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Asian Journal of Surgery Mar 2022
Topics: Ankle Fractures; Ankle Joint; Arthroscopy; Fracture Fixation, Internal; Humans; Open Fracture Reduction
PubMed: 35034808
DOI: 10.1016/j.asjsur.2021.12.065 -
Orthopaedics & Traumatology, Surgery &... Dec 2020Medial ankle instability is likely underestimated. Three types of medial collateral ligament (MCL) lesion exist: isolated lesions, in case of valgus sprain in external... (Review)
Review
Medial ankle instability is likely underestimated. Three types of medial collateral ligament (MCL) lesion exist: isolated lesions, in case of valgus sprain in external rotation; lesions associated with chronic lateral instability, in case of rotational instability; and lesions associated with medial insufficiency and valgus flat-foot. Diagnostic confirmation and treatment of MCL lesions, isolated or associated with chronic lateral instability, by ligament suture is at present largely arthroscopic. Chronic MCL lesions with valgus flat-foot are probably irreversible: ligament reconstruction is unreliable, and bone surgery (osteotomy, fusion) is required.
Topics: Ankle; Ankle Joint; Collateral Ligaments; Humans; Joint Instability; Sprains and Strains
PubMed: 32900668
DOI: 10.1016/j.otsr.2020.08.005 -
Orthopaedic Surgery Jul 2022To establish a digital model of the ankle joint through 3D imaging technology and explore the preoperative placement of ankle replacement prostheses.
OBJECTIVE
To establish a digital model of the ankle joint through 3D imaging technology and explore the preoperative placement of ankle replacement prostheses.
METHODS
Computed tomography images of intact ankle joints from 54 cases in the outpatient and inpatient departments of our hospital were collected; according to the INBONE® total ankle system surgery process, the surgery model and surgical osteotomy were finished using MIMICS based on computer simulation method. The shortest distance was measured between the center point and the anterior, posterior, medial, and lateral, respectively, to ensure the precise position of the ankle replacement prosthesis by digital simulation surgery. The relationship between the two variables was analyzed by bivariate correlation analysis.
RESULTS
The dataset of this study included 48 cases of the sub-data set (26 males and 22 females) and included 27 cases of left ankle and 21 cases of right ankle. The average medial malleolar angle was 18.67°± 2.87°, the average amount of bone resection was 12.13 ± 1.86 cm , the mid-anterior distance was 1.72 ± 0.19 cm, the mid-posterior distance was 2.00 ± 0.19 cm, the ratio of mid-anterior to mid-posterior was 0.87, the mid-medial distance was 1.26 ± 0.17 cm, the mid-lateral distance was 1.19 ± 0.16 cm, and the ratio of mid-medial to mid-lateral was 1.06. After osteotomy, the anteroposterior diameter was 3.73 ± 0.32 cm, the transverse diameter was 2.46 ± 0.27 cm, and the ratio of anteroposterior diameter to transverse diameter was 1.53. In the bottom view, the shape after osteotomy is rectangular. The mid-anterior distance was strongly negatively correlated with age, the mid-anterior distance and the amount of bone resection, the mid-medial distance and the amount of bone resection, the mid-lateral distance and the amount of bone resection, the mid-lateral distance and the anteroposterior diameter, the anteroposterior diameter and the transverse diameter were all strongly positively correlated.
CONCLUSION
The projection point of the lower tibia centerline on the tibial horizontal osteotomy surface is located at a position slightly anterior to the midpoint of the transverse diameter after ankle arthroplasty. The rational positioning of the total ankle replacement is located at both a position slightly anterior to the midpoint of the transverse diameter and midpoint of the anteroposterior diameter, which can be used as a reference method before total ankle arthroplasty surgery.
Topics: Ankle Joint; Arthroplasty, Replacement, Ankle; Computer Simulation; Female; Humans; Male; Osteotomy; Tibia
PubMed: 35656705
DOI: 10.1111/os.13287 -
PloS One 2019In the study of balance and postural control the (Single) Inverted Pendulum model (SIP) has been taken for a long time as an acceptable paradigm, with the implicit...
In the study of balance and postural control the (Single) Inverted Pendulum model (SIP) has been taken for a long time as an acceptable paradigm, with the implicit assumption that only ankle rotations are relevant for describing and explaining sway movements. However, more recent kinematic analysis of quiet standing revealed that hip motion cannot be neglected at all and that ankle-hip oscillatory patterns are characterized by complex in-phase and anti-phase interactions, suggesting that the SIP model should be substituted by a DIP (Double Inverted Pendulum) model. It was also suggested that DIP control could be characterized as a kind of optimal bi-axial active controller whose goal is minimizing the acceleration of the global CoM (Center of Mass). We propose here an alternative where active feedback control is applied in an intermittent manner only to the ankle joint, whereas the hip joint is stabilized by a passive stiffness mechanism. The active control impulses are delivered to the ankle joint as a function of the delayed state vector (tilt rotation angle + tilt rotational speed) of a Virtual Inverted Pendulum (VIP), namely a pendulum that links the ankle to the CoM, embedded in the real DIP. Simulations of such DIP/VIP model, with the hybrid control mechanism, show that it can reproduce the in-phase/anti-phase interaction patterns of the two joints described by several experimental studies. Moreover, the simulations demonstrate that the DIP/VIP model can also reproduce the measured minimization of the CoM acceleration, as an indirect biomechanical consequence of the dynamic interaction between the active control of the ankle joint and the passive control of the hip joint. We suggest that although the SIP model is literally false, because it ignores the ankle-hip coordination, it is functionally correct and practically acceptable for experimental studies that focus on the postural oscillations of the CoM.
Topics: Ankle Joint; Biomechanical Phenomena; Hip Joint; Humans; Models, Biological; Standing Position
PubMed: 30897124
DOI: 10.1371/journal.pone.0213870 -
Acta Medica Okayama Dec 2018We retrospectively evaluated the altered biomechanics of the talus in 15 adult patients (7 males, 8 females) with chronic lateral ankle instability when the ankle joint...
We retrospectively evaluated the altered biomechanics of the talus in 15 adult patients (7 males, 8 females) with chronic lateral ankle instability when the ankle joint moved actively from full dorsiflexion to full plantarflexion under a non-weight bearing condition. CT images were taken for the unstable ankle and the contralateral normal (control) ankle. Three-dimensional surface models of both ankle joints were reconstructed from the CT data, and we used a computer simulation program to compare both ankle motions of inversion/eversion in the coronal plane, plantarflexion/dorsiflexion in the sagittal plane, and internal rotation/external rotation in the axial plane. This evaluation method provides in vivo, dynamic, and 3D results of ankle motion. In the ankles with chronic lateral instability and the controls, the average talar rotational movement of inversion (+)/eversion (-) was 19.0° and 15.5° and the internal rotation (+)/external rotation (-) was 30.4° and 20.7°, respectively. Paired t-tests revealed significant differences in the amount of inversion (+)/eversion (-) (p=0.012) and internal rotation (+)/external rotation (-) (p<0.001) between unstable and normal ankle joints. The difference of mean rotational movement in internal rotation (9.7°) was greater than that of inversion (3.5°). Rotational instability should be considered when evaluating chronic lateral ankle instability.
Topics: Adolescent; Adult; Ankle Joint; Biomechanical Phenomena; Female; Humans; Joint Instability; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed; Young Adult
PubMed: 30573913
DOI: 10.18926/AMO/56376 -
Acta Bio-medica : Atenei Parmensis Dec 2020Ankle arthrodesis has been considered the surgical Gold Standard for advanced ankle arthritis; prosthetic replacement of the tibio-talar joint played a secondary...
Ankle arthrodesis has been considered the surgical Gold Standard for advanced ankle arthritis; prosthetic replacement of the tibio-talar joint played a secondary role.The introduction of last generation ankle prostheses lead to better outcome and a lower rate of complication. PSI represents the most recent innovations introduced on the market of ankle arthroplasty:PSI is proposed as a surgical technique capable of making ankle arthroplasty more accurate and more reproducible compared to standard referencing guides Aim of the study is to report early clinical and radiographic outcomes obtained from a single surgeon experience by implanting the same ankle prosthesis using a standard (STD) or a PSI instrumentation Unlike no difference in the average increment of normalized sub score related to function in each group (PSI vs STD), the analysis of normalized pain sub score pointed out a greater average improvement in the PSI group(+75%)compared to the STD group(+62%);this result has been adovacated to the absence of post operative gutter impingement syndrome in the PSI group compared to the STD referencing group. The analysis of radiographic angles revealed a more accurate and reproducible positioning of the components in the PSI group; ankle arthroplasty performed with PSI reported a reduction of both surgical times and the need of intraop.fluoroscopy. PSI ankle arthroplasty achived more accurate and reproducible clinical and radiographic results compared to STD instrumentation;long-term follow-up are needed to demonstrate whether a better positioning of the implant is associated with an increased survival of the prosthesis and therefore justifies the additional costs of PSI.
Topics: Ankle; Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Humans; Joint Prosthesis; Treatment Outcome
PubMed: 33559635
DOI: 10.23750/abm.v91i14-S.10989 -
Journal of Orthopaedic Surgery and... Aug 2023Syndesmosis injury is proposed to contribute to ankle stability and osteoarthritis (OA). However, whether distal tibiofibular syndesmosis structure is closely related to...
BACKGROUND
Syndesmosis injury is proposed to contribute to ankle stability and osteoarthritis (OA). However, whether distal tibiofibular syndesmosis structure is closely related to ankle OA is unclear. We hypothesized that different DTS morphology classifications would affect the biomechanics properties in ankle OA. The study aimed to determine the association between the distal tibiofibular syndesmosis (DTS) morphological classification and ankle OA.
METHODS
This is a retrospective study examining imaging data of 147 patients (87 males and 60 females) with ankle OA. Magnetic resonance imaging was used to access the DTS morphological classification, according to measuring various parameters. Joint space narrowing and osteophytes were measured using ankle weight-bearing radiography. The classification and parameters were analyzed to determine the relationship between the syndesmosis classification and the abnormality of ankle OA.
RESULTS
Five morphological classifications of the DTS, including Chevron (19.6%), Widow's peak (16.2%), Flat (22.3%), Trapezoid (32.0%), and Crescent (19.6%), were shown. There were statistical differences between DTS classification and tibial angle surface angle (TAS) (P = .009) and talar tilt angle (TTA) (P = .014). The TAS (degree) of the Crescent (86.47 ± 3.21) was less than Chevron (88.75 ± 2.72) (P = .006), Widow's peak (89.26 ± 3.15) (P = .001), Flat (88.83 ± 3.62) (P = .003) and Trapezoid (88.11 ± 2.62) (P = .041), respectively. The TTA (degree) of Crescent (86.83 ± 5.30) was less than Chevron (89.28 ± 2.46) and Widow's peak (89.82 ± 3.41). The men were greater than women for TAS (P = .008) and angle (P = .003), which are consistent with osteophyte (P = .019) and the modified Kellgren-Lawrence grades (P = .041) between gender.
CONCLUSIONS
DTS morphological classification might affect the biomechanics properties in TAS and TTA in ankle OA. In clinical practice, surgeons should pay attention to the effects of DTS on ankle OA.
LEVEL OF EVIDENCE
Level III, retrospective study.
Topics: Male; Humans; Female; Retrospective Studies; Ankle Joint; Ankle; Osteoarthritis; Tibia; Osteophyte
PubMed: 37537622
DOI: 10.1186/s13018-023-03985-1 -
Journal of the Royal Society of Medicine Apr 1985The indications for ankle joint replacement and the advantages of a 'ball-and-socket' type of prosthesis are examined. The results of 24 Richard Smith ankle replacements...
The indications for ankle joint replacement and the advantages of a 'ball-and-socket' type of prosthesis are examined. The results of 24 Richard Smith ankle replacements of which 18 were followed for an average of 7 years are analysed and the case for abandoning this prosthesis is discussed.
Topics: Adult; Ankle Joint; Arthritis, Rheumatoid; Female; Follow-Up Studies; Humans; Joint Diseases; Joint Prosthesis; Middle Aged; Postoperative Complications; Radiography
PubMed: 3981527
DOI: 10.1177/014107688507800406 -
Journal of Applied Biomechanics Jun 2019The triceps surae muscle-tendon units are important in governing walking performance, acting to regulate mechanical behavior of the ankle through interaction between...
The triceps surae muscle-tendon units are important in governing walking performance, acting to regulate mechanical behavior of the ankle through interaction between active muscle and passive elastic structures. Ankle joint quasi-stiffness (the slope of the relation between ankle moment and ankle rotation, k) is a useful aggregate measure of this mechanical behavior. However, the role of muscle activation and length-tension behavior in augmenting k remains unclear. In this study, 10 subjects completed eccentric isokinetic contractions at rest and at 2 soleus activation levels (25% and 75% isometric voluntary contraction) prescribed using electromyographic biofeedback. Ultrasound imaging quantified activation-dependent modulation of soleus muscle length-tension behavior and its role in augmenting k. The authors found that soleus muscle stiffness (k) and k exhibit nonlinear relations with muscle activation and both were more sensitive to the onset of activation than to subsequent increases in activation. Our findings also suggest that k can be modulated via activation through changes in soleus muscle length-tension behavior. However, this modulation is more complex than previously appreciated-reflecting interaction between active muscle and passive elastic tissues. Our findings may have implications for understanding normal and pathological ankle joint function and the design of impedance-based prostheses.
Topics: Ankle Joint; Biomechanical Phenomena; Electromyography; Female; Humans; Isometric Contraction; Male; Muscle Contraction; Muscle, Skeletal; Ultrasonography; Young Adult
PubMed: 30676171
DOI: 10.1123/jab.2018-0297 -
Journal of Orthopaedic Research :... Feb 2020Tibiotalar arthrodesis is a common surgical treatment for end-stage ankle arthritis. Proper ankle alignment is important as malalignment can lead to complications that...
Tibiotalar arthrodesis is a common surgical treatment for end-stage ankle arthritis. Proper ankle alignment is important as malalignment can lead to complications that may require revision surgery. This study aimed to determine how anteroposterior (AP) translational malalignment of ankle arthrodesis affects distal foot joint kinematics and plantar pressure. Ankle arthrodesis was performed on 10 cadaveric foot specimens using a custom fixture that could fuse the ankle neutrally and induce discrete malalignments (3, 6, and 9 mm) anteriorly and posteriorly. Gait was simulated under each alignment with a robotic gait simulator, and foot bone motion and plantar pressure were quantified. AP translational malalignment did not substantially affect plantar pressure or joint range of motion, but there were several significant differences in joint position throughout stance phase. Differences were seen in five joints (talocalcaneal, talonavicular, calcaneocuboid, fifth tarsometatarsal, and first metatarsophalangeal) and in the position of the first metatarsal relative to the talus. The most extreme effects occurred when the talus was displaced 6 mm or more posteriorly. In vivo, this may lead to aberrant joint loading, which could negatively impact patient outcomes. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:450-458, 2020.
Topics: Adult; Ankle Joint; Arthrodesis; Biomechanical Phenomena; Cadaver; Female; Foot Joints; Gait; Humans; Male; Middle Aged
PubMed: 31502697
DOI: 10.1002/jor.24464