A systematic review on ankle injury and ankle sprain in sports

The relationship between chronic ankle instability and sleep behaviour

Chronic Ankle Instability (CAI) is a condition characterized by giving-way episodes, instability and recurrent ankle sprains. Poor sleep can increase the risk of musculoskeletal injury and sleep is known to be an important aspect of injury recovery. However, the effect sleep has on those with CAI as well as its risk for recurrent episodes of giving-way remains unclear. The purpose of this study was to examine the relationship between sleep behaviour and giving-way episodes associated with CAI. Twenty-five participants with CAI (11 M/14 F, age = 22.9 ± 2.7 years, height = 171.9 ± 8.9 cm, mass = 76.7 ± 15.9 kg) were included in this study. All participants completed baseline patient-reported outcome measures and wore a fitness tracker that measured sleep for 1 month. Seven participants had a giving-way (GW, no-giving way = NWG) episode. Those with a giving-way episode spent significantly less time asleep (GW = 325.3 ± 63.2 min, NGW = 413.9 ± 49.5 min, p < 0.001, d = 1.659), less time in bed (GW = 384.9 ± 79.0 min, NGW = 473.1 ± 55.0 min, p = 0.002, d = 1.419), less minutes in REM (GW = 59.9 ± 19.9 min, NGW = 93.5 ± 25.4 min, p = 0.002, d = 1.400) and less minutes in light sleep (GW = 197.6 ± 51.5 min, NGW = 250.2 ± 34.4 min, p = 0.003, d = 1.328) compared to those without. In conclusion, this study shows that individuals with CAI who suffered a giving-way episode had poorer sleep behaviour the night before an episode.

A cross-sectional study on peroneal muscle echogenicity changes and their effects on balance functions in individuals with chronic ankle instability

This study investigated the relationship between peroneal muscle echogenicity and balance function in individuals with chronic ankle instability (CAI). While prior research has examined peroneal muscle activity, reaction time, and balance, the impact of echogenicity-an indicator of myosteatosis/fibrosis-remained underexplored. Cross-sectional study. Sixty-two adults with CAI were included. Peroneal muscle size, echogenicity, and stiffness were assessed using ultrasound. Dynamic balance was evaluated via the Y balance test (YBT), and static postural control was evaluated during lateral step-down (LSDT) and single-leg stance test (SLST). Eversion strength was assessed with a dynamometer. The relationship between muscle characteristics and balance was assessed using canonical correlation and stepwise linear regression. Individuals with increased peroneal muscle echogenicity had reduced muscle size, poorer eversion strength, and poorer balance. Eversion strength is positively associated with YBT scores across all echogenicity levels and negatively associated with posture parameters during the LSDT in moderate echogenicity. Peroneal longus stiffness was positively associated with YBT in severe echogenicity and posture parameters during the SLST. Increased peroneal muscle echogenicity is associated with poorer eversion strength and stiffness, resulting in poorer balance performance. Improving the peroneal muscle quality may enhance functions in the CAI condition.

The Relationship Between the Kinetic Parameters, Electromyography Activity, and Kinesiophobia Among Copers, Chronic Ankle Instability, and Healthy Subjects During Gait Initiation: A Cross-Sectional Study

CONTEXT

Following a lateral ankle sprain, chronic ankle instability (CAI) subjects show recurrent episodes of giving way, while copers do not exhibit giving way and overcome the challenging condition of postural control. During gait initiation (GI), individuals with CAI reveal shorter center of pressure (COP) displacement and earlier muscle activity compared with healthy controls. Copers have not been previously compared with healthy controls and individuals with CAI during GI.

DESIGN

The study design was cross-sectional.

METHOD

Sixty participants (20 CAI, 20 copers, and 20 healthy controls) with a right (dominant) limb injury participated in the study based on inclusion and exclusion criteria. The short form of the Tampa Scale of Kinesiophobia was filled out. Participants performed GI with the nonaffected leg on the force plate that was synchronized with Electromyography Megawin for 2 strides. GI was divided into 3 phases based on COP excursion (S1, S2, and S3). Onset time and electromyography activity of both soleus and tibialis anterior muscles were analyzed along with maximum and mean excursion and velocity of COP excursion in the anterior-posterior and medial-lateral directions and the total phases of GI.

RESULTS

The results indicated that the copers had a significantly higher peak of COP excursion in the medial-lateral direction during S2 (P = .029), S3 (P = .018), and total phases (P = .018) of GI compared with the individuals with CAI. Additionally, individuals with CAI showed earlier activation of the right soleus compared with healthy controls (P = .022). There was a significant difference in short form of the Tampa Scale of Kinesiophobia scores between individuals with CAI and other groups (P < .001).

CONCLUSION

The findings demonstrated that individuals with CAI had earlier soleus activation and supraspinal alteration compared with controls. Copers who had lower Tampa Scale of Kinesiophobia scores exhibited an increased peak of COP excursion in the medial-lateral direction during GI compared with individuals with CAI.

The effect of visual feedback on balance rehabilitation in people with impaired ankle instability: a systematic review and meta-analysis

BACKGROUND

Ankle instability is a consequence of ankle injuries that can impair balance and affect an individual's ability to perform activities of daily living. Consequently, visual feedback is frequently employed in rehabilitation to enhance training outcomes. However, inconsistencies exist in the scientific literature regarding the effect size of visual feedback and the optimal method of delivery.

AIM

The objective of this systematic review and meta-analysis was twofold: firstly, to conduct a comprehensive assessment of the potential impact of visual feedback on balance exercises for individuals with ankle instability; secondly, to quantify the effects of visual feedback on balance in this population.

METHODS

A total of 10 studies were included in this systematic review and meta-analysis. The review was conducted in accordance with the PERSiST (Implementing Prisma in Exercise, Rehabilitation, Sport Medicine, and Sports Science) guidance. The research was conducted using four databases and was required to be written in English. Additionally, the studies had to involve the provision of visual feedback during balanced rehabilitation.

RESULTS

The provision of visual feedback has been demonstrated to enhance the efficacy of rehabilitation programs designed to improve balance. Improvement in static, dynamic, and perceptual balance during balance training. The provision of visual feedback was found to simultaneously increase the subjects' subjective motivation to train and their satisfaction and enjoyment of the rehabilitation training. The results demonstrated that visual feedback improved the Foot and Ankle Ability Measure by approximately 17% (MD = 2.42, 95%CI = 0.72 to 4.12, I²[total] = 0%). Additionally, the provision of visual feedback during the training cycle may positively affect the star excursion balance test (SEBT) (MD = 4.83, 95%CI = 3.09 to 6.56, I²[total] = 21%). Moreover, the Biodex system is expected to demonstrate notable improvements in measures of balance (MD = 0.14, 95% CI = 0.01 to 0.28, I²[total] = 24%).

CONCLUSION

The provision of visual feedback in the context of balance rehabilitation has been demonstrated to facilitate beneficial adaptations to balance in individuals presenting with ankle instability. The research included in our analysis demonstrates the positive impact of visual feedback, with nearly all results exhibiting superior outcomes relative to those observed in the absence of visual feedback. Visual feedback can be employed as an "additive" or alternative to conventional rehabilitation for individuals with ankle instability.

Effects of differing platform orientations on forefoot and hindfoot kinematics in chronic ankle instability during single leg landing

OBJECTIVES

To investigate how modifiable landing platforms influence intra-foot movement during single-leg landings, comparing forefoot and hindfoot kinematics between individuals with chronic ankle instability (CAI) and controls to inform segment-focused rehabilitation strategies.

DESIGN

Cross-sectional.

SETTING

Biomechanics laboratory.

PARTICIPANTS

20 university students, 12 with CAI, 8 controls.

MAIN OUTCOME MEASURES

Participants performed single-leg landing on platforms with three orientations (inverted, plantarflexed-everted-abducted and dorsiflexed-inverted-adducted), and four inclinations (10°, 12°, 14°, 16°). These configurations were based on prior studies and safety limits. Net frontal-plane movement of the forefoot and hindfoot was calculated across a 400ms window.

RESULTS

The CAI group showed significantly greater forefoot inversion (η2 = 0.32; p < 0.01) and non-significant group difference in hindfoot eversion (ƞ2 = 0.183; p = 0.06). Orientation and inclination had large effects on forefoot motion (η2 = 0.56 and 0.80, respectively; p < 0.001). A significant group × segment interaction (η2 = 0.24; p < 0.001) indicated contrasting movement between the forefoot and hindfoot in CAI, not observed in controls.

CONCLUSION

Individuals with CAI demonstrated a less adaptive, segment-specific landing strategy. Findings support the use of modifiable platforms and multi-segment foot models to guide targeted interventions addressing forefoot compensation and improving segmental control during landing.

Does involvement of the anterior syndesmosis affect the functional outcome of acute ligamentous ankle injuries?

PURPOSE

To compare patient-reported outcomes between acute ligamentous ankle injuries 1) without anterior syndesmosis involvement and 2) with anterior syndesmosis involvement (without clinical instability).

STUDY DESIGN

Prospective cohort study.

METHODS

Between September 2016 and December 2020 all athletes (≥18) with an acute ankle injury presenting within 7 days post-injury were screened for eligibility. Athletes were excluded if imaging demonstrated a frank fracture or 3T magnetic resonance imaging could not be acquired within 10 days post-injury. Athletes with unstable syndesmosis injuries or athletes who underwent surgery within 1-year post-injury were excluded. Athletes underwent criteria-based rehabilitation and functional outcomes (Karlsson & Peterson score, Foot and Ankle Outcome Score) were assessed at 6 weeks, 6 months, and 1 year.

RESULTS

A total of 94 athletes were included. In 28 athletes (30 %) the anterior syndesmosis was injured. In the first six weeks post-injury, median Karlsson & Peterson score improved from 37 (interquartile range 20.5-49) to 80 (interquartile range 70-90) for the group without involvement versus 35 (interquartile range 25-62) to 82 (interquartile range 72-87) for the group with involvement. FAOS sports improved similarly in both groups. No statistically significant between group differences in functional outcome scores were observed at six weeks, six months and 1 year follow-up.

CONCLUSIONS

In athletes, acute ligamentous ankle injuries with involvement of the anterior syndesmosis ligament (without clinical instability) are not associated with worse functional outcome at 6 weeks, 6 months, and 1-year post-injury compared to acute ligamentous ankle injuries without involvement.

Ultrasound-guided repair of the anterior talofibular ligament with or without Gould augmentation is safe and improves clinical outcomes for chronic lateral ankle instability: A case series of 49 patients

OBJECTIVES

We have previously shown that ultrasound-guided repair results in an accurate anchor placement and restores ankle joint stability using cadaveric models. The objective of this study is to assess the safety and clinical outcomes of ultrasound-guided anterior talofibular ligament (ATFL) repair with or without augmentation.

METHODS

Forty-nine patients with chronic lateral ankle instability underwent ultrasound-guided ATFL repair with or without augmentation. Following the procedure, patients completed a standardized postoperative rehabilitation protocol. The primary outcome was the complication rate in 49 patients. The clinical outcomes were analyzed as a secondary outcome for 28 patients (20 athletes and 8 nonathletes) after excluding 21 patients with such concomitant injuries that could affect clinical course. These included (1) the Numerical Rating Scale (NRS) for pain, (2) Foot and Ankle Outcome Score (FAOS), (3) Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale (a Japanese equivalent of the American Orthopedic Foot and Ankle Society Ankle-Hindfoot score), and (4) Self-Administered Foot Evaluation Questionnaire Sports (SAFE-Q Sports) score at baseline, 3 months, and 6 months.

RESULTS

The overall complication rate was 2.0%, with one superficial peroneal nerve irritation out of 49 cases, which was improving at 6 months. All 4 clinical outcome scores resulted in statistically significant improvement at 6 months. NRS decreased from 3.6 ​± ​2.1 at the baseline to 1.3 ​± ​1.6 (p ​< ​0.001, Student's t-test). FAOS increased from 74.7 ​± ​11.9 to 93.4 ​± ​8.1 (p ​< ​0.001). JSSF scale increased from 56.9 ​± ​15.1 to 90.9 ​± ​10.2 (p ​< ​0.001). All 20 athletes returned to sports at a preinjury level, and their SAFE-Q sports activity scores increased from 40.7 ​± ​17.6 to 90.6 ​± ​0.2 (p ​< ​0.001).

CONCLUSION

Ultrasound-guided ATFL repair with or without augmentation for chronic lateral ankle instability is safe and results in clinical improvement at 6 months.

EVIDENCE LEVEL

IV.

Effect of internal rotation of the hindfoot on diagnosis of anterior talofibular ligament injury: An in vitro simulation study

BACKGROUND

The anterior drawer test of the ankle is widely used to diagnose anterior talofibular ligament injuries caused by ankle sprains; however, low sensitivity has been reported. The braking effect of the deltoid ligament is likely responsible for this low sensitivity. This study aimed to examine the effect of consistent and mandated internal rotation of the hindfoot, which leads to relaxation of the deltoid ligament, on the conventional anterior drawer test.

METHODS

Seven cadaveric ankle specimens were subjected to quantitative analysis with a stretchable strain sensor at 30° plantarflexion, with or without 10° internal rotations, under accurate three-axial joint angle monitoring using inertial measurement units. The anterior drawer distance (mm) was calculated from the measured change in the capacitance value (picofarad) detected using the stretchable strain sensor and compared with that measured with the anterior talofibular ligament detached.

FINDINGS

A two-way repeated measures analysis of variance and post-hoc pairwise analysis revealed that the anterior drawer test with internal rotation revealed a significantly greater mean value than the conventional anterior drawer test (4.7 ± 1.6 mm vs. 2.2 ± 1.5 mm) in anterior talofibular ligament-detached samples (P < 0.001). The capacitance data revealed an intraclass correlation coefficient (1,1) of 0.903.

INTERPRETATION

Present findings suggest that our modified anterior drawer test with consistent and mandatory internal rotation, prevents the braking effect of the deltoid ligament and is expected to improve the sensitivity in assessing anterior talofibular ligament injuries.

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.

Risk Factors of Ankle Sprain in Soccer Players: A Systematic Review and Meta-Analysis

BACKGROUND

Soccer is associated with substantial injury risk, with reported between 13 to 35 injuries per 1000 player-hours of competitive play. Notably, approximately 77% of soccer-related ankle injuries are attributed to ankle sprain injuries (ASIs). ASI can lead to chronic ankle instability, obesity, and post-traumatic osteoarthritis. This study focuses on identifying factors such as gender, age, body mass index (BMI), and a history of ASIs, which contribute to the development of ASI in soccer players.

METHODS

A systematic literature search was conducted in October 2023 across databases, including PubMed, Web of Science, Scopus, Cochrane Library, and ProQuest, without applying any filters. Keywords included ankle, ankle joint, sprain, risk factors, etc. Data extraction was performed on the included studies, with findings standardized and analyzed using Stata Statistical Software: Release 17 to determine a weighted treatment effect.

RESULTS

Our systematic review included 26 studies. The meta-analysis revealed that a history of ankle sprain is the most significant risk factor for future ASIs. BMI emerged as a risk factor in three out of seven studies, while age and height were significant in one out of six studies each. Gender and weight were not found to significantly affect ASI occurrence. Other factors identified but not subjected to a meta-analysis due to methodological heterogeneity or insufficient studies included playing surface, joint laxity, muscle weakness, match congestion, strength asymmetries, ground reaction forces, balance maintenance, skill level, and playing position.

CONCLUSIONS

This research contributes valuable insights into the prevention of ASIs in soccer, highlighting the importance of previous ankle sprains and playing surface quality. These findings assist sports professionals in developing optimal conditions and strategies for effective ankle sprain prevention.

New insights into chronic ankle instability: an in vivo evaluation of three-dimensional motion and stability of the ankle joint complex

Introduction

Chronic ankle instability (CAI) is generally associated with repetitive ankle sprains with concomitant ligament injuries and abnormal joint motion, which affects the stability of the joint. This study aims to quantify and compare the 3D motion differences in the ankle joint complex (AJC) during walking between CAI patients and healthy controls and to analyze the effect of CAI on the vertical ground reaction force (vGRF) and center of pressure (COP) distribution.

Methods

Fifteen CAI patients (6 males, 9 females; height 165 ± 3.8 cm; weight 68.5 ± 10.2 kg; BMI 21.6 ± 3.5 kg/m2) with anterior talofibular and calcaneofibular ligament sprains and fifteen healthy participants (8 males, 7 females; height 168 ± 4.2 cm; weight 74.5 ± 12.6 kg; BMI 22.3 ± 4.2 kg/m2) participated in this study. Dynamic biplanar radiography were used to analyze the 3D motion and stability of the ankle joint complex during the stance phase. Synchronous force plate data were used to assess vGRF and COP trajectories.

Results

Compared to controls, CAI patients showed increased plantarflexion (1.3°), internal rotation (2.0°), and medial translation (0.6 mm) in the tibiotalar joint, along with decreased dorsiflexion (3.0°). For the subtalar joint, plantarflexion decreased (1.8°), and external rotation increased (0.9°). The tibio-calcaneal joint showed increased internal rotation (1.9°) and posterior translation (0.5 mm). Stability differences included more dispersed axes of rotation and greater spatial motion volumes of landmarks in the CAI group. Additionally, CAI patients exhibited greater peak vGRF with earlier peaks, higher loading rates, and more lateral and unstable COP trajectories.

Conclusion

These findings reveal that CAI not only alters the 3D motion and stability of the AJC but also affects foot-ground interaction forces, such as vGRF and COP distribution, during walking. This study provides critical insights into the altered biomechanics of the AJC in CAI patients and contributes to the clinical diagnosis of CAI and evaluation of results from surgical or conservative intervention.

Examining prior injury relative to Achilles tendon ruptures in National Basketball Association players

The purpose of this study is to examine Achilles Tendon (AT) rupture and prior injury in the National Basketball Association (NBA). Publicly available data was sourced via two online databases and filtered to identify those reported as having sustained AT rupture. A full injury history was then generated for those players. A total of 51 AT ruptures were identified. Thirty-five per cent (18) had previously missed at least one game for "Achilles tendinitis" or "Achilles tendon injury" on the side of the affected limb. A further 18% were noted to have suffered plantar fasciitis or foot inflammation (9) or previous ankle injury (9). Seven previous injuries were knee related, and five were described as calf muscle injuries. The remaining three had prior soft tissue injuries to the quadriceps, hamstring or groin. Understanding any potential association between previous small time-loss injuries and large time-loss injuries such Achilles tendon ruptures is an important step in advancing injury risk mitigation strategies in professional basketball.

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.

Injury risk reduction programs including balance training reduce the incidence of anterior cruciate ligament injuries in soccer players: a systematic review and meta-analysis

BACKGROUND

Anterior cruciate ligament (ACL) injuries are exceedingly common among soccer players and severely impact their careers and health. This study evaluates the effects of injury risk reduction programs, including balance training exercises, on the incidence of ACL injuries in soccer players through a meta-analysis. The aim is to promote the health of soccer players, enhance their athletic performance, and provide valuable insights for further research in the field of sports medicine.

METHODS

This study strictly adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted through PubMed, EBSCO, and Web of Science databases, covering all entries from the inception of the databases until February 2024.

RESULTS

Eligible studies were individually assessed using the Cochrane Risk of Bias Tool version 2, and the quality of the evidence obtained was rigorously evaluated using the GRADE approach. Data analysis and processing were performed using Stata 18 software. Eight studies were ultimately selected for inclusion in the meta-analysis, encompassing 20,336 participants and 1,512,099 exposure hours, with 190 cases of ACL injuries identified among soccer players. The pooled results indicated that, compared to the control group, groups using injury risk reduction programs that included balance training had a 58% reduction in the overall rate of ACL injuries per 1,000 exposure hours (IRR 0.42, 95% CI: 0.27 to 0.66). The overall study heterogeneity was low, with an I2value of 33.3% and a P-value of 0.186. Subgroup analyses showed that in trials involving male participants, the rate of ACL injuries per 1,000 exposure hours was reduced by 50% compared to the control group (IRR 0.50, 95% CI: 0.29 to 0.88), with an I2 value of 44.8% and P = 0.178. In trials involving female participants, ACL injuries were reduced by 61% (IRR 0.39, 95% CI: 0.24 to 0.62), with an I2 value of 42.5% and P = 0.157. In trials with participants training less than three times per week, ACL injuries were reduced by 43% per 1,000 exposure hours compared to the control group (IRR 0.57, 95% CI: 0.35 to 0.93), with an I2 value of 0.00% and P = 0.727. In trials with participants training three times or more per week, ACL injuries were reduced by 57% (IRR 0.43, 95% CI: 0.21 to 0.88), with an I2 value of 28.2% and P = 0.238. In trials with participants training for 20 min or more per week, the rate of ACL injuries per 1,000 exposure hours was reduced by 50% compared to the control group (IRR 0.50, 95% CI: 0.26 to 0.93), with an I2 value of 1.2% and P = 0.363. In trials with participants training less than 20 min per week, ACL injuries were reduced by 46% (IRR 0.54, 95% CI: 0.33 to 0.91), with an I2 value of 0.00% and P = 0.544.

CONCLUSION

In summary, injury risk reduction programs that include balance training significantly reduce the risk of ACL injuries in soccer players. The reduction in injuries is more pronounced in female athletes, and high-frequency training along with longer-duration interventions further enhance the preventative effects.

Chronic Pain Influences Lower Extremity Energetics During Landing Cutting in Patients With Chronic Ankle Instability

CONTEXT

Chronic ankle instability (CAI) patients exhibit altered movement patterns during jump landing/cutting movements. Persistent pain is one of the residual symptoms that may affect movements. Calculating joint energetics affected by chronic pain offers a novel method to understand how chronic pain influences energetics of lower extremity joints in CAI patients.

OBJECTIVE

To identify the effects of chronic pain on lower extremity energy dissipation and generation during jump landing and cutting in patients with CAI.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Fifteen CAI patients with higher pain (6 men and 9 women; age = 22.1 ± 2.1 years, height = 1.74 ± 0.09 m, mass = 71.3 ± 10.6 kg, pain = 66.9 ± 9.4), 15 patients with CAI and lower pain (6 men and 9 women; age = 22.3 ± 2.1 years, height = 1.74 ± 0.08 m, mass = 70.1 ± 10.7 kg, pain = 89.3 ± 2.6), and 15 healthy control individuals (6 men and 9 women; age = 21.3 ± 1.7 years, height = 1.73 ± 0.08 m, mass = 70 ± 10.3 kg, pain = 100 ± 0).

MAIN OUTCOME MEASURE(S)

Ground reaction force data were collected during 5 trials of maximal jump landing/cutting tasks. Joint power was defined as the product of angular velocity and joint moment. Energy dissipation and generation by the ankle, knee, and hip joints were calculated by integrating regions of the joint power curve.

RESULTS

CAI patients with higher pain displayed less ankle energy dissipation (P = .013 and P = .018) and generation in the ankle (P = .002 and P = .028) than CAI patients with lower pain and healthy control individuals during the jump landing/cutting phase. CAI patients with higher pain showed more hip energy generation than CAI patients with lower pain (P = .038) and healthy control individuals (P = .013) during the cutting phase.

CONCLUSIONS

CAI patients with higher pain changed both energy dissipation and generation in the lower extremities, reducing the burden of the ankle joint during jump landing/cutting and having a hip-dominant compensatory strategy during the cutting phase. Our results suggest that chronic pain could be one of the factors that affect motor strategies in the CAI population.

How do neuromuscular characteristics of the peroneal muscles differ in adults with and without chronic ankle instability? A systematic review with meta-analysis

BACKGROUND

Chronic ankle instability (CAI) has been associated with neuromuscular control dysfunction, particularly of the peroneal musculature.

RESEARCH QUESTION

How do neuromuscular characteristics of the peroneal muscles, including corticospinal excitability, strength, proprioception (force sense) and electromyographic measures differ in individuals with CAI compared to healthy control counterparts aged 18-45?

METHODS

A systematic review with meta-analysis was conducted by retrieving relevant articles from electronic databases including EBSCOhost (CINAHL Complete, AMED, SPORTDiscus), Ovid (MEDLINE, Embase), Web of Science, Scopus and Cochrane Library as well as Grey literature sources. The eligibility and methodological quality of the included case-control and cross-sectional studies were assessed by two reviewers. The random effects model and the standard mean difference with a 95 % confidence interval were utilised to calculate pooled estimates of the overall effect size.

RESULTS

Of the total 13,670 studies retrieved, 42 were included in the systematic review. Of these, 25 were eligible for the meta-analyses. Two of the meta-analyses, each consisting of two studies, showed less evertor force sense accuracy at 10 % (d=0.50, p = 0.03) and 20 % of maximum voluntary isometric contraction (d=1.14, p < 0.00001) in individuals with CAI than the control group. In addition, another meta-analysis of two studies showed that the CAI population had longer peroneus longus latency (d=1.69, p < 0.0001) than the control group during single-leg landing inversion perturbation test under unexpected conditions.

SIGNIFICANCE

Individuals with CAI showed specific sensorimotor impairments in evertor force sense accuracy and peroneus longus latency, which may indicate that neuromuscular dysfunction of the peroneal muscles is associated with the underlying mechanisms of the CAI pathogenesis. However, the meta-analyses are limited by the inclusion of only two studies with small sample sizes. Therefore, these findings should be cautiously interpreted, and further research is required to validate them.

Conceptual modeling of structural malalignments and ankle joint contact forces during walking

BACKGROUND

Structural malalignments, such as talar malalignments and hindfoot varus, are hypothesized to contribute to early ankle joint degeneration by altering joint contact force (JCF). These malalignments, common in individuals with chronic ankle instability (CAI), can modify the articular geometry of the ankle joint, potentially leading to abnormal joint loading patterns. This study leverages musculoskeletal modeling and simulation to conceptualize the effects of increasing severity of these malalignments on ankle JCF during walking.

RESEARCH QUESTION

Using a theoretical framework based on biomechanical principles, how do increasing talar malalignments and rearfoot varus, as seen in CAI patients, influence ankle JCF during walking?

METHODS

A conceptual musculoskeletal modeling approach was employed to simulate the effects of structural alterations on ankle JCF in uninjured individuals. Using an instrumented treadmill, musculoskeletal modeling was used to estimate the effects of increasing talar positional malalignments and/or rearfoot varus, both in isolation and in combination, on ankle JCF during the stance phase of walking. Variables included peak, impulse, and loading rates for compressive, posterior shear, and lateral shear JCF.

RESULTS

Anterior translation and internal rotation of the talus significantly increased lateral shear JCF, while an increase in rearfoot varus decreased lateral shear JCF (p < 0.01). However, combining modifications of the talus and rearfoot varus had no significant effects on ankle JCF.

SIGNIFICANCE

This conceptual analysis highlights the effectiveness of musculoskeletal modeling in providing theoretical insights into how CAI-related structural malalignments affect ankle joint loading during walking. Talar positional malalignments increase lateral shear loading, whereas rearfoot varus reduces lateral shear loading. The effects of these structural alterations on lateral shear JCF counterbalance each other, highlighting the need to consider other factors of CAI to more accurately reflect the ankle JCF in those with CAI.

Physical Therapy Intervention Effects on Alteration of Spinal Excitability in Patients With Chronic Ankle Instability: A Systematic Review and Meta-analysis

CONTEXT

Chronic ankle instability (CAI) is a common injury in athletes. Different forms of physical therapy have been applied to the population with CAI to assess their impact on spinal excitability.

OBJECTIVE

The purpose of this systematic review and meta-analysis was to investigate the effectiveness of various physical therapy interventions on the alteration of spinal excitability in patients with CAI.

DATA SOURCES

Four databases (EMBASE, MEDLINE, Cochrane CENTRAL, and Scopus) were searched from inception to November 2022.

STUDY SELECTION

A total of 253 studies were obtained and screened; 11 studies on the effects of physical therapy intervention on the alteration of spinal excitability in patients with CAI were identified for meta-analysis.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 3a.

DATA EXTRACTION

A total of 11 studies that included the maximal Hoffmann reflex normalized by the maximal muscle response (H/M ratio) in the peroneus longus and soleus muscles were extracted and summarized. The quality of the studies was assessed using the PEDro scale.

RESULTS

The extracted studies had an average PEDro score of 4.7 ± 1.4, indicating that most of them had fair-to-good quality. The physical therapy interventions included cryotherapy, taping, mobilization, proprioceptive training, and dry needling. The overall effects showed that the H/M ratios of the peroneus longus (P = 0.44, I2 = 0%) and soleus (P = 0.56,I2 = 22%) muscles were not changed by physical therapy in patients with CAI.

CONCLUSION

The meta-analysis indicated that physical therapy interventions such as cryotherapy, taping, mobilization, proprioceptive training, and dry needling do not alter the spinal excitability in patients with CAI. Given that only 1 study reported ineffective changes in spinal excitability with dry needling, more research is essential to establish and validate its efficacy.

PROSPERO REGISTRATION

CRD42022372998.

Toe-out landing reduces anterior talofibular ligament strain while maintains calcaneofibular ligament strain in people with chronic ankle instability

BACKGROUND

The anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) are vulnerable to be torn or ruptured during lateral ankle sprain (LAS), especially in people with chronic ankle instability (CAI). This study aims to determine whether landing with a larger toe-out angle would influence ATFL and CFL strains in people with CAI, aiming to contribute to the development of effective landing strategies to reduce LAS risk.

METHODS

Thirty participants with CAI (22 males and 8 females, age: 21.6 ± 1.5 years, height: 175.3 ± 7.1 cm, body mass: 70.8 ± 7.1 kg, mean ± SD) were recruited. Each participant landed on a specialized trap-door device with their unaffected limbs on a support platform and their affected limbs on a movable platform, which could be flipped 24° inward and 15° forward to mimic LAS conditions. Two landing conditions were tested-i.e., natural landing (NL, with natural toe-out angle at landing) and toe-out landing (TL, with toe-out angle increased to over 150% of that under the NL conditions). Kinematic data were captured using a 12-camera motion analysis system, and ATFL and CFL strains were calculated using a 3D rigid-body foot model. Paired sample t tests and Pearson's correlations were used to analyze data.

RESULTS

Compared to NL conditions, ATFL strain decreased (p < 0.001, d = 2.42) while CFL strain remained unchanged (p = 0.229, d = 0.09) under TL conditions. The toe-out angle was negatively and strongly correlated with ATFL strain (r = -0.743, p < 0.001) but not with CFL strain (r = 0.153, p = 0.251). Compared to NL conditions, participants exhibit a lower ankle inversion angle (p < 0.001, d = 0.494), a higher plantarflexion angle (p < 0.001, d = 1.101), and no significant difference in external rotation angle (p = 0.571, d = 0.133) under TL conditions.

CONCLUSION

Toe-out landing may reduce ATFL strain while maintaining CFL strain in people with CAI, thereby reducing the risk of LAS.

Time-loss and recurrence rate of lateral ankle sprains in male professional football players depending on the severity grade: do we trivialise LAS?

Objectives

Lateral ankle sprains (LAS) are among the most common injuries in professional football (soccer). Despite this, the severity and possible long-term consequences of LAS remain trivialised. This multicentre observational study in German elite football provides insights into time-loss and recurrence rates after LAS. Time-loss and recurrence rates are outcome measures vital for the future evaluation of rehabilitation protocols.

Methods

798 male football players representing 34 teams from 13 professional German football clubs participated in this study during the 2021-2022 season, followed by a 12-month follow-up period. Data collection and reporting were carried out in accordance with the UEFA recommendations for the standardised collection of data on football injuries. Time-loss, recurrence rate and standardised severity grades (I-III) after LAS were recorded for professionals, U23, U19 and U17, respectively.

Results

A total of 187 ankle injuries were reported, with 115 out of the total being analysed. The overall time-loss was 29.89 days, with significant differences between youth elite players and professionals (32.96 vs 15.53 days lost; p<0.001). Professional players demonstrated the shortest time-loss in all LAS injury grades. Time-loss decreased with advancing age (R 2=0.03, F(1, 106)=3.16, p=0.078). Grade I LAS's time-loss differs significantly from grades II and III (p<0.001). A recurrent LAS was recorded in 34 players. The overall LAS recurrence rate was 25.6%.

Conclusion

This study provides data on time-loss and recurrence, which serve as reference values for future evaluation of rehabilitation concepts after LAS in elite football players.

Injury risk factors and their priority for mitigation in women's netball: a systematic review and Delphi consensus

This study aimed to establish consensus on injury risk factors in netball via a combined systematic review and Delphi method approach. A systematic search of databases (PubMed, Scopus, MEDLINE, SPORTDiscus and CINAHL) was conducted from inception until June 2023. Twenty-four risk factors were extracted from 17 studies and combined with a three-round Delphi approach to achieve consensus. In round one, experts listed perceived risk factors for injury in netball which were combined with the risk factors identified via the systematic review. In round two and round three, experts rated their level of agreement with each risk factor on a 5-point Likert scale (1, strongly disagree to 5, strongly agree). Consensus was defined as ≥80% agreement (with<10% in disagreement). In round three, experts also rated the priority for mitigating the risk factor (1, very low to 5, very high). Nineteen experts participated in round one and round two, and 16 participated in round three (response rate 84%). One-hundred and nine risk factors for injury were identified by the systematic review and experts combined. Sixty-one risk factors reached consensus, categorised into five groups: 'individual characteristics' (n=22), 'lifestyle' (n=11), 'training and competition' (n=14), 'sport science and medical provision' (n=6) and 'facilities and equipment' (n=8). 'Poor landing technique/mechanics' had a median (IQR) mitigation priority rating of 5 (1), while all others had median ratings of 3-4.5. This study identifies a range of risk factors for injury, provides focus areas for injury prevention and highlights the importance of a multidisciplinary approach to injury mitigation in netball.

Factors contributing to chronic ankle instability in parcel delivery workers based on machine learning techniques

BACKGROUND

Ankle injuries in parcel delivery workers (PDWs) are most often caused by trips. Ankle sprains have high recurrence rates and are associated with chronic ankle instability (CAI). This study aimed to develop, determine, and compare the predictive performance of statistical machine learning models to classify PDWs with and without CAI using postural control, ankle range of motion, ankle joint muscle strength, and anatomical deformity variables.

METHODS

244 PDWs who had worked in parcel delivery for more than 6 months were screened for eligibility. Thirteen predictors were included in the study: 12 numeric (age, body mass index, work duration, the number of balance retrials eyes-closed single-limb stance, Y-balance test, ankle dorsiflexion range of motion, lunge angle, strength ratio of the evertor in plantar flexion and neutral position to the invertor, ankle dorsiflexor strength, navicular drop, and resting calcaneal stance position) and one categorical (success of the eyes-closed single-limb stance). Five machine learning algorithms, including LASSO logistic regression, Extreme Gradient boosting machine, support vector machine, Naïve Bayes machine, and random forest-were trained.

RESULTS

The support vector machine and random forest models confirmed good predictive performance in the training and test datasets, respectively, for PDWs. For the Shapley Additive Explanations, among the five machine learning models, the variables entered into three or more models were low ankle dorsiflexion range of motion, low lunge angle, high body mass index, old age, a high number of balance retrials of the eyes-closed single-limb stance, and low strength ratio of the evertor in the neutral position to the invertor.

CONCLUSION

Our approach produced machine learning models to classify PDWs with and without CAI and confirmed good predictive performance in PDWs.

Clinical outcomes of all-inside arthroscopic lateral ankle ligament reconstruction for chronic lateral ankle instability: A prospective series with minimum 12 month outcomes

BACKGROUND

Chronic lateral ankle instability (CAI) is a common condition that can be effectively treated with lateral ankle ligament reconstruction to restore ankle stability and function. The aim was to assess the functional outcomes of arthroscopic lateral ligament reconstruction using the Manchester-Oxford Foot Questionnaire (MOXFQ), Visual Analog Score (VAS) and Euroqol-5D-5L (EQ-5D) patient-reported outcome measures (PROMs).

METHODS

This prospective series included 36 consecutive patients who underwent isolated arthroscopic lateral ligament reconstruction for CAI between November 2020 and November 2022 with minimum 12-month follow up. All patients completed the MOXFQ, VAS, and EQ5D PROMs preoperatively, and a minimum of 12 months postoperatively. The MOXFQ is a foot and ankle-specific PROM that assesses foot and ankle function, the VAS measures pain and the EQ5D evaluates general health-related quality of life.

RESULTS

Patients were followed up for 12-25 months. In all patients, there was significant improvement in all postoperative PROMs (p < 0.05). The MOXFQ index decreased from 59.1 ± 19.2-13.5 ± 18.1 (p < 0.01), EQ-5D index increased from 0.607 ± 0.224-0.854 ± 0.175 (p < 0.01) and VAS pain decreased from 36.6 ± 22.3-13.6 ± 18.4 (p < 0.01).A total of 6 patients(16.3 %) were lost to follow up and mean follow-up time was 1.63 ± 0.54 years.

CONCLUSION

Arthroscopic lateral ankle ligament reconstruction is an effective treatment for chronic ankle instability, with significant improvements in clinical and health-related quality of life outcomes.

LEVEL OF EVIDENCE

IV.

Kinematic and kinetic characteristics of individuals with coping lateral ankle sprain during landing and walking/running tasks: A systematic review with meta-analysis

BACKGROUND

We aimed to synthesize the kinematics and kinetics during landing and walking/running tasks of ankle copers compared with patients with chronic ankle instability and controls.

METHODS

We systematically searched PubMed, CINAHL, SPORTDiscus, and Web of Science. Tri-planar lower extremity biomechanics (joint angle and moment at maximum and initial contact, and joint displacement) were synthesized using standard mean difference and 95 % confidence intervals. We assessed methodological quality, study heterogeneity, and publication bias.

FINDINGS

We identified 13 studies. Pooled evidence indicated that copers had less inversion and eversion angles, and ankle frontal displacement during landing compared with patients with chronic ankle instability (|standard mean difference| 0.31-0.40). Copers revealed greater dorsiflexion, plantarflexion, and ankle sagittal displacement during landing and less plantarflexion moment during walking than patients with chronic ankle instability (|standard mean difference| 0.29-0.46); however, most ankle biomechanics of copers were not significantly different from those of controls. In the proximal joints, copers revealed less knee valgus angle at maximum and initial contact (|standard mean difference| 0.25-0.33); and less hip flexion angle at maximum and initial contact, hip external rotation angle and sagittal and frontal displacement during landing (standard mean difference 0.49-0.73) than patients with chronic ankle instability. Copers had less hip extension moment during walking and greater maximum hip adduction angle during landing than controls (|standard mean difference| 0.66-0.77).

INTERPRETATIONS

Our results provide insight into the lower extremity biomechanics of copers during dynamic tasks, contributing injury coping mechanisms and developing rehabilitation programs to return to sports.

Medicaid Patients Face Limited Access to Care for Ankle Sprains in Unexpanded States

PURPOSE

Our goal was to determine whether state Medicaid expansion and patient insurance statuses affected access to care for ankle sprain patients.

METHODS

Four pairs of Medicaid expanded (Kentucky, Louisiana, Iowa, and Arizona) and unexpanded (North Carolina, Alabama, Wisconsin, and Texas) states were chosen. Twelve practices from each state (N = 96) were randomly selected from the American Orthopaedic Foot and Ankle Society (AOFAS) directory and called twice to request an appointment for a fictitious 16-year-old with a first-time ankle sprain using either Medicaid insurance or Blue Cross Blue Shield (BCBS) private insurance.

RESULTS

An appointment was obtained at 65.6% clinics when calling with BCBS and at 45.8% with Medicaid (P =.006). There was a significant difference in successful scheduling based on insurance status in Medicaid unexpanded states (P = .007). In all states except Iowa, there were more appointments scheduled using BCBS than with Medicaid. The 3 main reasons for appointment denial were inability to provide an insurance identification number (47.1%), insurance status (23.5%), and whether the patient was referred (17.6%). The waiting period for an appointment did not differ by Medicaid expansion or insurance statuses.

CONCLUSION

For patients with first-time ankle sprains, access to care is more difficult using Medicaid insurance rather than private insurance, especially in Medicaid unexpanded states.

LEVEL OF EVIDENCE

Level II prospective cohort study.

Muscle mechanics and energetics in chronic ankle instability and copers during landing: Strategies for adaptive adjustments in locomotion pattern

Individuals with chronic ankle instability (CAI) and copers typically exhibited aberrant landing kinematics. Altered kinematics might lead to changes in muscle loading, potentially affecting the energy demand of locomotion. Understanding alterations in muscle mechanics and energetics during landing could enhance the rehabilitation program design. Therefore, the objective of this study was to explore the muscle mechanics and energetics of individuals with CAI, copers, and healthy controls during single leg jump landing. Three groups, CAI, copers, and healthy individuals (total n = 66), performed the landing task, and data on 3D motion capture, ground reaction force (GRF), and muscle activation were simultaneously collected. A musculoskeletal model was applied to estimate muscle force and mechanical power. Compared to healthy groups, individuals with CAI showed increased peak muscle forces in the gluteus maximus (p < 0.001), gluteus medius (p < 0.001), vastus lateralis (p < 0.001), and peroneus longus (p < 0.001) during landing. Whereas copers exhibited higher peak muscle forces in the vastus lateralis (p < 0.05), medial gastrocnemius (p < 0.05), soleus (p < 0.05), and peroneus longus (p < 0.001). Additionally, negative mechanical power redistribution in CAI shifted from the ankle to the hip (p < 0.001), while copers exhibited a similar redistribution from the ankle to the knee (p < 0.05). This study suggested that both CAI and copers exhibit biomechanical modifications in proximal joints. Copers showed a novel landing strategy aimed for enhancing landing stability, but with the risk of ACL injury. The identified energy redistribution observed in both CAI and copers could potentially contribute to the recurrent ankle sprains. This research facilitates a better understanding of how muscle mechanics and energy demands influence the landing pattern in individuals with CAI and copers.

Postural stability measures as diagnostic tools for chronic ankle instability: a comprehensive assessment

BACKGROUND

Chronic ankle instability (CAI) is characterized by recurrent sprains and persistent symptoms, which impair postural control. This study evaluates the diagnostic utility of various linear and nonlinear postural stability measures in distinguishing individuals with CAI from healthy controls.

METHODS

Postural stability was assessed in 24 participants (12 with CAI and 12 healthy controls) using a force platform under four conditions: hard surface with eyes open, hard surface with eyes closed, soft surface with eyes open, and soft surface with eyes closed. Linear measures of center of pressure (COP) included range in the anteroposterior (Rfa) and mediolateral (Rsw) directions, mean velocity (MV), and sway area. Nonlinear measures included approximate entropy (ApEn), the largest Lyapunov exponent, and correlation dimension (CD) with its standard deviation. Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) analysis to determine cutoff scores, allowing effective differentiation between CAI and healthy participants.

RESULT

AI individuals exhibited increased mediolateral COP sway and higher mean velocity on hard surfaces with both eyes open and closed. On soft surfaces with eyes closed, they showed significant deficits in sway area and mean velocity, reflecting challenges in postural control. ROC analysis revealed that certain linear and nonlinear measures showed strong diagnostic accuracy in distinguishing individuals with CAI from healthy controls. Nonlinear analysis revealed elevated ApEn and reduced CD in CAI participants, indicating greater postural irregularity and reduced dynamic stability. On a hard surface with eyes open both Rsw (cutoff: 1.18 cm, OR: 4.55) and ApEn (cutoff: 0.07, OR: 4.0) were particularly strong diagnostic indicators.

CONCLUSION

Linear and nonlinear postural stability measures effectively differentiate individuals with CAI from healthy controls. Key metrics, including Rsw, MV, ApEn, and CD, offer strong diagnostic value for early detection and personalized rehabilitation. Incorporating these measures into clinical practice may improve CAI management and patient outcomes.

ETHICAL CODE

IR.TUMS.FNM.REC.1400.236. March 14, 2022.

Foot tissue stress in chronic ankle instability during the stance phase of cutting

Lower limb biomechanics of chronic ankle instability (CAI) individuals has been widely investigated, but few have evaluated the internal foot mechanics in CAI. This study evaluated bone and soft tissue stress in CAI contrasted with copers and non-injured participants during a cutting task. Integrating scanned 3D foot shapes and free-form deformation, sixty-six personalized finite element foot models were developed. Computed Achilles tendon forces and measured regional plantar pressure were applied as boundary loading conditions for simulation. It was observed that the primary group differences in foot stress occurred during midstance and heel-off phases of the cutting task. Specifically, healthy individuals had significantly higher stress in the talus and soft tissue around the talus compared to CAI participants. In contrast, CAI participants had significantly higher stress in the cuneiforms and lateral forefoot bones during mid-stance and push-off phases. CAI participants appeared to adopt a protective strategy by transferring greater force to the lateral forefoot at the heel-off phase while lowering stress around the talus, which may be associated with pain relief near the ankle. These findings suggest further attention should be placed on internal stress in CAI at the push-off phase with implications for long-term foot adaptation.

Ionic aggregates induced room temperature autonomous self-healing elastic tape for reducing ankle sprain

Traditional kinesiology tape (KT) is an elastic fabric tape that clinicians and sports trainers widely use for managing ankle sprains. However, inadequate mechanical properties, adhesive strength, water resistance, and micro-damage generation could affect the longevity of the tape on the skin during physical activity and sweating. Therefore, autonomous room-temperature self-healing elastomers with robust mechanical properties and adequate adhesion to the skin are highly desirable to replace traditional KT. Ionic aggregates were introduced into the polymer matrix via electrostatic attraction between polymer colloid and polyelectrolyte to achieve such elastic tape. These ionic aggregates act as physical crosslink points to enhance mechanical properties and dissociate at room temperature to provide self-healing functions. The obtained elastic tape possesses a tensile strength of 3.7 MPa, elongation of 940 %, toughness of 16.6 MJ∙m-3, and self-healing efficiency of 90 % for 2 h at room temperature. It also exhibits adequate reversible adhesion on the skin via van der Waals force and electrostatic interaction in both dry and wet conditions. The new elastic tapes have great potential in biomedical engineering for preventing and rehabilitating ankle sprain.

Severity-dependent recovery time in acute lateral ankle sprains: An ultrasonographic assessment of talofibular displacement

Purpose

There is no consensus on treatment protocols based on severity and timing for acute lateral ankle sprain (LAS). Appropriate decision-making is necessary to prevent reinjury or chronic ankle instability. In this retrospective observational study, we clarified the duration of recovery from anterior ankle joint displacement in patients with initial acute LAS of several severities.

Methods

Overall, 101 patients with varying grades of initial unilateral LAS were included. Injury severity was based on ligament tears and anterior ankle joint displacement using the reverse anterior drawer test with ultrasonography. The automated length measurement system software measured changes in the talofibular distance.

Results

The median (95% confidence interval) change in the talofibular distance on the affected side was 1.24 (0.96-1.76), 3.03 (2.91-3.74) and 3.06 (2.37-4.69) mm for LAS grades I, II and III, respectively, on the first medical examination. The increase in talofibular distance for grade I injuries was significantly smaller than for Grades II and III (p < 0.01). The regression equation was y = -0.02 × days + 1.43, -0.05 × days + 3.30 and -0.05 × days + 3.42 for Grades I, II and III, respectively; the time it took to reach the value of the unaffected side was 14.5, 43.2 and 45.6 days, respectively. Regression coefficients were significantly greater for Grades II and III than for Grade I (p < 0.01 and p = 0.01, respectively). No significant differences were observed between Grades II and III.

Conclusion

These results revealed that the recovery time for displacement varies according to the severity of the sprain, suggesting the need to develop optimal treatment protocols.

Level of Evidence

Level III.

The short version of the ALR-RSI scale is a valid and reproducible scale to evaluate psychological readiness to return to sport after ankle lateral reconstruction

Purpose

To develop and validate a short and mini version of the ALR-RSI (Ankle Ligament Reconstruction-Return to Sport after Injury) scale.

Methods

The ALR-RSI scale contains 12 items and was administered to 109 patients following arthroscopic anatomical lateral ankle reconstruction. The short (6-item) and mini (3-item) versions were developed using a systematic selection process to eliminate items based on their category, mean, standard deviation and pertinence. A second group of 75 patients participated in an analysis to validate the predictive value of these scores. These patients filled out all three ALR-RSI versions 6 months after arthroscopic anatomical reconstruction of the lateral ankle to determine the predictive value for the return to sport (RTS) at 12 months. The predictive value was evaluated with receiver operating characteristic curves (area under the curve [AUC]).

Results

The long version of the ALR-RSI had a high internal consistency (Cronbach's α = 0.97), suggesting redundancy of certain items. A short version of 6 items was developed (Cronbach's α = 0.94). A mini version of 3 items was also developed which retained one key item from each category. Factorial analysis confirmed that only one factor explained 76% of the total variance in the mini version (Cronbach's α = 0.89). The scores of the three versions were higher in patients who returned to sport at the same pre-injury level of play or better (p < 0.0001). Both versions were found to have a good predictive value for the RTS at 12 months, with comparable AUC values (full version AUC 0.70 [95% confidence interval; CI, 0.57-0.83]; short version AUC 0.72 [95% CI, 0.59-0.84]); mini version, AUC 0.73 [95% CI, 0.61-0.85].

Conclusion

The shorter versions (6 and 3 items) of the ALR-RSI may be used to predict the RTS at the pre-injury level without affecting the psychometric characteristics of the long score.

Level of Evidence

Level II prospective cohort study.

The feasibility of diagnosing sprained ankle via 3D MRI reconstructing three-dimensional model of anterior talofibular ligament

Introduction

The anterior talofibular ligament (ATFL) is the most vulnerable ligament in ankle sprains. Most patients recover after this injury with conservative treatment, while 20%-40% progress to chronic ankle instability that requires surgical stabilization. Conventional MRI does not provide a comprehensive image of the ATFL. We aimed to evaluate the feasibility of using 3D MRI to facilitate the understanding of ATFL injuries and the operative planning.

Methods

A total of 21 healthy asymptomatic volunteers with 30 normally functioning ankles and 13 patients with 18 sprained ankles were studied. MRI scans were divided into two groups: Group 1 (normal ankle) and Group 2 (injured ankle). The data of all 48 cases were exported to Mimics and reconstructed into 3D models. The image quality of all 3D models was evaluated using a 5-point subjective scoring system. The length, width, and thickness of the ATFL were measured in the 3D model in Mimics and compared to the 3D MPR image data.

Results

The image quality score was 4.57 ± 0.32. There was no statistically significant difference between the 3D model and the 3D MPR image of ATFL measurements in both groups (P > 0.05).

Discussion

We concluded that 3D MRI can be used to reconstruct a 3D model of the ATFL for accurate measurements of the ATFL anatomical structure, which holds potential to improve preoperative planning and intraoperative navigation for young sports medicine doctor, facilitate diagnosis of ATFL injuries and make the decision about the operative method.

Assessment of peroneal tendon lesions using 2-dimensional and 3-dimensional isotropic magnetic resonance imaging with surgical correlation

Accurate diagnoses of peroneal pathologies remains a challenge due to limitations of conventional 2D (dimensional) imaging, which can impact long-term patient outcomes. This study evaluates MRI accuracy and inter-reader reliability of peroneal compartment pathology for 2D and 3D MRI. A consecutive series of patients who underwent peroneal compartment surgery with preoperative 1.5- or 3.0-Tesla ankle MRIs from 2009 to 2024 included 32 scans (22 with 2D, 10 with 2D+3D) from 31 patients (ages 17-74 years, all genders). Three musculoskeletal readers blinded to surgical findings independently analyzed MRI scans for common peroneal tenosynovitis, peroneus brevis and peroneus longus tenosynovitis, tendinopathy, and tears. Inter-reader reliability and diagnostic performance measures were calculated. Using majority vote, overall accuracy, sensitivity, and specificity for peroneal tendons using 2D MRI were 80%, 81%, and 79%, respectively. Using 3D MRI sequences, whether in isolation or combination with 2D MRI, accuracy, sensitivity, and specificity increased to 85%, 88%, and 83%, respectively. The inter-reader reliability for peroneus brevis lesions was 0.45-0.75 for 2D, 0.25-0.35 for 3D, and 0.31-0.54 for combined 2D+3D, while for peroneus longus lesions, it was 0.45-0.90 for 2D, 0.20-0.71 for 3D, and 0.64-0.81 for combined 2D+3D scans. The inter-reader reliability for tenosynovitis ranged from 0.62-0.64 for 2D, 0.25-0.37 for 3D, and 0.57-0.66 for combined 2D+3D scans. The addition of 3D MRI to 2D high-resolution ankle MRI protocol or 3D MRI alone increases accuracy of peroneal compartment lesion detection with minor decrease in inter-reader reliability for peroneal brevis tendon assessment. Larger studies may help validate our findings.

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.

Deltoid ligament injuries: A review of the anatomy, diagnosis and treatments

PURPOSE

Ankle sprains remain the most common soft tissue injury presenting to Emergency Departments. Recently, there has been increased awareness and reporting of deltoid ligament injuries in association with injuries to the lateral ligament complex as well as with fibula fractures. This article reviews the currently available literature on the anatomy of the deltoid ligament, clinical and radiological diagnosis of injuries to the deltoid ligament and treatment recommendations.

METHODS

A literature review was conducted for keywords associated with deltoid ligament injuries. MEDLINE, PubMed and Embase databases were utilised for this search. Articles were included if involving an adult population, were English-language, were related to deltoid ligament injuries (with or without associated injuries) and reported on patho-anatomy, clinical or radiological diagnosis or treatment methods.

RESULTS

A total of 93 articles were assessed for relevance from the database search, and 47 were included after the removal of irrelevant articles and duplicates. Several studies reported on the clinical findings of deltoid ligament injury, as well as the radiographic analysis. Arthroscopy was considered the gold standard of diagnosis, with authors reporting on the potential benefit of performing arthroscopic repair or reconstruction at the same time. There were no studies that provided a system for the classification of deltoid ligament injury or larger studies of treatment pathways. Long-term studies of the incidence of instability in deltoid ligament injuries were not available.

CONCLUSION

There is limited evidence available regarding deltoid ligament injuries, particularly in terms of treatment options, either in isolation or with concomitant injuries. Long-term follow-up studies are needed to obtain more accurate data on the number of complications.

LEVEL OF EVIDENCE

Level IV.

Forces experienced at different levels of the musculoskeletal system during horizontal decelerations

Horizontal decelerations are frequently performed during team sports and are closely linked to sports performance and injury. This study aims to provide a comprehensive description of the kinetic demands of decelerations at the whole-body, structural, and tissue-specific levels of the musculoskeletal system. Team-sports athletes performed maximal-effort horizontal decelerations whilst full-body kinematics and ground reaction forces (GRFs) were recorded. A musculoskeletal model was used to determine whole-body (GRFs), structural (ankle, knee, and hip joint moments and contact forces), and tissue (twelve lower-limb muscle forces) loads. External GRFs in this study, especially in the horizontal direction, were up to six times those experienced during accelerated or constant-speed running reported in the literature. To cope with these high external forces, large joint moments (hip immediately after touchdown; ankle and knee during mid and late stance) and contact forces (ankle, knee, hip immediately after touchdown) were observed. Furthermore, eccentric force requirements of the tibialis anterior, soleus, quadriceps, and gluteal muscles were particularly high. The presented loading patterns provide the first empirical explanations for why decelerating movements are amongst the most challenging in team sports and can help inform deceleration-specific training prescription to target horizontal deceleration performance, or fatigue and injury resistance in team-sports athletes.

Male National Basketball Association G-League and Collegiate Basketball Athletes Have a High Prevalence of Radiographic Ankle Abnormalities

Purpose

To characterize radiographic foot/ankle bony abnormalities in elite-level, asymptomatic male basketball athletes and to investigate the association between anthropometric (age, height, weight) or sport-specific characteristics (total exposures, player position, pregame ankle taping) and the prevalence of abnormal radiographic findings in asymptomatic basketball athletes.

Methods

Elite-level basketball players who underwent routine, preseason static radiographic imaging, including anteroposterior, lateral, and mortise views of the ankle were included. Radiographs were collected from asymptomatic athletes participating in preseason history and physical with negative anterior drawer/talar tilt test. Radiographs were evaluated by a musculoskeletal radiologist and board-certified orthopaedic surgeon; kappa statistics were used to evaluate agreement.

Results

Fifty-four basketball players (34 collegiate, 20 professional; mean age 21.5 years) were included, totaling 5,148 player exposures from 2017 to 2019. In total, 106 ankles presented with radiographic findings (98.15%). The most prevalent radiographic finding was pes planus (47.22%), followed by degenerative joint disease (DJD; 33.33%), talonavicular sclerosis (28.70%), prominent stieda process (25.93%), os trigonum (20.93%), os subfibulare (11.11%), pes cavus (5.56%), subtalar coalition (2.78%), and cavovarus (0.93%). Height ≥80 inches was significantly associated with talonavicular sclerosis and Kellgren-Lawrence 1 changes.

Conclusions

This study showed a strong association between height and talonavicular sclerosis and DJD, as well as a relatively high prevalence of pes planus and DJD in asymptomatic collegiate and professional basketball players.

Level of Evidence

Level II; Cross-sectional study.

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.

Visualized trends and bibliometric analysis in ankle cartilage repair from 2004 to 2024

Ankle cartilage injuries are a common sports-related condition that significantly impairs patients' daily activities and imposes substantial economic burdens on both families and society. Effective cartilage repair strategies are crucial to addressing this pathological condition. Current conservative treatments include muscle strengthening, use of ankle braces, physical therapy, and the administration of NSAIDs. In cases of severe injury, surgical interventions such as osteophyte resection and cartilage transplantation may be necessary. However, the inherent regenerative capacity of articular cartilage is limited, and conventional treatments are insufficient to promote cartilage regeneration and repair. Consequently, innovative therapies such as stem cell therapy, exosome therapy, and cartilage regeneration scaffolds are prioritized for future development. In recent years, significant progress has been made in ankle cartilage repair. While bibliometric studies on cartilage repair exist, specific analyses focused on ankle cartilage repair are lacking. This study aims to address this gap by conducting a bibliometric analysis of 131 articles published over the past two decades, highlighting development trajectories, research hotspots, and evolutionary trends through knowledge mapping. Our findings indicate growing global interest, with the United States leading in international collaboration, funding, publication output, and citation frequency. Foot & Ankle International emerges as the leading journal for publication and dissemination in this field, with Kerkhoffs GMMJ identified as the most influential author. Notable hotspot keywords include "osteochondral lesions" and "platelet-rich plasma." By highlighting critical research hotspots and collaboration patterns, this study not only enriches the existing literature on ankle cartilage repair but also serves as a foundational resource for clinicians and researchers aiming to develop innovative strategies for improving patient outcomes. Furthermore, our findings underscore the necessity of interdisciplinary collaboration in advancing the understanding and treatment of ankle cartilage injuries. Ultimately, the visual characterization of these trends provides valuable insights into the field's evolutionary trajectory, offering guidelines for future research directions and encouraging further exploration of this promising area.

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.

Ankle Taping Does Not Affect Running Kinematics During a Treadmill Protocol in Well-Trained Runners: A Secondary Analysis from a Randomized Cross-Over Controlled Trial

Background: The purpose of this randomized cross-over controlled trial was to evaluate the biomechanical effects of ankle taping using rigid tape (RT) or kinesiotape (KT) compared to no taping during treadmill running in well-trained amateur runners. Methods: A total of 22 participants (15 men and 7 women) completed three running sessions on a treadmill, each lasting 30 min, under different conditions: no taping (CG), RT, and KT. Sagittal and frontal plane kinematics were analyzed using the Kinovea software to assess the ankle dorsiflexion, knee flexion, hip extension, tibial angle, foot strike pattern, heel eversion, and pelvic drop across three intervals (0-10, 10-20, and 20-30 min). Results: The results demonstrated no significant differences in sagittal plane variables (ankle dorsiflexion, knee flexion, hip extension, and cadence) or frontal plane variables (heel eversion and pelvic drop) between the CG, RT and KT groups at any time point. Although heel eversion significantly increased over time due to fatigue, the taping conditions did not affect running kinematics. Conclusions: These findings suggest that neither RT nor KT alters running biomechanics in well-trained runners over prolonged treadmill running. The study highlights that taping, commonly used to prevent ankle injuries, does not significantly modify lower limb kinematics in the absence of injury. Further research is needed to evaluate the effects of taping in novice or injured runners and under more demanding conditions, such as overground running.

Effects of textured insoles on dynamic balance and ankle muscle activity in soccer players with and without chronic ankle instability

BACKGROUND

Chronic ankle instability (CAI) poses challenges in sports. Textured insoles (TI) are a promising intervention for enhancing dynamic balance in CAI athletes. This study aimed to investigate the effects of TI on dynamic balance performance and ankle muscle activity in soccer players with and without CAI.

METHODS

Thirty-eight soccer players (19 CAI, 19 non-CAI) participated. Participants performed a modified star excursion balance test (mSEBT) while wearing TI and standard insoles (SI). The %SEBT reach distance and electromyography (EMG) activity of tibialis anterior (TA), medial gastrocnemius (MG), and peroneus longus (PL) were measured during maximum reached in each direction of the mSEBT.

RESULTS

No significant effects or interactions were found between ankle conditions (CAI vs. non-CAI) or insole types (TI vs. SI) on %SEBT reach. However, CAI players showed greater MG activity in posteromedial and posterolateral direction (P=0.04, P=0.01).

CONCLUSIONS

Overall, the application of TI did not have immediate effects on dynamic balance performance or ankle muscle activity in either CAI or non-CAI soccer players. Nonetheless, CAI players seemed to employ a different ankle strategy involving the MG muscle, possibly to control stability during dynamic movement, particularly in the posteromedial and posterolateral directions.

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.

Mind your step: predicting maximum ankle inversion during cutting movements in soccer

The objective of this investigation was to identify parameters at initial contact that would predict the subsequent maximum ankle inversion angle during cutting movements. We conducted a secondary data analysis and calculated kinematics of 1,400 cuttings performed by 46 male soccer athletes. The movement task consisted of an approach run, followed by a pre-planned cutting movement. A linear mixed regression model was applied to predict the maximum ankle inversion angle during the first 100 ms of ground contact. The prediction was made based on six predictors that describe change-of-direction intensity and foot placement as found to be relevant in the literature. The model explained 62% of the variance of maximum ankle inversion angles. A change of the main predictors (foot rotation, cutting angle and initial ankle inversion) by 1 SD caused a reduction of the subsequent maximum ankle inversion angle by 2.6-4.4°. Regarding the intensity of a change-of-direction movement, cutting angle seems to have a higher influence on maximum ankle inversion angle than approach velocity. With respect to the individual foot positioning, the maximum ankle inversion angle can be reduced by increasing exorotation and eversion of the foot while shifting towards forefoot landing.

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.

Evaluating the effectiveness of quantitative pupillometry in assessing dynamic aerobic training intensity

Sports injuries often arise from improper scheduling of exercise loads, and timely assessment of these loads is essential for minimizing injury risk. This article investigates the validity of using changes in pupillary light reflex (PLR) during dynamic aerobic training as a novel approach to evaluating exercise load. Dynamic aerobic training was conducted on a power bicycle for 15 min. With a 3-minute interval as the demarcation line, PLR measurement was performed before training and heart rate was recorded throughout the process. The Rating of Perceived Exertion (RPE) scale invented by Borg was used for scoring before training and after training. The normal distribution of data was confirmed through the Shapiro-Wilk test. Pearson correlation analysis was used to quantify the correlation between variables. The Receiver Operating Characteristic (ROC) curve and the area under the curve (AUC) analysis were used to determine the indicators of exercise load. The optimal threshold of the indicators was calculated through the Youden index to evaluate sensitivity and specificity. Thirty male second-tier athletes with a mean age of 23.66 ± 2.21 years, a mean height of 175.3 ± 6.5 cm, and a mean weight of 68.99 ± 10.35 kg participated in this study. Based on the RPE scale results, it was confirmed that the 15-minute dynamic aerobic exercise successfully elicited varying levels of perceived exertion among the athletes. The findings of this study indicate significant changes in PLR and heart rate (HR) with increasing exercise duration and external load. There were strong correlations between RPE and maximum constriction velocity (MCV) (|r| = 0.8309, p < 0.001, negative correlation), maximum diameter (INIT) (r = 0.7641, p < 0.001, positive correlation), time to reach 75% recovery (T75) (|r| = 0.7289, p < 0.001, negative correlation), and HR (r = 0.8170, p < 0.001, positive correlation). Additionally, the results suggest that MCV is the most significant potential indicator for detecting internal load, exhibiting high specificity and sensitivity (AUC = 0.8509, p < 0.001). Further analysis using the Youden index identified 5.07 mm/s as the optimal cutoff value for MCV, indicating that when MCV ≤ 5.07 mm/s, the athletes' internal load has reached an "Intense" state. PLR may be a potential indicator for assessing internal load Further investigation could involve developing a non-invasive exercise load detection system based on pupillary variable indicators, providing a valuable new approach for accurately measuring exercise load.

Non-contact lower limb injuries in Rugby Union: A two-year pattern recognition analysis of injury risk factors

The cause of sport injuries are multifactorial and necessitate sophisticated statistical approaches for accurate identification of risk factors predisposing athletes to injury. Pattern recognition analyses have been adopted across sporting disciplines due to their ability to account for repeated measures and non-linear interactions of datasets, however there are limited examples of their use in injury risk prediction. This study incorporated two-years of rigorous monitoring of athletes with 1740 individual weekly data points across domains of training load, performance testing, musculoskeletal screening, and injury history parameters, to be one of the first to employ a pattern recognition approach to predict the risk factors of specific non-contact lower limb injuries in Rugby Union. Predictive models (injured vs. non-injured) were generated for non-contact lower limb, non-contact ankle, and severe non-contact injuries using Bayesian pattern recognition from a pool of 36 Senior Academy Rugby Union athletes. Predictors for non-contact lower limb injuries included dorsiflexion angle, adductor strength, and previous injury history (area under the receiver operating characteristic (ROC) = 0.70) Dorsiflexion angle parameters were also predictive of non-contact ankle injuries, along with slower sprint times, greater body mass, previous concussion, and previous ankle injury (ROC = 0.76). Predictors of severe non-contact lower limb injuries included greater differences in mean training load, slower sprint times, reduced hamstring and adductor strength, reduced dorsiflexion angle, greater perceived muscle soreness, and playing as a forward (ROC = 0.72). The identification of specific injury risk factors and useable thresholds for non-contact injury risk detection in sport holds great potential for coaches and medical staff to modify training prescriptions and inform injury prevention strategies, ultimately increasing player availability, a key indicator of team success.

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.

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.

Clinical Outcomes of a Minimally Invasive Percutaneous Brostrom Technique without Arthroscopic Assistance

BACKGROUND/OBJECTIVES

Surgical management of chronic lateral ankle instability has traditionally been performed using an open technique. Arthroscopic-assisted and all-arthroscopic techniques have gained popularity as they have achieved strong clinical outcomes. However, they rely on the surgeon's arthroscopic skills and familiarity with arthroscopic anatomy. Recently, a minimally invasive percutaneous technique without arthroscopic assistance has been developed that incorporates the benefits of arthroscopy, such as minimal soft tissue disruption, without the additional requirements of performing an arthroscopic technique. The aim of the current study is to describe the minimally invasive percutaneous technique for chronic lateral ankle instability and report on its clinical outcomes.

METHODS

Fifty-four consecutive patients without intra-articular ankle pathology underwent lateral ligament repair for chronic ankle instability with a percutaneous technique at a single institution by a fellowship-trained foot and ankle surgeon. Foot Function Index (FFI) score was recorded pre-operatively and post-operatively at final follow-up. All patients had a minimum follow-up of 12 months. Post-operative complications and patient satisfaction were also recorded.

RESULTS

A significant improvement (p < 0.001) in FFI compared to pre-operative values (from 55, SD 4.1, to 10, SD 1.9) was observed. A single patient required a return to the operating room for open revision with allograft reconstruction following a fall 2.5 months post-operatively. There were no other complications including infection or nerve injury. The overall rate of satisfaction after surgery was 98.1%, with one patient dissatisfied due to excessive ankle stiffness.

CONCLUSIONS

The described minimally invasive percutaneous Brostrom procedure is safe and effective for the treatment of chronic lateral ankle instability without intra-articular ankle pathology.