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At least 37 records · Page 2Linked to original sources
PubMed2004

Effects of circumferential ankle pressure on ankle proprioception, stiffness, and postural stability: a preliminary investigation.

STUDY DESIGN: Cross-sectional repeated-measures design. OBJECTIVE: Determine the effects of circumferential ankle pressure (CAP) intervention on proprioceptive acuity, ankle stiffness, and postural stability. BACKGROUND: The application of CAP using braces, taping, and adaptive shoes or military boots is widely used to address chronic ankle instability (CAI). An underlying assumption is that the CAP intervention might improve ankle stability through increased proprioceptive acuity and stiffness in the ankle. METHOD AND MEASURES: A convenience sample of 10 subjects was recruited from the local university community and categorized according to proprioceptive acuity (high, low) and ankle stability (normal, CAI). Proprioceptive acuity was measured when blindfolded subjects were asked to accurately reproduce a self-selected target ankle position before and after the application of CAP. Proprioceptive acuity was determined in 5 different ankle joint position sense tests: neutral, inversion, eversion, plantar flexion, and dorsiflexion. Joint position angles were recorded electromechanically using a potentiometer. Passive ankle stiffness was computed from the ratio of applied static moment versus angular displacement. Active ankle stiffness was determined from biomechanical analyses of ankle motion following a mediolateral perturbation. Postural stability was quantified from the center of pressure displacement in the mediolateral and the anteroposterior directions in unipedal stance. All measurements were recorded with and without CAP applied by a pediatric blood pressure cuff. Data were analyzed using a separate mixed-model analysis of variance (ANOVA) for each dependent variable. Post hoc comparison using Tukey's honestly significant difference (HSD) test was performed if significant interactions were obtained. Significance level was set at P<.05 for all analyses. RESULTS: Significant group (high versus low proprioceptive acuity) x CAP interactions were identified for postural stability. Passive ankle stiffness was not increased by an application of CAP. Active ankle stiffness was significantly different between the high and low proprioceptive acuity groups and was not affected by an application of CAP. Significant group (normal versus CAI) x CAP interactions were observed for mediolateral center-of-pressure displacement with a main effect of group on neutral joint position sense. CONCLUSIONS: Application of CAP increased proprioceptive acuity and demonstrated trends toward increased active stiffness in the ankle, hence improved postural stability. The effects tend to be limited to individuals with low proprioceptive acuity.

Adolescent↗
PubMed1987

Total ankle arthroplasty using biological fixation components compared to ankle arthrodesis.

When conservative measures fail to alleviate pain and disability of ankle joint disease, tibiotalar arthrodesis is the present accepted surgical treatment. Unfortunately, ankle arthrodesis also carries a significant rate of complications and the success rate does not parallel the results of hip and knee joint arthroplasties. A large percentage of ankle arthrodeses remain painful, and function is not normal. There is no satisfactory "salvage procedure" to a painful ankle fusion. Patients with primary ankle arthritis tend to develop bilateral ankle involvement as well as involvement of the subtalar and midtarsal joints; bilateral ankle fusion results in a severe handicap to gait and function. Ankle fusion with involvement of the subtalar or midtarsal joints might well result in a painful fusion. Maintenance of tibiotalar motion appears essential in both instances. It is apparent that all ankle problems cannot be dealt with by fusion and a successful long-term ankle arthroplasty is needed. Total ankle arthroplasty using cement fixation remains controversial. Continued use of polymethylmethacrylate and additional design changes do not appear to be the answer to possible ankle joint replacement. Initial success using the PCA concept of biological cementless fixation of the Scholz total ankle prosthetic components appears to offer a new dimension in the success of total ankle arthroplasty.

Adult↗
PubMed2006

Ankle alignment on lateral radiographs. Part 1: sensitivity of measures to perturbations of ankle positioning.

BACKGROUND: In ankles with end-stage osteoarthritis or with total ankle replacement (TAR), radiographic landmarks based on joint surface morphology usually are obscured and inadequate for radiographic measurement. Furthermore, because of difficulty in reproducibly positioning the ankle for a standing radiograph, any radiographic measure to accurately describe ankle alignment must tolerate perturbations of ankle positioning on clinical radiographs. To identify a radiographic measure of anteroposterior tibial-talar alignment that meets those requirements, three methods were compared to determine their sensitivity to perturbations in ankle positioning. METHODS: Ten cadaver ankles had lateral radiographs taken in varying ankle positions in nine prespecified positions in the transverse plane and in seven positions in the sagittal plane. The anteroposterior tibial-talar alignment was quantified by three methods. Sensitivities to changes of ankle position in each plane were then compared. RESULTS: With the tibial-axis-to-talus ratio (T-T ratio: the ratio into which the midlongitudinal axis of the tibial shaft divides the longitudinal talar length), sensitivity to ankle positional changes in either plane was lowest, with errors associated with 10 degrees of ankle malpositioning being 2.2%. The posterior-tibial-line-to-talus ratio (P-T ratio: a similar ratio, but using the posterior longitudinal line of the tibial shaft) showed higher sensitivity in the transverse plane than the T-T ratio, though the associated errors in either plane were nearly comparable. The tibial-axis-to-lateral-process distance (T-L distance: the perpendicular distance from the tibial axis to the tip of the lateral talar process) showed highest sensitivity in both planes. CONCLUSIONS: The T-T ratio tolerated perturbations of ankle positioning best among the tested measures. This measure is potentially applicable to clinical radiographic measurement when determining the anteroposterior tibial-talar alignment in ankles with articular degeneration or TAR. The P-T ratio also appears to have reasonable tolerance.

Aged↗
PubMed1997

Ankle braces effectively reduce recurrence of ankle sprains in female soccer players.

OBJECTIVE: The purpose of this study was to examine the effectiveness of ankle bracing and taping in preventing recurrencess of ankle sprains, specifically in female athletes. DESIGN AND SETTING: Varsity soccer players' medical records over a five-year period were retrospectively reviewed at a Division III women's college. Data were extracted regarding any history of ankle sprain(s), type of intervention used as prophylaxis after the ankle sprain, number of exposures, and any incidence of recurrence. SUBJECTS: All collegiate varsity soccer players who had suffered a previous sprain to either one or both ankles (38 players) were identified as subjects. MEASUREMENTS: Each previously injured ankle (n = 56) was considered as a case for the analysis. Ankles that had a previous sprain received one of four interventions: 1) a canvas, laced ankle brace (n = 19), 2) taping (n = 12), 3) a combination of taping and ankle bracing (n = 8), or 4) no treatment (n = 17). RESULTS: The four intervention groups had a total of 1717 practice exposures and 650 competitive game exposures; exposures did not differ among the 4 groups. Ankle sprain recurrence frequency was 0%, 25%, 25%, and 35% for the braced, taped, combination, and untreated groups, respectively. The recurrence incidence for the braced group was significantly lower than that of the other three groups. The ankle sprain recurrence frequency did not differ among the taped, combination, and no treatment groups. CONCLUSION: We suggest that prophylactic ankle bracing is effective in reducing the incidence of ankle sprains in female soccer players with a previous history of ankle sprains.

Journal Article↗
PubMed1995

Comparison of passive stiffness variables and range of motion in uninvolved and involved ankle joints of patients following ankle fractures.

BACKGROUND AND PURPOSE: The purpose of this study was to quantify several variables of ankle stiffness and dorsiflexion (DF) range of motion (ROM) in the casted (fractured) and noncasted ankles of humans after cast removal. SUBJECTS: Thirty subjects (mean age = 32.4 years, SD = 15.8) with malleolar ankle fractures were tested within 4 days of cast removal but before they began physical therapy. METHODS: A torque motor system generated torque-versus-displacement graphs by recording angular displacement and resistive torque during a 6 0/s passive cycling of the ankle from 10 degrees of plantar flexion to the limit of DF ROM: Maximum passive DF ROM, passive torque, and passive elastic stiffness at the neutral position and energy loss were measured. Testing was performed in the absence of triceps surae muscle electromyographic activity. For analysis, subjects were separated into two groups based on fracture severity. RESULTS: There was no difference in passive torque between the fractured ankles and the matched noncasted ankles. There was a small difference in passive elastic stiffness between the more severely fractured ankles and the matched noncasted ankles. The fractured ankles were different in terms of energy loss from the matched noncasted ankles. For maximum passive DF ROM, there was a large difference between the fractured ankles (more severe: mean = 4.4 degrees; less severe: mean = 6.8 degrees) and the matched noncasted ankles (more severe: mean = 15.1 degrees; less severe: mean = 19.1 degrees). CONCLUSION AND DISCUSSION: Altered length-tension relationships and neuromuscular mechanisms have been suggested to produce postimmobilization joint contractures. The results of this study on humans are consistent with both possibilities and support the theory that changes that occur during immobilization result in protection from overstretching of the fragile calf musculature after a period of ankle fixation. The time course of normalization of stretch reflexes warrants investigation.

Adolescent↗
PubMed2004

The HINTEGRA ankle: rationale and short-term results of 122 consecutive ankles.

The HINTEGRA ankle was developed as an attempt to specifically address the needs of minimal bone resection, extended bone support, proper ligament balancing, and minimal contact stresses within and around the prosthesis. The purpose of this study was to determine the short-term results in a consecutive series of 116 patients (122 ankles). Preoperative diagnoses were posttraumatic osteoarthrosis in 91 ankles (75%), primary osteoarthrosis in 16 ankles (13%), and systemic arthritis in 15 ankles (12%). Eight ankles had to be revised. Four were revised because of loosening of at least one component; one because of dislocation of the meniscus; and three for other reasons. All revisions were successful. After an average of 18.9 months (range, 1-3 years), 84% of patients were satisfied, and the clinical result was rated as good or excellent in 82% of the cases. The American Orthopaedic Foot and Ankle Society hindfoot score improved from 40 points preoperatively to 85 points at followup. Eighty-three ankles (68%) were completely pain-free. The average range of motion clinically was 39 degrees (range, 15 degrees-55 degrees) and under fluoroscopy (true ankle motion) it was 37 degrees (range, 7 degrees-62 degrees). Radiographically, the tibial component was stable in all ankles, and no tilting of the component occurred since surgery. However, migration of the talar component was observed in two ankles. The concept of minimal bone resection and wide bony support was shown to be successful on the tibial and talar sides. Obtained function, pain relief, and patient satisfaction were promising and, compared with other devices, the results mostly were superior. This may support the idea that anatomic-shaped surfaces, as is the case in the HINTEGRA ankle, may be successful in total ankle replacement.

Adult↗
PubMed2007

A systematic review on ankle injury and ankle sprain in sports.

This article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201,600 patients were included, with 32,509 ankle injuries. Ankle injury information was available from 14,098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports.

Ankle Injuries↗
PubMed1995

Detection of radiographically occult ankle fractures following acute trauma: positive predictive value of an ankle effusion.

OBJECTIVE: The purpose of our study was to determine if the presence of an ankle effusion on plain radiographs after acute ankle trauma is predictive of occult ankle fracture when no fracture is visible on the standard radiographic series. SUBJECTS AND METHODS: The ankle radiographs of 1153 patients with acute ankle trauma were examined for fracture and for the presence and extent of anterior and posterior capsular distension. Patients with ankle effusions but no detectable fracture subsequently underwent sagittal and coronal complex-motion tomography. RESULTS: Eleven of 33 patients with ankle effusions and otherwise normal plain radiographs had occult fractures identified with tomography. The fracture sites were as follows: osteochondral fracture of talar dome (n = 4), neck of talus (n = 1), medial malleolus (n = 1), anterior tibial rim (n = 1), posterior tibial rim (n = 1), tibial plafond (n = 1), lateral malleolus (n = 1), and anterior process of calcaneus (n = 1). The radiographic size of an ankle effusion was predictive of occult fracture. An ankle effusion measuring 13 mm or more in anterior plus posterior capsular distension had an 82% sensitivity and 91% specificity for underlying fracture in our series. The positive predictive value of an ankle effusion 13 mm or greater was 82%. CONCLUSION: The presence of an ankle effusion on plain radiographs following acute ankle trauma is suggestive of an underlying fracture. An ankle effusion of 13 mm or greater in total capsular distension has a positive predictive value of 82% for occult fracture and is a reasonable threshold to prompt additional imaging.

Adolescent↗
PubMed1999

Relationship between ankle invertor H-reflexes and acute swelling induced by inversion ankle sprain.

STUDY DESIGN: Single group, post-test design using the uninvolved lower extremity as the experimental control. OBJECTIVES: To determine relationships between ankle swelling and flexor digitorum longus and peroneus longus H-reflex amplitude and latency. BACKGROUND: Primary capsuloligamentous injury, neural injury, and joint effusion and swelling may contribute to H-reflex changes following inversion ankle sprain. The relationship between ankle swelling and invertor or evertor H-reflexes has not been reported. METHODS AND MEASURES: Fifteen subjects with acute grade I or II inversion ankle sprains (mean +/- SD) 6.5 +/- 3 days after onset participated in this study. Swelling was estimated using a tape measure and the figure-of-eight girth assessment method. H-reflexes were determined using standard techniques. Paired t-tests were used to compare mean differences in ankle girth (swelling) and ankle invertor or evertor H-reflex amplitude and latency between the involved and uninvolved limbs. Pearson product moment correlations were used to assess relationships between swelling and H-reflex variables. RESULTS: Involved limb ankle girth was increased with respect to the uninvolved limb (1.5 +/- 0.9 cm) and the involved ankle flexor digitorum longus latency was delayed (0.72 +/- 0.7 ms). There was a moderate positive association (r = 0.73) between the latency delay in the involved ankle flexor digitorum longus and swelling. There were no significant differences in H-reflex amplitude and peroneus longus latency between ankles. CONCLUSIONS: Grade I or II inversion sprains and the related swelling appear to delay involved ankle flexor digitorum longus latency to a greater extent than peroneus longus latency. Clinicians need to direct greater attention to the ankle invertors when designing and implementing ankle rehabilitation programs, particularly during the swelling management phase of treatment.

Acute Disease↗
PubMed2003

Uncemented STAR total ankle prostheses. Three to eight-year follow-up of fifty-one consecutive ankles.

BACKGROUND: The feasibility of replacing the ankle joint has been a matter of speculation for a long time. In recent years, the designs of ankle prostheses have been improved, and three designs, all used without bone cement, currently dominate the market. However, documentation of the clinical results of the use of these prostheses is sparse. We reviewed the intermediate-term results of fifty-one consecutive Scandinavian Total Ankle Replacements (STAR). METHODS: Between 1993 and 1999, fifty-one consecutive ankles were replaced with an uncemented, hydroxyapatite-coated STAR total ankle prosthesis. Clinical examination for the present study was performed by one surgeon who had not taken part in the operations. Standardized radiographs were used. Complications and failures were recorded, and patient satisfaction and functional outcome scores were determined for all patients with an unrevised implant. RESULTS: Twelve ankles had to be revised. Seven were revised because of loosening of at least one of the components; two, because of fracture of the meniscus; and three, for other reasons. A component was exchanged in seven of the twelve revisions, whereas the ankle was successfully fused in the other five. An additional eight ankles had radiographic signs of loosening. The thirty-nine unrevised ankles (thirty-seven patients) were examined after thirty-six to ninety-seven months (median, fifty-two months). The patient was satisfied with the result after thirty-one of the ankle replacements, somewhat satisfied after two, and not satisfied after six. The median Kofoed score increased from 39 points before the surgery to 70 points at the time of the follow-up examination. A median follow-up score of 74 points was recorded when the system described by Mazur et al. and the AOFAS (American Orthopaedic Foot and Ankle Society) system were used. The median range of motion was approximately the same preoperatively and postoperatively. The estimated five-year survival rate, with revision for any reason as the end point, was 0.70. When radiographic loosening of either component was used as the end point, the estimated five-year radiographic survival rate was significantly better for the last thirty-one ankles treated in the series (p = 0.032). CONCLUSIONS: Total ankle replacement may be a realistic alternative to arthrodesis, provided that the components are correctly positioned and are of the correct size. However, the risks of loosening and failure are still higher than are such risks after total hip or total knee replacement.

Adult↗
PubMed1977

A study of ankle instability utilizing ankle arthrography.

A preclinical and clinical study of ankle arthrography for chronic ankle instability was performed. In the first study, ankle arthrograms were done on 50 cadaver ankles to demonstrate the limits of the normal ankle joint, and it was demonstrated that contrast in tendon sheaths is not a sign of a torn ankle ligament. The second study consisted of investigating ten cases of chronic ankle instability utilizing ankle arthrography. It was concluded that ankle arthrography is helpful in diagnosing torn ankle ligaments if all remaining investigative procedures are negative. A positive ankle arthrogram is proof that a torn capsule and ligament has occurred. However, in this small series a negative a negative arthrogram and a normal talar tilt was still associated with a torn ligament of the ankle.

Adolescent↗
PubMed2005

Combined use of brachial-ankle pulse wave velocity and ankle-brachial index for fast assessment of arteriosclerosis and atherosclerosis in a community.

BACKGROUND: Pulse volume recordings and blood pressures at arms and ankles can be obtained automatically and simultaneously to allow fast measurements of the brachial-ankle pulse wave velocity and the ankle-brachial index. We applied this novel technique to assess the extent of arteriosclerosis and atherosclerosis in a community. METHODS: A total of 1329 residents in Kinmen completed a health survey including interview, physical examination, blood test, and the measurements of brachial-ankle pulse wave velocity and ankle-brachial index in 10 working days. RESULTS: Brachial-ankle pulse wave velocity was significantly related to age, systolic blood pressure, body mass index, waist circumference, ankle-brachial index, and fasting blood levels of glucose, triglyceride, high-density lipoprotein cholesterol, uric acid, and creatinine, and was significantly related to the 10-year risk of developing coronary heart disease estimated from the Framingham risk function. The prevalence of arteriosclerosis as defined by brachial-ankle pulse wave velocity values higher than the age and sex stratified references from the low risk subjects was 27.1% for men and 25.4% for women. The prevalence of atherosclerosis defined by ankle-brachial index <0.9 was 2.8% in men and 1.7% in women. In men but not in women, subjects with low ankle-brachial index had significantly greater risk for developing coronary artery disease than those with normal values. CONCLUSIONS: Brachial-ankle pulse wave velocity and ankle-brachial index can be obtained simultaneously and quickly for the assessment of arteriosclerosis and atherosclerosis in a community.

Adult↗
PubMed1996

Improving the detection of radiographically occult ankle fractures: positive predictive value of an ankle joint effusion.

OBJECTIVE: To assess the value of an ankle effusion on plain radiographs as a predictor of radiographically occult fracture after acute ankle trauma. PATIENTS: Consecutive patients with acute ankle trauma and radiographic evidence of an ankle joint effusion. Patients were excluded if ankle trauma was sustained more than 48 h previously or if a fracture was visible on initial photographs. METHODS: All subjects (n = 26) underwent computed tomography (CT) of the ankle in sagittal and coronal planes. Ankle effusion size was measured from initial lateral ankle radiographs. RESULTS: Twelve patients (46%) had radiographically occult fractures identified with CT. Fracture sites included: posterior or lateral malleoli (n = 4), calcaneus (n = 1), or talus (n = 7). Ankle effusion size was 11.2 mm in the group without fracture and 17.1 mm in the group with fracture (P < 0.0001). The positive predictive value of an effusion 15 mm or greater was 83%. CT detected significant soft-tissue injuries in four (15%) patients including peroneal retinaculum tear (n = 1), anterior talofibular ligament avulsion (n = 1), and tears of the peroneus longus (n = 1) and tibialis posterior (n = 1) tendons. CONCLUSIONS: The presence of a large ankle effusion of radiographs after acute ankle trauma suggests an underlying fracture. An ankle effusion of > or = 15 mm is a reasonable threshold to prompt additional imaging. Computed tomography provides good visualization of subtle bone injuries and may detect clinically imported soft-tissue injuries.

Adult↗
PubMed2006

Effect of ankle joint stiffness during eccentric phase in rebound jumps on ankle joint torque at midpoint.

The purposes of this study were to investigate firstly, the ankle joint stiffness during the eccentric phase in rebound jumps, and secondly, the effect of ankle joint stiffness during the eccentric phase on ankle joint torque at midpoint. Nine active males executed rebound drop jumps from a height of 30 cm (RDJ30) and 50 cm (RDJ50), and 5-repetition rebound jumps (5RJ). Force plate data, limb position and electromyogram (EMG) of the medial head of gastrocnemius (GAS), soleus (SOL), and tibialis anterior (TA) muscles were recorded simultaneously during all jumps. When compared with RDJ30 and RDJ50, 5RJ displayed significantly higher jumping height, ankle joint torque at midpoint, ankle joint stiffness during the eccentric phase, and integrated EMG (IEMG) of GAS and SOL. Furthermore, 5RJ displayed significantly lower contact time and IEMG of TA than RDJ30 and RDJ50 did. The ankle joint torque at midpoint showed a significant positive correlation with jumping height but a significant negative correlation with contact time in rebound jumps. There was a significant positive correlation between the ankle joint stiffness during the eccentric phase and ankle joint torque at midpoint in rebound jumps. These results suggested that for the rebound jumps to be effective, it may be important to enhance the ankle joint torque at midpoint by greater ankle joint stiffness during the eccentric phase. These results also suggested that compared to 5RJ, RDJ30 and RDJ50 may reduce ankle joint stiffness in order to protect the tendomuscular system from the stretch load. However, ankle joint stiffness is possibly increased in 5RJ because the restraint to defend the tendomuscular system is reduced by prediction or adaptation to the stretch load because it is a continuous jump.

Adult↗
PubMed2004

Accurate measurement of ankle range of motion after total ankle arthroplasty.

There is no standardized method reported in the literature to measure ROM of the ankle after a total ankle arthroplasty, which limits the possibility to compare results from the various ankle designs. It seems that most of the measurements are a combination of ankle and midfoot motion, not the tibiotalar joint. A protocol was developed to accurately measure the true tibiotalar and midfoot motion before and after an ankle replacement. Lateral radiographs were taken of the ankle with the patient in a weightbearing position, and measurements were done along fixed landmarks. In this study, the tibiotalar, midfoot, and combined ROM were measured preoperative and 1 year postoperative in a standardized, reproducible fashion. The preoperative tibiotalar ROM was 18.5 degrees and combined ankle and midfoot motion 25.1 degrees. The true tibiotalar motion after an Agility total ankle arthroplasty was 23.4 degrees, and the combined ankle and midfoot motion was 31.3 degrees. The average improvement in ROM in the tibiotalar joint was approximately 5 degrees, and combined ROM was 6.1 degrees. Preoperative ROM proved to be the main factor determining the eventual postoperative ROM. It is possible to accurately measure the true ankle and the midfoot motion and those measurements should be used when reporting on the results of ankle replacements. Total ankle arthroplasty resulted in a statistically significant, but clinically less than expected, increase in ROM.

Adult↗
PubMedDate not supplied

The effect of ankle disk training on muscle reaction time in subjects with a history of ankle sprain.

The purpose of this study was to determine whether 8 weeks of ankle disk training alters ankle muscle onset latency of patients with a history of lateral ankle sprain. The training was completed by eight minimally symptomatic subjects with a history of nonrehabilitated, unilateral, inversion ankle sprain sustained between 6 and 16 months before entry into the study. Ankle inversion perturbations monitored by fine-wire electromyography were performed in four lower extremity muscles (anterior tibialis, posterior tibialis, peroneus longus, and flexor digitorum longus) of all subjects on both the injured (experimental) and noninjured (control) legs. Testing was performed at study entry and after 8 weeks of ankle disk training on the previously injured ankle. Results revealed a statistically significant decrease in the anterior tibialis onset latency in both the experimental (67.6 +/- 20.3 to 51.7 +/- 17.6) and control (65.5 +/- 9.8 to 53.8 +/- 23.7) ankles after the training period. These findings indicate that muscle onset latency decreases in specific ankle muscle groups after ankle disk training in previously injured ankles. Both the experimental and control ankles demonstrated a significant change, which raises the question as to whether a proprioceptive cross-training effect occurred.

Adult↗
PubMed2005

Risk factors for noncontact ankle sprains in high school football players: the role of previous ankle sprains and body mass index.

BACKGROUND: In a previous study, we noted a possible connection between an athlete's weight and risk of ankle sprain. HYPOTHESIS: A high body mass index and a history of a previous ankle sprain increase the risk of a subsequent noncontact sprain. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: One hundred fifty-two athletes from 4 football teams were observed (2 varsity and 2 junior varsity). Two teams were observed for 3 seasons, and 2 teams were observed for 1 season. Before each season, body mass, height, history of previous ankle sprains, and ankle tape or brace use were recorded. RESULTS: There were 24 ankle sprains, of which 15 were noncontact inversion sprains (11 grade I, 3 grade II, 1 grade III; incidence, 1.08 per 1000 athlete-exposures). Injury incidence was higher in athletes with previous ankle injuries (2.60 vs 0.39; P < .001). Body mass index was also a risk factor (P < .05): injury incidence was 0.52 for players with a normal body mass index, 1.05 for players at risk of overweight, and 2.03 for overweight players. Injury incidence was 0.22 for normal-weight players with no previous ankle sprain compared with 4.27 for overweight players who had a previous sprain. CONCLUSION: An overweight player who had a previous ankle sprain was 19 times more likely to sustain a noncontact ankle sprain than was a normal-weight player with no previous ankle sprain. CLINICAL RELEVANCE: Ankle sprain prevention strategies should be targeted at football players with a high body mass index and a history of previous ankle sprains.

Adolescent↗
PubMed2000

Kinematics of a total arthroplasty of the ankle: comparison to normal ankle motion.

Although the concept of a total ankle arthroplasty has been advanced as a method for treating severe ankle arthritis, the clinical experience with all of the models developed has been discouraging. Both the constrained designs, which maximize joint contact area by restricting the available motion, and the unconstrained designs, which allow more normal motion at the expense of higher contact stresses, uniformly result in implant loosening, pain, and clinical failure in 2 to 7 years. This has led to the recommendation against the use of a total ankle arthroplasty except in very low-demand patients. Failure of ankle implants can be ascribed to either anatomic considerations (e.g.--the talus is too small to accommodate the stress transfers of a prosthesis), or mechanical etiologies. Abnormal 3-dimensional motion of the ankle following arthroplasty would fall into the latter category. This study examined the motion that occurs after implantation of an unconstrained-type total ankle arthroplasty. Using previously validated methodology, axially loaded ankle specimens were cycled through an arc of plantarflex/dorsiflexion while measuring the resulting coupled internal/external and varus/valgus rotations. The average coupled motions in prosthetic ankles were not significantly different than their intact controls. There was, however, a significantly increased amount of hysteresis (defined as the difference between the upper and lower pathways of coupled motion at any given sagittal position) that occurred as the ankle was dorsiflexed and plantar flexed. The increased hysteresis was seen in both the axial and coronal planes. This indicates that there was a greater permitted envelop of motion in the prosthetic ankles compared to normal ankles. It is hypothesized that this subtle change in ankle kinematics caused by the arthroplasty leads to abnormal stress transfer at the prosthesis-bone interface, thereby promoting early implant failure.

Aged↗