International SportMed Journal - Volume 4, Issue 4, 2003
Volume 4, Issue 4, 2003
Author Thomas O. ClantonSource: International SportMed Journal 4, pp 1 –10 (2003)More Less
With the ever-increasing forces involved in high-level sports participation, there has been an associated increase in the frequency of syndesmotic ankle injury. Due to the spectrum of injury and frequent failure of proper diagnosis, the exact incidence is unknown, but ranges from 1-18% of patients who present with ankle sprain symptoms. Not only can these injuries be difficult to differentiate from a typical lateral ankle sprain, they can also be quite difficult to treat. Careful examination and appropriate diagnostic studies are keys to proper diagnosis and to distinguishing between a stable and unstable injury. The stable syndesmotic sprain can be treated non-operatively, but the time to return to sport can be lengthy in comparison to the more common lateral sprain. Unstable syndesmosis injuries should be treated operatively to avoid late sequelae that can include pain, instability, and arthritis. Late treatment of missed injuries can include arthroscopic debridement, reconstruction with tendon graft, or arthrodesis. Proper postoperative rehabilitation should allow a period of progressively increased weight bearing and strengthening exercises, while concentrating on range-of-motion and proprioception. Return to sports for those athletes who are injured more severely requires both successful surgery and the successful completion of a functional rehabilitation programme.
Author Hans Van der WallSource: International SportMed Journal 4, pp 1 –12 (2003)More Less
The increasing participation in both professional and amateur sport has seen a growth in the need for specialised sports medicine. Evidence points to increased intensity and duration of a high level of performance contributing to injury. Nuclear medicine offers a diagnostic window into both bone and soft tissue injury in the ankle at a nascent stage, prior to the onset of concomitant anatomical changes. Follow-up studies and prognostic information are also available from scintigraphic studies. Care must be taken in planning the studies, based on history, physical examination and an understanding of the mechanism of injury. Novel positioning and consideration of normal variants are important in arriving at an accurate diagnosis, especially in children.
Source: International SportMed Journal 4, pp 1 –17 (2003)More Less
Objective: This paper updates a previous assessment of the published evidence regarding the effectiveness of different approaches to preventing ankle sprains among athletes.
Data sources: Citations were identified from textbooks, searches of electronic databases (MEDLINE 1966-2003), Current Contents 1996-2003, Biomedical Collection 1993-2003, and dissertation abstracts 1993-2003) were updated in all languages by using the following subject terms: ankle sprain, ankle injury, and sports injury. The searches were limited by using the terms prevention and control, aetiology, and epidemiology. Citations from reference sections of papers retrieved, from contacting experts, and from the Cochrane Collaboration, were identified.
Study selection: From 650 citations identified in the search, 143 relevant articles were identified that reported the risk for ankle sprains in sports, methods for providing support, the effect of interventions on performance, and a comparison of prevention efforts. Papers that did not provide primary research data, that addressed treatment or rehabilitation only rather than prevention, or that provided previously published data, were excluded.
Data extraction: Two authors independently extracted data from the analytical studies and randomised controlled trials. Three authors assessed the quality of the randomised controlled clinical trials and cohort studies by using a previously published rating instrument.
Data synthesis: The most common risk factor for ankle sprains in sport is history of a previous sprain. Twenty studies involving athletes in basketball, football, soccer, or volleyball compared alternative methods of prevention, including wrapping the ankle with tape or cloth, semi-rigid braces, high-top shoes, balance boards, or a combination of methods. The majority of studies indicate that appropriately applied braces or tape do not adversely affect performance. Evidence from the same studies indicate that conditioning that focuses on agility, balance, and flexibility decreases injury risk, as does use of high-top shoes and use of ankle bracing to prevent recurrence. Pooled data from five randomised controlled clinical trials demonstrated that use of balance board training substantially reduced the risk for ankle sprains.
Conclusions: Carefully structured pre-season conditioning, with special emphasis on proprioception and ankle strengthening using balance boards or their equivalents, is likely to decrease the occurrence of ankle injuries. Warming up should precede all intensive practices or games. Athletes with sprained ankles should complete rehabilitation before competing, and those suffering a moderate or severe sprain should wear an appropriate brace for at least 6 months. Research should focus on methods for primary prevention, especially assessing the effectiveness of conditioning programmes that emphasise agility, balance, and flexibility.
Source: International SportMed Journal 4, pp 1 –27 (2003)More Less
Objective: To review the role of imaging techniques in the diagnosis and management of chronic ankle injuries in athletes.
Data sources: A MEDLINE search was performed to find relevant articles. Search words included ankle injuries, athletes, imaging ankle injuries, MR imaging ankle, US imaging ankle injuries, ankle impingement.
Study selection: Where possible, studies were selected that were recent and prospective. However, due to the relatively small amount of information available on some subjects, retrospective studies have been included.
Conclusions: Imaging of chronic ankle injuries in athletes is sophisticated. Due to the often complex mechanism of the injury, multiple pathologies may be present. Conventional radiography allows the assessment of bony anatomy and complications of fractures. Musculoskeletal ultrasound (US) is now increasingly used to assess the soft tissues of the ankle as it allows high resolution and dynamic assessment of the muscles, tendons and ligaments. Magnetic resonance (MR) imaging has largely superseded computed tomography (CT) and bone scintigraphy. MR imaging can demonstrate osseous and soft tissue oedema, but its role is yet to be established in the diagnosis of impingement syndromes. Cross-sectional (CT and MR) arthrography appears to offer the most accurate imaging assessment of capsular, osteochondral and ligamentous abnormalities.