Ankles Braced for Impact

You just saw your favorite athlete take the field (or floor) wearing an ankle brace. “Oh no,” you think. He or she must have had an injury! Maybe not. Many athletes wear ankle braces to prevent an injury. Studies show that ankle bracing can reduce the risk of an ankle sprain.

This study tried to find out which ankle brace is the best one to use when jumping and landing on an object. Most often, players land on another athlete’s foot or a rock on the field. The ankle twists inward, and an injury occurs. This type of ankle sprain is called ankle inversion.

This study mimicked conditions during an ankle inversion injury. Each subject jumped up and landed on one foot with a force equal to twice his body weight. A special sole on the shoe forced the foot into an inverted position. The 14 subjects landed on a special plate that measured the force of the impact. A microcomputer collected the data.

Three different braces were tested: the Swede-O, Aircast, and Bledsoe. The Swede-O is made of a soft nylon with laces up the front and elastic in the back. The Aircast is a semi-rigid brace with air-filled padding on either side. The Bledsoe is semi-rigid with metal stays on either side. It has a hinge joint at the ankle to allow foot motion up and down.

How well did they work? Which one was best? All three were able to protect the ankle from turning in after jumping and landing on one leg. The Aircast and Bledsoe held the ankle more stable than the Swede-O. Which one did the athletes prefer? The Swede-O was ranked the most comfortable. Players had more confidence in the Aircast and Bledsoe. Soccer players reported that the Bledsoe didn’t allow enough foot motion to play normally.

The authors conclude that a semi-rigid ankle brace works best in preventing ankle inversion. Ground reaction forces in basketball rebounding can reach three to 14 times the athlete’s body weight. Back somersaults in gymnastics and landing from a block in volleyball have similar forces. Athletes may want to use ankle bracing to prevent ankle injuries during sports with this kind of impact.

A Closer Look at Injured Ankles

Today’s modern imaging is helping doctors diagnose many problems. X-rays, MRIs, and arthroscopic exams can locate the damage in cases of chronic ankle pain after injury. Each one of these tools shows a something a little different.

Trauma such as ankle sprain can cause osteochondral lesions (OCL). Osteo refers to bone and chondral describes the cartilage. An OCL lesion can happen from an injury with enough force to damage the cartilage and the bone below it. The damage of OCL lesions can be tricky to see.

X-rays can show a fracture in the bone, but they don’t show a tear in the cartilage. MRI clearly identifies damage to the cartilage, but it doesn’t always show a crack or break in the bone. Looking inside the ankle with an arthroscope gives the doctor a clear view of the joint. Arthroscopic exam shows the condition of the cartilage. It doesn’t show the damage beneath the cartilage. This area is called subchondral.

The authors of this study used all three forms of imaging to diagnose ankle pain. They compared which imaging type or combination of imaging worked the best to find the problem. They found that by using ankle arthroscopy along with an MRI they could accurately see the damage to both the bone and the cartilage.

The authors say that even though it’s more expensive, combining these two imaging studies is necessary for finding OCL. In cases of chronic ankle pain, OCL is often the problem. The imaging studies show the exact location and help doctors as they go about repairing the damage.

Scientists Find New Risk Factor for Ankle Sprain

Take a look at your ankle bones. Are they straight across from each other? Is one in front of the other? Research shows that the position of these bones might have something to do with ankle injuries. Ankle sprains are a common sports injury. Identifying risk factors could help prevent ankle injuries. Could bone position be an identifying risk factor? This study compared the ankle bone position of two groups. One group of 61 patients had just sprained their ankles. The other group of 101 adults without ankle injury was the control group.

The researchers used CT scans to look at the position of the bones around the ankle. They found a range of positions for the control group from -8 to +16 degrees. If the bones are exactly across from each other, the angle is zero. If the outside bone (lateral malleolus) is in front of the inside bone (medial malleolus), the angle is negative. If the lateral malleolus is in back of the medial malleolus, the angle is positive. This measurement is called the malleolar index.

The group with ankle sprains had a wider index range, from -6 to +39 degrees. After analyzing the results, the authors report a higher number of injuries in patients with a positive malleolar index. In this group the lateral malleolus is behind the medial malleolus. The lateral malleolus is the bottom part of the bone along the outside of the lower leg, called the fibula.

How does knowing this help us? It shows us that some people may be more likely to injure their ankle than others. The authors point out this difference in anatomy doesn’t lead to injury until the body is in action. Many factors can cause ankle sprains. A posterior fibula is only one and may not make a difference by itself.

These scientists say the next step is to study the specific effect of this anatomic difference on ankle sprains. They will do this during athletic events. It may be that players with a posterior fibula should use an ankle brace or splint during sports to prevent injury. Perhaps special exercises will could also help.

Early Ankle Motion after Achilles Tendon Tear

Achilles was a Greek mythological hero. When he was young, his mother held him by the heel and dipped him in the river Styx. Everything the sacred waters touched became strong and unbeatable. The heel remained dry and was unprotected, leaving Achilles’ heel weak and at risk for injury.

In human anatomy, the Achilles is the tendon from the calf muscles to the heel. It’s the thickest and strongest tendon in the body. When it’s injured or torn, a person has trouble putting weight on the foot or walking on it. Like the mythologic hero, Achilles, the tendon is a mystery. How to treat it to get the fastest and best results is unknown. This study attempts to sort out some treatment options after surgery for an Achilles rupture. Two groups of patients were studied.

In the first group, the Achilles tendon was repaired surgically. The ankle was put in a cast with the toes pointed down. This position is called equinus or plantigrade. Group one was told to put weight on the foot and leg as soon as possible. The cast was changed after two weeks.

Group two also had surgery to repair the tendon, and the lower leg was put in a cast. The cast was changed at two weeks and at four weeks. Each time the position of the ankle and foot was changed slightly. Group two didn’t put weight on the foot until after week four.

Researchers found that by putting tension on the tendon during healing, the tendon healed faster. Early ankle motion and putting weight on the foot in group one resulted in faster return to work and play. Overstretching the tendon is avoided. The cast prevented too much motion in the wrong direction.

Patients in group one stopped using their crutches sooner than group two. Group one had fewer visits to a physical therapist and reported greater satisfaction with the results of early treatment. Both groups went back to regular physical activity, sports, and work in about the same amount of time.

The authors conclude that early tension on the repaired Achilles tendon is a good idea. The best results come when the Achilles tendon is put under tension early in the healing and recovery phase. This breaks with the traditional treatment of no weight bearing for six weeks.

Cast and Walking Boot Used to Treat Achilles Tendon Tear

Is an operation needed to repair a torn Achilles tendon? Doctors still don’t agree on the best way to treat these injuries. The Achilles is the tendon that attaches to the calf muscle in the lower leg. Everyone agrees it heals faster with tension, so patients are allowed to use the muscle early on in the recovery process.

But whether or not the tendon heals faster and better with or without surgery is unknown. This study from Switzerland compared two groups of patients with Achilles tendon rupture. The first group was operated on using a simple stitch to repair the torn tendon. Patients wore a cast below the knee. When swelling and pain decreased, the cast was replaced with a special removable splint that allowed walking. The patients were allowed to put weight on the ankle and foot as soon as was possible.

The second group did not have surgery. They were put in an ankle cast and special boot with a heel to keep the ankle in a slightly flexed (foot pointed down) position. This is called the equinus or plantar flexed position. It protects the tendon from overstretching too early. Walking was allowed with as much weight as the patient could handle. The boot (but not the cast) could be taken off at night.

Both groups had good results. People who didn’t have surgery went back to work sooner than the surgery group. People who didn’t have surgery also had faster pain relief and could walk sooner. However, there were more re-ruptures in the nonoperative group. Some of these injuries were from new accidents, such as falling down stairs.

The authors of this study say nonoperative treatment has to be started right away to be successful. The torn ends of the tendon must be positioned just right for healing in the first 24 to 48 hours. The healing tendon must be protected during the early phase of healing to prevent new ruptures. The most vulnerable phase is from six to 12 weeks after the injury.

Choosing before Fusing: Which Method is Best?

Nobody really wants to lose spine motion, but sometimes spinal fusion is the only way to get rid of pain and hold the problem part of the spine together. If one or more segments of the spine must be fused, what’s the best way to do it? What method gives the best result?

This is the focus of a recent study from Japan. The researchers looked at 19 cases of degenerative spondylolisthesis. In spondylolisthesis, there is a fracture in one of the columns of bone supporting the vertebra. The body of the damaged vertebra slips forward over the vertebra below it. This condition causes many problems. Holding the bone in place is important. Screws and bone graft are often used to do this. The result is called a posterolateral fusion.

A newer method of fusion for spondylolisthesis is the posterior interbody lumbar fusion (PLIF). PLIF uses devices that look like cages. Cages are made of titanium, bone, or graphite and fit between the vertebral bones. During PLIF surgery, the disc material is removed through an incision in the back. The cages are filled with bone graft material and inserted in the space where the disc material was taken out.

It’s hard to say if one fusion method is best for everyone. Each patient has his or her own unique problems and needs. Different patients have different amounts of spinal damage and instability. The surgeon tries to restore the patient’s normal spinal angles and curves.

Is extra support needed along the front of the spine? The cages used in PLIF can also be put in from the front of the spine to support the front column of the spine. In this study, researchers use a special tool to measure how much force it takes to spread apart (or distract) the bones at the fused site. This force is called distraction stiffness. It is a measure of spinal stability. The researchers compared the amount of distraction stiffness with findings on X-rays. Since doctors can’t measure distraction stiffness before surgery, the hope is that X-rays show the same information in a different way. The X-rays show disc angle, spinal range of motion, and disc height.

The authors report that disc angle in flexion and range of motion as seen on X-ray can be used to help decide if a patient needs anterior column support. The researchers report which patients could benefit the most from this type of fusion. The authors say the information from this study will help in deciding if anterior column support is needed in lumbar fusion.

Japanese Doctors Eye New Method for Repairing Cartilage Damage in the Ankle

How do doctors get the word out when they’ve made a new discovery or tried something different that worked? They use technical notes. This is a short article in a medical journal telling what they did, how they did it, and the results.

Doctors from the Hirosaki University School of Medicine in Japan wrote a technical note on an ankle problem involving the talar dome. The talar dome is a curved surface on top of the ankle bone, the talus. Sometimes a small area of bone with its covering of cartilage tears in this area. It can be a small tear, a partially detached piece, or a piece torn off completely. Complete tears create osteochondral lesions (OCL). The OCL fragment may stay connected to the dome, or it may move into another part of the joint.

Surgery is one treatment for OCL. How the operation is done depends on the size and location of the tear. A tear in the front of the joint is easier to reach. Only a small incision is needed. A tear in the back is more difficult to treat. Usually, the doctor has to remove the ankle bone on the inside of the leg to get to a back tear. This part of the ankle is called the medial malleolus.

In this study, doctors report a new way to reach an OCL in the back. Instead or removing the medial malleolus, the surgeon drills a tunnel through the bone. Then an arthroscope is passed through the tunnel to the talar dome. An arthroscope is a slender tool with a tiny TV camera on the end. It allows the doctor to see inside the joint and repair the damage.

There is a danger of breaking the malleolus when drilling through it. These doctors haven’t had this problem. They were even able to return the core of bone taken out when the tunnel was made. Patients are able to move the foot right away, and they can put partial weight on the ankle two weeks after the operation.

The authors say that OCL of the talus is hard to treat. They report using this new method to go through the malleolus works well if done right.

Brace Yourself to Prevent Ankle Sprains

Sports injuries. If you haven’t had one yourself, you’ve probably watched on TV as players were injured on the field. Everyone waits in silence until the player is able to get up and leave. It’s the one moment when even opponents applaud the athlete.

One-quarter of those injuries occur at the ankle and foot. So if the athlete is hobbling off the field on one leg, it could very well be a foot or ankle injury. Ankle sprain is the most common ankle injury. Wouldn’t it be better to wear an ankle brace and prevent that injury? That’s the focus of this study by a group of physical therapists at the University of North Carolina at Chapel Hill.

First researchers identified people at greatest risk for ankle sprain. They found three groups at risk: people who have sprained their ankles before, military trainees, and athletes. Not all athletes are at increased risk. Risk increases for those who are at higher levels of competition. It’s also higher in sports that involve jumping, landing, and cutting from side to side. Soccer and basketball players rank the highest in ankle sprains.

A review of studies already done in this area show that athletes with a previous ankle injury are two to five times more likely to reinjure the ankle. Military personnel in basic training or involved in parachute jumping are at risk. Other risk factors are female gender, exercising on uneven ground, and college level sports (compared to high school).

These researchers also reviewed studies to see if ankle bracing prevents injuries (or reinjuries) from occurring. They found ankle bracing does reduce injuries, especially for anyone who’s had a previous ankle sprain.

Finally, what kind of ankle brace works best? Tape, cloth, canvas, or plastic? Should the brace be soft, hard, or semi-rigid? The authors say it may be a matter of trial and error. It’s best to find a brace the athlete will wear. If the brace rubs the skin or slows the player down, he or she won’t wear it. Softer braces that mold to the ankle may work best.

With the new line of ankle supports coming out, more research is needed to compare which ones work the best for each group of athletes or trainees.

A STAR of Hope for Ankle Arthritis

Slowly but surely, ankle joint implants are making their way onto the market with better and better results. Whether you have rheumatoid arthritis, osteoarthritis, or arthritis after trauma, these implants can replace the damaged ankle joint.

Studies from around the world are helping reshape and redesign ankle implants. The tools used during the surgery to put the new joint in place are also improving. This study from Sweden reviews the results of 51 uncemented STAR (Scandinavian Total Ankle Replacement) implants.

The operations were all done between 1993 and 1999. Since that time the implants have improved. Doctors now use even better tools. Early results with the STAR weren’t as good as implants just five years later.

The authors report that getting full ankle motion back isn’t always easy. Ankles with good motion before the operation actually lose range after the operation. Getting full dorsiflexion (pulling toes toward the nose) is a common problem with the STAR.

The operation to replace the ankle takes a lot of skill and practice. In this review, technical failures resulted in the need to replace the original joint replacement. Sometimes just one part of the implant was replaced. In other cases the implant was removed and the ankle joint fused. These problems are getting worked out over time.

The authors conclude the ankle joint replacement has its place. Patients with rheumatoid arthritis seem to do the best and get enough motion to walk normally. Choosing the right-sized implant and putting it in correctly are important.

Even with an experienced surgeon and the right implant, failure is still possible. The risk of implant loosening and failure is much higher with ankle implants than with total hip or knee replacements. Researchers are working to change this and improve the outcome with STAR.

The Achilles Tendon: Use It or Lose It?

When muscles aren’t used, they tend to get weaker and shrink in size. Bones that aren’t used become less dense and weaker. When tendons aren’t used, they become weaker too. When tendons are weak, they are more likely to tear.

The Achilles tendon, which runs down the back of the lower leg and connects to the heel, is one of the most commonly torn tendons. It usually tears while jumping or cutting during sports activities. A torn Achilles tendon typically causes much pain and disability, and it almost always requires surgery.

These researchers tested the effects of immobilizing the Achilles tendon in rabbits. The rabbits wore a cast on one leg for up to eight weeks. Tendon function was then compared to the legs that had not been immobilized. The idea was to study any changes in the tendon and find out how it had weakened while in the cast.

The immobilized tendons looked the same as the healthy tendons under the microscope. However, they functioned much differently. The immobilized tendons had less range of motion. When researchers tested them under conditions of jumping, the tendons often broke at the point where they join the heel. Sometimes the heel bone actually broke, too. These tears most likely happen because of the reduced bone density that comes with immobilization. The researchers were surprised to find that the main part of the tendons did not rupture, which is usually how Achilles tendon tears happen in sports injuries.

The authors conclude that immobilization is not as damaging to the Achilles tendon as doctors may have thought. They suggest that rehabilitation after immobilization of the leg may need to focus more on regaining bone density than on strengthening the tendons, although more research is needed.

The Ins and Outs of Ankle Sprains

Ankle sprains are the most common injury to the soft tissue in the body. Most people turn the ankle inward and sprain the lateral ligament. This is called an inversion injury. After such an injury, almost half of all patients continue to suffer minor problems. Patients often report there is a sensation that the ankle is going to give way.

Since so many people are affected by this injury, physical therapists are trying to find out if there is muscle weakness causing ankle sprains. From other studies, we know that the muscles on either side of the ankle are in balance with each other in the normal ankle.

A study to measure the strength of these muscles was done in Australia. A special machine was used to measure muscle contractions around the ankle. Sixteen men and women with a sprain of one ankle were included.

Researchers were able to compare the injured side to the noninjured side in this group. Earlier studies showed that there is no major difference in muscle strength from side to side in the ankle. The authors of this study reported that weakness of the muscles that twist the ankle out (evertors) doesn’t seem to affect the ankle.

Weakness of the muscles that turn the ankle in (invertors) are believed to lead to ankle sprains. This is the opposite of what therapists have always thought about ankle sprains. In the past, weakness of the evertors has been blamed for inversion sprains.

Researchers think that muscle weakness of the invertors, combined with the body weight shifting over the ankle, may be the real issue. The ankle invertors can’t hold the foot down as the body weight shifts over the foot. The arch lifts up and the foot is forced inward, resulting in injury. The authors of this study suggest exercises to strengthen the invertors.

Comparison of Braces and Casts after Surgery for Ankle Fracture

A broken ankle is the most common fracture treated in hospitals. They are increasingly common in active younger people and in the elderly. Some ankle fractures need surgery that includes metal plates and screws to make the ankle stable again. After this type of surgery, patients usually wear a cast.

These authors questioned whether ankle braces might work better than a cast. Doctors now think that complete immobilization can get in the way of the healing process. Complete immobilization can result in less range of motion, muscle loss, and osteoporosis. Braces allow some movement, which could help avoid these problems.

The authors tested their theory. They divided 100 patients who needed surgery for ankle fractures into two groups. One group of patients wore a below-knee cast for six weeks. They used crutches for the first two weeks, until the stitches were removed. Then they were allowed to put some weight on their leg for two more weeks, and full weight for the final two weeks. The second group wore a specific kind of ankle brace for six weeks. They followed the same weight-bearing schedule as the cast group. They also took the brace off every day to do range-of-motion exercises. After the six weeks were up, both groups began more active exercises.

All patients were evaluated over the two years after surgery. They got regular X-rays and physical exams, and they answered questions about their ankle function and activities. The authors saw no major differences between the two groups in any of the tests or the questions. The two groups spent almost exactly the same amount of time in the hospital. They also returned to work at about the same time.

However, there was one significant difference between the two groups. Only eight of the 50 people in the cast group had post-surgical problems (such as wound infections). But 33 patients in the brace group had post-surgical problems, mainly with the wound. The authors note that two of the patients in the cast group developed a deep venous thrombosis (a blood clot) that was treated successfully. A blood clot can be life threatening if not treated. Clots can form because of lack of movement after surgery. None of the patients in the brace group developed blood clots.

The authors conclude that casts and the braces work equally well after surgery to repair an ankle fracture. However, they warn that the high risk of complications with ankle braces after surgery means that extra care needs to be taken if a brace is used instead of a cast. More research on how to best use casts and braces after surgery for ankle fracture seems necessary.

One-Two Punch for Ankle Sprains

If you sprained your ankle this year, you’re one of a million people in the United States who did the same. About half of these injuries are sports-related. Besides the usual treatment of RICE (rest, ice, compression, elevation), did you take an over-the-counter medication? Doctors often suggest ibuprofen for the pain and swelling.

A new drug called Celecoxib (Celebrex) is now available. Doctors studied 445 adult patients with ankle sprains to see if Celebrex was any better than the usual ibuprofen. Celebrex is part of a group of drugs called COX-2 inhibitors. These drugs are generally easier on the stomach. Ibuprofen and other anti-inflammatory drugs sometimes cause stomach pain, upset, and even ulcers.

Medications help speed recovery from ankle sprain when taken along with RICE treatments. Ibuprofen and Celebrex are both good at reducing the pain and swelling. Using either of these drugs, patients are able to get back to their normal activities or work. They can do this faster than if no medication is used.

Faster healing is important. Swelling prevents normal ankle motion, keeping the patient from normal walking and activities. Delayed healing can put the patient at risk for another injury. Celebrex added to traditional treatment can speed recovery. It appears to be equal to, but not necessarily better than, ibuprofen for ankle sprains.

These Boots Are Made for Snowboarding

Snowboarding has become an increasingly popular sport. Injuries from snowboarding are also on the increase. Most of the injuries are to the arms, caused by falls. About 20 percent of the accidents affect the legs. Half of these occur in the lead foot. Most leg injuries are a result of wearing soft boots.

The lead foot absorbs most of the physical stress that comes with snowboarding. This can result in leg, ankle, and foot injuries. Rigid snowboard boots allow only a small amount of ankle motion. This limits how much the muscles can contract and protects the lower leg from overuse. Soft boots don’t offer this kind of protection.

Snowboarding injuries don’t just happen with overuse. Damage to the lower leg can also occur from poorly fitted equipment. Boots that are too big allow the muscles to come in contact with the stiff upper boot. The slicing motion of the boot back and forth against the muscle can cause a condition called compartment syndrome. Compartment syndrome occurs when injury to a confined area, or compartment, causes a buildup of swelling. Along with the fluid build-up, there is decreased circulation to muscles and nerves in the area.

Compartment syndromes are very painful. These must be treated right away to save the muscles. Surgery to release the lining of the compartment around the muscles is needed. These kinds of injuries can be prevented in snowboarders with proper size and use of equipment. Rigid boots that fit correctly are essential in both snowboarding and downhill skiing. Changes in the way boots are made may also help.

It May Pay to Ice before You Play

Icing is one of the main treatments for injured or sore joints. Athletes ice their sprains and strains after training, after competition, and after rehabilitation exercises. But could icing be useful to these athletes before training, competition, and rehabilitation? The experts disagree. Some think icing before exercise makes athletes more likely to injure a joint. Others think the healing benefits of icing can help muscles and joints perform better.

This research added some data to the debate. The authors targeted the soleus muscle, the deeper of the two calf muscles. Thirty healthy volunteers were tested for nerve reaction and strength in the soleus. Then 15 of the volunteers iced their ankles for 30 minutes, similar to the way a sprained ankle would be iced. All of the volunteers repeated the tests after 30, 60, and 90 minutes. Skin temperatures were also recorded.

The results showed that icing improved muscle strength and nerve reaction. The volunteers who iced their ankles had better results after icing, and they also had better results than the control group. This data suggests that icing would improve joint and muscle function. The authors note that they don’t know how exactly the icing affects the joints. They also warn that results might be different in other muscles of the ankle and in other joints.

At Odds with Ankle Taping

Does ankle taping before exercise help prevent ankle sprains? Some exercise specialists think so. Some, including these authors, don’t. They tested the effects of ankle tape and ankle braces on landing force. What they found suggests that ankle taping might prove harmful.

The authors had 14 healthy, active volunteers drop from a box onto a platform. The platform measured the force of the landing on the ankle. The volunteers went through three testing sessions. In one session they wore an ankle brace. In one their ankle was taped. And in another, they had no tape or brace. The volunteers did six stiff (knees straight) and six soft (knees bent) landings before and after 20 minutes on a treadmill.

What the authors found is that taping and bracing, in effect, short circuit the natural shock absorber. Normally, the feet, ankles, legs, and hips all work together to absorb forces from running and jumping. This research showed that taping and bracing compressed the landing force into a shorter time period. This means higher stress on the joints and muscles. It may also mean that the knee and hips have to work harder and deal with more force.

The authors also noted that the taping and bracing results were the same before and after the treadmill run. Past research suggests that tape and braces become looser during exercise, letting the joint move more freely. This would lessen any effect of taping and bracing.

However, the authors point out that the treadmill run in this study was much different than regular sports activity for many athletes. Many exercises demand more jumping, stopping, and bursts of activity. And 20 minutes is not a very long bout of exercise for many athletes. Also the braces were new and therefore very stiff. An older brace might lose its stiffness quicker.

More research is needed to find out what these results really mean. The authors suggest a detailed analysis of how the legs and hips handle landing force with and without ankle tape and ankle braces. They also feel that more research using different types of braces and more intense exercise would help focus the taping debate.

Scoping Out a Rear View of the Ankle Joint

The ankle is a unique and complex joint. Getting inside the ankle to repair or remove tissue is often a challenge for doctors, especially when they need to work from the back of the ankle. Nerves and blood vessels can be damaged easily in this part of the ankle. Making a large incision to open up and visualize the back of the joint is one way to avoid damage.

Doctors around the world are trying to find an easier way to solve this problem. The arthroscope may help find an answer. An arthroscope is a slender instrument that can be inserted into a joint. It has a tiny TV camera on the end that allows the doctor to see inside the joint and perform the needed repairs.

Doctors in the Netherlands and Italy are working together to find a safe way to enter the back of the ankle joint using an arthroscope. They are using cadavers to practice first. Cadavers are human bodies preserved for study.

Using a cadaver gives the doctor the chance to insert instruments and then open the joint to see where the instruments are located. The doctors can then measure how close the instrument gets to nearby nerves or blood vessels. Researchers use this method to give other doctors specific directions. They can describe where and how to place surgical instruments for the safest approach and best results.

These authors found a place to insert the arthroscope in an area along the inside edge of the back of the ankle. According to the authors, this spot provides safe clearance of the arthroscope from the nerves and vessels.

Inside Scoop on Avoiding Future Ankle Sprains

What’s the number one goal of an athlete who’s been injured? Get back into the game! Trainers and physical therapists see this a bit differently. They want to return athletes to sport quickly, but without reinjury.

Reinjury is very common with ankle sprains. Rehabilitation restores ankle motion. Even so, up to 80 percent of athletes injure their ankles again. This is a puzzle to experts in sports medicine. A group of physical therapists studied this problem more closely.

The therapists measured ankle motion in 12 athletes who had ankle sprains on the outside of one ankle. This is called lateral ankle sprain. The therapists also looked at normal gliding motions of the bones that make up the ankle joint. All 12 athletes could fully move their injured ankles, but the normal gliding motion within the ankle joint hadn’t been restored. The reasons for this are unclear.

When treating an ankle sprain, it’s not enough to exercise the joint and stretch the muscles to restore joint motion. Treatment must also focus on the specific motions of the anklebones. Restoring bone glide may help prevent further injuries.

Surgery for Athletes with Chronic Ankle Sprains: Two Methods Compete

About half of all ankle sprains happen during sports. Most sprains get better without surgery. But in 20 percent of cases, one sprain leads to another. When this happens, surgery is needed.

There are a number of surgical techniques to restore ankle stability. These can be divided into two groups. One is called anatomic reconstruction. With this method, surgeons use the original ankle ligaments to repair the ankle. In the other method, called tenodesis, surgeons reconstruct the ankle ligament using tissue from elsewhere in the body, such as the lower leg.

Some studies suggest that anatomic reconstruction has better results. However, these studies have been done on patients with varied activity levels. Obviously, the amount of activity or stress placed on the ankle after surgery affects the results. These authors zeroed in on athletes, to see which surgery held up better under heavy functional demands.

Forty-one athletes had anatomic reconstruction. Thirty-six had tenodesis. All of the patients had tried other kinds of treatment for at least six months before surgery. After surgery, patients wore casts for six weeks. Then they started exercises to improve motion in the joint.

Patients were followed-up about five years after surgery. Compared to patients who had anatomic reconstruction, patients who had tenodesis were more likely to be less active because of the operated ankle. Tenodesis patients had less movement bending their foot upward, and push-off power than the other group. They also showed more looseness in the joint and degenerative changes. Taken together, these problems may lead to more injury and shorten the athlete’s career.

Fifty-eight percent of patients in the tenodesis group had good or excellent results from surgery. In contrast, 88 percent of patients who had anatomic reconstruction had good or excellent results. The authors think anatomic reconstruction is the best choice for athletes with chronic ankle sprains. This method has a better chance of restoring normal movement and stability to the ankle so the athlete can safely return to sport.

Ankles Smile for the Camera

Tendinopathy affects tendons by causing pain, swelling, and poor physical performance. It isn’t simply a problem of inflammation as in tendinitis. Rather, tendinopathy causes degeneratation in the cellular make-up of the tissue. Tendinopathy of the Achilles tendon–the tendon that joins the calf muscles to the heel bone–often comes from intense athletic training and overuse. People with this condition often get better without surgery. But about 25 percent of people with chronic problems need surgery.

Achilles tendon surgery using large incisions (open surgery) causes wound healing problems in 10 to 15 percent of patients. These authors wanted to explore the use of a less invasive surgical technique. They used an endoscope, an instrument with a tiny camera on the end of it. This lets doctors see inside the body without making big incisions in the skin. This instrument has been used in many joint surgeries. However, only a few studies have examined endoscopic surgery for tendon problems.

Seven patients with chronic Achilles problems had this type of surgery. The patients were recreational athletes who didn’t improve after a few months of physical therapy. Their symptoms included pain with activity, morning stiffness, tenderness, and poor sports performance. In some cases, they also had changed walking patterns and decreased strength.

Doctors used an endoscope to “release” the inflamed tissue and shave off any damaged tissue. Three to six days after surgery, most patients were allowed to put weight on the affected leg. Patients returned to sports gradually. Three to six weeks after surgery, they started jogging.

Before and after surgery, patients’ symptoms were rated on a scale of zero to 100, with zero being the worst symptoms. Before surgery, the average score was 39. About a year after surgery, all but one of the patients scored in the 90 to 100 range. (The patient with the lowest score had stopped rehabilitation because of an unrelated health problem.) MRI showed no degenerative changes in the tendon after surgery.

There were no major complications from surgery. Though the number of patients studied was small, the authors think this procedure may have several benefits over open surgery for the treatment of chronic Achilles tendinopathies. The endoscopic procedure is faster and easier. It reduces symptoms and get patients back to their activities without the added complications of wound healing. Still, more studies are needed to confirm these results.