-
Haemophilia : the Official Journal of... May 2022Haemarthrosis is a clinical feature of haemophilia leading to haemarthropathy. The ankle joint is most commonly affected, resulting in significant pain, disability and a... (Review)
Review
INTRODUCTION
Haemarthrosis is a clinical feature of haemophilia leading to haemarthropathy. The ankle joint is most commonly affected, resulting in significant pain, disability and a reduction in health-related quality of life. Footwear and orthotic devices are effective in other diseases that affect the foot and ankle, such as rheumatoid arthritis, but little is known about their effect in haemophilia.
AIMS
To review the efficacy and effectiveness of footwear and orthotic devices in the management of ankle joint haemarthrosis and haemarthropathy in haemophilia.
METHODS
A systematic literature review was conducted. Two review authors independently screened studies for inclusion and appraised methodological quality using Joanna Briggs Institute Critical Appraisal checklists. A narrative analysis was undertaken.
RESULTS
Ten studies involving 271 male participants were eligible for inclusion. All studies were quasi-experimental; three employed a within-subject design. Two studies included an independent comparison or control group. A range of footwear and orthotic devices were investigated. Limited evidence from non-randomised studies suggested that footwear and orthotic devices improve the number of ankle joint bleeding episodes, gait parameters and patient-reported pain.
CONCLUSION
This review demonstrates a lack of robust evidence regarding the efficacy and effectiveness of footwear and orthotic devices in the management of ankle joint haemarthrosis and haemarthropathy in haemophilia. Methodological heterogeneities and limitations with the study designs, small sample sizes and limited follow-up of participants exist. Future studies utilising randomised designs, larger sample sizes, long-term follow-up and validated patient-reported outcome measures are needed to inform the clinical management of ankle joint haemarthrosis and haemarthropathy.
Topics: Ankle; Ankle Joint; Female; Hemarthrosis; Hemophilia A; Humans; Male; Orthotic Devices; Pain; Quality of Life
PubMed: 35245413
DOI: 10.1111/hae.14521 -
Journal of Orthopaedic Surgery and... May 2020Osteoarthritis (OA) is a growing health concern that affects approximately 27 million people in the USA and is associated with a $185 billion annual cost burden.... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Osteoarthritis (OA) is a growing health concern that affects approximately 27 million people in the USA and is associated with a $185 billion annual cost burden. Choosing between open surgery and arthroscopic arthrodesis for ankle arthritis is still controversial. This study compared arthroscopic arthrodesis and open surgery by performing a systematic review and meta-analysis.
METHODS
For the systematic review, a literature search was conducted in 4 English databases (PubMed, Embase, Medline and the Cochrane Library) from inception to February 2020. Three prospective cohort studies and 7 retrospective cohort studies, enrolling a total of 507 patients with ankle arthritis, were included.
RESULTS
For fusion rate, the pooled data showed a significantly higher rate of fusion during arthroscopic arthrodesis compared with open surgery (odds ratio 0.25, 95% CI 0.11 to 0.57, p = 0.0010). Regarding estimated blood loss, the pooled data showed significantly less blood loss during arthroscopic arthrodesis compared with open surgery (WMD 52.04, 95% CI 14.14 to 89.94, p = 0.007). For tourniquet time, the pooled data showed a shorter tourniquet time during arthroscopic arthrodesis compared with open surgery (WMD 22.68, 95% CI 1.92 to 43.43, p = 0.03). For length of hospital stay, the pooled data showed less hospitalisation time for patients undergoing arthroscopic arthrodesis compared with open surgery (WMD 1.62, 95% CI 0.97 to 2.26, p < 0.00001). The pooled data showed better recovery for the patients who underwent arthroscopic arthrodesis compared with open surgery at 1 year (WMD 14.73, 95% CI 6.66 to 22.80, p = 0.0003).
CONCLUSION
In conclusion, arthroscopic arthrodesis was associated with a higher fusion rate, smaller estimated blood loss, shorter tourniquet time, and shorter length of hospitalisation than open surgery.
Topics: Ankle Joint; Arthrodesis; Arthroscopy; Humans; Length of Stay; Osteoarthritis; Prospective Studies; Retrospective Studies
PubMed: 32448398
DOI: 10.1186/s13018-020-01708-4 -
The Journal of Foot and Ankle Surgery :... 2020Prosthetic joint infection (PJI) after total ankle replacement (TAR) is a challenging complication, which often requires debridement and implant retention (DAIR) with or... (Meta-Analysis)
Meta-Analysis
Prosthetic joint infection (PJI) after total ankle replacement (TAR) is a challenging complication, which often requires debridement and implant retention (DAIR) with or without polyethylene exchange, revision surgery, implantation of a cement spacer, conversion to arthrodesis, or even amputation. The optimum treatment for ankle PJI is not well established. We conducted a systematic review and meta-analysis to compare the clinical effectiveness of various treatment strategies for infected ankle prostheses. We searched MEDLINE, Embase, Web of Science, and the Cochrane Library up to December 2018 for studies evaluating the impact of treatment in patient populations with infected ankle prostheses following TAR. Binary data were pooled after arcsine transformation. Six citations comprising 17 observational design comparisons were included. The reinfection rates (95% confidence intervals) for DAIR with or without polyethylene exchange, 1-stage revision, 2-stage revision, cement spacer, and arthrodesis were 39.8% (24.4 to 56.1), 0.0% (0.0 to 78.7), 0.0% (0.0 to 8.5), 0.2% (0.0 to 17.9), and 13.6% (0.0 to 45.8), respectively. Rates of amputation for DAIR with or without polyethylene exchange and cement spacer were 5.6% (0.0 to 16.9) and 22.2% (6.3 to 54.7), respectively. Measures of function, pain, and satisfaction could not be compared because of limited data. One- and 2-stage revision strategies seem to be associated with the lowest reinfection rates, but these findings are based on limited data. Arthrodesis and DAIR with or without polyethylene exchange appear to be commonly used in treating infected ankle prosthesis, but are associated with poor infection control. Clear gaps exist in the literature, and further research is warranted to evaluate treatment strategies for infected ankle prosthesis.
Topics: Ankle Joint; Arthritis, Infectious; Arthrodesis; Arthroplasty, Replacement, Ankle; Debridement; Humans; Prosthesis-Related Infections; Reoperation; Treatment Outcome
PubMed: 32131004
DOI: 10.1053/j.jfas.2019.04.016 -
Medicine and Science in Sports and... Jul 2020Chronic ankle instability (CAI) is known to induce impairments throughout the lower quarter kinetic chain, however there is currently no synthesized information on... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Chronic ankle instability (CAI) is known to induce impairments throughout the lower quarter kinetic chain, however there is currently no synthesized information on proximal adaptations of the trunk, hip, thigh, and knee for neuromuscular and biomechanical outcomes during strength, balance, jumping, and gait among CAI patients. The purpose of this systematic review and meta-analysis was to synthesize trunk, hip, thigh and knee neuromuscular and biomechanical outcome measures during functional assessments when comparing CAI to healthy groups.
METHODS
Cumulative Index of Nursing and Allied Health Literature and Medical Literature Analysis and Retrieval System Online with PubMed databases were searched on June 3, 2019. Studies comparing outcomes at the trunk, hip, thigh, or knee regardless of assessment type in CAI versus healthy groups were considered for inclusion. Assessment categories were used to differentiate adaptations by assessment type after inclusion. Two independent reviewers assessed methodological quality using the Physiotherapy Evidence Database scoring criteria. Data pertaining to study methodology and primary proximal adaptation outcomes were extracted. Separate random effects meta-analyses were performed for consistently reported outcome measures.
RESULTS
Pooled estimates reflected that CAI patients had decreased triplanar isometric hip strength outcomes (P < 0.001, effect size range: 0.52-0.93). Knee kinematics did not differ from healthy groups during dynamic balance testing (P = 0.26). Few studies found CAI patients have altered knee kinematics during jumping tasks. The remaining findings were isolated to individual studies and thus inconclusive.
CONCLUSIONS
The CAI groups demonstrated triplanar hip strength deficits and altered knee flexion angles during jumping assessments. Clinicians should consider proximal evaluations and interventions for CAI patients.
Topics: Adaptation, Physiological; Ankle Injuries; Ankle Joint; Chronic Disease; Gait Analysis; Hip; Humans; Joint Instability; Knee; Muscle Strength; Plyometric Exercise; Postural Balance; Sprains and Strains; Thigh; Torso
PubMed: 31977639
DOI: 10.1249/MSS.0000000000002282 -
The American Journal of Sports Medicine Jul 2010Generalized joint hypermobility is a highly prevalent condition commonly associated with joint injuries. The current literature has conflicting reports of the risk of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Generalized joint hypermobility is a highly prevalent condition commonly associated with joint injuries. The current literature has conflicting reports of the risk of joint injury in hypermobile sporting participants compared with their nonhypermobile peers. Systematic reviews have not been conclusive and no meta-analysis has been performed.
PURPOSE
This review was undertaken to determine whether individuals with generalized joint hypermobility have an increased risk of lower limb joint injury when undertaking sporting activities.
STUDY DESIGN
Systematic review with meta-analysis.
METHODS
Studies were identified through a search without language restrictions of PubMed, CINAHL, Embase, and SportDiscus databases from the earliest date through February 2009 with subsequent handsearching of reference lists. Inclusion criteria for studies were determined before searching and all included studies underwent methodological quality assessment by 2 independent reviewers. Meta-analyses for joint injury of the lower limb, knee, and ankle were performed using a random effects model. The difference in injury proportions between hypermobility categories was tested with the z statistic.
RESULTS
Of 4841 identified studies, 18 met all inclusion criteria with methodological quality ranging from 1 of 6 to 5 of 6. A variety of tests of hypermobility and varied cutoff points to define the presence of generalized joint hypermobility were used, so the authors determined a standardized cutoff to indicate generalized joint hypermobility. Using this criterion, a significantly increased risk of knee joint injury for hypermobile and extremely hypermobile participants compared with their nonhypermobile peers was demonstrated (P < .001), whereas no increased risk was found for ankle joint injury. For knee joint injury, a combined odds ratio of 4.69 (95% confidence interval, 1.33-16.52; P = .02) was calculated, indicating a significantly increased risk for hypermobile participants playing contact sports.
CONCLUSION
Sport participants with generalized joint hypermobility have an increased risk of knee joint injury during contact activities but have no altered risk of ankle joint injury.
Topics: Adolescent; Adult; Athletic Injuries; Child; Humans; Joint Instability; Knee Injuries; Lower Extremity; Male; Risk; Young Adult
PubMed: 20601606
DOI: 10.1177/0363546510364838 -
Physical Therapy in Sport : Official... Jan 2018The objective of this systematic review was to evaluate the association between ankle dorsiflexion (ADF) and dynamic knee valgus (DKV). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The objective of this systematic review was to evaluate the association between ankle dorsiflexion (ADF) and dynamic knee valgus (DKV).
METHODS
Electronic searches were conducted in MEDLINE, EMBASE, CINAHL and SPORTDiscus. A modified Downs and Black checklist was used for quality assessment and meta-analysis was performed to compare standardised mean differences (SMD) of ADF.
RESULTS
Seventeen studies met the inclusion criteria. Meta-analysis showed that reduced ADF is associated with participants presenting with DKV compared to controls (SMD -0.65, 95% CI -0.88 to -0.41). Subgroup analysis showed consistent results regarding different forms of ADF measurement; restriction in ADF measured in weight-bearing position (SMD -1.25, 95% CI -2.24 to -0.25), non-weight-bearing with knee flexed (SMD -0.56, 95% CI -0.97 to -0.16) or non-weight-bearing with knee extended (SMD -0.54, 95% CI -0.80 to -0.28) was significantly associated with DKV.
CONCLUSION
The meta-analysis results provide evidence that reduced ADF is correlated with DKV. The assessment of ADF in the clinical setting is important, as it may be related to harmful movement patterns of the lower limbs.
Topics: Ankle Joint; Humans; Knee Joint; Range of Motion, Articular; Weight-Bearing
PubMed: 28974358
DOI: 10.1016/j.ptsp.2017.07.003 -
Sports Medicine (Auckland, N.Z.) Apr 2020Treadmills are often used in research, clinical practice, and training. Biomechanical investigations comparing treadmill and overground running report inconsistent... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Treadmills are often used in research, clinical practice, and training. Biomechanical investigations comparing treadmill and overground running report inconsistent findings.
OBJECTIVE
This study aimed at comparing biomechanical outcomes between motorized treadmill and overground running.
METHODS
Four databases were searched until June 2019. Crossover design studies comparing lower limb biomechanics during non-inclined, non-cushioned, quasi-constant-velocity motorized treadmill running with overground running in healthy humans (18-65 years) and written in English were included. Meta-analyses and meta-regressions were performed where possible.
RESULTS
33 studies (n = 494 participants) were included. Most outcomes did not differ between running conditions. However, during treadmill running, sagittal foot-ground angle at footstrike (mean difference (MD) - 9.8° [95% confidence interval: - 13.1 to - 6.6]; low GRADE evidence), knee flexion range of motion from footstrike to peak during stance (MD 6.3° [4.5 to 8.2]; low), vertical displacement center of mass/pelvis (MD - 1.5 cm [- 2.7 to - 0.8]; low), and peak propulsive force (MD - 0.04 body weights [- 0.06 to - 0.02]; very low) were lower, while contact time (MD 5.0 ms [0.5 to 9.5]; low), knee flexion at footstrike (MD - 2.3° [- 3.6 to - 1.1]; low), and ankle sagittal plane internal joint moment (MD - 0.4 Nm/kg [- 0.7 to - 0.2]; low) were longer/higher, when pooled across overground surfaces. Conflicting findings were reported for amplitude of muscle activity.
CONCLUSIONS
Spatiotemporal, kinematic, kinetic, muscle activity, and muscle-tendon outcome measures are largely comparable between motorized treadmill and overground running. Considerations should, however, particularly be given to sagittal plane kinematic differences at footstrike when extrapolating treadmill running biomechanics to overground running. Protocol registration CRD42018083906 (PROSPERO International Prospective Register of Systematic Reviews).
Topics: Adolescent; Ankle Joint; Biomechanical Phenomena; Cross-Over Studies; Exercise Test; Female; Humans; Male; Range of Motion, Articular; Running
PubMed: 31802395
DOI: 10.1007/s40279-019-01237-z -
Journal of Clinical Medicine Jul 2019Misdiagnosis and inadequate treatment of syndesmosis could result in significant long-term morbidity including pain, instability, and degenerative changes of the ankle... (Review)
Review
Misdiagnosis and inadequate treatment of syndesmosis could result in significant long-term morbidity including pain, instability, and degenerative changes of the ankle joint. The objective of this systematic review and meta-analysis was to determine whether radiologic tests accurately and reliably diagnose ankle syndesmosis injury. Medline, Embase, and Cochrane were searched. The database search resulted in 258 full text articles that we assessed for eligibility, we used eight studies that met all the inclusion criteria. In subgroup meta-analysis, the sensitivity analysis showed significant differences only in the MRI (Magnetic Resonance Imaging), and specificity was not statistically significant. In diagnostic meta-analysis, the pooled sensitivity and specificity were 0.528 and 0.984 for X-rays, 0.669 and 0.87 for CT (Computed Tomography), and 0.929 and 0.865 for MRI, all respectively. For sensitivity, MRI showed significantly sensitivity as higher than the other methods, and we detected no significance for specificity. Syndesmosis injuries differed significantly in the accuracy of radiological methods according to the presence of accompanied ankle fractures. In patients with fractures, simple radiography has good specificity, and CT and MRI have high sensitivity and specificity irrespective of fracture; in particular, MRI has similar accuracy to gold standard arthroscopic findings.
PubMed: 31277316
DOI: 10.3390/jcm8070968 -
Acta Radiologica (Stockholm, Sweden :... May 2022Posterior ankle impingement syndrome (PAIS) is a common and debilitating condition, commonly affecting people who participate in activities that involve repetitive ankle...
BACKGROUND
Posterior ankle impingement syndrome (PAIS) is a common and debilitating condition, commonly affecting people who participate in activities that involve repetitive ankle plantarflexion. The relationship between clinical and imaging findings in PAIS has not been established.
PURPOSE
To investigate the relationship between clinical and imaging features in PAIS by reviewing the literature comparing symptomatic patients to asymptomatic controls.
MATERIAL AND METHODS
A systematic literature search was performed to identify all English-language articles that compared imaging features in patients diagnosed with PAIS to imaging in an asymptomatic control group.
RESULTS
A total of 8394 articles were evaluated by title and abstract, and 156 articles were read in full text. No articles compared imaging findings to an asymptomatic control group, thus no articles met the inclusion criteria.
CONCLUSION
This systematic review found no published research that compared the imaging findings of people diagnosed with PAIS to asymptomatic people. Until this information is available, imaging features in people with posterior ankle impingement should be interpreted with caution.
Topics: Ankle; Ankle Joint; Arthroscopy; Humans; Joint Diseases; Syndrome
PubMed: 33874783
DOI: 10.1177/02841851211008389 -
Ortopedia, Traumatologia, Rehabilitacja Oct 2023The COVID-19 pandemic is still an unresolved situation in Thailand and worldwide at large. The purpose of this study was to interpret the impacts of COVID-19 on the...
The COVID-19 pandemic is still an unresolved situation in Thailand and worldwide at large. The purpose of this study was to interpret the impacts of COVID-19 on the management of ankle fractures and their outcomes. A systematic search and review were performed in accordance with the PRISMA guideline based on the PubMed database. The search terms were 'ankle fracture' and 'COVID'. From an initial search, a total of 29 abstracts were found and screened in accordance with the eligibility criteria. Then, five articles were considered eligible papers for further review. This review investigated a total of 16,813 patients with ankle fractures, including 215 patients (1.27%) who were also COVID-19-positive. According to our results, the incidence of ankle fractures showed a decrease during the pandemic. However, COVID-positive ankle fracture patients demonstrated a higher prevalence of comorbidities, including chronic kidney disease, diabetes, hypertension, and obesity. COVID-19 infection was a factor that delayed the operation and increased the length of hospital stay and adverse effects from the surgery. COVID-19 infection affected the management of ankle fractures and their outcomes in terms of negative impacts such as delayed operation, increased length of hospital stay, and increased adverse effects from the surgery. Outpatient surgery was recommended to solve some of these problems.
Topics: Humans; Ankle Fractures; Pandemics; Fracture Fixation, Internal; COVID-19; Length of Stay
PubMed: 38088098
DOI: 10.5604/01.3001.0053.9672