The ANKLE TRIAL (ankle treatment after injuries of the ankle ligaments): what is the benefit of external support devices in the functional treatment of acute ankle sprain? A randomised controlled trial.
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Differences in lateral ankle ligaments between affected and unaffected legs in children with spastic hemiplegic cerebral palsy.
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OBJECTIVES: To investigate the architectural alterations of the lateral ankle ligaments in spastic hemiplegic cerebral palsy. METHODS: Eight children (5 male and 3 female; mean age +/- SD, 5.2 +/- 2.7 years) with spastic hemiplegic cerebral palsy were recruited. A modified Ashworth scale and passive ankle dorsiflexion angle were evaluated. Sonograms of the anterior talofibular ligament and calcaneofibular ligament were obtained to measure ligament thickness, and the anterior talofibular/calcaneofibular ligament thickness ratio was calculated. Two sonographic measurements were taken to check for intra-rater reliability. RESULTS: The interclass correlation coefficients of the repeated anterior talofibular ligament and calcaneofibular ligament thickness measurements in the unaffected/affected legs were 0.960/0.945 and 0.922/0.933, respectively. The anterior talofibular ligament thickness in the affected legs was significantly greater than that in the unaffected legs (2.50 +/- 0.35 versus 1.40 +/- 0.28 mm; P = .011), but the calcaneofibular ligament thickness in the affected legs was significantly less than that in the unaffected legs (0.80 +/- 0.18 versus 1.28 +/- 0.31 mm; P = .021). The anterior talofibular/calcaneofibular ligament thickness ratio in the affected legs was significantly greater than that in unaffected legs (2.10 +/- 0.81 versus 1.03 +/- 0.13; P = .012). The ratio was positively correlated with the modified Ashworth scale and age but negatively correlated with the passive ankle dorsiflexion angle in the affected legs. CONCLUSIONS: This study revealed an increased anterior talofibular ligament thickness and a decreased calcaneofibular ligament thickness in the affected legs compared with the unaffected legs. These architectural features of the lateral ankle ligaments may contribute to the equinovarus deformity of the ankle together with spastic leg muscles in children with spastic hemiplegic cerebral palsy. (+info)
Comparison of two manual tests for ankle laxity due to rupture of the lateral ankle ligaments.
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BACKGROUND: Assessment of ankle laxity can be both subjective and difficult, especially in less-experienced hands. The commonly-practiced anterior drawer test can mislead practitioners in the diagnosis of ankle instability due to subtalar joint motion. A manual stress test, focusing on tibiotalar translation, may be required. OBJECTIVE: To evaluate the validity, reliability, and diagnostic accuracy of the modified manual stress test--the anterolateral drawer test (ALDT)--compared with the original anterior drawer test (ADT) in two groups of examiners with different levels of experience. METHODS: A cadaveric study was performed at University Research Laboratory. Nine below the- knee specimens were randomized into three groups to simulate different degrees of lateral ligament injury. Two groups of examiners (Group A was four athletic training students; Group O was four senior orthopaedic trainees) performed ADT and ALDT while direct anatomical measurement (DAM) of tibiotalar translation was used as a reference under controlled load (Telos device). Ankle translation from DAM, ADT, and ALDT was recorded in millimeters. Measurements were compared using a paired t-test. Pearson correlation was used to determine linear relationship between groups. Inter- and intra-rater reliability was identified using ICC (intraclass correlation coefficient). The diagnostic threshold was determined by a receiver operating characteristic curve. RESULTS: Both groups of examiners demonstrated excellent intra-observer reliability (0.94 for ADT and 0.80 for ALDT) and fair-to-good inter-observer reliability (0.52 for ADT and ALDT). There was no difference in the mean of measurement between group A and group O except for the ALDT on intact specimens (P = 0.01) and the ADT on the ATFL+CFL cut specimens (P = 0.02). Correlation with the DAM was superior in the ALDT (r = 0.73) compared to the ADT (r = 0.57). When using 4 mm or more as a diagnostic threshold, sensitivity and specificity (respectively) were found to be 100% and 66.67% for the ADT and 100% and 66.67% for the ALDT. CONCLUSION: For diagnosis of ankle ligament injuries, this cadaveric study demonstrated high sensitivity, reliability and correlation with the gold standard using ADLT, regardless of the examiner's experience. (+info)
Treatment of acute ankle ligament injuries: a systematic review.
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Medial ankle pain after lateral ligament rupture.
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After a severe ankle sprain the incidence of residual complaints, particularly on the medial side of the joint, is high. We studied a consecutive series of 30 patients who had operative repair of acute ruptures of lateral ligaments. During operation, arthroscopy revealed a fresh injury to the articular cartilage in 20 ankles, in 19 at the tip and/or anterior distal part of the medial malleolus as well as on the opposite medial facet of the talus. In six patients, a loose piece of articular cartilage was found. We conclude that in patients with a rupture of one or more of the lateral ankle ligaments after an inversion injury, an impingement occurs between the medial malleolus and the medial facet of the talus. Patients with a lesion of the lateral ankle ligament caused by a high-velocity injury (a faulty landing during jumping or running) had a higher incidence of macroscopic cartilage damage (p < 0.01), medially-located pressure pain (p = 0.06) and medially-located complaints at one-year follow-up (p = 0.02) than those with low-velocity injury (a stumble). (+info)