الفهرس 
Anatomy and Biomechanics of the Ankle Joint
Ankle sprainOnly 14 pages are availabe for public view
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Abstract
Ankle sprains are the most common musculoskeletal injury that occurs in athletes, and several studies have noted that sports that require sudden stops and cutting movements, such as basketball and soccer, cause the highest percentage of these injuries. Ankle sprains not only result in numerous visits to emergency care facilities and significant time loss from sports participation, but they can also cause long-term disability and have a major impact on health care costs and resources.
Because the exact timeline of ankle ligament healing is unknown and the patients may be return to activity before the ligaments of the ankle have fully healed, making sound, evidence-based rehabilitation and return-to-play decisions is difficult and better to be based on functional basis. By understanding the healing process, we can make better decisions that help to prevent further injury and co-morbidities. This highlights the need for quantitative evaluation of ligament damage after ankle sprain as a means to better identify therapeutic programs that may lead to better patient outcomes.
The present study was designed to investigate the value of diagnostic musculoskeletal ultrasound as an assessment tool of ankle sprains in athletes and to assess their improvement after rehabilitation.This study was performed on 100 athletes with ankle sprains. All patients underwent full medical history taking, thorough clinical and musculoskeletal examination.
Patients were assessed before and after receiving their rehabilitation program. Assessment included ankle manual stress tests, balance assessments, diagnostic musculoskeletal ultrasound to examine ATFL and CFL in static and dynamic conditions.
The rehabilitation program was done over 8 weeks and was tailored for each athletes according to his condition and focusing on increasing ankle ROM, strengthening of ankle musculature, restoring normal balance control and regaining functional capacity of lower limbs with respects of ankle joint protection, using ankle support, as well as early and functional exercise.
By the end of rehabilitation program there was a clinical and functional improvement of high statistical significance in all included patients; this improvement was assessed by disappearance of signs of inflammation as pain and swelling, normal gait, full weight-bearing, resolved all the tender ligaments and points, unlimited painless free ROM with full muscle power in all planes, ankle stability tests, balancing tests. As regarding diagnostic musculoskeletal ultrasound examination, our results showed a difference of high statistical significance after rehabilitation program; this difference was assessed by increase number of thickened ligaments and disappearance of hypoechoic areas within the ligaments. Additionally, dynamic assessment of the length of ATFL before and after applying inversion stress was found to be a useful tool in follow up assessment as it could detect an objective difference in the length of ATFL under stress following the rehabilitation program; this difference was assessed by a highly statically significant decrease in the length difference of ATFL after rehabilitation program.
Analysis of the time scale clarify that 4 weeks of rehabilitation was sufficient to overcome pain and weakness, but balance and functional impairments need additional time. Depending on this, non-athletic population will benefit from a shorter rehabilitation program as their functional demands are less
Our results showed that athletic patients needed additional time to RTP with 96% success rate. Only 4 players that could not return to sport by the end of the 8 weeks were with grade II traumatic ankle sprains with statistically non-significant improvement in the length difference of the ATFL by the end of the rehabilitation program.