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Foot and Ankle Clinics Mar 2022A full-length standing posteroanterior radiograph that includes the calcaneus (hip-to-calcaneus radiograph) is obtained for evaluation of the mechanical axis of the... (Review)
Review
A full-length standing posteroanterior radiograph that includes the calcaneus (hip-to-calcaneus radiograph) is obtained for evaluation of the mechanical axis of the entire lower limb in patients with a lower limb condition involving malalignment. Such evaluation clarifies several pathomechanical aspects of hindfoot disorders, facilitates surgical planning, and elucidates factors contributing to unsatisfactory results of a particular operation. Whole limb alignment is influenced not only by the knee joint but also by the ankle joint; thus, knee realignment influences hindfoot alignment and vice versa. It is essential to analyze alignment of the whole limb in planning corrective lower limb surgery.
Topics: Ankle; Ankle Joint; Arthritis; Humans; Knee Joint; Radiography
PubMed: 35219359
DOI: 10.1016/j.fcl.2021.11.014 -
The Orthopedic Clinics of North America Apr 2020Brazil experiences a late participation in total ankle arthroplasty, which could have positive and negative aspects. The positive view argues about the modern implants... (Review)
Review
Brazil experiences a late participation in total ankle arthroplasty, which could have positive and negative aspects. The positive view argues about the modern implants that Brazil has received in the past years, skipping the early total ankle replacement generation who present more complications and low survival rate in the literature. The negative aspects are related to gap of experience with Brazilian surgeons unable to participate in the development of the technique and implant designs during these years. This article discusses the aspects of the Brazilian experience with total ankle replacement since the earliest procedures performed.
Topics: Adult; Aged; Ankle Joint; Arthritis; Arthroplasty, Replacement, Ankle; Brazil; Female; Humans; Joint Prosthesis; Male; Middle Aged; Prosthesis Design
PubMed: 32138866
DOI: 10.1016/j.ocl.2019.11.013 -
Foot and Ankle Clinics Mar 2021Chronic lateral ankle instability is the sensation of the ankle giving way along with recurrent sprains, chronic pain and swelling of the ankle for 1 year. The lateral... (Review)
Review
Chronic lateral ankle instability is the sensation of the ankle giving way along with recurrent sprains, chronic pain and swelling of the ankle for 1 year. The lateral ankle complex comprises the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament. The anterior talofibular ligament is the most commonly injured ligament of the lateral ankle. Evaluation comprises a history and physical with concomitant imaging to confirm the diagnosis and can be used to evaluate for concurrent pathology. The most popular treatment is a direct anatomic repair; however, additional options can be used in specific patient populations.
Topics: Ankle; Ankle Injuries; Ankle Joint; Humans; Joint Instability; Lateral Ligament, Ankle
PubMed: 33487245
DOI: 10.1016/j.fcl.2020.11.003 -
Foot and Ankle Surgery : Official... Jul 2020For the diagnosis and treatment of the foot and ankle, bone alignments have long been evaluated using planar radiographs in weight-bearing conditions and a large number... (Review)
Review
BACKGROUND
For the diagnosis and treatment of the foot and ankle, bone alignments have long been evaluated using planar radiographs in weight-bearing conditions and a large number of measurements have been reported. The present survey reviews the major radiographic angles that are currently present in the literature for a possible better comprehension and classification of them.
METHODS
PubMed and Google Scholar were used to retrieve technical and clinical papers related to these angles, and were classified based on five typologies and the three projection planes. These angles were grouped into one definition if they described similar concepts, regardless of their anatomical references and names. A corresponding original definition and diagrammatic representation are offered.
RESULTS
Thirty-one conceptual radiographic angles were identified across all descriptions from the literature: 18 in the sagittal plane, 9 in the transverse, and 4 in the coronal. Most angular measures represent relative bone orientations; absolute orientations, bone morphology and joint lines are less frequently used or reported.
CONCLUSIONS
The present survey reveals a confused scenario of angular measures, particularly in terms of anatomical references and names. It is therefore recommended to establish common relevant techniques and terminology.
Topics: Ankle Joint; Humans; Radiography; Weight-Bearing
PubMed: 31402285
DOI: 10.1016/j.fas.2019.07.008 -
Foot & Ankle Specialist Jun 2023The promising data from Ankle Arthroplasty are consequence of the evolution of instruments and implants. Recent studies have shown good results in the short and...
INTRODUCTION
The promising data from Ankle Arthroplasty are consequence of the evolution of instruments and implants. Recent studies have shown good results in the short and intermediate follow-up, in addition to high patient satisfaction. The aim of this study is to present the results obtained with 49 cases treated with the Infinity total ankle prosthesis in 2 South America countries.
METHODS
This is a case series of 48 patients (27 women and 22 men), treated with 49 Infinity prostheses in Brazil and Colombia. They underwent surgical treatment between April 1, 2016, and January 18, 2020. We used the visual-analogue pain scale (VAS), the AOFAS score for ankle and hindfoot and the measurement of range of motion (ROM) in the pre- and post-surgical period. The radiological evaluation was performed on ankle radiographs in anteroposterior and lateral views, obtained in orthostasis, measuring the parameters suggested by Hintermann. Average follow-up was 4 years.
RESULTS
VAS reduced from an average of 7.94 to 1.98; AOFAS increased from 28.02 to 83.16 and ROM increased from 11.45 to 28.08. Distal Tibial Slope is higher for higher improvements in VAS and lower for higher improvements in AOFAS and ROM. We observed 4 wound infections, 1 intra-op medial malleolus fracture. No bone cysts, tibial or talar components subsidence, polyethylene component wear or failure were observed. No salvation procedures were required in this series.
DISCUSSION
This study results corroborates literature data showing great improvements in pain, functional pattern, and movement.
CONCLUSION
Infinity Ankle Arthroplasty is a safe and reproducible procedure with good outcomes at a short-term follow-up.
LEVEL OF EVIDENCES
4 - Case series.
Topics: Male; Humans; Female; Ankle; Arthroplasty, Replacement, Ankle; Ankle Joint; Joint Prosthesis; Radiography
PubMed: 35656840
DOI: 10.1177/19386400221097565 -
The Journal of Foot and Ankle Surgery :... 2021Recent literature has proposed that restriction of joints in the rearfoot secondary to coalitions may lead to increased risk for severe ankle fracture after trauma....
Recent literature has proposed that restriction of joints in the rearfoot secondary to coalitions may lead to increased risk for severe ankle fracture after trauma. There is a paucity of literature regarding the rigidity of the ankle joint after arthrodesis of the subtalar and talonavicular joints. In this study, load-to-failure testing of cadaveric ankle joints with and without fusion of the subtalar and talonavicular joints was performed to determine if clinically relevant fracture patterns could be reproduced. Of the 3 fixation patterns studied, combined subtalar and talonavicular joint fusion resulted in a measurable increase in joint stiffness; however, this was not statistically significant. Clinical and radiographic examination postloading revealed that all tested ankle joints sustained a dislocation type injury rather than a specific bone fracture pattern. It was determined that a pure low-speed bending and compression model does not produce clinically relevant fracture patterns, and that higher energy mechanisms are required.
Topics: Ankle Joint; Arthrodesis; Cadaver; Humans; Subtalar Joint; Tarsal Joints
PubMed: 34210604
DOI: 10.1053/j.jfas.2020.09.009 -
Operative Orthopadie Und Traumatologie Aug 2022All arthroscopic one-step treatment of osteochondral defects of the talus with matrix-assisted bone marrow stimulation with a cell-free hyaluronic acid 3D matrix. (Review)
Review
OBJECTIVE
All arthroscopic one-step treatment of osteochondral defects of the talus with matrix-assisted bone marrow stimulation with a cell-free hyaluronic acid 3D matrix.
INDICATIONS
Symptomatic osteochondral defects of the talus (1-2 cm, ICRS III-IV).
CONTRAINDICATIONS
Large non-shouldered osteochondral defects (2 cm) of the talus, arthritis, kissing lesions of the distal tibia, metabolic arthropathies, non-reconstructable defects, hindfoot malalignment, chronic inflammatory systemic disorders.
SURGICAL TECHNIQUE
Arthroscopic examination of the ankle joint and visualization of the osteochondral defect of the talus to confirm the indication via standard portals. First, debridement of the osteochondral defect with arthroscopic curette or shaver, removal of loose fragments, resection of the sclerotic bone via shaver and measurement of the defect size. Second, multiple perforation of the subchondral plate to recruit mesenchymal stem cells from the underlying bone marrow by an microfracturing awl to stimulate the differentiation of fibrocartilaginous repair tissue in the defect zone. Then, the cell-free hyaluronic acid 3D matrix is placed into the defect via arthroscopic forceps and modulated by a probe to avoid detachment of the matrix by ankle joint movement.
POSTOPERATIVE MANAGEMENT
Postoperative management includes movement restrictions for pro- and supination but free passive dorsal extension and plantar flexion. No weight-bearing is allowed for 6 weeks.
RESULTS
Twenty-three patients (male: 11/women: 12) with a mean age of 33 years (range: 18-56) and a minimum follow-up of 24 months were included in this retrospective two-center study. The mean values for Foot and Ankle Outcome Score (FAOS) were 79 (range 33-93), for Tegner score 3 (range: 1-5) and the Visual analog scale (VAS) pain 1 (range: 0-3) and VAS function 2 (range: 0-5). At follow-up, MRI was available in 17 of 23 patients. MRI results showed a mean Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score of 81 (range: 65-90). Complications were not observed during the follow-up period.
Topics: Adult; Ankle Joint; Arthroscopy; Bone Marrow; Female; Humans; Hyaluronic Acid; Intra-Articular Fractures; Magnetic Resonance Imaging; Male; Retrospective Studies; Talus; Transplantation, Autologous; Treatment Outcome
PubMed: 34609575
DOI: 10.1007/s00064-021-00737-4 -
Scientific Reports Mar 2021Foot posture and ankle joint dorsiflexion have long been proposed to be risk factors for plantar heel pain, however body mass may be a confounder when investigating... (Observational Study)
Observational Study
Foot posture and ankle joint dorsiflexion have long been proposed to be risk factors for plantar heel pain, however body mass may be a confounder when investigating these factors. The aim of this study was to determine if clinical measures of foot posture and ankle joint dorsiflexion differ in adults with and without plantar heel pain after accounting for body mass. This was a cross-sectional observational study that compared 50 participants with plantar heel pain to 25 control participants without plantar heel pain who were matched for age, sex and body mass index. Foot posture was assessed using the Foot Posture Index and the Arch Index. Ankle joint dorsiflexion was assessed with a weightbearing lunge test with the knee extended and with the knee flexed. No significant differences (P < 0.05) were found between the groups for foot posture, whether measured with the Foot Posture Index or the Arch Index. Similarly, no significant differences were found in the weightbearing lunge test whether measured with the knee extended or with the knee flexed. Clinical measures of foot posture and ankle joint dorsiflexion do not differ in adults with and without plantar heel pain when body mass is accounted for. Therefore, clinicians should not focus exclusively on foot posture and ankle dorsiflexion and ignore the contribution of overweight or obesity.
Topics: Adult; Aged; Ankle Joint; Fasciitis, Plantar; Female; Foot; Humans; Male; Middle Aged; Posture; Weight-Bearing
PubMed: 33742026
DOI: 10.1038/s41598-021-85520-y -
Foot and Ankle Clinics Mar 2022Distal tibia sagittal plane deformities are a frequent finding in tibial malunions (antecurvatum or recurvatum) or ankle posttraumatic arthritis (anterior or posterior... (Review)
Review
Distal tibia sagittal plane deformities are a frequent finding in tibial malunions (antecurvatum or recurvatum) or ankle posttraumatic arthritis (anterior or posterior ankle arthritis). They should be evaluated in all deformities using long leg and tibia radiographs. Measuring the anterior distal tibia angle is necessary to evaluate the deformity severity. To evaluate the magnitude of secondary talar anterior or posterior displacement, the tibial axis to talus ratio and/or the talar lateral process position relative to the tibia axis should be measured. Anterior closing or opening wedge osteotomies are the recommended treatment options for posterior ankle arthritis or anterior ankle arthritis, respectively.
Topics: Ankle Joint; Humans; Osteoarthritis; Osteotomy; Radiography; Talus; Tibia
PubMed: 35219361
DOI: 10.1016/j.fcl.2021.11.011 -
Foot and Ankle Clinics Jun 2024Cartilage lesions to the ankle joint are common and can result in pain and functional limitations. Surgical treatment aims to restore the damaged cartilage's integrity... (Review)
Review
Cartilage lesions to the ankle joint are common and can result in pain and functional limitations. Surgical treatment aims to restore the damaged cartilage's integrity and quality. However, the current evidence for establishing best practices in ankle cartilage repair is characterized by limited quality and a low level of evidence. One of the contributing factors is the lack of standardized preoperative and postoperative assessment methods to evaluate treatment effectiveness and visualize repaired cartilage. This review article seeks to examine the importance of preoperative imaging, classification systems, patient-reported outcome measures, and radiological evaluation techniques for cartilage repair surgeries.
Topics: Humans; Cartilage, Articular; Ankle Injuries; Ankle Joint; Patient Reported Outcome Measures; Magnetic Resonance Imaging
PubMed: 38679436
DOI: 10.1016/j.fcl.2023.11.003