Chronic Ankle Instability Impairs Cartilage Health and Balance in Middle-Aged Adults
Poster #: 176
Session/Time: A
Author:
Amin Mohammadi, BS, MS
Mentor:
Ryan McCann, MS, PhD
Research Type: Clinical Research
Abstract
INTRODUCTION:
Chronic ankle instability (CAI) is associated with impaired function and the development of post-traumatic osteoarthritis. While CAI has been studied extensively in younger adults, its long-term impact on talar cartilage health, balance, and sensorimotor function in middle-aged adults remains underexplored. This study evaluated differences in talar cartilage structure, postural control, ankle-specific function, and injury-related fear between middle-aged adults with and without CAI.
METHODS:
Talar cartilage characteristics, including medial and lateral cross-sectional area (CSA), echointensity (EI), and echogenicity (EG) were assessed using diagnostic ultrasound. Postural control was assessed using the Clinical Test of Sensory Interaction and Balance (CTSIB) under six sensory conditions (firm and foam surfaces with eyes open, closed, and sway-referenced vision). Center of pressure (COP) data were collected and analyzed to derive medial-lateral (ML) sway, anterior-posterior (AP) sway, and total sway path length. Patient-reported outcomes assessed included the Foot and Ankle Disability Index (FADI), Fear Avoidance Beliefs Questionnaire (FABQ), and Tampa Scale of Kinesiophobia-11 (TSK-11). Independent t-tests (P < 0.05) and Cohen's d effect sizes with 95% confidence intervals were used to compare outcomes between groups.
RESULTS:
Twenty middle-aged adults (40-59 years) participated (CAI: n=10 [age: 51.5±6.2]; Control: n=10 [age: 48.9±6.6]). CAI was defined using the International Ankle Consortium guidelines. The CAI group demonstrated significantly greater medial CSA (P=0.001, d=1.76[0.69, 2.78]) and lateral CSA (P=0.025, d=1.09[0.13, 2.02]) than controls. They also showed greater ML sway in the eyes-open condition (P=0.030, d=1.05[0.1, 1.98]) and increased path length in the eyes-closed condition (P=0.035, d=1.02[0.07, 1.94]). CAI participants had lower FADI-ADL scores (P=0.034, d=-1.03[-1.95, -0.08]) and higher FABQ scores (P=0.006, d=1.41[0.40, 2.38]), indicating reduced function and elevated fear. No other differences were significant.
CONCLUSION:
Middle-aged adults with CAI exhibit structural alterations in talar cartilage, characterized by increased CSA, which may reflect early-stage cartilage swelling and maladaptive remodeling in response to abnormal joint loading. These changes, alongside balance deficits, reduced ankle function, and elevated fear-avoidance beliefs, may contribute to long-term functional decline and heightened risk for joint degeneration.
Chronic ankle instability (CAI) is associated with impaired function and the development of post-traumatic osteoarthritis. While CAI has been studied extensively in younger adults, its long-term impact on talar cartilage health, balance, and sensorimotor function in middle-aged adults remains underexplored. This study evaluated differences in talar cartilage structure, postural control, ankle-specific function, and injury-related fear between middle-aged adults with and without CAI.
METHODS:
Talar cartilage characteristics, including medial and lateral cross-sectional area (CSA), echointensity (EI), and echogenicity (EG) were assessed using diagnostic ultrasound. Postural control was assessed using the Clinical Test of Sensory Interaction and Balance (CTSIB) under six sensory conditions (firm and foam surfaces with eyes open, closed, and sway-referenced vision). Center of pressure (COP) data were collected and analyzed to derive medial-lateral (ML) sway, anterior-posterior (AP) sway, and total sway path length. Patient-reported outcomes assessed included the Foot and Ankle Disability Index (FADI), Fear Avoidance Beliefs Questionnaire (FABQ), and Tampa Scale of Kinesiophobia-11 (TSK-11). Independent t-tests (P < 0.05) and Cohen's d effect sizes with 95% confidence intervals were used to compare outcomes between groups.
RESULTS:
Twenty middle-aged adults (40-59 years) participated (CAI: n=10 [age: 51.5±6.2]; Control: n=10 [age: 48.9±6.6]). CAI was defined using the International Ankle Consortium guidelines. The CAI group demonstrated significantly greater medial CSA (P=0.001, d=1.76[0.69, 2.78]) and lateral CSA (P=0.025, d=1.09[0.13, 2.02]) than controls. They also showed greater ML sway in the eyes-open condition (P=0.030, d=1.05[0.1, 1.98]) and increased path length in the eyes-closed condition (P=0.035, d=1.02[0.07, 1.94]). CAI participants had lower FADI-ADL scores (P=0.034, d=-1.03[-1.95, -0.08]) and higher FABQ scores (P=0.006, d=1.41[0.40, 2.38]), indicating reduced function and elevated fear. No other differences were significant.
CONCLUSION:
Middle-aged adults with CAI exhibit structural alterations in talar cartilage, characterized by increased CSA, which may reflect early-stage cartilage swelling and maladaptive remodeling in response to abnormal joint loading. These changes, alongside balance deficits, reduced ankle function, and elevated fear-avoidance beliefs, may contribute to long-term functional decline and heightened risk for joint degeneration.