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Journal of Functional Morphology and... Sep 2022Sensorimotor and range of motion deficits due to chronic ankle instability (CAI) are abnormalities of the movement system that make postural control difficult. This... (Review)
Review
Sensorimotor and range of motion deficits due to chronic ankle instability (CAI) are abnormalities of the movement system that make postural control difficult. This review aimed to quantify the effect of joint mobilization on the range of motion, dynamic balance, and function in individuals with CAI. Randomized controlled trials in which joint mobilization was performed in individuals with CAI were searched for in five international databases (CENTRAL, CINAHL, Embase, MEDLINE, PEDro). Qualitative and quantitative analyses were performed using the risk of bias tool and RevMan 5.4 provided by the Cochrane Library. Nine studies with 364 individuals with CAI were included in this study. This meta-analysis reported that joint mobilization showed significant improvement in the dorsiflexion range of motion (standardized mean difference [SMD] = 1.02, 95% confidence interval [CI]: 0.41 to 1.63) and dynamic balance (SMD = 0.49, 95% CI: 0.06 to 0.78) in individuals with CAI. However, there was no significant improvement in function (patient-oriented outcomes) (SMD = 0.76, 95% CI: -0.00 to 1.52). For individuals with CAI, joint mobilization has limited function but has positive benefits for the dorsiflexion range of motion and dynamic balance.
PubMed: 36135424
DOI: 10.3390/jfmk7030066 -
Sports Medicine (Auckland, N.Z.) Jan 2018Many factors are thought to contribute to chronic ankle instability (CAI). Multiple systematic reviews have synthesised the available evidence to identify the primary... (Review)
Review
BACKGROUND
Many factors are thought to contribute to chronic ankle instability (CAI). Multiple systematic reviews have synthesised the available evidence to identify the primary contributing factors. However, readers are now faced with several systematic reviews that present conflicting findings.
OBJECTIVE
The aim of this systematic review and meta-analysis was to establish the statistical significance and effect size of primary factors contributing to CAI and to identify likely reasons for inconsistencies in the literature.
METHODS
Relevant health databases were searched: CINAHL, MEDLINE, PubMed, Scopus and SPORTDiscus. Systematic reviews were included if they answered a focused research question, clearly defined the search strategy criteria and study selection/inclusion and completed a comprehensive search of the literature. Included reviews needed to be published in a peer-reviewed journal and needed to review observational studies of factors and/or characteristics of persons with CAI, with or without meta-analysis. There was no language restriction. Studies using a non-systematic review methodology (e.g. primary studies and narrative reviews) were excluded. Methodological quality of systematic reviews was assessed using the modified R-AMSTAR tool. Meta-analysis on included primary studies was performed.
RESULTS
Only 17% of primary studies measured a clearly defined CAI population. There is strong evidence to support the contribution of dynamic balance, peroneal reaction time and eversion strength deficits and moderate evidence for proprioception and static balance deficits to non-specific ankle instability.
CONCLUSIONS
Evidence from previous systematic reviews does not accurately reflect the CAI population. For treatment of non-specific ankle instability, clinicians should focus on dynamic balance, reaction time and strength deficits; however, these findings may not be translated to the CAI population. Research should be updated with an adequately controlled CAI population.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO 2016, CRD42016032592.
Topics: Ankle; Ankle Injuries; Ankle Joint; Humans; Joint Instability; Proprioception; Sprains and Strains
PubMed: 28887759
DOI: 10.1007/s40279-017-0781-4 -
Foot & Ankle Specialist Apr 2015As the number of total ankle replacements (TARs) performed has risen, so has the need for revision. The purpose of this investigation was to perform a systematic review... (Review)
Review
PURPOSE
As the number of total ankle replacements (TARs) performed has risen, so has the need for revision. The purpose of this investigation was to perform a systematic review of clinical outcomes following a salvage ankle arthrodesis from a failed TAR to identify patient- and technique-specific prognostic factors and to determine the clinical outcomes and complications following an ankle arthrodesis for a failed TAR.
METHODS
We searched PubMed, Medline, EMBASE, and the Cochrane Central Register of Controlled Trials for studies that analyzed ankle fusion after failed TAR with a minimum follow-up of 1 year.
RESULTS
We included 16 studies (193 patients). The majority of patients (41%) underwent the index TAR for rheumatoid arthritis. The majority of these revision surgeries were secondary to component loosening, frequently of the talar component (38%). In the cases that were revised to an ankle arthrodesis, 81% fused after their first arthrodesis procedure. The intercalary bone graft group and the blade plate group had the highest rate of fusion after the first attempt at fusion at 100%, whereas the tibiotalocalcaneal fusion with cage group had the lowest fusion rate at 50%. The overall complication rate was 18.2%, whereas the overall nonunion rate was 10.6%.
CONCLUSION
A salvage ankle arthrodesis for a failed TAR results in favorable clinical end points and overall satisfaction at short-term follow-up if the patients achieve fusion. The bone graft fusion and blade plate group resulted in the highest first-attempt fusion rate, with a low complication rate. Future studies should include prospective, comparative control or surgical groups and use standardized outcome measurements that will make direct comparisons easier.
LEVELS
Level IV: Systematic Review of Level IV Studies.
Topics: Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Humans; Osteoarthritis; Reoperation; Treatment Failure; Treatment Outcome
PubMed: 25561701
DOI: 10.1177/1938640014565046 -
Foot & Ankle Specialist Feb 2023Nonunion is a postoperative complication after ankle arthrodesis (AA), which leads to increased morbidity and revision rates. Previous studies have identified risk... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Nonunion is a postoperative complication after ankle arthrodesis (AA), which leads to increased morbidity and revision rates. Previous studies have identified risk factors for nonunion following AA, but no meta-analysis has been performed to stratify risk factors based on strength of evidence.
METHODS
Abstracts and full-text articles were screened by 2 independent reviewers. Relevant data were extracted from the included studies. Random effects meta-analyses were summarized as forest plots of individual study and pooled random effect results.
RESULTS
Database search yielded 13 studies involving 987 patients were included, and 37 potential risk factors for nonunion. Meta-analysis found 5 significant risk factors for nonunion post-AA. Strong evidence supports male gender (OR: 1.96; 95% CI: 1.13-3.41), smoking (OR: 2.89; 95% CI: 1.23-6.76), and history of operative site infection prior to arthrodesis (OR: 2.40; 95% CI: 1.13-5.09) as predictors for nonunion following AA. There was moderate evidence supporting history of open injury (OR: 5.95; 95% CI: 2.31-15.38) and limited evidence for preoperative avascular necrosis (OR: 13.16; 95% CI: 2.17-79.61) as possible risk factors for nonunion.
CONCLUSION
The results of our meta-analysis suggest that male gender, smoking, and history of operative site infection have strong evidence and that history of open injury and avascular necrosis also have evidence as risk factors for nonunion. Surgeons should be cognizant of these risks when performing AA and closely follow up with patients with the aforementioned risk factors to ensure postoperative success.
LEVELS OF EVIDENCE
Level V: Systematic review of cohort and case-control studies.
Topics: Humans; Male; Ankle; Ankle Joint; Retrospective Studies; Risk Factors; Arthrodesis; Necrosis
PubMed: 33660542
DOI: 10.1177/1938640021998493 -
Journal of Sport Rehabilitation May 2017Elastic bandages are commonly used in sports to treat and prevent sport injuries. (Review)
Review
CONTEXT
Elastic bandages are commonly used in sports to treat and prevent sport injuries.
OBJECTIVE
To conduct a systematic review assessing the effectiveness of elastic bandaging in orthopedic- and sports-injury prevention and rehabilitation.
EVIDENCE ACQUISITION
The researchers searched the electronic databases MEDLINE, CINAHL, SPORTDiscus, EMBASE, and Physiotherapy Evidence Database (PEDro) with keywords elastic bandaging in combination, respectively, with first aid, sports injuries, orthopedic injuries, and sports injuries prevention and rehabilitation. Research studies were selected based on the use of the term elastic bandaging in the abstract. Final selection was made by applying inclusion and exclusion criteria to the full text. Studies were included if they were peer-reviewed clinical trials written in English on the effects of elastic bandaging for orthopedic-injury prevention and rehabilitation.
EVIDENCE SYNTHESIS
Twelve studies met the criteria and were included in the final analysis. Data collected included number of participants, condition being treated, treatment used, control group, outcome measures, and results. Studies were critically analyzed using the PEDro scale.
CONCLUSIONS
The studies in this review fell into 2 categories: studies in athletes (n = 2) and nonathletes (n = 10). All included trials had moderate to high quality, scoring ≥5 on the PEDro scale. The PEDro scores for the studies in athletes and nonathletes ranged from 5 to 6 out of 10 and from 5 to 8 out of 10, respectively. The quality of studies was mixed, ranging from higher- to moderate-quality methodological clinical trials. Overall, elastic bandaging can assist proprioceptive function of knee and ankle joint. Because of the moderate methodological quality and insufficient number of clinical trials, further effects of elastic bandaging could not be confirmed.
Topics: Ankle Joint; Athletic Injuries; Compression Bandages; Humans; Knee Joint; Orthopedics; Proprioception; Randomized Controlled Trials as Topic
PubMed: 27632889
DOI: 10.1123/jsr.2015-0126 -
The Journal of Foot and Ankle Surgery :... 2021Total ankle arthroplasty is an increasingly utilized treatment for ankle arthritis due to decreasing failure rates and improved outcomes. However, the literature on this... (Review)
Review
Total ankle arthroplasty is an increasingly utilized treatment for ankle arthritis due to decreasing failure rates and improved outcomes. However, the literature on this procedure remains heterogeneous with large variability in outcome reporting methods. PRISMA guidelines were used to systematically review outcome reporting measures used in prospective studies and randomized control trials on total ankle arthroplasty published in 15 high-impact journals between Jan 1, 2009-May 1, 2020. A total of 43 studies were included and outcome measures were grouped into seven categories: pain, subjective function, patient satisfaction, complications, objective function, implant survivorship, and imaging. The most common topic of study was implant design followed by differences in outcomes when comparing total ankle arthroplasty and arthrodesis. The most commonly reported outcome measure was post-surgical complications. No study reported on all seven categories, while 22 (51.2%) studies reported on four or more. Subjective measures had significant variability with fifteen different Patient Reported Outcome Measures used across the studies. While the included studies were quite comprehensive, there was little consistency in reporting outcomes after total ankle arthroplasty. With improving outcomes and techniques in total ankle arthroplasty, and thus an expected increase in utilization and number of published studies, efforts should be made to use commonly employed outcome reporting methods to facilitate comparison of results across studies.
Topics: Ankle; Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Humans; Prospective Studies; Treatment Outcome
PubMed: 33766479
DOI: 10.1053/j.jfas.2021.02.003 -
The Journal of Foot and Ankle Surgery :... 2016Posterior malleolar fractures are relatively common and usually result from rotational ankle injuries. Although treatment of associated lateral and medial structures is... (Review)
Review
Posterior malleolar fractures are relatively common and usually result from rotational ankle injuries. Although treatment of associated lateral and medial structures is well established, several controversies exist in the management of posterior malleolus fractures. We performed a systematic review of the current published data with regard to the diagnosis, management, and prognosis of posterior malleolus fractures. A total of 33 studies (8 biomechanical and 25 clinical) with >950 patients were reviewed. The outcome of ankle fractures with posterior malleolar involvement was poor; however, the evidence was not enough to prove that the size of the posterior malleolus affects the outcome. Significant heterogeneity was noted in the cutoff size of the posterior malleolar fragment in determining management. The outcome was related to other factors, such as fracture displacement, congruency of the articular surface, and residual tibiotalar subluxation. Indirect evidence showed that large fracture fragments were associated with fracture dislocations and ankle instability and, thus, might require surgical fixation. We have concluded that the evidence to prove that the size of the posterior malleolar affects the outcome of ankle fractures is not enough, and the decision to treat these fractures should be determined by other factors, as stated previously.
Topics: Ankle Fractures; Ankle Joint; Disease Management; Fracture Fixation; Humans; Radiography; Range of Motion, Articular
PubMed: 26100091
DOI: 10.1053/j.jfas.2015.04.001 -
Journal of Clinical Medicine Dec 2021Charcot neuroarthropathy is a non-infective, destructive process occurring in patients rendered insensate by peripheral neuropathy, which is caused mainly by diabetes.... (Review)
Review
BACKGROUND
Charcot neuroarthropathy is a non-infective, destructive process occurring in patients rendered insensate by peripheral neuropathy, which is caused mainly by diabetes. Repetitive trauma from standing and walking provides a neuro-traumatic stimulus that leads to dislocation, or peri-articular fracture, or both, within the ankle. This review concentrates on the management protocols regarding the ankle only.
METHODS
A Pubmed search for clinical trials performed to manage ankle Charcot neuroarthropathy and a systematic review of these articles were undertaken.
RESULTS
Twenty papers met the inclusion criteria: four of them describe non-surgical management, while the rest show different surgical management options of ankle Charcot neuroarthropathy.
CONCLUSIONS
Surgical algorithms for the treatment of CN of the ankle are based almost entirely on level four. There is inconclusive evidence concerning the timing of treatment and the use of different fixation methods. Instability and ulceration are the main precursors for surgical interventions. Prospective series and randomized studies, albeit difficult to perform, are necessary to support and strengthen current practice.
PubMed: 34945220
DOI: 10.3390/jcm10245923 -
Physical Therapy in Sport : Official... Nov 2023Proprioceptive training and resistance training are physiotherapy treatment methods for Chronic Ankle Instability (CAI). (Meta-Analysis)
Meta-Analysis Review
Efficacy of resistance training with elastic bands compared to proprioceptive training on balance and self-report measures in patients with chronic ankle instability: A systematic review and meta-analysis.
BACKGROUND
Proprioceptive training and resistance training are physiotherapy treatment methods for Chronic Ankle Instability (CAI).
OBJECTIVE
To compare the efficacy of proprioceptive training to resistance training with elastic bands for treating CAI as measured by the Star Excursion Balance Test (SEBT), the Foot and Ankle Ability Measure (FAAM), and the Cumberland Ankle Instability Tool (CAIT).
METHOD
Our systematic study and meta-analysis was based on the PICOS and PRISMA protocols. The PubMed, PEDro, and ScienceDirect databases were searched for randomized clinical trials on proprioceptive and resistance training. Risk of bias was assessed according to Cochrane guidelines and quality of evidence was reported using the Grading of Recommendations Assessment, Development, and Evaluation approach (GRADE).
RESULTS
Five studies involving 259 patients were included in the review. According to the findings of the meta-analysis, proprioceptive training was similarly effective with resistance training in SEBT and FAAM measures. Compared with resistance exercise, proprioceptive training demonstrated some benefits in CAIT scores (weighted mean difference [WMD] = -2.21, 95% CI = -4.05-0.36), but these intervention results were not clinically significant (MDC, MCID score >3 points).
CONCLUSION
Low-quality evidence from studies showed that neither of the interventions was superior on the SEBT or the FAAM scores in individuals with CAI because no clinically significant differences were found. More high-quality studies comparing the two interventions are needed to draw firm conclusions.
Topics: Humans; Resistance Training; Self Report; Ankle; Ankle Joint; Postural Balance; Joint Instability; Chronic Disease
PubMed: 37801793
DOI: 10.1016/j.ptsp.2023.09.009 -
The Journal of Foot and Ankle Surgery :... 2021Ankle arthrodesis (AA) provides reliable pain relief, good patient satisfaction scores, and improved overall function. However, this procedure has been associated with... (Review)
Review
Ankle arthrodesis (AA) provides reliable pain relief, good patient satisfaction scores, and improved overall function. However, this procedure has been associated with numerous complications and sequelae, such as pseudoarthrosis, malunion, gait abnormalities, increased demand on surrounding joints, and a long period of convalescence. Conversion to total ankle arthroplasty (TAA) is a potential option in the management of these complex and challenging situations. The purpose of this study is to investigate the outcomes of AA conversion to TAA. A systematic review of electronic databases was performed. Six studies involving 172 ankles met inclusion criteria. The weighted mean preoperative Visual Analogue Scale (VAS) score at the time of TAA conversion was 7.8 and the weighted mean postoperative VAS score at the time of final follow-up was 2.5. The weighted mean preoperative AOFAS score at the time of TAA conversion was 32 and the weighted mean postoperative AOFAS score at the time of final follow-up was 72.4. The rate of salvage tibiotalocalcaneal arthrodesis was 2.3% and rate of transtibial amputation was also 2.3% after attempted conversion from initial AA to TAA. Conversion of AA to TAA appears to be a viable option to improve patient outcomes and prevent extensive hindfoot arthrodesis and transtibial amputation. More prospective studies with consistent reporting of outcomes, complications, and revision rates with long-term follow-up are needed.
Topics: Ankle; Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Humans; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 33422442
DOI: 10.1053/j.jfas.2020.06.025