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International Journal of Environmental... Jun 2022Some patients with moderate haemophilia (PWMH) report joint damage potentially responsible for gait disorders. Three-dimensional gait analysis (3DGA) is a relevant tool...
Some patients with moderate haemophilia (PWMH) report joint damage potentially responsible for gait disorders. Three-dimensional gait analysis (3DGA) is a relevant tool for the identification of complex musculoskeletal impairment. We performed an evaluation with 3DGA of 24 PWMH aged 44.3 ± 16.1 according to their joint status [Haemophilia Joint Health Score (HJHS) < 10 or HJHS ≥ 10] and assessed the correlation with the radiological and clinical parameters. Sixteen had HJHS < 10 (group 1) and eight had HJHS ≥ 10 (group 2). They were compared to 30 healthy subjects of a normative dataset. Both knee and ankle gait variable scores were increased in group 2 compared to the controls (p = 0.02 and p = 0.04, respectively). The PWMH of group 2 had a significant increase in their stance phase, double support duration, and stride width compared to the controls and group 1 (p < 0.01). Very low correlations were found for the ankle gait variable score with the ankle Pettersson sub-score (r2 = 0.250; p = 0.004) and ankle HJHS sub-score (r2 = 0.150; p = 0.04). For the knee, very low correlation was also found between the knee gait variable score and its HJHS sub-score (r2 = 0.290; p < 0.0001). Patients with moderate haemophilia presented a gait alteration in the case of poor lower limb joint status.
Topics: Ankle Joint; Arthritis; Gait; Hemophilia A; Humans; Knee Joint
PubMed: 35742774
DOI: 10.3390/ijerph19127527 -
BMC Musculoskeletal Disorders Jan 2022Open pilon fractures combined with sizeable segmental bone defects are rare, difficult to treat, and often result in the loss of ankle joint function. The purpose of...
Ankle joint salvage and reconstruction by limited ORIF combined with an Ilizarov external fixator for complex open tibial pilon fractures (AO 43-C3.3) with segmental bone defects.
BACKGROUND
Open pilon fractures combined with sizeable segmental bone defects are rare, difficult to treat, and often result in the loss of ankle joint function. The purpose of this study was to determine clinical outcomes in patients with open pilon fractures and sizeable segmental bone defects treated by limited ORIF combined with an Ilizarov external fixator.
METHODS
We conducted a retrospective analysis of open pilon fractures with sizeable segmental bone defects treated by limited ORIF combined with the Ilizarov external fixator strategy between July 2014 and August 2019. All patients were included for assessments of fracture healing and infection rates. Ankle functional outcomes were assessed in all patients according to the Paley criteria and American Orthopedic Foot and Ankle Society Score (AOFAS) at least 24 months post-injury.
RESULTS
All patients were followed up for a mean of 41.09 months. The mean bone defect size was 5.64 ± 1.21 cm. The average EFI and BTI were 1.56 ± 0.28 months/cm and 11.12 ± 0.74 days/cm, respectively. According to the Paley evaluation system, the success rate of ankle joint reconstruction was 64% (7/11). The mean score based on the AOFAS functional assessment was 77.73 ± 8.87. Five patients showed posttraumatic arthritis, one of whom required ankle arthrodesis. Three patients developed pin site infections, and one patient developed a deep infection after bone grafting.
CONCLUSION
The strategy of limited ORIF combined with an Ilizarov external fixator can restore ankle function in most patients with complex open tibial pilon fractures. Ankle stiffness, pin tract infection, and traumatic arthritis were the most common complications associated with this therapy.
Topics: Ankle Injuries; Ankle Joint; External Fixators; Humans; Retrospective Studies; Tibial Fractures
PubMed: 35090407
DOI: 10.1186/s12891-022-05060-y -
BMC Musculoskeletal Disorders Jul 2022Analysis of the outcomes of Ilizarov treatment of tibial nonunion shows functional deficits in the lower limbs of some patients. Biomechanical gait parameters are an...
BACKGROUND
Analysis of the outcomes of Ilizarov treatment of tibial nonunion shows functional deficits in the lower limbs of some patients. Biomechanical gait parameters are an important measure for assessing musculoskeletal disorder treatments that aim to restore normal gait. The purpose of our study was to compare the kinematic parameters in patients with tibial nonunion treated using the Ilizarov method and those in a control group of healthy volunteers.
METHODS
The study population consisted of 23 patients (age 54.9 ± 16.4 years) who were treated for tibial nonunion using the Ilizarov method, as well as 22 healthy adult controls (age 52.7 ± 10.6 years). Kinematic parameters were measured using a Noraxon MyoMOTION System. We measured hip flexion and abduction, knee flexion, ankle dorsiflexion, inversion, and abduction during walking.
RESULTS
Our analysis showed significant differences between the patients' operated limbs (OLs) and the controls' nondominant limbs (NDLs) in the ranges of hip flexion, hip abduction, and knee flexion. We observed no significant differences in knee flexion between the OL and the NOL in patients or between the dominant limb (DL) and NDL in controls. Our evaluation of the kinematic parameters of the ankle joint demonstrated significant differences between the patients' OLs and the controls' NDLs in the ranges of ankle dorsiflexion, ankle inversion, and ankle abduction. There were also significant differences in the range of ankle dorsiflexion and ankle abduction between the patients' NOLs and the controls' DLs.
CONCLUSION
Tibial nonunion treatment using the Ilizarov method does not ensure complete normalization of kinematic parameters assessed 24-48 months following the completion of treatment and rehabilitation.
Topics: Adult; Aged; Ankle Joint; Biomechanical Phenomena; Gait; Humans; Ilizarov Technique; Knee Joint; Middle Aged; Tibia
PubMed: 35902916
DOI: 10.1186/s12891-022-05683-1 -
Orthopaedic Surgery Oct 2022To evaluate the clinical curative effect of Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.
OBJECTIVE
To evaluate the clinical curative effect of Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.
METHODS
From June 2013 to August 2019, 72 patients with elderly traumatic ankle arthritis were treated with arthrodesis through Ilizarov external fixation technique in our institution. Conventional double-feet standing X-ray films were taken before and after operation. The tibiotalar angle on X-ray image was measured to evaluate the degree of talipes varus and valgus. The Foot and Ankle pain score of American Orthopaedics Foot and Ankle Society (AOFAS) and Visual Analog Scale (VAS) were compared by using paired t-test to evaluate the functional recovery.
RESULTS
All of the patients acquired effective postoperative 18-49 months follow-up, with an average of 31.5 months. All patients were included in the analysis, among which 38 cases were males and 34 cases were females, with an average of 65.4 years (ranging from 60 to 74). All ankles achieved bony fusion; the clinical healing time was 12.7 weeks on average (11-18 weeks). The AOFAS score was 45.36 ± 6.43 preoperatively and 80.25 ± 9.16 at 12 months post-operation, with a statistically significant difference (p < 0.0001). The VAS score was 8.56 ± 1.85 on average preoperatively and 2.72 ± 0.83 at 12 months post-operation, with a statistically significant difference (p < 0.0001). The tibiotalar angle was 101.93° ± 4.12° preoperatively and 94.45° ± 2.37° at 12 months post-operation, with a statistically significant difference (p < 0.0001). The results of the functional evaluation indicated that 44 patients (61.1%) had excellent results, 18 (25%) had good results, and 10 (13.9%) had fair results.
CONCLUSION
Our study demonstrated that it is possible to obtain satisfactory outcome with Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.
Topics: Aged; Ankle; Ankle Joint; Arthritis; Arthrodesis; External Fixators; Female; Humans; Ilizarov Technique; Male; Retrospective Studies; Treatment Outcome
PubMed: 36001696
DOI: 10.1111/os.13399 -
Clinical Anatomy (New York, N.Y.) Sep 2021Flattening of the trochlear tali is clinically observed as structural and functional changes advance in patients with hemarthropathy of the ankle. However, the degree of... (Comparative Study)
Comparative Study
Flattening of the trochlear tali is clinically observed as structural and functional changes advance in patients with hemarthropathy of the ankle. However, the degree of this flattening has not yet been quantified, and distribution of the morphological changes across the talus not yet defined. Chronologically sequential MR images of both a hemophilic patient group (N = 5) and a single scan from a nondiseased, sex-matched, control group (N = 11) were used to take four measurements of the trochlear talus morphology at three locations (medial, central and lateral) along the sagittal plane. Three ratios of interest were defined from these to assess whether the talar dome flattens with disease. The control group MRI measurements were validated against literature data obtained from CT scans or planar X-Rays. The influence of disease on talar morphology was assessed by direct comparison of the hemophilic cases with the control group. The values for all three ratios, in all locations, differed between the control and the hemophilic group. Flattening was indicated in the hemophilic group in the medial and lateral talus, but differences in the central talus were not statistically significant. This work demonstrates that morphological assessment of the talus from MR images is similar to that from CT scans or planar X-Rays. Talar flattening does occur with hemarthropathy, especially at the medial and lateral edges of the joint surface. General flattening of the trochlear talus was confirmed in this small patient sample, however the degree and rate of change is unique to each ankle.
Topics: Adolescent; Adult; Ankle Joint; Child; Diagnostic Imaging; Hemophilia A; Humans; Talus; Young Adult
PubMed: 33998061
DOI: 10.1002/ca.23757 -
Scientific Reports Aug 2021Individuals post-stroke experience persisting gait deficits due to altered joint mechanics, known clinically as spasticity, hypertonia, and paresis. In engineering,... (Clinical Trial)
Clinical Trial
Individuals post-stroke experience persisting gait deficits due to altered joint mechanics, known clinically as spasticity, hypertonia, and paresis. In engineering, these concepts are described as stiffness and damping, or collectively as joint mechanical impedance, when considered with limb inertia. Typical clinical assessments of these properties are obtained while the patient is at rest using qualitative measures, and the link between the assessments and functional outcomes and mobility is unclear. In this study we quantify ankle mechanical impedance dynamically during walking in individuals post-stroke and in age-speed matched control subjects, and examine the relationships between mechanical impedance and clinical measures of mobility and impairment. Perturbations were applied to the ankle joint during the stance phase of walking, and least-squares system identification techniques were used to estimate mechanical impedance. Stiffness of the paretic ankle was decreased during mid-stance when compared to the non-paretic side; a change independent of muscle activity. Inter-limb differences in ankle joint damping, but not joint stiffness or passive clinical assessments, strongly predicted walking speed and distance. This work provides the first insights into how stroke alters joint mechanical impedance during walking, as well as how these changes relate to existing outcome measures. Our results inform clinical care, suggesting a focus on correcting stance phase mechanics could potentially improve mobility of chronic stroke survivors.
Topics: Adult; Ankle; Ankle Joint; Biomechanical Phenomena; Chronic Disease; Female; Gait; Humans; Male; Middle Aged; Stroke; Walking; Walking Speed
PubMed: 34408174
DOI: 10.1038/s41598-021-95737-6 -
Journal of Healthcare Engineering 2020While individual ankle and metatarsophalangeal joint stiffness is related to training intensity and sport performances, sport athletes may develop specific passive joint...
While individual ankle and metatarsophalangeal joint stiffness is related to training intensity and sport performances, sport athletes may develop specific passive joint stiffness among the spectrum from endurance to powerful types of sports. The objective of this study examined whether marathon runners, basketball players, and other sports athletes would demonstrate distinct passive ankle and metatarsophalangeal joint stiffness as well as vertical stiffness. Fifteen marathon runners, nineteen basketball players, and seventeen other sports athletes performed both joint stiffness measurement and single-leg hopping tests. We used a computerized dynamometer to control foot alignment and speed for passive ankle and metatarsophalangeal joint stiffness measurements. We calculated vertical stiffness by body deceleration and body mass displacement during hopping on the force platform. One-way ANOVA was performed to identify the group differences. Bivariate correlation test was also performed among ankle, metatarsophalangeal, and vertical stiffness. The basketball group displayed 13% higher ankle passive stiffness than the other sports players group ( = 0.03). Metatarsophalangeal joint passive stiffness in sitting and standing positions was 23% higher in the basketball group than the runner and other sports athlete groups ( < 0.01). However, there was no significant group differences in metatarsophalangeal joint passive stiffness and vertical stiffness. Significant correlations among all stiffness variables were determined ( < 0.05). These findings indicate that ankle and metatarsophalangeal joint passive stiffness, rather than vertical leg stiffness, would be in relation to types of sports participation. Ankle and toe strengthening exercises could improve basketball players' performance and prevent injury.
Topics: Adult; Ankle Joint; Athletic Performance; Basketball; Humans; Male; Metatarsophalangeal Joint; Movement; Running; Young Adult
PubMed: 32257087
DOI: 10.1155/2020/9025015 -
Foot and Ankle Surgery : Official... Oct 2021Foot and ankle injuries are common. Radiographic assessment is difficult because of the complex anatomy. In the past decade SPECT/CT made its introduction in assessing... (Review)
Review
INTRODUCTION
Foot and ankle injuries are common. Radiographic assessment is difficult because of the complex anatomy. In the past decade SPECT/CT made its introduction in assessing bone pathology, it combines both morphologic and pathologic imaging in one image aiming to increase sensitivity and specificity when compared with MRI or CT alone. The purpose of this review was to provide a literature overview on the diagnostic value of SPECT/CT in foot and ankle pathology.
METHODS
A literature search was conducted in the databases of PubMed and EMBASE between January 2004 and September 2019 for articles describing the diagnostic value of SPECT/CT in foot and ankle pathology. For assessment of methodological quality of each study included in the analysis, QUADAS-2 checklist was used. Main outcomes were change of management, improved diagnosis and symptomatic improvement.
RESULTS
A total of eight studies were identified describing the diagnostic value of SPECT/CT in foot and ankle pathology based on patient data. The combined analysis shows that change of management and improved diagnosis occurred in 48-62% and 40-79% of the patients when compared with other imaging modalities and/or clinical assessment. Symptomatic improvement due to treatment based on SPECT/CT findings occurred in 92% of the patients.
CONCLUSION
SPECT/CT is useful when diagnosis based on other imaging modalities is inconclusive or when treatment based on these modalities does not lead to the desired symptomatic improvement.
Topics: Ankle; Ankle Joint; Foot Diseases; Humans; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed
PubMed: 33046381
DOI: 10.1016/j.fas.2020.09.009 -
Journal of Orthopaedic Surgery (Hong... 2023Lateral ankle instability is a common condition which responds well to non-surgical management. However, the chronic symptomatic instability may require surgical... (Review)
Review
Lateral ankle instability is a common condition which responds well to non-surgical management. However, the chronic symptomatic instability may require surgical intervention. The acceptable and practiced procedure is the Brostom Gould modification and it has a high patient satisfaction score. However, the current understanding and newer techniques for stabilising the lateral ligament complex has resulted in arthroscopic repairs, augmentation and tendon graft reconstructions. The literature does not provide an answer to the efficacy of these new techniques but there is some preliminary information favouring some of the latest procedures. It is now accepted practise to include ankle arthroscopy as a pre repair step. Augmentation of anatomical repair is also favoured in a select group of patients. This article provides an up to date account of the newer techniques for lateral ankle stabilisation.
Topics: Humans; Lateral Ligament, Ankle; Ankle; Ankle Joint; Arthroscopy; Joint Instability; Arthroplasty, Replacement
PubMed: 37449536
DOI: 10.1177/10225536231182348 -
The Journal of Foot and Ankle Surgery :... 2022Research demonstrating improved outcomes with third-generation ankle replacement implants has resulted in increasing utilization of total ankle arthroplasty over the...
Research demonstrating improved outcomes with third-generation ankle replacement implants has resulted in increasing utilization of total ankle arthroplasty over the past 3 decades. The purpose of this study was to examine the quality and trends of clinical outcomes research being published on third-generation total ankle arthroplasty implants. Two fellowship-trained foot and ankle surgeons reviewed all peer-reviewed, Medline-indexed English-language clinical outcomes studies evaluating total ankle arthroplasty published between 2006 and 2019. Articles were assessed for study design and indicators of study quality. A total of 694 published articles were reviewed and 231 met all inclusion criteria. The majority (78%) of studies were retrospective, most of which were case series (54%) or cohorts (32%). Ten percent (10%) of studies were funded by industry and 28% did not disclose funding sources. Thirty-eight percent (38%) of studies reported a conflict of interest and 6% did not disclose whether or not there were conflicts. The average patient follow-up time across studies was 72 months. We found that although the study of outcomes with third-generation total ankle arthroplasty prostheses is steadily increasing, most studies are Level IV, retrospective case series. Some studies have disclosed industry funding and/or a conflict of interest, and a considerable number did not disclose potential funding and/or financial conflicts. Future investigators should strive to design studies with the highest quality methodology possible.
Topics: Ankle; Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Humans; Outcome Assessment, Health Care; Retrospective Studies; Treatment Outcome
PubMed: 34244049
DOI: 10.1053/j.jfas.2021.05.011