RESUMO
INTRODUCTION: After an ankle sprain, up to 20% of patients may develop chronic lateral ankle instability (CLAI) requiring surgical treatment. The objective of this study was to investigate the functional outcomes and rates of return to sport activities in a cohort of non-athlete patients with chronic lateral ankle instability (CLAI) who underwent the opened Brostrom-Gould technique (BGT). MATERIALS AND METHODS: Seventy-nine patients (seventy-nine feet) from three different centers undergoing BGT were reviewed. For clinical and functional analysis, the AOFAS ankle-hindfoot scale was applied and rates of return to sport activities were assessed. Correlation of Δ-AOFAS and rates of return to sport activities with all variables analyzed was performed. RESULTS: Mean AOFAS score improved from 64.6 to 97.2 (p < 0.001). Sixty-one (77.2%) returned to preinjury activities and 18 (22.8%) changed to a lower-level modality. Symptoms of instability were related to Δ-AOFAS (p = 0.020). Change in the sport activity was related to pain and symptoms of instability (p = 0.41 and p < 0.001). CONCLUSION: Recreational athlete patients who underwent the BGT demonstrated excellent functional outcomes after a mean follow-up of 7 years. Residual pain and symptoms of instability after surgery were the main complaints associated with limitations in physical activities.
Assuntos
Traumatismos do Tornozelo , Instabilidade Articular , Volta ao Esporte , Humanos , Volta ao Esporte/estatística & dados numéricos , Masculino , Feminino , Adulto , Instabilidade Articular/cirurgia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/etiologia , Seguimentos , Traumatismos do Tornozelo/cirurgia , Traumatismos do Tornozelo/fisiopatologia , Adulto Jovem , Resultado do Tratamento , Recuperação de Função Fisiológica , Pessoa de Meia-Idade , Estudos Retrospectivos , Adolescente , Articulação do Tornozelo/cirurgia , Articulação do Tornozelo/fisiopatologia , Procedimentos Ortopédicos/métodosRESUMO
OBJECTIVE: To investigate whether Kinesio taping technique, applied to ankles of healthy people as a preventive intervention and people with ankle injuries, is superior to sham or alternative interventions on ankle function. DATA SOURCES: Medline, Embase, Amed, CINAHL, SPORTDiscus, Cochrane Library and Web of Science, from inception to August 2020. REVIEW METHODS: The terms "ankle" and "kinesio taping" were used in the search strategy. Included studies were randomized controlled trials (including crossover design) investigating Kinesio taping effects on ankle functional performance compared to any alternative or control/sham technique. RESULTS: From 5,572 studies, 84 met the eligibility criteria which evaluated 2,684 people. Fifty-eight meta-analyses from 44 studies were performed (participants in meta-analyses ranging from 27 to 179). Fifty-one meta-analyses reported ineffectiveness of Kinesio taping: moderate evidence for star excursion balance test (anterior direction), jump distance, dorsiflexion range of motion, and plantar flexion torque for healthy people (effect size = 0.08-0.13); low to very-low evidence for balance, jump performance, range of motion, proprioception, muscle capacity and EMG for healthy people; balance for older people; and balance and jump performance for people with chronic instability. Seven meta-analyses reported results favoring Kinesio taping (effect size[95% CI]): low to very-low evidence for balance (stabilometry, ranging from 0.42[0.07-0.77] to 0.65[0.29-1.02]) and ankle inversion (0.84[0.28-1.40]) for healthy people; balance for older people (COP velocity, 0.90[0.01-1.78]); and balance for people with chronic instability (errors, 0.55[0.06-1.04]). CONCLUSIONS: Current evidence does not support or encourage the use of Kinesio taping applied to the ankle for improvements in functional performance, regardless the population.
Assuntos
Traumatismos do Tornozelo/terapia , Articulação do Tornozelo/fisiologia , Tornozelo/fisiologia , Fita Atlética , Tornozelo/fisiopatologia , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Humanos , Desempenho Físico Funcional , Propriocepção , Amplitude de Movimento ArticularRESUMO
Injuries to the tibio-fibular syndesmotic ligaments are different than ankle collateral ligament injuries and occur in isolation or combination with malleolar fractures. Syndesmotic ligament injury can lead to prolonged functional limitations and ultimately long-term ankle dysfunction if not identified and treated appropriately. The syndesmosis complex is a relatively simple construct of well-documented ligaments, but the dynamic kinematics and the effects of disruption have been a point of contention in diagnosis and treatment. Syndesmotic ligament injuries are sometimes referred to as "high ankle sprains" because the syndesmotic ligaments are more proximal than the collateral ligaments of the ankle joint. Rotational injuries to the ankle often result in malleolar fractures, which can be combined with ankle joint or syndesmotic ligament injuries. Most of the orthopaedic literature to this point has addressed syndesmosis ligament injuries in combination with fractures and not isolated syndesmotic ligament injuries. Thus, we propose a simplified general video guide to do the diagnostic examinations and arthroscopic-assisted reduction based on current evidence-based medicine.
Assuntos
Fraturas do Tornozelo/diagnóstico , Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/diagnóstico , Traumatismos do Tornozelo/cirurgia , Artroscopia/métodos , Fixação Interna de Fraturas/métodos , Fixação de Fratura/métodos , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Exame Físico/métodos , Anestesia , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo , Fenômenos Biomecânicos , Parafusos Ósseos , Medicina Baseada em Evidências , Humanos , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/fisiopatologia , Planejamento de Assistência ao Paciente , Radiografia , Técnicas de Sutura , SuturasRESUMO
CONTEXT: Patients with chronic ankle instability (CAI) exhibit deficits in neuromuscular control, resulting in altered movement strategies. However, no researchers have examined neuromuscular adaptations to dynamic movement strategies during multiplanar landing and cutting among patients with CAI, individuals who are ankle-sprain copers, and control participants. OBJECTIVE: To investigate lower extremity joint power, stiffness, and ground reaction force (GRF) during a jump-landing and cutting task among CAI, coper, and control groups. DESIGN: Cross-sectional study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 22 patients with CAI (age = 22.7 ± 2.0 years, height = 174.6 ± 10.4 cm, mass = 73.4 ± 12.1 kg), 22 ankle-sprain copers (age = 22.1 ± 2.1 years, height = 173.8 ± 8.2 cm, mass = 72.6 ± 12.3 kg), and 22 healthy control participants (age = 22.5 ± 3.3 years, height = 172.4 ± 13.3 cm, mass = 72.6 ± 18.7 kg). INTERVENTION(S): Participants performed 5 successful trials of a jump-landing and cutting task. MAIN OUTCOME MEASURE(S): Using motion-capture cameras and a force plate, we collected lower extremity ankle-, knee-, and hip-joint power and stiffness and GRFs during the jump-landing and cutting task. Functional analyses of variance were used to evaluate between-groups differences in these dependent variables throughout the contact phase of the task. RESULTS: Compared with the coper and control groups, the CAI group displayed (1) up to 7% of body weight more posterior and 52% of body weight more vertical GRF during initial landing followed by decreased GRF during the remaining stance and 22% of body weight less medial GRF across most of stance; (2) 8.8 W/kg less eccentric and 3.2 W/kg less concentric ankle power, 6.4 W/kg more eccentric knee and 4.8 W/kg more eccentric hip power during initial landing, and 5.0 W/kg less eccentric knee and 3.9 W/kg less eccentric hip power; and (3) less ankle- and knee-joint stiffness during the landing phase. Concentric power patterns were similar to eccentric power patterns. CONCLUSIONS: The CAI group demonstrated altered neuromechanics, redistributing energy absorption from the distal (ankle) to the proximal (knee and hip) joints, which coincided with decreased ankle and knee stiffness during landing. Our data suggested that although the coper and control groups showed similar landing and cutting strategies, the CAI group used altered strategies to modulate impact forces during the task.
Assuntos
Adaptação Fisiológica/fisiologia , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Movimento/fisiologia , Adulto , Fenômenos Biomecânicos , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Adulto JovemRESUMO
CONTEXT: Ankle injury is one of the most common conditions in athletics and military activities. Strength asymmetry (SA) and imbalance may represent a risk factor for injury, but past investigations have produced ambiguous conclusions. Perhaps one explanation for this ambiguity is the fact that these authors used univariate models to predict injury. OBJECTIVE: To evaluate the predictive utility of SA and imbalance calculations for ankle injury in univariate and multivariate prediction models. DESIGN: Prospective cohort study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 140 male US Air Force Special Forces. MAIN OUTCOME MEASURE(S): Baseline testing consisted of body composition, isometric strength, and aerobic and anaerobic capacity. A clinician conducted medical chart reviews 365 days posttesting to document the incidence of ankle injury. Strength asymmetries were calculated based on the equations most prevalent in the literature along with known physiological predictors of injury in the military: age, height, weight, body composition, and aerobic capacity. Simple logistic regression was conducted using each predictor, and backward stepwise logistic regression was conducted with each equation method and the physiological predictors entered initially into the model. RESULTS: Strength asymmetry or imbalance or both, as a univariate predictor, was not able to predict ankle injury 365 days posttesting. Body mass (P = .01) and body mass index (P = .01) significantly predicted ankle injury. Strength asymmetry or imbalance or both significantly predicted ankle injury when considered with body mass (P = .002-.008). CONCLUSIONS: As a univariate predictor, SA did not predict ankle injury. However, SA contributed significantly to predicting ankle injury in a multivariate model using body mass. Interpreting SA and imbalance in the presence of other physiological variables can help elucidate the risk of ankle injury.
Assuntos
Traumatismos do Tornozelo , Traumatismos em Atletas , Militares , Força Muscular/fisiologia , Equilíbrio Postural/fisiologia , Adulto , Traumatismos do Tornozelo/epidemiologia , Traumatismos do Tornozelo/etiologia , Traumatismos do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/prevenção & controle , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/prevenção & controle , Índice de Massa Corporal , Feminino , Humanos , Incidência , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Esportes/fisiologia , Estados UnidosRESUMO
INTRODUCTION: Comprehensive evaluation of movement strategies during functional movement is a difficult undertaking. Because of this challenge, studied movements have been oversimplified. Furthermore, evaluating movement strategies at only a discrete time point(s) provide limited insight into how movement strategies may change or adapt in chronic ankle instability (CAI) patients. This study aimed to identify abnormal movement strategies in individuals with a history of ankle sprain injury during a sports maneuver compared with healthy controls. METHODS: Sixty-six participants, consisting of 22 CAI patients, 22 ankle sprain copers, and 22 healthy controls, participated in this study. Functional profiles of lower extremity kinematics, kinetics, and EMG activation from initial contact (0% of stance) to toe-off (100% of stance) were collected and analyzed during a jump landing/cutting task using a functional data analysis approach. RESULTS: Compared with copers, CAI patients displayed landing positions of less plantarflexion, less inversion, more knee flexion, more hip flexion, and less hip abduction during the first 25% of stance. However, restricted dorsiflexion angle was observed in both CAI patients and copers relative to controls during the midlanding to mid-side-cutting phase when the ankle and knee reached its peak range of motion (e.g., dorsiflexion and knee flexion). Reduced EMG activation of tibialis anterior, peroneus longus, medial gastrocnemius, and gluteus medius may be due to altered kinematics that reduce muscular demands on the involved muscles. CONCLUSIONS: CAI patients displayed altered movement strategies, perhaps in an attempt to avoid perceived positions of risk. Although sagittal joint positions seemed to increase the external torque on the knee and hip extensors, frontal joint positions appeared to reduce the muscular demands on evertor and hip abductor muscles.
Assuntos
Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Movimento/fisiologia , Adolescente , Adulto , Fenômenos Biomecânicos , Eletromiografia , Feminino , Humanos , Instabilidade Articular/etiologia , Extremidade Inferior/fisiopatologia , Masculino , Músculo Esquelético/fisiopatologia , Análise e Desempenho de Tarefas , Adulto JovemRESUMO
CONTEXT: Rehabilitation programs for patients with chronic ankle instability (CAI) generally involve balance-perturbation training (BPT). Anticipatory postural adjustments (APAs) and compensatory postural adjustments (CPAs) are the primary strategies used to maintain equilibrium during body perturbations. Little is known, however, about how APAs and CPAs are modified to promote better postural control for individuals with CAI after BPT. OBJECTIVE: To investigate the effect of BPT that involves kicking a ball on postural-control strategies in individuals with CAI. DESIGN: Randomized controlled clinical trial. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: We randomly assigned 44 volunteers with CAI to either a training group (TG; 11 women, 11 men; age = 24 ± 4 years, height = 173.0 ± 9.8 cm, mass = 72.64 ± 11.98 kg) or control group (CG; 11 women, 11 men; age = 22 ± 3 years, height = 171.0 ± 9.7 cm, mass = 70.00 ± 11.03 kg). INTERVENTION(S): The TG performed a single 30-minute training session that involved kicking a ball while standing on 1 foot. The CG received no intervention. MAIN OUTCOME MEASURE(S): The primary outcome was the sum of the integrated electromyographic activity (∑∫EMG) of the lower extremity muscles in the supporting limb that were calculated during typical intervals for APAs and CPAs. A secondary outcome was center-of-pressure displacement during similar intervals. RESULTS: In the TG after training, the ∑∫EMG decreased in both dorsal and ventral muscles during compensatory adjustment (ie, the time interval that followed lower limb movement). During this interval, muscle activity (∑∫EMG) was less in the TG than in the CG. Consequently, center-of-pressure displacement increased during the task after training. CONCLUSIONS: A single session of ball-kicking BPT promoted changes in postural-control strategies in individuals with CAI. These results should stimulate new and more comprehensive studies to investigate the effect of this and other BPT techniques on postural control in patients with CAI.
Assuntos
Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Terapia por Exercício/métodos , Instabilidade Articular/fisiopatologia , Movimento/fisiologia , Músculo Esquelético/fisiologia , Equilíbrio Postural/fisiologia , Adulto , Traumatismos do Tornozelo/reabilitação , Doença Crônica , Eletromiografia , Feminino , Humanos , Instabilidade Articular/reabilitação , Masculino , Pressão , Método Simples-Cego , Adulto JovemRESUMO
BACKGROUND: Ballet is a high-performance activity that requires an advanced level of technical skills. Ballet places great stress on tendons, muscles, bones, and joints and may act directly as a trigger of injury by overuse. OBJECTIVES: 1) to describe the main types of injuries and affected areas related to classical ballet and 2) to compare the frequency of musculoskeletal injuries among professional and non-professional ballet dancers, considering possible gender differences among the professional dancers. METHOD: A total of 110 questionnaires were answered by professional and non-professional dancers. The questionnaire contained items related to the presence of injury, the regions involved, and the mechanism of the injury. RESULTS: We observed a high frequency of musculoskeletal injuries, with ankle sprains accounting for 69.8% of injuries in professional dancers and 42.1% in non-professional dancers. Pirouettes were the most frequent mechanism of injury in professional dancers, accounting for 67.9% of injuries, whereas in the non-professional dancers, repetitive movement was the most common mechanism (28.1%). Ankle sprains occurred in 90% of the women's injuries, and muscle sprains occurred in 54.5% of the men's injuries. The most frequent injury location was the ankle joint in both sexes among the professional dancers, with 67.6% in women and 40.9% in men. CONCLUSIONS: The identification of the mechanism of injury and time of practice may contribute to better therapeutic action aimed at the proper function of the dancers' bodies and improved performance by these athletes.
Assuntos
Humanos , Adulto Jovem , Traumatismos do Tornozelo/fisiopatologia , Doenças Musculoesqueléticas/epidemiologia , Dança/fisiologia , Prevalência , Doenças Musculoesqueléticas/fisiopatologiaRESUMO
BACKGROUND: Ballet is a high-performance activity that requires an advanced level of technical skills. Ballet places great stress on tendons, muscles, bones, and joints and may act directly as a trigger of injury by overuse. OBJECTIVES: 1) to describe the main types of injuries and affected areas related to classical ballet and 2) to compare the frequency of musculoskeletal injuries among professional and non-professional ballet dancers, considering possible gender differences among the professional dancers. METHOD: A total of 110 questionnaires were answered by professional and non-professional dancers. The questionnaire contained items related to the presence of injury, the regions involved, and the mechanism of the injury. RESULTS: We observed a high frequency of musculoskeletal injuries, with ankle sprains accounting for 69.8% of injuries in professional dancers and 42.1% in non-professional dancers. Pirouettes were the most frequent mechanism of injury in professional dancers, accounting for 67.9% of injuries, whereas in the non-professional dancers, repetitive movement was the most common mechanism (28.1%). Ankle sprains occurred in 90% of the women's injuries, and muscle sprains occurred in 54.5% of the men's injuries. The most frequent injury location was the ankle joint in both sexes among the professional dancers, with 67.6% in women and 40.9% in men. CONCLUSIONS: The identification of the mechanism of injury and time of practice may contribute to better therapeutic action aimed at the proper function of the dancers' bodies and improved performance by these athletes.
Assuntos
Traumatismos do Tornozelo/fisiopatologia , Dança/fisiologia , Doenças Musculoesqueléticas/epidemiologia , Humanos , Doenças Musculoesqueléticas/fisiopatologia , Prevalência , Adulto JovemRESUMO
CLINICAL SCENARIO: Chronic ankle instability (CAI) is a condition commonly experienced by physically active individuals. It has been suggested that foot orthotics may increase a CAI patient's postural control. CLINICAL QUESTION: For patients with CAI, is there evidence to suggest that an orthotic intervention will help improve postural control? SUMMARY OF KEY FINDINGS: The literature was searched for studies of level 2 evidence or higher that investigated the effects of foot orthotics on postural control in patients with CAI. The search of the literature produced 5 possible studies for inclusion; 2 studies met the inclusion criteria and were included. One randomized controlled trial and 1 outcomes study were included. Foot orthotics appear to be effective at improving postural control in patients with CAI. CLINICAL BOTTOM LINE: There is moderate evidence to support the use of foot orthotics in the treatment of CAI to help improve postural control. STRENGTH OF RECOMMENDATION: There is grade B evidence that foot orthotics help improve postural control in people with CAI. The Centre of Evidence Based Medicine recommends a grade of B for level 2 evidence with consistent findings.