Background:Chronic ankle instability(CAI) is a common sequela following an acute lateral ankle sprain(LAS).To treat an acture LAS more effectively and efficiently,it is important to identify patients at substantial ri...Background:Chronic ankle instability(CAI) is a common sequela following an acute lateral ankle sprain(LAS).To treat an acture LAS more effectively and efficiently,it is important to identify patients at substantial risk for developing CAI.This study identifies magnetic resonance imaging(MRI) manifestations for predicting CAI development after a first episode of LAS and explores appropriate clinical indications for ordering MRI scans for these patients.Methods:All patients with a first-episode LAS who received plain radiograph and MRI scanning within the first 2 weeks after LAS from December 1,2017 to December 1,2019 were identified.Data were collected using the Cumberland Ankle Instability Tool at final follow-up.Demographic and other related clinical variables,including age,sex,body mass index,and treatment were also recorded.Univariable and multivariable analyses were performed successively to identify risk factors for CAI after first-episode LAS.Results:A total 131 out of 362 patients with a mean follow-up of 3.0± 0.6 years(mean ± SD;2.0—4.1 years) developed CAI after first-episode LAS.According to multivariable regression,development of CAI after first-episode LAS was associated with 5 prognostic factors:age(odds ratio(OR)=0.96,95% confidence interval(95%CI):0.93-1.00,p=0.032);body mass index(OR=1.09,95%CI:1.02-1.17,p=0.009);posterior talofibular ligament injury(OR=2.17,95%CI:1.05-4.48,p=0.035);large bone marrow lesion of the talus(OR=2.69,95%CI:1.30-5.58,p=0.008),and Grade 2 effusion of the tibiotalar joint(OR=2.61,95%CI:1.39-4.89,p=0.003).When patients had at least 1 positive clinical finding in the 10-m walk test,anterior drawer test,or inversion tilt test,they had a 90.2% sensitivity and 77.4% specificity in terms of detecting at least 1 prognostic factor by MRI.Conclusion:MRI scanning is valuable in predicting CAI after first-episode LAS for those patients with at least 1 positive clinical finding in the10-m walk test,anterior drawer test,and inversion tilt test.Further prospective and large-scale studies are necessary for validation.展开更多
BACKGROUND Recently,the use of ligament advanced reinforcement system(LARS)artificial ligament,a new graft which has several unique advantages such as no donor-site morbidity,early recovery and no risk of disease tran...BACKGROUND Recently,the use of ligament advanced reinforcement system(LARS)artificial ligament,a new graft which has several unique advantages such as no donor-site morbidity,early recovery and no risk of disease transmission which has been a significant breakthrough for anatomical ligament reconstruction.Growing studies suggested that the special design of the LARS ligament with open fibers in its intra-articular part was believed to be more resistant to torsional fatigue and wearing.However,the safety and efficacy of LARS artificial ligament for ankle joint lateral collateral ankle ligament reconstruction has not been defined to date.AIM To evaluate the clinical results of all-arthroscopic anatomical reconstruction of ankle joint lateral collateral ligaments with the LARS artificial ligament for chronic ankle instability.METHODS Twenty-two patients with chronic lateral instability underwent anatomical reconstruction of the lateral collateral ligaments of ankle with LARS artificial ligament.The visual analogue score(VAS),American Orthopaedic Foot and Ankle Society score(AOFAS score)and Karlsson score were used to evaluate the clinical results before and after surgery.RESULTS A total of 22 patients(22 ankles)were followed up for a mean of 12 mo.All patients reported significant improvement compared to their preoperative status.The mean AOFAS score improved from 42.3±4.9 preoperatively to 90.4±6.7 postoperatively.The mean Karlsson score improved from 38.5±3.2 preoperatively to 90.1±7.8 postoperatively.The mean VAS score improved from 1.9±2.5 preoperatively to 0.8±1.7 postoperatively.CONCLUSION All-arthroscopic anatomical reconstruction of the lateral collateral ligaments with LARS artificial ligament achieved a satisfactory surgical outcome for chronic ankle instability.展开更多
Background:Several case studies observed that the lateral ankle sprain resulted from a sudden increase in ankle inversion accompanied by internal rotation.However,without sufficient ankle kinetics and muscle activity ...Background:Several case studies observed that the lateral ankle sprain resulted from a sudden increase in ankle inversion accompanied by internal rotation.However,without sufficient ankle kinetics and muscle activity information in the literature,the detailed mechanism of ankle sprain is still unrevealed.The purpose of our case report is to present 2 accidental ankle giving way incidents for participants with chronic ankle instability(CAI)and compare to their normal trials with data of kinematics,kinetics,and electromyography(EMG).Case description:Two young female participants accidentally experienced the ankle giving way when landing on a 25°lateral-tilted force plate.3 D kinematics,kinetics,and muscle activity were recorded for the lower extremity.Qualitative comparisons were made between the giving way trials and normal trials for joint angles,angular velocities,moments,centers of pressure and EMG linear envelopes.Results:One participant’s giving way trial displayed increased ankle inversion and internal rotation angles in the pre-landing phase and at initial contact compared to her normal trials.Another participant’s giving way trial exhibited greater hip abduction angles and delayed activation of the peroneus longus muscle in the pre-landing phase versus her normal trials.Conclusion:A vulnerable ankle position(i.e.,more inverted and internally rotated),and a late activation of peroneus activity in the pre-landing phase could result in the ankle giving way or even sprains.A neutral ankle position and early activation of ankle evertors before landing may be helpful in preventing ankle sprains.展开更多
基金supported by the Biomedicine Supporting Program of Shanghai "Science and Technology Innovation Plan" (19441902400)the Ningxia Hui Autonomous Region Key R&D program (2020BCH01001)+1 种基金the Shanghai "Science and Technology Innovation Action Plan" Domestic Science and Technology Cooperation Project (20025800200)the Clinical Research Program of Shanghai Municipal Health Commission (201940367)。
文摘Background:Chronic ankle instability(CAI) is a common sequela following an acute lateral ankle sprain(LAS).To treat an acture LAS more effectively and efficiently,it is important to identify patients at substantial risk for developing CAI.This study identifies magnetic resonance imaging(MRI) manifestations for predicting CAI development after a first episode of LAS and explores appropriate clinical indications for ordering MRI scans for these patients.Methods:All patients with a first-episode LAS who received plain radiograph and MRI scanning within the first 2 weeks after LAS from December 1,2017 to December 1,2019 were identified.Data were collected using the Cumberland Ankle Instability Tool at final follow-up.Demographic and other related clinical variables,including age,sex,body mass index,and treatment were also recorded.Univariable and multivariable analyses were performed successively to identify risk factors for CAI after first-episode LAS.Results:A total 131 out of 362 patients with a mean follow-up of 3.0± 0.6 years(mean ± SD;2.0—4.1 years) developed CAI after first-episode LAS.According to multivariable regression,development of CAI after first-episode LAS was associated with 5 prognostic factors:age(odds ratio(OR)=0.96,95% confidence interval(95%CI):0.93-1.00,p=0.032);body mass index(OR=1.09,95%CI:1.02-1.17,p=0.009);posterior talofibular ligament injury(OR=2.17,95%CI:1.05-4.48,p=0.035);large bone marrow lesion of the talus(OR=2.69,95%CI:1.30-5.58,p=0.008),and Grade 2 effusion of the tibiotalar joint(OR=2.61,95%CI:1.39-4.89,p=0.003).When patients had at least 1 positive clinical finding in the 10-m walk test,anterior drawer test,or inversion tilt test,they had a 90.2% sensitivity and 77.4% specificity in terms of detecting at least 1 prognostic factor by MRI.Conclusion:MRI scanning is valuable in predicting CAI after first-episode LAS for those patients with at least 1 positive clinical finding in the10-m walk test,anterior drawer test,and inversion tilt test.Further prospective and large-scale studies are necessary for validation.
文摘BACKGROUND Recently,the use of ligament advanced reinforcement system(LARS)artificial ligament,a new graft which has several unique advantages such as no donor-site morbidity,early recovery and no risk of disease transmission which has been a significant breakthrough for anatomical ligament reconstruction.Growing studies suggested that the special design of the LARS ligament with open fibers in its intra-articular part was believed to be more resistant to torsional fatigue and wearing.However,the safety and efficacy of LARS artificial ligament for ankle joint lateral collateral ankle ligament reconstruction has not been defined to date.AIM To evaluate the clinical results of all-arthroscopic anatomical reconstruction of ankle joint lateral collateral ligaments with the LARS artificial ligament for chronic ankle instability.METHODS Twenty-two patients with chronic lateral instability underwent anatomical reconstruction of the lateral collateral ligaments of ankle with LARS artificial ligament.The visual analogue score(VAS),American Orthopaedic Foot and Ankle Society score(AOFAS score)and Karlsson score were used to evaluate the clinical results before and after surgery.RESULTS A total of 22 patients(22 ankles)were followed up for a mean of 12 mo.All patients reported significant improvement compared to their preoperative status.The mean AOFAS score improved from 42.3±4.9 preoperatively to 90.4±6.7 postoperatively.The mean Karlsson score improved from 38.5±3.2 preoperatively to 90.1±7.8 postoperatively.The mean VAS score improved from 1.9±2.5 preoperatively to 0.8±1.7 postoperatively.CONCLUSION All-arthroscopic anatomical reconstruction of the lateral collateral ligaments with LARS artificial ligament achieved a satisfactory surgical outcome for chronic ankle instability.
文摘Background:Several case studies observed that the lateral ankle sprain resulted from a sudden increase in ankle inversion accompanied by internal rotation.However,without sufficient ankle kinetics and muscle activity information in the literature,the detailed mechanism of ankle sprain is still unrevealed.The purpose of our case report is to present 2 accidental ankle giving way incidents for participants with chronic ankle instability(CAI)and compare to their normal trials with data of kinematics,kinetics,and electromyography(EMG).Case description:Two young female participants accidentally experienced the ankle giving way when landing on a 25°lateral-tilted force plate.3 D kinematics,kinetics,and muscle activity were recorded for the lower extremity.Qualitative comparisons were made between the giving way trials and normal trials for joint angles,angular velocities,moments,centers of pressure and EMG linear envelopes.Results:One participant’s giving way trial displayed increased ankle inversion and internal rotation angles in the pre-landing phase and at initial contact compared to her normal trials.Another participant’s giving way trial exhibited greater hip abduction angles and delayed activation of the peroneus longus muscle in the pre-landing phase versus her normal trials.Conclusion:A vulnerable ankle position(i.e.,more inverted and internally rotated),and a late activation of peroneus activity in the pre-landing phase could result in the ankle giving way or even sprains.A neutral ankle position and early activation of ankle evertors before landing may be helpful in preventing ankle sprains.
