The distal fascicle of the anterior inferior tibiofibular ligament as a cause of tibiotalar impingement syndrome: a current concepts review

Impingement syndromes of the ankle involve either osseous or soft tissue impingement and can be anterior, anterolateral, or posterior. Ankle impingement syndromes are painful conditions caused by the friction of joint tissues, which are both the cause and the effect of altered joint biomechanics. The distal fascicle of the anterior inferior tibiofibular ligament (AITFL) is possible cause of anterior impingement. The objective of this article was to review the literature concerning the anatomy, pathogenesis, symptoms and treatment of the AITFL impingement and finally to formulate treatment recommendations. The AITFL starts from the distal tibia, 5 mm in average above the articular surface, and descends obliquely between the adjacent margins of the tibia and fibula, anterior to the syndesmosis to the anterior aspect of the lateral malleolus. The incidence of the accessory fascicle differs very widely in the several studies. The presence of the distal fascicle of the AITFL and also the contact with the anterolateral talus is probably a normal finding. It may become pathological, due to anatomical variations and/or anterolateral instability of the ankle resulting from an anterior talofibular ligament injury. When observed during an ankle arthroscopy, the surgeon should look for the criteria described to decide whether it is pathological and considering resection of the distal fascicle. The presence of the AITFL and the contact with the talus is a normal finding. An impingement of the AITFL can result from an anatomical variant or anteroposterior instability of the ankle. The diagnosis of ligamentous impingement in the anterior aspect of the ankle should be considered in patients who have chronic ankle pain in the anterolateral aspect of the ankle after an inversion injury and have a stable ankle, normal plain radiographs, and isolated point tenderness on the anterolateral aspect of the talar dome and in the anteroinferior tibiofibular ligament. The impingement syndrome can be treated arthroscopically

Motor competence and health-related fitness in children: A cross-cultural comparison between Portugal and the United States

Background: Motor competence and health-related fitness are important components for the development and maintenance of a healthy lifestyle in children. This study examined cross-cultural performances on motor competence and health-related fitness between Portuguese and U.S. children. Methods: Portuguese (n = 508; 10.14 ± 2.13 years , mean ± SD) and U.S. (n = 710; 9.48 ± 1.62 years) children performed tests of cardiorespiratory fitness (Progressive Aerobic Cardiovascular Endurance Run), upper body strength (handgrip), locomotor skill performance (standing long jump), and object projection skill performance (throwing and kicking). Portuguese and U.S. children were divided into 2 age groups (6–9 and 10–13 years) for data analysis purposes. A two–factor one–way analysis of covariance (ANOVA) was conducted with the Progressive Aerobic Cardiovascular Endurance Run, handgrip, standing long jump scores, kicking, and throwing speed (km/h) as dependent variables. Results: Results indicated that Portuguese children, irrespective of sex, presented better performances in locomotor and cardiorespiratory performance (standing long jump and Progressive Aerobic Cardiovascular Endurance Run) than U.S. children in both age bands. U.S. children outperformed Portuguese children during throwing and handgrip tests. Kicking tests presented gender differences: Portuguese boys and U.S. girls outperformed their internationally matched counterparts. Conclusion: Cultural differences in physical education curricula and sports participation may impact differences in motor competence and fitness development in these countries. Keywords: Children, Cross-cultural comparison, Health-related fitness, Motor competenc