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.
Panoramica dello studio
Stato
Descrizione dettagliata
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.
Tipo di studio
Iscrizione (Effettivo)
Contatti e Sedi
Luoghi di studio
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Istanbul, Turchia (Türkiye)
- Medipol University
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Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
- Adulto
Accetta volontari sani
Metodo di campionamento
Popolazione di studio
Descrizione
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.
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
Coorti e interventi
Gruppo / Coorte |
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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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Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
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Valutazione dell'equilibrio dinamico
Lasso di tempo: 15 minuti
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Il test di bilanciamento Y, una breve e pratica variazione del test di bilanciamento delle stelle, verrà utilizzata per valutare la stabilità dinamica.
Gli atleti eseguiranno il test di equilibrio Y secondo le procedure di prova definite da Plisky et al.
Tre fasce bianche, ogni 125 cm di lunghezza, saranno apposte a terra per formare una forma y, con il piccolo angolo a 90 ° e i due angoli più grandi a 135 ° e i segni su scala centrale verranno aggiunti alle fasce e le parti del contatto saranno posizionate a mano. Nel piano sagittale, entrambi allineati con la linea mediana.
Ai partecipanti verrà chiesto di stare in piedi con le mani a livello della cresta iliaca, adiacente ai loro corpi, e con il piede da misurare sul terreno, per raggiungere l'altro piede nelle direzioni anteriori, posteromediali e posterolaterali, una volta in ciascuna direzione e per toccare leggermente il punto finale che possono raggiungere.
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15 minuti
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Valutazione della stabilità posturale
Lasso di tempo: 20 minuti
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La stabilità posturale degli atleti e le valutazioni del centro della pressione (COP) verranno eseguite utilizzando la piattaforma di forza Prokin (Prokin PK 252).
Prokin PK 252 è un sistema propriocettivo utilizzato per la valutazione e la formazione dell'equilibrio statico e dinamico.
In questo studio, il "Programma statico e dinamico di valutazione della stabilità" verrà utilizzato per fornire dati dettagliati e accurati sulla posizione statica statica dei partecipanti attraverso la piattaforma di stabilizza e i sensori posizionati sul corpo [47].
Durante il test, la posizione eretta dei partecipanti verrà determinata con i loro piedi a distanza della larghezza delle spalle e le loro posizioni del piede saranno allineate a pari distanze dal punto di origine, usando le linee sugli assi X e Y della piattaforma come riferimenti. Prima verrà eseguito un test di stabilità statica a gamba singola.
Questo test verrà somministrato in due sotto-test: con gli occhi aperti e con gli occhi chiusi.
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20 minuti
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Muscle and Ligament Size Assessment
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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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Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
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Misura di abilità del piede e della caviglia (FAAM)
Lasso di tempo: 15 minuti
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Le funzioni fisiche degli atleti saranno valutate utilizzando la versione turca del piede e la misura della caviglia (FAAM).
FAAM è uno strumento di misurazione di auto-relazione sviluppato per valutare le funzioni fisiche degli individui con problemi muscoloscheletrici legati al piede e alla caviglia.
La FAAM è costituita da un totale di 29 articoli, tra cui una sottoscala di attività di vita da 21 elementi (ADL) e una sottoscala sportiva a 8 elementi.
La sottoscala sportiva fornisce una sottoclasse specifica per lo sport per valutare la capacità di svolgere attività sportive.
Ogni domanda viene valutata utilizzando una scala Likert a 5 punti che va da 0 (incapace di eseguire) a 4 (in grado di esibirsi senza difficoltà).
Il punteggio massimo per la sottoscala ADL è 84, mentre il punteggio massimo per la sottoscala sportiva è di 32.
I punteggi totali sono calcolati come punteggi percentuali che vanno dallo 0% al 100%, con un punteggio più elevato che indica un livello di funzione più elevato [48].
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15 minuti
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Cumberland Ankle Instability Tool (CAIT)
Lasso di tempo: 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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