scholarly journals Talar and Subtalar T1ρ Relaxation Times in Limbs with and without Chronic Ankle Instability

Cartilage ◽  
2021 ◽  
pp. 194760352199462
Author(s):  
Kyeongtak Song ◽  
Brian Pietrosimone ◽  
Joshua N. Tennant ◽  
Daniel B. Nissman ◽  
Katherine M. Dederer ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Relaxation Times ◽  
Chronic Ankle Instability ◽  
Talar Dome ◽  
Contralateral Limb ◽  
Secondary Purpose ◽  
Healthy Control ◽  
Control Limb ◽  
Proteoglycan Content ◽  
Magnetic Resonance Imaging Mri

Objective The primary aim was to determine differences in talocrural and subtalar joint (STJ) articular cartilage composition, using T1ρ magnetic resonance imaging (MRI) relaxation times, between limbs in individuals with unilateral chronic ankle instability (CAI) and compare with an uninjured control. Our secondary purpose was to determine the association between talocrural and STJ composition in limbs with and without CAI. Design T1ρ MRI relaxation times were collected on 15 CAI (11 females, 21.13 ± 1.81 years, body mass index [BMI] = 23.96 ± 2.74 kg/m2) and 15 uninjured control individuals (11 females, 21.07 ± 2.55 years, BMI = 24.59 ± 3.44 kg/m2). Talocrural cartilage was segmented manually to identify the overall talar dome. The SJT cartilage was segmented manually to identify the anterior, medial, and posterior regions of interest consistent with STJ anatomical articulations. For each segmented area, a T1ρ relaxation time mean and variability value was calculated. Greater T1ρ relaxation times were interpreted as decreased proteoglycan content. Results Individuals with CAI demonstrated a higher involved limb talocrural T1ρ mean and variability relative to their contralateral limb ( P < 0.05) and the healthy control limb ( P < 0.05). The CAI-involved limb also had a higher posterior STJ T1ρ mean relative to the healthy control limb ( P < 0.05). In healthy controls ( P < 0.05), but not the CAI-involved or contralateral limbs (p>0.05), talocrural and posterior STJ composition measures were positively associated. Conclusions Individuals with CAI have lower proteoglycan content in both the talocrural and posterior STJ in their involved limbs relative to the contralateral and a healthy control limb. Cartilage composition findings may be consistent with the early development of posttraumatic osteoarthritis.

scholarly journals Patient-Reported Outcome Measures in Individuals With Chronic Ankle Instability: A Systematic Review

2015 ◽  
Vol 50 (10) ◽  
pp. 1019-1033 ◽  
Author(s):  
Megan N. Houston ◽  
Johanna M. Hoch ◽  
Matthew C. Hoch
Keyword(s):  
Ankle Sprain ◽  
Ankle Instability ◽  
Data Extraction ◽  
Patient Reported Outcome Measures ◽  
Chronic Ankle Instability ◽  
Healthy Controls ◽  
Hand Search ◽  
Methodologic Quality ◽  
Patient Reported ◽  
Healthy Control

Context  A comprehensive systematic literature review of the health-related quality-of-life (HRQOL) differences among individuals with chronic ankle instability (CAI), ankle-sprain copers, and healthy control participants has not been conducted. It could provide a better indication of the self-reported deficits that may be present in individuals with CAI. Objective  To systematically summarize the extent to which HRQOL deficits are present in individuals with CAI. Data Sources  We searched for articles in the electronic databases of EBSCO Host and PubMed Central using key words chronic, functional, mechanical, coper, instability, sprains, and patient-assessed. We also performed a hand search of reference lists, authors, and patient-reported outcomes (PROs) of the articles screened for inclusion. Study Selection  Studies were included if they (1) incorporated a PRO as a participant descriptor or as a study outcome to compare adults with CAI to ankle-sprain copers or healthy controls, (2) were written in English, and (3) were published in peer-reviewed journals. Data Extraction  Two authors independently assessed methodologic quality using the modified Downs and Black Index. Articles were filtered into 3 categories based on between-groups comparisons: CAI and copers, CAI and healthy control participants, copers and healthy participants. We calculated Hedges g effect sizes and 95% confidence intervals to examine PRO group differences. Data Synthesis  Of the 124 studies assessed for eligibility, 27 were included. A total of 24 articles compared PROs in individuals with CAI and healthy controls, 7 compared individuals with CAI and copers, and 4 compared copers and healthy controls. Quality scores on the modified Downs and Black Index ranged from 52.9% to 88.2%, with 8 high-, 16 moderate-, and 3 low-quality studies. Overall, we observed moderate to strong evidence that individuals with CAI displayed deficits on generic and region-specific PROs compared with copers and healthy controls. However, evidence that differences exist between copers and healthy controls was conflicting. In addition, for dimension-specific outcomes, evidence to suggest that fear of reinjury is heightened in individuals with CAI was limited. Conclusions  The evidence suggested that CAI is associated with functional and HRQOL deficits, particularly when examined with region-specific PROs. However, PROs do not appear to differ between copers and healthy controls.

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

2015 ◽  
Vol 50 (4) ◽  
pp. 350-357 ◽  
Author(s):  
Mark A. Feger ◽  
Luke Donovan ◽  
Joseph M. Hart ◽  
Jay Hertel
Keyword(s):  
Lower Extremity ◽  
Surface Electromyography ◽  
Muscle Activation ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Ankle Sprains ◽  
Activation Time ◽  
Peroneus Longus ◽  
Healthy Control

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 = 23 ± 4.2 years, height = 173 ± 10.8 cm, mass = 72.4 ± 14 kg) and 15 matched healthy control adults (5 men, 10 women; age = 22.9 ± 3.4 years, height = 173 ± 9.4 cm, mass = 70.8 ± 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% ± 10.3%) than the control group (23.3% ± 22.2%; P = .05). No differences were noted between groups for measures of electromyographic amplitude at either preinitial or postinitial contact (P &gt; .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.

scholarly journals Abnormal Gutter Geometry as a Risk Factor of Chronic Ankle Instability

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Yuki Tochigi ◽  
Masato Ogawa ◽  
Masataka Kakihana ◽  
Satoru Ozeki
Keyword(s):  
Risk Factor ◽  
Ankle Instability ◽  
Side Wall ◽  
Chronic Ankle Instability ◽  
Reference Points ◽  
Opening Angle ◽  
Talar Dome ◽  
Significant Difference ◽  
Side Walls ◽  
Wall Geometry

Category: Ankle, Sports Introduction/Purpose: Abnormalities in the tibial plafond geometry, such as varus deformity or insufficient talar anterior coverage, have been recognized as the congenital risk factors of chronic ankle instability (CAI) and eventual osteoarthritis (OA) development. Given that the gutter articulations are playing a substantial role in ankle stability, presumably, geometrical abnormality of these articulations also increases such risks, though this concept has not been well addressed to date. Our recent study (2016 AOFAS Annual Summer Meeting) revealed that OA ankles are frequently (>50%) marked by excessive anterior and/or inferior opening of the talar side-walls. The present study examined whether or not CAI cases share these geometrical characteristic, so as to identify a risk factor that predispose ankles to CAI and eventual OA development. Methods: Clinical multi-detector computed tomography (MDCT) images, from 29 symptomatic CAI cases who were indicated for surgical repair or reconstruction of the lateral ligaments, and from 54 asymptomatic non-degenerative (control) ankles, were selected for 3-D morphometric evaluation of the talar dome side-wall geometry. Using a DICOM viewer, a local coordinate system for each ankle was established using talar landmarks. Then, on a transverse section at 3-5 mm distal to the superior aspect of the talar trochlea, the angle between the medial and lateral side-wall tangential lines (regressed from five cortical surface reference points for each) was measured as the “anterior opening angle.” Similarly, the “inferior opening angle” was measured on a mid-coronal section. Differences between groups were statistically tested using a t-test. Results: The anterior opening angles in CAI cases (mean +/- SD: 11.9 +/- 4.4 degrees) were significantly larger (p < 0.001) than in control cases (7.4 +/- 3.4). Defining the range of mean +/- 2SD in Control as “normal” (Figure 1), 9 out of 29 CAI cases (31%) had excessive anterior opening of the talar side-wall surfaces. Although the inferior opening angle did not exhibit significant difference between the groups (28.5 +/- 9.6 in CAI versus 25.5 +/- 5.9 in Control, p = 0.082). Defining the range of mean +/- 2SD in Control as “normal” (Figure 1), 4 CAI cases (14%) had excessive inferior opening. In total, 12 out of 29 CAI cases (41%) had abnormal talar side-wall geometry. Conclusion: These data suggest that a certain fraction of CAI ankles feature abnormal geometrical characteristics consistent with OA ankles, i.e. excessive anterior and/or inferior opening of the talar dome side-walls. Given that none of the CAI cases had remarkable degenerative or traumatic deformities, these characteristics are arguably congenital. Theoretically, the posteriorly narrower shape of the talar trochlea would reduce talocurural congruity in plantar flexion, while the inferiorly wider shape itself would reduce coronal plane stability. These geometrical abnormalities appear to predispose ankles to CAI. For such ankles, aggressive surgical stabilization may forestall OA development following lateral ligament injuries.

scholarly journals Neural Excitability and Joint Laxity in Chronic Ankle Instability, Coper, and Control Groups

2016 ◽  
Vol 51 (4) ◽  
pp. 336-343 ◽  
Author(s):  
Samantha Bowker ◽  
Masafumi Terada ◽  
Abbey C. Thomas ◽  
Brian G. Pietrosimone ◽  
Claire E. Hiller ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Spinal Reflex ◽  
Hoffmann Reflex ◽  
Neural Excitability ◽  
Reflex Excitability ◽  
Total Displacement ◽  
Ankle Arthrometer ◽  
Healthy Control ◽  
And Control

Neuromuscular and mechanical deficiencies are commonly studied in participants with chronic ankle instability (CAI). Few investigators have attempted to comprehensively consider sensorimotor and mechanical differences among people with CAI, copers who did not present with prolonged dysfunctions after an initial ankle sprain, and a healthy control group.Context: To determine if differences exist in spinal reflex excitability and ankle laxity among participants with CAI, copers, and healthy controls.Objective: Case-control study.Design: Research laboratory.Setting: Thirty-seven participants with CAI, 30 participants categorized as copers, and 26 healthy control participants.Patients or Other Participants: We assessed spinal reflex excitability of the soleus using the Hoffmann reflex protocol. Participants' ankle laxity was measured with an instrumented ankle arthrometer. The maximum Hoffmann reflex : maximal muscle response ratio was calculated. Ankle laxity was measured as the total displacement in the anterior-posterior directions (mm) and total rotation in the inversion and eversion directions (°).Main Outcome Measure(s): Spinal reflex excitability was diminished in participants with CAI compared with copers and control participants (P = .01). No differences were observed among any of the groups for ankle laxity.Results: Changes in the spinal reflex excitability of the soleus that likely affect ankle stability were seen only in the CAI group, yet no mechanical differences were noted across the groups. These findings support the importance of finding effective ways to increase spinal reflex excitability for the purpose of treating neural excitability dysfunction in patients with CAI.Conclusion:

scholarly journals Current Perception Threshold Testing in Chronic Ankle Instability

2020 ◽  
Author(s):  
Ran Zhang ◽  
Xi Zhang ◽  
Yaping Chen ◽  
Weiqun Song
Keyword(s):  
Ankle Instability ◽  
Sensory Nerve ◽  
Chronic Ankle Instability ◽  
Nerve Fibers ◽  
Sensory Function ◽  
Control Group ◽  
Perception Threshold ◽  
Current Perception Threshold ◽  
Significant Difference ◽  
Healthy Control

Abstract Background: Damage to sensory input is one of the pathologies underlying chronic ankle instability (CAI). Therefore, it is necessary to evaluate the sensory function of patients with CAI. This study aims to quantitatively evaluate sensory nerve function in patients with CAI and healthy controls using current perception threshold (CPT) measurements.Methods: Fifty-nine subjects with CAI and 30 healthy control individuals participated in this study. CPT values at the anterior talofibular ligament region were tested on the injured and uninjured sides in CAI patients and on a random side in the healthy control group.Results: There were no significant differences in age, gender, height, weight or BMI between the CAI and healthy control groups. The CPT values did not show significant gender differences. The CPT values were not significantly correlated with age or BMI. Compared to the control group (250 Hz: 24.32±9.28, 5 Hz: 6.87±1.56), the CAI group had significantly higher CPT values on the injured (250 Hz: 42.83±28.49, 5 Hz: 23.43±18.53) and uninjured sides (250 Hz: 38.62±19.98, 5 Hz: 18.84±14.21) under 250 Hz and 5 Hz electrical stimuli (p<0.01). No significant difference was observed under 2000 Hz stimuli. There were correlations among CPT values at different frequencies (p<0.01).Conclusion: This study revealed increased sensory thresholds in injured and uninjured ankles of 250 Hz- and 5 Hz-related sensory nerve fibers among patients with CAI. The bilateral change in sensory threshold may indicate a central sensory modulation process.Level of Evidence: Level III, case-control study.

scholarly journals Current perception threshold testing in chronic ankle instability

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ran Zhang ◽  
Xi Zhang ◽  
Yaping Chen ◽  
Weiqun Song
Keyword(s):  
Ankle Instability ◽  
Sensory Nerve ◽  
Chronic Ankle Instability ◽  
Sensory Function ◽  
Control Group ◽  
Healthy Controls ◽  
Perception Threshold ◽  
Current Perception Threshold ◽  
Significant Difference ◽  
Healthy Control

Abstract Background Damage to sensory input is an underlying pathology of chronic ankle instability (CAI). Therefore, it is necessary to evaluate the sensory function of patients with CAI. The present study quantitatively evaluated sensory nerve function in patients with CAI and healthy controls using current perception threshold (CPT) measurements, as well as the influence of sex, age, and body mass index (BMI) on CPT values and the relations between CPT frequencies. Methods Fifty-nine subjects with CAI and 30 healthy controls participated in this study. CPT values at the anterior talofibular ligament region were recorded on the injured and uninjured sides in CAI patients and on both sides in the healthy control group. Between group differences were compared. The influence of sex, age and BMI on CPT values was evaluated. Correlations between different frequencies were also studied. Results There were no significant differences in age, sex, height, weight or BMI between the CAI and healthy control groups. The CPT values did not show a significant difference by sex. The CPT values did not significantly correlate with age or BMI. Compared to the control group, the CAI group had significantly higher CPT values on the injured and uninjured sides under 250-Hz and 5-Hz electrical stimuli; the difference between the groups was significant (p < 0.01), and the effect size were large. No significant difference was observed under 2000-Hz stimuli. There were correlations between CPT values at different frequencies (p < 0.01), especially 250 Hz and 5 Hz. Conclusion The present study revealed increased sensory thresholds in 250-Hz- and 5-Hz-related sensory nerve fibres in the injured and uninjured ankles of patients with CAI. This increase may indicate dysfunction of A-delta and C fibres. Sex, age and BMI did not significantly impact CPT values. There were correlations between CPT values at different frequencies, especially 250 Hz and 5 Hz. Level of evidence Level III, case-control study.

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