Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT04645082 |
| Other study ID # |
AYBU0507 |
| Secondary ID |
|
| Status |
Completed |
| Phase |
|
| First received |
|
| Last updated |
|
| Start date |
March 12, 2019 |
| Est. completion date |
October 10, 2019 |
Study information
| Verified date |
November 2020 |
| Source |
Ankara Yildirim Beyazit University |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Observational [Patient Registry]
|
Clinical Trial Summary
This study was undertaken to examine the effect of Q angle, lateral distal tibial angle
(LDTA), and lower extremity isometric muscle torque on ankle sprain. Among 40 participants
with ankle sprain, Q angle and LDTA measurements in both extremities were performed using
X-ray images, while the muscle strength in gluteus maximus, gluteus medius, and quadriceps
femoris were determined with hand held dynamometer, and the muscle torque was estimated by
multiplying these values with the distance to the joint center. The obtained data were
analyzed by separation analysis. No significant relationship was found between the Q angle
and ankle sprain (p> 0.05). A strong positive correlation was found between LDTA and ankle
sprain (p = 0.01). A strong negative correlation was found between quadriceps femoris muscle
strength, gluteus medius muscle strength and gluteus maximus muscle strength with ankle
sprain (p <0.001, p = 0.001, p <0.001, respectively). A strong negative relationship was
found between quadriceps, gluteus medius and gluteus maximus muscle torques with ankle sprain
(p <0.001, p = 0.011, p = 0.002, respectively). As suggested by the discrimination analysis,
independent variables that contributed most to ankle injury included the gluteus maximus
muscle torque (MAXIMUSTORQ) (.906), gluteus medius muscle torque (MEDIUSTORQ) (. 494),
lateral distal tibial angle (.436) and quadriceps femoris muscle. torque (QUADRTORQ) (. 341),
respectively. In conclusion, strengthening the quadriceps femoris, gluteus medius and gluteus
maximus muscles may be suggested as an effective strategy to prevent ankle sprain. It may be
helpful to pay attention to individuals with high LDTA to prevent ankle sprains.
Description:
Ankle sprain is the most common type of ankle injury, comprising nearly 80% of all injuries
affecting this area. Among these, 77% consists of sprains involving the lateral ankle (1). In
sedentary individuals, the reported incidence is 5.2 to 6 per 1000 persons (2). Although the
reported risk factors for ankle sprain include asymmetric tension in the flexor muscles of
the ankle, increased body mass index (BMI), increased bodyweight, and younger age, definitive
data is lacking (2).
The alignment of the pelvis, knee, and ankle has attracted significant research interest as a
potential risk factor for lower extremity injury. Also, the quadriceps angle (Q angle) was
reported to be an indicator for the biomechanical functions of the lower extremity,
reflecting the effect of the quadriceps mechanisms on the knee, as well as providing
information on patellar movements within the trochlear sulcus and on the functions of the
thigh muscles (3). Q angle is measured as the narrow angle between the line that connects the
anterior superior iliac spine (ASIS) to mid-patella and the line that connects the tibial
tubercle with the center of patella (3, 4). Currently, no consensus exists regarding the
normal value of the Q angle. While the American Orthopedics Society considers 10 degrees
normal and 15 to 20 degrees as pathologic, the normal values reported by Schulthies et al.
for males and females are 10 to 14 degrees, and 14.5 to 17 degrees, respectively (5). Several
studies suggested that Q angle may actually represent an independent risk factor associated
with increased risk of ankle sprain (4, 5). It has been proposed that individuals with knee
valgus and a Q value exceeding 15 degrees have an increased risk of lower extremity injury.
Also, a positive correlation between ankle sprain and Q angle was reported among recreational
basketball players (3). On the other hand, no direct correlations were found between these
two parameters in a study involving 45 professional athletes (4).
Another parameter that can be utilized to evaluate the alignment disorders of the lower
extremity is the lateral distal tibial angle (LTDA). The average angle between the distal
tibial joint orientation line and the anatomical and mechanical axis of the tibia is 89
degrees. This angle is referred to as LDTA (Figure 1). An angle of less than 86 degrees and
more than 92 degrees indicate the presence of valgus and varus deformities, respectively (6).
To the best of our knowledge, no previous studies have examined the association between LDTA
and ankle sprain. It is plausible to assume that pathological LDTA, which is one of the
alignment parameters of the lower extremity, may increase the predisposition to varus or
valgus sprains. Therefore, our study was based on the hypothesis that LDTA may have an effect
on the occurrence of ankle sprain, and thus it represents an intriguing research parameter.
Also, when proximal muscle strength is assessed in people with chronic ankle imbalance, lack
of muscle strength may be another potential risk factor for injury risk (9). This latter was
particularly evident in studies that showed that the abductor muscle defects may lead to poor
balance and neuromuscular adaptations in the ankle, therefore, contributing to increased
inversion moments, increased activation, and earlier activation of the ankle evertors. When
compared with athletes without injury, those with injury had weaker pelvic abduction and
pelvic external rotation strength. In contrast, a prospective study by McHugh and colleagues
concluded that the pelvic abductor, flexor or adductor strength had no role in predicting the
future risk of ankle sprain (10).
Therefore, the published literature on the potential effects of Q angle on ankle sprain is
controversial. On the other hand, literature data on the role of LDTA and proximal muscle
strength on injury risk is also far from being clear. The primary objective of our study was
to examine whether Q angle, LDTA, and knee and pelvic muscular torque were associated with
ankle sprain. The secondary objective was to determine the parameter that had the most
prominent impact on ankle injury risk.
