Regional brain atrophy in patients with chronic ankle instability: A voxel-based morphometry study

As an effective scale for the condition assessment of patients with chronic ankle instability (CAI), the Cumberland Ankle Instability Tool (CAIT) is the most widely used scale, and its original version is written in English. Therefore, the purpose of our study is to apply the CAIT to Chinese patients and evaluate its responsiveness, reliability, and validity in terms of Chinese patients with CAI. First, we adapted the CAIT into the Chinese edition (CAIT-C), through which cross-cultural adaptation and translation can be carried out in a five-step procedure. Next, recruited patients completed the three periods of the Foot and Ankle Ability Measure (FAAM), CAIT-C, and the Medical Outcomes Study Short-Form 36 (SF-36) scales. Afterward, to assess the responsiveness, reliability, and validity, we calculated the standardized response mean (SRM), effect size (ES), Spearman's correlation coefficient (rs), minimal detectable change (MDC), standard error of measurement (SEM), intraclass correlation coefficient (ICC), and Cronbach’s alpha. Generally, in the use of CAI, 131, 119, and 86 patients favorably completed the three periods of the scales. The CAIT-C was proven to have good test–retest reliability (ICC = 0.930) and fine internal consistency (Cronbach’s alpha = 0.845–0.878). The low-value of MDC (0.04–2.28) and SEM (1.73) show it is possible to detect clinical changes when we take advantage of CAIT-C. Good or moderate correlations (rs = 0.422–0.738) were gained from the physical subscales of the SF-36 and the subscales of the FAAM and the CAIT-C. Fair or poor correlations (rs = 0.003–0.360) were gained between the mental subscales of the SF-36 and the CAIT-C, which sufficiently indicated that the CAIT-C had good validity. Moreover, good responsiveness was observed in the CAIT-C (ES = 1.316, SRM = 1.418). The CAIT-C scale is an effective, valid, and reliable tool to evaluate Chinese CAI patients.

A randomized comparison between lateral ligaments augmentation using suture-tape and modified Broström repair in young female patients with chronic ankle instability

Ankle sprains are one of the most common injuries in both athletes and the general population. A major problem accompanying ankle injury is the high rate of recurrence, with about 20% of acute ankle sprain patients developing chronic ankle instability. Unlike acute ankle sprain, chronic ankle instability usually needs surgical intervention. Various anatomic reconstruction techniques using the ruptured ends of the ligaments to restore stability have gained popularity. The purpose of this study was to evaluate the functional results of the treatment of chronic lateral ankle instability with anatomic repair of the injured ligaments and reinforcement with polyester tape. A prospective study of 30 consecutive patients who underwent anatomic reconstruction of the lateral ligaments using transosseous suturing and augmentation using a polyester tape done at a single centre by a single surgeon from 2016 to 2017. All patients were assessed preoperatively and postoperatively at 6 weeks, 3, 6 and 12 months. The American Orthopaedic Foot and Ankle Score (AOFAS) and Free Online Foot and Ankle Ability Measure (FAAM) were recorded and used for results analysis. At 12 months' follow-up, the AOFAS had improved from mean 52.47 ± 2.06 to 91.0 ± 6.03 (p< 0.001) .The FAAM mean score had improved from mean 55.21± 1.9 to 90.43 ± 4.02 Conclusion. The ankle ligament reconstruction with additional polyester tape augmentation is an effective technique in treating chronic ankle instability with a satisfactory surgical outcome.

Patient-Reported Outcome Measures (PROMs): Influence of Motor Tasks and Psychosocial Factors on FAAM Scores in Foot and Ankle Trauma Patients

PURPOSE: Foot and ankle injuries account for up to 30% of all pediatric sports medicine visits. Self-reported outcome measures can be utilized to capture the patient’s perspectives on their injury and monitor recovery, however, this has not been well studied in youth athletics. The objective of this study is to examine the relationship between patient injury characteristics and FAAM scores. METHODS: A retrospective cross-sectional pilot study was conducted on patients that completed the Foot and Ankle Ability Measure (FAAM) survey as standard of care for either their first clinic or physical therapy visit. Factors of interest include age, sex, diagnosis and type of rehabilitation program. Descriptive statistics and multiple linear regression models were performed. RESULTS: In this pilot study, 457 individuals were identified as having completed the FAAM over the 3 year review period. A sample of 36 patients with 42 distinctive injuries were reviewed. The average age of the sample was 16.38 years, 53% were female. Only 8 athletes (22%) identified as participating in multiple sports. Soft tissue injury was the most common diagnosis (65% of encounters) and more than half of the patients were referred to physical therapy. The average time from injury to presentation was 63 days (RNG: 1-694 days). The average initial FAAM score was 0.52 (SD ± 0.28, RNG: 0.03-0.96). Multiple linear regression models showed no significant predictors. Only time from injury to initial FAAM score approached a p-value of 0.10. CONCLUSIONS: The use of the FAAM may provide insight into patient perception of function and recovery from a musculoskeletal injury. Our study unveils characteristics of one cohort of adolescents from a pediatric sports medicine clinic with foot and ankle injuries. Time to presentation was significantly longer than expected but perceived level of dysfunction was higher. The multiple linear regression models showed no strong predictors of FAAM scores, however, this pilot study was underpowered. Future efforts will focus on further evaluation of this entire cohort and the interaction between injury characteristics, management recommendations, and FAAM scores.

Background:Competitive adolescent athletes should be aware of the early signs of chronic ankle instability (CAI) and the connection between the condition and performance.Purpose:To investigate whether CAI is related to foot alignment and morphology as well as dynamic postural stability after a jump landing among adolescent competitive athletes with and without a history of a lateral ankle sprain and CAI.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Between July 2020 and August 2021, adolescent competitive athletes (N = 85; n = 49 boys; n = 36 girls) were classified into 3 groups using Cumberland Ankle Instability Tool (CAIT) scores: healthy athletes (n = 55), coper athletes (n = 19), and athletes with CAI (n = 11). Results of foot alignment assessments involving the leg-heel angle (LHA) and navicular height, intrinsic foot muscle morphology, dynamic postural stability index (DPSI), and other parameters were compared among the 3 groups. The relationship between the CAIT score and the LHA and dynamic postural stability and instability were examined using multiple linear regression.Results:Compared with the healthy group, the CAI group had a significantly greater LHA (8.73°± 3.22° vs 6.09°± 3.26°; P < .05), higher DPSI (0.336 ± 0.046 vs 0.298 ± 0.035), and higher vertical stability index (0.303 ± 0.048 vs 0.264 ± 0.037; P < .05 for all). Multiple regression analysis showed that the LHA (β = −0.228; P = .033) and DPSI (β = −0.240; P = .025) were significantly associated with the CAIT score .Conclusion:Valgus rearfoot alignment and poorer dynamic postural control were associated with CAI among adolescent athletes.

Context: Manual therapy (MT) is reported to increase range of motion (ROM), improve balance, and decrease pain in individuals with chronic ankle instability (CAI). Additional literature is needed to examine the effectiveness of the addition of MT to a therapeutic exercise regimen in individuals with CAI. Objective: To examine the combined effects of thrust joint manipulation (TJM) and exercise on function in participants reporting CAI. Design: Randomized controlled trial. Setting: Research laboratory. Participants: A convenience sample of 30 participants (mean age 23.7 [3.65] y; mean height 169.50 [9.50] cm; mean mass 66.48 [10.64] kg). Intervention: Participants were randomly allocated to the exercise (n = 15) or exercise + TJM group (n = 20) and completed an exercise program. The exercise + TJM group also received MT at the talocrural, proximal, and distal tibiofibular joints in the first 3 sessions. Main Outcome Measures: Self-reported outcomes were recorded at baseline and follow-up using the Foot and Ankle Ability Measure (FAAM), the FAAM-Sport (FAAM-S) subscale, and the Ankle Joint Functional Assessment Tool (AJFAT). The side-hop test, figure-of-8 hop test, 3 directions of the Star Excursion Balance Test, and dorsiflexion ROM were also assessed at baseline and follow-up. Results: Only the exercise + TJM group demonstrated an improvement in weight-bearing dorsiflexion with the knee flexed following treatment (P = .02). For all outcome measures, except ROM, subjects improved significantly at follow-up regardless of group assignment (P ≤ .01). Conclusions: Our data suggest that rehabilitation of patients with CAI is related to improved ROM, function, and self-reported outcomes. This provides evidence that the addition of MT to exercise may enhance improvements in ROM as compared with exercise alone. Additional research is needed to identify optimal parameters to maximize therapeutic benefit.

Category:ArthroscopyIntroduction/Purpose:Peroneal tendoscopy may be used to treat patients with peroneal tendinopathy. It is typically used for diagnostic purposes and to address tendinopathy in the absence of large tendon tears. Its value includes preservation of the superior peroneal retinaculum, small incision size, and faster postoperative recovery compared to open treatment. The goal of this study is to explore the functional outcomes of patients who have undergone isolated peroneal tendoscopy.Methods:Consecutive adult patients who underwent isolated peroneal tendoscopy between January 2010 and January 2018 at a single Foot and Ankle center were identified. The electronic medical record and operative notes were reviewed to identify patients with a minimum 12-month follow-up. Those undergoing open tendon repair, tendon transfer, peroneal groove deepening, and any other concurrent foot or ankle procedure were excluded from the study. Eligible patients were administered the PROMIS Physical Function-Short Form 10A (PF SF10A), Foot and Ankle Ability Measure (FAAM), and the Visual Analog Scale (VAS).Demographic information was also collected. Data was pooled, and descriptive analyses and unpaired T-tests were conducted.Results:Thirty patients met inclusion criteria and 22/30 patients (73%) were able to be reached. Our patient cohort was predominantly female (90.9%), had a mean age of 46.4 years, and an average BMI of 27.6. The mean pre-operative FAAM and PROMIS PF SF10A for patients were 58.3 and 39.7, while the mean post-operative FAAM and PROMIS PF SF10A were 83.3 and 50.5, respectively. There was a statistically significant improvement between the mean pre-operative and post-operative FAAM and PROMIS PF SF10A scores for patients (p =0.0050 and 0.0025, respectively) with a mean improvement of 25.0 in FAAM and 10.8 for PROMIS PF SF10A scoring. At an average of 33.4 month follow-up, the mean VAS for pain was 20.9 out of 100.Conclusion:Isolated peroneal tendoscopy is an effective treatment for patients who have peroneal pain in the absence of frank tears or tendon instability. The improvement in FAAM and PF SF10A scores was statistically significant and exceeds published MCIDs for both FAAM and PROMIS PF SF10A. Additional research is required to further evaluate the effectiveness of peroneal tendoscopy as compared to other methods of treating peroneal tendinopathy, such as open peroneal tenosynovectomy.

Category:Ankle ArthritisIntroduction/Purpose:There is limited information regarding the outcomes of operative treatment for ankle instability with coexisting arthritic changes in the medial gutter. This study was performed to evaluate the intermediate-term clinical and radiological outcomes following a modified Broström procedure and arthroscopic debridement in middle-aged patients with combined medial gutter osteoarthritis and chronic lateral ankle instability.Methods:Twenty-four patients with medial gutter osteoarthritis related to chronic lateral ankle instability were followed for more than 3 years after operative treatment. All patients showed medial joint space narrowing of Takakura stage II at the time of surgery. The clinical evaluation consisted of the American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS) for medial ankle pain during walking, and Foot and Ankle Ability Measure (FAAM).Results:Mean AOFAS and FAAM scores significantly improved from 51.2 and 45.7 points preoperatively to 80.3 and 78.4 points at final follow-up, respectively (P < .001). Although mean pain-VAS significantly improved from 6.8 points to 3.1 points (P < .001), 5 patients (20.8%) complained of gait discomfort with considerable pain of 4 or more points. There was only 1 patient (4.2%) with recurrent ankle instability, while 6 patients (25%) showed a progression of arthritis stage.Conclusion:Modified Broström procedure combined with arthroscopic debridement appears to be an effective operative option for medial gutter osteoarthritis secondary to chronic ankle instability. Despite the onset of arthritis, most patients were able to achieve significant improvement in reducing pain while eliminating instability.

Patient reported outcome measures in the foot and ankle literature: A systematic review.

The purpose of this study was to study the effects of the severity of preoperative bone marrow oedema (BME) on the postoperative short-term outcomes following bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) and to propose a new metric that combines volume and signal density to evaluate BME. Sixty-five patients with symptomatic OLTs (<100 mm2) and preoperative BME, who received BMS in our institution from April 2017 to July 2021 with follow-ups of 3, 6and 12 months, were analysed retrospectively. The area, volumeand signal value of the BME were collected on preoperative magnetic resonance imaging. The enroled patients were divided into two groups according to the BME index (BMEI), which was defined as the product of oedema relative signal intensity and the relation of oedema volume to total talar volume. Visual analogue scale,American Orthopedic Foot and Ankle Society (AOFAS), Tegner, Foot and Ankle Ability Measure (FAAM)-activities of daily living (ADL) and Sports scores were assessed before surgery and at each follow-up. The relationship between the scores and the volume, relative signal intensityand BMEI was explored. Sixty-five patients with preoperative BME were divided into the mild (n = 33) and severe (n = 32) groups based on the BMEI. A significant difference was found for each score with the general linear model for repeated measures through all follow-up time points (p < 0.001). For the preoperative and 12-month postoperative changes of the enroled patients, 53 patients (81.5%) exceeded the minimal clinically important difference of AOFAS and 26 (40.0%) exceeded that of FAAM-sports in this study. The mild group showed significantly more improvement in AOFAS scores at 12 months (89.6 ± 7.0 vs. 86.2 ± 6.2) and FAAM-ADL scores at 6 months (83.6 ± 7.6 vs. 79.7 ± 7.7) and 12 months (88.5 ± 8.5 vs. 84.4 ± 7.7) than the severe group (p < 0.05). No significant difference of all the scores between the groups was found at 3 months. No significant correlation was found in each group between BMEI and clinical outcomes. The severity of the preoperative BME negatively affected short-term clinical outcomes following arthroscopic BMS for OLTs. Worse clinical outcomes were shown at postoperative 6 and 12 months in patients with a high preoperative BMEI, which could be a favourable parameter for assessing the severity of BME and assist in developing personalised rehabilitation plans and determining the approach and timing of surgery. Level III.

Lateral ankle sprains are one of the most common musculoskeletal injuries. Up to 70% of individuals who sustain lateral ankle sprains develop chronic ankle instability (CAI). Exercise therapy is considered an effective treatment for patients with CAI. This meta-analysis investigated the efficacy of exercise therapy in CAI patients by reviewing 15 randomized controlled trials (RCTs) involving 586 participants. Databases including PubMed, EMBASE, Cochrane Library, and Web of Science were searched from inception to September 13, 2024. The Cochrane Risk of Bias Tool was used to assess study quality. Meta-analysis, sensitivity analysis, and publication bias analysis were conducted using RevMan 5.3.0 and Stata 18.0 software. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was applied to evaluate the quality of evidence. Main outcomes were assessed using the Foot and Ankle Ability Measure (FAAM) and the Star Excursion Balance Test (SEBT). The results demonstrated that exercise therapy significantly improved FAAM-S (MD = 7.98, CI: 4.11 to 11.86, p < 0.0001, I² = 30%). Long-term exercise therapy (over 4 weeks) significantly enhanced FAAM-A (MD = 10.95, CI: 6.60 to 15.29, p < 0.00001, I² = 0%) and dynamic balance ability of ankle joint (SBET-A: MD = 4.83, CI: 1.04 to 8.63, p = 0.01, I² = 62%; SEBT-PM: MD = 6.93, CI: 2.37 to 11.48, p = 0.003, I² = 69%; and SEBT-PL: MD = 8.98, CI: 2.66 to 15.29, p = 0.005, I² = 86%). After categorizing by exercise type, the results indicated that strength training was more effective in improving SEBT-PL (MD = 8.15, CI: 6.09 to 10.21, p < 0.00001, I² = 0%), joint mobilization was more effective in improving SEBT-A (MD = 7.65, CI: 4.93 to 10.37, p < 0.00001, I² = 0%), and proprioceptive training was more effective in improving SEBT-PM (MD = 10.46, CI: 5.27 to 15.65, p < 0.0001, I² = 33%). In conclusion, long-term, multifaceted exercise therapy demonstrates superior rehabilitation efficacy for patients with CAI. Personalized treatment plans, informed by SEBT assessment results, should prioritize targeted interventions such as joint mobilization, strength training, or proprioceptive training. This approach holds significant theoretical and practical value for optimizing CAI treatment strategies and enhancing patient outcomes.

The relationship between joint kinematic patterns during single-leg drop landing and perceived instability in individuals with chronic ankle instability

Category:OtherIntroduction/Purpose:Patient-reported outcome measures (PROMs) are an increasingly important tool for assessing the impact of treatments orthopaedic surgeons render to patients. They provide information directly reported by the patient pertaining to the perception of their own outcome, functional status, and quality of life. Despite their importance, they can present a burden for patients as well as for a busy outpatient clinic. The Foot and Ankle Ability Measure (FAAM) is a freely available validated anatomy-specific outcome measure consisting of 32 questions, and has been found to be reliable for patients with a wide spectrum of foot and ankle conditions. We examined the validity and utility of a computerized adaptive testing (CAT) method to reduce the number of questions on the Foot and Ankle Ability Measure.Methods:A previously developed FAAM CAT system was applied to the responses of patients undergoing foot and ankle evaluation and treatment at a busy tertiary referral orthopaedic practice over a 3-year period (2017-2019). A total of 15,902 responses for the Activities of Daily Living (ADL) subscale and a total of 14,344 responses for the Sports subscale were analyzed. The accuracy of the CAT to replicate the full-form score was assessed using the mean and standard deviation of scores for both groups (FAAM versus CAT), frequency distributions of the scores and score differences for both groups, Pearson and intraclass correlation coefficients, and Bland-Altman assessments of patterns in score differences.Results:The CAT system required 11 questions to be answered for the ADL subscale in 85.1% of cases (compared to 22 questions for the FAAM) and 12 in 14.9% of cases. The number of questions answered on the Sports subscale was 6 in 66.4% of cases (compared to 10 for the FAAM) and 5 in 33.6% of cases. The mean difference between the full FAAM ADL subscale (out of 100 points) and CAT was 0.6266 of a point and scores were within 7.5 points in greater than 95% of cases. The mean difference between the FAAM Sports subscale (out of 100 points) and CAT was 0.5967 of a point and scores were within the minimal clinically important difference of 9 in greater than 95% of cases.Conclusion:The FAAM CAT was able to reduce the number of responses a patient would need to answer by nearly 50%, while still providing a valid outcome score. This measure can therefore be directly correlated with previously obtained full FAAM scores in addition to providing a foot/ankle-specific measure, which previously reported CAT systems are not able to do.

Background:In this study, we aimed to evaluate the effectiveness of extracorporeal shockwave treatment (ESWT) on pain and ankle-hindfoot scale of the American Orthopedic Foot and Ankle Society (AOFAS) score of patients with chronic Achilles tendinopathy (AT).Materials and Methods:In this double-blind clinical trial, 43 patients with chronic AT were selected and randomly allocated in two groups to receive a basic treatment with ESWT or sham SWT (radial and focused shock waves, four sessions once a week for 4 weeks). AOFAS and pain scores for each patient were recorded at baseline (before intervention), immediately after intervention, and 4 and 16 weeks after intervention using AOFAS and visual analog scale (VAS) scaling method.Results:A total of 43 patients (22 ESWT and 21 sham SWT) were participated in this study. Both groups improved during the treatment and follow-up period. The mean VAS score decreased from 7.55 to 3 in the intervention group and from 7.70 to 4.30 in the sham SWT group. Mean AOFAS and VAS scores were significantly different between ESWT and no ESWT groups at 16 weeks of follow-up (P = 0.013) (P = 0.47). There was no significant difference in terms of AOFAS and VAS scores between both the groups in the other follow-up times.Conclusion:Overall, ESWT causes decrease in VAS score and increase in AOFAS score. However, due to the small sample size, the results were not statistically significant. It is recommended to plan more interventional studies with larger sample size in the future.