Anatomical reconstruction for chronic lateral ankle instability in the high-demand athlete: Functional outcomes after the modified Brostrm repair using suture anchors. A table of protocols used in this study can be found in Table 1. The other 13 protocols were from private practice clinics. A total of 57.1% of the repair protocols said week 12+, 42.8% (6/14) of the reconstruction protocols said week 10 to 12, and 66% (2/3) of the suture tape augmentation protocols said week 8 to 10. Maffulli N, Del Buono A, Maffulli GD, Oliva F, Testa V, Capasso G, Denaro V. Isolated anterior talofibular ligament Brostrm repair for chronic lateral ankle instability: 9-year follow-up. Imprint this Page; Operative Overview. The .gov means its official. A total of 33% (1/3) of the suture tape augmentation protocols said before week 12 while the other 66% (2/3) did not specify. This can be demonstrated by provocative tests such as the anterior drawer or talar tilt (either clinically or by stress radiography). The incidence is high between 15 and 19years of age with no significant difference in the gender [2]. It is designed for rehabilitation following Ankle Sprain. For the Clinician: The intent of this protocol is to provide the clinician with a guideline of the post-operative rehabilitation for the patients who undergo therapy for a Lateral Ankle ligament repair, Brostrom type. The scale measures athletes emotions, confidence in performance, and appraisal in relation to return to sport. Two sets of 10 repetitions, separated by a 2-min rest, are performed. Indeed, the score was based on an adaptation of the ACL-RSI score, a validated score to quantify the psychological readiness of athletes to return to sport following surgical ACL reconstruction. To describe the dichotomous variables, the number of events and their percentage were used. Anatomic repairs by retentioning and directly suturing the anterior talofibular ligament (ATFL) are accepted to be the gold standard for treatment of CLAI [6, 10] although arthroscopic anatomical ligament reconstruction is becoming more and more popular. Lateral ankle sprains respond well to the conservative treatment which includes initially RICErest, ice, compression, and elevationfollowed by early mobilization. is then reattached so the ATFL and CFL fit into the trough through the drill holes. 2019 The Author(s). Buerer Y, Winkler M, Burn A, Chopra S, Crevoisier X. Lateral foot lacing reconstruction is a surgery to tighten and strong go one button more ankle liaisons on the outside in your bone. This helps improving joint position sense. Garrick JG. Exercises should focus on strengthening the peroneal muscles because insufficient strength in this group of muscles has been associated with CAI and recurrent injury. Their recommendation was a 10 to 14-day immobilization phase.13 Of DF, PF, eversion, and inversion, inversion was restricted for the longest time in protocols that included these. Star excursion balance training can also be used in which the athlete stands on the sprained ankle while using another foot to reach as far as possible in eight directions as outlined in the Star Excursion Balance Test. It is characterized by residual ankle instability as a result of either mechanical ankle stability or functional ankle instability or a combination of both [6]. Athletes with the greatest instability benefit most from the tape. Standardization of rehabilitation would benefit patient outcomes and education. Clanton TO, Viens NA, Campbell KJ, Laprade RF, Wijdicks CA. The search was done in June 2019. Hence it helps improve joint position sense through proprioceptive mechanism. It makes sense that protocols allow patients to return to these activities earlier on in rehabilitation than the RTS date as these activities should prepare a patient for the functional demands of RTS. As the joint develops MI, proprioceptive changes occur, which result in alterations in defense mechanism to prevent injuries, thus leading to CAI. Grades I and II respond well to functional treatment. These exercises can be progressed by having the athlete use different-sized hemispheres and by varying visual input. This study included patients who were active in sports and underwent ankle ligament reconstruction between January 2016 and May 2017. de Vries JS, Krips R, Sierevelt N, Blankevoort L, van Dijk CN. The site is secure. The scale was then validated according to the international COSMIN methodology. Range of motion exercises include both active and passive exercises. Reliability was evaluated on the intraclass correlation coefficient (ICCC). High scores corresponded to a positive psychological response. Guidelines suggest that a normal ROM should be achieved within 2weeks after injury [13]. 1) The anterior talofibular ligament (ATFL), which connects the talus (ankle bone) to the fibula (outer leg bone) on the outside of the ankle. Star excursion balance test [20]. A limitation present in this study was that the model for the ALR-RSI score was not originally developed for ankle instability. Post Operative Instructions: Modified Brostrom Gould Procedure. White WJ, McCollum GA, Calder JD. Clement D, Arvinen-Barrow M, Fetty T. Psychosocial responses during different phases of sport-injury rehabilitation: a qualitative study. The most consistent aspects of protocols were the postoperative restricted ROM and non-weight-bearing status. Ankle sprain is a common athletic injury and About 20% of acute ankle sprain patients develop chronic ankle instability.Two million lateral ankle sprains occur annually in the United States, affecting the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and/or the posterior talofibular ligament (PTFL). Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. FI can result in balance deficits, joint position sense deficits, delayed peroneal muscle reaction time, altered common peroneal nerve function, strength deficits, a decreased range of motion (ROM), sinus tarsi syndrome, and anterolateral impingement syndrome. After sustaining ankle injury, the most important issues for athletes are to recover as fast as possible and to return to sport at their initial performance level. Lateral Ligament Complex Injury. A total of 42.8% (3/7) of repair protocols, 42.8% (6/14) of the reconstruction protocols, and 66% (2/3) of the suture tape augmentation protocols used a cast. The https:// ensures that you are connecting to the As PhD students, we found it difficult to access the research we needed, so we decided to create a new Open Access publisher that levels the playing field for scientists across the world. Maffulli et al. Their use in performance with a series of progressive drills has effectively returned athletes to a high functional level. Brief introduction to this section that descibes Open Access especially from an IntechOpen perspective, Want to get in touch? All (7/7) repair protocols, 85.7% (12/14) of reconstruction protocols, all (3/3) suture tape augmentation protocols, and all (2/2) of the unspecific protocols allowed no ROM. Private practice protocols also were included, which were found either during the academic protocol search or through a general Google search for lateral ankle repair rehab protocol, lateral ankle reconstruction protocol, suture tape augmentation ankle rehab protocol, and ankle internal brace rehab protocol. Using a web-based search for published rehabilitation protocols after lateral ankle ligament repair, reconstruction, and suture tape augmentation, a total of 26 protocols were found. Shawen SB, Dworak T, Anderson RB. There is an incomplete tear of ATFL with little swelling and tenderness, minimal or no functional loss, and no mechanical joint instability. A total of 57.1% (8/14) of reconstruction protocols said week 6 to 8. This is likely because inversion provides the greatest stress to the lateral ankle fixation and inversion force is the original mechanism of injury for the patients suffering from ankle sprains. An official website of the United States government. Ankle arthroscopy is an important adjunct to ligamen- The different functional scores concerning the ankle, the Karlsson score and the AOFAS score were chosen because they are the most commonly used. The fabric of this tape is air permeable and water resistant and can be worn for repetitive days. The most common mechanism of injury in lateral ankle sprains is when, in forced plantar flexion, inversion occurs with excessive ankle supination. government site. Konradsen L, Bech L, Ehrenbjerg M, Nickelsen T. Seven years follow-up after ankle inversion trauma. Circles and figure of 8 are commonly employed patterns. Song Y-J, Hua Y-H. These values of the ceiling effect can be explained by the fact that the patients have a median duration of 3years postoperative, and by the good results of ankle ligament reconstruction [18, 22, 25]. Korean version of the anterior cruciate ligament-return to sport after injury scale: translation and cross-cultural adaptation. To date our community has made over 100 million downloads. The position of the mobilization belt allows the examiner to fix the talus and calcaneus with his/her hands and draws the tibia forward on the talus, thereby creating a relative posterior talar glide. For the reconstruction protocols, 35.7% (5/14) said week 12 to 16 and 35.7% (5/14) said week 16 to 20. Grade IIISevere. Early mobilization versus immobilization after ankle ligament stabilization. Five protocols allowed post-operative weight-bearing in a cast to keep ROM restricted. Indeed, patients have to be ready not only physically, but also psychologically, to resume sports after a surgical intervention. Lui TH. It differs from the traditional athletic tape with respect to its elasticity, i.e., it can be stretched up to 140% of its original length before applying it on the skin. In areas where suture tape augmentation protocols included recommendations, generally they were earlier in rehabilitation than repair and reconstruction protocols.17,21,22 This included weightbearing immediately postoperatively, all aspects of ROM (DF, PF, eversion, and inversion) during earlier weeks than other protocols, and single leg and running earlier than other protocols (when included). government site. The purpose of this study was to analyze and assess the variability across different rehabilitation protocols for patients undergoing either lateral ankle ligament repair, reconstruction, and suture tape augmentation. sharing sensitive information, make sure youre on a federal Our team is growing all the time, so were always on the lookout for smart people who want to help us reshape the world of scientific publishing. Protocols inclusion of different recommendations was recorded along with the time frame that activities were suggested in each protocol. Pearce CJ, Tourn Y, Zellers J, et al. Various aspects of ROM were more specifically looked at, including dorsiflexion, plantar flexion, inversion, and eversion. Cho BK, Park KJ, Park JK, SooHoo NF. When the training is performed bilaterally, we can expect substantial strength gains in both extremities. There is better lymphatic drainage from the injured area because of the lower pressure on the extravascular fluid (Table 1). Suture tape augmentation protocols generally allowed rehabilitation to occur on a quicker time-line with full weight-bearing by week 46 in 100% (3/3) of protocols and full ROM by week 810 in 66% (2/3) protocols. The athlete often complains of difficulty and apprehension on uneven surfaces. Surgical procedures for chronic lateral ankle instability. Yasui Y, Shimozono Y, Kennedy JG. Learn What Mr Gordon's Patients Are Saying. The common mechanism of injury is inversion with excessive ankle supination in forced plantarflexion when the ankle joint is in its most unstable position. Of the unspecified protocols, 50% (1/2) used an unspecific brace and 50% (1/2) did not mention bracing. In that position the ankle joint is the most unstable. Proprioception is useful for preventing injury in slow, moderately quick, or even quick tasks; however, it may not be adequate for forces that challenge the neuromuscular system at the highest levels. Have no negative effect on most performance tests. Femoroacetabular Impingement: Anatomy and Pathogen Arthroscopic and Endoscopic Management of the Inte Local numbness and anesthesia (decreased conductivity of regional nerve fibers), Reflex deep tissue vasodilation without an increase in metabolism, Sancheti Institute College of Physiotherapy, Pune, India. RTS time recommended by protocols were included in 22 of the 26 protocols. This allows better insight into their real recovery. Week 4-6: Full weight bearing in cast boot. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. However, this small number is also an important indication of the lack of publishing of protocols from programs. However, 20% of patients develop chronic lateral ankle instability (CLAI) [8, 16], some require surgical treatment, particularly those who are young and athletic. A scoring rubric was created to analyze different inclusion, exclusion, and timing of protocols such as weight-bearing, range of motion (ROM), immobilization with brace, single leg exercises, return to running, and return to sport (RTS). Decreased blood flow limits edema; there is less histamine release and therefore less capillary breakdown than would normally be present after injury. Careers, Unable to load your collection due to an error. The main purpose of this study was to propose and to validate a similar tool to quantify psychological readiness to return to sport after ankle ligament reconstruction. Lateral ankle ligament stabilization procedure utilizing two 2.4mm BioComposite SutureTaks to repair the ATFL, CFL, lateral ankle capsule and extensor retinaculum with InternalBrace fixation using a 4.75mm . Diagnostic and treatment protocols vary. Their actual sport capacities were analyzed to circumvent that issue. Ankle sprains are extremely frequent; they represent 1520% of all sport-related injuries. Reproducibility of the testretest was excellent (=0.92; 95% CI [0.860.96]). By making research easy to access, and puts the academic needs of the researchers before the business interests of publishers. . One of these programs had two published lateral ankle protocols for both repair/reconstruction and suture tape augmentation, both protocols were used in their respective categories. These activities can also be done using ankle weight to increase the difficulty level. Rupture of these ligaments is common as a result of diagnoses including but not limited to: Inversion ankle sprains1 Chronic lateral ankle instability (CAI)2 Hypomobility occurs at the subtalar, talocrural joint, distal tibiofibular joint, and proximal tibiofibular joint [7, 8]. Ankle Reconstruction/Modified Brostrom Repair/Peroneal Tendon Repair. It has been shown in the context of ACL surgery [3] that patients with positive psychological responses before surgery and at the start of recovery were associated with a better return to sport, suggesting that attention to recovery psychological in addition to physical recovery could be justified. The oscillations are given for 60s, 2 or more times with a rest of 10s taken in between. A total of 57.6% (15/26) of protocols included recommendations over returning to running (Figure 14). It has been noted that many patients after surgery do not return to sport activities at the same level as prior to the injury, even though they have recuperated good functional results [22, 25, 29]. Webster et al. National Library of Medicine Normally a nonadhesive tape should be renewed after 3days, and an adhesive tape should be renewed after 5days [10]. Passive ROM (PROM) was only specifically included in 5 out of the 26 protocols, therefore, no graph was included. A total of 53.8% (14/26) of protocols included eversion of the ankle (Figure 12). Salatkait S, iupinskas L, Gudas R. Translation and cultural adaptation of Lithuanian version of the anterior cruciate ligament return to sport after injury (ACL-RSI) scale. Guillo S, Cordier G, Sonnery-Cottet B, Bauer T. Anatomical reconstruction of the anterior talofibular and calcaneofibular ligaments with an all-arthroscopic surgical technique. Proprioceptive exercises (the variation and changes should be according to the athletes requirements). Lateral Ankle Ligament Reconstruction Rehabilitation Protocol Weight Bearing: Week 1-3: strict non-weight bearing on crutches. Reliability was evaluated on the intraclass correlation coefficient (ICCC). Ice therapy should be started immediately after the injury and ice application initiated within day 0 or day 1. Concentric contraction refers to the active shortening of the muscle with resultant lengthening of the resistance band, while eccentric contraction involves the passive lengthening of the muscle by the elastic pull of the band. Ankle Reconstruction Rehabilitation Protocol. This should be done for 1520 repetitions 12 times/day and with increasing progression. Semirigid brace like Swede-O-Universal and nonrigid brace like subtalar supports provide a better non-weight-bearing restriction in plantar flexion, dorsiflexion, and eversion than taping after 15min of activity. Guidelines for the process of cross-cultural adaptation of self-report measures. National Library of Medicine Functional treatment is considered better in achieving more effective mobilization and an earlier return to daily activities. Bethesda, MD 20894, Web Policies Grade IMild. Sixty-six percent (2/3) of internal brace protocols allowed full weight-bearing. Fifty-seven patients were included (59 ankles), 27 (47.4%) women and 30 men (Table (Table1)1) with a median of 3.0 (2.5; 3.7) years after ankle ligament reconstruction. Many programs probably have protocols that they distribute or discuss with patients, but they are not accessible which leaves a wide range of variability unknown. http://creativecommons.org/licenses/by/4.0/. Passive exercises can be started in stage 3 which is the local numbness stage in which the athlete experiences less discomfort when exercising. Furthermore, the athlete can be tested under various visual and support conditions. Time when inversion of the ankle was allowed after surgery were included in 13 of 26 protocols. Lateral Ankle Ligament Reconstruction Rehabilitation Protocol. Microfracture surgery. A total of 80.7% (21/26) of protocols included single leg exercises (Figure 13). In this technique the athlete position is high kneeling with weight-bearing on the affected limb or standing with the affected foot placed forward. The most commonly injured ligament is the ATFL as it is the weakest of all three ligaments. Twenty-six total protocols were found. Evaluation of a modified Brostrm-Gould procedure for treatment of chronic lateral ankle instability: A retrospective study with critical analysis of outcome scoring. All patients were athletes who practiced: in competition: 29 ankles (49.2%), as a regular leisure activity: 26 ankles (44.0%) or an occasional leisure activity: four ankles (6.8%). Those results are similar to what is reported in the literature. Informed consent was obtained from each patient. Sixty-six percent (2/3) of the suture tape augmentation protocols allowed DF at week 2 to 4. Epidemiology of sprains in the lateral ankle and foot. Patients were excluded if they did not practice sport. A total of 84.6% (22/24) of protocols included a RTS recommendation (Figure 15). Strengthening begins with isometric exercises performed against an immovable object in four directions of ankle movement and is progressed to dynamic resistive exercises (isotonic exercises) using ankle weights, surgical tubing, or resistance bands. Brostrom developed this technique in 1966 to surgically address chronic ankle instability by performing an anatomical repair of the anterior talofibular (ATF) and calcaneofibular (CF) ligaments. Similarly, Pearce et al.13 outlined the conflict between immobilizing and protecting the joint versus avoiding stiffness and the complications of immobilization. A flow chart of the protocol selection process is shown in Figure 1. The https:// ensures that you are connecting to the The frequency of diagnosed ankle sprains is 6000 cases per day in France and 24,000 cases per day in the United States: they represent 47% of emergency department consultation [14]. There are three clinical grades of lateral ankle sprains [4, 5, 6]. For repair and reconstruction, none of these categories had greater than 60% agreement between protocols. Ankle Reconstruction/Modified Brostrm Repair/Peroneal Tendon Repair. Such a questionnaire can be easily used by doctors and surgeons in their daily practice. Nevertheless, the questions are not specific to a certain articulation of the body, and can easily be transposed to other articulations implicated in sport injuries. Ankle joint stability is a prerequisite to the institution of functional rehabilitation. HHS Vulnerability Disclosure, Help They do not always correspond to the actual recovery of their athletic performance, because they inform on an objective state of ankle function without taking into consideration the psychological state. The lateral ligament complex includes 3 capsular ligaments: the anterior tibiofibular (ATFL), calcaneofibular (CFL) and posterior talofibular (PTFL) ligaments. Gerometta A, Klouche S, Herman S, Lefevre N, Bohu Y. Protocols that included both repair and reconstruction were placed in the reconstruction group. Ice application causes vasoconstriction which decreases blood flow and therefore swelling to the injured area. Cheesapeaker Orthopaedic & Sports Medicine Center. The rate of injury is as high as 70%. Similarly, protocols for lateral ankle reconstructions were found by [Program Name] lateral ankle reconstruction rehab protocol. Compression with an adhesive bandage and a foot elevation of more than 45 is the standard prescribed treatment for lateral ankle sprains. Ultimately, future studies that compare different rehabilitation regimens are necessary to determine the best approach to rehabilitation. The ALR-RSI is a valid, reproducible scale to evaluate the relevant psychological factors in the return to the same sport after ankle ligament reconstruction. The rehabilitation protocol post-surgery remains the same as that of the conservative treatment. Modified Brostrm Gould Repair for Chronic Ankle Instability. FOIA Patellar tendinitis and Chondromalacia. As mentioned previously many different chronic lateral instability surgical techniques exist, and their outcome seems to appear to be similar. Return to sport was most likely to correlate between protocols and the literature. Resistive exercises should be performed (23 sets of 1012 repetitions) in all four directions twice a day. Two duplicates were found, and one protocol was excluded due to being primarily over operative wound care and not ankle rehabilitation. Complete tears of ATFL and CFL with marked swelling, hemorrhage, and tenderness. Surgical repairs are aimed at the reconstruction of the normal anatomy by overlapping the existing joint capsule and lateral ligaments. (Fig.11). Patients selected for the surgery are usually young and athletic, and the most important goal of ankle ligament reconstruction is to enable them to return to their prior level in sports [14, 25, 29]. Specific changes in the program will be made by the physician as appropriate for the individual patient. The most commonly involved ligament is the anterior talofibular ligament (ATFL), followed by the calcaneofibular (CFL) and posterior talofibular ligament (PTFL). As the body is trained to sense directions from perturbation, sensory input is received from all parts of the body and sent to the central nervous system via afferent pathways. Complete tear of ATFL with or without an incomplete tear of CFL with moderate pain, swelling, and tenderness over the involved structures; some joint motion is lost, and joint instability is mild to moderate. A study by Pearce et al.13 outlined the European Ankle Instability groups guidelines for rehabilitation, which included immobilization for 6 weeks, early rehabilitation from 6 to 10 weeks, and late rehabilitation from 8 to 12 weeks postoperatively. A common progression when performing balance exercise is to move from a position of non-weight-bearing to weight-bearing, bilateral stance to unilateral stance, eyes open to eyes closed, firm surface to soft surface, uneven or moving surface. Mechanical instability (MI) and functional instability (FI) are both due to recurrent lateral ankle sprains. In summary, ankle taping and bracing: Lose limitation of movement after exercise. The feeling of giving way, defined as functional instability or true mechanical instability, is frequently experienced. Full participation should be allowed once the athlete has complete range of motion, 8090% of preinjury strength and a normal gait pattern including the ability to perform sports-specific activities such as cutting and landing without any compensation due to the injury. ANKLE BROSTROM REPAIR REHABILITATION PROTOCOL. The PTFL is rarely injured as it is the strongest of all the three ligaments. Ha JK, Kim JG, Yoon KH, Wang JH, Seon JK, Bae JH, Jang KM. Functional treatment includes RICE protocol, i.e., rest, ice, compression, and elevation. The stretches should be maintained 1530s, repeated 10 times, and should be done 35 times per day. This prevents swelling and immobilizes the injured area which prevents further injury and thus promotes healing. Lateral Ligament Reconstruction-Postoperative Protocol. It reduces pain through neurological suppression. The ankle joint is the most commonly affected joint in sports of which lateral ankle sprains are the most common. Repetitions should be 520, 12 times/day (Figure 1). For the unspecific protocols, 50% (1/2) said week 8 to 10 and 50% (1/2) said week 1012. Stationary biking can also be included to improve dorsiflexion and plantar flexion motion in a controlled environment while providing a cardiovascular workout for the athlete. 3) The posterior talofibular ligament (PTFL), which stabilizes the back of the ankle. Once the athlete achieves a pain-free range of motion and weight-bearing, balance-training exercises should be included to regulate neuromuscular control. The ALR-RSI was completed twice at a 15-day interval. Chronic Ankle Instability Clinical Practice Guideline. Gentle oscillations are then given to the joint to avoid pain and spasm. A total of 73% (19/26) of protocols included plantar flexion (PF; Figure 10). The principal findings of the study were that the ALR-RSI represented a valid and reliable instrument, that can identify patients who are psychologically ready to return to the same sport, after ankle ligament reconstruction. This protocol provides you with general guidelines for initial platform and progression away . Cast immobilization does not improve healing compared with an active mobilization rehabilitation program and may have negative implications in relation to muscle wasting and stiffness. Return to sport was most likely to correlate between protocols and the literature. Seven total protocols were for lateral ankle ligament repair. Although taping does improve mechanical instability, the restricting effect is lost after varying periods of exercise. Athletes should be instructed to pause 1s between the concentric and eccentric phases of exercise and perform the eccentric component over a 4-s period. Overall, the variability between programs demonstrated the need for standardization of rehabilitation protocols. The use of sports-specific means of training, parallel to general conditioning training, leads to considerable improvement of performance among athletes. Immediately after surgery, the ankle was immobilized in the majority for all types of protocols, and although the types of immobilization varied across protocols most did specify the use of either a cast, boot, or splint to keep the ankle restricted. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License. Most of the sprains respond well to functional treatment. A total of 69.2% (18/26) of protocols included dorsiflexion (DF; Figure 9). 2, Table Table44). Arthroscopic-assisted lateral ligamentous reconstruction in combined ankle and subtalar instability. Rest can be applied selectively to allow some general activity, but athletes must avoid stressful activities. Protocols were included if they were rehabilitation protocols for post-operative care of the unstable ankle that were meant for the physical rehabilitation of the ankle. It typically takes place as an outpatient procedure. [22] published the long-term results (9years) on athletes, following a Brstrom procedure, 58% were able to return to their preinjury level, 16% at a lower level, and 26% abandoned active sport participation. About 40% of taping effect is lost after 10min of vigorous exercise like jumping, pivoting, running, etc. official website and that any information you provide is encrypted ; Sprains can range from tiny tears in the fibers . Specific changes in the program will be made by the physician as appropriate for the individual patient. Inclusion in an NLM database does not imply endorsement of, or agreement with, Pearce et al.13 outlined RTS as occurring between 12 weeks and 4 months postoperatively. There is significant variability in the post-operative protocols after surgery for ankle instability. Specific training can include functional activities on various surfaces, e.g., trampoline and foam, and in water with weights. Early mobilization of ankle sprains as compared with cast immobilization has been shown to be more comfortable as it results in less pain and provides for an earlier return to work. Ankle braces have certain advantages over tape allowing self-application without the expertise of qualified personnel. There was variability across rehabilitation protocols for lateral ankle ligament operative patients especially in the type of immobilizing brace, time to partial and full weigh bearing, time to plantar flexion, dorsiflexion, eversion and inversion movements of the ankle, and return to single leg exercise and running. Taping and bracing the ankle can be used for prevention as well as for rehabilitation. Your experiences may differ from those described. official website and that any information you provide is encrypted The goal of this study was to validate a tool to quantify psychological readiness to return to sport after ankle ligament reconstruction. Ankle sprains are one of the most common athletic injuries. Clinical screening for inappropriate psychological responses in athletes can help clinicians identify athletes at risk of not returning to their sport level. Anterior talofibular ligament ruptures, part 2: biomechanical comparison of anterior talofibular ligament reconstruction using semitendinosus allografts with the intact ligament. Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Bethesda, MD 20894, Web Policies The simplest device for proprioceptive training is the wobble board. J Athl Train. Therefore, the practitioners will be able to offer them specific advice to overcome their apprehension. Twenty-six protocols were analyzed. Some of the authors disclosed potential conflict of interest. *Address all correspondence to: rach.nik25@gmail.com. Cryotherapy involves a nice bath with a temperature of 410C for 1220min, one to three times per day, and applying an ice pack to the injured area for 1520min, one to three times per day. Protocols for multi-ligament surgeries and non-operative care were excluded. Sixty-six percent (2/3) of the suture tape augmentation protocols said before week 4. There was variability across rehabilitation protocols for lateral ankle ligament operative patients especially in the type of immobilizing brace, time to partial and full weigh bearing, time to plantar flexion, dorsiflexion, eversion and inversion movements of the ankle, and return to single leg exercise and running. An official website of the United States government. Fetty T. Psychosocial responses during different phases of sport-injury rehabilitation: a qualitative study. ; The less common medial ankle sprain is caused by an eversion injury (the foot turns out) to the deltoid ligament on the inside of the ankle. Although many of them mention similar broad topics, within those categories the dates and specific exercises were often completely different from one protocol to the next. Bohu Y, Klouche S, Lefevre N, Webster K, Herman S. Translation, cross-cultural adaptation and validation of the French version of the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale. Lateral ankle sprains are one of the most common injuries in athletes. The reference scales used were the American Orthopedic Foot & Ankle Society (AOFAS) score [15] and the Karlsson score [27]. The internal consistency of the scale measuring the strength of the correlation between the 12 items was excellent with a Cronbach alpha coefficient of 0.96. Each protocol included was assessed for inclusion, exclusion, and variability in timing of range of motion (ROM), weight-bearing, bracing, single leg exercises, return to running, RTS, and functional testing. Publishing on IntechOpen allows authors to earn citations and find new collaborators, meaning more people see your work not only from your own field of study, but from other related fields too. FS, PAB, EK, PA and AM have made substantial contributions to acquisition of data, or analysis and interpretation of data. The nonrigid ones are often made of canvas or a neoprene-type material, which can easily be slipped on and off, and some are with additional lacing. Achilles tendon stretching should be started within 4872h in a pain-free range irrespective of weight-bearing status of the athlete to avoid the tissue from contracting. Fourteen protocols either specifically were for lateral ankle reconstruction or included it as part of their protocol (6 protocols for reconstruction only and 8 protocols including both repair and reconstruction, which were included with reconstruction results). This score should be able to be applied to all CLAI surgeries regardless of the method used. The first part of the procedure consists of standard anterior arthroscopy of the ankle with the foot vertical and dorsiflexed. sharing sensitive information, make sure youre on a federal It also helps in avoiding stress on the injured tissue that might disrupt the fragile fibrin bond, which is the first element of the repair process. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. It also shows a significant reduction in the frequency of ankle sprain recurrence. 1University of Kansas School of Medicine, Kansas City, KS, 2University of Kansas School of Medicine-Wichita, Department of Orthopaedics, Wichita, KS, 3University of Kansas Medical Center, Department of Orthopedic Surgery and Sports Medicine, Kansas City, KS. Results from studies such as the two previously mentioned, set a framework on which patients could expect to return to daily activities and movements postoperatively, but did not create a standard protocol to follow. Mobilization with movement is another technique of manual therapy suggested by Mulligan [12] which helps with increasing the ROM actively. Around 90% of ankle sprains involve an inversion injury (the foot turns inward) to the anterior talofibular (ATFL) and calcaneofibular (CFL) ligaments the lateral ligaments on the outside of the ankle. The most commonly involved ligament is the anterior talofibular ligament (ATFL), followed by the calcaneofibular (CFL) and posterior talofibular ligament (PTFL). Most ankle injuries in footballers are caused by player's . A total of 92.3% (24/26) of protocols included a goal time for full weight-bearing (Figure 5). [2], looked into the psychological factors associated with returning to sport following injury. For repair protocols, RTS was one of the most consistent aspects with all protocols RTS level training being around 12 to 16 weeks, which matches up with recommendations in the literature.13,42,43 Although slightly more variable, reconstruction protocols mostly recommended RTS between 12 to 20 weeks, which matches relatively well with the literature.28,31,35,38,44 However, in the literature there is also variability in RTS time. FOIA A total of 66% (2/3) of the suture tape augmentation protocols included AROM at week 2 to 4. Time of returning to full weight-bearing status were included in 24 of 26 protocols. The athlete can participate fully in the sporting activity once the pain has been reduced completely. Description: This protocol applies to patients following the Gould modified Bostrm repair of the Anterior Talo-fibular Ligament (ATFL) and Calcaneal Fibular Ligament (CFL). 5 Princes Gate Court, Guillo S, Bauer T, Lee JW, Takao M, Kong SW, Stone JW, Mangone PG, Molloy A, Perera A, Pearce CJ, Michels F, Tourn Y, Ghorbani A, Calder J. Hence, the rationale of minimum 15min of cryotherapy per treatment. Fifty (87.7%) patients returned to sport: 24 patients (42.1%) returned to the same sport as before the injury at the same level, 13 patients (22.8%) at an inferior level, and 13 (22.8%) changed sport. However, their clinical value is not sufficient, for giving patients the permission to return to sport. FS, AH, RL, PA and AS have been involved in drafting the manuscript or revising it critically. The results of this study indicated that there is considerable variability across different rehabilitation protocols for lateral ankle ligament operative patients especially with regards to immobilizing brace, time of partial and full weigh bearing, time to different ROM movements of the ankle, and return to single leg exercise and running. HHS Vulnerability Disclosure, Help Similar outcomes at early term after arthroscopic or open repair of chronic ankle instability: a systematic review and meta-analysis. The internal consistency was evaluated by the correlation between the 12 items of the ALR-RSI, by the Cronbach alpha coefficient. Operative treatment of lateral ligament instability. The Karlsson score and the AOFAS score were between 0 (very poor) and 100 (excellent). Different protocol institutions and which surgical category the protocol fell under. Both unspecific protocols did not include PF. Fifty percent (1/2) of the unspecified protocols said week 12 to 16 and 50% (1/2) did not specify. p<0.05 was considered to be significant. Two protocols did not specify which lateral ankle procedure they were meant to follow, but did specify that it was meant for post-operative care. Orthop J Sports Med 2019;7: 2325967119828953. Time when plantar flexion was allowed after surgery were included in 19 of the 26 protocols. Ardern CL, Bizzini M, Bahr R. It is time for consensus on return to play after injury: five key questions. The athlete should proceed to the next line when he/she can lock out (complete with correct form) the 4th set 10 times. Grade IIModerate. It improves circulation of blood and lymph by eliminating tissue fluid or bleeding beneath the skin by moving the muscle. Rehabilitation Guidelines for Lateral Ankle Reconstruction. We are a community of more than 103,000 authors and editors from 3,291 institutions spanning 160 countries, including Nobel Prize winners and some of the worlds most-cited researchers. Chronic ankle instability is the main complication of ankle sprains and requires surgery if non-operative treatment fails. symptoms. Knee Surgery, Sports Traumatology, Arthroscopy. Nowadays different braces are used such as lace-up braces and the Swede-O (Swede-O-Universal, North Branch, MN) and multiple models by McDavid Sports Medical Products (Woodridge, IL); lace-up braces with straps such as the ASO (Medical Specialties, Charlotte, NC), the RocketSoc (DonJoy Orthopedics, Inc., Vista, CA), and the Ankle Brace Lock (Breg, Vista, CA); and semirigid plastic braces with strapping configurations such as the Ankle Ligament Protector (DonJoy Orthopedics, Inc.), the Universal Ankle Stirrup (DonJoy Orthopedics, Inc.), the T2 Active Ankle Support (Active Ankle, Louisville, KY) and the Ultra Ankle, and the Guardian Ankle (McDavid Sports Medical Products). [31] developed the anterior cruciate ligament-return to sport after injury (ACL-RSI) a scale of 12 items, to quantify the psychological readiness of athletes to return to sport following surgical ACL reconstruction. This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Essentials in Hip and Ankle, Submitted: May 14th, 2019 Reviewed: September 3rd, 2019 Published: November 22nd, 2019, Edited by Carlos Suarez-Ahedo, Anell Olivos-Meza and Arie M. Rijke, Total Chapter Downloads on intechopen.com. Lateral ankle ligament reconstruction is a surgical procedure to tighten and secure one or more ankle ligaments on the outside of your ankle. The CFL is secured with the foot in slight plantar flexion and eversion and the ATFL is secured with maximal dorsiflexion and eversion. This scale may help to identify athletes who will find sport resumption difficult. Open Access is an initiative that aims to make scientific research freely available to all. Lee et al.42 found a mean time of return to personal training in 1.9 months, team training in 2.9 months, and competitive play in 3.9 months. Lopes R, Decante C, Geffroy L, Brulefert K, Noailles T. Arthroscopic anatomical reconstruction of the lateral ankle ligaments: a technical simplification. After well-conducted surgery and physical therapy, some patients experience failure or a decrease in their performance, without physically objectifiable reasons. *All the exercises done by the Athlete, can be done in pairs or the athlete can stand opposite to a wall at distance of 5 m. Once the distance walked by the athlete is no longer limited by pain, he/she can be put on sports-specific training or advanced training. There were no significant differences between repair and reconstruction protocols in terms of the timing of rehabilitation measures. Another variant is when the therapist manually moves the ankle and foot through various positions and then asks the athlete to actively and passively replicate the joint angles. Postoperative bracing recommendations were included in 23 of 26 protocols. 2015; 50:95-104. doi: 10.4085/1062-6050-49.3.52. Of the unspecified protocols, 50% (1/2) said week 0 to 2 and 50% (1/2) did not specify. Open and arthroscopic lateral ligament repair for treatment of chronic ankle instability: A systematic review. https://creativecommons.org/licenses/by-nc-nd/4.0/, https://www.michaelbahkmd.com/pdf/modified-brostrom-procedure-rehabilitationprotocol.pdf, https://www.stoneclinic.com/brostrom-procedure-rehab, http://www.chesapeakeortho.com/files/cosmc/forms/Brostrom.pdf, https://www.kansashealthsystem.com/-/media/Files/PDF/Ortho-Sports-Med/Ankle-Reconstruction-Brostrom-Internal-Brace.pdf, https://www.kansashealthsystem.com/-/media/Files/PDF/Ortho-Sports-Med/AnkleReconstructionBrostromSyndesmotic.pdf, https://www.tamc.amedd.army.mil/offices/musculoskeletal/anklefoot_guidelines/ankle_foot.htm, https://www.uwhealth.org/files/uwhealth/docs/sportsmed/SM-39916_Lateral_AnkleProtocol.pdf, https://tcomn.com/wp-content/uploads/2014/08/Internal-Brace-Ankle-Ligament-Reconstruction.pdf, https://tcomn.com/wp-content/uploads/2017/08/JCC_Internal-Brace-Ankle-Ligament-Reconstruction-8.28.2017-1.pdf, https://www.indyboneandspine.com/therapy-protocols, https://orthonc.com/uploads/pdf/Ankle_Reconsrtuction_Modified_Brostrom_Peroneal_Tendon_Repair_New.pdf, http://www.utosm.com/wp-content/uploads/2015/06/ankle-ligament-repair-djoh.pdf, https://www.newyorkortho.com/pdf/modified-brostromgould-procedure-complete-packet-03feb17.pdf, http://bcfootandankle.com/wp-content/uploads/2013/02/Microsoft-Word-Postop-Lateral-Lig-Recon-Protocol-revised-April-2011.pdf, http://www.sosmed.org/wp-content/uploads/2014/03/Lateral-Ankle-Reconstruction.pdf, https://www.sanfordhealth.org/-/media/org/files/medical-professionals/resources-and-education/modifiedbrostrom-procedure-rehabilitation-guideline.pdf?la=en&hash=16A0BB50537FF352426C77A7CF99356C4AAE3303, https://gopack.com/documents/2015/9/8//2_Brostrom_8_5_2013.pdf?id=11758, https://mountainortho.com/wp-content/uploads/2016/10/Lateral-Ankle-Ligament-Reconstruction-Rehabilitation-Protocol.pdf, https://www.wbamc.amedd.army.mil/PatientCare/Documents/PostOpRehabProtocols/Brostrom%20WB08.pdf, https://www.brighamandwomens.org/assets/BWH/patients-and-families/pdfs/ankle-brostrom-gould-repairfor-lateral-ankle-instablility.pdf, https://www.stoneclinic.com/sites/default/files/uploads/brostromrepair.docx.pdf, https://dranandvora.com/rehabilitation-protocol/ankle-reconstruction/, https://brianwatermanmd.com/postop/ankle-reconstruction-modified-brostrom-repair-peroneal-tendon-repair/, https://wexnermedical.osu.edu/-/media/files/wexnermedical/patient-care/healthcare-services/sports-medicine/education/medicalprofessionals/knee-ankle-and-foot/chronic-ankle-instability-cpg-2019.pdf?la=en&hash=97A3C17853F6072AD5C6C759ED46AE8E4CD546E2, https://tcomn.com/wp-content/uploads/2020/01/Coetzee_Ankle_Ligament_Reconstruction_2020-01.pdf, https://s3-us-west-2.amazonaws.com/scal-assets/scal-pt-residencyfellowship/09FootRegion/30Ankle-LateralLigamentReconstruction.pdf, Minnesota Orthopedic Sports Medicine Institute. Suture tape augmentation protocols were found both by [Program Name] Lateral Ankle Suture Tape Augmentation rehab protocol and by [Program Name] Internal brace rehab protocol. Ankle Ligament Reconstruction Internal Brace Rehabilitation Protocol. For example, the question 2: Do you think you are likely to re-injure your knee by participating in your sport? was replaced by Do you think you are likely to re-injure your ankle by participating in your sport? (Fig. The purpose of this paper was to determine the variability between protocols after lateral ligament repair, reconstruction, and suture tape augmentation surgeries used to treat ankle instability and to evaluate the need for standardization in rehab protocols. Ankle Reconstruction/Modified Brstrom Repair/Peroneal Tendon Repair. The purpose of the score is to enable physicians to recognize patients who have psychological factors that prevent them from resuming their activities. Saper MG, Fantozzi P, Bompadre V, et al. The AOFAS and Karlsson scores were used as reference questionnaires.
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