The Epidemiology of Ankle Sprains in the United States

Waterman, Brian R.; Owens, Brett D.; Davey, Shaunette; Zacchilli, Michael A.; Belmont, Philip J.

doi:10.2106/jbjs.i.01537

Cited by 826 publications

(592 citation statements)

References 37 publications

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“…Various physical features are associated with increased risk of ankle sprains, including elevated BMI, midfoot or hindfoot malalignment, and generalized ligamentous laxity [29,2]. Deformities that increase the risk of ankle sprain and ankle instability include first ray plantarflexion, midfoot cavus, and hindfoot varus [30].…”

Section: Risk Factorsmentioning

confidence: 99%

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Operative treatment of lateral ligament instability

Shakked

Karnovsky

Drakos

2017

Curr Rev Musculoskelet Med

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Purpose of review Ankle sprains, which account for 40% of sports injuries in the USA, can lead to chronic ankle instability. Chronic ankle instability can be classified as functional, mechanical, or a combination of both and is diagnosed using a combination of a physical exam, an MRI, and stress radiographs. This review focuses on different approaches to treatment, including non-operative and operative techniques, of chronic ankle instability, including reviewing traditional procedures as well as more novel and newer techniques. Recent findings Based on existing literature, non-operative treatment should always precede operative treatment of chronic ankle instability. If rehabilitation fails, Brostrom-Gould type ankle stabilization has been the preferred surgical option. Recent literature suggests that arthroscopic repair might reduce recovery time and improve outcomes in certain populations; however, there are higher rates of complication following these surgeries. In more high-risk populations, some literature reports that ligament repair with peroneus brevis transfer could be a more effective treatment option. Summary Currently, varying surgical techniques exist for the treatment of chronic ankle instability. While the more recently reported techniques show promise, it is important to note that there is little evidence showing they are more successful than traditional techniques. It is imperative that future studies focus on outcomes and complication rates of these newer procedures.

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Section: Risk Factorsmentioning

confidence: 99%

“…In the USA, there are approximately 30,000 ankle sprains per day [1] and 2 million per year [2]. Furthermore, 20-40% of all sports-related injuries in the USA are ankle sprains [3].…”

Section: Introductionmentioning

confidence: 99%

Operative treatment of lateral ligament instability

Shakked

Karnovsky

Drakos

2017

Curr Rev Musculoskelet Med

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“…1 Researchers [2][3][4] have estimated that more than 325 000 ankle sprains occur each year in high school athletes alone, and nearly half (49.3%) of all ankle sprains occur during athletic activities. After an initial ankle sprain, up to 40% of individuals develop chronic ankle instability (CAI).…”

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confidence: 99%

Lower Extremity Muscle Activation in Patients With or Without Chronic Ankle Instability During Walking

Feger

Donovan

Hart

et al. 2015

Journal of Athletic Training

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Context: Ankle sprains are among the most common musculoskeletal injuries, and many individuals with ankle sprains develop chronic ankle instability (CAI). Individuals with CAI exhibit proprioceptive and postural-control deficits, as well as altered osteokinematics, during gait. Neuromuscular activity is theorized to play a pivotal role in CAI, but deficits during walking are unclear.Objective: To compare motor-recruitment patterns as demonstrated by surface electromyography amplitudes between participants with CAI and healthy control participants during walking.Design: Descriptive laboratory study. Setting: Laboratory.Patients or Other Participants: Fifteen adults with CAI (5 men, 10 women; age ¼ 23 6 4.2 years, height ¼ 173 6 10.8 cm, mass ¼ 72.4 6 14 kg) and 15 matched healthy control adults (5 men, 10 women; age ¼ 22.9 6 3.4 years, height ¼ 173 6 9.4 cm, mass ¼ 70.8 6 18 kg).Intervention(s): Participants walked shod on a treadmill while surface electromyography signals were recorded from the anterior tibialis, peroneus longus, lateral gastrocnemius, rectus femoris, biceps femoris, and gluteus medius muscles.Main Outcome Measure(s): Preinitial contact amplitude, postinitial contact amplitude, time of activation relative to initial contact, and percentage of activation time across the stride cycle were calculated for each muscle.Results: Time of activation for all muscles tested occurred earlier in the CAI group than in the control group. The peroneus longus was activated for a longer duration across the entire stride cycle in the CAI group (36.0% 6 10.3%) than the control group (23.3% 6 22.2%; P ¼ .05). No differences were noted between groups for measures of electromyographic amplitude at either preinitial or postinitial contact (P . .05).Conclusions: We identified differences between the CAI and control groups in the timing of muscle activation relative to heel strike in multiple lower extremity muscles and in the percentage of activation time across the entire stride cycle in the peroneus longus muscle. Individuals with CAI demonstrated neuromuscular-activation strategies throughout the lower extremity that were different from those of healthy control participants. Targeted therapeutic interventions for CAI may need to be focused on restoring normal neuromuscular function during gait.

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“…1 After the first injury, a substantial number of these individuals experience the sensation of ankle instability and recurrent sprains, a condition known as chronic ankle instability (CAI). 2 Balance deficits are among the main symptoms of CAI, usually verified through impaired standing stability 3 or increased displacement of the center of pressure (COP) when these individuals stand motionless on 1 lower extremity with their eyes open or closed.…”

mentioning

confidence: 99%

Changes in Postural Control After a Ball-Kicking Balance Exercise in Individuals With Chronic Ankle Instability

Conceição

Araújo

Santos

et al. 2016

Journal of Athletic Training

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Context:Rehabilitation programs for patients with chronic ankle instability (CAI) generally involve balance-perturbation training (BPT). Anticipatory postural adjustments (APAs) and compensatory postural adjustments (CPAs) are the primary strategies used to maintain equilibrium during body perturbations. Little is known, however, about how APAs and CPAs are modified to promote better postural control for individuals with CAI after BPT.Objective: To investigate the effect of BPT that involves kicking a ball on postural-control strategies in individuals with CAI.Design: Randomized controlled clinical trial. Setting: Laboratory. Patients or Other Participants: We randomly assigned 44 volunteers with CAI to either a training group (TG; 11 women, 11 men; age ¼ 24 6 4 years, height ¼ 173.0 6 9.8 cm, mass ¼ 72.64 6 11.98 kg) or control group (CG; 11 women, 11 men; age ¼ 22 6 3 years, height ¼ 171.0 6 9.7 cm, mass ¼ 70.00 6 11.03 kg).Intervention(s): The TG performed a single 30-minute training session that involved kicking a ball while standing on 1 foot. The CG received no intervention.Main Outcome Measure(s): The primary outcome was the sum of the integrated electromyographic activity ( PR EMG) of the lower extremity muscles in the supporting limb that were calculated during typical intervals for APAs and CPAs. A secondary outcome was center-of-pressure displacement during similar intervals.Results: In the TG after training, the PR EMG decreased in both dorsal and ventral muscles during compensatory adjustment (ie, the time interval that followed lower limb movement). During this interval, muscle activity ( PR EMG) was less in the TG than in the CG. Consequently, center-of-pressure displacement increased during the task after training.Conclusions: A single session of ball-kicking BPT promoted changes in postural-control strategies in individuals with CAI. These results should stimulate new and more comprehensive studies to investigate the effect of this and other BPT techniques on postural control in patients with CAI.Key Words: recurrent sprains, reactive responses, balance training Key PointsAfter balance-perturbation training, postural sway increased during the ball-kicking activity and decreased during a static task in individuals with chronic ankle instability. Ventral and dorsal muscle activity decreased just before kicking the ball, and tibialis anterior and peroneus longus activity increased after the kick in the balance-perturbation-training group. Researchers should conduct more comprehensive studies to determine if balance-perturbation training improves postural control and simultaneously augments ankle stability in individuals with chronic ankle instability.

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The Epidemiology of Ankle Sprains in the United States

Cited by 826 publications

References 37 publications

Operative treatment of lateral ligament instability

Operative treatment of lateral ligament instability

Lower Extremity Muscle Activation in Patients With or Without Chronic Ankle Instability During Walking

Changes in Postural Control After a Ball-Kicking Balance Exercise in Individuals With Chronic Ankle Instability

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