Physical Impairments in Adults With Ankle Osteoarthritis: A Systematic Review and Meta-analysis

Abstract

Study Design Systematic review with meta-analysis. Background Lower-limb osteoarthritis (OA) is associated with pain and reduced function. Most research focuses on hip and knee OA- related impairments; consequently, impairments that characterize ankle OA are not well understood. Objective To systematically review available evidence of physical impairments in individuals with ankle OA. Methods A comprehensive search of electronic databases was conducted from their inception to July 2017. Studies were screened using predefined inclusion/exclusion criteria. Studies that compared physical measures (excluding gait) between individuals with ankle OA and healthy controls or the unaffected ankle were included. Two reviewers rated studies for quality. Meta-analyses with random effects were conducted when appropriate. Results Of 4565 identified studies (563 participants), 8 satisfied the inclusion criteria and 3 studies were included in meta-analyses. All studies evaluated a range of impairments at end-stage OA, and exhibited poor reporting of missing data, assessor blinding, and measurement validity. Meta-analyses revealed large impairments of ankle sagittal plane motion and strength. Evidence from single studies indicated large deficits of ankle frontal plane motion and strength, talar translation and rotation on arthrometry, balance, and electromyography of ankle joint muscles. There were also abnormal bony alignments and greater fatty infiltrate in all calf muscle compartments. Conclusion The results of this literature review suggest significant ankle motion, strength, and functional impairments in individuals with ankle OA. The strength of the conclusions is limited, due to the small number and methodological limitations of published studies. Level of Evidence Symptom prevalence, level 1a. J Orthop Sports Phys Ther 2018;48(6):449-459. Epub 7 Apr 2018. doi:10.2519/jospt.2018.7569.

The ankle cartilage cascade: incremental cartilage damage in the ankle joint

“…Hence, more focus should be put on early detection and primary and secondary individualized preventive interventions to prevent cartilage damage in the earliest step of the cascade: the subclinical phase. This approach could allow for an early delay or even stop to the cartilage crack that leads to the waterfall of degeneration, and could prevent the development of osteochondral lesions and end-stage OA; two conditions with severe symptoms that affect the quality of life of the patient [ 1 , 24 ]. Moreover, from a societal perspective, one can also state that this is a paramount undertaking, as we know from previous literature that end-stage OA is associated with high direct and indirect costs [ 12 , 23 ].…”

Falls and falls-related injuries in individuals with chronic ankle symptoms: A cross-sectional study

“…Impairments in muscle strength, ankle range of motion, balance and ambulatory function have been shown in individuals with chronic ankle symptoms [13,14]. As these characteristics have been linked to falls in other populations [10,11], it is possible that they may contribute to the increased risk of falls in individuals with chronic ankle symptoms.…”

“…Many factors, such as impaired balance [10] and ankle muscle weakness [11], have been suggested to increase falls risk. Individuals with ankle OA and chronic ankle symptoms have impaired balance [12], decreased muscle strength [13,14], reduced ankle joint motion [13,14] and decreased mobility [14]. In light of the relationship between these impairments and falls, individuals with ankle OA may be at an increased risk of falling.…”

Surgical management of concurrent lateral ankle instability and osteochondral lesions of the talus increases dynamic sagittal ankle range of motion

“…The postoperative kinematic change in patients with concurrent LAI and OLT in the current study is mainly about the increase in dynamic ankle ROM rather than the static ankle ROM. The progression from patients with solitary LAI to patients with concurrent LAI and OLT and finally to patients with ankle osteoarthritis is accompanied by intra‐articular lesion progression and kinematic adaptations from increased laxity to reduced ROM [2]. Future studies on the kinematics of patients with LAI should involve imaging modalities such as MRI in the inclusion criteria to differentiate patients with solitary LAI or with concurrent LAI and OLT.…”