Postural Control Deficits During Static Single-leg Stance in Chronic Ankle Instability: A Systematic Review and Meta-Analysis

Abstract

Context: Postural control deficits arising from injured ankles are central to chronic ankle instability (CAI) and its persistent symptoms. This is usually measured by recording the center of pressure (CoP) trajectory during static single-leg stance using a stable force plate. However, existing studies have produced conflicting results on whether this mode of measurement adequately reveals the postural deficits in CAI. Objective: To determine whether postural control during static single-leg stance is impaired in CAI patients when compared with uninjured healthy controls. Data Sources: Literature databases, PubMed, Embase, Web of Science, Cochrane Library, Scopus, CINAHL, and SPORTDiscus, were searched from inception to April 1, 2022, using ankle-, injury-, and posture-related terms. Study Selection: Two authors independently performed the step-by-step screening of article titles, abstracts, and full texts to select peer-reviewed studies investigating CoP trajectory during static single-leg stance using a stable force plate in CAI patients and healthy controls. A total of 13,637 studies were reviewed, and 38 studies (0.003%) met the selection criteria. Study Design: Meta-analyses of descriptive epidemiological study. Level of Evidence: Level 4. Data Extraction: CoP parameters, sway directions, visual condition, and numerical data (means and standard deviations) were extracted. Results: The injured ankles of CAI patients had higher standard deviations of sway amplitude in both anterior-posterior and medial-lateral directions (standardized mean difference [SMD] = 0.36 and 0.31, respectively) under conditions of open eyes than controls. Higher mean sway velocity in anterior-posterior, medial-lateral, and total directions (SMD = 0.41, 0.37, and 0.45, respectively) with closed eyes was also found. Conclusion: CAI patients had deficits of postural control during static single-leg stance, and these deficits were identified by the CoP trajectory. Further methodological explorations of CoP parameters and corresponding test conditions are required to enhance the sensitivity and reliability of postural deficit assessments in CAI using force plates.

Test-retest, intra- and inter-rater reliability of the reactive balance test in patients with chronic ankle instability

“…Therefore, further defining errors could minimize rater variability and improve the reliability of the RBT test. Another potential reason to explain this increased variability compared to healthy recreational athletes (80), might be the inherent increased variability in postural control strategies used by patients with CAI (103)(104)(105)(106)(107)(108). It might be driven by the neuroplastic changes they experience related to their ligamentous ankle injuries (109,110).…”

The Investigation of Nonlinear Variability Underlying Postural Control in The Injure-Limb in Individuals with and without Chronic Ankle Instability

“…Many postural control studies have looked at the area, velocity, and excursion length of the center-of-pressure (COP) in individuals with CAI. However, there is conflicting evidence showing that individuals with CAI have impaired postural control in unilateral stance when compared to healthy controls [8]- [13]. The lack of consistency could be attributed to the fact that standard COP measures do not specify the temporal proximity to stability boundaries that individuals should strive for when maintaining an upright posture [14].…”

EMG Analysis During Static Balance in Chronic Ankle Instability, Coper and Controls

“…Particularly, CAI patients frequently display altered postural control, which can be attributed to sensorimotor dysfunction [7]. While deficits in postural control are recognized as contributing factors that perpetuate the condition of CAI [8], there are conflicting results in the static balance literature [9,10]. For example, CAI patients displayed increased excursions of the center of pressure (CoP) and decreased time-to-boundary scores during single-leg balance tests [9].…”

“…For example, CAI patients displayed increased excursions of the center of pressure (CoP) and decreased time-to-boundary scores during single-leg balance tests [9]. However, they also had no differences in static balance between individuals with and without CAI [10]. These discrepancies in the literature may hinder researchers and clinicians in understanding the factors that perpetuate the condition of CAI.…”