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Journal of Orthopaedic Surgery (Hong... 2022To evaluate the outcomes of intermediate stage varus ankle arthritis treated by supramalleolar osteotomy.
OBJECTIVE
To evaluate the outcomes of intermediate stage varus ankle arthritis treated by supramalleolar osteotomy.
METHODS
Clinical data of 57 patients with varus arthritis who underwent supramalleolar osteotomy at our hospital between March 2018 and December 2019 were retrospectively analyzed. The patients were grouped according to the Takakura classification, and assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and the Visual Analogue Score (VAS). Tibial anterior surface (TAS) angle and talar tilt (TT) angle were measured at the weight-bearing anteroposterior view. Tibial lateral surface (TLS) angle was measured at the weight-bearing lateral view. The differences in the above indicators of patients with different stages of varus ankle arthritis before and after treatment were analyzed.
RESULTS
The patients were followed up for an average of 31.9 ± 5.8 months. Upon the last follow-up, the AOFAS score was 84.1 ± 9.7, the VAS score 2.2 ± 1.3, the TAS angle 92.4 ± 5.5°, the TLS angle 79.3 ± 5.3°, and the TT angle 3.7±3.4°, which were significantly different from the preoperative levels (64.2 ± 14.6, 4.5 ± 1.8, 80.5 ± 6.7°, 74.9 ± 4.6°, and 5.2 ± 64.1°, respectively) ( < .05). There were significant differences in AOFAS and VAS scores before surgery and upon the last follow-up in each group ( < .05). The postoperative TT angle was significantly different from the preoperative level in stage IIIb patients ( = .003).
CONCLUSIONS
Supramalleolar osteotomy achieved good short-to mid-term clinical outcomes for intermediate stage varus ankle arthritis. This procedure could significantly improve the TAS and TLS angles of the patients at any stage and the TT angle of stage IIIb patients.
Topics: Ankle; Ankle Joint; Humans; Osteoarthritis; Osteotomy; Retrospective Studies
PubMed: 36197148
DOI: 10.1177/10225536221132769 -
Orthopaedics & Traumatology, Surgery &... Nov 2022The severity of a foot or ankle deformity is a major prognostic factor for the success of ankle replacement. Varus deformity is at once the most arthrogenic and the most...
INTRODUCTION
The severity of a foot or ankle deformity is a major prognostic factor for the success of ankle replacement. Varus deformity is at once the most arthrogenic and the most frequent.
HYPOTHESIS
The severity of preoperative varus is a negative factor for ankle replacement survival.
MATERIAL AND METHOD
A retrospective study compared results in a continuous series of 57 Salto-Talaris® ankle replacements according to preoperative varus: 31 moderate (5-15̊) and 26 severe (> 15̊). Radiological and clinical assessment at a minimum 1 year focused on complications, revision and implant exchange and on AOFAS score, range of motion and tibiotalar angle at last follow-up.
RESULTS
At a mean 2.4 years' follow-up, implant survival in the moderate and severe varus groups was respectively 83% and 92%. Postoperative AOFA score and range of motion improved significantly in both groups, without significant difference. Analysis of cumulative survival showed no significant intergroup difference.
DISCUSSION
Severity of preoperative varus did not impact implant survival. Only postoperative alignment and stability emerged as survival factors. These results were related to the quality of associated procedures aiming to reduce deformity and to achieve ligament balance.
LEVEL OF EVIDENCE
IV, retrospective comparative study.
Topics: Humans; Retrospective Studies; Ankle; Treatment Outcome; Arthroplasty, Replacement, Ankle; Ankle Joint
PubMed: 35944869
DOI: 10.1016/j.otsr.2022.103390 -
Unfallchirurgie (Heidelberg, Germany) Dec 2022Treatment of the ankle joint with total ankle arthroplasty (TAA) is an established and safe surgical treatment for osteoarthritis of the ankle. Modern implants have low... (Review)
Review
Treatment of the ankle joint with total ankle arthroplasty (TAA) is an established and safe surgical treatment for osteoarthritis of the ankle. Modern implants have low revision rates and are superior to ankle arthrodesis in terms of patient-reported outcomes. The importance of primary TAA treatment of ankle fractures is unclear. There are currently no studies in the literature on this topic. In view of the increasing number of cases of unstable ankle fractures, especially in older patients and with increasing functional demands also in old age, it is important to consider TAA in the management of these fractures in the future. Clinical studies are necessary to evaluate the treatment of ankle fractures using TAA.
Topics: Humans; Aged; Ankle Fractures; Arthroplasty, Replacement, Ankle; Elective Surgical Procedures; Ankle Joint; Arthrodesis
PubMed: 36416890
DOI: 10.1007/s00113-022-01252-2 -
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 -
Acta Orthopaedica Scandinavica.... 1989Roentgen stereophotogrammetric analysis has been used to study ankle/foot kinematics in eight healthy volunteers. All the joints between the tibia and the first... (Review)
Review
Roentgen stereophotogrammetric analysis has been used to study ankle/foot kinematics in eight healthy volunteers. All the joints between the tibia and the first metatarsal as well as the talo-calcaneal and tibio-fibular joints were analysed in input plantar flexion/dorsiflexion and pronation/supination of the foot as well as internal/external rotation of the leg. The findings included the following: INDIVIDUAL JOINTS 1. The joint axis of the talo-crural joint varied with varying kinds of input motion. Substantial amounts of rotation occurred about axes close to the vertical; this occurred particularly when the input motion was in the internal rotation part of the arc of leg rotation and in pro-/supination of the foot. 2. The total amount of rotation in the talo-calcaneal joint was small in internal rotation of the leg and in pronation of the foot compared to external rotation of the leg and supination of the foot. 3. The talo-navicular joint showed a limited ball-and-socket joint pattern in all subjects. The total amounts of rotation were larger than in the talo-calcaneal joint in all subjects. Plantar flexion axes were more transverse than the axes seen in other kinds of input motion. 4. The talo-calcaneal and talo-navicular joint axes were seldom parallel, indicating that these joints do not necessarily behave as a simple hinge. JOINT INTERACTION Joint interaction varied in different qualities of input motion. Plantar flexion induced rotation in the talo-crural joint, and to some extent in the joints of the arch. Dorsiflexion mainly induced talo-crural joint motion. Pronation/supination induced motion in all joints. The distal joints of the arch displayed more rotation in pronation than in supination, while the talo-calcaneal joint showed less motion in pronation than in supination. Internal leg rotation induced little rotation in the joints of the ankle/foot complex. External rotation induced external rotation, dorsiflexion, and supination in the talo-navicular and talo-calcaneal joints. The distal joints of the arch displayed compensatory plantar flexion and pronation. TRANSFERRAL OF ROTATION The ankle/foot complex showed ability to transform leg rotation into pro-/supination and vice versa. This function was most pronounced in external leg rotation. MOTIONS OF THE FIBULA The fibula showed consistent lateral and posterior translation from input plantar flexion to dorsiflexion of the foot.
Topics: Adult; Ankle Joint; Calcaneus; Female; Humans; Male; Metatarsal Bones; Movement; Photogrammetry; Radiography; Rotation; Talus; Tarsal Bones; Tibia
PubMed: 2686345
DOI: 10.1186/1757-1146-5-s1-k5 -
Journal of Athletic Training 2009Health care professionals commonly prescribe external stabilization to decrease the incidence and severity of ankle sprains. The mechanism for this decrease is not... (Comparative Study)
Comparative Study
CONTEXT
Health care professionals commonly prescribe external stabilization to decrease the incidence and severity of ankle sprains. The mechanism for this decrease is not clearly understood. Examining the effects of ankle bracing on biomechanical stability and influencing factors may provide important information regarding the neuromuscular effects of bracing.
OBJECTIVE
To study the effects of 2 different ankle braces on the neuromuscular factors influencing ankle stiffness.
DESIGN
Mixed-model repeated-measures design.
SETTING
Research laboratory.
PATIENTS OR OTHER PARTICIPANTS
Twenty-eight physically active participants composing 2 groups: 14 with unilateral functional ankle instability (age = 26.19 +/- 6.46 years, height = 166.07 +/- 12.90 cm, mass = 69.90 +/- 13.46 kg) and 14 with bilaterally stable ankles (age = 23.76 +/- 5.82 years, height = 174.00 +/- 11.67 cm, mass = 68.60 +/- 13.12 kg).
INTERVENTION(S)
Participants were fitted with surface electromyography electrodes over the peroneus longus, peroneus brevis, tibialis anterior, and soleus muscles. Each participant received transient motion oscillations to his or her ankle on a custom-built medial-lateral swaying cradle in each of 3 conditions: no ankle brace (NB), lace-up brace (LU), and semirigid brace (SR).
MAIN OUTCOME MEASURE(S)
Ankle stiffness as measured by the cradle and preactivation levels (percentage of maximal voluntary isometric contraction) of the 4 test muscles.
RESULTS
Stiffness levels increased across brace conditions (NB = 24.79 +/- 6.59 Nm/rad, LU = 28.29 +/- 7.05 Nm/rad, SR = 33.22 +/- 8.78 Nm/rad; F(2,52) = 66.185, P < .001). No differences were found between groups for rotational stiffness (stable = 27.36 +/- 6.17 Nm/rad, unstable = 30.18 +/- 8.21 Nm/rad; F(1,26) = 1.084, P = .307). Preactivation levels did not change for any of the tested muscles with the application of an ankle brace (F(2,52) = 1.326, P = .275).
CONCLUSIONS
The increase in ankle rotational stiffness with the addition of an ankle brace and the lack of any demonstrable neuromuscular changes suggested ankle braces passively contributed to the stability of the system.
Topics: Adult; Analysis of Variance; Ankle Injuries; Ankle Joint; Biomechanical Phenomena; Braces; Confidence Intervals; Electromyography; Female; Health Status Indicators; Humans; Incidence; Isometric Contraction; Male; Muscle, Skeletal; Severity of Illness Index
PubMed: 19593418
DOI: 10.4085/1062-6050-44.4.363 -
Clinical Orthopaedics and Related... Aug 2009Quantification of joint space width of the ankle could provide information essential to evaluate the effects of potential disease-modifying agents and adverse effects of...
Quantification of joint space width of the ankle could provide information essential to evaluate the effects of potential disease-modifying agents and adverse effects of devices intended to ameliorate osteoarthritis elsewhere in the lower extremity. Current methods require proprietary software or have not been well validated; our purpose was to develop and assess the reliability of a digital joint space width quantification method using public access software. We studied 95 patients, asymptomatic in the ankles and without history of ankle trauma, but with symptomatic medial knee osteoarthritis, participating in an ongoing longitudinal trial. Weightbearing anteroposterior radiographs of the ankle and supine radiographs of the pelvis were assessed, and the narrowest medial and lateral tibiotalar joint space widths and hip joint space widths were measured using Image J software (US NIH, Bethesda, MD). Medial joint space widths were 2.56 +/- 0.50 and 2.55 +/- 0.48 mm, and lateral joint space widths were 2.45 +/- 0.55 and 2.44 +/- 0.52 mm, for right and left ankle, respectively. Coefficients of variation for repeat measurements by the same observer were 1.13% and 4.5%, and by different observers 7.30% and 7.27%, for medial and lateral joint space widths, respectively. Men had wider joint space widths than women when accounting for height. Joint space width of the ankle correlated with the joint space width of the hip and with height and weight, but not with age.
Topics: Aged; Ankle Joint; Female; Humans; Male; Osteoarthritis, Knee; Radiography; Reproducibility of Results
PubMed: 19381746
DOI: 10.1007/s11999-009-0832-8 -
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 -
Osteoarthritis and Cartilage Feb 2005Variations among joints in the initiation and progression of degeneration may be explained, in part, by metabolic, biochemical and biomechanical differences. Compared to... (Review)
Review
Variations among joints in the initiation and progression of degeneration may be explained, in part, by metabolic, biochemical and biomechanical differences. Compared to the cartilage in the knee joint, ankle cartilage has a higher content of proteoglycans and water, as well as an increased rate of proteoglycan turnover and synthesis, all of which are responsible for its increased stiffness and reduced permeability. Chondrocytes within ankle cartilage have a decreased response to catabolic factors such as interleukin-1 and fibronectin fragments, compared to the chondrocytes of knee cartilage. Moreover, in response to damage, ankle chondrocytes synthesize proteoglycans at a higher rate than that found in knee cartilage chondrocytes, which suggests a greater capacity for repair. In addition to the cartilages of the two joints, the underlying bones also respond differently to degenerative changes. Taken together, these metabolic, biochemical and biomechanical differences may provide protection to the ankle.
Topics: Adult; Ankle Joint; Biomechanical Phenomena; Cartilage, Articular; Chondrocytes; Extracellular Matrix Proteins; Humans; Joints; Knee Joint; Osteoarthritis; Proteoglycans
PubMed: 15694570
DOI: 10.1016/j.joca.2004.11.006