The Effects of Augmenting Balance Training with Stroboscopic Goggles on Postural Control in Chronic Ankle Instability Patients: A Critically Appraised Topic.

CLINICAL SCENARIO: Individuals with chronic ankle instability (CAI) typically complete balance training protocols to improve postural control and reduce recurrent injury risk. However, the presence of CAI persists after traditional balance training protocols suggesting that such programs may be missing elements that could be beneficial to patients. Visual occlusion modalities, such as stroboscopic goggles, may be able to augment balance training exercises to further enhance postural control gains in those with CAI. However, a cumulative review of the existing evidence has yet to be conducted. FOCUSED CLINICAL QUESTION: Does wearing stroboscopic goggles during balance training result in greater improvements to postural control than balance training alone in those with CAI? SUMMARY OF KEY FINDINGS: All 3 studies indicated that the stroboscopic goggles group had statistically significant improvements in either a measure of static or dynamic postural control relative to the standard balance training group. However, significant improvements were not consistent across all postural control outcomes assessed in the included studies. CLINICAL BOTTOM LINE: Postural control may improve more in those with CAI when stroboscopic goggles were worn while completing balance training exercises relative to completing balance training exercises alone. STRENGTH OF RECOMMENDATION: Overall, consistent moderate- to high-quality evidence was present in the 3 studies, suggesting grade C evidence for the use of stroboscopic goggles during balance training in those with CAI.

Development of a core domain set for ankle osteoarthritis: an international consensus study of patients and health professionals.

OBJECTIVES: To develop an internationally agreed-upon core domain set for ankle osteoarthritis (OA). METHODS: In a three-part Delphi process, a group of multidisciplinary health professionals with expertise in ankle OA and people with ankle OA responded to online questionnaires. The questionnaires proposed a list of 29 candidate domains derived from a systematic review of ankle OA research, and interviews with people with ankle OA and health professionals. Consensus was defined a priori as ≥70% agreement in people with ankle OA and health professionals whether a domain should or should not be included in a core domain set. RESULTS: A total of 100 people (75 health professionals and 25 people with ankle OA) from 18 countries (4 continents) participated in this study. Five domains reached consensus for inclusion in a core domain set for ankle OA - pain severity, health-related quality of life, function, disability and ankle range of motion. Twenty-one candidate domains reached agreement not to be included in the core domain set, and three domains remained undecided (ankle instability, physical capacity, and mental health). CONCLUSION: This international consensus study, which included people with ankle OA and health professionals, has established a core domain set for ankle OA with five domains that should be measured and reported in all ankle OA trials - pain severity, health-related quality of life, function, disability and ankle range of motion. This core domain set will guide the reporting of outcomes in clinical trials on ankle OA. Future research should determine which outcome measurement instruments should be used to measure each of the core domains.

Modeling Risk for Lower Extremity Musculoskeletal Injury in U.S. Military Academy Cadet Basic Training.

INTRODUCTION: Sport and tactical populations are often impacted by musculoskeletal injury. Many publications have highlighted that risk is correlated with multiple variables. There do not appear to be existing studies that have evaluated a predetermined combination of risk factors that provide a pragmatic model for application in tactical and/or sports settings. PURPOSE: To develop and test the predictive capability of multivariable risk models of lower extremity musculoskeletal injury during cadet basic training at the U.S.Military Academy. MATERIALS AND METHODS: Cadets from the class of 2022 served as the study population. Sex and injury history were collected by questionnaire. Body Mass Index (BMI) and aerobic fitness were calculated during testing in the first week of training. Movement screening was performed using the Landing Error Scoring System during week 1 and cadence was collected using an accelerometer worn throughout initial training. Kaplan-Meier survival curves estimated group differences in time to the first musculoskeletal injury during training. Cox regression was used to estimate hazard ratios (HRs) and Akaike Information Criterion (AIC) was used to compare model fit. RESULTS: Cox modeling using HRs indicated that the following variables were associated with injury risk : Sex, history of injury, Landing Error Scoring System Score Category, and Physical Fitness Test (PT) Run Score. When controlling for sex and history of injury, amodel including aerobic fitness and BMI outperformed the model including movement screening risk and cadence (AIC: 1068.56 vs. 1074.11) and a model containing all variables that were significant in the univariable analysis was the most precise (AIC: 1063.68). CONCLUSIONS: In addition to variables typically collected in this tactical setting (Injury History, BMI, and aerobic fitness), the inclusion of kinematic testing appears to enhance the precision of the risk identification model and will likely continue to be included in screening cadets at greater risk.

Effect of sensor location for modifying center of pressure during gait using haptic feedback in people with chronic ankle instability.

BACKGROUND: Gait retraining using haptic biofeedback medially shifts the center of pressure (COP) while walking in orthopedic populations. However, the ideal sensor location needed to effectively shift COP medially has not been identified in people with chronic ankle instability (CAI). RESEARCH QUESTIONS: Can a heel sensor location feasibly be employed in people with CAI without negatively altering kinematics? Does a heel sensor placement relative to the 5th metatarsal head (5MH) impact COP location while walking in people with CAI? METHODS: In this exploratory crossover study, 10 participants with CAI walked on a treadmill with vibration feedback for 10 minutes with a plantar pressure sensor under the heel and 5MH. Separate 2×2 repeated measures analyses of covariances (rmANCOVAs) were used to compare the averaged COP location and 3-D lower extremity kinematics from the first 10% of stance before and after training and between sensor locations. Baseline measures served as covariates to adjust for baseline differences. RESULTS: Feedback triggered by a heel sensor resulted in 40% of participants avoiding a heel strike. There were no significant main effects or interactions between time and sensor location on COP location when controlling for baseline COP (p>0.05). However, with the 5MH placement, participants displayed less ankle internal rotation(IR) (5MH/Heel: -4.12±0.00º/ -6.43±0.62º), less forefoot abduction (-4.29±0.00º/ -5.14±1.01º), more knee flexion (3.40±0.32º/ 0.14±0.57º), less knee external rotation (-10.95±0.00º/-11.24±1.48º), less hip extension (-0.20±0.00º/-1.42±1.05º), and less hip external rotation (3.12±0.00º/3.75±1.98º). SIGNIFICANCE: A 5MH location may be more feasible based on difficulties maintaining heel strike when the sensor was under the heel. While no sensor location was statistically better at changing the COP, the 5MH location decreased proximal transverse plane motions making participants' gait more like controls. Individual response variations support comprehensive lower extremity assessments and the need to identify responder profiles using sensory feedback in people with CAI.

Muscle contributions to reduced ankle joint contact force during drop vertical jumps in patients with chronic ankle instability.

Chronic ankle instability is a condition linked to progressive early ankle joint degeneration. Patients with chronic ankle instability exhibit altered biomechanics during gait and jump landings and these alterations are believed to contribute to aberrant joint loading and subsequent joint degeneration. Musculoskeletal modeling has the capacity to estimate joint loads from individual muscle forces. However, the influence of chronic ankle instability on joint contact forces remains largely unknown. The objective of this study was to compare tri-axial (i.e., compressive, anterior-posterior, and medial-lateral) ankle joint contact forces between those with and without chronic ankle instability during the ground contact phase of a drop vertical jump. Fifteen individuals with and 15 individuals without chronic ankle instability completed drop vertical jump maneuvers in a research laboratory. We used those data to drive three-dimensional musculoskeletal simulations and estimate muscle forces and tri-axial joint contact force variables (i.e., peak and impulse). Compared to those without chronic ankle instability, the ankles of patients with chronic ankle instability underwent lower compressive ankle joint contact forces as well as lower anterior-posterior and medial-lateral shearing forces during the weight acceptance phase of landing (p <.05). These findings suggest that patients with chronic ankle instability exhibit lower ankle joint loading patterns than uninjured individuals during a drop vertical jump, which may be considered in rehabilitation to potentially reduce the risk of early onset of ankle joint degeneration.

Applications of Artificial Intelligence in PSMA PET/CT for Prostate Cancer Imaging.

Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) has emerged as an important imaging technique for prostate cancer. The use of PSMA PET/CT is rapidly increasing, while the number of nuclear medicine physicians and radiologists to interpret these scans is limited. Additionally, there is variability in interpretation among readers. Artificial intelligence techniques, including traditional machine learning and deep learning algorithms, are being used to address these challenges and provide additional insights from the images. The aim of this scoping review was to summarize the available research on the development and applications of AI in PSMA PET/CT for prostate cancer imaging. A systematic literature search was performed in PubMed, Embase and Cinahl according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 26 publications were included in the synthesis. The included studies focus on different aspects of artificial intelligence in PSMA PET/CT, including detection of primary tumor, local recurrence and metastatic lesions, lesion classification, tumor quantification and prediction/prognostication. Several studies show similar performances of artificial intelligence algorithms compared to human interpretation. Few artificial intelligence tools are approved for use in clinical practice. Major limitations include the lack of external validation and prospective design. Demonstrating the clinical impact and utility of artificial intelligence tools is crucial for their adoption in healthcare settings. To take the next step towards a clinically valuable artificial intelligence tool that provides quantitative data, independent validation studies are needed across institutions and equipment to ensure robustness.

Comparison of EMG activity in shank muscles between individuals with and without chronic ankle instability when running on a treadmill.

Changes in movement capabilities after an injury to the ankle may impose adaptations in the peripheral and central nervous system. The purpose of our study was to compare the electromyogram (EMG) profile of ankle stabilizer muscles and stride-time variation during treadmill running in individuals with and without chronic ankle instability (CAI). Recreationally active individuals with (n = 12) and without (n = 15) CAI ran on a treadmill at two speeds. EMG activity of four shank muscles as well as tibial acceleration data were recorded during the running trials. EMG amplitude, timing of EMG peaks, and variation in stride-time were analyzed from 30 consecutive stride cycles. EMG data were time-normalized to stride duration and amplitude was normalized relative to the appropriate maximal voluntary contraction (MVC) task. Individuals with CAI had similar EMG amplitudes and peak timing, but an altered order of peak EMG activity in ankle stabilizer muscles, a significantly greater EMG amplitude for PL with an increase in speed, and a greater stride-time variability during treadmill running compared with individuals who had no history of ankle sprains. The results of our study indicate that individuals with CAI exhibit altered activation strategies for ankle stabilizer muscles when running on a treadmill.

Epidemiology of Lateral Ligament Complex Tears of the Ankle in National Collegiate Athletic Association (NCAA) Sports: 2014-15 Through 2018-19.

BACKGROUND: Epidemiological studies of lateral ankle sprains in NCAA sports are important in appraising the burden of this injury and informing prevention efforts. PURPOSE: To describe the epidemiology of lateral ankle sprains in NCAA sports during the 2014-15 through 2018-19 seasons. STUDY DESIGN: Descriptive epidemiology study. METHODS: Injury and exposure information collected within the NCAA Injury Surveillance Program (ISP) were examined. Counts, rates, and proportions of lateral ankle sprains were used to describe injury incidence by sport, event type (practices, competitions), season segment (preseason, regular season, postseason), injury mechanism (player contact, noncontact, and surface contact, injury history (new, recurrent), and time loss (time loss [≥1 day], non-time loss). Injury rate ratios (IRRs) were used to examine differential injury rates, and injury proportion ratios (IPRs) were used to examine differential distributions. RESULTS: A total of 3910 lateral ankle sprains were reported (4.61 per 10,000 athlete exposures) during the study period, and the overall rate was highest in men's basketball (11.82 per 10,000 athlete exposures). The competition-related injury rate was higher than the practice-related rate (IRR, 3.24; 95% CI, 3.04-3.45), and across season segments, the overall rate was highest in preseason (4.99 per 10,000 athlete exposures). Lateral ankle sprains were most often attributed to player-contact mechanisms in men's (43.2%) and women's sports (35.1%), although injuries were more prevalently attributed to player contact in men's than in women's sports (IPR, 1.23; 95% CI, 1.13-1.34). Overall, 49.7% of all lateral ankle sprains were time loss injuries. CONCLUSIONS: The findings of this study are consistent with previous epidemiological investigations of lateral ankle sprains among NCAA athletes. Results offer additional context on differential injury mechanisms between men's and women's sports and on injury risk across the competitive season. Future research may examine the effectiveness of deploying injury prevention programs before the start of a season.

Mechanical and Sensorimotor Outcomes Associated With Talar Cartilage Deformation After Static Loading in Those With Chronic Ankle Instability.

CONTEXT: Those with chronic ankle instability (CAI) demonstrate deleterious changes in talar cartilage composition, resulting in alterations of talar cartilage loading behavior. Common impairments associated with CAI may play a role in cartilage behavior in response to mechanical loading. OBJECTIVE: To identify mechanical and sensorimotor outcomes that are linked with the magnitude of talar cartilage deformation after a static loading protocol in patients with and those without CAI. DESIGN: Cross-sectional study. SETTING: Laboratory setting. PATIENTS OR OTHER PARTICIPANTS: Thirty individuals with CAI and 30 healthy individuals. MAIN OUTCOME MEASURES(S): After a 60-minute off-loading period, ultrasonographic images of the talar cartilage were acquired immediately before and after a 2-minute static loading protocol (single-legged stance). Talar cartilage images were obtained and manually segmented to enable calculation of medial, lateral, and overall average talar thickness. The percentage change, relative to the average baseline thickness, was used for further analysis. Mechanical (ankle joint laxity) and sensorimotor (static balance and Star Excursion Balance Test) outcomes were captured. Partial correlations were computed to determine associations between cartilage deformation magnitude and the mechanical and sensorimotor outcomes after accounting for body weight. RESULTS: In the CAI group, greater inversion laxity was associated with greater overall (r = -0.42, P = .03) and medial (r = -0.48, P = .01) talar cartilage deformation after a 2-minute static loading protocol. Similarly, poorer medial-lateral static balance was linked with greater overall (r = 0.47, P = .01) and lateral (r = 0.50, P = .01) talar cartilage deformation. In the control group, shorter posterolateral Star Excursion Balance Test reach distance was associated with greater lateral cartilage deformation (r = 0.42, P = .03). No other significant associations were observed. CONCLUSIONS: In those with CAI, inversion laxity and poor static postural control were moderately associated with greater talar cartilage deformation after a 2-minute static loading protocol. These results suggest that targeting mechanical instability and poor balance in those with CAI via intervention strategies may improve how the talar cartilage responds to static loading conditions.

Ankle joint contact force profiles differ between those with and without chronic ankle instability during walking.

BACKGROUND: Individuals with chronic ankle instability (CAI) exhibit aberrant gait biomechanics relative to uninjured controls. Altered gait biomechanics likely contribute aberrant joint loading and subsequent early onset ankle joint degeneration. Joint (i.e. cartilage) loading cannot be directly measured without invasive procedures but can be estimated via joint contact forces (JCF) generated from musculoskeletal modeling. However, no investigation has quantified JCF in those with CAI during walking despite the link between ligamentous injury and ankle post-traumatic ankle osteoarthritis. RESEARCH QUESTION: Do patients with CAI exhibit altered ankle compressive and shear JCF profiles during the stance phase of walking compared to those without CAI? METHODS: Ten individuals with CAI and 10 individuals without a history of ankle sprain completed a gait assessment at their self-selected speed on an instrumented treadmill. Musculoskeletal modeling was applied to estimate ankle JCF variables within a generic model. Variables included the peak, impulse, and loading rates for compressive, anteroposterior shear, and mediolateral shear JCF. RESULTS: Those with CAI had significantly different JCF forces, relative to uninjured controls, in all directions. More specifically, lower compressive peak and impulse values were noted while higher anteroposterior shearing forces (1 st peak, impulse, loading late) were observed in those with CAI. Those with CAI also demonstrated higher mediolateral shearing forces (1 st peak and impulse). SIGNIFICANCE: Our finding suggests that those with CAI exhibit different ankle joint loading patterns than uninjured controls. Directionality of the identified differences depends on the axis of movement.

Patient-Reported Outcomes at Return to Sport After Lateral Ankle Sprain Injuries: A Report From the Athletic Training Practice-Based Research Network.

CONTEXT: Limited evidence exists regarding the assessment of single-item patient-reported outcomes when patients are medically cleared to return to sport after a lateral ankle sprain (LAS) injury. OBJECTIVE: To evaluate self-reports of improvement in health status, pain, function, and disability at return to sport after an LAS. DESIGN: Descriptive study. SETTING: Sixty-nine athletic training facilities across 24 states. PATIENTS OR OTHER PARTICIPANTS: A total of 637 patients (males = 53.2%) who were diagnosed with an LAS, restricted from sport after injury, and subsequently medically cleared to return to sport within 60 days were included. MAIN OUTCOME MEASURE(S): Descriptive statistics were used to summarize scores for health status (Global Rating of Change), pain (Numeric Pain Rating Scale), function (Global Rating of Function), and disability (Global Rating of Disability). Mann-Whitney U tests were used to compare score differences between sexes. A Kaplan-Meier analysis was performed to provide a visual depiction of sex differences in the time to return to sport. RESULTS: Most patients sustained an LAS injury while participating in basketball, football, or soccer and were cleared to return to sport 8 days after injury. More than two-thirds of patients reported a meaningful improvement in health status between the time of injury and return to sport. However, many noted deficits related to pain (65.1%), function (86.2%), or disability (35.8%) at return to sport. No differences were seen between males and females for pain (P = .90), function (P = .68), change in health status (P = .45), or disability (P = .21) at return to sport, although males returned to sport slightly sooner than females (P = .025). CONCLUSIONS: Despite self-perceived improvements in health status since the time of injury, patients typically returned to sport with deficits in pain, function, and disability after an LAS. Patients may be returning to unrestricted sport participation before they feel their bodies have fully recovered from the injury.

Patients Experience Significant and Meaningful Changes in Self-Report of Function During the First 2 Weeks After an Ankle Sprain Injury: A Report From the Athletic Training Practice-Based Research Network.

CONTEXT: Ankle sprains are common during sport participation and associated with long-term deficits in self-report of function. However, little is known of short-term changes in self-report of function following injury. The authors aimed to assess statistical and clinically meaningful changes in self-report of function, as measured by the Foot and Ankle Ability Measure (FAAM), during the first 2 weeks after an ankle sprain injury. DESIGN: A retrospective analysis of electronic medical records. METHODS: Eighty-eight patients, who were diagnosed with an ankle sprain injury by an athletic trainer, received usual care from an athletic trainer, and completed the FAAM during treatment at weeks 1 and 2 postinjury. The authors calculated the percentage of patients who reported clinically meaningful changes and used Wilcoxon signed-rank tests to compare differences in FAAM scores between time points. RESULTS: Between weeks 1 and 2, significant differences were noted for the FAAM Activities of Daily Living (FAAM-ADL) (P < .001) and FAAM Sport (FAAM-Sport) (P < .001). At the patient level, 86.5% (64/74) and 85.2% (69/81) of patients reported changes that exceeded the minimal clinically important difference value for the FAAM-ADL and FAAM-Sport, respectively, between weeks 1 and 2. At week 2, 31.8% (28/88) and 47.7% (42/88) of patients reported a score below 90% on the FAAM-ADL and below 80% on the FAAM-Sport subscale, respectively. Also, 36.4% (32/88) and 25.0% (22/88) of patients reported a score of 100% on the FAAM-ADL and FAAM-Sport subscales, respectively, at week 2. CONCLUSIONS: Patients report statistically significant and meaningful improvements in self-report of function during the first 2 weeks following ankle sprain injury. However, almost half of patients still report deficits in sport function at 2 weeks postinjury. Patient-reported outcome measures such as the FAAM, can help capture the patient's perception of function and inform patient care decisions. Research efforts should explore individual response patterns to treatment.

Protocol for the development of a core domain set for individuals with ankle osteoarthritis.

BACKGROUND: Ankle osteoarthritis (OA) is a debilitating health condition that is increasing in prevalence. Currently, there are no evidence-based guidelines for managing ankle OA. One of the current challenges to establishing guidelines is the lack of a widely agreed-upon set of outcome measures that are consistently used in ankle OA research. Without a set of agreed-upon outcome measures, it is difficult to synthesise clinical trial outcomes through meta-analysis-an essential element of evidence-informed practice. In order to develop an appropriate set of outcome measures for ankle OA, it is important first to develop a core domain set. In this protocol, we describe the methodological approach that we will use to develop such a core domain set for ankle OA. METHODS: We established an international steering committee to guide the development of a core domain set for ankle OA. The core domain set development will follow a multi-staged approach consisting of three phases, involving participation by patients and clinicians/healthcare professionals. In phase 1, a list of candidate domains will be gleaned from (a) a scoping review of outcome measures used in ankle OA research, (b) qualitative interviews with individuals with ankle OA, and (c) qualitative interviews with healthcare professionals with expertise in ankle OA. In phase 2, the steering committee will review and generate a list of candidate domains from those gleaned in phase 1. In phase 3, this list of candidate domains will be considered in a Delphi process to reach a consensus on a core domain set. We anticipated this will involve 3 rounds of surveys. CONCLUSION: This protocol describes the methods that will be used to develop a core domain set of health-related aspects for ankle OA. Importantly, it will include both healthcare professional and patient involvement. This is a prerequisite step to developing a core outcome set for ankle OA that should be reported in all clinical trials for ankle OA. The findings will be widely disseminated across peer-refereed publication(s) and national and international conferences, as well as via relevant professional societies, patient support group organisations, and social media platforms. PROJECT REGISTRATION: This project is registered with the Core Outcome Measures in Effectiveness Trials (COMET) database on 17 March 2021. https://www.comet-initiative.org/Studies/Details/1837 .

Gait Biomechanics and Balance Associate with Talar and Subtalar T1ρ Relaxation Times in Those with Chronic Ankle Instability.

PURPOSE: This study aimed to determine associations between T1ρ relaxation times of talar and subtalar articular cartilage and commonly altered gait biomechanics and postural control outcomes in those with chronic ankle instability (CAI). METHODS: Fifteen individuals with CAI (21.13 ± 1.81 yr) completed a T1ρ magnetic resonance imaging as well as a postural control and an overground gait assessment. Talocrural and subtalar cartilage was segmented manually to calculate T1ρ relaxation times. Greater T1ρ relaxation times were interpreted as decreased proteoglycan content. Pearson product-moment bivariate correlations examined the relationships between T1ρ relaxation times and the gait biomechanics and postural control outcomes. RESULTS: Across multiple variables, worse postural control demonstrated moderate to strong associations (range, 0.433-0.642 and -0.713) with greater talar T1ρ relaxation times. At the subtalar joint, greater T1ρ relaxation times were associated with lower peak vertical ground reaction forces, lower average vertical ground reaction force loading rates, and lower peak loading rates (range, -0.438 to -0.622). At the talar dome, greater talar T1ρ relaxation times were associated with increased knee extensor moments (r = 0.457), as well as greater knee flexion (r = 0.482) and knee adduction (r = 0.407) at initial contact. Larger step spatiotemporal gait parameters also associated with greater talar and subtalar T1ρ relaxation times (range, 0.434-0.697). CONCLUSIONS: In individuals with CAI, worse postural control and altered kinematic, kinetic, and spatiotemporal outcomes demonstrate moderate to strong associations with greater talar T1ρ and/or subtalar relaxation times (i.e., less proteoglycan content). Associations between modifiable neuromechanical variables and greater T1ρ relaxation times may represent potential therapeutic interventions to mitigate ankle joint degeneration in those with CAI.

Dorsiflexion and Hop Biomechanics Associate with Greater Talar Cartilage Deformation in Those with Chronic Ankle Instability.

PURPOSE: This study aimed to identify associations between dorsiflexion range of motion (DFROM), functional hop test performance, and hopping biomechanics with the magnitude of talar cartilage deformation after a standardized hopping protocol in individuals with and without chronic ankle instability (CAI). METHODS: Thirty CAI and 30 healthy individuals participated. Ankle DFROM was assessed using the weight-bearing lunge test. Four different functional hop tests were assessed. Three-dimensional kinematics and kinetics were sampled during a 60-cm single-leg hop. We calculated cartilage deformation after a dynamic loading protocol consisting of sixty 60-cm single-leg forward hops by assessing the change in average thickness for the overall, medial, and lateral talar cartilage. Linear regressions examined the associations between cartilage deformation magnitude and DFROM, functional hop tests, and hop biomechanical variables after accounting for body weight and time since the initial ankle sprain. RESULTS: In CAI group, lesser static DFROM (ΔR2 = 0.22) and smaller peak ankle dorsiflexion angle (ΔR2 = 0.17) was associated with greater medial deformation. Greater peak vertical ground reaction force (vGRF) (ΔR2 = 0.26-0.28) was associated with greater medial and overall deformation. Greater vGRF loading rate (ΔR2 = 0.23-0.35) was associated with greater lateral and overall deformation. Greater side hop test times (ΔR2 = 0.31-0.36) and ankle plantarflexion at initial contact (ΔR2 = 0.23-0.38) were associated with greater medial, lateral, and overall deformation. In the control group, lesser side hop test times (ΔR2 = 0.14), greater crossover hop distances (ΔR2 = 0.14), and greater single-hop distances (ΔR2 = 0.21) were associated with greater overall deformation. CONCLUSIONS: Our results indicate that lesser static DFROM, poorer functional hop test performance, and hop biomechanics associate with greater talar cartilage deformation after a dynamic loading protocol in those with CAI. These factors may represent targets for therapeutic interventions within this population to slow ankle posttraumatic osteoarthritis progression.

Pitching shoulder passive flexibility: torque-angle analysis for external rotation and internal rotation.

In this study, a custom device was developed to analyse the pitching shoulder's external rotation (ER) and internal rotation (IR) passive flexibility. We analysed three novel measures: the resistance onset angle (ROA = angle where the shoulder begins stretching), rotational stiffness, and torque at the end range of motion (ROM). The purpose was to conduct a bilateral analysis to determine if there are significant differences between the throwing and non-throwing shoulder. Participants were 30 upper level pitchers (13 division I, 17 minor league). During testing, pitchers laid supine on a treatment table and the arm was secured to a rotational wheel with the shoulder abducted 90° and elbow flexed 90°. Dependent t-tests revealed significant (p < 0.01) and relatively extreme bilateral differences for all three variables. The throwing shoulder had: increased ER ROA (9°), decreased IR ROA (5.3°), increased ER stiffness (17%), increased IR stiffness (34%), increased ER torque (21%), and increased IR torque (30%). Secondary correlation analysis was completed to determine if the torque-angle variables were good predictors of the end ROM. Stiffness correlations were weak for ER (r = 0.35, p = 0.048) and IR (r = 0.42, p = 0.017) but ROA correlations were strong for ER (r = 0.85, p < 0.001) and IR (r = 0.86, p < 0.001).

Seven-Weeks Gait-Retraining in Minimalist Footwear Has No Effect on Dynamic Stability Compared With Conventional Footwear.

Purpose: To investigate the effects of two different running footwear conditions (transition to minimalist footwear and conventional running footwear) on dynamic postural stability before and after 7 weeks of gait retraining program, and to evaluate the effect of fatigue on dynamic stability. Method: This randomized controlled clinical trial was carried out by 42 recreational male runners, who were randomly divided into two groups; Conventional Footwear Group (CFG) (n = 22) and Minimalist Footwear Group (MFG) (n = 20). Dynamic Postural Stability Index (DPSI), in a fatigued and non-fatigued state, were assessed before and after a gait retraining program. The gait retraining program consisted of three guided training sessions per week for 7 weeks. Training program was mainly focused on running technique and submaximal aerobic training with step-frequency exercises. Minimalist footwear was progressively introduced in the MFG. The CFG and MFG performed the same training exercises and a full body conditioning program. Fatigue was induced using a 30-minute running test at individual 85% of the maximal aerobic speed. Results: No differences in dynamic stability variables were found between MFG and CFG in any of the study condition. MFG and CFG showed better dynamic stability after the intervention program (CFG: 13.1% of change, DPSIpre = 0.3221 ± 0.04, DPSIpost = 0.2799 ± 0.04; p < .05; MFG: 6.7% of change, DPSIpre = 0.3117 ± 0.04, DPSIpost = 0.2907 ± 0.05). Finally, dynamic stability was significatively lower in both groups after fatigue protocol (p < .05). Conclusions: Following a 7-week gait retraining program, footwear did not affect the results, being the gait retraining program more relevant on improving dynamic stability.

Reliability of Manually Segmenting T1ρ Magnetic Resonance Sequences of Talar Articular Cartilage.

CONTEXT: Quantifying early posttraumatic ankle osteoarthritis pathogenesis using compositional magnetic resonance (MR) imaging sequences is becoming more common. These MR sequences are often manually segmented to isolate the cartilage of interest before cartilage compositional values (eg, T1ρ or T2) are quantified. However, limited information is available regarding the reliability and reproducibility of manual segmentation for the entire talar dome. OBJECTIVE: The purpose of this study was to determine the intraobserver and interobserver reliability of manually segmenting T1ρ MR sequences of the entire talar dome and 4 subregions of interest. DESIGN: Descriptive observational study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Ten uninjured healthy individuals (4M and 6F: 21.40 [3.03] y, 170.00 [7.93] cm, 71.03 [14.97] kg) participated. INTERVENTION: None. MAIN OUTCOME MEASURES: Two investigators manually segmented 10 T1ρ ankle MR sequences using ITK-SNAP software to calculate T1ρ mean relaxation times and cartilage volumes. Each observer repeated the segmentation twice, with segmentations separated by 1 month. Intraobserver and interobserver reliability was determined using intraclass correlation coefficients (ICCs) with 95% confidence intervals and root mean square coefficient of variations (RMSCVs). RESULTS: For T1ρ relaxation time, intraobserver (ICC = .994-.997, RMSCV = 1.31%-1.51%) and interobserver reliability (ICC = .990, RMSCV = 2.36%) was excellent for the overall talar dome. Excellent intraobserver (ICC = .975-.980, RMSCV = 3.88%-4.59%) and excellent interobserver reliability (ICC = .970, RMSCV = 5.13%) was noted for overall talar cartilage volume. CONCLUSIONS: The results demonstrate that manual segmentation of the entire talar dome from a T1ρ MR is reliable and repeatable.

Dynamic reach deficits in those with chronic ankle instability: A systematic review and meta-analysis.

OBJECTIVE: The purpose of this review with meta-analyses was to determine the dynamic reach differences 1) between chronic ankle instability (CAI) and uninjured individuals, 2) between the limbs of an individual with CAI, and 3) between the uninvolved CAI limb and the healthy control limb across all possible reach directions of the Star Excursion Balance Test (SEBT). METHODS: PubMed, CINAHL, SPORTDiscus, and Scopus databases were searched up to October 2021. Data were extracted from the retained studies and underwent methodological quality assessment and meta-analysis using random-effect models. RESULTS: After screening, 33 articles were included for the analyses. In all possible SEBT reach directions, the CAI group demonstrated significantly decreased normalized dynamic reach distances relative to the uninjured control group (SMDs: -0.66 to -0.48, p ≤ 0.05). Similarly, the involved CAI limb demonstrated significantly decreased normalized dynamic reach distances relative to the uninvolved CAI limb (SMDs: -0.61 to -0.33, p ≤ 0.05). However, no differences were noted between the uninvolved CAI limb and the healthy control limb (SMDs: -0.22 to 0.09, p ≥ 0.13). CONCLUSIONS: Our findings were that the involved limb of those with CAI has dynamic postural deficits relative to (i) an uninjured control group and (ii) relative to their uninvolved limb. However, the uninvolved limb of the CAI group does not differ from an uninjured control group in any reach direction.