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PubMed1997

Measurement of plantar pressure distribution during gait for diagnosis of functional lateral ankle instability.

INTRODUCTION:: Chronic functional instability of the lateral ankle may be difficult to distinguish from mechanical instability when radiological stress tests reveal only small ligamentous defects. For decision making whether to surgically reconstruct the ligaments or not, it can be helpful to use additional information on joint and foot function. Therefore, the aim of a prospective study of patients with longstanding chronic ankle instability was to demonstrate that the dynamic measurement of plantar pressure distribution can identify patients with functional ankle instability. [Table: see text] MATERIALS AND METHODS:: Sixty five patients (mean age 24 (4.6 years)) were included. After clinical examination and radiological stress views, plantar pressure patterns were measured during gait using a capacitive platform, the EMED-SF 2-system. Five trials of each foot were documented and the maximum impulses in eight points of the foot (central heel, lateral and medial heel, midfoot, 1st, 2nd, 5th metatarsal head and hallux) were calculated intraindividually and compared with a group of 100 healthy subjects. The medio-lateral loading factor (MLF) as the quotient of the medial and lateral relative impulses indicated the tendency to walk on the lateral edge of the foot. RESULTS:: Based on clinical criteria alone, two comparable groups of patients were separated, 35 with functional instability and 30 with mechanical instability. After collective analyses of the results, the patients with functional instability showed a significantly increased lateral loading of the unstable foot (p=0 0 1), whereas the mechanically unstable group tended to walk more on the medial side of the unstable foot (Table 1). DISCUSSION:: Dynamic measurement of plantar pressure can identify a group of patients walking on the lateral side of the unstable foot when compared with the stable foot. This finding is explained by a deficit of peroneal strength during stance phase based on a proprioceptive defect after trauma. The new application of the EMED-system provides additional information which helps to make decisions about the individual patient with chronic instability.

Journal Article↗
PubMed2004

Electrochemical instability in the transfer of cationic surfactant across the 1,2-dichloroethane/water interface.

The electrochemical instability has been shown to appear in the transfer of cationic surfactant ions across the 1,2-dichloroethane/water interface. Cyclic voltammograms possess all fundamental characteristics that are predicted by the theory of electrochemical instability: the presence of the instability window, that is, the potential range where the interface becomes unstable, the location of the instability window around the standard ion transfer potential of surface-active ions, and the dependence of the width of the instability window on the concentration of the surfactant ions. Electrocapillary measurements clearly demonstrate that the interface becomes unstable, while the interfacial tension is positive, being higher than 20 mN m(-1). The electrocapillary curve exhibits the discontinuities at both ends of the instability window, indicating the similarity between the electrochemical instability and the phase transitions induced by the temperature, pressure, and chemical potential. The results from voltammetry and interfacial tension measurements for cationic surfactants support the idea that the electrochemical instability, so far reported in the transfer of anionic surfactants across the liquid/liquid interface, is one of intrinsic properties of the two-phase systems where the partition of surface-active ions takes place.

Journal Article↗
PubMedDate not supplied

Study of three intragenic polymorphisms in the Machado-Joseph disease gene (MJD1) in relation to genetic instability of the (CAG)n tract.

Intergenerational instability is one of the most important features of the disease-associated trinucleotide expansions, leading to variation in size of the repeat among and within families, which manifests as variable age at onset and severity, and is probably the basis for the occurrence of anticipation. Several factors are known to affect the degree of instability, namely the type of repeated sequence, its initial size, the presence or absence of interruptions in the repetitive tract and the gender of the transmitting parent. A recent study demonstrated the effect of an intragenic polymorphism (C987GG/G987GG) in the Machado-Joseph disease causative gene, immediately downstream of the CAG repeat, on the intergenerational instability of the expanded repeat. Surprisingly, there was an effect not only of the specific allele in cis to the disease chromosome, but also of the allele on the normal chromosome, suggesting the existence of an interaction between the normal and expanded alleles that affects the fidelity of replication of the (CAG)n tract. This effect could be a direct effect of the polymorphism studied or, alternatively, this polymorphism could be in disequilibrium with some other flanking sequence which affects the instability of the repetitive (CAG)n tract. In order to confirm the previous results in a different population and to distinguish between a direct and indirect effect of the CGG/GGG polymorphism, we typed 70 parent-progeny pairs for which the variation in the (CAG)n length in the MJD1 gene was known, for three intragenic polymorphisms: C987GG/G987GG and two additional, newly described ones, TAA1118/TAC1118 and A669TG/G669TG. We also typed a control population of 125 individuals for the A669TG/G669TG, C987GG/G987GG and TAA1118/TAC1118 polymorphisms, in an attempt to identify any association between haplotype and (CAG)n length in normal chromosomes, suggestive of an instability-predisposing effect of the repeat-flanking sequences, which could have led to the origin of the MJD mutation in the human population. We confirmed the effect of the C987GG/G987GG polymorphism on intergenerational instability when present in trans. Our results suggest that this effect is restricted to a small region of the gene, immediately downstream of the CAG repeat, which includes this particular nucleotide substitution and the stop codon of the MJD1 cDNA, and is not a more widespread chromosomal effect. The lack of a significant association of any specific intragenic haplotype with larger CAG repeats in normal chromosomes, together with the absence of an effect of the intragenic haplotype in cis on the intergenerational instability of the expanded (CAG)n in MJD families does not indicate the existence of an instability-predisposing haplotype.

Alleles↗
PubMed2003

Frequency of microsatellite instability in unselected sebaceous gland neoplasias and hyperplasias.

Sebaceous gland neoplasias are the cutaneous manifestation of the Muir-Torre syndrome, which is known to be a phenotypical variant of hereditary nonpolyposis colorectal cancer. Both hereditary nonpolyposis colorectal cancer and Muir-Torre syndrome are caused by inherited DNA mismatch repair defects. As a prominent molecular genetic feature, all tumors associated with a DNA mismatch repair defect exhibit high microsatellite instability. So far, the frequency of DNA mismatch repair defects in patients selected solely on the basis of a sebaceous gland tumor has never been determined. In order to estimate this frequency, we assessed microsatellite instability with up to 10 microsatellite markers in a newly collected unselected series of 25 sebaceous gland neoplasias (six sebaceous adenomas, 16 sebaceous epitheliomas, three sebaceous carcinomas) in comparison to 32 sebaceous gland hyperplasias from unrelated patients. As many as 15 of the 25 sebaceous gland neoplasias (60%), but only one of the 32 sebaceous gland hyperplasias (3%), exhibited high microsatellite instability. Thus, in our study, the majority of patients with a sebaceous gland neoplasia in contrast to patients with a sebaceous gland hyperplasia are highly suspicious for an inherited DNA mismatch repair defect. On the basis of the subsequently collected tumor histories, nine of the 15 patients with a high microsatellite unstable sebaceous gland neoplasia were identified to have Muir-Torre syndrome. In none of these cases, however, were the clinical Amsterdam criteria for diagnosing hereditary nonpolyposis colorectal cancer fulfilled. In the sebaceous tumors of the remaining six patients, high microsatellite instability was an incidental finding. In two of these six patients, single relatives were known to be affected with internal cancer; however, their family histories were not suggestive of Muir-Torre syndrome or hereditary nonpolyposis colorectal cancer. In comparison with microsatellite instability screening studies in a variety of other randomly selected tumors, our study identifies sebaceous gland neoplasias as tumors with the highest frequency of high microsatellite instability reported so far, whereas sebaceous gland hyperplasia rarely exhibits high microsatellite instability. Therefore, screening for microsatellite instability in sebaceous gland neoplasias will be of great value in the detection of an inherited DNA mismatch repair defect, which predisposes to various types of internal cancers.

Adult↗
PubMed1993

Genetic instability in Drosophila melanogaster mediated by hobo transposable elements.

Eight independent recessive lethal mutations that occurred on derivatives of an unstable X chromosome (Uc) in Drosophila melanogaster were analyzed by a combination of genetic and molecular techniques. Seven of the mutations were localized to complementation groups in polytene chromosome bands 6E; 7A. In situ hybridization and genomic Southern analysis established that hobo transposable elements were associated with all seven of the mutations. Six mutations involved deletions of DNA, some of which were large enough to be seen cytologically, and in each case, a hobo element was inserted at the junction of the deletion's breakpoints. A seventh mutation was associated with a small inversion between 6F and 7A-B and a hobo element was inserted at one of its breakpoints. One of the mutant chromosomes had an active hobo-mediated instability, manifested by the recurrent production of mutations of the carmine (cm) locus in bands 6E5-6. This instability persisted for many generations in several sublines of an inbred stock. Two levels of instability, high and basal, were distinguished. Sublines with high instability had two hobo elements in the 6E-F region and produced cm mutations by deleting the segment between the two hobos; a single hobo element remained at the junction of the deletion breakpoints. Sublines with low instability had only one hobo element in the 6E-F region, but they also produced deletion mutations of cm. Both types of sublines also acquired hobo-mediated inversions on the X chromosome. Collectively, these results suggest that interactions between hobo elements are responsible for the instability of Uc. It is proposed that interactions between widely separated elements produce gross rearrangements that restructure the chromosome and that interactions between nearby elements cause regional instabilities manifested by the recurrence of specific mutations. These regional instabilities may arise when a copy of hobo transposes a short distance, creating a pair of hobos that can interact to produce small rearrangements.

Animals↗
PubMedDate not supplied

Traumatic shoulder instability. Nonsurgical management versus surgical intervention.

Shoulder instability is classified as either traumatic or atraumatic based on the mechanism of injury. Traditional treatment for both forms of instability involves a nonsurgical approach, consisting of immobilization, rehabilitation, and a delay in the return to vigorous activities. This treatment is often quite successful in preventing recurrent dislocations in the patient with atraumatic instability. However, those patients with traumatic instability often experience further dislocations or subluxations, with recurrence rates as high as 94% in patients younger than 20 years. These recurrent episodes of instability can result in injuries to the capsulolabral structures (Bankart lesions), humeral head (Hill Sachs defect), and neurologic structures. Open surgical reconstructions for anterior instability have been reported to be 94-100% successful in preventing recurrence. Arthroscopic stabilization procedures are successful in preventing recurrence in 80-90% of patients and result in low morbidity. However, the most common form of initial treatment for traumatic anterior shoulder instability remains immobilization, supervised rehabilitation, and gradual return to full activity, despite significantly inferior results when compared to operative intervention. This article addresses the treatment options available to the nurse practitioner when managing the patient with traumatic anterior instability.

Adult↗
PubMed2006

Suppression of instability in liquid flow down an inclined plane by a deformable solid layer.

The linear stability of a liquid layer flowing down an inclined plane lined with a deformable, viscoelastic solid layer is analyzed in order to determine the effect of the elastohydrodynamic coupling between the liquid flow and solid deformation on the free-surface instability in the liquid layer. The stability of this two-layer system is characterized by two qualitatively different interfacial instability modes: In the absence of the deformable solid layer, the free surface of the liquid film undergoes a long-wave instability due to fluid inertia. With the presence of the deformable solid layer, the interface between the fluid and the solid undergoes a finite-wavelength instability when the deformable solid becomes sufficiently soft. The effect of the solid layer deformability on the free-surface instability of the liquid film flow is analyzed using a long-wave asymptotic analysis. The asymptotic results show that for a fixed Reynolds number and inclination angle, the free-surface instability is completely suppressed in the long-wave limit when the nondimensional (inverse) solid elasticity parameter Gamma=Va eta/(GR)increases beyond a critical value. Here, Va is the average velocity of the liquid film flow, eta is the viscosity of the liquid, G is the shear modulus of the solid layer, and is R the thickness of the liquid layer. The predictions of the asymptotic analysis are verified and extended to finite wavelengths using a numerical solution, and this indicates that the suppression of the free-surface instability indeed continues to finite wavelength disturbances. Further increase of Gamma is found to have two consequences: first, the interface between the liquid and the deformable solid layer could become unstable at finite wavelengths; second, the free-surface interfacial mode could also become unstable at finite wavelengths due to an increase in solid layer deformability. However, our numerical results demonstrate that, for a given average velocity, there exists a sufficient window in the value of shear modulus G where both the unstable modes are absent at all wavelengths. Our study therefore suggests that soft solid layer coatings could potentially provide a passive method of suppressing free-surface instabilities in liquid film flows.

Journal Article↗
PubMed2006

Wave instability induced by nonlocal spatial coupling in a model of the light-sensitive Belousov-Zhabotinsky reaction.

We study spatiotemporal patterns resulting from instabilities induced by nonlocal spatial coupling in the Oregonator model of the light-sensitive Belousov-Zhabotinsky reaction. In this system, nonlocal coupling can be externally imposed by means of an optical feedback loop which links the intensity of locally applied illumination with the activity in a certain vicinity of a particular point weighted by a given coupling function. This effect is included in the three-variable Oregonator model by an additional integral term in the photochemically induced bromide flow. A linear stability analysis of this modified Oregonator model predicts that wave and Turing instabilities of the homogeneous steady state can be induced for experimentally realistic parameter values. In particular, we find that a long-range inhibition in the optical feedback leads to a Turing instability, while a long-range activation induces wave patterns. Using a weakly nonlinear analysis, we derive amplitude equations for the wave instability which are valid close to the instability threshold. Therein, we find that the wave instability occurs supercritically or subcritically and that traveling waves are preferred over standing waves. The results of the theoretical analysis are in good agreement with numerical simulations of the model near the wave instability threshold. For larger distances from threshold, a secondary breathing instability is found for traveling waves.

Journal Article↗
PubMed2001

Genetic instability in epithelial tissues at risk for cancer.

Epithelial tumors develop through a multistep process driven by genomic instability frequently associated with etiologic agents such as prolonged tobacco smoke exposure or human papilloma virus (HPV) infection. The purpose of the studies reported here was to examine the nature of genomic instability in epithelial tissues at cancer risk in order to identify tissue genetic biomarkers that might be used to assess an individual's cancer risk and response to chemopreventive intervention. As part of several chemoprevention trials, biopsies were obtained from risk tissues (i.e., bronchial biopsies from chronic smokers, oral or laryngeal biopsies from individuals with premalignancy) and examined for chromosome instability using in situ hybridization. Nearly all biopsy specimens show evidence for chromosome instability throughout the exposed tissue. Increased chromosome instability was observed with histologic progression in the normal to tumor transition of head and neck squamous cell carcinomas. Chromosome instability was also seen in premalignant head and neck lesions, and high levels were associated with subsequent tumor development. In bronchial biopsies of current smokers, the level of ongoing chromosome instability correlated with smoking intensity (e.g., packs/day), whereas the chromosome index (average number of chromosome copies per cell) correlated with cumulative tobacco exposure (i.e., pack-years). Spatial chromosome analyses of the epithelium demonstrated multifocal clonal outgrowths. In former smokers, random chromosome instability was reduced; however, clonal populations appeared to persist for many years, perhaps accounting for continued lung cancer risk following smoking cessation.

Aneuploidy↗
PubMed1986

Shoulder instability: impact of glenohumeral arthrotomography on treatment.

We used arthrotomography to study the glenoid labrum in 114 patients. Sixty-nine of the patients had anatomic instability of the shoulder (including recurrent dislocation and subluxation of the shoulder), and 45 patients had functional instability of the shoulder (denoted by chronic pain, clicking of the joint, and the sensation that an unstable condition exists without the objective signs of it). Labral tears were revealed arthrotomographically in 86% of the patients with anatomic instability, while only 40% of the patients with functional instability had labral abnormalities, and these were primarily of minor severity. Fifty-six patients (44 of whom had anatomic instability; 12, functional instability) required surgery. The surgical findings were correlated with the arthrotomographic findings, and no false-positive results were revealed. However, arthrotomography demonstrated only part of the pathologic condition of two patients. These results confirm that there is a strong correlation between labral pathologic conditions and anatomic instability of the shoulder. Arthrotomographic studies have a great impact on the selection of therapy in cases of both anatomic and functional instability of the shoulder.

Adolescent↗
PubMed2001

Instability and triangulation of the action potential predict serious proarrhythmia, but action potential duration prolongation is antiarrhythmic.

BACKGROUND: Prolongation of action potential duration (APD) is considered a major antiarrhythmic mechanism (class 2I), but paradoxically, it frequently is also proarrhythmic (torsade de pointes). METHODS AND RESULTS: The cardiac electrophysiological effects of 702 chemicals (class 2I or HERG channel block) were studied in 1071 rabbit Langendorff-perfused hearts. Temporal instability of APD, triangulation (duration of phase 3 repolarization), reverse use-dependence, and induction of ectopic beats were measured. Instability, triangulation, and reverse use-dependence were found to be important determinants of proarrhythmia. Agents that lengthened the APD by >50 ms, with induction of instability, triangulation, and reverse use-dependence (n=59), induced proarrhythmia (primarily polymorphic ventricular tachycardia); in their absence (n=19), the same prolongation of APD induced no proarrhythmia but significant antiarrhythmia (P<0.001). Shortening of APD, when accompanied by instability and triangulation, was also markedly proarrhythmic (primarily monomorphic ventricular tachycardia). In experiments in which instability and triangulation were present, proarrhythmia declined with prolongation of APD, but this effect was not large enough to become antiarrhythmic. Only with agents without instability did prolongation of APD become antiarrhythmic. For 20 selected compounds, it was shown that instability of APD and triangulation observed in vitro were strong predictors of in vivo proarrhythmia (torsade de pointes). CONCLUSIONS: Lengthening of APD without instability or triangulation is not proarrhythmic but rather antiarrhythmic.

Action Potentials↗
PubMed2003

The TP53 dependence of radiation-induced chromosome instability in human lymphoblastoid cells.

The dose and TP53 dependence for the induction of chromosome instability were examined in cells of three human lymphoblastoid cell lines derived from WIL2 cells: TK6, a TP53-normal cell line, NH32, a TP53-knockout created from TK6, and WTK1, a WIL2-derived cell line that spontaneously developed a TP53 mutation. Cells of each cell line were exposed to (137)Cs gamma rays, and then surviving clones were isolated and expanded in culture for approximately 35 generations before the frequency and characteristics of the instability were analyzed. The presence of dicentric chromosomes, formed by end-to-end fusions, served as a marker of chromosomal instability. Unexposed TK6 cells had low levels of chromosomal instability (0.002 +/- 0.001 dicentrics/cell). Exposure of TK6 cells to doses as low as 5 cGy gamma rays increased chromosome instability levels nearly 10-fold to 0.019 +/- 0.008 dicentrics/cell. There was no further increase in instability levels beyond 5 cGy. In contrast to TK6 cells, unexposed cultures of WTK1 and NH32 cells had much higher levels of chromosome instability of 0.034 +/- 0.007 and 0.041 +/- 0.009, respectively, but showed little if any effect of radiation on levels of chromosome instability. The results suggest that radiation exposure alters the normal TP53-dependent cell cycle checkpoint controls that recognize alterations in telomere structure and activate apoptosis.

Apoptosis↗
PubMed2025

Human Placental Genomic Instability Predicts Adverse Pregnancy Outcomes.

Preeclampsia is a leading cause of pregnancy-related death, accounting for over 50,000 maternal and 500,000 fetal deaths worldwide each year1-4. Preeclampsia has been linked to confined placental mosaicism, which underscores a potential role of placental genomic instability in driving adverse pregnancy outcomes. Here, using bulk RNA sequencing from 59 preeclamptic and 53 normotensive pregnancies, we explored somatic genomic instability and hypoxia with respect to clinical maternal-placental-neonatal outcomes. We found that genomic instability increased the probability of delivering at an earlier gestational age with a diagnosis of preeclampsia, maternal vascular malperfusion placental lesions, and small for gestational age neonates. Notably, genomic instability and hypoxia are predictive biomarkers for all three adverse pregnancy outcomes. In an induced pluripotent stem cell-derived trophoblast stem cell model, we observed increased genomic instability in trophoblast stem cells obtained from placentas demonstrating maternal vascular malperfusion with preeclampsia. Additionally, increased genomic instability correlated with reduced extravillous trophoblast invasion, implicating a functional role for genomic instability. These findings provide promising insights into the underlying mechanisms of genomic instability in the placenta which may be useful biomarkers for early clinical diagnosis of placental injury underlying preeclampsia.

Journal Article↗
PubMed1999

Critical target and dose and dose-rate responses for the induction of chromosomal instability by ionizing radiation.

To investigate the critical target, dose response and dose-rate response for the induction of chromosomal instability by ionizing radiation, bromodeoxyuridine (BrdU)-substituted and unsubstituted GM10115 cells were exposed to a range of doses (0.1-10 Gy) and different dose rates (0.092-17.45 Gy min(-1)). The status of chromosomal stability was determined by fluorescence in situ hybridization approximately 20 generations after irradiation in clonal populations derived from single progenitor cells surviving acute exposure. Overall, nearly 700 individual clones representing over 140,000 metaphases were analyzed. In cells unsubstituted with BrdU, a dose response was found, where the probability of observing delayed chromosomal instability in any given clone was 3% per gray of X rays. For cells substituted with 25-66% BrdU, however, a dose response was observed only at low doses (<1.0 Gy); at higher doses (>1.0 Gy), the incidence of chromosomal instability leveled off. There was an increase in the frequency and complexity of chromosomal instability per unit dose compared to cells unsubstituted with BrdU. The frequency of chromosomal instability appeared to saturate around approximately 30%, an effect which occurred at much lower doses in the presence of BrdU. Changing the gamma-ray dose rate by a factor of 190 (0.092 to 17.45 Gy min(-1)) produced no significant differences in the frequency of chromosomal instability. The enhancement of chromosomal instability promoted by the presence of the BrdU argues that DNA comprises at least one of the critical targets important for the induction of this end point of genomic instability.

Animals↗
PubMed2001

Cancer-specific genomic instability in bronchial lavage: a molecular tool for lung cancer detection.

We examined genomic instability in DNA from 80 bronchial lavage samples from patients with lung cancer and individuals with no malignant lung disease. We used a multiplex assay of eight fluorescent-tagged microsatellite markers that have a very high incidence of allelic imbalance in lung tumors. When genomic instability at individual loci was analyzed statistically against diagnosis, markers D3S1289 (P = 0.033), D3S1300 (P = 0.001), D13S171 (P = 0.009), and D17S2179E (P = 0.017) demonstrated significantly higher frequency of instability in bronchial lavage specimens from lung cancer cases than those with nonmalignant conditions. In contrast, markers D9S157, D9S161, D13S153, and D5S644 demonstrated lower specificity (P > 0.05) for lung tumors. These results suggest that genomic instability in some loci may be related to high proliferation rates but not necessarily to cell commitment to malignancy. When genomic instability was scored with only the four cancer-specific markers, the assay produced a sensitivity of 73.9% and a specificity of 76.5%. On combining the results from the cytological examination and the molecular assay, the sensitivity reached 82.6%. These results indicate that in our efforts to investigate genomic instability as a potential marker for the early detection of lung cancer, we need to identify cancer-specific genomic instability markers. This paper has shown that these first four markers may be considered to form an individual set of cancer-specific genomic instability markers.

Adult↗
PubMed2002

Surgical Considerations in the Treatment of Ankle Instability.

OBJECTIVE: To review the surgical indications, techniques, biomechanical testing, and clinical results reported for the most common surgical techniques used to treat ankle instability. DATA SOURCES: We searched MEDLINE from 1960-2001 using the terms ankle instability, functional ankle instability, mechanical ankle instability, ankle ligament surgery, Broström, Chrisman-Snook, and Evans. DATA SYNTHESIS: Although 80% to 85% of acute ankle sprains are successfully treated with a functional ankle-rehabilitation program, the remaining 15% to 20% have recurrent ankle instability and reinjury, necessitating surgical intervention. The fundamentals of the surgical approach to lateral ankle instability are based on the anatomy of the lateral ankle ligaments, the anterior talofibular ligament, and the calcaneofibular ligament. Ankle-instability surgery has been broadly divided into an anatomic repair consisting of an imbrication of the lateral ligamentous complex and an ankle-ligament reconstruction. An ankle-ligament reconstruction weaves a harvested tendon graft, most commonly the peroneus brevis, to augment the lateral ligaments of the ankle. Goals of surgery are to reestablish ankle stability and function without compromising motion and without complications. Anatomic repair and imbrication of the lateral ligament complex with the Gould modification has an 85% to 95% success rate, and the risk of associated nerve injuries is low. This approach provides increased stability by reinforcing local host tissue, preserving subtalar and talocrural motion, eliminating the comorbidity associated with tendon-graft harvest, and offering a quicker functional recovery. One concern in using the anatomic approach is the resultant strength of the repair, although the literature does not support this concern. Ankle-reconstruction procedures that sacrifice tendons are thought to provide a stronger construct, and hence, more stability. This increased stability results in loss of talocrural and subtalar range of motion, prolonging recovery and decreasing sport performance. Adjacent nerve injury is more common with ankle-ligament reconstruction. CONCLUSIONS/RECOMMENDATIONS: Based on the literature, we believe that a modified Broström lateral-ligament repair should be considered the first choice for persistent ankle instability refractory to a functional ankle-rehabilitation protocol. Ankle reconstruction with tendon augmentation should be reserved for patients with generalized ligamentous laxity or long-standing ligamentous insufficiency or as a salvage procedure in a patient with a failed modified Broström lateral-ligament repair.

Journal Article↗
PubMed2005

Functional-Performance Deficits in Volunteers With Functional Ankle Instability.

Context: Although functional-performance tests are dynamic measures used to assess general lower body function, studies investigating these tests for ankle instability have yielded conflicting results.Objective: To determine if a relationship exists between a measure of functional ankle instability and deficits in functional performance.Design: A case-control study correlating subject performance on a set of lower extremity functional-performance tests with a measure of ankle instability.Setting: University athletic training research laboratory.Patients or Other Participants: We recruited 60 participants (43 females, 17 males, age = 22.4 +/- 4.9 years, height = 169.9 +/- 9.7 cm, mass = 72.6 +/- 16.3 kg; 42 injured, 18 uninjured) to participate in the study. Six questions were used to determine if functional ankle instability was present in each participant. A point was added for each yes response to produce an index that represents a continuous variable of functional ankle instability.Main Outcome Measure(s): Four unilateral hopping tests were used in this study: figure-of-8 hop, side hop, up-down hop, and single hop. For the first 3 tests, the total time was recorded with a handheld stopwatch to the nearest 0.01 second; for the single hop-for-distance test, the distance was recorded to the nearest 0.01 m. Correlations were computed with the functional ankle instability index and each of the 4 functional-performance tests.Results: No relationship was revealed between the functional ankle instability index and single hop for distance or up-down hop, with r values of -.008 and .245, respectively. A significant relationship was found between the functional ankle instability index and the side hop (r = .35, P </= .01) and the figure-of-8 hop (r = .31, P </= .02).Conclusions: A positive relationship existed between functional ankle instability and performance deficits on the side hop and figure-of-8 hop. Conversely, a relationship did not exist between functional ankle instability and frontal-plane functional-performance activities.

Journal Article↗
PubMedDate not supplied

Low-load eversion force sense, self-reported ankle instability, and frequency of giving way.

CONTEXT: Functional ankle instability has been attributed to proprioceptive loss. However, in previous studies of proprioception,authors have not investigated the ability to sense force at the ankle. Additionally, previous investigators have viewed functional ankle instability as either a present or absent condition,rather than a continuum. OBJECTIVE: To determine the relationship of ankle giving-way frequency and perceived ankle instability to ankle eversion force sense. DESIGN: Cohort design. SETTING: Sports medicine research laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty individuals (5 men,15 women) with a history of unilateral ankle instability. INTERVENTION(S): We tested subjects with 2 loads: 10% and 30% of maximal voluntary isometric contraction. MAIN OUTCOME MEASURE(S): We measured eversion force sense by calculating absolute, constant, and variable errors from a 3-trial force-matching procedure. Furthermore, subjects reported their frequency of giving way in units of times per day,week, or month, and these data were extrapolated to estimate annual giving-way frequency. Finally, subjects answers to 6 questions about ankle stability during typical daily or sports activities were summed to create a perceived ankle instability index. RESULTS: Significant relationships were found for only the 10% maximal voluntary isometric contraction. For absolute error,a positive relationship existed between the number of self reported episodes of giving way and eversion force sense for both ipsilateral (r .58) and contralateral (r .49) testing of the injured ankle. Constant error was correlated with giving way(r = -.56) for ipsilateral testing of the injured ankle. The ankle instability index was also positively correlated with eversion force sense absolute error (r .51) for ipsilateral testing only. CONCLUSIONS: Our results suggest that subjects with ankle instability had difficulty replicating eversion forces. Specifically,larger errors were related to both self-reported giving-way episodes and perceived ankle instability.

Journal Article↗