Biomechanics Following Anatomic Lateral Ligament Repair of Chronic Ankle Instability: A Systematic Review

The Effect of Kinesio Taping on Balance and Dynamic Stability in College-Age Recreational Runners with Ankle Instability

(1) Background: Running is one of many sports that have increased in popularity since it can be conducted at any time or anywhere. Ankle instability is a common injury that usually occurs during running and is usually associated with abnormalities in postural stability. Recently, kinesio taping has gained increasing interest as a tool that can be used in rehabilitation, to improve stability, and to help in injury prevention. This study aimed to investigate the effect of Kinesio taping on balance and dynamic stability in recreational runners with ankle instability. (2) Methods: This randomized controlled trial recruited 90 RRs with ankle instability. The participants were randomly divided into three equal groups: a KT group (KTG) who received Kinesio taping on their ankle joints; a mixed group (MG) who received Kinesio taping and exercises; and an exercise group (EG) who received exercises only. Outcome measures (balance and dynamic stability) were assessed before and after the end of an 8-week treatment program using a Biodex balance system and a star excursion balance test, respectively. (3) Results: Within-group comparisons showed statistically significant improvements in most of the outcome values when compared to baseline. Overall stability index was statistically significantly better (with a high effect size) in the MG compared to KTG or EG (p = 0.01, Cohen's d = 1.6, and p < 0.001, Cohen's d = 1.63, respectively). A similar finding was evident in the anteroposterior stability index (p = 0.02, Cohen's d = 0.95, and p < 0.001, Cohen's d = 1.22, respectively). The mediolateral stability index of the KTG was statistically significantly better with a high effect size when compared to MG or EG (p = 0.04, Cohen's d = 0.6, and p < 0.01, Cohen's d = 0.96, respectively). The star excursion balance test values were statistically significant with high effect sizes in the posterior (p = 0.002, Cohen's d = 1.2) and lateral (p < 0.02, Cohen's d = 0.92) directions in the MG compared to KTG and EG. (4) Conclusions: Kinesiotape with exercises is superior to either kinesiotape alone or exercises alone in improving postural stability indices and dynamic stability in recreational runners with ankle instability. Recreational runners with ankle instability should be educated about practicing balance exercises and applying kinesiotape.

Functional effects of arthroscopic modified Broström procedure on lateral ankle instability: A pilot study

BACKGROUND

This study aims to assess the mechanical and functional effects of the arthroscopic modified Broström procedure (AMBP) on patients with lateral ankle instability.

METHODS

Eight patients with unilateral ankle instability treated with AMBP and eight healthy subjects were recruited. Healthy subjects, preoperative and one-year postoperative patients were assessed using outcome scales and the Star Excursion Balance Test (SEBT) for dynamic postural control. One-dimensional statistical parametric mapping was performed to compare ankle angle and muscle activation curve during stair descent.

RESULTS

The patients with lateral ankle instability showed good clinical outcomes and increased posterior lateral reach during the SEBT after the AMBP (p = 0.046). The medial gastrocnemius activation after initial contact was reduced (p = 0.049), and the peroneal longus activation after initial contact was promoted (p = 0.014).

CONCLUSION

The AMBP has functional effects of promoting dynamic postural control and peroneal longus activation within one year of follow-up, which can benefit patients with functional ankle instability. However, the medial gastrocnemius activation was unexpectedly reduced post operation.

Current concepts in the surgical management of chronic ankle lateral ligament instability

Background/aims

Ankle sprains are common injuries which can lead to chronic lateral ankle ligament instability (CAI).

Methods

The aim of this review is to provide a comprehensive overview of the epidemiology, pathophysiology, investigation, surgical management and rehabilitation of CAI.

Results

Investigation of CAI is based on history, clinical examination, and imaging. Surgical management of CAI can be defined as anatomic reconstruction, anatomic and non anatomic repair of ATFL and/or CFL. Anatomic repair has been shown to have better functional outcomes and less secondary osteoarthritis when compared to non anatomic repair. Non-anatomic methods do not replicate the normal anatomical course of ATFL/CFL and may lead to stiffness. The most common surgical treatment for CAI is the open modified Broström repair augmented with the Gould modification. There are arthroscopic techniques being developed which have reported promising clinical results. However, there are considerable areas of further research which should be carried out to improve understanding and effectiveness of current treatment options. Standardised validated patient reported outcome measures and evidence-based protocols in the rehabilitation periods are crucial for positive and reproducible outcomes.

Conclusion

Surgical repair has proven to show excellent outcomes for patients suffering from CAI, however larger prospective studies should be carried out to evaluate the use of newer surgical techniques.

Preoperative Lymphocyte-to-Monocyte Ratio Can Indicate the Outcomes in Repair of I-III Degree Injury of Lateral Ankle Ligament

Background. This study is aimed at exploring the prognostic value of preoperative lymphocyte-to-monocyte ratio (LMR), an index of systemic inflammation before operation, in ankle lateral ligament repair (ALLR). Methods. A total of 213 I-III degrees injuries of lateral ankle ligament patients received ALLR and were followed up for more than 2 years. Univariate and multivariable linear regression analysis was used to determine the relationship between preoperative LMR and postoperative recovery. The evaluations of postoperative recovery include American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson-Peter ankle score (KPAS), Cumberland Ankle Instability Tool (CAIT) score, Visual Analog Scale (VAS) score, and range of motion (ROM). The prognostic value of preoperative LMR was measured by receiver operating characteristic (ROC) curve. Results. 178 patients (178 ankles) were followed up successfully, with a follow-up of $2.82\pm 1.54$ years. Overall, the mean AOFAS, KPAS, CAIT and VAS scores, and ankle varus angle were significantly improved at the final follow-up. Univariate and multiple linear regression analysis showed that preoperative LMR was the only independent factor associated with postoperative function, ROM, and pain. The preoperative LMR of patients with poor recovery was significantly lower than that of patients with good recovery. Based on the ROC analysis, the cutoff value of preoperative LMR was 3.824. The clinical outcomes of patients with $\text{preoperative}\text{LMR}<3.824$ were significantly lower than that of patients with $\text{preoperative}\text{LMR}\ge 3.824$ . The corresponding specificity and sensitivity were 84.6% and 71.4%. Conclusion. The clinical outcomes of open or arthroscopic repair for ATFL injury are satisfactory. As a marker of systemic inflammation, preoperative LMR can be used as a prognostic indicator for ALLR.

Straight Form of Calcaneofibular Ligament as a Three-Dimensional Magnetic Resonance Imaging Sign in Diagnosis of Calcaneofibular Ligament and Anterior Talofibular Ligament Inferior Fascicle Injury

The present study was performed to investigate the morphological characteristics of the calcaneofibular ligament (CFL) and evaluate its relationship to the anterior talofibular ligament (ATFL) in patients with lateral ankle ligament injury using 3-dimensional magnetic resonance imaging (3D-MRI). This retrospective study involved 35 patients with lateral ankle ligament injury and 24 patients without a history of ankle trauma and a bone abnormality as controls. Reconstructed 3D-MRI was used to classify the form of the CFL as curved, wavy, or straight. The presence/absence of continuity between the fibula and CFL was evaluated in the 35 patients with injury, who were divided into 2 groups (continuity and discontinuity groups). The number of fascicles in the ATFL and the continuity between the distal end of the fibula and the proximal end of the ATFL were then evaluated. Among the patients with injury, 54.3% had the curve type of CFL, 34.3% had the wave type, and 11.4% had the straight type. In the control group, 62.5% had the curve type, 37.5% had the wave type, and none had the straight type. Continuity between the fibula and CFL was seen in 88.6%, and discontinuity was seen in 11.4%. Additionally, 85.7% had double fascicles in the ATFL. Inferior fascicle discontinuity between the ATFL and fibula was found in 13.3% with a double-fascicle ATFL; in all of these patients, the form of the CFL was straight and exhibited inferior fascicle discontinuity. The straight form of CFL could be a 3D-MRI sign in the diagnosis of CFL and ATFL inferior fascicle injury.