-
PloS One 2021Joint flexibility is theoretically considered to associate with muscle-tendon unit (MTU) architecture. However, this potential association has not been experimentally... (Clinical Trial)
Clinical Trial
Joint flexibility is theoretically considered to associate with muscle-tendon unit (MTU) architecture. However, this potential association has not been experimentally demonstrated in humans in vivo. We aimed to identify whether and how MTU architectural parameters are associated with joint range of motion (RoM), with a special emphasis on slack angle. The fascicle length, pennation angle, tendinous tissue length, MTU length, and shear modulus of the medial gastrocnemius (MG) were assessed during passive ankle dorsiflexion using ultrasound shear wave elastography in 17 healthy males. During passive dorsiflexion task, the ankle joint was rotated from 40° plantar flexion to the maximal dorsiflexion joint angle at which each subject started experiencing pain. From the ankle joint angle-shear modulus relationship, the angle at which shear modulus began to rise (slack angle) was calculated. Two dorsiflexion RoMs were determined as follows; 1) range from the anatomical position to maximal angle (RoManat-max) and 2) range from the MG slack angle to maximal angle (RoMslack-max). The MTU architectural parameters were analyzed at the anatomical position and MG slack angle. The resolved fascicle length (fascicle length × cosine of pennation angle) and ratios of resolved fascicle or tendinous tissue length to MTU length measured at the MG slack angle significantly correlated with the RoMslack-max (r = 0.491, 0.506, and -0.506, respectively). Any MTU architectural parameters assessed at the anatomical position did not correlate with RoManat-max or RoMslack-max. These results indicate that MTUs with long fascicle and short tendinous tissue are advantageous for joint flexibility. However, this association cannot be found unless MTU architecture and joint RoM are assessed with consideration of muscle slack.
Topics: Adult; Ankle Joint; Elasticity Imaging Techniques; Humans; Male; Muscle, Skeletal; Range of Motion, Articular; Tendons
PubMed: 33667276
DOI: 10.1371/journal.pone.0248125 -
Orthopaedics & Traumatology, Surgery &... Feb 2020Anterior cruciate ligament (ACL) injuries are common in adults and cause knee instability, pain, and an increased risk of osteoarthritis. Previous studies demonstrated...
BACKGROUND
Anterior cruciate ligament (ACL) injuries are common in adults and cause knee instability, pain, and an increased risk of osteoarthritis. Previous studies demonstrated changed gait patterns in adult patients with ACL deficiency. In paediatric patients, ACL injuries were once thought to be rare but are being increasingly diagnosed due to greater involvement of children in contact sports and to the introduction of more effective diagnostic tools such as magnetic resonance imaging (MRI). However, little is known about gait adaptation in children with ACL deficiency. The objective of this study was to look for compensatory foot and ankle behaviours during gait in paediatric patients with symptomatic ACL deficiency.
HYPOTHESIS
Compensation for ACL deficiency during gait occurs at the foot and ankle in children, because compensation at the hip and pelvis would require greater energy expenditure.
MATERIAL AND METHODS
We included 47 patients, 33 males and 14 females, ranging in age from 9 to 17 years (mean, 14.1 years). The patients had a history of unilateral ACL injury documented by MRI and initially treated by immobilisation and physical therapy. They were allowed to walk with full weight-bearing on the affected limb and were not taking medications at the time of the study. All patients had pain, knee instability, or functional limitation. The physical examination showed joint laxity indicating surgical ACL reconstruction. None had neurological conditions, congenital musculoskeletal abnormalities, or a history of knee surgery. Gait analysis (GA) was performed using a Vicon 460 system. Kinematic data for the ankle and foot were compared to those in a control group of 37 healthy children. Ankle angular positions were calculated for each group at the following stance time points: initial contact (0% of gait cycle [GC]), mid-stance (25% GC), terminal stance (60% GC), and swing (83% GC). Foot progression data were recorded at mid-stance (25% GC) and swing (70% GC). Student's t test was applied to compare the results to reference values obtained at our laboratory and to data from the control group.
RESULTS
Compared to the reference values, the ankle was in plantar flexion at initial contact in 41 patients, and ankle dorsiflexion during the stance phase was diminished in 39 patients. The external foot progression angle was increased in 23 patients during the stance phase and 38 patients during the swing phase. Compared to the control group (mean age, 9.1 years), the patients had plantar flexion of the ankle at initial contact (3.43°±3.5° vs. 0.74°±3.6°, p<0.05) and decreased dorsiflexion during the stance phase (3.43°±3.5° vs. 0.74°±3.6°, p<0.05). No significant differences were found for any of the other parameters.
DISCUSSION
Children with ACL deficiency developed compensatory foot and ankle behaviours during gait that improved knee stability. Understanding these compensations may guide treatment optimisation.
LEVEL OF EVIDENCE
III, retrospective comparative study.
Topics: Adolescent; Adult; Ankle; Ankle Joint; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Biomechanical Phenomena; Child; Female; Gait; Humans; Knee Joint; Male; Range of Motion, Articular; Retrospective Studies
PubMed: 31526709
DOI: 10.1016/j.otsr.2019.07.009 -
Statistical shape modeling of the talocrural joint using a hybrid multi-articulation joint approach.Scientific Reports Apr 2021Historically, conventional radiographs have been the primary tool to morphometrically evaluate the talocrural joint, which is comprised of the distal tibia, distal...
Historically, conventional radiographs have been the primary tool to morphometrically evaluate the talocrural joint, which is comprised of the distal tibia, distal fibula, and proximal talus. More recently, high-resolution volumetric imaging, including computed tomography (CT), has enabled the generation of three-dimensional (3D) reconstructions of the talocrural joint. Weightbearing cone-beam CT (WBCT) technology provides additional benefit to assess 3D spatial relationships and joint congruency while the patient is load bearing. In this study we applied statistical shape modeling, a computational morphometrics technique, to objectively quantify anatomical variation, joint level coverage, joint space distance, and congruency at the talocrural joint. Shape models were developed from segmented WBCT images and included the distal tibia, distal fibula, and full talus. Key anatomical variation across subjects included the fibular notch on the tibia, talar trochlea sagittal plane rate of curvature, tibial plafond curvature with medial malleolus prominence, and changes in the fibular shaft diameter. The shape analysis also revealed a highly congruent talocrural joint with minimal inter-individual morphometric differences at the articular regions. These data are helpful to improve understanding of ankle joint pathologies and to guide refinement of operative treatments.
Topics: Adult; Ankle Joint; Biomechanical Phenomena; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Models, Anatomic; Models, Statistical; Models, Theoretical; Motion; Principal Component Analysis; Reproducibility of Results; Tibia; Tomography, X-Ray Computed; Weight-Bearing
PubMed: 33795729
DOI: 10.1038/s41598-021-86567-7 -
Journal of Orthopaedic Surgery and... Mar 2023Paralytic foot-drop is a disabling deformity that results from nerve or direct muscle injuries. Palliative surgeries such as tendon transfer and ankle arthrodesis are...
BACKGROUND
Paralytic foot-drop is a disabling deformity that results from nerve or direct muscle injuries. Palliative surgeries such as tendon transfer and ankle arthrodesis are reserved for permanent deformity, with the arthroscopic technique had not been widely studied before. This study aims to evaluate the clinical outcome and quality of life after arthroscopic ankle fusion of paralytic foot-drop deformity.
MATERIALS AND METHODS
The patients who were retrospectively enrolled in this study underwent arthroscopic ankle fusion for paralytic foot-drop deformity between March 2017 and December 2021. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Cumberland Ankle Instability Tool (CAIT) were the measures used for clinical assessment. To judge the union, serial plain radiographs of the ankle were obtained. The preoperative and postoperative means were analyzed utilizing a two-tailed paired t-test, with a p value of less than 0.05 indicating statistical significance.
RESULTS
This study included 21 consecutive patients with a mean follow-up of 35.09 ± 4.5 months and a mean age of 41.5 ± 6.1 years. Highly significant improvements were observed between the preoperative and final follow-up means of the AOFAS score (from 57.6 ± 4.6 to 88.3 ± 2.7) and CAIT (from 12.1 ± 2.2 to 28.9 ± 1.01; p ˂ 0.00001 for both). All patients attained radiographic union and resumed their previous occupations without reporting serious adverse effects.
CONCLUSIONS
Arthroscopic ankle fusion is an effective, minimally invasive palliative surgery for patients suffering from permanent paralytic foot-drop deformity. This technique was shown to provide good functional and radiologic outcomes without significant complications.
LEVEL OF EVIDENCE
Retrospective cohort; level of evidence (IV).
Topics: Humans; Adult; Middle Aged; Retrospective Studies; Treatment Outcome; Ankle; Peroneal Neuropathies; Quality of Life; Joint Instability; Foot Deformities; Arthrodesis; Ankle Joint; Arthroscopy
PubMed: 36918915
DOI: 10.1186/s13018-023-03691-y -
The Journal of Bone and Joint Surgery.... Nov 2011We evaluated the incidence of heterotopic ossification following total ankle replacement to determine whether the degree of ossification was associated with the clinical...
We evaluated the incidence of heterotopic ossification following total ankle replacement to determine whether the degree of ossification was associated with the clinical outcome. We evaluated 90 ankles in 81 consecutive patients who underwent total ankle replacement, and heterotopic ossification was assessed according to proportional involvement of the ankle joint. Correlation analysis was used to investigate the association between heterotopic ossification and outcome. No significant association was found between the formation of heterotopic ossification and the clinical outcome. The degree of heterotopic ossification in the posterior ankle joint was not significantly correlated with posterior ankle pain (p = 0.929), the American Orthopaedic Foot and Ankle Society score (p = 0.454) or range of movement (p = 0.283). This study indicates that caution should be observed in attributing symptoms and functional limitation to the presence of heterotopic ossification in the posterior ankle joint when considering excision of heterotopic bone after total ankle replacement.
Topics: Adult; Aged; Aged, 80 and over; Ankle Joint; Arthroplasty, Replacement, Ankle; Female; Humans; Male; Middle Aged; Ossification, Heterotopic; Radiography; Retrospective Studies; Severity of Illness Index; Treatment Outcome
PubMed: 22058303
DOI: 10.1302/0301-620X.93B11.27641 -
Journal of Athletic Training Nov 2023Individuals with mechanical ankle instability (MAI) have obvious lateral ligament laxity and excessive ankle joint motion beyond the physiological range. Arthrometry has...
CONTEXT
Individuals with mechanical ankle instability (MAI) have obvious lateral ligament laxity and excessive ankle joint motion beyond the physiological range. Arthrometry has been introduced to quantitatively measure the laxity of the ankle joint. However, the diagnostic accuracy of arthrometry in MAI is still debatable.
OBJECTIVES
To (1) evaluate the difference in laxity between bilateral ankles in patients with and those without MAI and (2) calculate the diagnostic accuracy of ankle arthrometry using bilateral comparisons.
DESIGN
Cross-sectional study.
SETTING
Research laboratory.
PATIENTS OR OTHER PARTICIPANTS
A total of 38 individuals with unilateral MAI (age = 31.24 ± 7.90 years, height = 168.93 ± 7.69 cm, mass = 65.72 ± 10.47 kg) and 38 individuals without MAI (control group; age = 32.10 ± 7.10 years, height = 166.59 ± 7.89 cm, mass = 62.93 ± 10.72 kg).
MAIN OUTCOME MEASURE(S)
Bilateral ankle laxity in each participant was quantitatively measured by performing the arthrometric anterior drawer test. Continuous data of loading force and joint displacement were recorded. Data from both ankles were compared for the ankle joint displacement at a loading force of 75 N (D75) and load-displacement ratio from 10 to 40 N (LDR 10-40).
RESULTS
The D75 between injured and uninjured ankles in patients with MAI was different (t37 = 9.78, P < .001). The mean LDR 10-40 in injured ankles was higher than that in uninjured ankles (t37 = 9.80, P < .001). In the control group, no differences were found between the left and right ankles. The MAI group had larger bilateral differences than the control group (t37 range = 7.33-8.18; P < .001). When LDR 10-40 was used to diagnose MAI, the arthrometer showed sensitivity and specificity of 0.900 and 0.933, respectively, with a cutoff value of 0.0351 mm/N.
CONCLUSIONS
An ankle arthrometer can be used to quantitatively measure the difference in bilateral ankle laxity in patients with MAI. Arthrometer-measured LDR 10-40 can be used to diagnose MAI with high diagnostic accuracy.
Topics: Humans; Young Adult; Adult; Ankle; Cross-Sectional Studies; Ankle Joint; Physical Examination; Joint Instability
PubMed: 36827611
DOI: 10.4085/1062-6050-0494.22 -
Knee Surgery, Sports Traumatology,... May 2010Anterior ankle arthroscopy can basically be performed by two different methods; the dorsiflexion- or distraction method. The objective of this study was to determine the...
Anterior ankle arthroscopy can basically be performed by two different methods; the dorsiflexion- or distraction method. The objective of this study was to determine the size of the anterior working area for both the dorsiflexion and distraction method. The anterior working area is anteriorly limited by the overlying anatomy which includes the neurovascular bundle. We hypothesize that in ankle dorsiflexion the anterior neurovascular bundle will move away anteriorly from the ankle joint, whereas in ankle distraction the anterior neurovascular bundle is pulled tight towards the joint, thereby decreasing the safe anterior working area. Six fresh frozen ankle specimens, amputated above the knee, were scanned with computed tomography. Prior to scanning the anterior tibial artery was injected with contrast fluid and subsequently each ankle was scanned both in ankle dorsiflexion and in distraction. A special device was developed to reproducibly obtain ankle dorsiflexion and distraction in the computed tomography scanner. The distance between the anterior border of the inferior tibial articular facet and the posterior border of the anterior tibial artery was measured. The median distance from the anterior border of the inferior tibial articular facet to the posterior border of the anterior tibial artery in ankle dorsiflexion and distraction was 0.9 cm (range 0.7-1.5) and 0.7 cm (range 0.5-0.8), respectively. The distance in ankle dorsiflexion significantly exceeded the distance in ankle distraction (P = 0.03). The current study shows a significantly increased distance between the anterior distal tibia and the overlying anterior neurovascular bundle with the ankle in a slightly dorsiflexed position as compared to the distracted ankle position. We thereby conclude that the distracted ankle position puts the neurovascular structures more at risk for iatrogenic damage when performing anterior ankle arthroscopy.
Topics: Ankle Joint; Arthroscopy; Humans; Patient Positioning; Range of Motion, Articular
PubMed: 20217392
DOI: 10.1007/s00167-010-1089-1 -
BMC Musculoskeletal Disorders Apr 2021Distraction osteogenesis using the Ilizarov external circular fixator has been applied in lower limb reconstructive surgery widely. The increasing ankle osteoarthritis...
BACKGROUND
Distraction osteogenesis using the Ilizarov external circular fixator has been applied in lower limb reconstructive surgery widely. The increasing ankle osteoarthritis (OA) progression and severity are often associated with the period of external fixator and the greater relative instability of the ankle joint, but few studies have quantified risk factors directly during this technique.
METHODS
The study was conducted on 236 patients who underwent bone transport surgery for tibias using the Ilizarov external circular fixator from 2008 to 2018. The cumulative incidence of ankle OA diagnoses in patients after the Ilizarov technique treatment was calculated and stratified by risk factors from preoperative and postoperative management. After the data were significant through the Mann-Whitney U test analyzed, odds ratios were calculated using logistic regression to describe factors associated with the OA diagnosis including gender, age, BMI, location of bone defect, diabetes, hypertension, osteoporosis, the history of metal allergy and glucocorticoid intake, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-HF scale scores, defect size (DS), the type of bone transport, the bone union time, external fixator time (EFT), and external fixator index (EFI).
RESULTS
There were 199 males and 37 females with a mean age of 47 years (range 28-59 years). Out of 236 patients, 49 had an additional treatment for ankle OA after the Ilizarov technique treatment of bone defects (average follow-up time 2.1 years, range 1.6-4.2 years). The incidence of postoperative ankle OA was 20.8 %, with 19 patients classified as K&L grade 3 and seven patients as grade 4. The top five risk factors included double-level bone transport (OR3.79, P = 0.005), EFI > 50days/cm (OR3.17, P = 0.015), age > 45years (OR2.29, P = 0.032), osteoporosis (OR1.58, P < 0.001), BMI > 25 (OR1.34, P < 0.001). Male, BMI > 25, diabetes, osteoporosis, and AOFAS ankle-HF scale scores are the independent risk factors.
CONCLUSIONS
Ilizarov external circular fixator is a safe and effective method of treatment for critical bone defects. The double level bone transport, EFI > 50days/cm, age > 45years, osteoporosis, BMI > 25 are the top five relevant risk factors of ankle OA. The probability of developing ankle OA among patients having three or more risk factors is 50-70 %.
Topics: Adult; Ankle; Ankle Joint; External Fixators; Female; Humans; Ilizarov Technique; Male; Middle Aged; Osteoarthritis; Risk Factors; Treatment Outcome
PubMed: 33836698
DOI: 10.1186/s12891-021-04214-8 -
The Bone & Joint Journal May 2016Few reports compare the contribution of the talonavicular articulation to overall range of movement in the sagittal plane after total ankle arthroplasty (TAA) and... (Comparative Study)
Comparative Study
AIMS
Few reports compare the contribution of the talonavicular articulation to overall range of movement in the sagittal plane after total ankle arthroplasty (TAA) and tibiotalar arthrodesis. The purpose of this study was to assess changes in ROM and functional outcomes following tibiotalar arthrodesis and TAA.
PATIENTS AND METHODS
Patients who underwent isolated tibiotalar arthrodesis or TAA with greater than two-year follow-up were enrolled in the study. Overall arc of movement and talonavicular movement in the sagittal plane were assessed with weight-bearing lateral maximum dorsiflexion and plantarflexion radiographs. All patients completed Short Form-12 version 2.0 questionnaires, visual analogue scale for pain (VAS) scores, and the Foot and Ankle Ability Measure (FAAM).
RESULTS
In all, 41 patients who underwent TAA and 27 patients who underwent tibiotalar arthrodesis were enrolled in the study. The mean total arc of movement was 34.2° (17.0° to 59.1°) with an average contribution from the talonavicular joint of 10.5° (1.2° to 28.8°) in the TAA cohort. The average total arc of movement was 24.3° (6.9° to 44.3°) with a mean contribution from the talonavicular joint of 22.8° (5.6° to 41.4°) in the arthrodesis cohort. A statistically significant difference was detected for both total sagittal plane movement (p = 0.00025), and for talonavicular motion (p < 0.0001). A statistically significant lower VAS score (p = 0.0096) and higher FAAM (p = 0.01, p = 0.019, respectively) was also detected in the TAA group.
CONCLUSION
TAA preserves more anatomical movement, has better pain relief and better patient-perceived post-operative function compared with patients undergoing fusion. The relative increase of talonavicular movement in fusion patients may play a role in the outcomes compared with TAA and may predispose these patients to degenerative changes over time.
TAKE HOME MESSAGE
TAA preserves more anatomic sagittal plane motion and provides greater pain relief and better patient-perceived outcomes compared with ankle arthrodesis. Cite this article: Bone Joint J 2016;98-B:634-40.
Topics: Adult; Aged; Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Female; Follow-Up Studies; Humans; Male; Middle Aged; Patient Outcome Assessment; Range of Motion, Articular; Retrospective Studies; Tarsal Joints; Visual Analog Scale; Young Adult
PubMed: 27143734
DOI: 10.1302/0301-620X.98B5.36887 -
Knee Surgery, Sports Traumatology,... Aug 2023The purpose of the present study was to assess the overall clinical success rate of non-operative management for osteochondral lesions of the talus (OLT). (Review)
Review
PURPOSE
The purpose of the present study was to assess the overall clinical success rate of non-operative management for osteochondral lesions of the talus (OLT).
METHODS
A literature search was conducted in the PubMed (MEDLINE), COCHRANE and EMBASE (Ovid) databases. Clinical success rates per separate study were calculated at the latest moment of follow-up and were defined as successful when a good or excellent clinical result at follow-up was reported in a qualitative manner or when a post-operative American Orthopaedic Foot and Ankle Society (AOFAS) score at or above 80 was reached. When clinical outcomes were based on other clinical scoring systems, outcomes reported as good or excellent were considered as clinical success. Studies methodologically eligible for a simplified pooling method were combined to calculate an overall pooled clinical success rate. Radiological changes over the course of conservative treatment were assessed either considering local OLT changes and/or overall ankle joint changes.
RESULTS
Thirty articles were included, including an overall of 868 patients. The median follow-up of the included studies was 37 months (range: 3-288 months). A simplified pooling method was possible among 16 studies and yielded an overall pooled clinical success rate of 45% (95% CI 40-50%). As assessed with plain radiographs, progression of ankle joint osteoarthritis was observed in of 9% (95% CI 6-14%) of the patients. As assessed through a Computed Tomography (CT) scan, focal OLT deterioration was observed in 11% (95% CI 7-18%) of the patients. As assessed with a Magnetic Resonance Imaging (MRI) scan, focal OLT deterioration was observed in 12% (95% CI 6-24%) of the patients. An unchanged lesion was detected on plain radiographs in 53% (48/91; CI 43-63%), 76% (99/131; 95% CI 68-82%) on a CT scan and on MRI in 84% (42/50; 95% CI 71-92%) of the patients.
CONCLUSION
The current literature on non-operative management of OLTs is scarce and heterogeneous on indication and type of treatment. Promising clinical results are presented but need to interpreted with caution due to the heterogeneity in indication, duration and type of treatment. Further studies need to focus on specific types on conservative management, indications and its results.
LEVEL OF EVIDENCE
Systematic review, Level IV.
Topics: Humans; Treatment Outcome; Talus; Radiography; Magnetic Resonance Imaging; Transplantation, Autologous; Ankle Joint; Retrospective Studies
PubMed: 37062042
DOI: 10.1007/s00167-023-07408-w