• Journal of Korean Foot and Ankle Society
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• v.22 no.2
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• pp.55-61
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• 2018

Chronic lateral ankle instability is a major complication of acute ankle sprains, which can cause discomfort in both daily and sports activity. In addition, it may result in degenerative changes to the ankle joint in the long term. An accurate diagnostic approach and successful treatment plan can be established based on a comprehensive understanding of the concept of functional and mechanical instability. The patients' history and correct physical examination would be the first and most important step. The hindfoot alignment, competence of the lateral ligaments, and proprioceptive function should be evaluated. Additional information can be gathered using standard and stress radiographs. In addition, concomitant pathologic conditions can be investigated by magnetic resonance imaging. Conservative rehabilitation composed of the range of motion, muscle strengthening, and proprioceptive exercise is the main treatment for functional instability and mechanical instability. Regarding the mechanical instability, surgical treatment can be considered for irresponsible patients after a sufficient period of rehabilitation. Anatomic repair (modified $Brostr{\ddot{o}}m$ operation) is regarded as the gold standard procedure. In cases with poor prognostic factors, an anatomical reconstruction or additional procedures can be chosen. For combined intra-articular pathologies, arthroscopic procedures should be conducted, and arthroscopic lateral ligament repair has recently been introduced. Regarding the postoperative management, early functional rehabilitation with short term immobilization is recommended.

• Korean Journal of Applied Biomechanics
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• v.32 no.1
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• pp.9-16
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• 2022

Objective: The purpose of this study was to investigate how the chronic ankle instability affects postural control during forward jump landing. Method: 20 women with chronic ankle instability (age: 21.7 ± 1.6 yrs, height: 162.1 ± 3.7 cm, weight: 52.2 ± 5.8 kg) and 20 healthy adult women (age: 21.8 ± 1.6 yrs, height: 161.9 ± 4.4 cm, weight: 52.9 ± 7.2 kg) participated in this study. For the forward jump participants were instructed to stand on two legs at a distance of 40% of their body height from the center of force plate. Participants were jump forward over a 15 cm hurdle to the force plate and land on their non-dominant or affected leg. Kinetic and kinematic data were obtained using 8 motion capture cameras and 1 force plates and joint angle, vertical ground reaction force and center of pressure. All statistical analyses were using SPSS 25.0 program. The differences in variables between the two groups were compared through an independent sample t-test, and the significance level was to p < .05. Results: In the hip and knee joint angle, the CAI group showed a smaller flexion angle than the control group, and the knee joint valgus angle was significantly larger. In the case of ankle joint, the CAI group showed a large inversion angle at all events. In the kinetic variables, the vGRF was significantly greater in the CAI group than control group at IC and mGRF. In COP Y, the CAI group showed a lateral shifted center of pressure. Conclusion: Our results indicated that chronic ankle instability decreases the flexion angle of the hip and knee joint, increases the valgus angle of the knee joint, and increases the inversion angle of the ankle joint during landing. In addition, an increase in the maximum vertical ground reaction force and a lateral shifted center of pressure were observed. This suggests that chronic ankle instability increases the risk of non-contact knee injury as well as the risk of lateral ankle sprain during forward jump landing.

• Journal of Korean Foot and Ankle Society
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• v.23 no.1
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• pp.1-5
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• 2019

Surgical treatment to restore stability in the ankle and hindfoot and prevent further degenerative changes may be necessary in cases in which conservative treatment has failed. Anatomical direct repair using native ligament remnants with or without reinforcement of the inferior retinaculum is the so-called gold standard operative strategy for the treatment of lateral ankle instability. Non-anatomical lateral ligament reconstruction typically involves the use of the adjacent peroneus brevis tendon and applies only those with poor-quality ligaments. On the other hand, anatomic reconstruction and anatomic repair provide better functional outcomes after the surgical treatment of chronic ankle instability patients compared to a non-anatomic reconstruction. Anatomical reconstruction using an autograft or allograft applies to patients with insufficient ligament remnants to fashion direct repair, failed previous lateral ankle repair, high body mass index, or generalized ligamentous laxity. These procedures can provide good-to-excellent short-term outcomes. Arthroscopic ligament repair is becoming increasingly popular because it is minimally invasive. Good-to-excellent clinical outcomes have been reported after short and long-term follow-up, despite the relatively large number of complications, including nerve damage, reported following the procedure. Therefore, further investigation will be needed before widespread adoption is advocated.

• Journal of Korean Foot and Ankle Society
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• v.26 no.4
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• pp.171-176
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• 2022

Purpose: This study reports on a series of patients with chronic lateral ankle instability that underwent the Brostrom procedure with suture tape augmentation and allowed early unrestricted weight-bearing in a simple stirrup brace. Materials and Methods: This retrospective study was conducted on 36 patients (22 males and 14 females of mean age 34 years [range 23~48 years]) with chronic lateral ankle instability treated using the Brostrom procedure using suture tape augmentation and inferior extensor retinaculum reinforcement with a fiber-wire connected to a SwiveLock screw inserted into the talus. When possible, patients started unrestricted weight-bearing in a stirrup brace from the third postoperative day. Demographics and functional outcomes, including American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot, visual analogue scale (VAS), and satisfaction scores, were recorded. In addition, varus stress radiographs obtained before and 24 months after surgery were compared. Patients were followed for a mean 29 months (range 25~40 months). Results: Mean AOFAS ankle-hindfoot scores increased from 51 points preoperatively to 92 points at final follow-up, and mean VAS decreased from 6.8 to 1.2 points. Mean patient satisfaction scores were 8.7 at 12 months and 9.6 at 24 months. Stress radiographs demonstrated that talar tilt decreased from a mean 18 degrees preoperatively to 7 degrees at 24 months. Conclusion: Early unrestricted weight-bearing in a stirrup brace following the Brostrom procedure with suture tape augmentation is a successful protocol for treating chronic lateral ankle instability.

• Journal of Korean Foot and Ankle Society
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• v.25 no.1
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• pp.6-9
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• 2021

The term chronic lateral ankle instability (CLAI) embraces a spectrum of conditions that involve functional and mechanical instability, both in athletes and lower-demand patients. The hallmarks of CLAI are recurrent sprains, persistent pain, and repeated episodes of the ankle giving way. CLAI is the main complication of acute ankle sprains, which can cause discomfort in daily and sports activity. Approximately 10% to 30% of patients with acute ligament ruptures will develop chronic instability over the course of a year from the index injury. An accurate diagnostic approach and successful treatment plan should be established based on a comprehensive understanding of the concept of functional and mechanical instability. Unfortunately, the optimal modality for the management of CLAI is unclear. Even after conservative treatment or surgical intervention, it could result in degenerative changes to the ankle joint in the long term. Thus far, the incidence of ligamentous posttraumatic ankle osteoarthritis was reported to be 13% to 78%. The mean latency time between injury and osteoarthritis was at least 10 to 34.3 years. CLAI is an important pathological condition that can cause discomfort or dysfunction in daily activity in the short term, resulting in joint destruction in the long term. Therefore, it is important to understand the various complications that can occur when CLAI is not treated properly.

• Journal of Korean Foot and Ankle Society
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• v.9 no.2
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• pp.197-200
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• 2005

We performed lateral ankle ligament reconstructions using Achilles allograft on patients who had failed previous Brostrom repair. The bone plug is fixed with an interference screw into the calcaneus, the tendon graft is passed through a fibular tunnel, and then anchored into the talus with the biotenodesis screw. The graft is strong enough to maintain joint stability until graft incorporation and remodeling occurs. In patients with chronic failed lateral ankle instability requiring graft for ligament reconstruction, this technique allows anatomic reconstruction without the need to sacrifice autogenous peroneal tendons.

• Journal of Korean Foot and Ankle Society
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• v.24 no.2
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• pp.98-101
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• 2020

We report on the case of a patient with chronic instability of the ball-and-socket ankle joint. The patient, a 21-year-old male, was diagnosed 10 years previously with chronic instability of the ball-and-socket ankle joint. He underwent Broström procedure and augmentation using a periosteal turn down from the fibula for this chronic instability despite having received conservative treatment since the diagnosis. After the procedure, the clinical symptoms of ankle instability were improved and the patient is being periodically followed-up. We report on this case of using a Broström procedure as a treatment option for patients with instability of the ball-and-socket ankle joint with normal range of foot and normal ankle joint alignment without damage in the joint and cartilage.

• The Journal of Korean Physical Therapy
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• v.34 no.3
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• pp.91-97
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• 2022

Purpose: This study investigated the short-term effectiveness of extracorporeal shock wave therapy (ESWT) on pain, the ankle instability, the ankle function, dorsiflexion range of motion (ROM), and dynamic balance in patients with chronic ankle instability (CAI). Methods: Eighteen participants were divided into an experimental (n=9) and control group (n=9). The ESWT in the experimental group was applied to the lateral collateral ligament in combination with the tibialis anterior whereas the ESWT was applied to the lateral collateral ligament of the ankle alone in the control group. Pain, the ankle instability, the ankle function, dorsiflexion ROM, and dynamic balance were measured using the Visual analog scale, Cumberland ankle instability tool, American Orthopedic Foot and Ankle Society ankle-hindfoot score, weight-bearing lunge, and Y-balance test, before and after ESWT intervention. Results: Significant interactions (group × time) and time effects were observed in the dorsiflexion ROM and dynamic balance. Bonferroni's post-hoc analysis showed that the experimental group revealed a more significant change in dorsiflexion ROM and dynamic balance than the control group. There was a significant time effect in the pain, the ankle instability, and the ankle function, but no significant interaction (group × time) was observed. Conclusion: The ESWT could improve the pain, ankle instability, ankle function, dorsiflexion ROM, and dynamic balance in patients with CAI. Furthermore, the ESWT combined with lateral ankle ligaments and tibialis anterior more improves the dorsiflexion ROM and dynamic balance.

• Journal of International Academy of Physical Therapy Research
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• v.9 no.4
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• pp.1608-1613
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• 2018

The purpose of this study was to investigate the effects of sling exercise on muscle activity and balance on football players with chronic ankle instability. Eight subjects performed Biodex and sling exercises for four weeks and compared the muscle activity and balance ability of the uninjured and injured feet. Stable and unstable foot % MVIC did not change significantly after treatment in all muscles. The total balance ability was not significantly different between the two groups, however, increased only in the unstable side. The anterior/posterior balance ability also represented no significant difference between the groups and was significantly improved only in the unstable side. The medial/lateral balance ability was not significantly different between the groups and was significantly improved only in the unstable side. This study suggests that sling exercise contributes to improving % MVIC, total balance ability, anterior/posterior balance ability, and medial/lateral balance ability of the unstable side.

• Journal of Korean Foot and Ankle Society
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• v.25 no.3
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• pp.117-125
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• 2021

Purpose: The aim of this study was to evaluate biological ligament healing quantitatively after suture-tape augmentation for chronic lateral ankle instability. Materials and Methods: Thirty-two patients underwent magnetic resonance imaging (MRI) at a minimum of 2 years after lateral ligament augmentation using suture-tape. Signal/noise ratios (SNRs) and widths of anterior talofibular ligaments (ATFLs) were measured on preoperative and postoperative MRI by three researchers. ATFL biological healing degrees were analyzed using changes in SNRs and widths of ATFLs and by comparing these metrics with those of normal contralateral ankles. Clinical evaluations were performed using foot and ankle outcome scores (FAOSs), Foot and Ankle Ability Measure (FAAM) scores, and ankle stress radiographs. Results: Mean FAOS and FAAM scores improved significantly from 62.4 to 93.6 and 58.3 to 92.3, respectively, at final follow-up (p<0.001). Mean SNRs and ATFL widths improved insignificantly from 8.49 to 8.21 and 2.07 to 2.15 mm, respectively, at final follow-up (p=0.424, p=0.718). Significant differences in mean SNRs and ATFL widths were found between ipsilateral and contralateral sides (p<0.001, p=0.002). Spearman's correlation analysis revealed no significant association between clinical outcomes and degrees of biological healing of ATFLs based on MRI findings. Conclusion: Despite improvements in clinical outcome measures, the effects of suture-tape augmentation for chronic lateral ankle instability on biological ligament healing were insignificant. In addition, no significant correlation was found between clinical outcomes and degrees of biological healing of ATFLs.