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Talocrural and subtalar joint instability after lateral ankle sprain
J Hertel1, C R Denegar, M M Monroe
1Department of Kinesiology, Center for Sports Medicine, The Pennsylvania State University, University Park 16802, USA. jnh3@psu.edu
Medicine and Science in Sports and Exercise
|December 10, 1999
Summary
Recurrent lateral ankle sprains (LAS) may involve combined talocrural (TC) and subtalar (ST) joint laxity. Stress fluoroscopy and physical exams can identify this instability in athletes with a history of ankle sprains.
Area of Science:
- Orthopedic sports medicine
- Biomechanics of the lower extremity
- Diagnostic imaging in sports injuries
Background:
- Recurrence of lateral ankle sprains (LAS) is a significant issue for athletes.
- Talocrural (TC) joint laxity is traditionally considered the primary cause of mechanical instability post-LAS.
- Subtalar (ST) joint involvement in chronic ankle instability is less understood.
Purpose of the Study:
- To evaluate the utility of stress fluoroscopy and physical examination in assessing TC and ST joint instability.
- To compare instability findings in athletes with a history of LAS versus healthy controls.
- To investigate the relationship between TC and ST joint laxity after LAS.
Main Methods:
- A comparative study involving 12 athletes with unilateral LAS history and 8 healthy controls.
- Physical examination included anterior drawer (AD), talar tilt (TTPE), and medial subtalar glide (MSTG) tests.
- Stress fluoroscopy assessed TC and ST joint laxity using specific stress views and imaging protocols.
Main Results:
- Stress fluoroscopy revealed unilateral TC joint laxity in 75% of previously injured subjects.
- A significant correlation was observed between positive physical tests (AD, MSTG, TTPE) and fluoroscopic findings of TC laxity.
- Approximately 67% of subjects with TC laxity also exhibited excessive ST joint laxity on stress fluoroscopy.
Conclusions:
- A subset of athletes with a history of LAS presents with combined TC and ST joint laxity.
- Stress fluoroscopy appears to be a valuable tool for identifying combined joint laxity post-LAS.
- These findings may inform more comprehensive rehabilitation and treatment strategies for chronic ankle instability.
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