Proprioception and neuromuscular control at return to sport after ankle surgery with the modified Broström procedure

Abstract

The modified Broström procedure (MBP) is an initial treatment for symptomatic chronic ankle instability (CAI) patients. This study aimed to compare the proprioception and neuromuscular control ability of both affected and unaffected ankles at the time of return to sports after MBP for patients with scores of normal controls. 75 individuals (40 who underwent MBP, 35 normal controls) participated. The dynamic balance test scores were significantly higher in the affected ankle of the patients than in the controls (1.5 ± 0.6° vs. 1.1 ± 0.4°, p < 0.003). The time to peak torque for dorsiflexion (60.8 ± 13.9 ms vs. 52.2 ± 17.5 ms, p < 0.022) and eversion (68.9 ± 19.1 ms vs. 59.3 ± 21.1 ms, p < 0.043) was significantly delayed in the affected ankle of the patients than in the controls. The dynamic balance test and time to peak torque in CAI patients remained significantly reduced at the time of return-to-sport after MBP. Clinicians and therapists should be aware of potential deficits in proprioception and neuromuscular control when determining the timing of return to sports after MBP.

Clinical Outcomes and Return to Preinjury Sports After Anatomic Reconstruction With a Gracilis Autograft Versus the Modified Broström Procedure in Patients With Generalized Joint Laxity

“…Muscle strength, postural stability, and neuromuscular control were also related to return to sports. [14][15][16] In CLAI patients, postural stability, neuromuscular control and muscle strength, or endurance has been found to decrease. 15 Modified Brostro ¨m repair may improve muscle strength and endurance and dynamic postural stability.…”

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

“…There are free nerve endings and mechanical receptors around the ligaments near the ankle which can perceive joint speed in movement. Due to the restricted flexibility of the ankle, abnormal signals from mechanical receptors will be introduced, affecting the proprioception of the ankle and, to varying degrees, a decline in balance [ 60 , 61 ]. The static position, speed, and direction of the ankle may change during Maitland mobilization at various frequencies.…”

Arthroscopic modified Broström procedure achieves faster return to sports than open procedure for chronic ankle instability

“…Lateral ankle sprains are the most common sports injury with 20% potentially leading to chronic lateral ankle instability (CLAI), which may be caused by loose ligaments and capsule tissue, altered proprioception and neuromuscular control, and decreased muscle strength [22]. As the gold standard and first‐line surgical treatment of CLAI [4], modified Broström procedure is widely used to repair the lateral ankle ligament and restore ankle stability [23] in patients who fail to recover with conservative treatments. In recent years, several modified Broström procedures under arthroscopic techniques have been reported and have achieved similar or even better clinical scores and faster rates of return to sports [10, 34] than open procedures and might potentially speed up the postoperative rehabilitation process [3].…”

“…There are many ways to evaluate the return to sports status after modified Broström procedure, such as self‐report questionnaires [27], muscle strength [23] and functionality tests [7], but the effectiveness of the above measurements is limited due to the subjectivity and incompleteness of the tests. As a precise and objective evaluation tool, foot pressure analysis can be used as a supplementary tool to verify dynamic biomechanical changes in the more natural movements (such as walking [16], running [13] and landing [25]) of the ankle joint complex and reflect the patient's potential sport function.…”

“…As a precise and objective evaluation tool, foot pressure analysis can be used as a supplementary tool to verify dynamic biomechanical changes in the more natural movements (such as walking [16], running [13] and landing [25]) of the ankle joint complex and reflect the patient's potential sport function. To date, foot pressure has been used to analyse the neuromuscular control deficits [23, 24, 31] in the CAI patients. However, no reports have compared the postoperative sport function in terms of foot pressure after open and arthroscopic modified Broström procedure.…”