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BMJ Case Reports Jun 2024A man in his early 70s with right Takakura stage IIIB varus ankle osteoarthritis underwent medial opening wedge supramalleolar osteotomy with inframalleolar correction...
A man in his early 70s with right Takakura stage IIIB varus ankle osteoarthritis underwent medial opening wedge supramalleolar osteotomy with inframalleolar correction as joint preserving procedure. We also performed anteroinferior tibiofibular ligament (AITFL) resection with fibular shortening valgisation osteotomy to enhance the talar tilt correction. Postoperative decrease in talar tilt with dramatic symptom improvement was achieved. Performing the AITFL resection with fibular shortening valgisation osteotomy plus concomitant supramalleolar osteotomy and inframalleolar correction for Takakura stage IIIB varus ankle osteoarthritis resulted in successful improvement in talar tilt by making room for the valgus deviation of the talus.
Topics: Humans; Male; Osteoarthritis; Osteotomy; Ankle Joint; Aged; Treatment Outcome; Fibula
PubMed: 38914523
DOI: 10.1136/bcr-2024-260585 -
Journal of Visualized Experiments : JoVE Jun 2024Stroke affects approximately 17 million individuals worldwide each year and is a leading cause of long-term disability. Robotic therapy has shown promise in helping...
Stroke affects approximately 17 million individuals worldwide each year and is a leading cause of long-term disability. Robotic therapy has shown promise in helping stroke patients regain lost motor functions. One potential avenue for increasing the understanding of how motor recovery occurs is to study brain activation during the movements that are targeted by therapy in healthy individuals. Functional Near-Infrared Spectroscopy (fNIRS) has emerged as a promising neuroimaging technique for examining neural underpinnings of motor function. This study aimed to investigate fNIRS neural correlates of complex lower limb movements in healthy subjects. Participants were asked to perform cycles of rest and movement for 6 min using a robotic device for motor rehabilitation. The task required coordinated knee and ankle joint movements to point to targets displayed on a computer screen. Two experimental conditions with different levels of movement assistance provided by the robot were explored. The results showed that the fNIRS protocol effectively detected brain regions associated with motor control during the task. Notably, all subjects exhibited greater activation in the contralateral premotor area during the no-assistance condition compared to the assisted condition. In conclusion, fNIRS appears to be a valuable approach for detecting changes in oxyhemoglobin concentration associated with multi-joint pointing movements of the lower limb. This research might contribute to the understanding of stroke motor recovery mechanisms and might pave the way for improved rehabilitation treatments for stroke patients. However, further research is needed to fully elucidate the potential of fNIRS in studying motor function and its applications in clinical settings.
Topics: Humans; Spectroscopy, Near-Infrared; Robotics; Lower Extremity; Movement; Male; Adult; Female
PubMed: 38912802
DOI: 10.3791/66004 -
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 -
The Journal of Foot and Ankle Surgery :... Jun 2024Different aspects of the learning curve in Total Ankle Replacement (TAR) have been studied in the short to mid-term, with 30 cases often considered critical. However,...
Different aspects of the learning curve in Total Ankle Replacement (TAR) have been studied in the short to mid-term, with 30 cases often considered critical. However, its impact on long-term (10 and 15-year) survival remains unclear. Therefore, we retrospectively analyzed 77 consecutive TARs performed by one orthopedic surgeon. The main outcome was long-term survival between cases 1-30 and 31-77 using the Kaplan-Meier with Competing Risk Analyses. Secondarily, we used Moving Average Method with LOESS regression to confirm the learning curve based on the perioperative complications. Thirdly, associations between perioperative complications and operation time on long-term survival were assessed using Cox proportional hazard models. The 10-year survival of cases 1-30 was 89.9% (95% CI 70.4-96.5), and of 31-77, 92.4% (95% CI 7745- 97.5) (p = 0.58). The 15-year survival was 81.8% (95% CI 59.5-91.8) and 74.8% (95% CI 52.4-86.6), respectively (p = 0.97). The long-term survival rate for the TAR that endured perioperative complication was 96.70% (95% CI 90.28-103.12), and for the uncomplicated TAR 87.50% (95% CI 77.12-97.88%) (p=0.24). Operating time nor occurrence of perioperative fractures were significantly associated with long-term survival (p= 0.11 and 0.26, respectively). However, moving average method revealed a significant decreasing trend with a cut-off value of 33 procedures regarding the marginal probability of perioperative osseous complications (p<0.01). In conclusion, surgeons should note a learning curve when adapting arthroplasty procedures. After the prosthesis design switch, the learning curve regarding perioperative osseous complications was confirmed at 33 TAR. The switch did not affect long-term survival.
PubMed: 38909964
DOI: 10.1053/j.jfas.2024.06.002 -
The Knee Jun 2024Isolated knee medial compartmental osteoarthritis(MOA) can be treated with High Tibial Osteotomy (HTO) or Unicompartmental Knee Arthroplasty (UKA). This study aims to...
High tibial osteotomy versus unicompartmental knee arthroplasty in advanced medial compartmental knee arthrosis: A comparative study with propensity score matched analysis.
BACKGROUND
Isolated knee medial compartmental osteoarthritis(MOA) can be treated with High Tibial Osteotomy (HTO) or Unicompartmental Knee Arthroplasty (UKA). This study aims to describe and compare outcomes of HTO and UKA in patients with isolated severe MOA. The authors hypothesized that similar outcomes can be achieved.
METHODS
Data was collected prospectively of HTOs and UKAs performed between January-2016 and April-2021 by a knee surgeon. Oxford Knee Score (OKS), Knee Society Knee Score (KSKS) and Function Score (KSFS) were collected pre-operatively, six-months and two-years post-surgery. OA severity was graded on pre-operative radiograph. Medial Proximal Tibia Angle (MPTA), Lateral Distal Femoral Angle (LDFA), Joint Line Convergence Angle (JLCA) and Hip-Knee-Ankle Angle (HKAA), were measured on full-length radiograph. 47 HTO and 74 UKA were included. Propensity score matching was performed, accounting for preoperative scores, age, gender and body mass index (BMI), before statistical analysis. Level of significance was set at 0.05.
RESULTS
Both groups were similar in age(56.42 vs 58.57, p = 0.067), BMI(29.82 vs 29.09, p = 0.484), gender distribution (p = 0.663) and laterality (p = 0.836). Pre-operatively, both groups were similar in clinical scores and lower limb alignment. On follow-up, both groups achieved similar improvements in clinical scores. However, the HTO group reported poorer extension at 6-months (7.91° vs 4.80°, p = 0.013) and 2-years (5.57° vs 3.24°, p = 0.018). Three cases of hinge fracture and six cases of implant removal occurred in the HTO group. One case of tibial fracture occurred in the UKA group.
CONCLUSIONS
In severe MOA, similar outcomes were achieved with HTO and UKA at two years.
PubMed: 38909589
DOI: 10.1016/j.knee.2024.06.003 -
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 -
Journal of Biomechanics Jun 2024Understanding the relationship between footwear features and their potential influence on running performance can inform the ongoing innovation of running footwear,...
Understanding the relationship between footwear features and their potential influence on running performance can inform the ongoing innovation of running footwear, aimed at pushing the limits of humans. A notable shoe feature is hollow structures, where an empty space is created in the midsole. Presently, the potential biomechanical effect of the hollow structures on running performance remains unknown. We investigated the role of hollow structures through quantifying the magnitude and timing of foot and footwear work. Sixteen male rearfoot runners participated in an overground running study in three shoe conditions: (a) a shoe with a hollow structure in the forefoot midsole (FFHS), (b) the same shoe without any hollow structure (Filled-FFHS) and (c) a shoe with a hollow structure in the midfoot midsole (MFHS). Distal rearfoot power was used to quantify the net power generated by foot and footwear together. The magnitude and timing of distal rearfoot work and ankle joint work were compared across shoe conditions. The results indicated that MFHS can significantly (p = 0.024) delay distal rearfoot energy return (3.4 % of stance) when compared to Filled-FFHS. Additionally, FFHS had the greatest positive (0.425 J/kg) and negative (-0.383 J/kg) distal rearfoot work, and the smallest positive (0.503 J/kg) and negative (-0.477 J/kg) ankle joint work among the three conditions. This showed that the size and location of the midsole hollow structure can affect timing and magnitude of energy storage and return. The forefoot hollow shoe feature can effectively increase distal rearfoot work and reduce ankle joint work during running.
PubMed: 38905927
DOI: 10.1016/j.jbiomech.2024.112197 -
Journal of Biomechanics Jun 2024Low-cost markerless motion capture systems offer the potential for 3D measurement of joint angles during human movement. This study aimed to validate a smartphone-based...
Low-cost markerless motion capture systems offer the potential for 3D measurement of joint angles during human movement. This study aimed to validate a smartphone-based markerless motion capture system's (OpenCap) derived lower extremity kinematics during common return-to-sport tasks, comparing it to an established optoelectronic motion capture system. Athletes with prior anterior cruciate ligament reconstruction (12-18 months post-surgery) performed three movements: a jump-landing-rebound, single-leg hop, and lateral-vertical hop. Kinematics were recorded concurrently with two smartphones running OpenCap's software and with a 10-camera, marker-based motion capture system. Validity of lower extremity joint kinematics was assessed across 437 recorded trials using measures of agreement (coefficient of multiple correlation: CMC) and error (mean absolute error: MAE, root mean squared error: RMSE) across the time series of movement. Agreement was best in the sagittal plane for the knee and hip in all movements (CMC > 0.94), followed by the ankle (CMC = 0.84-0.93). Lower agreement was observed for frontal (CMC = 0.47-0.78) and transverse (CMC = 0.51-0.6) plane motion. OpenCap presented a grand mean error of 3.85° (MAE) and 4.34° (RMSE) across all joint angles and movements. These results were comparable to other available markerless systems. Most notably, OpenCap's user-friendly interface, free software, and small physical footprint have the potential to extend motion analysis applications beyond conventional biomechanics labs, thus enhancing the accessibility for a diverse range of users.
PubMed: 38905926
DOI: 10.1016/j.jbiomech.2024.112200