Incidence and risk factors for poor ankle functional recovery, and the development and progression of posttraumatic ankle osteoarthritis after significant ankle ligament injury (SALI): the SALI cohort study protocol

Abstract

Background Ankle sprains are one of the most common musculoskeletal injuries, accounting for up to 5% of all Emergency Department visits in the United Kingdom. Ankle injury may be associated with future ankle osteoarthritis. Up to 70% of ankle osteoarthritis cases may be associated with previous ankle injury. There is limited research regarding the association between ankle sprain and ankle osteoarthritis development. The current study aims to phenotype those who suffer significant ankle ligament injuries, identify potential risk factors for ankle injuries and subsequent poor recovery, examine why individuals may develop osteoarthritis, and what factors influence this chance. Methods In this multicentre cohort study participants were recruited from nine Emergency Departments and two Urgent Care Centres in the United Kingdom. Participants (aged 18–70 years old) were defined as those who had suffered an isolated acute ankle sprain, which was Ottawa Ankle Rules positive, but negative for a significant ankle fracture on x-ray. Age and sex matched controls were also recruited. The controls were individuals who had not suffered a significant ankle injury, including ankle pain, function affected for more than 7 days, or the ankle caused them to report to an Emergency Department. Data is collected through a series of seven questionnaires (at baseline, 3 months, 1 year, 3 years, 5 years, 10 years, and 15 years later). The questionnaires include four sections (demographic questions; index injury, and injury history questions; functional assessment questions; and quality of life questions) and are designed to collect detailed information about the individual, their injury, potential risk factors for ankle sprains and ankle osteoarthritis, plus their medical history and any medication consumed. Discussion The Significant Ankle Ligament Injury (SALI) study aims to add to the limited knowledge regarding which factors can predict ankle sprains, complaints, and osteoarthritis. This is important because despite ankle sprains being regarded as a benign injury that resolves quickly, residual symptoms are not uncommon months and years after the injury.

Management of Elderly Traumatic Ankle Arthritis with Ilizarov External Fixation

“…A biomechanical study proved that cancellous bone screws provided better anti‐rotation stress in human specimens with superior bone quality 35 . In contrast, the external fixation demonstrated better anti‐rotation stress in models with poorer bone quality 36 . Moreover, the screw fixation is invalid in osteopenic models 37 …”

“… 35 In contrast, the external fixation demonstrated better anti‐rotation stress in models with poorer bone quality. 36 Moreover, the screw fixation is invalid in osteopenic models. 37 …”

Effectiveness of the Rehabilitation Training Combined with Maitland Mobilization for the Treatment of Chronic Ankle Instability: A Randomized Controlled Trial

“…About 33% of affected people did not receive systematic rehabilitation treatment after the first ankle sprain. In the following two years, they would continue to suffer from symptoms such as decreased ankle range of movement, decreased muscle strength, proprioception abnormality, and decreased excitability of the nervous system, which weakened lower limb function and raised the risk of re-injury [ 57 , 58 ]. After the first injury, the recurrence rate is as high as 80% [ 54 ].…”

Can Weightbearing Cone-beam CT Reliably Differentiate Between Stable and Unstable Syndesmotic Ankle Injuries? A Systematic Review and Meta-analysis

“…Ankle sprains are one of the most common contributors to ankle instability [10]. Residual symptoms, such as pain, weakness, loss of function and instability may be present in approximately one-third of patients after ankle sprains [3]. This can lead to functional and mechanical impairments and represents a high socioeconomic burden [10].…”

“…Although functional instability might resolve with early proprioceptive rehabilitation, mechanical instability—defined as laxity induced by ligamentous injuries—often requires surgical treatment for improved stability and return to baseline functional status [10]. The accurate and timely diagnosis of ankle injuries is crucial to minimize residual symptoms and improve treatment [3].…”