms to get the fine-level bone segmentation. AFSegNet is applied to the 16-class segmentation task utilizing 123 in-house CT scans, which only requires a GPU with 24 GB memory since the three sub-networks can be successively and individually trained. AFSegNet achieves a Dice of 0.953 and average surface distance of 0.207. The ablation study and comparison with two basic state-of-the-art networks indicates the effectiveness of the progressively distilled features, attention and feature fusion modules, and hybrid loss functions, with the mean surface distance error decreased up to 50 %.

Effects of dual-task paradigm on the injury potential during landing among individuals with chronic ankle instability

Purpose

Chronic ankle instability (CAI) causes maladaptive neuroplastic changes in the central nervous system, which may lead to high injury potential under dual-task conditions. This study aims to explore the effects of dual-task paradigm on the injury potential during landing among individuals with CAI.

Methods

Twenty participants with CAI (4 female and 16 male, 12 were affected with their right limbs and 8 were affected with their left limbs, 20.4 ± 1.7 years, 176.9 ± 5.0 cm, and 72.0 ± 11.1 kg) and eighteen without CAI (6 female and 12 male, 20.2 ± 1.5 years, 173.5 ± 7.0 cm, and 70.3 ± 10.8 kg) were recruited. They drop-landed on a trap-door device, with their affected or matched limbs on a flippable platform, under single- (drop-landing only) and dual-task (drop-landing while subtracting of serial threes) conditions. A twelve-camera motion capture system was used to capture the kinematic data. Two-way ANOVA with mixed design (CAI vs non-CAI groups by single-vs dual-task conditions) was used to analyze the data.

Results

Significant group-by-condition interactions were detected in the ankle inversion angle (P = 0.040, η 2 p = 0.012) and ankle inversion angular velocity (P = 0.038, η 2 p = 0.114). Both indicators decreased among individuals without CAI from single-to dual-task conditions, while remained unchanged among those with CAI; and they were higher among individuals with CAI under both single- and dual-task conditions, compared to those without CAI.

Conclusion

Individuals with CAI have a reduced ability to limit ankle inversion compared to those without CAI. Under dual-task conditions, individuals without CAI limited their ankle inversion, while those with CAI did not. Drop-landing, especially under dual-task conditions, poses a high risk of excessive ankle inversion for individuals with CAI.

Effects of an Instability Training Program Using Global Versus Selective Instability Devices on Dynamic Balance and Ankle Stability in Young Amateur Soccer Players

Background/Objectives: Both Sides Utilized it is one of the most employed global instability devices (GID), but it is difficult to progress and select a particular foot structure. In this sense, the Blackboard has been created as selective instability device (SID). The aim of this study is to compare the effects of both devices on balance and ankle stability. Methods: The study was designed as a randomized controlled clinical trial. Twenty healthy amateur soccer players were divided into two groups: GID and SID. Both performed balance training (4-weeks, 3 days/week). Ankle balance and stability were assessed. Paired t-tests were used to analyze the pre-, post-, and between-groups differences. Results: No differences were found between the groups. Significant intra-group changes were found in both groups for posterolateral balance and summation. Moreover, posteromedial balance increased in the GID group. No changes were found in ankle stability results. Conclusions: A balance intervention using GID or SID is effective in improving general and posterolateral balance. Moreover, the GID intervention improved posteromedial balance.

The effect of fresh and used ankle taping on lower limb biomechanics in sports specific movements

OBJECTIVES

We aimed to investigate the effects of ankle taping on lower extremity biomechanics related to injury development and how these effects change after sports-specific use.

DESIGN

Randomized, repeated measures design with three conditions: Barefoot, tape applied fresh, and tape after sports-specific use (between-subject factor: sex).

METHODS

Twenty-five healthy participants (ten female) performed sports-specific movements, including running, drop jumping, and 180° change of direction, under the three conditions. Kinetic and kinematic data were collected using 3D motion capturing and force platforms.

RESULTS

Tape applied fresh and tape after sports-specific use significantly reduced peak ankle inversion. Biomechanical risk factors for anterior cruciate ligament or running overuse injuries were either unchanged or decreased with tape applied fresh, except for the peak loading rate of the resultant ground reaction force, which increased between 4% and 18% between movement types. After 15 minutes of sports-specific use of the tape, the alterations induced by tape applied fresh remained for some biomechanical risk factors while they became closer to barefoot again for others, indicating a differential response to prolonged use of taping for different biomechanical variables.

CONCLUSIONS

Ankle taping protects the ankle joint by reducing biomechanical risk factors associated with ankle sprains, and most biomechanical risk factors for anterior cruciate ligament or running overuse injuries are not increased. Further research is needed to explore the duration of protective effects, variations across sports, and its impact on patients with chronic ankle instability, contributing to a more comprehensive understanding of ankle taping's influence on lower extremity biomechanics.

Quantitative evaluation of calcaneofibular ligament injury on the oblique coronal view of magnetic resonance imaging in chronic lateral ankle instability

BACKGROUND

In the treatment of chronic lateral ankle instability (CLAI), the repair of the calcaneofibular ligament (CFL) and anterior talofibular ligament (ATFL) is still being discussed, possibly due to the difficulty in assessing CFL injuries. In particular, it is challenging to evaluate the extent of CFL deficiency quantitively. We hypothesized that CFL tension change would alter morphology of the CFL on magnetic resonance imaging (MRI) and that measuring this morphological change allows assessing CFL injury quantitatively. Thus, this study aimed to analyze the feasibility of quantitatively assessing CFL injuries using MRI.

METHODS

Sixty-four ankles with CLAI were included and divided into two groups: with (ATFL and CFL group, 31 ankles) or without CFL repair (ATFL group, 33 ankles) in addition to arthroscopic ATFL repair. The angle between the CFL and calcaneal axis (CFLCA) and the bending angles of the CFL was defined as the flexed CFL angle (FCA) were measured on the oblique CFL view of preoperative MRI. The diagnostic abilities of these angles for CFL injury and correlations between these angles and stress radiographs were analyzed.

RESULTS

The sensitivity and specificity of CFLCA were 86.7 % and 88.7 %, and those of FCA were 63.3 % and 77.4 %, respectively. The combination of CFLCA and FCA improved the sensitivity to 93.3 %. The cutoff points of CFLCA and FCA were 3.8° and 121.2°, respectively. There were significant moderate and weak correlations between the talar tilting angle and CFLCA or FCA (rs = -0.533, and rs = -0.402, respectively). The CFLCA and FCA were significantly smaller in the ATFL and CFL group than those in the other groups.

CONCLUSIONS

Measurement of CFLCA and FCA in oblique CFL view on MRI could be useful for the quantitative evaluation of CFL injury in patients with CLAI． LEVEL OF EVIDENCE: Level IV. case-control study.

Ankle Injury Prevention Programs for Youth Sports: A Systematic Review and Meta-analysis

CONTEXT

Previous research has demonstrated that using a multicomponent approach to ankle injury preventions can significantly reduce ankle injuries; however, these studies lack specific intervention recommendations.

OBJECTIVE

To evaluate the exercise components of prevention programs on ankle injuries specifically in high school athletes. Secondary objectives were to assess the overall effectiveness of prevention programs on ankle injuries in this population and how compliance and education may impact success.

DATA SOURCES

A total of 5 databases were searched through September 26, 2022.

STUDY SELECTION

Study inclusion criteria included randomized control trials (RCTs) investigating exercise interventions in high school athletes aged 13 to 19 years, participation in sports competition, reporting of injury incidence, and specific exercise interventions used.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 1.

DATA EXTRACTION

Pooled overall ankle injury incidence rate ratio and 95% CIs were calculated using random-effects meta-analysis.

RESULTS

A total of 10 studies were included, of which 9 used multicomponent exercise interventions and 1 used only balance training. Of the 10 studies, 3 demonstrated statistically significant reduction in ankle injuries. When data from all 10 studies were pooled and analyzed, there was a statistically significant overall reduction (incidence rate ratio, 0.74; 95% CI 0.60-0.91) in ankle injuries when comparing intervention groups with controls.

CONCLUSION

The most effective injury prevention programs included multiple components, emphasized strengthening and agility exercises, and promoted high adherence to the intervention. The importance of coach and player education on how and why to perform an injury prevention program as well as the frequency and duration of programs was also important. Exercise-based injury prevention programs may reduce ankle injury incidence in youth athletes by 26% when pooling data from a multitude of sport types/settings.

Safety and Efficacy of One vs Two Incision Broström Gould with Calcaneal Osteotomy and Peroneal Tendon Debridement Surgery

Surgical intervention, such as the Broström-Gould procedure, is typically indicated for patients with chronic lateral ankle instability. In this study, we are comparing the safety and efficacy of the Broström-Gould procedure with peroneal tendon debridement, a sliding lateralizing calcaneal osteotomy, and adjuvant procedures performed with a single- versus double-incision approach. Our retrospective analysis included patients who underwent the procedure of interest between 2011 and 2020. Patients were divided into 2 groups: undergoing either a 1-incision (n = 53) or a 2-incision approach (n = 47), both with a lateralizing calcaneal osteotomy. A significant difference in skin bridge breakdown was observed between the 2-incision (n = 6 [13%]) and 1-incision groups (n = 0 [0%]). There were no significant differences in infection, deep wound dehiscence, nerve palsy, or neuroma between patients in the 2 groups. Furthermore, no statistically significant differences in mean PROMIS scores existed between the cohorts. The described Broström-Gould procedure shows promise for treating chronic ankle instability. While patients in both single- and double-incision groups had similar rates of postoperative complications, the decreased incidence of skin bridge breakdown in the 1incision group highlights the approach's safety and potential benefits in reducing wound-related complications.

Ankle Sprain Recurrence and Rehabilitation Among Athletes: A Case Study in the West Region of Cameroon

OBJECTIVES

To investigate the prevalence, risk factors, and impact of physiotherapy on ankle sprain recurrence among professional and amateur athletes in the West region of Cameroon.

METHODS

Cross-sectional study from February to July 2024 in the West region of Cameroon sports clubs. Professional and amateur athletes practice their sport at least three times a week. The main outcomes are reported as the prevalence of the first ankle sprain, the prevalence of recurrence, and the factors associated with recurrence (bivariate analysis, significance set at P<0.05; 95% CI).

RESULTS

 Among the 215 participants, the prevalence of first ankle sprain was 72.6% (156). Of these 156 athletes, only 70 received physiotherapy (44.9%) and only 56 athletes had functional recovery before restarting sport (35.9%). The main barrier to physiotherapy intervention was the lack of knowledge. The prevalence of recurrence was 61.5% (96/156), with significant associations found between recurrence and professional athlete status (aOR: 2.48; CI: 1.09-4.29; P<0.001) and hand-on-ball sports participation (aOR: 4.72; CI: 1.08-29.62; p=0.04). Conversely, physiotherapy intervention (aOR: 0.65; CI: 0.26-0. 98; p=0.01), functional recovery before return to play (aOR: 0.41; CI: 0.05-0.84; p<0.001), and moderate sports frequency (aOR: 0.81; CI: 0.28-0.91; p=0.03) demonstrated protective effects against recurrence.

CONCLUSION

Education and awareness campaigns are necessary to promote physiotherapy intervention and reduce the burden of ankle sprain recurrence among athletes in Cameroon and Sub-Saharan Africa.

Impact of Quadriceps Muscle Fatigue on Ankle Joint Compensation Strategies During Single-Leg Vertical Jump Landing

This study investigates the impact of quadriceps fatigue on lower limb biomechanics during the landing phase of a single-leg vertical jump (SLJ) in 25 amateur male basketball players from Ningbo University. Fatigue was induced through single-leg knee flexion and extension exercises until task failure. Kinematic and dynamic data were collected pre-fatigue (PRF) and post-fatigue (POF) using the Vicon motion capture system and the AMTI force platform and analyzed using an OpenSim musculoskeletal model. Paired sample t-tests revealed significant changes in knee and hip biomechanics under different fatigue conditions, with knee joint angle (p < 0.001), velocity (p = 0.006), moment (p = 0.006), and power (p = 0.036) showing significant alterations. Hip joint angle (p = 0.002), moment (p = 0.033), and power (p < 0.001) also exhibited significant changes. Muscle activation and joint power were significantly higher in the POF condition, while joint stiffness was lower. These findings suggest that quadriceps fatigue leads to biomechanical adjustments in the knee and hip joints, which may increase the risk of injury despite aiding in landing stability.

Impact of chronic ankle instability on gait loading strategy in individuals with chronic ankle instability: a comparative study

BACKGROUND

Lateral ankle sprains rank among the most prevalent musculoskeletal injuries, while chronic ankle instability (CAI) is its most common cascade. In addition to the conflicting results of the previous studies and their methodological flaws, the specific gait loading strategy is still not well studied.

PURPOSE

The study aimed to investigate the fluctuations in gait loading strategy in people with chronic ankle instability compared to health control.

METHODS

A total of 56 male subjects participated in this study and were allocated into two groups: (A) CAI group: 28 subjects with unilateral CAI (age 24.79 ± 2.64 and BMI 26.25 ± 3.50); and (B) control group: 28 subjects without a history of ankle sprains (age 24.57 ± 1.17 and BMI 26.46 ± 2.597). Stance time, weight acceptance time, and load distribution were measured to investigate gait loading strategy.

RESULTS

The study findings revealed that the CAI group had a significant higher load over the lateral rearfoot. However, MANOVA indicates that there was no overall significant difference in gait loading strategy between the CAI and control groups. Furthermore, in terms of stance time, time of weight acceptance phase, load over medial foot, and load over lateral foot, CAI and healthy controls seemed to walk similarly.

CONCLUSIONS

The findings revealed that individuals with CAI had the significant alteration in the lateral rearfoot loading, suggesting a potential compensatory mechanism to address instability during the weight acceptance phase. This could manifest a laterally deviated center of pressure and increased frontal plane inversion during the early stance phase. However, it is acknowledged that these alterations could be both the result and the origin of CAI. The study highlights the vulnerability of CAI during the early stance phase, emphasizing the need for gait reeducation as individuals return to walking as healthcare clinicians should focus on treatment modalities aimed at reducing rearfoot inversion in individuals with CAI.

Ankle-GO score is associated with the probability of becoming coper after lateral ankle sprain: a 1-year prospective cohort study

OBJECTIVE

To analyse the association between Ankle-GO score during the return to sport process and the probability of becoming a coper 1 year after lateral ankle sprain (LAS). Copers were defined as patients returning to their preinjury sport without loss of function and reporting no episodes of reinjury or giving-way.

METHODS

Two months after a LAS, patients performed the Ankle-GO assessment which includes a cluster of four functional tests and two self-reported questionnaires for a maximum score of 25 points. One year after injury, participants were classified as copers or non-copers. Eight potential predictive variables associated with coper status were compared between the groups. Receiver operating characteristic curves (area under the curve (AUC)) and multivariable logistic regression models with OR and 95% CIs were used to determine the association of potential factors, including the Ankle-GO score, with copers.

RESULTS

64 patients (56% females; age 33.7±13.2 years) completed the Ankle-GO-GO at 2 months postinjury. At 1 year postinjury, 10 patients (15%) were lost to follow-up, and only 17 of 54 patients (31%) became copers. Two-month Ankle-GO score was higher among copers (9.9±4.9 points vs 6.9±3.7, p=0.015) and was associated with future coper status at 1 year (AUC=0.70). Patients with an Ankle-GO score above 11 points and male patients were more likely to become copers (OR=12.1; 95% CI 2.5 to 59, p=0.002 and OR=5.2; 95% CI 1.2 to 22.4, p=0.026, respectively).

CONCLUSION

The Ankle-GO may help identify patients more likely to become copers within a year of injury. Those with low Ankle-GO scores and female patients should receive additional rehabilitation to increase the odds of becoming a coper.

Cross-Cultural Adaptation, Feasibility, Reliability, and Validity Tests of the Chinese Version of Ankle Ligament Reconstruction-Return to Sport After Injury Scale

Background

The Ankle Ligament Reconstruction-Return to Sport After Injury (ALR-RSI) scale can be utilized for assessing patients who have previously sustained lateral ankle ligament injury before returning to sport. Given its original development for use in different languages, it is essential to translate and validate this scale for application to the Chinese population.

Purposes

To translate and culturally adapt the ALR-RSI scale into a Chinese version and assess its reliability and validity.

Study Design

Cohort study (Diagnosis); Level of evidence, 2.

Methods

The procedure of translation and cross-cultural adaptation was performed following the recommended guidelines and the Chinese version of ALR-RSI (ALR-RSI-CHN) was conducted in patients with lateral ankle ligament surgery. Feasibility was assessed by floor/ceiling effects. Reliability was assessed by using Cronbach α as a measure to analyze internal consistency, while the intraclass correlation coefficient was utilized to examine test-retest reliability. Validity was assessed by using Spearman coefficients to analyze the correlations between ALR-RSI-CHN, the Karlsson scale, and the American Orthopaedic Foot and Ankle Society (AOFAS) scale.

Results

A total of 66 participants were included. The ALR-RSI-CHN scale showed good feasibility with no floor/ceiling effects. The internal consistency of the scale was adequate with a Cronbach α of 0.93, and test-retest reliability was excellent with an interclass correlation coefficient of 0.97 (95% CI, 0.92-0.99). The ALR-RSI-CHN scale demonstrated moderate correlation with the Karlsson scale (r = 0.48 [range, 0.26-0.65]) and strong correlation with the AOFAS scale (r = 0.55 [range, 0.35-0.71]). A significant difference in ALR-RSI-CHN scores was observed between patients who returned to sports and those who did not, with respective scores of 53.60 (range, 44.50-62.69) and 42.25 (range, 35.51-49) (P = .04).

Conclusion

The study demonstrated that the ALR-RSI-CHN scale had satisfactory psychometric properties, rendering it a feasible, reliable, and valid instrument for evaluating patients who have lateral ligament surgery in China.

Hormonal Fluctuation and Ankle Instability in Women-Is There a Correlation?

Background

With higher incidences of ankle sprains and chronic ankle instability in women, it has been postulated that hormonal modulation and ligamentous laxity influences injury propensity. The purpose of this study is to investigate the impact of hormonal fluctuation on ankle stability and ligamentous laxity and their potential contribution to injury propensity in the female athlete.

Methods

In November 2023, a systematic review of the MEDLINE, Embase, and Cochrane Library databases was performed following PRISMA guidelines. Articles were included if they were published after the year 2000, evaluated outcomes related to the impact of hormones on ankle stability in healthy patients, and included menstrual tracking. The following search terms were used: "(sex or gender) AND (ankle stability)" and "(hormone) AND (ankle)."

Results

Thirteen articles were included, with 253 (76.4%) women at a weighted mean age of 21.9 ± 2.0 years (range, 20.0-25.9). Five studies evaluated postural sway and balance noting greater sway rates during ovulation compared with the follicular phase. Greater muscle tone (P < .001) was observed in the follicular phase than ovulation for the tibialis anterior, peroneus longus, and lateral gastrocnemius. Significantly higher ankle joint laxity was observed in ovulation (P = .016).

Conclusion

This review found that during ovulation, when estrogen peaks, subjects showed impaired balance with higher postural sway rates, greater ankle joint laxity, and decreased muscle and ligamentous tone and stiffness-an indicator of laxity. An underlying hormonally mediated etiology for the increased propensity to ankle instability in the female athlete is suggested. Syncing an athlete's workout type and intensity around menstrual cycle phase may be an advantageous strategy for injury prevention.

The evolution of patient-reported outcome measures after a first lateral ankle sprain: A prospective study

PURPOSE

A lateral ankle sprain is the most common musculoskeletal injury in the physically active population. However, it is unclear how the clinical condition evolves during the period after the injury and what proportion of patients develops chronic symptoms. Therefore, the purpose of this study is to assess the evolution of patient-reported outcome measures after a first time lateral ankle sprain.

METHODS

A prospective clinical study assessed the patient-reported outcome measures (PROMs) of a consecutive group of 100 patients during 1 year after a first lateral ankle sprain. The Karlsson score and Foot and Ankle Outcome Score (FAOS) were assessed at 6 weeks, 3 months, 6 months, 9 months and 1 year. The Cumberland Ankle Instability Tool (CAIT)-score was assessed at 6 months, 9 months and 1 year. The difference between the time points of all scores was analysed using the positive change over time (binomial test versus 50%) and the difference in score (signed rank test). The time to sustained excellent level was also assessed overall and in several subgroups: age, gender, degree of injury (2 or 3), avulsion fracture, use of crutches, use of cast. Differences between subgroups were assessed by a generalized log-rank test.

RESULTS

All clinical scores demonstrated an improvement up to 12 months after the sprain. The median Karlsson score (interquartile range) improved from 62 (50-80) at 6 weeks to 90 (72-100) at 3 months, to 97 (82-100) at 6 months to 100 (90-100) at 9 months, to 100 (100-100) at 1 year. The analysis of positive change over time demonstrated a significant positive change (P-value <.0005) between all time points except between 6 weeks and 12 weeks when using the FAOS quality score. The difference in score demonstrated a significant change (P-value <.01) between all time points except between 36 weeks and 48 weeks when using the FAOS pain and FAOS sports score. Age and presence of an avulsion fracture were correlated with a slower recovery and worse results. At 1 year, in total 13 patients (13%) had a worse outcome corresponding to a Karlsson score < 81 or CAIT score < 24.

CONCLUSION

The clinical condition after a first ankle sprain demonstrated a significant improvement in PROMs between the different time points in the first year. Twelve months after a first lateral ankle sprain 13% had a fair or poor outcome. Higher age and presence of an avulsion fracture were correlated with a slower recovery and worse results. This information is useful in clinical practice to predict further progression and inform patients. Moreover, it is valuable to improve treatment strategies.

LEVEL OF EVIDENCE

Level II (prospective cohort study).

Kinesiology taping improves balance in football players with chronic ankle instability

INTRODUCTION

There appears to be no consensus on the usefulness of kinesiological tape in athletes with chronic ankle instability, therefore the aim of this study was to examine the effects of kinesiological tape on dynamic balance in football players with chronic ankle instability.

DESIGN, SETTING AND PARTICIPANTS

Football players who were eligible for this randomized controlled study were randomly assigned (allocation ratio 1:1:1) to one of three groups: experimental group, placebo group or control.

INTERVENTIONS

The experimental group received kinesiological tape bands applied to the peroneal and tibialis anterior muscles. The tape was applied for 48 h. The placebo group received a sham kinesiological tape application for the same duration, while the control group did not receive any tape.

OUTCOME MEASURES

Balance was assessed using the Y-Balance Test at baseline and 48 h later, with the kinesiological tape still in place, either sham or control.

RESULTS

A total of 69 (23 per group) semi-professional, male, players (22.1 ± 4.3 years) completed the study. There was a significant change in test performance over time (F1,66 = 9.425; P = 0.003; ηp2 = 0.125), with a significant interaction for group × time (F2,66 = 11.154; P < 0.001; ηp2 = 0.253). The kinesiological tape group improved the overall performance in the Y-balance test (85.2 ± 8.7% to 90.3 ± 8.4%, P < 0.001), while no differences were observed for the placebo and control groups.

CONCLUSION

The application of kinesiological tape for 48 h improved overall dynamic balance performance on the Y-balance test. These findings suggest that kinesiological tape could be a beneficial strategy for addressing the consequences of chronic ankle instability.

The Association Between Menstrual Cycle Phase, Menstrual Irregularities, Contraceptive Use and Musculoskeletal Injury Among Female Athletes: A Scoping Review

BACKGROUND

The influence of menstrual cycle phases (MCPs), menstrual irregularities (MI) and hormonal contraceptive (HC) use on injury among female athletes has been scrutinised. Existing systematic reviews investigating the effect of exposures affecting the endogenous reproductive hormone status on sporting injuries are limited in terms of the types of studies included and injuries investigated.

OBJECTIVE

This scoping review aims to summarise the coverage of the literature related to the extent, nature and characteristics of the influence of MCP, MI and HC use on musculoskeletal injuries among athletes. It also aims to summarise key concepts and definitions in the relevant literature. Observational and experimental studies investigating the effect of MCP, MI, and HC on musculoskeletal injuries among female individuals of reproductive age were included. Studies specifically stating pregnant women, perimenopausal/postmenopausal athletes, or those using medication (other than HC) that affects reproductive hormone profiles or the musculoskeletal system were excluded.

METHODS

This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping reviews and JBI scoping review guidelines. Published and unpublished studies were sourced from several databases and resources. Initial keywords used included terms related to "menstrual cycle", "hormonal contraception" and "injury." Titles and abstracts of identified citations were screened independently and assessed for eligibility by two independent reviewers. Data from the included studies were extracted using a standard data extraction form.

RESULTS

The search yielded 10,696 articles, of which 96 met the eligibility criteria. Most studies investigated MI (77%), and 49% included MCP as a contributing injury risk factor. Publications have increased over the last two decades. Collectively, only 16% of research has been conducted in Africa, Asia and Oceania. There were no studies from South America. Seventy-five percent of the studies investigated individual versus team (25%) sport athletes. Most studies only investigated elite or professional (n = 24; 25%) level athletes. The definitions of injury, eumenorrhea and MI differ vastly among studies. Regarding MI, most studies (69%) investigated secondary amenorrhea, followed by oligomenorrhea (51%) and primary amenorrhea (43%). Concerning HC, the influence of oral contraceptive pills was mainly investigated.

CONCLUSIONS

Research related to MCP, MI and HC as contributing musculoskeletal injury risk factors is increasing; however, several gaps have been identified, including research from countries other than North America and Europe, the study population being non-professional/elite level athletes, athletes participating in team sports and specific injuries related to MCP, MI and HC, respectively. Differences in methodology and terminology of injury, MCP and MI hinder comparative summative research, and future research should consider current published guidelines during the study design. Identifying barriers to following standard guidelines or research investigating the most practical yet accurate methods to investigate the influence of MCP on musculoskeletal health might yield valuable insights for future research designs.

CLINICAL TRIAL REGISTRATION

Scoping review registration number: Open Science Framework ( https://doi.org/10.17605/OSF.IO/5GWBV ).