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Journal of Orthopaedic Surgery and... Oct 2016Although differences in the results of the bone marrow stimulation technique between the knee and ankle have been reported, a detailed mechanism for those differences...
BACKGROUND
Although differences in the results of the bone marrow stimulation technique between the knee and ankle have been reported, a detailed mechanism for those differences has not been clarified. The purpose of this study was to examine whether morphological differences between the knee and ankle joint affect the results of drilling as treatment for osteochondral defects in a rabbit model.
METHODS
Osteochondral defects were created at the knee and ankle joint in the rabbit. In the knee, osteochondral defects were created at the medial femoral condyle (MFC) and patellar groove (PG). At the ankle, defects were created in the talus at either a covered or uncovered area by the tibial plafond. After creating the osteochondral defect, drilling was performed. At 4, 8, and 12 weeks after surgery, repair of the osteochondral defects were evaluated histologically. The proliferation of rabbit chondrocytes and proteoglycan release of cartilage tissue in response to IL-1β were analyzed in vitro in both joints.
RESULTS
At 8 weeks after surgery, hyaline cartilage repair was observed in defects at the covered area of the talus and the MFC. At 12 weeks, hyaline cartilage with a normal thickness was observed for the defect at the covered area of the talus, but not for the defect at the MFC. At 12 weeks, subchondral bone formation progressed and a normal contour of subchondral bone was observed on CT in the defect at the covered area of the talus. No significant differences in chondrocyte proliferation rate and proteoglycan release were detected between the knee and ankle in vitro.
CONCLUSIONS
Our results demonstrate that the covered areas of the talus show early and sufficient osteochondral repair compared to that of the knee and the uncovered areas of the talus. These results suggest that the congruent joint shows better subchondral repair prior to cartilage repair compared to that of the incongruent joint.
Topics: Animals; Ankle Joint; Cartilage, Articular; Cells, Cultured; Chondrocytes; Knee Joint; Male; Models, Animal; Rabbits
PubMed: 27716360
DOI: 10.1186/s13018-016-0444-4 -
BMC Musculoskeletal Disorders Aug 2021To prevent recurrent ankle sprain, it is important to clarify the pathology of chronic ankle instability (CAI). An association has been reported between CAI and...
BACKGROUND
To prevent recurrent ankle sprain, it is important to clarify the pathology of chronic ankle instability (CAI). An association has been reported between CAI and abnormalities of foot posture and ankle alignment. There is no consensus on the types of these abnormalities that occur in individuals with CAI. The objective of this systematic review is to clarify the relevance of abnormality of foot posture and ankle alignment for CAI.
METHODS
A systematic computerized literature search was performed of the PubMed, CINAHL, SPORTDiscus, Web of Science, and the Cochrane Register of Clinical Trials databases. The selected studies either compared CAI patients with a control group or CAI ankles with contralateral healthy ankles and specifically reported foot posture and alignment of the ankle in the outcomes. They were written in English and published prior to June 2021. The methodological quality of the included studies was evaluated using a 16-question index. Data were extracted independently by two reviewers, and the certainty of evidence was assessed using GRADE approach.
RESULTS
Sixteen studies including 872 patients of high to low methodological quality were included. These showed there was significant anterior displacement and internal rotation of the talus in CAI ankles (low evidence), but there was no consensus on fibular alignment or foot posture.
CONCLUSIONS
This review showed there was significant anterior displacement and internal rotation of the talus in CAI ankles but found no consensus on the characteristics of fibular and foot alignment. Further investigations are required to clarify the characteristic foot and ankle malalignment in CAI to facilitate the development of efficient interventions.
Topics: Ankle; Ankle Joint; Chronic Disease; Humans; Joint Instability; Sprains and Strains
PubMed: 34384403
DOI: 10.1186/s12891-021-04537-6 -
Medicine Mar 2015Lateral talar process fragment excision may be followed by hindfoot instability and altered biomechanics. There is controversy regarding the ideal fragment size for...
Lateral talar process fragment excision may be followed by hindfoot instability and altered biomechanics. There is controversy regarding the ideal fragment size for internal fixation versus excision and a concern that excision of a large fragment may lead to significant instability. The aim of this study was to assess the effect of a simulated large lateral talar process excision on ankle and subtalar joint stability.A custom-made seesaw rig was designed to apply inversion/eversion stress loading on 7 fresh-frozen human cadaveric lower legs and investigate them in pre-excision, 5 cm and 10 cm lateral talar process fragment excision states. Anteroposterior radiographs were taken to assess ankle and subtalar joint tilt and calculate angular change from neutral hindfoot alignment to 10-kg forced inversion/eversion. Ankle joint pressures and contact areas were measured under 30-kg axial load in neutral hindfoot alignment.In comparison to the pre-excision state, no significantly different mediolateral angular change was observed in the subtalar joint after 5 and 10 cm lateral talar process fragment excision in inversion and eversion. With respect to the ankle joint, 10-cm fragment excision produced significantly bigger inversion tibiotalar tilt compared with the pre-excision state, P = .04. No significant change of the ankle joint pressure and contact area was detected after 5 and 10-cm excision in comparison with the pre-excison state.An excision of up to 10 cm of the lateral talar process does not cause a significant instability at the level of the subtalar joint but might be a destabilizing factor at the ankle joint under inversion stress. The latter could be related to extensive soft tissue dissection required for resection.
Topics: Ankle Joint; Biomechanical Phenomena; Humans; Joint Instability; Talus
PubMed: 25789950
DOI: 10.1097/MD.0000000000000606 -
Scientific Reports Mar 2024The paper deals with the torques of external muscles acting on the upper ankle joint under weight-bearing conditions and their importance in diagnosing and treating the...
The paper deals with the torques of external muscles acting on the upper ankle joint under weight-bearing conditions and their importance in diagnosing and treating the human foot. Experimental data were collected and calculations were performed. Based on the experiments with the biomechanical model of the foot and upper ankle joint, it was shown how the changes in the force arms of the external muscles of the foot under weight-bearing conditions, change the torque. The real values of muscle forces and torques of the external muscles of the foot were calculated. Taking into account the distance of the lines of muscle action from the axis of rotation of the upper ankle joint the rotational force of the muscles was calculated. The influence of changing the force arm on the rotational efficiency of the muscle balancing the moment of gravity was shown. Knowledge of muscle torque under weight-bearing conditions is crucial for correctly assessing foot biomechanics. It has been shown that torque (gravitational and muscular), not pure force, is crucial when assessing the rotational capacity of the analyzed joint. A change in the approach to diagnostics and treating paresis or weakness of extrinsic foot muscles was proposed through the manipulation of the distance of their action line from the axis of joint rotation.
Topics: Humans; Ankle Joint; Torque; Muscle, Skeletal; Foot; Tarsal Bones; Biomechanical Phenomena
PubMed: 38553519
DOI: 10.1038/s41598-024-57698-4 -
Gait & Posture Jan 2021Joint kinetic calculations are sensitive to joint centre locations. Although geometric hip and knee joint centre/axis are generally developed, the ankle joint centre...
BACKGROUNDS
Joint kinetic calculations are sensitive to joint centre locations. Although geometric hip and knee joint centre/axis are generally developed, the ankle joint centre (AJC) is conventionally defined as the midpoint between the malleolus lateralis and medialis (AJC) in most gait analyses.
RESEARCH QUESTION
We examined the positional difference of the AJC from the geometric centre of rotation (AJC) and its effect on the ankle joint kinetics in representative human gaits.
METHODS
In the first experiment, we calculated the AJC and indicated its location on the ankle MRI in 14 (seven male and seven female) participants. In the second experiment, we compared ankle kinematics/kinetics based on AJC and AJC during walking and hopping at 2.6 Hz in 17 (nine male and eight female) participants.
RESULTS
In both experiments, AJC was located at positions significantly medial (-9.2 ± 5.4 mm and -10.1 ± 4.4 mm) and anterior (17.0 ± 7.4 mm and 15.3 ± 5.2 mm) from the AJC. Furthermore, the AJC underestimated peak dorsiflexion (AJC/AJC: 52.6 ± 17.1%) and inversion (AJC/AJC: 62.2 ± 11.5%) torques and their durations in walking. Additionally, AJC overestimated the plantar flexion torque in both gait modes [AJC/AJC: 111.3 ± 4.8% (walking) and 112.7 ± 6.3% (hopping)].
SIGNIFICANCE
We therefore concluded that the positional difference between the geometric and landmark-based AJC definitions significantly affected ankle kinetics, thereby indicating that the functional method should be used for defining AJC for gait analysis.
Topics: Adult; Ankle Joint; Biomechanical Phenomena; Female; Humans; Imaging, Three-Dimensional; Male; Rotation
PubMed: 33176233
DOI: 10.1016/j.gaitpost.2020.10.018 -
Clinical Anatomy (New York, N.Y.) Sep 2021Flattening of the trochlear tali is clinically observed as structural and functional changes advance in patients with hemarthropathy of the ankle. However, the degree of... (Comparative Study)
Comparative Study
Flattening of the trochlear tali is clinically observed as structural and functional changes advance in patients with hemarthropathy of the ankle. However, the degree of this flattening has not yet been quantified, and distribution of the morphological changes across the talus not yet defined. Chronologically sequential MR images of both a hemophilic patient group (N = 5) and a single scan from a nondiseased, sex-matched, control group (N = 11) were used to take four measurements of the trochlear talus morphology at three locations (medial, central and lateral) along the sagittal plane. Three ratios of interest were defined from these to assess whether the talar dome flattens with disease. The control group MRI measurements were validated against literature data obtained from CT scans or planar X-Rays. The influence of disease on talar morphology was assessed by direct comparison of the hemophilic cases with the control group. The values for all three ratios, in all locations, differed between the control and the hemophilic group. Flattening was indicated in the hemophilic group in the medial and lateral talus, but differences in the central talus were not statistically significant. This work demonstrates that morphological assessment of the talus from MR images is similar to that from CT scans or planar X-Rays. Talar flattening does occur with hemarthropathy, especially at the medial and lateral edges of the joint surface. General flattening of the trochlear talus was confirmed in this small patient sample, however the degree and rate of change is unique to each ankle.
Topics: Adolescent; Adult; Ankle Joint; Child; Diagnostic Imaging; Hemophilia A; Humans; Talus; Young Adult
PubMed: 33998061
DOI: 10.1002/ca.23757 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jul 2021The effects of changes in distal tibiofibular joint (DTFJ) congruence on clinical and functional outcomes are unclear in patients operated on for ankle fractures. The...
The relationship between changes in distal tibiofibular joint congruence and clinical and functional results in the short-term follow-up of patients operated on for ankle fracture.
BACKGROUND
The effects of changes in distal tibiofibular joint (DTFJ) congruence on clinical and functional outcomes are unclear in patients operated on for ankle fractures. The present study aims to evaluate the relationship between changes in DTFJ congruence and clinical and functional outcomes in the short-term follow-up of the patients operated on for ankle fractures.
METHODS
In this study, hospital records of patients who were operated on for ankle fractures were retrospectively analyzed. The data of patients who underwent bilateral ankle computed tomography scans at least 18 months after surgery were used. DTFJ congruence was evaluated using four methods. Method 1: the distance between the most prominent anterior points of the tibia and fibula (anterior incisura [AI]) and that between the most prominent posterior points of the tibia and fibula (posterior incisura [PI]) were measured. Method 2: the direct anterior (DA) and direct posterior (DP) distances were measured based on perpendicular lines drawn from the most prominent anterior and posterior points of the longitudinal axis of the fibula to the tibia, respectively, and a direct translation (DT) distance was measured based on a perpendicular line drawn to the DA from the most prominent anterior point of the tibia. Method 3: the angle between a line connecting the most anterior and posterior points of the tibia and a line connecting the most anterior and posterior points of the fibula (rotational angle [RA]) was measured. The differences in distances and angles (dAI, dPI, dDA, dDP, dDT, and dRA) between the injured and non-injured sides were calculated in the first three methods. Method 4: any rotational/translational incongruency on the injured side was subjectively reported. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Olerud-Molander Ankle Score (OMAS), and Visual Analog Scale (VAS) were used for clinical and functional evaluations.
RESULTS
Thirty patients (18 males and 12 females; mean age, 43.3 [range, 20-78 years] years) were included in this study. The average follow-up was 37.6 (range, 18-54 months) months. Negative correlations were detected between dDA and the AOFAS-pain subscale (r=-0.37; p=0.04), between dDP and the OMAS (r=-0.57; p=0.01), and between dDT and the AOFAS-pain, AOFAS-function, and OMAS (r=-0.55 p=0.01; r=-0.40; p=0.03; r=-0.39; p=0.04, respectively).
CONCLUSION
Changes in dDA, dDP, and dDT values affect the clinical and functional outcomes. These parameters should be provided in accordance with the anatomy of the patient during the reduction of the DTFJ to achieve better outcomes.
Topics: Adult; Aged; Ankle Fractures; Ankle Joint; Female; Humans; Male; Middle Aged; Retrospective Studies; Young Adult
PubMed: 34212995
DOI: 10.14744/tjtes.2020.23691 -
Bulletin of the NYU Hospital For Joint... 2011Although ankle arthrodesis has been considered the gold standard for treatment of symptomatic end stage arthritis, recent improvements in arthroplasty designs and... (Review)
Review
Although ankle arthrodesis has been considered the gold standard for treatment of symptomatic end stage arthritis, recent improvements in arthroplasty designs and instrumentation have led to a resurgence in interest in ankle arthroplasty. While first generation arthroplasty systems had high failure rates due to cemented techniques or highly constrained designs, newer generations of ankle replacements have introduced more anatomic and pressfit techniques. Early results have been promising, with improved functional outcomes versus ankle arthrodesis. However, complication rates are still substantial, and the procedure should be restricted to properly indicated patients. Long-term follow-up studies are necessary, but total ankle arthroplasty has become a viable option for surgical treatment of ankle arthritis.
Topics: Ankle Joint; Arthroplasty, Replacement, Ankle; Humans
PubMed: 21332436
DOI: No ID Found -
Foot and Ankle Clinics Mar 2021In the past 2 decades, there has been a rapid expansion of clinical studies investigating the safety and efficacy of biological treatment methods for a wide range of... (Review)
Review
In the past 2 decades, there has been a rapid expansion of clinical studies investigating the safety and efficacy of biological treatment methods for a wide range of diseases. These biological treatment methods increasingly are used in clinical practice based on limited available evidence. This article provides an overview of evidence on biological treatment methods for foot and ankle pathologies, including ankle osteoarthritis, osteochondral lesions of the talus, and Achilles tendinopathy.
Topics: Achilles Tendon; Ankle; Ankle Joint; Humans; Talus; Tendinopathy
PubMed: 33487242
DOI: 10.1016/j.fcl.2020.11.001 -
Orthopaedic Surgery Oct 2022To evaluate the clinical curative effect of Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.
OBJECTIVE
To evaluate the clinical curative effect of Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.
METHODS
From June 2013 to August 2019, 72 patients with elderly traumatic ankle arthritis were treated with arthrodesis through Ilizarov external fixation technique in our institution. Conventional double-feet standing X-ray films were taken before and after operation. The tibiotalar angle on X-ray image was measured to evaluate the degree of talipes varus and valgus. The Foot and Ankle pain score of American Orthopaedics Foot and Ankle Society (AOFAS) and Visual Analog Scale (VAS) were compared by using paired t-test to evaluate the functional recovery.
RESULTS
All of the patients acquired effective postoperative 18-49 months follow-up, with an average of 31.5 months. All patients were included in the analysis, among which 38 cases were males and 34 cases were females, with an average of 65.4 years (ranging from 60 to 74). All ankles achieved bony fusion; the clinical healing time was 12.7 weeks on average (11-18 weeks). The AOFAS score was 45.36 ± 6.43 preoperatively and 80.25 ± 9.16 at 12 months post-operation, with a statistically significant difference (p < 0.0001). The VAS score was 8.56 ± 1.85 on average preoperatively and 2.72 ± 0.83 at 12 months post-operation, with a statistically significant difference (p < 0.0001). The tibiotalar angle was 101.93° ± 4.12° preoperatively and 94.45° ± 2.37° at 12 months post-operation, with a statistically significant difference (p < 0.0001). The results of the functional evaluation indicated that 44 patients (61.1%) had excellent results, 18 (25%) had good results, and 10 (13.9%) had fair results.
CONCLUSION
Our study demonstrated that it is possible to obtain satisfactory outcome with Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.
Topics: Aged; Ankle; Ankle Joint; Arthritis; Arthrodesis; External Fixators; Female; Humans; Ilizarov Technique; Male; Retrospective Studies; Treatment Outcome
PubMed: 36001696
DOI: 10.1111/os.13399