Long-term Stress Distribution Patterns Across the Ankle Joint in Soccer Players: A Computed Tomography Osteoabsorptiometry Study

Abstract

Background: The distribution pattern of subchondral bone density is considered to accurately reflect the stress distribution over a joint under long-term physiologic loading. The biomechanical characteristics of the surface of the ankle joint in soccer players can be determined by measuring this distribution pattern under long-term loading. Purpose: To evaluate the distribution of subchondral bone density across the ankle joint in soccer players and to determine the effects of soccer activities, including kicking motion, on the ankle joint surface under long-term loading conditions by computed tomography (CT) osteoabsorptiometry (CTOAM). Study Design: Cross-sectional study; Level of evidence, 3. Methods: CT imaging data were obtained from both ankles of 10 soccer players (soccer group) and 10 nonathletic volunteers (control group). The distribution patterns of subchondral bone density across the articular surface of the ankle joints were assessed by CTOAM. Quantitative analysis was performed of the locations and percentages of high-density areas on the articular surface. Results: Stress distribution patterns over the ankle joint differed between the soccer players and controls. In the soccer players, the high-density areas were found in the anterior part of the distal tibia and proximal talus as well as the distal fibula. The percentages of high-density areas were greater in the soccer players compared with controls ( P < .0001). Conclusion: Stress distribution over the articular surface of the ankle joint was affected by soccer activities. A high stress concentration was seen in soccer players in the anterior part of the tibia and talus and in the fibula; such excessive stress may lead to anterior impingement.

Characterization of Changes in Subchondral Bone Tissue Density of the Ankle Joint in Taekwondo Players

“…Compared with the experimental results of Shiota et al (2020) , the distribution pattern of the high-density area of the tibial ankle joint of Taekwondo athletes is similar to that of soccer players. Although soccer and Taekwondo belong to lower limb sports, soccer players have a shorter time dribbling the ball and running distance, while running without the ball more time.…”

“…Therefore, we believe that Taekwondo athletes’ take off movement in a short period of time, and gravity reaction force after landing, lower limb mobility technology, and long-term impact stress loading lead to the high-density distribution of the distal tibial articular surface and talar dome area. Finally, we also observed several unreported distribution types of high-density areas ( Leumann et al, 2015 ; Deml et al, 2017 ; Shiota et al, 2020 ), such as blank area and annular high-density area on the talar dome of subjects in the control group and Taekwondo group, and annular and comprehensive high-density area on the distal tibia. We suggested that the control subjects may not have a long-term or high-intensity exercise habit and therefore do not develop a large area of high density in the medial to lateral area of the talar dome surface.…”

Anterior ankle impingment syndrome is less frequent, but associated with a longer absence and higher re-injury rate compared to posterior syndrome: a prospective cohort study of 6754 male professional soccer players

“…Data collection was undertaken in accordance with the 2006 consensus statement on how to conduct injury surveillance research in soccer [ 22 ] and in line with the recent 2020 International Olympic Committee (IOC) consensus statement [ 2 ]. The overall study methodology has previously been described in detail [ 7 ].…”

“…Ankle impingement is considered a syndrome and can be due to a broad range of pathologies and etiologies. They may present as acute traumatic injuries, but more commonly as gradual-onset conditions due to repetitive stress [ 11 , 22 , 28 , 30 ]. While ankle impingement syndromes can be classified in detail according to the anatomical zone into anterior, anterolateral, anteromedial, posterolateral, and posteromedial, most practitioners categorize them, for simplicity, into either anterior ankle impingement syndrome (AAIS) or posterior ankle impingement syndrome (PAIS) [ 11 ].…”

Computed tomography Osteoabsorptiometry: Review of bone density, mechanical strength of material and clinical application

“…Shiota et al conducted bone mineralization analysis on the ankle joint surface of college football players. It was found that the high-density areas are in the anteromedial and anterolateral parts of the distal tibia, the anteromedial and anterolateral parts of the proximal talus, and the distal fibula ( Shiota et al, 2020 ). The results indicated that the excessive stress in football produces the anterior impact of the ankle joint, which led to the impact of the medial anterolateral front of the ankle joint of football players, forming a high-density distribution.…”