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ANKLE LIGAMENT STRAIN DURING SUPINATION SPRAIN INJURY – a Alt, W., Lohrer, H., & Gollhofer, A

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ANKLE LIGAMENT STRAIN DURING SUPINATION SPRAIN INJURY – a Alt, W., Lohrer, H., & Gollhofer, A Vilas-Boas, Machado, Kim, Veloso (eds.) Portuguese Journal of Sport Sciences Biomechanics in Sports 29 11 (Suppl. 2), 2011 REFERENCES: ANKLE LIGAMENT STRAIN DURING SUPINATION SPRAIN INJURY – A Alt, W., Lohrer, H., & Gollhofer, A. (1999). FunctionalProperties of Adhesive Ankle Taping: COMPUTATIONAL BIOMECHANICS STUDY Neuromuscular and Mechanical Effects Before and After Exercise. Foot & Ankle International , 20(4), 238-45. Daniel Tik-Pui Fong1,2, Feng Wei3, Youlian Hong4,5, Tron Krosshaug6, Benesch, S., Putz, W., Rosenbaum, D., & Becker, H.-P. (2000). Reliability of Peroneal Reaction Time Roger C. Haut3 and Kai-Ming Chan1,2 Measurements. Clin Biomech , 15. Cordova, M. L., Bernard, L. W., Au, K. K., Demchak, T. J., Stone, M. B., & Sefton, J. M. (2010). Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Cryotherapy and ankle bracing effects on peroneus longus response during sudden inversion. J 1 Electromyogr Kinesiol , 20, 248-53. Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Delahunt, E. (2007). Peroneal reflex contribution to the development of functional instability of the 2 ankle joint. Phys Ther Sport , 8, 98-104. Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China 3 Docherty, C. L., & Arnold, B. L. (2008). Force sence deficits in functionally unstable ankles. J Orthop Orthopaedic Biomechanics Laboratories, Michigan State University, USA Res , 26(11), 1489-93. Department of Sports Science and Physical Education, Faculty of Education, 4 Eechaute, C., Vaes, P., Duquet, W., & Gheluwe, B. v. (2009). Reliability ans discriminative validity of The Chinese University of Hong Kong, Hong Kong, China sudden ankle inversion measurements in patients with chronic ankle instability. Gait & Posture , 42(1), Department of Sports Medicine, Chengdu Sports University, Chengdu, China5 82-6. Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Frier, P. (1990). Effectiveness of taping for the prevention of ankle ligament sprains. Br J Sp Med , Ullevall Stadion, Oslo, Norway6 24(1), 47-50. Gribble, P. A., & Hertel, J. (2003). Considerations for normalizing measures of the star excursion This study presents ankle ligament strain data during a grade I mild anterior talofibular alance test. MPEES , 7(2), 89-100. ligamentous sprain. Kinematics data obtained during the injury and a 3BW were imported Hertel, J., & Olmsted-Kramer, L. C. (2007). Deficits in time-to-boundary measures of postural control to a validated dynamic foot model. Four simulations were done: (1) inversion, (2) with chronic ankle instability. Gait & Posture , 25, 247-51. inversion plus plantarflexion, (3) inversion plus internal rotation, and (4) inversion, plantarflexion and internal rotation. Results showed that in situation (1), the Hopkins, J. T., Brown, T. N., Christensen, L., & Palmieri-Smith, R. M. (2009). Deficits in Peronial calcaneofibular ligament was strained the most (12%), followed by the anterior talofibular Latency and Electromecanical Delay in Patients with Functionl Ankle Instability. J Orthop Res , 27(12), ligament (10%). In situations (2) and (3), both ligaments were strained to about 14-16%. 1541-6. In situation (4), the anterior talofibular ligament was strained to 20%. This study Hubbard, T., Kramer, L. C., Denegar, C. R., & Hertel, J. (2007). Correlations Among Multiple suggested that plantarflexion and internal rotation, together with inversion, may have Measures of Functional and Mechanical Instability in Subjects with Chronic Ankle Instability. J Athl greatly strained and torn the anterior talofibular ligament during the reported injury event. Train , 42(3), 361-6. Hume, P., & Gerrard, D. F. (2007). Effectiveness of external ankle support bracing and taping in rugby KEY WORDS: injury mechanism, injury aetiology, ankle inversion sprain. union. J Athle Train , 42(3), 361-6. Karlsson, J., & Andreasson, G. O. (1992). The effect of external ankle support in chronic lateral joint INTRODUCTION: Ankle sprain is a common sports trauma (Fong et al, 2007). A suggested instability: an electromyographic study. Am J Sports Med , 20(3), 257-61. mechanism is excessive ankle joint supination, which accounts for over 80% of all ankle Konradsen, L., & Ravs, J. B. (1990). Ankle instability caused by prolonged peroneal reaction time. sprain injuries. This mechanism has been widely presented in the literature clinically and Acta Orthop Scand , 61(5), 388-90. qualitatively as a combination of inversion and plantarflexion. A recent first ever Maroco, J. (2007). Análise estatística comutilização do SPSS. Lisboa: Edições Sílabo. biomechanics quantitative investigation on a real accidental supination ankle sprain injury Pijnappel, H. (2009). Medical Taping Concept Handbook. Aneid Press. event revealed that internal rotation also occurred in such an injury (Fong et al, 2009b). The injury was diagnosed as a grade I mild anterior talofibular ligamentous sprain immediately, Refshauge, K. M., Raymond, J., Kilbreath, S. L., Pengel, L., & Heijnen, I. (2009). The effect of ankle taping on detection of inversion-eversion movements in participants with recurrent ankle sprain. AmJ and was presented with the kinematics as captured by three video cameras, plus the plantar Sports Med , 37(2), 371-5. pressure data as captured by a pair of pressure insoles. In normal landing, the ground reaction force vector is close to the ankle joint centre, so the Rosenbaum, D., Becker, H. P., Gerngro, H., & Claes, L. (2000). Peroneal reacton times for diagnosis of functional ankle instability. Foot Ankle Surg , 6, 31-8. short moment arm results in a small ankle twisting torque which could be accommodated by the muscles and ligaments. An ankle sprain is probably caused by the deviation of such Sijmonsma, J. (2007). Taping Neuromuscular Manual. Espanola. ground reaction force vector from the ankle joint centre, usually at the lateral plantar edge Vaes, P., Duquet, W., & Gheluwe, B. v. (2002). Peroneal reaction times ans eversion motor response acting to the medial aspect during a sideway cutting movement, resulting in a large moment in healthy andunstable ankles. J Athl Train , 37(4), 475-480. arm and thus an explosive ankle supination torque (Fong et al, 2009a). Such torque would Vries, J. S., Kingma, I., Blankevoort, L., & Dijk, C. v. (2010). Difference in balance measures between trigger very fast joint twisting motion and stretch the lateral ligaments in a vigorous way. patients with chronic ankleinstability and patents after an acute ankle inversion trauma. Knee Surg Information on the ankle ligament strain during the injury may help a better understanding of Sports Traumatol Artgrosc , 18(5), 601-6 the injury aetiology and mechanism. This computational biomechanics study presents the ankle ligament strains during this real accidental injury event. Four simulations were conducted to show the effect of different combinations of joint orientation on the strain in various ligaments. Since the injury was diagnosed as a grade I mild anterior talofibular ligamentous sprain, a high strain in this lateral ligament was expected. METHODS: A three-dimensional multi-body dynamic foot model was used in this study (Wei et al, 2011). The model has been validated for studying ankle injury by a human cadaveric ISBS 2011 655 Porto, Portugal Vilas-Boas, Machado, Kim, Veloso (eds.) Portuguese Journal of Sport Sciences Biomechanics in Sports 29 11 (Suppl. 2), 2011 biomechanics study (Wei et al, 2010). Joint anatomical features were taken from computer tomography (CT) images. Detailed features of the foot/ankle complex were obtained by importing Digital Imaging and Communications in Medicine (DICOM) files from an individual CT scan into Materialise’s Interactive Medical Imaging Control System (MIMICS) (Materialise, Ann Arbor, MI). This yielded a three-dimensional surface model of the bones as Stereolithography (STL) files for export. To reduce the size of the surface files and subsequent model, the STL files were re-meshed in MIMICS to smooth the surface of each bone. Exported files were then imported into the three-dimensional solid modelling software SolidWorks (TriMech Solutions, LLC, Columbia, MD) as Mesh Files. SolidWorks along with the ScanTo3D package was used to further construct each bone and simplify the bone surfaces. SolidWorks Motion was then used to assemble bones, obtain proper positioning, add necessary components, and run simulations. The tibia was fixed in space, the fibula, Figure 2: Anterior views of the ankle model in (a) neutral position; (b) 48° inversion; (c) talus, and calcaneus were free to move, and the rest of the bones were fused together and inversion plus 20° plantarflexion; (d) inversion plus 30° internal rotation, and (e) combined moved as a rigid body. Twenty ligaments were included and represented as linear spring inversion, plantarflexion and internal rotation. elements (Figure 1), with stiffness values from the literature. A model sensitivity analysis was conducted to ensure that moderate ligament stiffness variations did not significantly alter Ligament strains were determined and were presented in percentage (%), which was the conclusions drawn from the model. relative elongation of the ligament. Only ligaments being strained 2% or more were presented in this report. RESULTS: Figure 3 showed the strains of selected ligaments for the four motion scenarios. For scenario 1, the calcaneofibular ligament (CaFL) was strained the
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