Differences in Ankle Sprain Risk Factors, Anterior Talofibular Ligament, Calcaneofibular Ligament and Lower Leg Muscles' Size Among Athletes With and Without Ankle Sprain Injury History: A Retrospective Study
This study aims to comprehensively explore the relationship between changes in muscle architecture and connective tissue structure in athletes with ankle sprains and the intrinsic biomechanical risk factors observed in these individuals. The main goal of the research is to compare the risk factors associated with ankle sprains, characteristics of lower extremity muscle architecture, and structural features of the anterior talofibular ligament (ATFL) between athletes with and without a history of ankle sprains. Additionally, the study seeks to identify intrinsic factors that may lead to lateral ankle sprains and to investigate the link between these factors and structural changes related to chronic ankle instability. Overall, the study aims to contribute scientifically to the early detection of sprain risk in athletes and the development of personalised preventative intervention strategies.
The hypotheses of the study are as follows:
Hypothesis 1: In athletes with a history of ankle sprains, the strength of the muscles surrounding the ankle differs from that of their uninjured ankles and ankles of the athletes without a history of sprains.
Hypothesis 2: Athletes with a history of ankle sprains have a different level of proprioception (position sense) compared to athletes without a history of sprains.
Hypothesis 3: Athletes with a history of ankle sprains have different muscle and ligament sizes compared to their uninjured legs and the legs of athletes without a history of sprains.
Hypothesis 4: Dynamic balance differs between athletes with a history of ankle sprains and those without a history of ankle sprains.
Aperçu de l'étude
Statut
Description détaillée
Ankle instability exhibits a significant propensity to evolve into a chronic condition. Chronic ankle instability (CAI), defined by enduring residual symptoms following a sprain, recurrent sprains, and perceived instability, occurs in approximately 10% to 40% of cases. According to research conducted by Van Rijn and colleagues, between 5% and 33% of patients continued to experience pain one year subsequent to an ankle sprain, and one-third of the participants reported at least one re-sprain three years thereafter (4, 6).
Research indicates that a minimum of 73% of individuals who have sustained an ankle sprain exhibit persistent symptoms, including pain, a sensation of instability, proprioceptive disturbances, and impairments in neuromuscular control (7, 8). This condition presents a significant risk of both re-injury and the development of CAI. A history of multiple sprains and recurrent feelings of instability are identified as CAI, and the ongoing nature of this condition increases joint damage and the likelihood of osteoarthritis (9). The treatment and prevention of these injuries are costly and hinder athletes' return to training and competition (10).
Numerous intrinsic risk factors have been identified in the literature concerning the incidence and recurrence of lateral ankle sprains. These risk factors include a previous sprain history, gender, height, body weight, anatomical foot posture, alignment abnormalities (e.g., pes cavus, genu varum), joint laxity, joint range of motion, muscle strength, proprioception, reaction time, and postural control (11). Current studies show that, although there are differences in performance levels between genders, there is no significant difference in exposure to injury risk (12, 13). Conversely, it is stated that a direct relationship exists between height, body weight, ankle laxity, muscle strength, and postural control and lateral sprains (7). When assessed in terms of muscle strength, weakness in the ankle and hip muscles is an important risk factor for the development of LAS. Research shows that athletes with more than 15% strength asymmetry, especially during the pre-season, face a higher risk of sprain compared to those without such asymmetry. Postural balance disorders are also regarded as a significant intrinsic risk factor in the development of LAS. In conclusion, ankle sprains are common injuries among athletes and can lead to significant functional impairments. Identifying intrinsic risk factors for these injuries and implementing targeted preventive strategies through individual assessments are essential for both injury prevention and reducing the development of OAS. A review of current literature shows that there are limited studies that thoroughly examine changes in the architecture and functional performance of the muscles around the ankle in athletes who have experienced recurrent ankle sprains. This study aims to comprehensively explore the relationship between changes in muscle architecture and connective tissue structure in athletes with ankle sprains and the intrinsic biomechanical risk factors observed in these individuals.
Type d'étude
Inscription (Réel)
Contacts et emplacements
Lieux d'étude
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Istanbul, Turquie (Türkiye)
- Medipol University
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
- Adulte
Accepte les volontaires sains
Méthode d'échantillonnage
Population étudiée
La description
Inclusion Criteria:
- At least 5 years of active participation in any sport.
- Age between 18 and 35.
- A history of at least two clinically diagnosed LAS episodes with inflammatory symptoms like pain and swelling.
- The last sprain occurred at least 3 months before the study start, and the participant has fully returned to their sport.
- No previous surgeries affecting
Exclusion Criteria:
- Any history of ankle fracture.
- Surgery or systemic disease impacting sensorimotor function in the lower limb.
- Neurological disorders.
- Recent (within a month) acute injury to the lower extremity.
- Visual or vestibular issues that impair balance or coordination.
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
Cohortes et interventions
Groupe / Cohorte |
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Control group
The control group will include athletes who have no history of ankle injuries.
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Ankle Instability Group
The group will consist of athletes diagnosed with chronic ankle instability (CAI).
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
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Évaluation de l'équilibre dynamique
Délai: 15 minutes
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Le test d'équilibre Y, une variation courte et pratique du test d'équilibre des étoiles, sera utilisé pour évaluer la stabilité dynamique.
Les athlètes effectueront le test d'équilibre Y en fonction des procédures de test définies par Plisky et al.
Trois bandes blanches, chacune de 125 cm de longueur, seront apposées au sol pour former une forme en y, avec le petit angle à 90 ° et les deux angles plus grands à 135 °, et les marquages à l'échelle des centimètres seront ajoutés aux bandes à la main. plan sagittal, tous deux alignés sur la ligne médiane.
Les participants seront invités à se tenir debout avec leurs mains au niveau de la crête iliaque, à côté de leur corps, et avec le pied à mesurer sur le sol, pour tendre la main avec l'autre pied dans les directions antérieures, postéro-médiales et postéro-latérales, une fois dans chaque direction, et à toucher légèrement le point final qu'ils peuvent atteindre.
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15 minutes
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Évaluation de la stabilité posturale
Délai: 20 minutes
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Les évaluations de stabilité posturale des athlètes (COP) seront effectuées à l'aide de la plate-forme de force Prokin (Prokin PK 252).
Le Prokin PK 252 est un système proprioceptif utilisé pour l'évaluation et la formation de l'équilibre statique et dynamique.
Dans cette étude, le «programme d'évaluation statique et dynamique de stabilité» sera utilisé pour fournir des données détaillées et précises sur la posture statique des participants à travers la plate-forme de stabilitrie et les capteurs placés sur le corps [47].
Pendant le test, la position debout des participants sera déterminée avec leurs pieds à l'écart de la largeur des épaules, et leurs positions de pied seront alignées à des distances égales par rapport au point d'origine, en utilisant les lignes des axes X et Y de la plate-forme comme références.Prépord, un test de stabilité statique à une seule jambe sera effectué.
Ce test sera administré en deux sous-tests: avec les yeux ouverts et avec les yeux fermés.
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20 minutes
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Muscle and Ligament Size Assessment
Délai: 1 hour
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Muscle and ATFL thickness will be measured using an HS60 ultrasound system (Samsung Medicine, Gangwon-do, Korea) with a 5-13 MHz linear probe.
Muscle cross-sectional area (MCA) of the ankle muscles will be assessed under two conditions: resting and maximal voluntary contraction (MVC), using B-mode ultrasound.
All measurements will be taken by a physical therapist experienced in musculoskeletal ultrasound.
Participants will lie on a medical bed with legs fully extended, the ankle in a neutral position, and muscles relaxed during imaging.
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1 hour
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Proprioception Assessment
Délai: 15 minute
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An ankle joint position sense test will be administered to assess deficiencies in ankle proprioception.
An electronic goniometer will be used to assess ankle joint position sense.
The reliability of this test among recreational athletes with ankle instability has been reported as ICC = 0.94-0.98
[45].
Athletes will be seated with their knees flexed at 90°, and their eyes will be closed to eliminate visual cues.
The ankle subtalar joint (STJN) will be held in a neutral position, and the goniometer will be set to zero.
The ankle will be passively moved through 10° dorsiflexion, 10° eversion, 15° plantar flexion, or 15° inversion, and then returned to the neutral position [46].
Participants will then be asked to actively perform these movements as closely as possible to the previous movements.
Three repeated measurements will be taken for each test angle, and deviations from the target angle will be recorded.
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15 minute
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Muscle Strength Assessment
Délai: 15 minute
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Isometric muscle strength measurements of the tibialis anterior, peroneus longus and brevis, gastrocnemius, and gluteus medius muscle groups will be performed using a MicroFET digital handheld dynamometer.
Measurements will be conducted with participants positioned supine, side-lying, and prone on an examination table [34].
For each muscle group, participants will be asked to perform three maximal voluntary contractions lasting 5 seconds each, with a 1-minute rest between contractions.
All measurements will be conducted by the same examiner, and all three recorded values will be used for data analysis.
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15 minute
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
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Mesure de capacité du pied et de la cheville (FAAM)
Délai: 15 minutes
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Les fonctions physiques des athlètes seront évaluées à l'aide de la version turque de la mesure de la capacité du pied et de la cheville (FAAM).
FAAM est un outil de mesure d'auto-évaluation développé pour évaluer les fonctions physiques des individus ayant des problèmes musculo-squelettiques liés au pied et à la cheville.
Le FAAM se compose d'un total de 29 articles, dont une sous-échelle d'activités de 21 éléments de la vie quotidienne (ADL) et une sous-échelle sportive de 8 éléments.
La sous-échelle sportive fournit une sous-classe sportive pour évaluer la capacité d'effectuer des activités liées au sport.
Chaque question est notée en utilisant une échelle de Likert à 5 points allant de 0 (incapable de fonctionner) à 4 (capable de fonctionner sans difficulté).
Le score maximal pour la sous-échelle ADL est de 84, tandis que le score maximal pour la sous-échelle sportive est de 32.
Les scores totaux sont calculés en pourcentage des scores allant de 0% à 100%, avec un score plus élevé indiquant un niveau de fonction plus élevé [48].
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15 minutes
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Cumberland Ankle Instability Tool (CAIT)
Délai: 10 minute
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Cumberland Ankle Instability Tool Developed in 2006, the Cumberland Ankle Instability Tool 17 (CAIT) was the first to provide a numerical value measuring the level of ankle instability based on individuals' perceptions [41].
The CAIT scale, designed to assess functional ankle instability levels, consists of 9 questions; the maximum total score is 30 and the minimum is 0. A lower total score indicates more severe functional ankle instability.
Test-retest reliability was found to be excellent at 0.96.
The CAIT is the first tool to validly and reliably assess functional ankle instability.
In the study, the cutoff score was set at 27.5, with a sensitivity of 82.9% and a specificity of 74.7%.
Finally, the CAIT score has the potential to predict the risk of re-sprain in individuals with functional ankle instability.
Individuals with a sprained ankle and a low CAIT score have a higher likelihood of re-sprain, while those with a high CAIT score have a lower likelihood of re-sprain [42].
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10 minute
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Collaborateurs et enquêteurs
Parrainer
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Réel)
Achèvement primaire (Réel)
Achèvement de l'étude (Réel)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
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Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Autres numéros d'identification d'étude
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Informations sur les médicaments et les dispositifs, documents d'étude
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