SLR - January 2022 - Ruchi R. Ram

Chronic Ankle Instability is Associated with Proprioception Deficits: A Systematic Review and Meta-Analysis

Reference: Xue, X., Ma, T., Li, Q., Song, Y., & Hua, Y. (2021). Chronic Ankle Instability is Associated with Proprioception Deficits: A Systematic Review and Meta-Analysis. Journal of Sport and Health Science, 10(2), 182–191. https://doi.org/10.1016/j.jshs.2020.09.014

Level of Evidence: 1

Scientific Literature Review

Reviewed By: Ruchi R. Ram, DPM
Residency Program: University Hospital – Newark, NJ

Podiatric Relevance: Lateral ankle sprains are one of the most common sports injuries and have the highest recurrence rate among all lower extremity musculoskeletal injuries. Fixing mechanical laxity through surgery is usually suggested for patients suffering persistent symptoms associated with chronic ankle instability, while other patients continue to experience poor ankle function. The first proposed sensorimotor factor in ligament injuries was joint proprioception, originally defined as the perception of position and movement, but now includes force and vibration. Low proprioception and impaired proprioceptive nerve endings within sprained joints are associated with functional losses in ligament injuries, higher risk of ankle-related sports injuries, worse sports performance, and progression of post-injury osteoarthrosis. Original studies and reviews of specific tests of proprioception in chronic ankle instability have given conflicting results. Evidence also indicates that kinematics beyond the ankle could also be altered by chronic ankle instability. The purpose of this study was to determine whether the originally defined proprioception was impaired in patients with chronic ankle instability compared with the uninjured contralateral side or healthy controls.

Methods: The study was a meta-analysis and systematic literature review. Studies were identified that compared kinesthesia or joint position sense in patients with chronic ankle instability with the uninjured contralateral side or with healthy controls. Meta-analyses were conducted for the studies with similar test procedures, and narrative syntheses were undertaken for the rest.

Results: Seven thousand seven hundred thirty-one (7,731) studies were identified, and 30 were included for review. 21 studies were eligible for meta-analysis. The most important finding of the review was that proprioceptive deficits did exist in ankles with chronic instability and varied according to differing test methodologies. An overview shows that kinesthesia, passive and active joint position sense of inversion, and kinesthesia of plantarflexion were impaired in chronic ankle instability when compared with the uninjured contralateral side. Kinesthesia and active joint position sense of ankle inversion and eversion were impaired in chronic ankle instability when compared with healthy controls. For the mechanism of deficits, sprain accidents could lead to ligament tears and damage to the articular receptors and muscle spindles. Posttraumatic inflammation and edema could also lead to partial deafferentation and influence the functions of proprioceptive receptors. Since sensory inputs are altered, motor outputs are also altered leading to functional losses.

Conclusions: Proprioception of the injured ankle of patients with chronic ankle instability was impaired compared with the uninjured contralateral limbs and healthy people. Proprioception varied depending on different movement directions and test methodologies. The study highlights the importance of detailed measurements and targeted interventions into proprioceptive inputs in the clinical management of chronic ankle instability. During competitive sports, vision is occupied by targets, and attention demands are increased in order to manage skilled performance, so the CNS relies more on proprioceptive sources through central reweighting, and the influence of deficits is enlarged. Thus, even a small deficit should not be overlooked in the management of sports injuries.

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