SLR - November 2023 - Moon
Title: Risk factors for chronic ankle instability after first episode of lateral ankle sprain: A retrospective analysis of 362 casesReference: Zhang J, Yang K, Wang C, Gu W, Li X, Fu S, Song G, Wang J, Wu C, Zhu H, Shi Z. Risk factors for chronic ankle instability after first episode of lateral ankle sprain: A retrospective analysis of 362 cases. Journal of Sport and Health Science. 2023 Mar 15.
Reviewed By: Zohaib Moon, PGY-3
Residency Program: HCA Florida Northwest Hospital. Margate, FL
Podiatric Relevance: This article is of significant interest to podiatric surgeons due to its focus on lateral ankle sprains (LAS) and their potential long-term consequences, particularly the development of chronic ankle instability (CAI). LAS is a common injury among young and active individuals, and it can lead to various issues, including pain, swelling, recurrent injury, and impaired joint function. These problems place a substantial social and economic burden on individuals and society as a whole. Podiatric surgeons often encounter patients with ankle injuries, making it crucial to understand the risk factors associated with the development of CAI after an acute LAS. Additionally, the article explores the value of magnetic resonance imaging (MRI) in predicting CAI, which could have implications for diagnostic and treatment strategies in podiatry.
Methods: This study employed a retrospective cohort design. Key aspects of the methodology included patients who visited the emergency department for a first-episode LAS and received both plain radiographs and MRI scans of the injured ankle within two weeks of the injury. Additionally, the use of the Cumberland Ankle Instability Tool (CAIT) for assessing CAI development at the last follow-up. Lastly, a definition of CAI according to specific criteria was formalized, followed by a statistical analysis to identify factors associated with CAI development.
Results: The study included 362 patients with a mean age of 27.5 years, and 40.3% were female. The main findings were as follows: The incidence of CAI after first-episode LAS was 36.2%. Factors associated with CAI development included age, BMI, posterior talofibular ligament (PTFL) injury, large bone marrow lesions (BML) of the talus, and Grade 2 effusion of the tibiotalar joint. Clinical examinations (10-m walk test, anterior drawer test, and inversion tilt test) were valuable for determining the need for MRI scanning.
Conclusions: The study concluded that MRI scanning can be valuable for predicting the development of CAI after a first-episode LAS. Additionally, it suggested that clinical examinations, when positive, can help determine which patients should undergo MRI scanning. The identified risk factors, such as age, BMI, PTFL injury, BML of the talus, and tibiotalar joint effusion, provide valuable insights for podiatric surgeons in assessing and managing patients with LAS to prevent the development of CAI. Further prospective studies are needed to validate these findings and improve clinical practice in podiatry.