Inclusion Criteria When Investigating Insufficiencies in Chronic Ankle Instability

Delahunt, Eamonn; Coughlan, Garrett F.; Caulfield, Brian; Nightingale, Elizabeth J.; Lin, Chung‐Wei Christine; Hiller, Claire E.

doi:10.1249/mss.0b013e3181de7a8a

Cited by 335 publications

(278 citation statements)

References 109 publications

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“…There are generally two categories of chronic instability: mechanical instability, in which ankle joint motion is greater than normal physiologic limits, and functional instability, in which motion is physiologic but no longer under voluntary control [46]. Patients with functional instability may have proprioceptive and strength deficits and are thought to improve with physical therapy [47].…”

Section: Non-operative Managementmentioning

confidence: 99%

Operative treatment of lateral ligament instability

Shakked

Karnovsky

Drakos

2017

Curr Rev Musculoskelet Med

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Purpose of review Ankle sprains, which account for 40% of sports injuries in the USA, can lead to chronic ankle instability. Chronic ankle instability can be classified as functional, mechanical, or a combination of both and is diagnosed using a combination of a physical exam, an MRI, and stress radiographs. This review focuses on different approaches to treatment, including non-operative and operative techniques, of chronic ankle instability, including reviewing traditional procedures as well as more novel and newer techniques. Recent findings Based on existing literature, non-operative treatment should always precede operative treatment of chronic ankle instability. If rehabilitation fails, Brostrom-Gould type ankle stabilization has been the preferred surgical option. Recent literature suggests that arthroscopic repair might reduce recovery time and improve outcomes in certain populations; however, there are higher rates of complication following these surgeries. In more high-risk populations, some literature reports that ligament repair with peroneus brevis transfer could be a more effective treatment option. Summary Currently, varying surgical techniques exist for the treatment of chronic ankle instability. While the more recently reported techniques show promise, it is important to note that there is little evidence showing they are more successful than traditional techniques. It is imperative that future studies focus on outcomes and complication rates of these newer procedures.

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Section: Non-operative Managementmentioning

confidence: 99%

Operative treatment of lateral ligament instability

Shakked

Karnovsky

Drakos

2017

Curr Rev Musculoskelet Med

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“…5,6 This condition is characterized by mechanical and functional instability of the ankle, as well as residual symptoms of ''giving way'' or ankle instability for at least 1 year after an initial sprain. 7 Mechanical instability refers to excessive inversion laxity of the rearfoot or excessive anterior laxity of the talocrural joint that results in a physiologic or accessory range of motion that is beyond what is expected for the ankle joint. 7 Functional instability is characterized by self-reported episodes of giving way and feelings of ankle-joint instability.…”

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confidence: 99%

“…7 Mechanical instability refers to excessive inversion laxity of the rearfoot or excessive anterior laxity of the talocrural joint that results in a physiologic or accessory range of motion that is beyond what is expected for the ankle joint. 7 Functional instability is characterized by self-reported episodes of giving way and feelings of ankle-joint instability. 7 Hertel 8,9 first identified the overlapping nature of mechanical and functional instability and later noted that individuals with CAI have a continuum of deficits associated with the use of afferent stimuli, reflexive responses, and efferent motor control.…”

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confidence: 99%

“…7 Functional instability is characterized by self-reported episodes of giving way and feelings of ankle-joint instability. 7 Hertel 8,9 first identified the overlapping nature of mechanical and functional instability and later noted that individuals with CAI have a continuum of deficits associated with the use of afferent stimuli, reflexive responses, and efferent motor control. Investigators have identified specific deficits in proprioception, 10,11 peroneal reaction time, 12,13 and postural control 14,15 in individuals with CAI.…”

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confidence: 99%

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Lower Extremity Muscle Activation in Patients With or Without Chronic Ankle Instability During Walking

Feger

Donovan

Hart

et al. 2015

Journal of Athletic Training

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Context: Ankle sprains are among the most common musculoskeletal injuries, and many individuals with ankle sprains develop chronic ankle instability (CAI). Individuals with CAI exhibit proprioceptive and postural-control deficits, as well as altered osteokinematics, during gait. Neuromuscular activity is theorized to play a pivotal role in CAI, but deficits during walking are unclear.Objective: To compare motor-recruitment patterns as demonstrated by surface electromyography amplitudes between participants with CAI and healthy control participants during walking.Design: Descriptive laboratory study. Setting: Laboratory.Patients or Other Participants: Fifteen adults with CAI (5 men, 10 women; age ¼ 23 6 4.2 years, height ¼ 173 6 10.8 cm, mass ¼ 72.4 6 14 kg) and 15 matched healthy control adults (5 men, 10 women; age ¼ 22.9 6 3.4 years, height ¼ 173 6 9.4 cm, mass ¼ 70.8 6 18 kg).Intervention(s): Participants walked shod on a treadmill while surface electromyography signals were recorded from the anterior tibialis, peroneus longus, lateral gastrocnemius, rectus femoris, biceps femoris, and gluteus medius muscles.Main Outcome Measure(s): Preinitial contact amplitude, postinitial contact amplitude, time of activation relative to initial contact, and percentage of activation time across the stride cycle were calculated for each muscle.Results: Time of activation for all muscles tested occurred earlier in the CAI group than in the control group. The peroneus longus was activated for a longer duration across the entire stride cycle in the CAI group (36.0% 6 10.3%) than the control group (23.3% 6 22.2%; P ¼ .05). No differences were noted between groups for measures of electromyographic amplitude at either preinitial or postinitial contact (P . .05).Conclusions: We identified differences between the CAI and control groups in the timing of muscle activation relative to heel strike in multiple lower extremity muscles and in the percentage of activation time across the entire stride cycle in the peroneus longus muscle. Individuals with CAI demonstrated neuromuscular-activation strategies throughout the lower extremity that were different from those of healthy control participants. Targeted therapeutic interventions for CAI may need to be focused on restoring normal neuromuscular function during gait.

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“…[2][3][4] The term used to describe this syndrome is functional ankle instability (FAI), which can be more specifically defined as ankles with repetitive bouts of ''giving way'' or instability that leads to recurring sprains. 5,6 Currently, a single source of this instability has not been established, but the causal factors range from mechanical to functional inadequacies. 7 Functional inadequacies associated with FAI include deficits in proprioception, kinesthesia, neuromuscular control, strength, and balance.…”

mentioning

confidence: 99%

Noise-Enhanced Eversion Force Sense in Ankles With or Without Functional Instability

Ross

Linens

Wright

et al. 2015

Journal of Athletic Training

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Context: Force sense impairments are associated with functional ankle instability. Stochastic resonance stimulation (SRS) may have implications for correcting these force sense deficits.Objective: To determine if SRS improved force sense. Design: Case-control study. Setting: Research laboratory.Patients or Other Participants: Twelve people with functional ankle instability (age ¼ 23 6 3 years, height ¼ 174 6 8 cm, mass ¼ 69 6 10 kg) and 12 people with stable ankles (age ¼ 22 6 2 years, height ¼ 170 6 7 cm, mass ¼ 64 6 10 kg).Intervention(s): The eversion force sense protocol required participants to reproduce a targeted muscle tension (10% of maximum voluntary isometric contraction). This protocol was assessed under SRS on and SRS off (control) conditions. During SRS on , random subsensory mechanical noise was applied to the lower leg at a customized optimal intensity for each participant.Main Outcome Measure(s): Constant error, absolute error, and variable error measures quantified accuracy, overall performance, and consistency of force reproduction, respectively.Results: With SRS, we observed main effects for force sense absolute error (SRS off ¼ 1.01 6 0.67 N, SRS on ¼ 0.69 6 0.42 N) and variable error (SRS off ¼ 1.11 6 0.64 N, SRS on ¼ 0.78 6 0.56 N) (P , .05). No other main effects or treatment-bygroup interactions were found (P . .05).Conclusions: Although SRS reduced the overall magnitude (absolute error) and variability (variable error) of force sense errors, it had no effect on the directionality (constant error). Clinically, SRS may enhance muscle tension ability, which could have treatment implications for ankle stability.

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Inclusion Criteria When Investigating Insufficiencies in Chronic Ankle Instability

Cited by 335 publications

References 109 publications

Operative treatment of lateral ligament instability

Operative treatment of lateral ligament instability

Lower Extremity Muscle Activation in Patients With or Without Chronic Ankle Instability During Walking

Noise-Enhanced Eversion Force Sense in Ankles With or Without Functional Instability

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