Balance training improves function and postural control in those with chronic ankle instability. Early mobilization versus immobilization after ankle ligament stabilization. Clinical and functional outcome after anatomic and nonanatomic ankle ligament reconstruction: Evans tenodesis versus periosteal flap. Outcomes of the Chrisman-Snook and modified-Broström procedures for chronic lateral ankle instability. A prospective, randomized comparison. Early range of motion training after ligament reconstruction of the ankle joint. Comparison of two anatomic reconstructions for chronic lateral instability of the ankle joint. High-intensity training with a bi-directional bicycle pedal improves performance in mechanically unstable ankles--a prospective randomized study of 19 subjects. The effect of a 4-week comprehensive rehabilitation program on postural control and lower extremity function in individuals with chronic ankle instability.
The purpose of this randomized controlled trial was to determine the effect of a 4-wk balance training program on static and dynamic postural control and self-reported functional outcomes in those with chronic ankle instability (CAI).
                Thirty-one young adults with self-reported CAI were randomly assigned to an intervention group (six males and 10 females) or a control group (six males and nine females). The intervention consisted of a 4-wk supervised balance training program that emphasized dynamic stabilization in single-limb stance. Main outcome measures included the following: self-reported disability on the Foot and Ankle Disability Index (FADI) and the FADI Sport scales; summary center of pressure (COP) excursion measures including area of a 95% confidence ellipse, velocity, range, and SD; time-to-boundary (TTB) measures of postural control in single-limb stance including the absolute minimum TTB, mean of TTB minima, and SD of TTB minima in the anteroposterior and mediolateral directions with eyes open and closed; and reach distance in the anterior, posteromedial, and posterolateral directions of the Star Excursion Balance Test (SEBT).
                The balance training group had significant improvements in the FADI and the FADI Sport scores, in the magnitude and the variability of TTB measures with eyes closed, and in reach distances with the posteromedial and the posterolateral directions of the SEBT. Only one of the summary COP-based measures significantly changed after balance training.
                Four weeks of balance training significantly improved self-reported function, static postural control as detected by TTB measures, and dynamic postural control as assessed with the SEBT. TTB measures were more sensitive at detecting improvements in static postural control compared with summary COP-based measures. Functional outcome, stability at radiographic investigation and ankle joint torque after anatomical reconstruction of the lateral ankle ligaments were evaluated in patients with early postoperative mobilization versus those with cast immobilization. Thirty patients with chronic lateral ligament instability of the ankle underwent anatomical reconstruction of the ligaments. Postoperatively the patients were randomly allocated to two groups: Group A (n=15) were immobilized in a below-knee plaster for 6 weeks and Group B (n=15) underwent early controlled range of motion training using an Air-Cast ankle brace. The functional results were evaluated using a scoring scale and objective results using standardized stress radiographs. Also eccentric and concentric muscle torque at 60 degrees/s was measured in plantar flexion and dorsiflexion, respectively. The functional results were satisfactory in 12/15 ankles in Group A and 14/15 in Group B (n.s.). All the patients with satisfactory results regained normal range of motion. Patients with unsatisfactory results had either residual pain or recurrent instability. In Group B, the strength measurements revealed significantly higher peak torque values after three months in plantar flexion at 60 degrees/s. Six months postoperatively, the torque values did not differ significantly between the groups. Also, there was no group difference in the laxity of the ankle joint, including both anterior talar translation test and talar tilt test, at the two-year follow-up. One patient had a superficial wound infection. We conclude that after the reconstruction of chronic lateral ligament instability of the ankle the functional and stability results were equally good with early postoperative mobilization and 6-week immobilization. However, using early mobilization plantar flexion strength was regained earlier than with cast immobilization, without any risk of short- or medium-term complications, such as increased ankle laxity. We recommend early mobilization after anatomical reconstruction of the lateral ankle ligaments. The present study investigated the effects of two different surgical procedures for the treatment of chronic ankle instability. Ten patients treated with an anatomic reconstruction using a periosteal flap were compared with a second group that received an Evans tenodesis. All patients were evaluated before and after surgery with clinical and radiographic examinations as well as dynamic pedobarography. Patient satisfaction and radiographic and functional results were comparable in both groups and revealed a good restoration of joint stability and gait symmetry. Our results indicate that both methods of ankle ligament reconstruction achieve a comparable clinical and functional outcome within 1 year after surgery. We prospectively and randomly compared the outcomes of the Chrisman-Snook and modified-Broström procedures for chronic lateral ankle instability in 40 patients. Both operations provided good or excellent stability in more than 80% of the patients. However, the modified-Broström procedure resulted in higher Sefton scores than the Chrisman-Snook procedure. In addition, a statistically significant greater proportion of complications occurred in patients treated with the Chrisman-Snook procedure. Early range of motion training after ligament reconstruction of the ankle ligaments for chronic ankle joint instability was evaluated. Forty patients were operated on with anatomic reconstruction of the lateral ankle ligaments, i.e. shortening, imbrication and reinsertion. The patients were randomized postoperatively between two groups: (1) immobilization for 6 weeks in a plaster cast and (2) early range of motion training, in a Walker-Boot. Both groups underwent an identical rehabilitation program, with peroneal strengthening and co-ordination training after 6 weeks. The functional results were evaluated using a scoring scale and the mechanical stability with standardized stress radiographs. The minimum follow-up was 2 years. The functional results were satisfactory in 16 (80%) of the patients in group I, and 19 (95%) in group II. The mean values of anterior talar translation and talar tilt were not significantly different between the groups preoperatively nor at follow-up. The mean time period for sick leave was significantly shorter for group II, 6.5 +/- 1.6 weeks compared with 8.5 +/- 1.8 weeks for group I. The mean time period for return to sports activity was significantly shorter for group II, 9.5 +/- 2.2 weeks, compared with 12.5 +/- 2.6 weeks for group I. Early range of motion training is recommended after ligament reconstruction of the ankle, as it will enable earlier return to sports activities, shorter sick leave and preserved mechanical stability. Two anatomic reconstructions for correction of chronic lateral ankle joint instability were compared. In a prospective, randomized study, 60 patients were allocated to one of two treatment groups: reconstruction of the ligaments as described by Karlsson et al. (Group I) or with the modification of the Broström procedure as described by Gould et al. (Group II). The functional results were evaluated with a scoring scale, and the mechanical stability with standardized stress radiographs. The minimum follow-up period was 2 years. The functional results were satisfactory in 27 of 30 (90%) patients in Group I and 25 of 30 (83%) in Group II. There was no significant difference between the groups regarding mechanical stability. The mean anterior talar translation in Group I was 7.1 mm (range, 4 to 10) at followup, compared with 6.7 mm (range, 3 to 9) in Group II. The corresponding values for talar tilt were 4.9 degrees (range, 0 degree to 8 degrees) in Group I and 4.4 degrees (range, 0 degree to 8 degrees) in Group II. The duration of operation time was significantly longer in Group II and surgical complications were more frequent, probably due to the more extensive surgical exposure. This study showed that the majority of patients with chronic ankle instability can be successfully treated with anatomic reconstruction of the lateral ankle ligaments. Mechanical stability was restored with both methods. A bi-directional bicycle pedal that combines proprioceptive training and evertor strengthening has been developed for the treatment of residual instability after ankle sprains. A prospective randomized study was carried out on 19 subjects with recurrent ankle sprains and positive stress X-ray films. The subjects were randomized to use either a bi-directional test pedal or a traditional uni-directional bicycle pedal and then completed a 6-week high-intensity training program on a cycle ergometer. Assessment of training intensity level was based on maximum oxygen uptake values, heart rate and lactate concentration in blood at various submaximal workloads. After completion of the training program, the subjects who had used the test pedal increased peak eversion torque at 180 degrees degrees s-1 by 14.2% (P = 0.020), reduced figure-of-eight running time by 0.24 s (P = 0.003), improved single leg stance speed from 72.5% to the maximum speed of 80% (P = 0.005), and improved Karlsson functional score by 5.1 points (P = 0.005). In the control group, single leg stance improved from 56.1 to 67.8% (P = 0.018), but otherwise no significant effects were found. This study indicates that short-term high-intensity training with a bi-directional pedal improves ankle performance and may be an option in the treatment of recurrent ankle sprains. Prospective, randomized controlled trial.
                To examine the effects of a 4-week rehabilitation program for chronic ankle instability (CAI) on postural control and lower extremity function.
                CAI is associated with residual symptoms, performance deficits, and reinjury. Managing CAI is challenging and more evidence is needed to guide effective treatment.
                Subjects with unilateral CAI were randomly assigned to the rehabilitation (CAI-rehab, n=16) or control (CAI-control, n=13) group. Subjects without CAI were assigned to a healthy group (n=19). Baseline testing included the (1) center of pressure velocity (COPV), (2) star excursion balance test (SEBT), and (3) Foot and Ankle Disability index (FADI) and FADI-Sports Subscale (FADI-Sport). The CAI-rehab group completed 4 weeks of rehabilitation that addressed range of motion, strength, neuromuscular control, and functional tasks. After 4 weeks, all subjects were retested. Nonparametric analyses for group differences and between-group comparisons were performed.
                Subjects with CAI demonstrated deficits in postural control and SEBT reach tasks of the involved limb compared to the uninvolved limb and reported functional deficits of the involved limb compared to healthy subjects. Following rehabilitation, the CAI-rehab group had greater SEBT reach improvements on the involved limb than the other groups and greater improvements in FADi and FADI-Sport scores.
                These results demonstrate postural control and functional limitations exist in individuals with CAl. In addition, rehabilitation appears to improve these functional limitations. Finally, there is evidence to suggest the SEBT may be a good functional measure to monitor change after rehabilitation for CAI.
Neuromuscular training alone appears effective in the short term but whether this advantage would persist on longer-term follow-up is not known. While there is insufficient evidence to support any one surgical intervention over another surgical intervention for chronic ankle instability, it is likely that there are limitations to the use of dynamic tenodesis. After surgical reconstruction, early functional rehabilitation appears to be superior to six weeks immobilisation in restoring early function.