predictors of chronic ankle instability: A Prospective Cohort Analysis.
Hertel J, Caulfield B, Ryan J, and Delahunt E. Am J Sports Med. 2016; [Epub ahead of print].
sprain, a patient who was unable to complete the single-leg drop landing and
drop vertical jump at 2 weeks post injury was more likely to be classified as
having chronic ankle instability. Patient-reported outcomes at 6 months was
also associated with onset of chronic ankle instability.
are a common injury in sports and are the gateway to chronic ankle instability.
No study has tracked people after their first lateral ankle sprain to identify early
motor control impairments that may predict chronic ankle instability. By finding
ways to identify patients who may be susceptible to chronic ankle instability,
clinicians can begin to develop effective interventions that could halt the
progression of chronic ankle instability. Therefore, Doherty and colleagues
completed a cohort study of people with a first time lateral ankle sprain to
identify motor control deficits that predict chronic ankle stability.
Eighty-two (54 male) recreationally active patients who sustained a lateral
ankle sprain in the past 2 weeks participated in the current study. The authors
evaluated participants 3 times: 2 weeks, 6 month, and 12 months post injury. To
assess chronic ankle instability, all patients completed the Cumberland Ankle Instability Tool and the activities of daily living and sport
subscale of the Foot and Ankle Ability Measure. The authors classified participants with chronic
ankle instability at the 12-month visit. Patients also completed 5 movement
tasks: single-limb stance (eyes open and eyes closed), Star Excursion Balance
Test (anterior, posterolateral, and posteromedial reach), single-leg drop
landing, drop vertical jump and walking gait). The authors assessed range of
motion and force plate data (for example, center of pressure or ground reaction
force). Of the 70 patients who completed all follow-ups, 28 (40%) were
categorized as having chronic ankle instability. At 2 weeks, a patient who was unable
to complete the single-leg drop landing and drop vertical jump were more likely
to develop chronic ankle instability. At 6 months, a participant who reported lower
levels of activities of daily living on the Foot and Ankle Ability Measure and
who had altered joint positions in the sagittal plane during the Star Excursion
Balance Test were more likely to develop chronic ankle instability.
presented in this study suggests that there are early findings that may warn us
about people at risk for chronic ankle instability following a patient’s
initial lateral ankle sprain. If these findings are confirmed, clinicians could
identify patients who may be susceptible to chronic ankle instability and begin
to intervene as early as possible to mitigate motor control deficits. Specifically,
the authors found that the inability to perform single-leg drop landing and
drop vertical jump at 2 weeks was key as was patient-reported function during
activities of daily living. This highlights the importance of using
patient-reported outcomes in our assessments. Future research should focus on
identifying the best possible rehabilitative methods of negating or reversing the
onsets of chronic ankle instability. This can potentially lead to clinicians
screening first time lateral ankle sprain patients within the first 2 weeks of
injury and implementing a rehabilitation program, which would best suit the
needs of that particular patient to avoid long-term deficits. Until this future
research can be done, clinicians should consider using patient-reported
outcomes and assess a patient’s ability to perform the two functional tasks to
screen for potential risk of chronic ankle instability.
for Discussion: Do you currently use
any methods which you believe help identify patients who may be at risk for
chronic ankle instability? Do you utilize any screening tools which were used
in this study in your current practice?
Doherty C, Bleakley C, Hertel J, Caulfield B, Ryan J, & Delahunt E (2016). Recovery From a First-Time Lateral Ankle Sprain and the Predictors of Chronic Ankle Instability: A Prospective Cohort Analysis. The American Journal of Sports Medicine PMID: 26912285