-
Journal of Orthopaedic Case Reports Jun 2024Fixed Equinus deformity is characterized by limited dorsiflexion of ankle joint and restricted passive movement, along with medial and lateral tibiotalar instability,...
INTRODUCTION
Fixed Equinus deformity is characterized by limited dorsiflexion of ankle joint and restricted passive movement, along with medial and lateral tibiotalar instability, progressive hindfoot varus, and a supination deformity of the forefoot. Degree of equinus deformity is determined by the Tibio-Metatarsal (TM) angle, subtended between the longitudinal axes of Tibia and 1st Metatarsal, in lateral view of foot. Lambrinudi triple arthrodesis involves the surgical fusion of the talonavicular, talocalcaneal, and calcaneocuboid joints to correct fixed foot deformities, to relieve pain from joint, to provide stability to the imbalanced foot, and to create a plantigrade foot. We combined a Lambrinudi type arthrodesis with a transfer of the posterior tibial tendon (PTT) in adult patients to provide dynamic dorsiflexion and pronation.
CASE REPORT
The case was of 39-year-old male diagnosed as fixed cavoequinus deformity of right foot and ankle, who was operated with Lambrinudi triple arthrodesis with PTT transfer in January 2019 and followed up to 5 years. Outcome measurements included radiographic and clinical investigations, including the TM Angle, American Orthopaedic Foot and Ankle Society (AOFAS) Score and Ankle range of motion (ROM), which were assessed preoperatively, immediate postoperatively, at 3 months, 6 months, 1 year, and 5 years.The TM angles were 177, 133, 125, and 122, at pre-operative, immediate post-operative, 3 months, 5 years, respectively. Fusion was seen at 1-year follow-up. Improvement in AOFAS Score with values 38, 57, 73, and improvement in Ankle ROM with values 0 (fixed), 10, 15° at pre-operative, 3 months, and 5 years postoperative, respectively. Patient could use ordinary footwear afterward and had no significant subjective pain or pain which affected his daily activities, but patient had post-procedural right lower limb shortening of 1 cm..
CONCLUSION
This combined procedure demonstrated clinical correction of foot deformity and significant improvement in functional outcome in the form of AOFAS score and Ankle ROM. The ability of all patients to use normal shoes and significant reduction in pain scores represent ultimately, the improvement in quality of life. We have corrected muscle imbalance and provided dynamic force for dorsiflexion and pronation of foot in the form of tibialis posterior.
PubMed: 38910996
DOI: 10.13107/jocr.2024.v14.i06.4540 -
Cureus May 2024Primary synovial osteochondromatosis (PSO), a seldom-seen synovial proliferative disease involving chondral metaplasia, presents a unique challenge when affecting the...
Primary synovial osteochondromatosis (PSO), a seldom-seen synovial proliferative disease involving chondral metaplasia, presents a unique challenge when affecting the ankle joint. Controversy exists regarding whether a combined posterior-anterior approach with total synovectomy is necessary to avert recurrence or malignancy. An 18-year-old Caucasian male presented to the outpatient clinic with clinical and imaging findings indicative of a stage III PSO. The surgical intervention involved a combined posterior-anterior arthroscopic approach with the removal of multiple loose bodies and complete synovectomy, resulting in complete relief of symptoms without recurrence at the 12-month follow-up. Pathological examination confirmed the diagnosis. The management of PSO in the ankle joint using a combined posterior-anterior arthroscopic approach with complete synovectomy demonstrated effectiveness in this case. Regular follow-ups are essential for monitoring long-term outcomes and detecting potential recurrence or malignant transformation.
PubMed: 38910686
DOI: 10.7759/cureus.60843 -
Journal of Orthopaedic Surgery (Hong... 2024To observe the activation strategies of the ankle muscles using surface electromyography (sEMG) during single-leg standing (SLS) and both-leg standing (BLS) on flat...
To observe the activation strategies of the ankle muscles using surface electromyography (sEMG) during single-leg standing (SLS) and both-leg standing (BLS) on flat ground (FG), soft mat (SM), and BOSU ball (BB) surfaces. Thirty healthy young adults participated in the study. The muscle activities of the tibialis anterior (TA) and gastrocnemius medial (GM) were measured on the three surfaces during SLS and BLS. Electromyographic evaluations of the TA and GM were recorded during maximum voluntary isometric contractions (MVIC). Muscle activation was evaluated using MVIC%, and muscle co-contraction was evaluated using the co-contraction index (CI). A statistically significant increase was observed in the MVIC% of the TA, GM, and CI on the three surfaces during SLS compared to BLS, except for the comparison of CI on BB between SLS and BLS (t = -1.35, = 0.19). The MVIC% of the TA and GM during SLS and BLS on BB was significantly increased in comparison with FG and SM. The CI during BLS on BB increased compared to FG (t = 3.19, < 0.01) and SM (t = 4.64, < 0.01). The CI during BLS on SM (t = -1.46, = 0.15) decreased when compared to FG but without statistical significance. SLS and unstable surfaces can induce greater muscle activation, and SLS can have a greater influence on ankle muscles.
Topics: Humans; Electromyography; Male; Muscle, Skeletal; Young Adult; Female; Standing Position; Adult; Ankle Joint; Isometric Contraction; Ankle; Postural Balance
PubMed: 38910029
DOI: 10.1177/10225536241258336 -
Journal of Neuroengineering and... Jun 2024The ankle is usually highly effective in modulating the swing foot's trajectory to ensure safe ground clearance but there are few reports of ankle kinetics and...
BACKGROUND
The ankle is usually highly effective in modulating the swing foot's trajectory to ensure safe ground clearance but there are few reports of ankle kinetics and mechanical energy exchange during the gait cycle swing phase. Previous work has investigated ankle swing mechanics during normal walking but with developments in devices providing dorsiflexion assistance, it is now essential to understand the minimal kinetic requirements for increasing ankle dorsiflexion, particularly for devices employing energy harvesting or utilizing lighter and lower power energy sources or actuators.
METHODS
Using a real-time treadmill-walking biofeedback technique, swing phase ankle dorsiflexion was experimentally controlled to increase foot-ground clearance by 4 cm achieved via increased ankle dorsiflexion. Swing phase ankle moments and dorsiflexor muscle forces were estimated using AnyBody modeling system. It was hypothesized that increasing foot-ground clearance by 4 cm, employing only the ankle joint, would require significantly higher dorsiflexion moments and muscle forces than a normal walking control condition.
RESULTS
Results did not confirm significantly increased ankle moments with augmented dorsiflexion, with 0.02 N.m/kg at toe-off reducing to zero by the end of swing. Tibialis Anterior muscle force incremented significantly from 2 to 4 N/kg after toe-off, due to coactivation with the Soleus. To ensure an additional 4 cm mid swing foot-ground clearance, an estimated additional 0.003 Joules/kg is required to be released immediately after toe-off.
CONCLUSION
This study highlights the interplay between ankle moments, muscle forces, and energy demands during swing phase ankle dorsiflexion, offering insights for the design of ankle assistive technologies. External devices do not need to deliver significantly greater ankle moments to increase ankle dorsiflexion but, they should offer higher mechanical power to provide rapid bursts of energy to facilitate quick dorsiflexion transitions before reaching Minimum Foot Clearance event. Additionally, for ankle-related bio-inspired devices incorporating artificial muscles or humanoid robots that aim to replicate natural ankle biomechanics, the inclusion of supplementary Tibialis Anterior forces is crucial due to Tibialis Anterior and Soleus co-activation. These design strategies ensures that ankle assistive technologies are both effective and aligned with the biomechanical realities of human movement.
Topics: Humans; Biomechanical Phenomena; Male; Adult; Female; Self-Help Devices; Ankle Joint; Ankle; Muscle, Skeletal; Walking; Gait; Young Adult; Foot; Equipment Design; Biofeedback, Psychology; Kinetics
PubMed: 38907255
DOI: 10.1186/s12984-024-01394-x -
Cureus May 2024A dislocation or break of the tarsometatarsal joint in the foot is referred to as a Lisfranc fracture, sometimes called a Lisfranc injury. It can be caused by less...
A dislocation or break of the tarsometatarsal joint in the foot is referred to as a Lisfranc fracture, sometimes called a Lisfranc injury. It can be caused by less stressful mechanisms like a twisting fall as well as high-energy events like car crashes or falls from heights. Swelling, bruises, and midfoot pain that gets worse when standing or walking are some of the symptoms. The damage may only affect the ligaments or the foot's bony structures. Nonoperative or surgical treatment may be part of the management, depending on how severe the injury is. In order to realign and stabilize the bones, open reduction internal fixation with Kirschner wires (K-wires) is a common surgical procedure. In this case, a 25-year-old male patient complained of left foot pain and wound. He gave a history of a left leg stuck in the harvester. Immediately, he was taken to a local hospital, where a dressing of his left foot was done. He was referred to a super specialty hospital where an investigation, like an X-ray, was done, which revealed a Lisfranc fracture. K-wire was applied to fix the Lisfranc fracture. Further on, rehabilitation was started to restore mobility, regain full range of motion, and develop muscle strength. American Orthopedic Foot and Ankle Score (AOFAS) and Lower Extremity Functional Scale (LEFS) were used as outcome measures.
PubMed: 38903267
DOI: 10.7759/cureus.60722 -
Frontiers in Bioengineering and... 2024In this paper, we introduce a novel method for determining 3D deformations of the human tibialis anterior (TA) muscle during dynamic movements using 3D ultrasound.
PURPOSE
In this paper, we introduce a novel method for determining 3D deformations of the human tibialis anterior (TA) muscle during dynamic movements using 3D ultrasound.
MATERIALS AND METHODS
An existing automated 3D ultrasound system is used for data acquisition, which consists of three moveable axes, along which the probe can move. While the subjects perform continuous plantar- and dorsiflexion movements in two different controlled velocities, the ultrasound probe sweeps cyclically from the ankle to the knee along the anterior shin. The ankle joint angle can be determined using reflective motion capture markers. Since we considered the movement direction of the foot, i.e., active or passive TA, four conditions occur: slow active, slow passive, fast active, fast passive. By employing an algorithm which defines ankle joint angle intervals, i.e., intervals of range of motion (ROM), 3D images of the volumes during movement can be reconstructed.
RESULTS
We found constant muscle volumes between different muscle lengths, i.e., ROM intervals. The results show an increase in mean cross-sectional area (CSA) for TA muscle shortening. Furthermore, a shift in maximum CSA towards the proximal side of the muscle could be observed for muscle shortening. We found significantly different maximum CSA values between the fast active and all other conditions, which might be caused by higher muscle activation due to the faster velocity.
CONCLUSION
In summary, we present a method for determining muscle volume deformation during dynamic contraction using ultrasound, which will enable future empirical studies and 3D computational models of skeletal muscles.
PubMed: 38903187
DOI: 10.3389/fbioe.2024.1388907 -
Arthroplasty (London, England) Jun 2024The functional integrity of the anterior cruciate ligament (ACL) influences surgical decision-making in patients with knee osteoarthritis (KOA). This study aimed to...
Is conventional magnetic resonance imaging superior to radiography in the functional integrity evaluation of anterior cruciate ligament in patients with knee osteoarthritis?
BACKGROUND
The functional integrity of the anterior cruciate ligament (ACL) influences surgical decision-making in patients with knee osteoarthritis (KOA). This study aimed to compare the diagnostic value of radiography and magnetic resonance imaging (MRI) in determining the functional status of ACL.
METHODS
We analyzed 306 knees retrospectively using preoperative hip-to-ankle anteroposterior standing (APS) radiographs, anteroposterior (AP) and lateral knee radiographs, AP valgus stress (VS) force radiographs, and standard orthogonal MRI. Based on the intraoperative visualization, the knees were grouped into ACL functionally-intact and ACL functionally-deficient (ACLD) groups. The diagnostic validity and reliability were calculated based on the radiograph parameters such as hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), posterior tibial slope (PTS), sagittal tibiofemoral subluxation (STFS), coronal tibiofemoral subluxation (CTFS), joint line convergence angle (JLCA), the maximum wear point of the proximal tibia plateau (MWPPT%), and MRI parameters including ACL grades and MWPPT%.
RESULTS
HKA, MPTA, PTS, STFS, JLCA, and CTFS on APS and AP radiographs, and MWPPT% on radiographs and MRI showed a significant diagnostic value (P < 0.05). There were no statistically significant differences in the single parameters from radiographs and MRI. After constructing the logistic regression models, MRI showed higher sensitivity, specificity, and accuracy, reaching 96.8%, 79.9%, and 83.3%, respectively (P < 0.001).
CONCLUSIONS
In patients with KOA, the diagnostic value of single radiographic or MRI parameter in assessing the functional integrity of the ACL are equivalent. However, by constructing predictive models, MRI could significantly improve diagnostic validity compared with radiography.
PubMed: 38902806
DOI: 10.1186/s42836-024-00262-2 -
Biomaterials Research 2024The occurrence of rheumatoid arthritis (RA) is highly correlated with progressive and irreversible damage of articular cartilage and continuous inflammatory response....
The occurrence of rheumatoid arthritis (RA) is highly correlated with progressive and irreversible damage of articular cartilage and continuous inflammatory response. Here, inspired by the unique structure of synovial lipid-hyaluronic acid (HA) complex, we developed supramolecular HA-nanomedicine hydrogels for RA treatment by mediating macrophage-synovial fibroblast cross-talk through locally sustained release of celastrol (CEL). Molecular dynamics simulation confirmed that HA conjugated with hydrophobic segments could interspersed into the CEL-loaded [poly(ε-caprolactone--1,4,8-trioxa[4.6]spiro-9-undecanone)-poly(ethylene glycol)-poly(ε-caprolaone--1,4,8-trioxa[4.6]spiro-9-undecanone] (PECT) nanoparticles to form the supramolecular nanomedicine hydrogel HA-poly(ε-caprolactone--1,4,8-trioxa[4.6]spiro-9-un-decanone)/PECT@CEL (HP@CEL), enabling fast hydrogel formation after injection and providing a 3-dimensional environment similar with synovial region. More importantly, the controlled release of CEL from HP@CEL inhibited the macrophage polarization toward the proinflammatory M1 phenotype and further suppressed the proliferation of synovial fibroblasts by regulating the Toll-like receptor pathway. In collagen-induced arthritis model in mice, HP@CEL hydrogel treatment substantial attenuated clinical symptoms and bone erosion and improved the extracellular matrix deposition and bone regeneration in ankle joint. Altogether, such a bioinspired injectable polymer-nanomedicine hydrogel represents an effective and promising strategy for suppressing RA progression through augmenting the cross-talk of macrophages and synovial fibroblast for regulation of chronic inflammation.
PubMed: 38894889
DOI: 10.34133/bmr.0046 -
Sensors (Basel, Switzerland) Jun 2024(1) Background: Marker-based 3D motion capture systems (MBS) are considered the gold standard in gait analysis. However, they have limitations for which markerless... (Meta-Analysis)
Meta-Analysis Review
Accuracy, Validity, and Reliability of Markerless Camera-Based 3D Motion Capture Systems versus Marker-Based 3D Motion Capture Systems in Gait Analysis: A Systematic Review and Meta-Analysis.
(1) Background: Marker-based 3D motion capture systems (MBS) are considered the gold standard in gait analysis. However, they have limitations for which markerless camera-based 3D motion capture systems (MCBS) could provide a solution. The aim of this systematic review and meta-analysis is to compare the accuracy, validity, and reliability of MCBS and MBS. (2) Methods: A total of 2047 papers were systematically searched according to PRISMA guidelines on 7 February 2024, in two different databases: Pubmed (1339) and WoS (708). The COSMIN-tool and EBRO guidelines were used to assess risk of bias and level of evidence. (3) Results: After full text screening, 22 papers were included. Spatiotemporal parameters showed overall good to excellent accuracy, validity, and reliability. For kinematic variables, hip and knee showed moderate to excellent agreement between the systems, while for the ankle joint, poor concurrent validity and reliability were measured. The accuracy and concurrent validity of walking speed were considered excellent in all cases, with only a small bias. The meta-analysis of the inter-rater reliability and concurrent validity of walking speed, step time, and step length resulted in a good-to-excellent intraclass correlation coefficient (ICC) (0.81; 0.98). (4) Discussion and conclusions: MCBS are comparable in terms of accuracy, concurrent validity, and reliability to MBS in spatiotemporal parameters. Additionally, kinematic parameters for hip and knee in the sagittal plane are considered most valid and reliable but lack valid and accurate measurement outcomes in transverse and frontal planes. Customization and standardization of methodological procedures are necessary for future research to adequately compare protocols in clinical settings, with more attention to patient populations.
Topics: Humans; Gait Analysis; Gait; Imaging, Three-Dimensional; Biomechanical Phenomena; Reproducibility of Results; Motion Capture
PubMed: 38894476
DOI: 10.3390/s24113686 -
Sensors (Basel, Switzerland) Jun 2024The use of wearable sensors, such as inertial measurement units (IMUs), and machine learning for human intent recognition in health-related areas has grown considerably....
The use of wearable sensors, such as inertial measurement units (IMUs), and machine learning for human intent recognition in health-related areas has grown considerably. However, there is limited research exploring how IMU quantity and placement affect human movement intent prediction (HMIP) at the joint level. The objective of this study was to analyze various combinations of IMU input signals to maximize the machine learning prediction accuracy for multiple simple movements. We trained a Random Forest algorithm to predict future joint angles across these movements using various sensor features. We hypothesized that joint angle prediction accuracy would increase with the addition of IMUs attached to adjacent body segments and that non-adjacent IMUs would not increase the prediction accuracy. The results indicated that the addition of adjacent IMUs to current joint angle inputs did not significantly increase the prediction accuracy (RMSE of 1.92° vs. 3.32° at the ankle, 8.78° vs. 12.54° at the knee, and 5.48° vs. 9.67° at the hip). Additionally, including non-adjacent IMUs did not increase the prediction accuracy (RMSE of 5.35° vs. 5.55° at the ankle, 20.29° vs. 20.71° at the knee, and 14.86° vs. 13.55° at the hip). These results demonstrated how future joint angle prediction during simple movements did not improve with the addition of IMUs alongside current joint angle inputs.
Topics: Humans; Movement; Machine Learning; Male; Algorithms; Adult; Female; Wearable Electronic Devices; Young Adult; Range of Motion, Articular; Biomechanical Phenomena; Knee Joint; Joints; Ankle Joint; Hip Joint
PubMed: 38894447
DOI: 10.3390/s24113657