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Published in: BMC Musculoskeletal Disorders 1/2021

01-12-2021 | Osteoarthrosis | Study protocol

Incidence and risk factors for poor ankle functional recovery, and the development and progression of posttraumatic ankle osteoarthritis after significant ankle ligament injury (SALI): the SALI cohort study protocol

Authors: Thomas Bestwick-Stevenson, Laura A. Wyatt, Debbie Palmer, Angela Ching, Robert Kerslake, Frank Coffey, Mark E. Batt, Brigitte E. Scammell

Published in: BMC Musculoskeletal Disorders | Issue 1/2021

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Abstract

Background

Ankle sprains are one of the most common musculoskeletal injuries, accounting for up to 5% of all Emergency Department visits in the United Kingdom. Ankle injury may be associated with future ankle osteoarthritis. Up to 70% of ankle osteoarthritis cases may be associated with previous ankle injury. There is limited research regarding the association between ankle sprain and ankle osteoarthritis development. The current study aims to phenotype those who suffer significant ankle ligament injuries, identify potential risk factors for ankle injuries and subsequent poor recovery, examine why individuals may develop osteoarthritis, and what factors influence this chance.

Methods

In this multicentre cohort study participants were recruited from nine Emergency Departments and two Urgent Care Centres in the United Kingdom. Participants (aged 18–70 years old) were defined as those who had suffered an isolated acute ankle sprain, which was Ottawa Ankle Rules positive, but negative for a significant ankle fracture on x-ray. Age and sex matched controls were also recruited. The controls were individuals who had not suffered a significant ankle injury, including ankle pain, function affected for more than 7 days, or the ankle caused them to report to an Emergency Department. Data is collected through a series of seven questionnaires (at baseline, 3 months, 1 year, 3 years, 5 years, 10 years, and 15 years later). The questionnaires include four sections (demographic questions; index injury, and injury history questions; functional assessment questions; and quality of life questions) and are designed to collect detailed information about the individual, their injury, potential risk factors for ankle sprains and ankle osteoarthritis, plus their medical history and any medication consumed.

Discussion

The Significant Ankle Ligament Injury (SALI) study aims to add to the limited knowledge regarding which factors can predict ankle sprains, complaints, and osteoarthritis. This is important because despite ankle sprains being regarded as a benign injury that resolves quickly, residual symptoms are not uncommon months and years after the injury.
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Literature
4.
go back to reference Bleakley CM, O’Connor SR, Tully MA, Rocke LG, MacAuley DC, Bradbury I, et al. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ. 2010;340:1964–72.CrossRef Bleakley CM, O’Connor SR, Tully MA, Rocke LG, MacAuley DC, Bradbury I, et al. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ. 2010;340:1964–72.CrossRef
6.
go back to reference Bleakley CM, O'Connor S, Tully MA, Rocke LG, MacAuley DC, McDonough SM. The PRICE study (protection rest ice compression elevation): design of a randomised controlled trial comparing standard versus cryokinetic ice applications in the management of acute ankle sprain [ISRCTN13903946]. BMC Musculoskelet Disord. 2007;8(1):125. https://doi.org/10.1186/1471-2474-8-125. Bleakley CM, O'Connor S, Tully MA, Rocke LG, MacAuley DC, McDonough SM. The PRICE study (protection rest ice compression elevation): design of a randomised controlled trial comparing standard versus cryokinetic ice applications in the management of acute ankle sprain [ISRCTN13903946]. BMC Musculoskelet Disord. 2007;8(1):125. https://​doi.​org/​10.​1186/​1471-2474-8-125.
9.
go back to reference Mailuhu AK, Verhagen EA, van Ochten JM, Bindels PJ, Bierma-Zeinstra SM, van Middelkoop M. The trAPP-study: cost-effectiveness of an unsupervised e-health supported neuromuscular training program for the treatment of acute ankle sprains in general practice: design of a randomized controlled trial. BMC Musculoskelet Disord. 2015;16(1):78–86. https://doi.org/10.1186/s12891-015-0539-9.CrossRefPubMedPubMedCentral Mailuhu AK, Verhagen EA, van Ochten JM, Bindels PJ, Bierma-Zeinstra SM, van Middelkoop M. The trAPP-study: cost-effectiveness of an unsupervised e-health supported neuromuscular training program for the treatment of acute ankle sprains in general practice: design of a randomized controlled trial. BMC Musculoskelet Disord. 2015;16(1):78–86. https://​doi.​org/​10.​1186/​s12891-015-0539-9.CrossRefPubMedPubMedCentral
18.
go back to reference Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42(2):311–9.PubMedPubMedCentral Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42(2):311–9.PubMedPubMedCentral
28.
go back to reference Anandacoomarasamy A, Barnsley L. Long term outcomes of inversion ankle injuries. Br J Sports Med. 2005;39(3):14–7.CrossRef Anandacoomarasamy A, Barnsley L. Long term outcomes of inversion ankle injuries. Br J Sports Med. 2005;39(3):14–7.CrossRef
39.
go back to reference Wikstrom EA, Mueller C, Cain MS. Lack of consensus on return-to-sport criteria following lateral ankle sprain: a systematic review of expert opinions. J Sport Rehabil. 2019;1(aop):1–7. Wikstrom EA, Mueller C, Cain MS. Lack of consensus on return-to-sport criteria following lateral ankle sprain: a systematic review of expert opinions. J Sport Rehabil. 2019;1(aop):1–7.
50.
go back to reference Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train. 2002;37(4):364–75.PubMedPubMedCentral Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train. 2002;37(4):364–75.PubMedPubMedCentral
56.
go back to reference McKeon PO, Hubbard TJ, Wikstrom EA. Consequences of ankle inversion trauma: a novel recognition and treatment paradigm. In: Zaslav KR, editor. An international perspective on topics in sports medicine and sports injury. Rijeka: InTech; 2011. p. 457–73. McKeon PO, Hubbard TJ, Wikstrom EA. Consequences of ankle inversion trauma: a novel recognition and treatment paradigm. In: Zaslav KR, editor. An international perspective on topics in sports medicine and sports injury. Rijeka: InTech; 2011. p. 457–73.
59.
go back to reference Bamber ZA, Fong D, Wheeler P. Assessing lateral ankle sprain risk using lower limb anthropometrics. ISBS Proc Arch. 2018;36(1):334–7. Bamber ZA, Fong D, Wheeler P. Assessing lateral ankle sprain risk using lower limb anthropometrics. ISBS Proc Arch. 2018;36(1):334–7.
60.
go back to reference Cooke M, Marsh J, Clark M, Nakash R, Jarvis R, Hutton J, et al. Treatment of severe ankle sprain: a pragmatic randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of three types of mechanical ankle support with tubular bandage. The CAST trial. Health Technol Assess (Winchester, England). 2009;13(13):iii ix–x 1–121. Cooke M, Marsh J, Clark M, Nakash R, Jarvis R, Hutton J, et al. Treatment of severe ankle sprain: a pragmatic randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of three types of mechanical ankle support with tubular bandage. The CAST trial. Health Technol Assess (Winchester, England). 2009;13(13):iii ix–x 1–121.
74.
go back to reference Uthman OA, van der Windt DA, Jordan JL, Dziedzic KS, Healey EL, Peat GM, et al. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis. BMJ. 2013;347:347–59. Uthman OA, van der Windt DA, Jordan JL, Dziedzic KS, Healey EL, Peat GM, et al. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis. BMJ. 2013;347:347–59.
76.
go back to reference Saltzman CL, Salamon ML, Blanchard GM, Huff T, Hayes A, Buckwalter JA, et al. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthopaed J. 2005;25:44–6. Saltzman CL, Salamon ML, Blanchard GM, Huff T, Hayes A, Buckwalter JA, et al. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthopaed J. 2005;25:44–6.
84.
go back to reference Kelso J. Phase transitions and critical behavior in human bimanual coordination. Am J Phys Regul Integr Comp Phys. 1984;246(6):1000–4. Kelso J. Phase transitions and critical behavior in human bimanual coordination. Am J Phys Regul Integr Comp Phys. 1984;246(6):1000–4.
95.
go back to reference Matthews PA, Scammell BE, Ali A, Coughlin T, Nightingale J, Khan T, et al. Early motion and directed exercise (EMADE) versus usual care post ankle fracture fixation: study protocol for a pragmatic randomised controlled trial. Trials. 2018;19-28(1):304.CrossRef Matthews PA, Scammell BE, Ali A, Coughlin T, Nightingale J, Khan T, et al. Early motion and directed exercise (EMADE) versus usual care post ankle fracture fixation: study protocol for a pragmatic randomised controlled trial. Trials. 2018;19-28(1):304.CrossRef
96.
go back to reference Fernandes GS, Sarmanova A, Warner S, Harvey H, Akin-Akinyosoye K, Richardson H, et al. Knee pain and related health in the community study (KPIC): a cohort study protocol. BMC Musculoskelet Disord. 2017;18-30(1):404.CrossRef Fernandes GS, Sarmanova A, Warner S, Harvey H, Akin-Akinyosoye K, Richardson H, et al. Knee pain and related health in the community study (KPIC): a cohort study protocol. BMC Musculoskelet Disord. 2017;18-30(1):404.CrossRef
102.
go back to reference Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B. Etiology of ankle osteoarthritis. Clin Orthop Relat Res. 2009;467(7):1800.CrossRefPubMed Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B. Etiology of ankle osteoarthritis. Clin Orthop Relat Res. 2009;467(7):1800.CrossRefPubMed
111.
go back to reference Estruch R, Sacanella E, Fernandez-Sola J, Nicolas JM, Rubin E, Urbano-Marquez A. Natural history of alcoholic myopathy: a 5-year study. Alcohol Clin Exp Res. 1998;22(9):2023–8.PubMed Estruch R, Sacanella E, Fernandez-Sola J, Nicolas JM, Rubin E, Urbano-Marquez A. Natural history of alcoholic myopathy: a 5-year study. Alcohol Clin Exp Res. 1998;22(9):2023–8.PubMed
Metadata
Title
Incidence and risk factors for poor ankle functional recovery, and the development and progression of posttraumatic ankle osteoarthritis after significant ankle ligament injury (SALI): the SALI cohort study protocol
Authors
Thomas Bestwick-Stevenson
Laura A. Wyatt
Debbie Palmer
Angela Ching
Robert Kerslake
Frank Coffey
Mark E. Batt
Brigitte E. Scammell
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2021
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-021-04230-8

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