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At least 19 recordsLinked to original sources
PubMed1994

Comparison of DonJoy ankle ligament protector and subtalar sling ankle taping in restricting foot and ankle motion before and after exercise.

Clinicians often must select an appropriate prophylactic ankle support system for their patients from a variety of ankle orthoses and ankle taping configurations. The purpose of this study was to compare the effectiveness of the DonJoy Ankle Ligament Protector and a newly developed ankle taping procedure in restricting foot and ankle motion before and after exercise. Subjects were eight males and eight females who reported no history of ankle injury during the 6 months prior to testing, neurological condition, lower extremity arthritis, lower extremity fracture, or cardiac or balance problems. A Biodex dynamometer and computer were used to impose passive moments and to measure eversion and inversion prior to application of the ankle support systems, following application, and following 10 minutes of figure-of-eight running and 20 unilateral toe raises. Both ankles of each subject were assessed for each ankle support system. Subjects also compared the support systems for comfort, stability, and cosmetic acceptability. Both ankle support systems significantly reduced eversion and inversion following application and following exercise compared with preapplication measurements. Eversion measurements increased significantly following exercise for both ankle support systems compared with postapplication measurements. Inversion displacement following application was greater for the Ankle Ligament Protector than the ankle taping system. The two ankle support systems did not differ significantly following exercise for eversion or inversion measurements. The results may assist clinicians in selecting either of these ankle support systems for use in protection against ankle sprain injury.

Adult↗
PubMedDate not supplied

Effect of an ankle orthosis and ankle ligament anesthesia on ankle joint proprioception.

The purposes of this study were to determine the effect of a rigid ankle orthosis (Aircast Air-Stirrup) and lateral ankle ligament anesthesia on ankle joint proprioception. Twelve noninjured subjects attempted to match nine reference ankle joint positions with their eyes closed before and after application of the ankle brace and before and after one or two of the lateral ankle ligaments (anterior talofibular and calcaneofibular) were anesthetized. Three-dimensional ankle joint orientations were recorded with a Motion Analysis system. No significant differences in the constant, variable, or absolute error were seen between subjects in the non-anesthetized and anesthetized conditions (P > 0.05), regardless of whether one or two ligaments were anesthetized. Thus, it appears that ligament mechanoreceptors contributed little to ankle joint proprioception, and that the afferent feedback from skin, muscle, and other joint receptors was adequate for the positioning task of the present study. Both the variable and absolute error in matching the reference positions were significantly less with the orthosis than without (P < 0.05). Application of an orthosis may increase the afferent feedback from cutaneous receptors in the foot and shank, which may in turn lead to an improved ankle joint position sense.

Adult↗
PubMed1999

Early influence of an ankle sprain on objective measures of ankle joint function. A prospective randomised study of ankle brace treatment.

The purpose of this study was to analyse objective modalities of ankle joint function after an acute ankle sprain and to see whether treatment with an air-cushioned ankle brace could enhance the restoration of function compared with a traditionally used compression bandage. The study included 73 consecutive patients between 15 and 55 years of age with an acute grade II or III ankle sprain, who sought medical care within 24 h of the time of injury. Patients with recurrent sprain were excluded. The patients were allocated at random to treatment with compression bandage or an air-cushioned ankle brace (Air-Stirrup, Aircast). The regimen included early motion and weight-bearing in both groups. The patients were examined initially within 24 h, after 3-5 days, 2, 4 and 10 weeks after the injury by the following tests: clinical examination including range of motion, recording of postural sway by stabilometry, joint position sense test, isokinetic eversion-inversion muscle torques and figure-of-eight running. A decreased active range of motion in eversion-inversion was observed during the entire follow-up period. Increased postural sway was registered when standing on the injured foot up to 4 weeks after the injury, as were a deficit in evertor muscle peak torque and an evertor-invertor muscle imbalance compared with the uninjured side. Women demonstrated a greater impairment in postural sway than men. A longer curve running time with the injured ankle at the outside of the curve was noted at the 10-week follow-up. With the exception of running in a figure of eight, these measures were not influenced by treatment with a semi-rigid ankle brace. The methods used in the present study are well suited for further studies of objective modalities of ankle joint function, with the possible exception of the joint position sense test.

Ankle Injuries↗
PubMed1997

Ankle bracing in running: the effect of a Push type medium ankle brace upon movements of the foot and ankle during the stance phase.

Functional ankle braces are designed to limit medio-lateral movements of the ankle without affecting ankle dorsiflexion or plantar flexion. As running forms a basic activity in sports, the current study investigated the influence of wearing a Push type medium ankle brace upon movements of the foot and ankle during the stance phase in running. The movements of the lower extremity of seven trained male long-distance runners were filmed frontally (250 s-1) and sagittally (50 s-1) while running at 4.5 +/- 0.1 m.s-1 over a Kistler force platform. The tested brace significantly reduced the range (total subtalar eversion 13.3 deg vs 18.1 deg, p < 0.05) and rate of subtalar eversion (maximal velocity -309 deg.s-1 vs -533 deg.s-1). Plantar and dorsiflexion were not affected. The vertical impact force peak was not altered. It was argued that, although this might not be the prime design feature of the tested ankle brace, this orthotic offers a strategy to influence the range and the rate of subtalar eversion. It may have the potential to prevent runners from overuse injuries associated with overpronation, but interaction between the passive support by the brace and the muscular stabilization of the ankle joint needs further investigation.

Adult↗
PubMed1995

Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle injuries. Multicentre Ankle Rule Study Group.

OBJECTIVE: To assess the feasibility and impact of introducing the Ottawa ankle rules to a large number of physicians in a wide variety of hospital and community settings over a prolonged period of time. DESIGN: Multicentre before and after controlled clinical trial. SETTING: Emergency departments of eight teaching and community hospitals in Canadian communities (population 10,000 to 3,000,000). SUBJECTS: All 12,777 adults (6288 control, 6489 intervention) seen with acute ankle injuries during two 12 month periods before and after the intervention. INTERVENTION: More than 200 physicians of varying experience were taught to order radiography according to the Ottawa ankle rules. MAIN OUTCOME MEASURES: Referral for ankle and foot radiography. RESULTS: There were significant reductions in use of ankle radiography at all eight hospitals and within a priori subgroups: for all hospitals combined 82.8% control v 60.9% intervention(P < 0.001); for community hospitals 86.7% v 61.7%; (P < 0.001); for teaching hospitals 77.9% v 59.9%; (P < 0.001); for emergency physicians 82.1% v 61.6%; (P < 0.001); for family physicians 84.3% v 60.1%; (P < 0.001); and for housestaff 82.3% v 60.1%; (P < 0.001). Compared with patients without fracture who had radiography during the intervention period those who had no radiography spent less time in the emergency department (54.0 v 86.9 minutes; P < 0.001) and had lower medical charges ($70.20 v $161.60; P < 0.001). There was no difference in the rate of fractures diagnosed after discharge from the emergency department (0.5 v 0.4%). CONCLUSIONS: Introduction of the Ottawa ankle rules proved to be feasible in a large variety of hospital and community settings. Use of the rules over a prolonged period of time by many physicians of varying experience led to a decrease in ankle radiography, waiting times, and costs without an increased rate of missed fractures. The multiphase methodological approach used to develop and implement these rules may be applied to other clinical problems.

Ankle Injuries↗
PubMed1981

Variability of Doppler ankle pressures with arterial occlusive disease: an evaluation of ankle index and brachial-ankle pressure gradient.

The variability of Doppler ankle pressures was studied in 35 men with clinically stable claudication. An average of 6.8 measurements was obtained from each man. The mean range of ankle index was 0.18 with a mean standard deviation of 0.07. The brachial-ankle pressure gradient had a wider spread, with a mean range of 38 mm Hg and a standard deviation of 13.9. The amount of variation in a given patient was unrelated to mean blood pressure or mean ankle index. The results of this study show that the ankle index must change at least 0.15 before it can be considered significant. Based on the variability found, we recommend that multiple baseline determinations be obtained on patients who are to be followed longitudinally.

Ankle↗
PubMed2000

Interventions for preventing ankle ligament injuries.

BACKGROUND: Some sports, for example basketball and soccer, have a very high incidence of ankle injuries, mainly sprains. This contributes to ankle sprains being one of the most commonly treated injuries. OBJECTIVES: To assess the effects of interventions used for the prevention of ankle ligament injuries or sprains in physically active individuals from adolescence to middle age. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, MEDLINE (1966 to July 1996), EMBASE (1980 to September 1996), CINAHL (1982 to June 1996), and bibliographies of study reports. We also contacted colleagues and some trialists. Date of the most recent search: March 1997. SELECTION CRITERIA: Randomised or quasi-randomised trials of interventions for the prevention of ankle sprains in physically active individuals from adolescence to middle age were included provided ankle sprains were recorded. Interventions include use of modified footwear and associated supports, adapted training programmes and health education. DATA COLLECTION AND ANALYSIS: At least four reviewers independently assessed methodological quality and extracted data. Wherever possible, results of outcome measures were pooled and sub-grouped by history of previous sprain. MAIN RESULTS: Five randomised trials with data for 3954 participants were included. All trials involved young, active, mostly male adults participating in high-risk, usually sporting, activities. With the exception of ankle disc training, all prophylactic interventions entailed the application of an external ankle support in the form of a semi-rigid orthosis, air-cast brace or high top shoes. There was a significant reduction in the number of ankle sprains in people allocated external ankle support (Peto odds ratio 0.49; 95% confidence interval 0.37 to 0.66). This reduction was greater for those with a previous history of ankle sprain, but still possible for those without prior sprain. There was no apparent difference in the degree of severity of the ankle sprain prevented nor any change to the incidence of other leg injuries. The protective effect of 'high-top' shoes remains to be established. There was limited evidence for reduction in ankle sprain for those with previous ankle sprains who did ankle disc training exercises. REVIEWER'S CONCLUSIONS: This review provides good evidence for the beneficial effect of ankle supports in the form of semi-rigid orthoses or air-cast braces to prevent ankle sprain during high-risk sporting activities (e.g. soccer, basketball). Participants with a history of previous sprain can be advised that wearing such supports may reduce the risk of incurring a future sprain. However, any potential prophylactic effect should be balanced against the baseline risk of the activity, the supply and cost of the particular device, and for some, the possible or perceived loss of performance. Further research is indicated principally to investigate other prophylactic interventions and general applicability.

Adolescent↗
PubMed1996

Stiffness control in posterior-type plastic ankle-foot orthoses: effect of ankle trimline. Part 1: A device for measuring ankle moment.

A device was developed to measure the dorsi- and plantar flexion moment of plastic ankle-foot orthoses when deflected. It is operated by manually controlling a lever which is used to apply a nearly static force. Various orthoses can be classified according to the characteristics of the correcting force measured by this device. Simplicity and high reproducibility are the major advantages. However, to obtain measurements approximating the characteristics of orthoses under wearing conditions its use is restricted to orthoses made of low-viscosity materials.

Ankle↗
PubMed2001

Quantitative measurement of ankle passive flexibility using an arthrometer on sprained ankles.

OBJECTIVE: The purpose of this study was to quantitatively examine the flexibility of sprained ankles using an arthrometer device and compare the differences in flexibility between ankles following the first sprains and ankles with repeated severe sprains and chronic symptoms. DESIGN: A retrospective in vivo study was used. BACKGROUND: Many in vitro studies have demonstrated a significant role of joint flexibility in determining mechanical laxity of human cadaveric ankles after sectioning of the lateral ligaments, but few in vivo studies have used the technique to provide objective measurement on the sprained ankles. Furthermore, there is a lack of extensive studies that compared the difference in the ankle flexibility between ankles following the first sprain and ankles with multiple repeated severe sprains and chronic symptoms. METHODS: A total of 27 subjects with unilateral ankle sprains participated in this study. The subjects were divided into a first injury group (group A, n=12) and a chronic symptom group (group B, n=15) based on the history of their ankle injuries. The ankle flexibility in anterior drawer and inversion/eversion tests was measured in both ankles of the subjects using an arthrometer device, the ankle flexibility tester -- a six-degree-of-freedom instrumented linkage used for measurements of applied forces/moments and resultant rotations and/or translations of the ankle joint complex. The difference in ankle flexibility between the injured ankle and the contralateral intact side was analyzed. RESULTS: The flexibility in anterior drawer test of the injured ankles significantly increased compared to the intact ankles of the same individual in group B, but the same difference was not significant in group A. There were more subjects in group B (46.6%) than in group A (33.3%) who showed a sign of mechanical laxity in their injured ankles. CONCLUSIONS: The results indicated that the approach with measurement of ankle flexibility may be a potential tool used to detect the mechanical laxity in the sprained ankles. A tendency was found that patients with multiple ankle sprains and chronic symptoms had a higher occurrence rate of mechanical laxity. The result of the present study may also be interpreted that the ankles with mechanical laxity had higher risk of re-injury and leading to chronic symptoms.

Adolescent↗
PubMed2002

Assessment of Ankle-Subtalar-Joint-Complex Laxity Using an Instrumented Ankle Arthrometer: An Experimental Cadaveric Investigation.

OBJECTIVE: To show the relationship between direct measurements of tibial-calcaneal bone motion and instrumented measurements of ankle-subtalar-joint-complex laxity using a portable ankle arthrometer; to assess within and between-tester measurement reliability; and to determine if the ankle arthrometer can detect increased mechanical laxity of the ankle-subtalar-joint-complex after simulated injury of the lateral ankle ligaments. DESIGN AND SETTING: We used linear regression analysis to examine the relationship between direct measurements of tibial-calcaneal bone motion and instrumented measurements of ankle-subtalar-joint-complex laxity. An intraclass correlation coefficient (2,1) was calculated to determine intratester and intertester reliability for instrumented measurements of ankle-subtalar-joint-complex laxity. In addition, 2 separate, one-way, repeated-measures analyses of variance were used to compare instrumented measures of anteroposterior displacement and inversion-eversion rotation among the intact ankles after sectioning the anterior talofibular ligament and both the anterior talofibular and calcaneofibular ligaments. Data were collected in a biomechanics laboratory setting. SUBJECTS: Six fresh-frozen human-cadaver ankle specimens were studied. MEASUREMENTS: Testing involved the concurrent measurement of tibial-calcaneal bone motion and ankle-subtalar-joint-complex motion during the application of external loads. An instrumented ankle arthrometer was used to load the ankle in a controlled manner. Two spatial kinematic linkages measured the 3-dimensional motion of the calcaneus relative to the tibia and the motion of the arthrometer's footplate relative to the tibia. RESULTS: The correlation between tibial-calcaneal bone motion and instrumented measurement for anterior-posterior displacement was.878 (P =.0001). Its linear relationship with bone motion accounted for approximately 77% of the variance of the instrumented measurement. The correlation between tibial-calcaneal bone motion and instrumented measurement for inversion-eversion rotation was.858 (P =.0001), with approximately 74% of the variance of the instrumented measurement accounted for by its linear relationship with bone motion. High intratester and intertester reliability coefficients (ICC [2,1] =.80 to.97) were observed for instrumented measurements of ankle-subtalar-joint-complex laxity. In addition, ligamentous sectioning resulted in significantly increased ankle-subtalar-joint-complex laxity. When compared with the intact condition, sectioning both the anterior talofibular and calcaneofibular ligaments produced significant increases in anterior-posterior displacement (P =.0001) and inversion-eversion rotation (P =.002). CONCLUSIONS: We found a strong relationship between tibial-calcaneal bone motion and arthrometric measurements of ankle-subtalar-joint-complex laxity. The instrumented ankle arthrometer may be suitable as a diagnostic tool for the evaluation of lateral ankle-ligament laxity.

Journal Article↗
PubMed2001

Control of acceleration during sudden ankle supination in people with unstable ankles.

STUDY DESIGN: Comparative study of differences in functional control during ankle supination in the standing position in matched stable and unstable ankles (ex post facto design). OBJECTIVES: To document acceleration and deceleration during ankle supination in the standing position and to determine differences in control of supination perturbation between stable and unstable ankles. BACKGROUND: Repetitive ankle sprain can be explained by mechanical instability only in a minority of cases. Exercise therapy for ankle instability is based on clinical experience. Joint stability has not yet been measured in dynamic situations that are similar to the situations leading to a traumatic sprain. The process of motor control during accelerating ankle supination has not been adequately addressed in the literature. METHODS AND MEASURES: Patients with complaints of ankle instability (16 unstable ankles) and nonimpaired controls (18 stable ankles) were examined (N = 17 subjects, 10 women and 7 men). The average age was 23.7 +/- 5.0 years (range, 20-41 y). Control of supination speed was studied during 50 degrees of ankle supination in the standing position using accelerometry (total supination time and deceleration times) and electromyography (latency time). Timing of motor response was estimated by measuring electromechanical delay. RESULTS: The presence of an early, sudden, and presumably passive slowdown of ankle supination in the standing position was observed. Peroneal muscle motor response was detected before the end of the supination. Unstable ankles showed significantly shorter total supination time (109.3 ms versus 124.1 ms) and significantly longer latency time (58.9 ms versus 47.7 ms). CONCLUSIONS: Functional control in unstable ankles is less efficient in decelerating the ankle during the supination test procedures used in our study. Our conclusions are based on significantly faster total supination and significantly slower electromyogram response in unstable ankles. The results support the hypothesis that both decelerating the total supination movement during balance disturbance and enhancing the speed of evertor activation through exercise can be specific therapy goals.

Acceleration↗
PubMed1999

[Anatomic reconstruction of the lateral ligaments of the ankle using a plantaris tendon graft in the treatment of chronic ankle joint instability].

The purpose of this work was to present our technique of anatomic reconstruction of the lateral ankle ligaments using a free plantaris tendon graft. Between 1988 and 1997, 52 ankles (48 patients) were treated for chronic ankle instability resisting to a training program of minimally 3 months. The average age was 28.6 years (16 to 46 years) at the time of surgery. There were 30 ankles in men and 22 ankles in females. 4 patients were treated on both ankles. 50 ankles were available for a follow-up investigation after a mean of 3.5 years (1 to 10 years). Based on the AOFAS-Hindfoot-Scale an average score of 97.9 points (90 to 100 points) was found. The functional result was found to be excellent in 39 ankles (78 %), good in 9 ankles (18 %), fair in 2 ankles (4 %), and poor in 0 ankle (0 %). Dorsi-/plantarflexion was not restricted in any ankle. Supination was slightly restricted in 2 ankles, but not increased in any ankle. High patient's satisfaction with respect to the achieved stability was found in all but one ankle. No deterioration with time was observed in any case. The overall good and excellent results with this method may be explained by the strictly anatomic reconstruction that did not alter the kinematics nor the mechanics of the ankle joint complex. In addition the peroneal tendons were not weakened. We feel that this procedure is a better alternative to other more complex ligament reconstructions, especially tenodesis operations by using the peroneal tendon.

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↗
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↗
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↗