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ObjectiveTo investigate the effects of whole body vibration training on postural stability in patients with chronic ankle instability (CAI) using meta-analysis. MethodsRandomized controlled trials about whole body vibration training on patients with CAI in relation to postural stability were retrieved from PubMed, Cochrane Library, Web of Science, Physiotherapy Evidence Database (PEDro) scale, CNKI and WanFang data from inception to November, 2022. Reference lists of included studies were also traced to supplement the relevant literature. Two researchers independently searched the literature, and extracted relevant data. The PEDro scale was used to assess the quality, and the Cochrane Handbook was used to assess the risk of bias. The meta-analysis was conducted using Review Manager 5.3. And Stata 15.0 was used to conduct the Egger's test to assess publication bias. ResultsTwelve randomized controlled trials involving 440 individuals were included. Compared with the other exercises or no exercise, whole body vibration training could improve the center of pressure-area (MD = -0.70, 95% CI -0.97 to -0.43, P < 0.001) and the Star Excursion Balance Test in the direction of anterior (MD = 6.16, 95% CI 3.88 to 8.44, P < 0.001), posteromedial (MD = 6.22, 95% CI 3.68 to 8.76, P < 0.001), posterolateral (MD = 6.68, 95% CI 4.28 to 9.08, P < 0.001), anteromedial (MD = 8.78, 95% CI 6.71 to 10.85, P < 0.001), medial (MD = 4.16, 95% CI 1.46 to 6.86, P = 0.002), posterior (MD = 6.69, 95% CI 3.81 to 9.58, P < 0.001), lateral (MD =12.37, 95% CI 8.09 to 16.65, P < 0.001) and anterolateral (MD = 5.29, 95% CI 1.44 to 9.13, P = 0.007). However, there was no significant difference in the overall stability index (MD = 0.02, 95% CI -0.05 to 0.09, P = 0.643) and hop-test (MD = 6.24, 95% CI -8.80 to 21.28, P = 0.416) between whole body vibration training and other exercises or no exercise. ConclusionWhole body vibration training can improve the range of all directions of the Star Excursion Balance Test in individuals with CAI. However, more studies are needed to determine the improvement of center of pressure-area.
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ObjectiveTo observe the effect of proprioceptive neuromuscular facilitation combined with neuromuscular electrical stimulation on chronic ankle instability (CAI). MethodsFrom April, 2016 to December, 2021, 48 patients with CAI were randomly divided into control group (n = 24) and observation group (n = 24). Both groups accepted routine rehabilitation, and the observation group accepted proprioceptive neuromuscular facilitation combined with neuromuscular electrical stimulation additionally, for eight weeks. They were assessed with Visual Analogue Scale (VAS), peak torque to body weight of ankle dorsiflexors and plantarflexors (AD/W, AP/W), Y Balance Test (YBT) and Foot and Ankle Disability Index (FADI) before and after treatment. ResultsAfter treatment, VAS score, AD/W, AP/W, YBT and FADI improved in the observation group (|t| > 2.208, P < 0.05), while VAS score and AP/W improved in the control group (|t| > 2.156, P < 0.05); and all the VAS score, AD/W, AP/W, YBT and FADI were better in the observation group than in the control group (|t| > 2.067, P < 0.05). ConclusionProprioceptive neuromuscular facilitation combined with neuromuscular electrical stimulation can effectively relieve the pain of patients with CAI, and increase the muscle strength around the ankle, to improve the stability and balance.
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Objective:To evaluate the clinical effects of anatomical reconstruction of the deltoid ligament and medial migration calcaneal osteotomy in the treatment of chronic ankle instability after trauma.Methods:A retrospective study was conducted to analyze of the clinical data of 16 patients with chronic post-traumatic instability of the medial malleolus who had been treated at The Eighth Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine from December 2015 to February 2017. There were 14 males and 2 females with an age of (28.1±4.2) years. Seven left sides and 9 right sides were affected; the time from injury to operation was (8.9±2.4) months. Before operation, X-rays (anteroposterior, lateral and Saltzman views) and MRI of weight-bearing ankle were taken. All patients were treated by anatomical reconstruction of the deltoid ligament using the autologous semitendinosus and medial migration osteotomy of the calcaneus. The time for injury healing and occurrence of complications were recorded. The talus tilt angle, Meary angle, hindfoot valgus angle, visual analogue scale (VAS), and the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot function score were compared between the preoperation and the last follow-up. The Sefton evaluation for efficacy in ankle ligament reconstruction was used to assess stability of the ankle joint.Results:Of this cohort, 14 patients were followed up for (16.4±4.9) months after operation and 2 patients lost to follow-up. The 14 patients all returned to normal physical activities 3 months after operation. All incisions healed at the first stage with no infection. One patient experienced pain at the site for harvest of the semitendinosus but the symptoms were relieved after rehabilitation treatment like massage and physical therapy. At the last follow-up, the talus tilt angle [1.0 (0.0, 2.0)°], Meary angle (1.4°±4.2°), hindfoot valgus angle (3.2°±2.4°), VAS score [0.5 (0.0, 1.0) points], and AOFAS ankle-hindfoot score [(89.2±6.1) points] were all significantly improved compared with the preoperative values [8.3°±1.8°, 0.8°±3.8°, 9.9°±3.4°, (5.7±2.5) points, and (49.6±9.8) points] (all P<0.05). According to the Sefton evaluation, the stability of the ankle joint was excellent in 9 cases, good in 4 cases, and fair in 1 case. Conclusion:In the treatment of chronic ankle instability after trauma, anatomical reconstruction of the deltoid ligament and medial migration calcaneal osteotomy is safe and effective, resulting in limited complications.
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ObjectiveTo investigate the immediate effect of wearing a soft ankle brace on dynamic and static balance function and biomechanics of affected lower limbs during walking in chronic ankle instability (CAI) patients. MethodsFrom January to August, 2021, 40 CAI patients from Musculoskeletal Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University were measured dynamic and static balance indexes with Zebris FDM-System and Y balance test, before and after wearing a soft ankle brace; while the kinetics indexes and surface electromyography of the affected lower extremities during walking were collected with Zebris FDM-System and a surface electromyography telemeter simultaneously. ResultsThe velocity and area of center of pressure reduced in both open and closed eye modes (|t| > 2.876, P < 0.01), the Y-balance scores increased in all the directions (|t| > 21.212, P < 0.001) after wearing brace; while the peak pressures and impulses increased in the midfoot and medial forefoot regions (|t| > 2.057, P < 0.05), and decreased in the lateral heel, lateral forefoot and toe regions (|t| > 2.464, P < 0.05), and the root mean square of surface electromyography increased in the tibialis anterior and lateral gastrocnemius (|t| > 2.159, P < 0.05) during walking. ConclusionWearing soft brace can immediately improve dynamic and static balance of CAI patients, and optimize plantar kinetic distribution and enhance activation of the anterior tibial and the lateral head of gastrocnemius of the affected limb during walking, to improve motor control of CAI patients.
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@#Objective To identify the effectiveness of physical therapy on neuromuscular control dysfunction of chronic ankle instability (CAI). Methods CAI physiotherapy-related systematic reviews, meta-analysis, randomized controlled studies and case-controlled studies were systematically searched in PubMed, Web of Science, Cochrane, PEDro, EBSCO and CNKI from October 1st, 2010 to October 1st, 2020. After quality assessment, the research evidence regarding certain intervention was then graded according to the Oxford Center for Evidence-based Medicine. Results A total of 20 articles were included. Intervention based on unstable plane exercise training could significantly improve lower limb balance control ability (Ⅰ A) and muscle strength (Ⅱ A) for CAI patients. The efficiency of exercise-based intervention could be further raised (Ⅱ C) with the aid of external equipment, but either the benefits in muscle reaction (Ⅲ C) or proprioception (Ⅱ D) was limited. Six sessions or more of manual therapy could be used to enhance the balance ability of the lower limbs (Ⅱ B), while taping failed to provide improvements in ankle proprioception in short period or immediately (Ⅰ A). Conclusion Unstable plane training-based therapeutic exercise and manual therapy could effectively enhance the neuromuscular control with high-quality evidence supporting, which can be primary interventions for CAI patients. Meanwhile, taping and other external devices could be used as adjunct methods to improve the efficiency of physiotherapy program, while there is currently no evidence to support the application of modality treatment in neuromuscular control of CAI.
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BACKGROUND: The motor neuromuscular control of the ankle is decreased in individuals with chronic ankle instability, which impairs athletic performance. Kinesio taping has been widely used in the prevention and treatment of chronic ankle instability. However, there is limited research exploring the effects of kinesio taping on motor neuromuscular control in individuals with chronic ankle instability currently, and moreover, the results are in controversy with large heterogeneity. OBJECTIVE: To describe the current research situation of the effects of kinesio taping on motor neuromuscular control in individuals with chronic ankle instability, thereby providing reliable reference in clinical practice METHODS: The first author searched the articles addressing the application of kinesio taping in chronic ankle instability from January 2009 to July 2019 in the databases of PubMed, Cochrane, WOS and CNKI. The keywords were “chronic ankle instability, ankle instability, ankle”, “kinesio tap*, kinesiology tap*, kinaesthetic tap*, tap*” in Chinese and English. RESULTS AND CONCLUSION: Kinesio taping may improve ankle proprioception and jumping biomechanical performance in individuals with chronic ankle instability, but more high-quality researches are required. There is insufficient evidence to encourage that the use of kinesio taping can facilitate muscle strength, activation characteristics and balance function in individuals with chronic ankle instability. The existing studies have extensive heterogeneity in the selection of subjects, so it is difficult to comprehensively summarize the patients with chronic ankle instability of different exercise types and levels. The included scales of different studies are different, there are obvious differences in the methods, pull, direction, and duration when using kinesio taping, and there is no uniform standard. There is a lack of high-quality meta-analysis for evidence-based argumentation.
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PURPOSE: Chronic ankle instability is a very common abnormality of the ankle, but there is still controversy regarding its evaluation criteria. The stress view has difficulties in reflecting the patient's symptoms and treatment progress. Therefore, this study examined the relationship between the center of pressure (COP) measured by a pedobarograph and the symptoms of the patient.MATERIALS AND METHODS: Thirty patients with chronic ankle instability from February to August 2018 were included. Each patient was surveyed with the foot and ankle outcome score (FAOS). The COP was measured with a foot pressure scanner, and the travel distance and ellipse area of the COP were calculated. Each patient was measured on one foot and on two feet with his or her eyes closed and open. The relationship between the COP measurement and FAOS score was analyzed using the Pearson correlation coefficient.RESULTS: The participants were consisted of 21 male and nine female, with a mean age of 30 years, mean weight of 72 kg, and mean foot size of 259 mm. With the eyes open, the correlation coefficient between the FAOS and travel distance of the affected side was −0.394 (p<0.05) and that between the FAOS and the ellipse area of the affected side was −0.425 (p<0.05). On the other hand, no significant correlations were found between the travel distance and ellipse area of the affected side when patients closed their eyes.CONCLUSION: Measurement of the COP using foot pressure scanner could evaluate objectively patients with chronic ankle instability, with measurements in patients with their eyes open being more significant. Based on the findings of this study, an analysis of the COP with the patients with their eyes open and standing on one foot may help determine the management strategy and assess the progress of the patients.
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Objective: To assess the effectiveness of lateral ligament reconstruction with autogenous partial peroneus longus tendon for chronic lateral ankle instability. Methods: Between September 2014 and November 2018, 32 patients (32 sides) with chronic lateral ankle instability were treated with lateral ankle ligament reconstruction by using autogenous anterior half of the peroneus longus tendon. There were 25 males and 7 females, with an average age of 28.5 years (range, 20-51 years). The disease duration was 6-41 months (mean, 8.9 months). The preoperative Karlsson-Peterson ankle score was 53.7±9.7. The talar tilt angle was (14.9±3.7)°, and the anterior talar translation was (8.2±2.8) mm. Six patients combined with osteochondral lesion of talus and 4 patients combined with bony impingement. Results: All incisions healed by first intention postoperatively. All patients were followed up 12-53 months (mean, 22.7 months). At last follow-up, the Karlsson-Peterson ankle score was 85.2±9.6; the talar tilt angle was (4.3±1.4)°; the anterior talar translation was (3.5±1.1) mm. There were significant differences in all indexes between pre- and post-operation ( P<0.05). Seventeen patients were very satisfied with the results, 10 patients were satisfied, 4 patients were normal, and 1 patient was unsatisfied. After operation, the ankle sprain occurred in 7 cases, the tenderness around the compression screws at calcaneus in 5 cases, the anterolateral pain of ankle joint over 6 months in 4 cases. No patient had discomfort around the reciepient sites. At last follow-up, the ultrasonography examination showed that there was no significant difference in the density and diameter between bilateral peroneus longus tendons in 12 cases. Conclusion: For chronic lateral ankle instability, the lateral ankle ligament reconstruction with the autogenous partial peroneus longus tendon is a safe and effective surgical option.
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Surgical treatment to restore stability in the ankle and hindfoot and prevent further degenerative changes may be necessary in cases in which conservative treatment has failed. Anatomical direct repair using native ligament remnants with or without reinforcement of the inferior retinaculum is the so-called gold standard operative strategy for the treatment of lateral ankle instability. Non-anatomical lateral ligament reconstruction typically involves the use of the adjacent peroneus brevis tendon and applies only those with poor-quality ligaments. On the other hand, anatomic reconstruction and anatomic repair provide better functional outcomes after the surgical treatment of chronic ankle instability patients compared to a non-anatomic reconstruction. Anatomical reconstruction using an autograft or allograft applies to patients with insufficient ligament remnants to fashion direct repair, failed previous lateral ankle repair, high body mass index, or generalized ligamentous laxity. These procedures can provide good-to-excellent short-term outcomes. Arthroscopic ligament repair is becoming increasingly popular because it is minimally invasive. Good-to-excellent clinical outcomes have been reported after short and long-term follow-up, despite the relatively large number of complications, including nerve damage, reported following the procedure. Therefore, further investigation will be needed before widespread adoption is advocated.
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Humans , Allografts , Ankle , Autografts , Body Mass Index , Collateral Ligaments , Follow-Up Studies , Hand , Ligaments , TendonsABSTRACT
PURPOSE: To investigate the alteration of lower extremity movement during maintaining balance test with their eyes closed in chronic ankle instability (CAI) patients compared to healthy group with and without plantar cutaneous sensation. METHODS: Ten healthy volunteers (age, 23.40±2.22 years; height, 165.42±6.67 cm; weight, 60.93±13.42 kg) and 10 CAI patients (age, 23.90±2.56 years; height, 166.89±10.50 cm; weight, 67.43±12.96 kg), were recruited. Subjects immersed both feet in an ice water for 10 minutes and performed three trials of a single-leg stance balance test with their eyes closed while standing on a force plate for 10 seconds. RESULTS: CAI group showed increased knee flexion, reduced knee external rotation, and hip internal rotation compared to the healthy group from single-limb stance with eyes closed after diminished plantar cutaneous sensation. However, there was no significant interaction between group and time. CONCLUSION: These findings indicate that the postural kinematic analyses revealed that individuals with CAI used different strategy of controlling their lower extremities, which alters transverse plane motion of hip and knee compared to the healthy group in order to compensate for their ankle deficits after freezing the plantar cutaneous.
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Humans , Ankle , Foot , Freezing , Healthy Volunteers , Hip , Ice , Knee , Lower Extremity , Sensation , WaterABSTRACT
Results and Conclusion The most commonly used methods were Wobble Board training and Progressive Hop-to-Stabilization Balance training. These methods had already provided the most consistent improvements in single leg static balance test, the Star Excursion Balance Test, the Functional Hopping Test, the self-reported questionnaire and the overall quality of life questionnaire. Nowadays, the system has been set based on structural deficient, functional disability and participant disability to assess the treatment effects for the CAI population. Objective:To investigate the effect of balance training on chronic ankle instability (CAI) by reviewing literatures. Methods:Randomized controlled trials about balance training on patients with CAI from January, 2000 to April, 2019 were searched from PubMed and Web of Science.
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Whole body vibration training (WBVT) is a new kind of therapeutic exercise, which can improve musculoskeletal function and motor performance by transferring vibration stimulation to the body to affect neuromuscular activity. In this paper, the clinical efficacy, mechanism and parameter setting of WBVT in the treatment of chronic ankle instability were introduced through a systematic review of relevant literatures, so as to provide theoretical basis for the clinical application of this technique.
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Objective To evaluate the clinical results of arthroscopic anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament for treatment of chronic ankle instability. Methods From June 2012 to August 2016, 27 patients with chronic ankle instability (28 ankles) were treated with arthroscopic anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament. All the patients were evaluated preoperatively and at the last follow-up using visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) score. The talar tilt angle and anterior translation were assessed radiographically in pre- and postoperative ankle stress views.Results The operations lasted for 75.8 minutes (from 72 to 104 minutes). The 27 patients received a mean follow-up of 14.8 months (range, from 12 to 25 months). All the wounds healed by the first intention. No neurovascular complications were observed and no patient reported ankle stiffness or pain in motion. On average, the anterior talar trans-lation was reduced from 10.82 ± 3.32 mm preoperatively to 4.03 ± 1.70 mm at the last follow-up, the talar tilt angle decreased from 15.60°± 3.86°to 6.01°± 2.64°, the VAS pain score decreased from 5.79 ± 1.79 to 1.54 ± 1.35, and the AOFAS ankle-hindfoot score improved from 63.64 ± 11.20 to 90.21 ± 4.48. All the above differences were statistically significant (P <0.01). Conclusion Arthroscopic anatomical re-construction of anterior talofibular ligament and calcaneofibular ligament can improve function and stability of the ankle joint effectively, providing a valid option for treatment of chronic ankle instability.
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This article introduced the neuromuscular activation characteristics of patients with chronic ankle instability during dif-ferent movement patterns, and explained the reasons of deficits of neuromuscular control in lower extremity muscle ac-tivity, kinetics, and kinematics, which aimed at further clarifying the mechanism of chronic ankle instability, and provid-ing theoretical basis for its rehabilitation training.
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Ankle sprains are among the most common injuries sustained during athletic activities and daily life. Acute ankle sprain is usually managed conservatively with functional rehabilitation but the failure of conservative treatment leads to the development of chronic ankle instability. The development of repetitive ankle sprains and persistent symptoms after injury has been termed chronic ankle instability. Acute ankle sprains and chronic ankle instability require a careful evaluation to detect other comorbidities, such as subtalar instability, osteochondral defect, peroneal tendinopathy, tarsal coalition, os trigonum, flexor hallucis longus tendinitis, calcaneus anterior process fracture, and neural injuries. For the successful treatment of acute ankle sprains and chronic ankle instability, the treatment of comorbidity lesions should be performed first.
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Ankle Injuries , Ankle , Calcaneus , Comorbidity , Diagnosis , Rehabilitation , Sports , Talus , TendinopathyABSTRACT
Objective To discuss the clinical effects of arthroscopy combined with Brostrom repair in the treatment for chronic ankle instability talofibular ligament injury.Methods From January 2012 to June 2015,42 cases of chronic ankle instability in our hospital were performed modified Brostrom repair.All the cases were evaluated by AOFAS scoring system.Results All the patients were followed up for 9 to 17 months,an average of (12.7±3.5)months.At the last follow-up,all cases could participate in normal daily running training mission.Activity levels of 2 cases with cartilage injury had a decline than before.The others were able to attend the confrontational training.Postoperative AOFAS score(88.4±4.9) increased compared with preoperative score (43.3±7.8),the difference was significant(P<0.05).ConclusionThe curative effect of arthroscopy combined with Brostrom repair in treatment of chronic ankle instability talofibular ligament injury is satifactory.It can be helpful to the wounded rapid rehabilitation and good for the popularization and application in basic-level hospitals.
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PURPOSE: The purpose of this study was to determine the effects of whole body vibration exercise (WBVE) on lower extremity muscle activity and balance ability according to different methods of exercises in football player and use it as basic data for the rehabilitation training of chronic ankle instability. METHODS: Thirty subjects were randomly divided into two groups: the two groups, which each group have 15 members, are WBVE group and neuromuscular training (NMT) group according to training method. The exercise program was conducted for six weeks. Subjects were measured on lower extremity muscle activity and balance ability. RESULTS: The muscle activity increasement of the WBVE group was significantly higher than that of the NMT group (p < 0.05) and the balance ability decreasement of the WBVE group was significantly higher than that of the NMT group (p < 0.05). CONCLUSION: These findings of this study suggest that WBVE may have a beneficial effect on improvement of lower extremity muscle activity and balance ability in football player with chronic ankle instability.
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Ankle , Exercise , Football , Lower Extremity , Methods , Rehabilitation , VibrationABSTRACT
[Summary] Ankle joint injury is one of the most common sports injuries , and some patients with chronic ankle instability need surgical treatment .Traditional incision surgeries are characterized with traumatic performance and high complication rates , and the exploration of the joint lesion is not comprehensive .With the development of minimally invasive surgery , the application of arthroscopy in the treatment of chronic ankle instability is increasing , which is conducive to the treatment of intra-articular lesions , while reducing the surgical trauma and improving the postoperative effects .In this paper , we summarized the current status of the application of arthroscopy in the surgery for chronic ankle instability from two aspects , which were arthroscopic surgery in the diagnosis and treatment of the disease, and total arthroscopic repair technology of ankle ligament .We also introduced domestic and overseas operation effects and new concepts .
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Objective To evaluate how proprioception affect ankle stability through comparing angle position awareness and peroneus reaction time between chronic ankle lateral instability patients and healthy controls.Methods A total of 51 participants were recruited into an experimental group of 21 patients with chronic ankle lateral instability (17 males,aged 31.6±2.6) and a control group of 30 healthy counterparts (24 males,aged 34.2±2.3).All the participants were asked to reoccur passive ankle position under the angular velocity at 2 degree per second when they were resting with non-weight bearing in their recruited ankles.The muscle reaction time (MRT)of peroneus longus(PL) and peroneus brevis (PB) in all the recruited ankles was measured during sudden ankle inversion both with and without ankle protective brace wearing.Results The difference between angle recurrence and the target angle (ankle inversion 20° and 30°) was significantly higher (P＜0.05) in the experimental group compared to the control group.The average MRTs of PL and PB were also significantly longer (P＜0.05) in the experimental group than the control group,whether wearing ankle protective braces or not.However,within both groups,no significant differences of PL and PB's MRT were identified between brace wearing and no brace (P＞0.05).Conclusions In patients with chronic lateral ankle instability,the position awareness decreases and the reaction time of peroneus is prolonged.Ankle braces can provide mechanical protection to the injured joints,but cannot promote MRT significantly.
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OBJECTIVE: To evaluate the prevalence of deltoid ligament and distal tibiofibular syndesmosis injury on 3T magnetic resonance imaging (MRI) in patients with chronic lateral ankle instability (CLAI). MATERIALS AND METHODS: Fifty patients (mean age, 35 years) who had undergone preoperative 3T MRI and surgical treatment for CLAI were enrolled. The prevalence of deltoid ligament and syndesmosis injury were assessed. The complexity of lateral collateral ligament complex (LCLC) injury was correlated with prevalence of deltoid or syndesmosis injuries. The diagnostic accuracy of ankle ligament imaging at 3T MRI was analyzed using arthroscopy as a reference standard. RESULTS: On MRI, deltoid ligament injury was identified in 18 (36%) patients as follows: superficial ligament alone, 9 (50%); deep ligament alone 2 (11%); and both ligaments 7 (39%). Syndesmosis abnormality was found in 21 (42%) patients as follows: anterior inferior tibiofibular ligament (AITFL) alone, 19 (90%); and AITFL and interosseous ligament, 2 (10%). There was no correlation between LCLC injury complexity and the prevalence of an accompanying deltoid or syndesmosis injury on both MRI and arthroscopic findings. MRI sensitivity and specificity for detection of deltoid ligament injury were 84% and 93.5%, and those for detection of syndesmosis injury were 91% and 100%, respectively. CONCLUSION: Deltoid ligament or syndesmosis injuries were common in patients undergoing surgery for CLAI, regardless of the LCLC injury complexity. 3T MRI is helpful for the detection of all types of ankle ligament injury. Therefore, careful interpretation of pre-operative MRI is essential.