Ankle syndesmosis repair and rehabilitation in professional rugby league players: a case series report

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background/aim

The distal tibiofibular joint is described as a syndesmosis. Traditionally, severe syndesmotic injuries with diastasis have been treated surgically with screw fixation. This case series details an ankle syndesmosis tightrope repair and an accelerated rehabilitation protocol that reduces the amount of time to return to professional rugby league in the UK. The aim of this study was to describe players’ journey from injury, through diagnosis to surgery, rehabilitation and return to participation, detailing time scales and methods used at each stage to highlight the change in current practice.

Methods

Players were identified via a single orthopaedic surgeon in the UK who specialises in ankle syndesmosis repair. Between January 2010 and September 2015, adult men playing full-time professional rugby league in the UK Super League with ankle syndesmosis injuries were identified.

Results

Eighteen players from six different clubs were included. The most common mechanism of injury was forced dorsiflexion/eversion. The average return to participation was 64 days (SD 17.2, range 38–108). This compares favourably to reports of between 120 and 180 days following screw fixation.

Conclusion

Ankle syndesmosis tightrope repair and an accelerated rehabilitation protocol is as safe as traditional methods. The accelerated rehabilitation protocol promotes early weight-bearing and has shown to expedite the return to sport for professional Rugby League players. It is possible to return to sport 2 months after a tightrope repair and accelerated rehabilitation, compared with 3–6 months post screw fixation. This is extremely encouraging for the professional sporting population.

Related collections

Most cited references 36

Record: found
Abstract: found
Article: not found

The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development

Joel Gagnier, Gunver Sophia Kienle, Douglas G. Altman … (2013)

Background: A case report is a narrative that describes, for medical, scientific, or educational purposes, a medical problem experienced by one or more patients. Case reports written without guidance from reporting standards are insufficiently rigorous to guide clinical practice or to inform clinical study design. Primary Objective: Develop, disseminate, and implement systematic reporting guidelines for case reports. Methods: We used a three-phase consensus process consisting of (1) premeeting literature review and interviews to generate items for the reporting guidelines, (2) a face-to-face consensus meeting to draft the reporting guidelines, and (3) postmeeting feedback, review, and pilot testing, followed by finalization of the case report guidelines. Results: This consensus process involved 27 participants and resulted in a 13-item checklist—a reporting guideline for case reports. The primary items of the checklist are title, key words, abstract, introduction, patient information, clinical findings, timeline, diagnostic assessment, therapeutic interventions, follow-up and outcomes, discussion, patient perspective, and informed consent. Conclusions: We believe the implementation of the CARE (CAse REport) guidelines by medical journals will improve the completeness and transparency of published case reports and that the systematic aggregation of information from case reports will inform clinical study design, provide early signals of effectiveness and harms, and improve healthcare delivery.

0 comments Cited 653 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Using the Star Excursion Balance Test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review.

Phillip A Gribble, Jay Hertel, Phil Plisky (2016)

A dynamic postural-control task that has gained notoriety in the clinical and research settings is the Star Excursion Balance Test (SEBT). Researchers have suggested that, with appropriate instruction and practice by the individual and normalization of the reaching distances, the SEBT can be used to provide objective measures to differentiate deficits and improvements in dynamic postural-control related to lower extremity injury and induced fatigue, and it has the potential to predict lower extremity injury. However, no one has reviewed this body of literature to determine the usefulness of the SEBT in clinical applications. To provide a narrative review of the SEBT and its implementation and the known contributions to task performance and to systematically review the associated literature to address the SEBT's usefulness as a clinical tool for the quantification of dynamic postural-control deficits from lower extremity impairment. Databases used to locate peer-reviewed articles published from 1980 and 2010 included Derwent Innovations Index, BIOSIS Previews, Journal Citation Reports, and MEDLINE. The criteria for article selection were (1) The study was original research. (2) The study was written in English. (3) The SEBT was used as a measurement tool. Specific data extracted from the articles included the ability of the SEBT to differentiate pathologic conditions of the lower extremity, the effects of external influences and interventions, and outcomes from exercise intervention and to predict lower extremity injury. More than a decade of research findings has established a comprehensive portfolio of validity for the SEBT, and it should be considered a highly representative, noninstrumented dynamic balance test for physically active individuals. The SEBT has been shown to be a reliable measure and has validity as a dynamic test to predict risk of lower extremity injury, to identify dynamic balance deficits in patients with a variety of lower extremity conditions, and to be responsive to training programs in both healthy people and people with injuries to the lower extremity. Clinicians and researchers should be confident in employing the SEBT as a lower extremity functional test.

0 comments Cited 211 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Persistent disability associated with ankle sprains: a prospective examination of an athletic population.

Charles Scoville, D. Taylor, Jason G. Williams … (1998)

The purpose of this study was to examine a young athletic population to update the data regarding epidemiology and disability associated with ankle injuries. At the United States Military Academy, all cadets presenting with ankle injuries during a 2-month period were included in this prospective observational study. The initial evaluation included an extensive questionnaire, physical examination, and radiographs. Ankle sprain treatment included a supervised rehabilitation program. Subjects were reevaluated at 6 weeks and 6 months with subjective assessment, physical examination, and functional testing. The mean age for all subjects was 20 years (range, 17-24 years). There were 104 ankle injuries accounting for 23% of all injuries seen. There were 96 sprains, 7 fractures, and 1 contusion. Of the 96 sprains, 4 were predominately medial injuries, 76 were lateral, and 16 were syndesmosis sprains. Ninety-five percent had returned to sports activities by 6 weeks; however, 55% of these subjects reported loss of function or presence of intermittent pain, and 23% had a decrement of >20% in the lateral hop test when compared with the uninjured side. At 6 months, all subjects had returned to full activity; however, 40% reported residual symptoms and 2.5% had a decrement of >20% on the lateral hop test. Neither previous injury nor ligament laxity was predictive of chronic symptomatology. Furthermore, chronic dysfunction could not be predicted by the grade of sprain (grade I vs. II). The factor most predictive of residual symptoms was a syndesmosis sprain, regardless of grade. Syndesmosis sprains were most prevalent in collision sports. This study demonstrates that even though our knowledge and understanding of ankle sprains and rehabilitation of these injuries have progressed in the last 20 years, chronic ankle dysfunction continues to be a prevalent problem. The early return to sports occurs after almost every ankle sprain; however, dysfunction persists in 40% of patients for as long as 6 months after injury. Syndesmosis sprains are more common than previously thought, and this confirms that syndesmosis sprains are associated with prolonged disability.

0 comments Cited 164 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): BMJ Open Sport Exerc Med

Journal ID (iso-abbrev): BMJ Open Sport Exerc Med

Journal ID (hwp): bmjosem

Journal ID (publisher-id): bmjosem

Title: BMJ Open Sport — Exercise Medicine

Publisher: BMJ Open Sport & Exercise Medicine (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2055-7647

Publication date (Electronic): 1 April 2017

Publication date Collection: 2017

Volume: 3

Issue: 1

Electronic Location Identifier: e000175

Affiliations

[1 ] East Cheshire NHS Trust, Macclesfield District General Hospital , Macclesfield, Cheshire, UK

[2 ] Manchester Metropolitan University , Manchester, UK

[3 ] Warrington Wolves RLFC, The Halliwell Jones Stadium , Warrington, UK

[4 ] York Hospitals NHS Foundation Trust , York, UK

Author notes

[Correspondence to ] Dr Alex James Latham; alex.latham@ 123456nhs.net

Author information

Peter Charles Goodwin http://orcid.org/0000-0001-6533-0949

Article

Publisher ID: bmjsem-2016-000175

DOI: 10.1136/bmjsem-2016-000175

PMC ID: 5530120

PubMed ID: 28761696

SO-VID: 8cc97d5e-a48d-4f85-b276-caf4caf76922

License:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

History

Date accepted : 28 February 2017

Custom metadata

special-feature unlocked

Keywords: ankle syndesmosis,tightrope repair,rehabilitation,high ankle sprain,distal tibiofibular joint.

Data availability:

Keywords: ankle syndesmosis, tightrope repair, rehabilitation, high ankle sprain, distal tibiofibular joint.

Comments

Comment on this article

scite_

Smart Citations

Citing PublicationsSupportingMentioningContrasting

View Citations

See how this article has been cited at scite.ai

scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.

Cited by 11

See all cited by

Most referenced authors 333

See all reference authors

Ankle syndesmosis repair and rehabilitation in professional rugby league players: a case series report

Read this article at

Abstract

Background/aim

Methods

Results

Conclusion

Related collections

Journal of Health and Rehabilitation Sciences

Most cited references 36

The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development

Using the Star Excursion Balance Test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review.

Persistent disability associated with ankle sprains: a prospective examination of an athletic population.

Author and article information

Journal

Affiliations

Author notes

Author information

Article

History

Categories

Custom metadata

Comments

Comment on this article

Similar content 929

Cited by 11

Most referenced authors 333