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OBJECTIVE: To analyse the association between Ankle-GO score during the return to sport process and the probability of becoming a coper 1 year after lateral ankle sprain (LAS). Copers were defined as patients returning to their preinjury sport without loss of function and reporting no episodes of reinjury or giving-way. METHODS: Two months after a LAS, patients performed the Ankle-GO assessment which includes a cluster of four functional tests and two self-reported questionnaires for a maximum score of 25 points. One year after injury, participants were classified as copers or non-copers. Eight potential predictive variables associated with coper status were compared between the groups. Receiver operating characteristic curves (area under the curve (AUC)) and multivariable logistic regression models with OR and 95% CIs were used to determine the association of potential factors, including the Ankle-GO score, with copers. RESULTS: 64 patients (56% females; age 33.7±13.2 years) completed the Ankle-GO-GO at 2 months postinjury. At 1 year postinjury, 10 patients (15%) were lost to follow-up, and only 17 of 54 patients (31%) became copers. Two-month Ankle-GO score was higher among copers (9.9±4.9 points vs 6.9±3.7, p=0.015) and was associated with future coper status at 1 year (AUC=0.70). Patients with an Ankle-GO score above 11 points and male patients were more likely to become copers (OR=12.1; 95% CI 2.5 to 59, p=0.002 and OR=5.2; 95% CI 1.2 to 22.4, p=0.026, respectively). CONCLUSION: The Ankle-GO may help identify patients more likely to become copers within a year of injury. Those with low Ankle-GO scores and female patients should receive additional rehabilitation to increase the odds of becoming a coper.
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PURPOSE: This study investigated the test-retest reliability and usefulness of the foot-ankle rebound-jump test (FARJT) for measuring foot-ankle reactive strength metrics in athletes. METHODS: Thirty-six highly trained, healthy athletes (5 female; 21.5 [3.9] y; 1.80 [0.10] m; 72.7 [10.4] kg) performed 8 repeated bilateral vertical foot-ankle rebound jumps on 2 testing days. Testing days were 1 week apart, and these sessions were preceded by a familiarization session. Reactive strength metrics were calculated by dividing jump height (in meters) by contact time (in seconds) for the reactive strength index (RSI) and flight time (in seconds) by contact time (in seconds) for the reactive strength ratio (RSR). The mean of 4 jumps (excluding the first and last 2 jumps) on each testing session were considered for RSI and RSR reliability and usefulness analysis. RESULTS: We found a high reliability of the FARJT for RSI (intraclass correlation coefficient [ICC] > .90 and coefficient of variation [CV] = 12%) and RSR (ICC ≥ .90 and CV = 8%). Regarding their usefulness, both RSI and RSR were rated as "marginal" in detecting the smallest worthwhile change (typical error > smallest worthwhile change) and "good" in detecting a moderate change in performance. CONCLUSIONS: The results showed that a FARJT is a highly reliable test for measuring foot-ankle reactive strength in athletes and useful for quantifying changes, for example, following a training block. However, its usefulness as an accurate daily or weekly monitoring tool in practice is questionable.
Subject(s)
Ankle , Exercise Test , Foot , Muscle Strength , Humans , Female , Reproducibility of Results , Foot/physiology , Male , Young Adult , Exercise Test/methods , Ankle/physiology , Muscle Strength/physiology , Athletes , Adult , AdolescentABSTRACT
The primary objective of this study was to investigate the relationship between metatarsophalangeal joint (MTPj) flexion torque and sprint acceleration, cutting and jumping performance, and kinetics. A secondary aim was to explore this relationship when MTP flexion strength was associated with other foot and lower limb neuromuscular outputs. After an initial MTPj flexion torque assessment using a custom-built dynamometer, 52 high-level athletes performed the following tasks on a force platform system: maximal sprint acceleration, 90-degree cutting, vertical and horizontal jumps, and foot-ankle hops. Their foot posture, foot passive stiffness and foot-ankle reactive strength were assessed using the Foot Posture Index, the Arch Height Index Measurement System and the Foot-Ankle Rebound Jump Test. Ankle plantarflexion and knee extension isometric torque were assessed using an isokinetic dynamometer. During maximal speed sprinting, multiple linear regressions suggested a major contribution of MTPj flexion torque, foot passive stiffness and foot-ankle reactive strength to explain 28% and 35% of the total variance in the effective vertical impulse and contact time. Ankle plantarflexor and quadriceps isometric torques were aggregately contributors of acceleration performance and separate contributors of cutting and jumping performance. In conclusion, MTPj flexion torque was more strongly associated with sprinting performance kinetics especially at high-speed.
Subject(s)
Acceleration , Athletic Performance , Foot , Muscle Strength , Running , Torque , Humans , Muscle Strength/physiology , Running/physiology , Athletic Performance/physiology , Foot/physiology , Young Adult , Male , Biomechanical Phenomena , Metatarsophalangeal Joint/physiology , Kinetics , Female , Ankle/physiology , Muscle, Skeletal/physiology , Adolescent , Adult , Posture/physiologyABSTRACT
BACKGROUND: Lateral ankle sprain (LAS) is the most common sports injury, leading to a high rate of recurrence and the development of chronic ankle instability. One possible explanation is the lack of objective, evidence-based criteria to inform return to sport decisions following LAS. The aim of this study was therefore to assess the efficacy of a new functional score to distinguish patients at risk of recurrent LAS within two years after the initial injury. METHODS: The Ankle-GO score was used in 64 active patients two months after LAS. This composite score includes 2 self-reported questionnaires and 4 functional tests, for a maximum score of 25 points. The rate of reinjury was prospectively recorded 2 years after inclusion. Potential predictive variables for reinjury were tested using the Chi-square and independent t-tests. The area under the receiver operating characteristics curve (AUC) with the optimal cut-off score was determined to assess the predictive value of the Ankle-GO score for the risk of reinjury. Multivariate logistic regression was then used to determine the influence of risk factors of reinjury. RESULTS: Fifty-four (85%) patients were included (23 men and 31 women, 34.7 ± 13 years old) including 18 (33.3%) with a reinjury. The two-month Ankle-GO score was lower in patients with a recurrent LAS (5.4 ± 2.8 points vs. 9.1 ± 4.5, p = 0.002) and predicted the risk of reinjury (AUC = 0.75). Patients with < 8 points were found to have a significantly higher risk of reinjury (OR = 8.6; 95%CI: 2-37.2, p = 0.001). Women also tend to have a higher risk of recurrence (OR = 3.8; 95%CI: 0.9-15.5, p = 0.065). CONCLUSION: The Ankle-GO score is a new objective criterion for RTS after LAS. Patients with a low score at two months have a 9-fold greater risk of recurrence within two years.
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CONTEXT: Chronic ankle instability (CAI) is prevalent amongst individuals who sustain a lateral ankle sprain (LAS) injury. The persistent of the characteristic long-standing clinical symptoms of CAI maybe attributable to the lack of adoption of evidence-informed clinical guidelines. OBJECTIVE: To investigate to what extent French-speaking physiotherapists implement the International Ankle Consortium Rehabilitation-Oriented-ASsessmenT (ROAST) framework when providing clinical care for individuals with an acute LAS injury. DESIGN: Cross-sectional study. SETTING: We created an online survey informed by a Delphi process of foot-ankle experts, and disseminated it to French-speaking physiotherapists in France, Switzerland, Quebec-Canada, Belgium, and Luxembourg. PATIENTS OR OTHER PARTICIPANTS: In total, 426 physiotherapists completed the online survey. MAIN OUTCOME MEASURE(S): The online survey comprised closed and open-ended questions organized in 5 sections: (1) participants' demographics, (2) participants' self-assessment expertise, (3) clinical diagnostic assessment (bones and ligaments), (4) clinical evaluation after an acute LAS injury (ROAST framework), and (5) CAI. The qualitative data from the open-ended questions was analyzed using best practice thematic analysis guidelines. RESULTS: Only 6% of the respondents could name all Ottawa Ankle Rules criteria. Only 25% of the respondents cited or described "gold standard" tests from the literature to assess the integrity of the ankle lateral ligaments. Less than 25% of the respondents used some of the International Ankle Consortium ROAST recommended clinical evaluation outcome metrics to inform their clinical care for individuals with an acute LAS injury. In general, the respondents had a greater knowledge of the functional insufficiencies that associated with CAI when compared to the mechanical insufficiencies. CONCLUSION: A minority of French-speaking physiotherapists use the International Ankle Consortium ROAST recommended clinical evaluation outcome metrics to inform their clinical care for individuals with an acute LAS injury. This highlights the responsibility of the scientific community to better disseminate evidence-informed research to clinicians.
Subject(s)
Cross-Cultural Comparison , Running , Humans , Universities , Wisconsin , Surveys and Questionnaires , Reproducibility of Results , Psychometrics , TranslationsABSTRACT
Purpose: To evaluate the variations in hip muscles strength following arthroscopy and 6-month rehabilitation in patients treated for femoroacetabular impingement (FAI). Methods: A retrospective analysis was carried out on a series of patients who were arthroscopically treated for FAI at La Tour Hospital between 2020 and 2022. Bilateral isometric strengths of 8 hip-related muscles (abductors, adductors, hamstrings, quadriceps, extensors, flexors, internal and external rotators) were assessed using a handheld dynamometer before surgery and postoperatively after 6 months of rehabilitation in terms of relative strength changes between time points. Results: A total of 29 patients (aged 26.9 ± 7.1 years, 86% of women) were included. Except for the abductors, which remained of comparable strength than before surgery, a statistically significant (P < .05) increase in hip muscle strength on the operated side could be noted at 6 postoperative months for hamstrings (9% ± 17%, P = .041), quadriceps (11% ± 27%, P = .045), extensors (17% ± 32%, P = .006), flexors (17% ± 29%, P = .003), adductors (18% ± 23%, P < .001), and internal rotators (32% ± 36%, P < .001). The proportion of patients who reached a strength level above their preoperative status ranged from 62% (quadriceps) to 86% (adductors and flexors), depending on the muscle studied. The external rotators were the only muscles that remained significantly weakened at 6 months on both operated (-13% ± 26%, P = .002) and nonoperated (-17% ± 25%, P < .001) sides, with a decrease beyond 15% in almost half of the patients (45% and 48%, respectively). Conclusions: Arthroscopic treatment followed by 6-month rehabilitation granted to most FAI patients a higher strength level for several hip muscles, except for abductors and external rotators, which remained comparable and weakened, respectively. Level of Evidence: Level IV, therapeutic case series.
ABSTRACT
Purpose: To provide normative values of maximal isometric torque of knee extensors and flexors measured at 80° of knee flexion and to characterize the results in healthy subjects practicing activities at risk of anterior cruciate ligament rupture. Methods: Seventy-four trained volunteers (35 male and 39 female) aged 18 to 41 years were recruited. They alternately performed 3 maximal voluntary isometric contractions of knee extension and flexion. The maximal voluntary isometric contraction net torque was computed as the mean value of the peak torques recorded over the 3 trials. Results: For women, the absolute torque for extensors was 143.5 ± 34.4 Nâ m (range, 87.7-253.1 Nâ m) and 66.8 ± 13.8 Nâ m (range, 37.5-93.1) for flexors. For men, the absolute torque for extensors was 199.8 ± 47.3 Nâ m (range, 99.3-311.5 Nâ m) and 89.8 ± 21.0 Nâ m (range, 51.8-137.2 Nâ m) for flexors. For women, the body mass normalized torque for extensors was 2.20 ± 0.51 Nâ m.kg-1 (range, 1.22-3.74 Nâ m.kg-1) and 1.04 ± 0.26 Nâ m.kg-1 (range, 0.41-1.50 Nâ m.kg-1) for flexors. For men, the normalized torque for extensors was 2.74 ± 0.58 Nâ m.kg-1 (range, 1.51-4.08 Nâ m.kg-1) and 1.24 ± 0.30 Nâ m.kg-1 (range, 0.64-2.05 Nâ m.kg-1) for flexors. Conclusions: This study provides absolute and normalized normative values of maximal isometric torque measured at 80° of knee flexion for extensors and flexors in a series of healthy trained subjects practicing activities at risk of anterior cruciate ligament rupture. The considerable level of interlimb asymmetry and the weak association between dominance and strength observed in uninjured subjects call into question the classical use of contralateral side as reference for injured patients. Clinical Relevance: Patients with anterior cruciate ligament (ACL) injuries are the most represented subjects using isokinetic dynamometers in many sport medicine and rehabilitation departments. Clinicians need reference values to compare patients with ACL injuries with comparable healthy subjects. This study may provide this information.