Clinical Association of Acute Lateral Ankle Sprain with Syndesmotic Involvement

Uys, Hendrik D.; Rijke, Arie M.

doi:10.1177/03635465020300061101

Cited by 70 publications

(51 citation statements)

References 23 publications

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“…172,174 Syndesmotic injury can also occur in athletes enduring chronic inversion and axial loading. 127,173,175 From an epidemiologic perspective, syndesmotic ankle sprains account for 1% to 11% of all ankle sprains 171,172,176,177 ; however, in athletes, the prevalence rate may range from 40% to 74% of all ankle sprains. 72,173,178 The primary role of the syndesmosis is to maintain congruency of the tibiotalar joint interface under physiologic axial loading.…”

Section: Special Considerations: Syndesmotic Ankle Sprainsmentioning

confidence: 99%

National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

Kaminski

Hertel

Amendola

et al. 2013

Journal of Athletic Training

213

233

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Objective: To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes.Background: Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short-and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented.Recommendations: The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available.

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Section: Special Considerations: Syndesmotic Ankle Sprainsmentioning

confidence: 99%

National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

Kaminski

Hertel

Amendola

et al. 2013

Journal of Athletic Training

213

233

View full text Add to dashboard Cite

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“…The 3.7-mm threshold is also similar to the 4-mm upper standard of anterior laxity used by van Dijk et al, 44 who used radiographic bony landmarks on the tibia and talus to identify talar movement resulting from anterior drawer stress, similar to other investigations. 35,43 Unlike previous investigations, our study utilized ultrasound to image the talocrural joints of a wide spectrum of subjects with a history of lateral ankle sprains, with and without stress applied, and calculated mean increases in anterior talocrural joint laxity. These methods do not expose the examiner, or the subject, to ionizing radiation and appear to demonstrate similar absolute changes in talar position as in vitro studies of cadaver ankles 31 and stress radiographic studies of subjects with ankle instability.…”

mentioning

confidence: 99%

Anterior Talocrural Joint Laxity: Diagnostic Accuracy of the Anterior Drawer Test of the Ankle

Croy¹,

Koppenhaver

Saliba³

et al. 2013

Journal of Orthopaedic & Sports Physical Therapy

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Study Design Prospective, blinded, diagnostic-accuracy study. Objectives To investigate the diagnostic accuracy of the ankle anterior drawer test (ADT) to detect anterior talocrural joint laxity in adults with a history of lateral ankle sprain. Background The ADT is used to manually detect anterior talocrural joint laxity following lateral ankle sprain injury; however, the diagnostic accuracy of this test has not been established. Methods Sixty-six subjects with a history of lateral ankle sprain were examined with the ADT. Anterior talocrural joint laxity was measured digitally from ultrasound images of the talofibular interval during performance of the ADT. In addition, anterior talocrural joint laxity was measured digitally in 20 control subjects to establish a reference standard. ADT results were defined as “positive” or “negative,” based on this and a second reference standard established from the literature. Results The group with a history of lateral ankle sprain had a mean ± SD anterior talocrural joint laxity of 3.36 ± 3.25 mm, compared with 0.17 ± 1.87 mm in the control group. Thirty-five of 66 (53%) subjects demonstrated anterior talocrural joint laxity at a reference standard of 2.3 mm or greater, and 24 (36%) at a reference standard of 3.7 mm or greater. Sensitivity of the ADT was 0.74 (95% confidence interval [CI]: 0.58, 0.86) and 0.83 (95% CI: 0.64, 0.93) at the 2.3 mm or greater and 3.7 mm or greater reference standards, respectively. Specificity of the test was 0.38 (95% CI: 0.24, 0.56) and 0.40 (95% CI: 0.27, 0.56), respectively. Positive likelihood ratios were 1.2 and 1.4, whereas the negative likelihood ratios were 0.66 and 0.41, respectively. Conclusion The ADT provides limited ability to detect excessive anterior talocrural joint laxity; however, it may provide useful information when used in side-to-side ankle comparisons and in conjunction with other physical exam procedures, such as palpation. Level of Evidence Diagnosis, level 3b. J Orthop Sports Phys Ther 2013;43(12):911–919. Epub 30 October 2013. doi:10.2519/jospt.2013.4679

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“…Both of these mechanisms of injury may result in an excessive external rotation force on the fibula with respect to the tibia that may lead to disruption of the syndesmotic ligaments, in particular the AITFL. 26,51 Severity of injury usually depends on the magnitude of the force and how long it was applied to the ankle mortise. The rehabilitation period for syndesmotic injuries tends to be longer than lateral ankle injuries.…”

Section: Mechanisms Of Ankle Sprainsmentioning

confidence: 99%

“…10,51 These advanced imaging tools may aid in ruling out osteochondral lesions and tumors or in reevaluating the grade of injury. [57][58][59][60] Stages of ligament healing Chronology of ligament healing has been separated into 3 distinct phases: inflammatory, reparative, and remodeling.…”

Section: Mechanisms Of Ankle Sprainsmentioning

confidence: 99%

“…38 In the case of a syndesmotic sprain that reveals diastasis of the ankle mortise greater than 6 mm, surgical fixation with screws would be necessary to stabilize the ankle mortise and allow for proper ligament healing. 26,40,51 An intact ankle mortise is necessary when attempting to push off the ground to propel forward or for cutting activities of most sports. 40 Reparative phase (3-5 days, collagen production intensifies 10-14 days)…”

Section: Mechanisms Of Ankle Sprainsmentioning

confidence: 99%

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