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Clinics in Podiatric Medicine and... Apr 2022Charcot neuroarthropathy (CN) of the foot/ankle is a devastating complication that can occur in neuropathic patients. It is a progressive and destructive process that is... (Review)
Review
Charcot neuroarthropathy (CN) of the foot/ankle is a devastating complication that can occur in neuropathic patients. It is a progressive and destructive process that is characterized by acute fractures, dislocations, and joint destruction that will lead to foot and/or ankle deformities. Early diagnosis is imperative, and early treatment may be advantageous, but the condition is not reversible. There is no cure for CN but only treatment recommendations. Ultimate goals of care should include providing a stable limb for ambulation and no ulcerations.
Topics: Ankle; Ankle Joint; Arthropathy, Neurogenic; Humans
PubMed: 35365330
DOI: 10.1016/j.cpm.2021.11.005 -
Foot and Ankle Surgery : Official... Apr 2023Total ankle replacements have become increasingly popular, providing a viable alternative to ankle arthrodesis in patients with end stage ankle arthritis. Continued...
Total ankle replacements have become increasingly popular, providing a viable alternative to ankle arthrodesis in patients with end stage ankle arthritis. Continued advancements in implant design have substantially improved long term survival outcomes as well as patient pain relief, range of motion, and quality of life. Surgeons continue to advance the indications for implantation of total ankle replacements in patients with more severe varus and valgus coronal plane deformity. This report of twelve cases demonstrates our algorithmic approach to total ankle arthroplasty in patients with deformity of the foot and ankle. By proposing a clinical algorithm with case examples, we aim to aid clinicians in successfully approaching coronal plane deformities of the foot and ankle when using total ankle replacement to ultimately improve clinical outcomes.
Topics: Humans; Arthroplasty, Replacement, Ankle; Ankle; Quality of Life; Treatment Outcome; Ankle Joint
PubMed: 36890086
DOI: 10.1016/j.fas.2023.02.011 -
Haemophilia : the Official Journal of... May 2024Patients with haemophilia (PwH) suffer from chronic pain due to joint alterations induced by recurring haemorrhage.
BACKGROUND
Patients with haemophilia (PwH) suffer from chronic pain due to joint alterations induced by recurring haemorrhage.
OBJECTIVES
This study aimed to investigate the relationship between structural alterations and pain perception at the ankle joint in PwH.
PATIENTS/METHODS
Ankle joints of 79 PwH and 57 healthy controls (Con) underwent ultrasound examination (US) and assessment of pain sensitivity via pressure pain thresholds (PPT). US discriminated between joint activity (synovitis) and joint damage (cartilage and/or bone degeneration) applying the HEAD-US protocol. Based on US-findings, five subgroups were built: PwH with activity/damage, PwH with activity/no damage, PwH with no activity/no damage, controls with activity/no damage and controls with no activity/no damage.
RESULTS
Joint activity and joint damage were significantly increased in ankles of PwH compared to Con (p ≤.001). Subgroup analysis revealed that structural alterations negatively impact pain perception. This is particularly evident when comparing PwH with both activity/damage to PwH with no activity/no damage at the tibiotalar joint (p = .001). At the fibulotalar joint, no significant differences were observed between PwH subgroups. Further analysis showed that both joint activity and joint damage result in an increase in pain sensitivity (p ≤.001).
CONCLUSION
The data suggest a relation between joint activity, joint damage and pain perception in PwH. Even minor changes due to synovitis appear to affect pain perception, with the effect not intensifying at higher levels of inflammation. In terms of joint damage, severe degeneration leads to a sensitised pain state most robustly, whereas initial changes do not seem to significantly affect pain perception.
Topics: Humans; Hemophilia A; Ankle Joint; Male; Adult; Pain Perception; Female; Middle Aged; Young Adult; Ultrasonography; Pain Threshold
PubMed: 38600680
DOI: 10.1111/hae.15011 -
Radiographics : a Review Publication of... Jan 2024Ankle arthritis can result in significant pain and restriction in range of motion. Total ankle replacement (TAR) is a motion-preserving surgical option used as an...
Ankle arthritis can result in significant pain and restriction in range of motion. Total ankle replacement (TAR) is a motion-preserving surgical option used as an alternative to total ankle arthrodesis to treat end-stage ankle arthritis. There are several generations of TAR techniques based on component design, implant material, and surgical technique. With more recent TAR implants, an attempt is made to minimize bone resection and mirror the native anatomy. There are more than 20 implant devices currently available. Implant survivorship varies among prosthesis types and generations, with improved outcomes reported with use of the more recent third- and fourth-generation ankle implants. Pre- and postoperative assessments of TAR are primarily performed by using weight-bearing radiography, with weight-bearing CT emerging as an additional imaging tool. Preoperative assessments include those of the tibiotalar angle, offset, and adjacent areas of arthritis requiring additional surgical procedures. US, nuclear medicine studies, and MRI can be used to troubleshoot complications. Effective radiologic assessment requires an understanding of the component design and corresponding normal perioperative imaging features of ankle implants, as well as recognition of common and device-specific complications. General complications seen at radiography include aseptic loosening, osteolysis, hardware subsidence, periprosthetic fracture, infection, gutter impingement, heterotopic ossification, and syndesmotic nonunion. The authors review several recent generations of TAR implants commonly used in the United States, normal pre- and postoperative imaging assessment, and imaging complications of TAR. Indications for advanced imaging of TAR are also reviewed. RSNA, 2023 Supplemental material is available for this article. Test Your Knowledge questions for this article are available through the Online Learning Center.
Topics: Humans; Arthroplasty, Replacement, Ankle; Treatment Outcome; Ankle Joint; Arthritis; Radiography; Retrospective Studies; Joint Prosthesis
PubMed: 38096110
DOI: 10.1148/rg.230111 -
Foot & Ankle International Jul 2021A substantial coronal plane deformity is common in the context of end-stage ankle osteoarthritis. Recent literature shows a trend toward extending the indication of...
BACKGROUND
A substantial coronal plane deformity is common in the context of end-stage ankle osteoarthritis. Recent literature shows a trend toward extending the indication of total ankle arthroplasty in increasingly severe coronal deformities, showing promising results when correct alignment is achieved. Nevertheless, the results of lateral transfibular total ankle replacement (LTTAR) in valgus has not been extensively studied. We aimed to evaluate if the outcomes of LTTAR in ankles with valgus deformity were similar to those with no major deformity at short-term follow-up.
METHODS
This retrospective cohort study included 228 LTTARs. Patients were classified into 2 groups according to the preoperative coronal plane tibiotalar angle (TTS): neutral (less than 10 degrees of coronal deformity, 209 patients) and valgus (above 10 degrees of valgus, 19 patients). Clinical evaluation was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS), 12-Item Short Form Health Survey 12 (SF-12) regarding its Physical and Mental Component Summary items. The radiographic evaluation considered anteroposterior and lateral ankle radiographs. Complications were also registered and classified as major or minor. The minimum follow-up was 2 years.
RESULTS
The average AOFAS, VAS, and SF-12 scores improved significantly postoperatively ( < .001), without differences between groups. At final radiographic follow-up, the valgus alignment group did not show significant differences with the neutral alignment group regarding TTS, lateral distal tibial angle, or anterior distal tibial angle ( > .05).
CONCLUSION
LTTAR in cases with valgus deformity achieved and maintained correction at short-term follow-up, as obtained in neutral alignment ankles. Clinical outcomes improved significantly regardless of preoperative valgus deformity.
LEVEL OF EVIDENCE
Prognostic Level III, retrospective cohort study.
Topics: Ankle; Ankle Joint; Arthroplasty, Replacement, Ankle; Humans; Range of Motion, Articular; Retrospective Studies; Treatment Outcome
PubMed: 33517787
DOI: 10.1177/1071100720985281 -
Foot & Ankle International Sep 2022Although correction of ankle and hindfoot deformity after supramalleolar osteotomy has been investigated extensively, the specific effect on the subtalar joint alignment...
BACKGROUND
Although correction of ankle and hindfoot deformity after supramalleolar osteotomy has been investigated extensively, the specific effect on the subtalar joint alignment remains elusive. This can be attributed to the limitations of 2-dimensional measurements, which impede an exact quantification of the 3-dimensional subtalar joint alignment. Therefore, we determined both the ankle, hindfoot, and subtalar joint alignment before and after supramalleolar osteotomy using autogenerated 3-dimensional measurements based on weightbearing CT imaging.
METHODS
Twenty-nine patients with a mean age of 50.4±10.6 years were retrospectively analyzed in a pre-post study design using weightbearing CT. Inclusion criteria were correction of ankle varus deformity by an opening wedge (n = 22) or dome osteotomy (n = 7). Exclusion criteria consisted of an additional inframalleolar arthrodesis or osteotomy. Corresponding 3-dimensional bone models were reconstructed to compute following autogenerated measurements of the ankle- and hindfoot alignment: tibial anterior surface (TAS), tibiotalar surface (TTS), talar tilt (TT) angle, hindfoot angle (HA). In addition, the talocalcaneal angle (TCA) in the axial (TCA), sagittal (TCA), and coronal (TCA) plane were measured to assess the subtalar joint alignment.
RESULTS
The preoperative radiographic parameters of the ankle joint alignment (TAS=88±4 degrees, TTS=82±7 degrees, TT=5.8±4.9 degrees) improved significantly relative to their postoperative equivalents (TAS = 93±5 degrees, TTS = 88±7 degrees, TT=4.2±4.5 degrees; < .05). The following radiographic parameters of the hindfoot and subtalar joint alignment improved significantly from preoperatively (8.7±8.9 degrees, TCA = 41±10 degrees, TCA = 48±10 degrees) to postoperatively (HA=4.5±8.6 degrees, TCA = 38±9 degrees, TCA = 44±11 degrees; < .05). No significant differences could be detected in the coronal plane alignment of the subtalar joint (TCA) pre- compared to postoperatively ( > .05).
CONCLUSION
This study quantified the 3-dimensional ankle, hindfoot, and subtalar joint alignment after a solitary supramalleolar osteotomy. We found alterations in the subtalar joint alignment, which occurred by 2 to 3 degrees in each anatomic plane. However, before recommendations can be given related to inframalleolar procedures in conjunction to supramalleolar osteotomies, further studies on the variation of subtalar joint alignment change are needed.
Topics: Adult; Ankle; Ankle Joint; Humans; Middle Aged; Osteotomy; Retrospective Studies; Subtalar Joint
PubMed: 35786021
DOI: 10.1177/10711007221108097 -
Arthroscopy : the Journal of... Apr 2021Surgical access to pathology of the talar dome (e.g., osteochondral lesions of the talus) can be limited because of the ankle joint congruity. When considering...
Surgical access to pathology of the talar dome (e.g., osteochondral lesions of the talus) can be limited because of the ankle joint congruity. When considering arthroscopic treatment, anterior arthroscopy with the ankle in plantar flexion or posterior arthroscopy with the ankle in dorsiflexion is used. The surgeon should carefully assess different clinical and radiologic aspects to plan the optimal operative approach. Meticulous physical examination, including ankle range of motion and possible palpation of a talar lesion, in combination with exact lesion localization on computed tomography or magnetic resonance imaging usually provide sufficient preoperative information. Most lesions with the anterior border localized on or anterior to the midline of the talus are accessible by anterior arthroscopy. In the case of preoperative doubt concerning the intraoperative accessibility, a computed tomography scan of the ankle in full plantarflexion is used to mirror arthroscopic reachability. Intraoperative surgical tricks to increase accessibility to the lesion may consist of an adjunct soft-tissue distraction device, reduction of the distal tibial rim, and treating the lesion from anteriorly to posteriorly, thereby gaining further exposure to the lesion throughout the procedure.
Topics: Ankle; Ankle Joint; Arthroscopes; Arthroscopy; Humans; Radiography; Talus
PubMed: 33485942
DOI: 10.1016/j.arthro.2021.01.020 -
JBJS Reviews Feb 2022Maisonneuve fractures (MFs), originally described as subcapital (high) fibular fractures with additional injury to the anterior and interosseous tibiofibular ligaments,... (Review)
Review
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Maisonneuve fractures (MFs), originally described as subcapital (high) fibular fractures with additional injury to the anterior and interosseous tibiofibular ligaments, display a variable injury pattern, ranging from stable to highly unstable fractures.
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The high incidence of associated fractures of the posterior malleolus, the medial malleolus, and the anterolateral distal tibia (the "anterior malleolus") as well as the variable position of the fibula in the fibular notch (FN) warrant preoperative examination via computed tomography (CT).
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The main goal of treatment is anatomic reduction of the distal fibula into the FN, which requires prior reduction of displaced posterior malleolar fractures, if present, to restore the integrity of the FN.
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Open reduction of the distal fibula into the FN and fixation with 2 transsyndesmotic screws or fixation with a screw(s) and suture-button implant, under direct vision, on the lateral aspect of the ankle joint and anterior tibiofibular alignment are preferred over closed reduction to avoid sagittal or rotational malpositioning, which is associated with an inferior outcome.
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Intra- or postoperative 3D CT visualization is essential for assessment of the accuracy of the reduction of the distal fibula into the FN.
Topics: Ankle; Ankle Fractures; Ankle Injuries; Ankle Joint; Fibula; Humans
PubMed: 35180143
DOI: 10.2106/JBJS.RVW.21.00160 -
Journal of Orthopaedic Research :... Feb 2023Implant loosening and bearing surface wear remain the most common failure problems of total ankle arthroplasty (TAA). One of the main factors leading to these problems...
Implant loosening and bearing surface wear remain the most common failure problems of total ankle arthroplasty (TAA). One of the main factors leading to these problems is the nonphysiologic design of articular surfaces. The goals of this study were to reveal the effects of the anatomical medial-lateral borders height differences, coronal and sagittal radii on the joint kinematics, contact mechanics, and implant-bone micromotion in TAA. A previously developed and validated musculoskeletal (MSK) multibody dynamics (MBD) modeling method of TAA based on AnyBody generic MSK MBD model (five simulations for each implant) was used by combining with a finite element analysis. Five ankle implant models with different articular surface morphologies were created according to the anatomic characteristics of Chinese measurement data, marked as Implant A to E. The total ankle forces and motions during walking simulation were predicted by MSK MBD models and the contact mechanics of the bearing surface and the micromotion of the implant-bone interface of TAA were predicted by FE models. Compared with Implant A, the internal-external rotation in Implant E increased by 12.14%, the maximum of anterior-posterior translation in Implant E increased by 5.62%, the maximum reduction of tibial micromotion in Implant E was 59.98%, and for talar, micromotion was 15.36%. The ankle implant with similar anatomic articular surface has the potential to allow patients to recover better motions and reduce the risk of early loosening. This study would provide design guidance for the development of new ankle implants and further advance the development of TAA. Clinical Significance: This study promoted the improvement of ankle implant design and made contributions to improve the service life of ankle implant and patient satisfaction.
Topics: Humans; Ankle; Biomechanical Phenomena; Prosthesis Design; Arthroplasty, Replacement, Ankle; Ankle Joint
PubMed: 35579007
DOI: 10.1002/jor.25381 -
Foot & Ankle International Oct 2021The number of total ankle replacements (TARs) performed in the United States has dramatically increased in the past 2 decades due to improvements in implant design and...
The number of total ankle replacements (TARs) performed in the United States has dramatically increased in the past 2 decades due to improvements in implant design and surgical technique. Yet as the prevalence of TAR increases, so does the likelihood of encountering complications and the need for further surgery. Patients with new-onset or persistent pain after TAR should be approached systematically to identify the cause: infection, fracture, loosening/subsidence, cysts/osteolysis, impingement, and nerve injury. The alignment of the foot and ankle must also be reassessed, as malalignment or adjacent joint pathology can contribute to pain and failure of the implant. Novel advanced imaging techniques, including single-photon emission computed tomography and metal-subtraction magnetic resonance imaging, are useful and accurate in identifying pathology. After the foot and ankle have been evaluated, surgeons can also consider contributing factors such as pathology outside the foot/ankle (eg, in the knee or the spine). Treatment of the painful TAR is dependent on etiology and may include debridement, bone grafting, open reduction and internal fixation, realignment of the foot, revision of the implants, arthrodesis, nerve repair/reconstruction/transplantation surgery, or, in rare cases, below-knee amputation.: Level V, expert opinion or review.
Topics: Ankle; Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Humans; Pain; Reoperation; Retrospective Studies; Treatment Outcome
PubMed: 34315246
DOI: 10.1177/10711007211027273