-
PloS One 2021Kinetic data obtained during gait can be used to clarify the biomechanical pathogenesis of osteoarthritis of the lower extremity. This study aimed to investigate the...
BACKGROUND
Kinetic data obtained during gait can be used to clarify the biomechanical pathogenesis of osteoarthritis of the lower extremity. This study aimed to investigate the difference in ankle varus moment between the varus angulation and medial translation types of medial ankle osteoarthritis, and to identify the radiographic measurements associated with ankle varus moment.
METHODS
Twenty-four consecutive patients [mean age 65.8 (SD) 8.0 years; 9 men and 15 women] with medial ankle osteoarthritis were included. Fourteen and 10 patients had the varus angulation (tibiotalar tilt angle≥3 degrees) and medial translation (tibiotalar tilt angle<3 degrees) types, respectively. All patients underwent three-dimensional gait analysis, and the maximum varus moment of the ankle was recorded. Radiographic measurement included tibial plafond inclination, tibiotalar tilt angle, talar dome inclination, and lateral talo-first metatarsal angle. Comparison between the two types of medial ankle osteoarthritis and the relationship between the maximum ankle varus moment and radiographic measurements were analyzed.
RESULTS
The mean tibial plafond inclination, tibiotalar tilt angle, talar dome inclination, lateral talo-first metatarsal angle, and maximum ankle varus moment were 6.4 degrees (SD 3.3 degrees), 5.0 degrees (SD 4.6 degrees), 11.4 degrees (SD 5.2 degrees), -6.5 degrees (SD 11.7 degrees), and 0.185 (SD 0.082) Nm/kg, respectively. The varus angulation type showed a greater maximum ankle varus moment than the medial translation type (p = .005). The lateral talo-first metatarsal angle was significantly associated with the maximum ankle varus moment (p = .041) in the multiple regression analysis.
CONCLUSION
The varus angulation type of medial ankle osteoarthritis is considered to be more imbalanced biomechanically than the medial displacement type. The lateral talo-first metatarsal angle, being significantly associated with the ankle varus moment, should be considered for correction during motion-preserving surgeries for medial ankle osteoarthritis to restore the biomechanical balance of the ankle.
Topics: Aged; Ankle; Ankle Joint; Biomechanical Phenomena; Female; Gait; Humans; Male; Middle Aged; Osteoarthritis; Prospective Studies; Tomography Scanners, X-Ray Computed
PubMed: 34166436
DOI: 10.1371/journal.pone.0253570 -
Annals of the Royal College of Surgeons... Apr 2017Introduction Pseudoaneurysm formation following ankle arthroscopy is a rare but potentially catastrophic complication. The placement of anterior ankle portals carries...
A cadaveric study showing the anatomical variations in the branches of the dorsalis pedis artery at the level of the ankle joint and its clinical implication in ankle arthroscopy.
Introduction Pseudoaneurysm formation following ankle arthroscopy is a rare but potentially catastrophic complication. The placement of anterior ankle portals carries inherent risk to the superficial and deep peroneal nerves, as well as to the dorsalis pedis artery. Anatomical variations in the dorsalis pedis and the presence of branches at the joint line may increase the risk of vascular injury and pseudoaneurysm formation during arthroscopy. There is limited anatomical evidence available regarding the branches of the dorsalis pedis artery, which occur at the point at which they cross the ankle joint. Objectives The objective of the study was to describe the frequency and direction of branches of the dorsalis pedis crossing the ankle joint. Materials and Methods Nineteen cadaveric feet were carefully dissected to explore the course of the dorsalis pedis artery, noting in particular the branching pattern at the joint line. Results Eleven of the nineteen feet had a branch of the dorsalis pedis artery that crossed the level of the ankle joint. Out of these, six were lateral, four medial and one bilateral. Eight of the eleven specimens had one branch at, or just before, the level of the joint. Two specimens had two branches and one had three branches crossing the ankle, which were all in the same direction, crossing laterally to the main trunk of the dorsalis pedis. Conclusions Our study demonstrated high rates of branching of the dorsalis pedis artery at the level of the ankle joint. The role of these branches in pseudoaneurysm formation during anterior hindfoot surgery remains unclear.
Topics: Anatomic Variation; Aneurysm, False; Ankle Joint; Arthroscopy; Cadaver; Foot; Humans; Postoperative Complications; Tibial Arteries
PubMed: 27659360
DOI: 10.1308/rcsann.2016.0288 -
Foot & Ankle International Jul 2021The goal of the study was to compare radiographic and functional outcomes between conventional closed syndesmotic reduction and screw fixation with open reduction,...
BACKGROUND
The goal of the study was to compare radiographic and functional outcomes between conventional closed syndesmotic reduction and screw fixation with open reduction, direct repair of the anterior inferior tibiofibular ligament (AiTFL) and screw fixation. We hypothesized that open reduction with restoration of the AiTFL would provide an improved reduction with better radiographic and functional outcomes.
METHODS
Fifty consecutive patients with OTA 44-C ankle fractures were enrolled. Treatment was nonrandomized and based on surgeon preference. Patients were treated with either open reduction, suture-anchor AiTFL repair, and screw fixation (ART group), or conventional closed reduction of the syndesmosis followed by screw fixation (CR group). The primary outcome measure was anteroposterior (AP) displacement of the fibula on CT scan at 3 months postoperatively. Secondary outcome measures included the Maryland Foot Score, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score, and the Foot and Ankle Outcome Score (FAOS).
RESULTS
Mean AP difference between injured and noninjured ankles was decreased in the ART group compared with the CR group (0.7 ± 0.3 mm vs 1.5 ± 0.3 mm, = .008). No differences were observed between groups in overall scores for secondary outcome measures. The ART group displayed a significant difference in Maryland Foot Shoe subscore at 12 months (ART = 9.5 vs CR = 8.3, = .03) and FAOS Quality of Life subscore at 12 months (64.1 compared to 38.3, = .04).
CONCLUSION
Open anatomic syndesmotic repair resulted in improved radiographic outcomes compared with closed reduction. Cosmesis was worse at 6 weeks compared to the CR group; however, quality of life and shoewear were improved in the ART group at 1 year postoperatively.
LEVEL OF EVIDENCE
Level II, prospective comparative study.
Topics: Ankle Fractures; Ankle Joint; Fracture Fixation, Internal; Humans; Prospective Studies; Quality of Life; Treatment Outcome
PubMed: 33559488
DOI: 10.1177/1071100721990008 -
Foot & Ankle International Mar 2020The purpose of this article was to report the feasibility and effectiveness of 3-stage Masquelet technique and 1-stage operation for different stages of foot and ankle...
BACKGROUND
The purpose of this article was to report the feasibility and effectiveness of 3-stage Masquelet technique and 1-stage operation for different stages of foot and ankle tuberculosis (TB).
METHODS
Ten consecutive patients with foot and ankle TB were retrospectively analyzed between January 2014 and December 2018. Five patients were treated with the 3-stage Masquelet technique, including thorough debridement with vacuum sealing drainage, implantation of antibiotic cement spacer, and subsequent reconstruction. Five patients were treated with a 1-stage reconstruction. The American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) pain scores were recorded at the last follow-up. The follow-up was 30.3 ± 17.8 months.
RESULTS
No reactivation of TB was observed in any patients. For the 3-stage operation group, 1 patient developed a distal tibia fracture. The duration of anti-TB therapy was 12.0 ± 0.8 months. The AOFAS score increased from 39.5 ± 9.9 preoperatively to 75.3 ± 7.0 postoperatively ( < .05). The VAS pain score decreased from 6.3 ± 1.9 to 1.5 ± 1.3 ( < .05). For the 1-stage operation, 1 patient had wound necrosis. The duration of anti-TB therapy was 13.8 ± 1.1 months. The AOFAS score increased from 51.8 ± 15.0 to 81.8 ± 6.3 ( < .05). The VAS pain score decreased from 5.4 ± 1.1 to 1.0 ± 0.7 ( < .05).
CONCLUSION
Three-stage operation was effective for foot and ankle TB with stage IV, sinus tracts or other infections, and 1-stage reconstruction was effective for early-stage TBs.
LEVEL OF EVIDENCE
Level IV, case series.
Topics: Adult; Aged; Aged, 80 and over; Ankle Joint; Feasibility Studies; Female; Foot Joints; Humans; Male; Middle Aged; Pain Measurement; Plastic Surgery Procedures; Surveys and Questionnaires; Tuberculosis, Osteoarticular
PubMed: 31801382
DOI: 10.1177/1071100719890854 -
Sensors (Basel, Switzerland) Jul 2023Ankle joint moment is an important indicator for evaluating the stability of the human body during the sit-to-stand (STS) movement, so a method to analyze ankle joint...
Ankle joint moment is an important indicator for evaluating the stability of the human body during the sit-to-stand (STS) movement, so a method to analyze ankle joint moment is needed. In this study, a wearable sensor system that could derive surface-electromyography (sEMG) signals and kinematic signals on the lower limbs was developed for non-invasive estimation of ankle muscle dynamics during the STS movement. Based on the established ankle joint musculoskeletal information and sEMG signals, ankle joint moment during the STS movement was calculated. In addition, based on a four-segment STS dynamic model and kinematic signals, ankle joint moment during the STS movement was calculated using the inverse dynamics method. Ten healthy young people participated in the experiment, who wore a self-developed wearable sensor system and performed STS movements as an experimental task. The results showed that there was a high correlation (all R ≥ 0.88) between the results of the two methods for estimating ankle joint moment. The research in this paper can provide theoretical support for the development of an intelligent bionic joint actuator and clinical rehabilitation evaluation.
Topics: Humans; Adolescent; Ankle Joint; Ankle; Knee Joint; Movement; Lower Extremity; Muscle, Skeletal; Wearable Electronic Devices; Biomechanical Phenomena
PubMed: 37514901
DOI: 10.3390/s23146607 -
Medicine Jul 2017Muscle fascicles lengthen in response to chronic passive stretch through in-series sarcomere addition in order to maintain an optimum sarcomere length. In turn, the...
Relationship of medial gastrocnemius relative fascicle excursion and ankle joint power and work performance during gait in typically developing children: A cross-sectional study.
Muscle fascicles lengthen in response to chronic passive stretch through in-series sarcomere addition in order to maintain an optimum sarcomere length. In turn, the muscles' force generating capacity, maximum excursion, and contraction velocity is enhanced. Thus, longer fascicles suggest a greater capacity to develop joint power and work. However, static fascicle length measurements may not be taking sarcomere length differences into account. Thus, we considered relative fascicle excursions through passive ankle dorsiflexion may better correlate with the capacity to generate joint power and work than fascicle length. Therefore, the aim of the present study was to determine if medial gastrocnemius relative fascicle excursions correlate with ankle joint power and work generation during gait in typically developing children. A sample of typically developing children (n = 10) were recruited for this study and data analysis was carried out on 20 legs. Medial gastrocnemius relative fascicle excursion from resting joint angle to maximum dorsiflexion was estimated from trigonometric relations of medial gastrocnemius pennation angle and thickness obtained from B-mode real-time ultrasonography. Furthermore, a three-dimensional motion capture system was used to obtain ankle joint work and power during the stance phase of gait. Significant correlations were found between relative fascicle excursion and peak power absorption (-) r(14) = -0.61, P = .012 accounting for 31% variability, positive work r(18) = 0.56, P = .021 accounting for 31% variability, and late stance positive work r(15) = 0.51, P = .037 accounting for 26% variability. The large unexplained variance may be attributed to mechanics of neighboring structures (e.g., soleus or Achilles tendon mechanics) and proximal joint kinetics which may also contribute to ankle joint power and work performance, and were not taken into account. Further studies are encouraged to provide greater insight on the relationship between relative fascicle excursions and joint function.
Topics: Ankle Joint; Biomechanical Phenomena; Child; Cross-Sectional Studies; Female; Gait; Humans; Leg; Male; Movement; Muscle, Skeletal; Organ Size; Ultrasonography
PubMed: 28723790
DOI: 10.1097/MD.0000000000007572 -
Foot and Ankle Surgery : Official... Dec 2022This study aimed to evaluate the use of distraction arthroplasty for ankle osteoarthritis, with respect to patient reported outcome measures (PROMs), complications,... (Review)
Review
BACKGROUND
This study aimed to evaluate the use of distraction arthroplasty for ankle osteoarthritis, with respect to patient reported outcome measures (PROMs), complications, range of motion and radiographic outcomes.
METHODS
A computer-based search was performed in PubMed, Cinahl, Embase, Scopus and ISI Web of Science. Two reviewers independently performed title/abstract and full-text screening. Quality assessment was performed using The Methodological Index for Non-Randomised Studies (MINORS) and Joanna Briggs Institute criteria.
RESULTS
Whilst all studies evaluating PROMs reported significant (P < 0.05) improvement, these were either below or only slightly above the minimally clinically important difference. The rate of conversion to arthrodesis or total ankle arthroplasty was high, with failure rates of up to 52% reported.
CONCLUSION
Due to the inconsistent improvements in PROMs, which are likely overestimated due to substantial bias, and the high failure rate, this review suggests that distraction arthroplasty is not currently an effective treatment option for ankle arthritis.
LEVEL OF EVIDENCE
Level IV, systematic review of level I to IV studies.
Topics: Humans; Ankle Joint; Osteoarthritis; Arthroplasty, Replacement, Ankle; Arthrodesis; Range of Motion, Articular; Treatment Outcome
PubMed: 35853785
DOI: 10.1016/j.fas.2022.07.005 -
Scientific Reports Aug 2022Knowledge about the orientation of a representative ankle joint axis is limited to studies of tarsal morphology and of quasistatic movements. The aim of our study was...
Knowledge about the orientation of a representative ankle joint axis is limited to studies of tarsal morphology and of quasistatic movements. The aim of our study was therefore to determine the development of the axis orientation during walking. Intracortical bone pins were used to monitor the kinematics of the talus and tibia of five healthy volunteers. The finite helical axis was determined for moving windows of 10% stance phase and its orientation reported if the rotation about the axis was more than 2°. A representative axis for ankle dorsi- and plantarflexion was also estimated based on tarsal morphology. As reported by literature, the morphology-based axis was inclined more medially upwards for dorsiflexion than for plantarflexion. However, when a mean of the finite helical axis orientations was calculated for each walking trial for dorsiflexion (stance phase 15-25%) and for plantarflexion (stance phase 85-95%), the inclination was less medially upwards in dorsiflexion than in plantarflexion in four out of five participants. Thus, it appears that the inclination of a representative ankle joint axis for dynamic loading situations cannot be estimated from either morphology or quasi-static experiments. Future studies assessing muscle activity, ligament behaviour and articulating surfaces may help to identify the determining factors for the orientation of a representative ankle joint axis.
Topics: Ankle; Ankle Joint; Biomechanical Phenomena; Humans; Talus; Walking
PubMed: 35974121
DOI: 10.1038/s41598-022-17984-5 -
Operative Orthopadie Und Traumatologie Apr 2024Osteochondral lesions of the talus (OLT) with a fragment on the talar dome that fail conservative treatment and need surgical treatment can benefit from in situ... (Review)
Review
OBJECTIVE
Osteochondral lesions of the talus (OLT) with a fragment on the talar dome that fail conservative treatment and need surgical treatment can benefit from in situ fixation of the OLT. Advantages of fixation include the preservation of native cartilage, a high quality subchondral bone repair, and the restoration of the joint congruency by immediate fragment stabilization. To improve the chance of successful stabilization, adequate lesion exposure is critical, especially in difficult to reach lesions located on the posteromedial talar dome. In this study we describe the open Lift, Drill, Fill, Fix (LDFF) technique for medial osteochondral lesions of the talus with an osteochondral fragment. As such, the lesion can be seen as an intra-articular non-union that requires debridement, bone-grafting, stabilization, and compression. The LDFF procedure combines these needs with access through a medial distal tibial osteotomy.
INDICATIONS
Symptomatic osteochondral lesion of the talus with a fragment (≥ 10 mm diameter and ≥ 3 mm thick as per computed tomography [CT] scan) situated on the medial talar dome which failed 3-6 months conservative treatment.
CONTRAINDICATIONS
Systemic disease, including active bacterial arthritis, hemophilic or other diffuse arthropathies, rheumatoid arthritis of the ankle joint, and malignancies. Neuropathic disease. End-stage ankle osteoarthritis or Kellgren and Lawrence score 3 or 4 [3]. Ipsilateral medial malleolus fracture less than 6 months prior. Relative contra-indication: posttraumatic stiffness with range of motion (ROM) < 5°. Children with open physis: do not perform an osteotomy as stabilization of the osteotomy may lead to early closure of the physis, potentially resulting in symptomatic varus angulation of the distal tibia. In these cases only arthrotomy can be considered.
SURGICAL TECHNIQUE
The OLT is approached through a medial distal tibial osteotomy, for which the screws are predrilled and the osteotomy is made with an oscillating saw and finished with a chisel in order to avoid thermal damage. Hereafter, the joint is inspected and the osteochondral fragment is identified. The cartilage is partially incised at the borders and the fragment is then lifted as a hood of a motor vehicle (lift). The subchondral bone is debrided and thereafter drilled to allow thorough bone marrow stimulation (drill) and filled with autologous cancellous bone graft from either the iliac crest or the distal tibia (fill). The fragment is then fixated (fix) in anatomical position, preferably with two screws to allow additional rotational stability. Finally, the osteotomy is reduced and fixated with two screws.
POSTOPERATIVE MANAGEMENT
Casting includes 5 weeks of short leg cast non-weightbearing and 5 weeks of short leg cast with weightbearing as tolerated. At 10-week follow-up, a CT scan is made to confirm fragment and osteotomy healing, and patients start personalized rehabilitation under the guidance of a physical therapist.
Topics: Child; Humans; Talus; Treatment Outcome; Tibia; Autografts; Osteotomy; Ankle Joint; Intra-Articular Fractures
PubMed: 37828133
DOI: 10.1007/s00064-023-00833-7 -
Journal of Ultrasound Dec 2022The aim of this study is to verify the usefulness of ultrasound-assisted mapping of the vascular and neurological structures in the anterior compartment of the ankle... (Review)
Review
PURPOSE
The aim of this study is to verify the usefulness of ultrasound-assisted mapping of the vascular and neurological structures in the anterior compartment of the ankle just before an anterior arthroscopic procedure to reduce these kinds of complications.
METHODS
Various complications can be present in anterior arthroscopy of the ankle. The structures most prone to iatrogenic damage are vessels and nerves. They are macroscopically visible and palpable in a little more than 50% of cases, but arterial ramifications are not visible because they are located deeper.
RESULTS
The authors have investigated how to reduce potential iatrogenic damage to the complex and variable neuro-vascular network of the anterior aspect of the ankle. They have completed the classic routine marking of the bony and tendinous structures with an ultrasound mapping of the neurovascular structures.
CONCLUSIONS
The authors concluded that ultrasound-assisted mapping is a non-invasive, fast, and safe procedure that can help to reduce potential iatrogenic damage when performing anterior arthroscopic surgery.
Topics: Humans; Arthroscopy; Ankle; Ankle Joint; Ultrasonography; Iatrogenic Disease
PubMed: 35294770
DOI: 10.1007/s40477-021-00611-w