Search Results

Context: It is unclear if lower-extremity joint cooling alters biomechanics during a functional movement. Objective: To investigate the effects of unilateral lower-extremity cryotherapy on movement alterations during a single-leg drop jump. Design: A crossover design. Setting: Laboratory. Patients: Twenty healthy subjects (10 males and 10 females; 23 y, 169 cm, 66 kg). Intervention(s): Subjects completed a single-leg drop jump before and after a 20-minute ankle or knee joint cooling on the right leg, or control (seated without cooling) on 3 separate days. Main Outcome Measures: Time to peak knee flexion, vertical ground reaction force, lower-extremity joint angular velocity (sagittal plane only), and angle and moment (sagittal and frontal planes) in the involved leg over the entire ground contact (GC; from initial contact to jump-off) during the first landing. Time to peak knee flexion was compared using an analysis of variance; the rest of the outcome measures were analyzed using functional analyses of variance (P < .05). Results: Neither joint cooling condition changed the time to peak knee flexion (F _2,95 = 0.73, P = .49). Ankle joint cooling reduced vertical ground reaction force (55 N at 4% of GC), knee joint angular velocity (44°/s during 5%–9% of GC), and knee varus moment (181 N·m during 18%–20% of GC). Knee joint cooling resulted in a reduction in knee joint angular velocity (24°/s during 37%–40% of GC) and hip adduction moment (151 N·m during 46%–48% of GC), and an increase in hip joint angular velocity (16°/s during 49%–53% of GC) and plantarflexion angle (1.5° during 11%–29% of GC). Conclusion: Resuming activity immediately after lower-extremity joint cooling does not seem to predispose an individual to injury during landing because altered mechanics are neither overlapping with the injury time period nor of sufficient magnitude to lead to an injury.

Clinical Scenario: Balance impairment is common in patients with chronic ankle instability (CAI), especially during dynamic tasks. Manual therapies, such as ankle joint mobilizations are known to improve clinician-oriented outcomes such as dorsiflexion range of motion, but their impact on sensorimotor outcomes such as dynamic postural control and the retention of benefits remains less clear. Focused Clinical Question: Do anterior-to-posterior ankle joint mobilizations improve dynamic postural control in patients with CAI relative to a control condition and are those benefits retained after termination of the treatment? Summary of Key Findings: Three studies quantified the immediate effect and two studies quantified the retained benefit of anterior-to-posterior ankle joint mobilizations on improving Star Excursion Balance Test (SEBT) reach distances. Two studies demonstrated large immediate improvements in SEBT reach distances and those same investigations found that those large improvements were retained. Clinical Bottom Line: Ankle joint mobilization appears to improve SEBT reach distances and those improvements are retained. Strength of Recommendation: Strength of recommendation is a B due to inconsistent moderate-quality patient-oriented evidence.

Clinical Scenario: Patients with chronic ankle instability (CAI) who require surgical intervention are often diagnosed with medial ankle osteoarthritis (OA). Lateral joint stabilization procedures are commonly performed among this patient population to restore bony alignment and improve cartilage loading patterns to increase patient-reported function and mitigate further degenerative changes. Focused Clinical Question: What is the available evidence to support joint stabilization procedures on patient-reported outcomes and progression of radiographic OA among patients with CAI who have medial ankle OA? Summary of Key Findings: An electronic search of relevant databases was performed to identify peer-reviewed articles examining preoperative and postoperative clinical outcomes and radiographic evidence of ankle OA. A total of 3 peer-reviewed articles were retrieved. All 3 articles employed a retrospective case series study design. All 3 articles demonstrated improved patient-reported outcomes at the final follow-up visit. Two articles demonstrated that between 11% and 27% of patients progressed in at least 1stage of radiographic ankle OA between the preoperative assessment and the final follow-up visit (40–56 mo). Clinical Bottom Line: Joint stabilization surgery for patients with CAI and medial ankle OA is associated with improved clinical outcomes and a low rate of worsening radiographic joint degeneration within the first 5 years. Strength of Recommendation: Consistent evidence exists across all 3 articles. However, this evidence is based on a low-quality study design. Therefore, there is a grade-C level of evidence to support joint stabilization for improving patient-reported and radiographic outcomes within the first 5 years after surgery for patients with CAI and medial ankle OA.

Context: Quantifying early posttraumatic ankle osteoarthritis pathogenesis using compositional magnetic resonance (MR) imaging sequences is becoming more common. These MR sequences are often manually segmented to isolate the cartilage of interest before cartilage compositional values (eg, T1ρ or T2) are quantified. However, limited information is available regarding the reliability and reproducibility of manual segmentation for the entire talar dome. Objective: The purpose of this study was to determine the intraobserver and interobserver reliability of manually segmenting T1ρ MR sequences of the entire talar dome and 4 subregions of interest. Design: Descriptive observational study. Setting: Laboratory. Patients or Other Participants: Ten uninjured healthy individuals (4M and 6F: 21.40 [3.03] y, 170.00 [7.93] cm, 71.03 [14.97] kg) participated. Intervention: None. Main Outcome Measures: Two investigators manually segmented 10 T1ρ ankle MR sequences using ITK-SNAP software to calculate T1ρ mean relaxation times and cartilage volumes. Each observer repeated the segmentation twice, with segmentations separated by 1 month. Intraobserver and interobserver reliability was determined using intraclass correlation coefficients (ICCs) with 95% confidence intervals and root mean square coefficient of variations (RMSCVs). Results: For T1ρ relaxation time, intraobserver (ICC = .994–.997, RMSCV = 1.31%–1.51%) and interobserver reliability (ICC = .990, RMSCV = 2.36%) was excellent for the overall talar dome. Excellent intraobserver (ICC = .975–.980, RMSCV = 3.88%–4.59%) and excellent interobserver reliability (ICC = .970, RMSCV = 5.13%) was noted for overall talar cartilage volume. Conclusions: The results demonstrate that manual segmentation of the entire talar dome from a T1ρ MR is reliable and repeatable.

Ankle joint mobilization has been shown to be effective at improving outcomes in those with chronic ankle instability (CAI), but the neuromuscular mechanisms are still unknown. We aimed to determine the immediate effect of a single Grade III anterior-to-posterior ankle joint mobilization bout on ankle musculotendinous stiffness (MTS) in those with CAI. Seventeen CAI participants had plantar flexor and fibularis MTS assessed before and after a 5-min joint mobilization treatment. MTS outcomes were estimated using the damped oscillation method. Fibularis (0.25 ± 0.41 N/m/kg, p = .028) but not plantar flexor MTS (−2.18 ± 14.35 N/m/kg, p = .539) changed following mobilization and exceeded the calculated minimal detectable change score (0.12 N/m/kg). Increased fibularis MTS may represent a neuromuscular mechanism by which ankle joint mobilizations improve postural control in those with CAI.