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Title: Structural characteristics and functional consequences of lateral ankle sprains
Author: Abdeen, Rawan
ISNI:       0000 0004 7960 2767
Awarding Body: University of Salford
Current Institution: University of Salford
Date of Award: 2019
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Ankles injuries account for 8% of health care consultations and ankle sprains constitute about 85% of all ankle injuries. Lateral ankle sprain is a type of injury that affects both the general and the sporting population. Lateral ankle sprain has a high rate of recurrence which can often lead to individuals developing chronic ankle instability. This chronicity contributes to continued deficits of sensorimotor and constrained functioning, which could have a decrease effect on the health-related quality of life, the level of physical activity, and absence from training or competition for athletes, and thus create a substantial global healthcare burden. With such negative consequences and related financial burden associated with LAS and CAI, enhanced effort to understand structure and function differences between those that develop CAI and those that do not following an initial acute LAS is needed. Understanding the relationships between the integrity of the ankle structures pre and post sprain, and functional ability of the ankle is important to inform our understanding of the long-term effects of sprains and consider better targeting of interventions. This thesis aims to study the structural characterisation and functional consequences of lateral ankle sprain. Three studies were undertaken. The first study used ultrasound to characterise and compare selected ankle structures between healthy (n=48), coper (n=22) and chronic ankle instability (n=32) groups. Participants with prior injury had significantly longer anterior talofibular ligament when the ligament was under tension (by 6% when compared CAI to healthy participants), and thicker anterior talofibular ligament and calcaneofibular ligament compared to healthy participants (by 54.21% and 8.3% respectively when compared CAI to healthy participants). These gross structural differences are evidence of residual structural damage. However, they do not indicate whether the quality and nature of the ligament tissue is similarly affected. In study 2 image analysis techniques were used to provide a quantitative measure of the echogenicity of the anterior talofibular ligament by computer-aided greyscale analysis. Echogenicity was used as an indicator of ligament quality. The result showed that the echo intensity of anterior taloibular ligament was lowest intensity in chronic ankle instability (40 % and 18.8% lower than the intensity of healthy and coper respectively) followed by copers and healthy respectively. The echogenicity of the anterior talofibular ligament in copers was significantly different from chronic ankle instability and from healthy participants. Characterisation of these further structural changes reveals the extent of residual tissue damage. However, it does not provide any insight into any functional consequences of these changes. In a third study, the dynamic balance was evaluated in healthy (n=28), coper (n=18) and chronic ankle instability (n=22) ankles during the star excursion balance tests, using force plate and ankle kinematic analysis. This sought to investigate the functional consequences of the structural changes identified in studies 1 and 2. Participants with chronic ankle instability demonstrated poorer dynamic balance and altered ankle kinematics compared to healthy and coper participants, and copers also had altered kinematics. There was a significant negative relationship between the thickness of the ligament and the distance achieved when reaching in the anterolateral direction of the balance test (r = -0.53, p < 0.001and r = -0.40, p < 0.001 respectively). Characterisation of normal and injured ligaments appears to differentiate post sprain functionally. Balance tests reveal functional balance deficits and altered kinematic strategies that relate to the lateral ankle structures previously injured. Lateral ankle sprain causes damage to lateral ankle ligaments and impaired sensory pathway to the CNS. Then the initial consequences lead to structural alteration (increased the laxity of ATFL and increased the thickness of ATFL and CFL). Joint loading could be altered and changes in normal movement patters occur as demonstrated in decrease reach distance and alter the kinematics of the ankle joint in injured participants compared to healthy participants. This is the first study that combined both structural changes and functional consequences of lateral ankle sprain and investigate any relationship between them to provide an overall understanding of how these two factors are related.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available