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Medicine Aug 2022The involvement of ankles in systemic lupus erythematosus (SLE) has not been widely studied. The aim of our prospective study was to determine the characteristics of the...
The involvement of ankles in systemic lupus erythematosus (SLE) has not been widely studied. The aim of our prospective study was to determine the characteristics of the ankle joint and tendon involvement in SLE using ultrasound (US) as an imaging modality. Sixty consecutive patients with SLE underwent a detailed clinical evaluation and US examination. Gray-scale and power Doppler US of the bilateral tibiotalar (TT) joints, subtalar (ST) joints, and ankle tendons were performed using a multiplanar scanning technique. Joint effusion, synovitis, tenosynovitis, enthesitis, and vascularization were assessed according to the OMERACT recommendations. The Total Ankle Ultrasound Score (TAUSS) was calculated as the sum of the grades of joint effusion and synovial hypertrophy for both TT and ST joints bilaterally (ranging from 0-24) and power Doppler activity was assessed separately. Finally, US findings were correlated with physical evaluation, laboratory parameters, and SLE activity scores. US ankle joint involvement was present in 32/60 (53.3%) patients. TT joints were affected in 26 (43.3%) and ST joints in 16 (26.7%) patients. Thirteen (21.7%) patients had US tendons and/or enthesal involvement. TT joint effusion was the most frequent finding, present in 55/240 (22.9%) examined joints, followed by synovial hypertrophy detected in 18/240 (7.5%) joints. The median (interquartile range; range) TAUSS of the US-affected joints was 1 (0-2; range 1-10). There were no significant correlations between US findings and inflammatory parameters or serological parameters of disease activity, but we found a weak positive correlation between TAUSS and the European Consensus Lupus Activity Measurement (r = 0.281, P = .029). This study revealed a high prevalence of pathological US ankle changes in patients with SLE and a positive correlation between ankle US involvement and disease activity score (European Consensus Lupus Activity Measurement).
Topics: Ankle; Ankle Joint; Cross-Sectional Studies; Humans; Lupus Erythematosus, Systemic; Prospective Studies; Synovitis; Ultrasonography, Doppler
PubMed: 35945784
DOI: 10.1097/MD.0000000000029196 -
Scientific Reports Jun 2021The aim of this study was to determine the relationship between strength of ankle plantar and dorsal flexors and range of motion (RoM), and body sway variables during...
The aim of this study was to determine the relationship between strength of ankle plantar and dorsal flexors and range of motion (RoM), and body sway variables during single-leg quiet stance, in highly trained athletes. The participants for this study were young athletes from 9 disciplines (n = 655). Center of pressure (CoP) velocity, amplitude, and frequency were measured during single-leg quiet stance. Moreover, athletes were measured for passive ankle plantar flexion (PF) and dorsal flexion (DF) RoM, and for rate of torque development (RTD) in the 0-50 (RTD50) and 0-200 ms time windows (RTD200). Ankle strength and RoM could not predict CoP velocity total, anterior-posterior (AP), and medial-lateral (ML) (p > 0.05). However, PF and PF and PF positively influenced CoP amplitude in ML direction (p < 0.001, R = 0.10). Moreover, CoP frequency in ML direction significantly increased with lower PF, DF, DF, PF, and DF (p < 0.05). We have demonstrated that ankle strength and RoM were related to single-leg quiet stance postural balance in trained athletes. The ankle RoM showed the greatest influence on CoP variables in ML directions.
Topics: Adolescent; Adult; Ankle Joint; Athletes; Female; Humans; Male; Muscle Strength; Musculoskeletal Physiological Phenomena; Postural Balance; Range of Motion, Articular; Young Adult
PubMed: 34083684
DOI: 10.1038/s41598-021-91337-6 -
Journal of Biomechanics Feb 2021The aims of this study were to compare male versus female and dominant versus non-dominant kinematics in the ankle and hindfoot, and to characterize coupled motion...
The aims of this study were to compare male versus female and dominant versus non-dominant kinematics in the ankle and hindfoot, and to characterize coupled motion between the subtalar and tibiotalar joints during the support phase of gait. Twenty healthy adults walked on a laboratory walkway while synchronized biplane radiographs of the ankle and hindfoot were collected at 100 frames/s. A validated tracking technique was used to measure tibiotalar and subtalar kinematics. Differences between male and female range of motion (ROM) were observed only in tibiotalar (AP and ML) and subtalar (ML) translation (all differences<1 mm and all p < 0.04). Statistical parametric mapping identified differences between kinematics waveforms of males and females in tibiotalar translation (AP and ML) and eversion, and subtalar ML translation. No differences between dominant and non-dominant sides were observed in ROM or kinematics waveforms. The average absolute side-to-side difference in the kinematics waveforms was 4.1° and 1.5 mm or less for all rotations and translations, respectively. Tibiotalar plantarflexion was coupled to subtalar inversion and eversion during the impact and push-off phases of stance (r = 0.90 and r = 0.87, respectively). This data may serve as a guide for evaluating ankle kinematics waveforms, ROM, symmetry, and restoration of healthy coupled motion after surgical intervention or rehabilitation. The observed kinematics differences between males and females may predispose females to higher rates of ankle and knee injury and suggest sex-dependent ankle reconstruction techniques may be beneficial.
Topics: Adult; Ankle; Ankle Joint; Biomechanical Phenomena; Female; Gait; Humans; Male; Radiography; Range of Motion, Articular; Sex Characteristics; Subtalar Joint
PubMed: 33422727
DOI: 10.1016/j.jbiomech.2020.110220 -
Journal of Orthopaedic Surgery (Hong... 2022To evaluate the outcomes of intermediate stage varus ankle arthritis treated by supramalleolar osteotomy.
OBJECTIVE
To evaluate the outcomes of intermediate stage varus ankle arthritis treated by supramalleolar osteotomy.
METHODS
Clinical data of 57 patients with varus arthritis who underwent supramalleolar osteotomy at our hospital between March 2018 and December 2019 were retrospectively analyzed. The patients were grouped according to the Takakura classification, and assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and the Visual Analogue Score (VAS). Tibial anterior surface (TAS) angle and talar tilt (TT) angle were measured at the weight-bearing anteroposterior view. Tibial lateral surface (TLS) angle was measured at the weight-bearing lateral view. The differences in the above indicators of patients with different stages of varus ankle arthritis before and after treatment were analyzed.
RESULTS
The patients were followed up for an average of 31.9 ± 5.8 months. Upon the last follow-up, the AOFAS score was 84.1 ± 9.7, the VAS score 2.2 ± 1.3, the TAS angle 92.4 ± 5.5°, the TLS angle 79.3 ± 5.3°, and the TT angle 3.7±3.4°, which were significantly different from the preoperative levels (64.2 ± 14.6, 4.5 ± 1.8, 80.5 ± 6.7°, 74.9 ± 4.6°, and 5.2 ± 64.1°, respectively) ( < .05). There were significant differences in AOFAS and VAS scores before surgery and upon the last follow-up in each group ( < .05). The postoperative TT angle was significantly different from the preoperative level in stage IIIb patients ( = .003).
CONCLUSIONS
Supramalleolar osteotomy achieved good short-to mid-term clinical outcomes for intermediate stage varus ankle arthritis. This procedure could significantly improve the TAS and TLS angles of the patients at any stage and the TT angle of stage IIIb patients.
Topics: Ankle; Ankle Joint; Humans; Osteoarthritis; Osteotomy; Retrospective Studies
PubMed: 36197148
DOI: 10.1177/10225536221132769 -
Orthopaedics & Traumatology, Surgery &... Nov 2022The severity of a foot or ankle deformity is a major prognostic factor for the success of ankle replacement. Varus deformity is at once the most arthrogenic and the most...
INTRODUCTION
The severity of a foot or ankle deformity is a major prognostic factor for the success of ankle replacement. Varus deformity is at once the most arthrogenic and the most frequent.
HYPOTHESIS
The severity of preoperative varus is a negative factor for ankle replacement survival.
MATERIAL AND METHOD
A retrospective study compared results in a continuous series of 57 Salto-Talaris® ankle replacements according to preoperative varus: 31 moderate (5-15̊) and 26 severe (> 15̊). Radiological and clinical assessment at a minimum 1 year focused on complications, revision and implant exchange and on AOFAS score, range of motion and tibiotalar angle at last follow-up.
RESULTS
At a mean 2.4 years' follow-up, implant survival in the moderate and severe varus groups was respectively 83% and 92%. Postoperative AOFA score and range of motion improved significantly in both groups, without significant difference. Analysis of cumulative survival showed no significant intergroup difference.
DISCUSSION
Severity of preoperative varus did not impact implant survival. Only postoperative alignment and stability emerged as survival factors. These results were related to the quality of associated procedures aiming to reduce deformity and to achieve ligament balance.
LEVEL OF EVIDENCE
IV, retrospective comparative study.
Topics: Humans; Retrospective Studies; Ankle; Treatment Outcome; Arthroplasty, Replacement, Ankle; Ankle Joint
PubMed: 35944869
DOI: 10.1016/j.otsr.2022.103390 -
Frontiers in Endocrinology 2023X-linked hypophosphatemia (OMIM 307800) is a rare bone disease caused by a phosphate-wasting condition with lifelong clinical consequences. Those affected suffer from...
BACKGROUND
X-linked hypophosphatemia (OMIM 307800) is a rare bone disease caused by a phosphate-wasting condition with lifelong clinical consequences. Those affected suffer from bone pain, complex skeletal deformities, impaired mobility and a reduced quality of life. Early osteoarthritis and reduced range of motion of the lower limbs are known pathologies in XLH patients. However, XLH-specific data on the affected compartments such as the ankle joint through the evaluation of radiographic and gait analysis data is still lacking.
PATIENTS AND METHODS
In this cross-sectional study, patients with genetically verified XLH, age ≥ 16 - 50 years and a complete record of gait analysis and or radiographic analysis data were included. Clinical examination, radiological and gait analysis data were compared to norms using the dataset of our gait laboratory registry. Radiographic analysis included tibial deformity analysis and assessment of osteoarthritis and enthesopathies. Western Ontario and McMaster Universities Arthritis Index (WOMAC), SF36v2, American Orthopedic Foot and Ankle Society score (AOFAS) and the Foot and Ankle Outcome Score (FAOS) were used. Twentythree participants with 46 limbs were eligible for the study.
RESULTS
A total of 23 patients (n=46 feet) met the inclusion criteria. Patients with XLH had significantly reduced gait quality, ankle power and plantar flexion (p < 0.001) compared to a historic gait laboratory control group. Ankle valgus deformity was detected in 22 % and ankle varus deformity in 30 % of the patients. The subtalar joint (59.1%) as well as the anterior tibiotalar joint (31.1%) were the main localizations of moderate to severe joint space narrowing. Ankle power was decreased in moderate and severe subtalar joint space narrowing (p < 0.05) compared to normal subtalar joint space narrowing. No lateral or medial ligament instability of the ankle joint was found in clinical examination. Tibial procurvatum deformity led to lower ankle power (p < 0.05).
CONCLUSIONS
This study showed structural and functional changes of the ankle in patients with XLH. Subtalar ankle osteoarthritis, patient reported outcome scores and clinical ankle restriction resulted in lower gait quality and ankle power.
Topics: Humans; Adolescent; Young Adult; Adult; Middle Aged; Ankle Joint; Ankle; Quality of Life; Familial Hypophosphatemic Rickets; Cross-Sectional Studies; Lower Extremity; Osteoarthritis
PubMed: 37033213
DOI: 10.3389/fendo.2023.1111104 -
BioMed Research International 2020As a rare and exceptional injury with significant syndesmotic disruption, the outcome of Logsplitter injury remains poor and unfavorable. In this study, we...
As a rare and exceptional injury with significant syndesmotic disruption, the outcome of Logsplitter injury remains poor and unfavorable. In this study, we retrospectively investigated the relationship between the intraoperative reduction quality and the prognosis such as the posttraumatic osteoarthritis to help surgeons achieve better functional outcomes for this high-energy transsyndesmotic ankle fracture dislocation. From January 2015 to February 2019, 31 patients (average 37.6 ± 9.4 years with 19 male and 12 female) diagnosed with the Logsplitter injury were treated by ORIF procedure and enrolled in our study. Particularly, nine vital radiographic parameters including medial clear space, talocrural angle, superior clear space, tibiofibular clear space, tibiofibular overlap, talar tilt, coin sign, tibial medial malleolus angle, and fibular lateral malleolus angle were measured from a postoperative film (AP and mortise view). Next, we compared the clinical outcome by using range of ankle motion, AOFAS scores, Burwell-Charnley score system, and Kellergen-Lawrence criteria from the patients who obtained the intraoperative anatomical reduction with those who failed. Our results showed that AOFAS score with all the patients was 79.33 ± 5.82 at the final follow-up. 14 (45.1%) of 31 patients were observed with radiographic posttraumatic arthritis of the ankle joint with an average Kellgren-Lawrence score of 1.75 ± 1.6 at final follow-up. Most importantly, our results proved that there were significant differences between the patients eligible for anatomical reduction quality with those who failed with regard to OA rate (33.3% vs. 85.7%, = 0.003) and AOFAS scores (75.33 ± 6.53 vs. 66.89 ± 4.28, = 0.037) at the final follow-up. Furthermore, the functional outcome after the operation showed an increased range of motion of the ankle joint of the patients obtained anatomical reduction compared with those who failed ( < 0.05). In this study, the significant discrepancy with regard to the functional outcomes was observed between the acceptable and unacceptable radiographic parameters, indicating that the quality of intraoperative reduction is scientifically significant and thus can be utilized as the major factor to predict the clinical outcomes for Logsplitter injuries. Moreover, this reduction algorithm arising from our study can also be applied to other ankle fractures and dislocation involving syndesmotic complex.
Topics: Adult; Algorithms; Ankle; Ankle Fractures; Ankle Injuries; Ankle Joint; Female; Fibula; Fracture Fixation, Internal; Humans; Joint Dislocations; Male; Middle Aged; Osteoarthritis; Prognosis; Range of Motion, Articular; Retrospective Studies; Tibia; Treatment Outcome; Young Adult
PubMed: 32219133
DOI: 10.1155/2020/4139028 -
Orthopaedics & Traumatology, Surgery &... Nov 2022V.
V.
Topics: Humans; Ankle Joint; Ankle; Arthroplasty, Replacement, Ankle; Arthrodesis
PubMed: 36183974
DOI: 10.1016/j.otsr.2022.103426 -
Cartilage Dec 2021The primary aim was to determine differences in talocrural and subtalar joint (STJ) articular cartilage composition, using T1ρ magnetic resonance imaging (MRI)...
OBJECTIVE
The primary aim was to determine differences in talocrural and subtalar joint (STJ) articular cartilage composition, using T1ρ magnetic resonance imaging (MRI) relaxation times, between limbs in individuals with unilateral chronic ankle instability (CAI) and compare with an uninjured control. Our secondary purpose was to determine the association between talocrural and STJ composition in limbs with and without CAI.
DESIGN
T1ρ MRI relaxation times were collected on 15 CAI (11 females, 21.13 ± 1.81 years, body mass index [BMI] = 23.96 ± 2.74 kg/m) and 15 uninjured control individuals (11 females, 21.07 ± 2.55 years, BMI = 24.59 ± 3.44 kg/m). Talocrural cartilage was segmented manually to identify the overall talar dome. The SJT cartilage was segmented manually to identify the anterior, medial, and posterior regions of interest consistent with STJ anatomical articulations. For each segmented area, a T1ρ relaxation time mean and variability value was calculated. Greater T1ρ relaxation times were interpreted as decreased proteoglycan content.
RESULTS
Individuals with CAI demonstrated a higher involved limb talocrural T1ρ mean and variability relative to their contralateral limb ( < 0.05) and the healthy control limb ( < 0.05). The CAI-involved limb also had a higher posterior STJ T1ρ mean relative to the healthy control limb ( < 0.05). In healthy controls ( < 0.05), but not the CAI-involved or contralateral limbs (p>0.05), talocrural and posterior STJ composition measures were positively associated.
CONCLUSIONS
Individuals with CAI have lower proteoglycan content in both the talocrural and posterior STJ in their involved limbs relative to the contralateral and a healthy control limb. Cartilage composition findings may be consistent with the early development of posttraumatic osteoarthritis.
Topics: Adolescent; Adult; Ankle; Ankle Joint; Case-Control Studies; Cross-Sectional Studies; Female; Humans; Joint Instability; Magnetic Resonance Imaging
PubMed: 33588577
DOI: 10.1177/1947603521994626 -
Orthopaedics & Traumatology, Surgery &... Oct 2021Ankle fracture-dislocation (AFD) represents a major threat to the joint and a potential source of complication and functional disability. This study was performed to...
INTRODUCTION
Ankle fracture-dislocation (AFD) represents a major threat to the joint and a potential source of complication and functional disability. This study was performed to assess the outcome of AFD in a resource-limited setting and factors associated with the posttraumatic ankle osteoarthritis (PTAOA). We hypothesized that conservative treatment after AFD was associated with higher risk of PTAOA compared to surgical treatment.
PATIENTS AND METHODS
Data from 52 consecutive patients (mean age 37.2±11.1years, with 57.7% n=30, males) who were treated and followed in a teaching hospital for AFD during a period of six years were collected. Forty-four of these patients were obtained at the time of the study for a retrospective evaluation. Functional outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS), ankle-hindfoot scale, and the patient's global satisfaction index. Radiographs were performed and analyzed for PTAOA. Logistic regression was used to determine factors associated with the presence of PTAOA.
RESULTS
PTAOA was found in 19 (43.2%) patients after an average follow-up period of 27.2±18.3months. Anatomic fracture reduction was achieved in 22 (50%) patients, while the talus was centered in the mortise in 30 (68.2%) patients. Despite these poor anatomical results, the clinical outcome was good to excellent in 33 (75%) patients, and 88.6% was satisfied or very satisfied. Factors associated with the presence of PTAOA were the non-anatomical reduction (OR=11.07; p=0.007, 95% CI: 2.096-58.77) and the time elapsed since trauma (OR=1.073; p=0.007, 95% CI: 1.109-1.129).
CONCLUSION
This study indicates that AFDs are associated with high rate of early and severe PTAOA. Non-anatomical realignment and a delay since trauma were positive predictors of PTAOA. There was no difference regarding the occurrence of PTAOA after AFD whatever the type of treatment, surgical or conservative.
LEVEL OF EVIDENCE
IV; retrospective cohort study.
Topics: Adult; Africa South of the Sahara; Ankle; Ankle Fractures; Ankle Joint; Humans; Male; Middle Aged; Osteoarthritis; Retrospective Studies; Treatment Outcome
PubMed: 34198007
DOI: 10.1016/j.otsr.2021.102996