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Saiga, Kenta, Suguru Yokoo, Hideki Ohashi, Masahiro Horita, Takayuki Furumatsu e Toshifumi Ozaki. "Effect of Lateral Gutter Osteophyte Resection on Correction of Varus Deformity in Arthroscopic Ankle Arthrodesis". Foot & Ankle International 41, n.º 6 (5 de março de 2020): 683–88. http://dx.doi.org/10.1177/1071100720910388.
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Background: Recently, arthroscopic ankle arthrodesis has been performed for moderate-to-severe varus-deformed ankle osteoarthritis. However, the effect of osteophyte resection in the lateral gutter in arthroscopic ankle arthrodesis has not been clarified. We hypothesized that a varus-deviated ankle with lateral gutter osteophytes can be corrected by osteophyte resection. Methods: Thirty-nine ankles of 38 patients were included. The mean age of patients was 70.0 (45-83) years. The patients were divided into the following groups: group with an osteophyte in the lateral gutter (osteophyte) and group with no osteophytes (nonosteophyte). Preoperative and postoperative tibiotalar angle, tibial plafond angle, and tibiotalar angle under valgus stress, as well as the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale, were recorded. Twelve ankles underwent lateral gutter osteophyte resection, whereas the other 27 ankles did not require osteophyte resection. Results: Preoperative tibiotalar angle was higher in the osteophyte group than in the nonosteophyte group (21.8 vs 11.2 degrees, P = .01). The tibiotalar angle in the preoperative valgus stress imaging was higher in the osteophyte group (12.9 vs 5.7, P < .01). However, the postoperative tibiotalar angle was similar between the 2 groups (7.1 vs 5.4, P = .183). JSSF ankle/hindfoot scale improved in both groups. Conclusion: Lateral gutter osteophyte resection enabled correction of the varus malalignment in arthroscopic ankle arthrodesis. Level of Evidence: Level III, retrospective comparative series.
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Lim, Jung-Won, Hong-Geun Jung e Jemin Im. "Comparison of the Outcome of the 3-Component Salto Total Ankle Arthroplasty for Ankle with Preoperative Varus, Valgus and Neutral Alignment in End-Stage Osteoarthritis". Foot & Ankle Orthopaedics 7, n.º 1 (janeiro de 2022): 2473011421S0031. http://dx.doi.org/10.1177/2473011421s00319.
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Category: Ankle; Ankle Arthritis Introduction/Purpose: As the popularity of total ankle arthroplasty (TAA) increases, indication of TAA also expands. Recently, the ankles more than 20° of varus or valgus deformity in the coronal plane are treated with TAA. However, severe varus or valgus deformity should be corrected in the coronal plane to avoid residual mal-alignment that leads to instability, insert wear, and clinical failure. In this study, we compare the clinical and radiologic outcome of the Salto mobile bearing 3-component total ankle prosthesis for ankles with preoperative varus, neutral, and valgus alignment. Methods: TAA was performed in 101 consecutive ankles (99 patients) by a single surgeon using 3-component Salto total ankle implant from June 2014 to October 2019. A prospectively collected database was used to identify all patients who underwent primary TAA with a minimum 1-year follow-up. We classified the enrolled ankles as neutral, varus, or valgus groups. More than 10° of tibial anterior surface angle, talta tilt angle, tibial axis-talar dome angle, talar dome-ground surface angle (TD-GSA), or tibio- calcaneal angle was defined as varus or valgus groups. All patients were followed up at postoperative three months, six months, at one year and yearly thereafter. Clinical outcome scoring was done pre-operatively and post-operatively. American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot functional score, pain VAS, satisfaction score and clinical range of motion (ROM) were collected along with weight-bearing radiographs of the ankle. Post-operative coronal alignment of the component were evaluated with radiographs. Results: The average follow-up was 21.6 months (range, 12-71). Preoperatively, there were 63 ankles (62%) with varus deformity, 27 ankles (27%) with neutral alignment, and 11 ankles with valgus deformity. In preoperative varus group, 13 ankles (21%) were performed with concomitant lateral sliding calcaneal osteotomy, and 23 ankles (37%) with deltoid release. No additional procedures for the correction of ankle and hindfoot deformity were performed in preoperative neutral and valgus groups. VAS pain score and AOFAS score were significantly improved in all groups (p < 0.05). Overall satisfaction rate was 88%. After TAA, there were no significant radiologic alignment among the groups (3.9° (range, 0.7°~9.7°) in varus group, 4.1° (range, 0.4°~6.8°) in neutral group, and 2.2° (range, -0.4°~4.4°) in valgus group; p > 0.05). Conclusion: There was no significant difference in outcome among the varus, neutral, and valgus groups postoperatively in the TAA series using single Salto 3-componenet implant. Postoperative neutral alignment was achieved in all ankles. For favorable long-term outcomes, coronal alignment should be corrected with proper additional procedures in TAA.
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Kvarda, Peter, Lena Siegler, Tamar Horn-Lang, Roman Susdorf, Roxa Ruiz e Beat Hintermann. "3D Analysis of the Hindfoot Following Total Ankle Replacement for Varus Ankle Osteoarthritis". Foot & Ankle Orthopaedics 7, n.º 4 (outubro de 2022): 2473011421S0073. http://dx.doi.org/10.1177/2473011421s00736.
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Category: Hindfoot; Ankle; Ankle Arthritis Introduction/Purpose: In advanced stages of varus ankle osteoarthritis (OA) progressive destabilization of the peritalar structures is common. Total ankle replacement (TAR) is a viable treatment option although data, particularly on changes in the subtalar joint position following TAR, is scarce. Therefore, we evaluated the subtalar joint using semi-automated measurements based on weightbearing cone-beam CT scans (WBCT) before and after TAR. Methods: 14 patients (15 ankles) who received TAR without additional bony procedures for varus ankle OA were analyzed using semi-automated measurements of the hindfoot based on pre-and postoperative WBCT. Pain on visual analog scale (VAS) and American Orthopedic Foot and Ankle Society Hindfoot Score (AOFAS) were assessed. Results: Five of 6 measurements showed a significant improvement including sagittal and axial talocalcaneal angle, talar horizontal inclination angle, hindfoot angle, and talar tilt. Conclusion: Besides ankle joint realignment, TAR for varus ankle OA without additional bony procedures achieved significant correction of the subtalar joint based on WBCT.
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Lee, Seung Yeol, Soon-Sun Kwon, Moon Seok Park, Ki Hyuk Sung, Seungbum Koo, Sung Jin Kim, Shin Sangyeop, Hyun Choi, Sangho Chun e Kyoung min Lee. "Is there a Relationship between Bone Morphology and Injured Ligament on Imaging Studies and Laxity on Ankle Stress Radiographs?" Foot & Ankle Orthopaedics 2, n.º 3 (1 de setembro de 2017): 2473011417S0002. http://dx.doi.org/10.1177/2473011417s000259.
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Category: Ankle, Sports Introduction/Purpose: We hypothesized that the bony configuration of the ankle could also be associated with ankle stress radiographs, in addition to ligament injury of the ankle. Therefore, this study aimed to investigate the relationship between bone morphology and injured ligament on imaging studies and laxity on ankle stress radiographs in patients with lateral ankle instability. Methods: In total, 115 patients who had undergone ankle MRI, ankle radiography, and stress radiography were included. Distal tibial articular surface angle, bimalleolar tilt, medial and lateral malleolar relative length, medial malleolar slip angle, anterior inclination of the tibia, and fibular position were measured on ankle radiographs. Tibiotalar tilt angle and anterior translation of the talus were measured on ankle stress radiographs. Degree of ligament injury was evaluated on ankle MRIs. Multiple regression analysis was performed using the following independent variables: age, sex, and factors significantly associated with ankle stress view on univariate linear regression analysis. Results: Age (p = 0.041), sex (p = 0.014), degree of anterior talofibular ligament injury (p < 0.001), and bimalleolar tilt (p = 0.016) were correlated with tibiotalar tilt angle (Table). Younger patients demonstrated a larger tibiotalar tilt angle than older patients, and the angle decreased by 0.07° per year of age. Tibiotalar tilt angle in female patients was 2.2° larger than that in male patients. Fibular position and degree of posterior talofibular ligament injury were factors significantly related to anterior translation of the talus. Conclusion: Differences in patient characteristics might predispose ankle stress radiograph results. Comparison of both ankles on stress radiographs is superior to applying fixed numerical values to the injured side, in order to reduce the influence of patient factors.
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Gougoulias, Nikolaos E., Filon G. Agathangelidis e Stephen W. Parsons. "Arthroscopic Ankle Arthrodesis". Foot & Ankle International 28, n.º 6 (junho de 2007): 695–706. http://dx.doi.org/10.3113/fai.2007.0695.
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Background: Arthroscopic arthrodesis has been used mainly for in situ fusion of arthritic ankles without deformity. This paper presents the application of arthroscopic arthrodesis of ankles with marked deformity. Methods: The results of 78 consecutive cases of arthroscopic ankle arthrodeses, performed in 74 patients, were retrospectively evaluated. Forty-eight ankles had minor deformity (group A), whereas 30 ankles had a varus or valgus deformity of more than 15 degrees (maximum 45 degrees) (group B). The average hospital stay was 3.8 and 3.4 days in groups A and B, respectively ( p = 0.74). Postoperative treatment included ankle immobilization for 3 months. Progressive weightbearing was initiated at 2 weeks. Mean followup was 21.1 months. Results: Fusion occurred in 47 of 48 (97.9%) ankles in group A at an average time of 13.1 ± 5.8 weeks and in 29 of 30 (96.7%) ankles at 11.6 ± 2.4 weeks in group B ( p = 0.19). Unplanned operative procedures were required in 11 ankles (14.1%). One superficial wound infection occurred. Symptomatic arthritis from the adjacent joints developed in six ankles (7.7%). Postoperative ankle alignment in the frontal plane averaged 0.7 and 0.4 degrees of valgus ( p = 0.41), whereas the sagittal plane angle averaged 106 ± 4 degrees and 104.5 ± 7 degrees in groups A and B, respectively ( p = 0.22). The outcome was graded as very good in 79.2% (38 feet) in group A and 80% (24 feet) in group B, fair in 18.8% (9 feet) in group A and 16.7% (5 feet) in group B and poor in one ankle in each group ( p = 0.68). Conclusions: The arthroscopic technique offered high fusion rates and low morbidity. Deformity correction was achieved with good results.
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Piga, Camilo, Federico Giuseppe Usuelli, Camilla Maccario e Claudia A. Di Silvestri. "Total Ankle Arthroplasty in Valgus Deformity". Foot & Ankle Orthopaedics 5, n.º 4 (1 de outubro de 2020): 2473011420S0038. http://dx.doi.org/10.1177/2473011420s00386.
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Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement use has increased among patients with end-stage ankle arthritis. Substantial coronal plane deformity is usual in that context. In addition, recent literature shows a trend towards the extension of the indication of total ankle arthroplasty in increasingly severe coronal deformities, showing good results when correct alignment is achieved. Nevertheless, the results of lateral transfibular total ankle replacement (LTTAR) in valgus has not been extensively studied. We aimed to evaluate if the outcomes of LTTAR in ankles with valgus deformity are similar with those with no major deformity. Methods: This retrospective cohort study included 228 LTTAR. Patients were classified into 2 groups according to the preoperative coronal plane tibiotalar angle (TTS): neutral (less than 10° of coronal deformity, 209 patients) and valgus (above 10° of valgus, 19 patients). Clinical evaluation was performed using American Orthopaedic Foot & Ankle Society Score (AOFAS), Visual analogue scale (VAS), short Form 12 Quality of Life (SF-12) regarding its physical (PCS) and mental (MCS) items. Radiographic evaluation considered anteroposterior and lateral ankle radiographs. Surgical times were recorded in all the cases. There were no differences between groups regarding mean age, mean body mass index and follow up. The minimum follow up was 24 months. Results: The average AOFAS, VAS and SF-12 scores improved significantly postoperatively (p-value<0.01), without differences between groups. At final radiographic follow up, the valgus alignment group did not show significant differences with the neutral alignment group regarding TTS, lateral distal tibial angle or anterior distal tibial angle (p-value>0.05). Surgical time was longer in the valgus group (152.84 +- 40.86 mins vs 129.51 +- 52.13), but the difference was not statistically significant. Conclusion: Lateral transfibular total ankle replacement in ankles with valgus deformity achieved and maintained correction of coronal alignment in a short term follow up, as obtained in neutral alignment ankles. Clinical outcomes improved significantly regardless preoperative valgus deformity. Additional surgical time may be needed in order to obtain a good deformity correction in a valgus ankle. This short term analysis shows that LTTAR in a valgus ankle seems to be a safe option in experienced surgeons hands.
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Witchalls, Jeremy, Gordon Waddington, Peter Blanch e Roger Adams. "Ankle Instability Effects on Joint Position Sense When Stepping Across the Active Movement Extent Discrimination Apparatus". Journal of Athletic Training 47, n.º 6 (1 de novembro de 2012): 627–34. http://dx.doi.org/10.4085/1062-6050-47.6.12.
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Context Individuals with and without functional ankle instability have been tested for deficits in lower limb proprioception with varied results. Objective To determine whether a new protocol for testing participants' joint position sense during stepping is reliable and can detect differences between participants with unstable and stable ankles. Design Descriptive laboratory study. Setting University clinical laboratory. Patients or Other Participants Sample of convenience involving 21 young adult university students and staff. Ankle stability was categorized by score on the Cumberland Ankle Instability Tool; 13 had functional ankle instability, 8 had healthy ankles. Intervention(s) Test-retest of ankle joint position sense when stepping onto and across the Active Movement Extent Discrimination Apparatus twice, separated by an interim test, standing still on the apparatus and moving only 1 ankle into inversion. Main Outcome Measure(s) Difference in scores between groups with stable and unstable ankles and between test repeats. Results Participants with unstable ankles were worse at differentiating between inversion angles underfoot in both testing protocols. On repeated testing with the stepping protocol, performance of the group with unstable ankles was improved (Cohen d = 1.06, P = .006), whereas scores in the stable ankle group did not change in the second test (Cohen d = 0.04, P = .899). Despite this improvement, the unstable group remained worse at differentiating inversion angles on the stepping retest (Cohen d = 0.99, P = .020). Conclusions The deficits on proprioceptive tests shown by individuals with functional ankle instability improved with repeated exposure to the test situation. The learning effect may be the result of systematic exposure to ankle-angle variation that led to movement-specific learning or increased confidence when stepping across the apparatus.
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Perotti, L. R., O. Abousamra, M. del Pilar Duque Orozco, K. J. Rogers, J. P. Sees e F. Miller. "Foot and ankle deformities in children with Down syndrome". Journal of Children's Orthopaedics 12, n.º 3 (junho de 2018): 218–26. http://dx.doi.org/10.1302/1863-2548.12.170197.
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Purpose Foot and ankle deformities are common orthopaedic disorders in children with Down syndrome. However, radiographic measurements of the foot and ankle have not been previously reported. The aim of this study is to describe the foot and ankle deformity in children with Down syndrome. Methods Children who had foot and ankle radiographs in the standing weight-bearing position were selected. Three groups of patients were identified. The relationship of radiographic measurements with age, body mass index and pain is discussed. In all, 41 children (79 feet) had foot radiographs and 60 children (117 ankles) had ankle radiographs, with 15 children overlapping between Groups I and II. Results In Group I, hallux valgus deformity was seen before ten years of age and hallux valgus angle increased afterwards. Metatarsus adductus angle showed a significant increase (p = 0.006) with obesity and was higher in patients who had foot pain (p = 0.05). In Group II, none of the ankle measurements showed a significant difference with age or body mass index percentiles. Tibiotalar angle (TTA) and medial distal tibial angle (MDTA) were higher in patients who had ankle pain. In Group III, correlation analysis was performed between the different measurements with the strongest correlations found between TTA and MDTA. Conclusion In children with Down syndrome, radiographic evaluation of the foot and ankle reveals higher prevalence of deformities than clinical examination. However, foot and ankle radiographs are needed only for symptomatic children with pain and gait changes. Level of Evidence Level IV - Prognostic Study
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Jung, Hong-Geun, Hwa-Jun Kang, Mao-Yuan Sun e Juan Agustin Coruna. "Magnetic Resonance Imaging Findings of the Lateral Ankle Instability after Anatomical Ligament Reconstruction Using a Semitendinosus Allograft Tendon with Biotenodesis Screws". Foot & Ankle Orthopaedics 3, n.º 3 (1 de julho de 2018): 2473011418S0027. http://dx.doi.org/10.1177/2473011418s00274.
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Category: Ankle Introduction/Purpose: Surgery for lateral ankle instability is indicated in patients who have repetitive inversion ankle sprains despite conservative therapy. There have been many reconstruction procedures performed for the lateral ankle ligament instability. However, there has not been any report of postoperative MRI findings of lateral ankle instability after ligament reconstruction using a free tendon and biotenodesis screws. Therefore, this study was to analysis the MRI finding of the postoperative lateral ankle reconstruction using semitendinosus allograft tendon and the correlation with clinical outcome. Methods: The study is based on 34 ankles (33 patients) of chronic lateral ankle instability which underwent anatomical lateral ankle ligament reconstruction using a semitendinosus allograft tendon with bio-tendosis screws from July 2009 to April 2017 with at least 6 month postoperative ankle MRI checked (mean follow-up 16.5mo). In addition, clinical outcomes were evaluated using VAS pain score, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Karlsson-Peterson score, ankle stress views and subjective patient satisfaction. Results: Six ankles (17.6%) showed normal signal intensity(SI) while 28 ankles (82.4%) showed high SI on reconstructed allograft tendon area. High signal was shown around the biotenodesis screws. Eleven ankles showed synovitis (39.3%), partial tear of reconstructed allograft tendon 6 ankles (21.4), 5 osteolysis of the bone tunnel (17.9%), 4 screw pulled-outs (14.3%), 2 tendon complete tear (7.1%), 2 mucoid changes (7.1%), 2 cystic changes (7.1%). One ankle showed post-op MRI findings of reconstructed tendon infection (3.6%). The mean VAS pain score significantly decreased from 5.7 to 1.5. The mean AOFAS score improved from 72.0 to 89.1, while the Karlsson-Peterson score significantly improved from 54.7 to 85.7 (p<0.01) with 88% patient satisfaction. Stress talar tilt angle improved from 15.7o to 5.4 o. Conclusion: In the current study, various postoperative MRI findings were found after lateral ankle ligament reconstruction using allograft tendon and biotenodesis screws including high signal change of tendon, synovitis, tunnel osteolysis, screw pull-outs, tendon tears and etc. However, these MRI findings did not present as clinical complications and did not correlate with poor clinical outcomes.
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Krähenbühl, Nicola, Lukas Zwicky, Manja Deforth, Beat Hintermann e Markus Knupp. "Subtalar Joint Alignment in Ankle Osteoarthritis". Foot & Ankle Orthopaedics 2, n.º 3 (1 de setembro de 2017): 2473011417S0002. http://dx.doi.org/10.1177/2473011417s000249.
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Category: Ankle Arthritis, Hindfoot Introduction/Purpose: The influence of the subtalar joint on the evolution of ankle joint osteoarthritis is still a matter of debate. Although subtalar joint compensation of deformities above the ankle joint was proposed until mid-stage of ankle osteoarthritis, the evidence of this assumption is weak. In this study, we investigated the subtalar joint alignment in different stages of ankle joint osteoarthritis using weightbearing CT scans. The influence of the tibio-talar tilt and presence of subtalar joint osteoarthritis was additionally assessed. We hypothesized, that the subtalar joint compensates for deformities above the ankle joint in early- to mid-stage of ankle osteoarthritis. We also hypothesized, that subtalar joint compensation increases with a pronounced tibio-talar tilt and decreases with the presence of subtalar joint osteoarthritis. Methods: We included patients with ankle joint osteoarthritis treated in our institution from January 2013 to April 2016. A control group of 28 patients was additionally assessed. Varus and valgus ankles were subdivided according to the modified Takakura classification, the tilt of the talus in the ankle mortise and stage of subtalar joint osteoarthritis. The type of ankle osteoarthritis was diagnosed on a plain weightbearing anterior to posterior radiograph of the ankle. The medial distal tibial angle (TAS) and the angle between the tibial shaft and the surface of the talar dome (TTS) were measured. The subtalar joint alignment was assessed using weightbearing CT scans. Two angles were assessed: The subtalar inclination angle (SIA) was measured to investigate the subtalar compensation. For assessment of the morphology of the talus, the inftal-subtal angle (ISA) was determined. Results: This analysis showed significant differences of the subtalar inclination between varus feet and the controls (SIA, P=.001). Regarding the talar morphology, significant differences were found between varus/ valgus feet and the controls (ISA, P=.001 and .036, respectively). No significant differences of the subtalar joint inclination and talar morphology could be identified comparing different stages of ankle joint osteoarthritis inside the varus or valgus group. No relationship between the tilt of the talus in the ankle joint mortise and the subtalar joint inclination or talar morphology was identified. Neither presence nor absence of subtalar joint osteoarthritis influenced the subtalar joint inclination and talar morphology. Conclusion: Varus ankles compensate in the subtalar joint for deformities above the ankle joint. Compensation had no influence on the stage of ankle osteoarthritis, extent of the tibio-talar tilt and stage of subtalar joint osteoarthritis. Consequently, the progression of ankle joint osteoarthritis is more depended on the supramalleolar alignment and integrity of the periarticular structures (i.e. ligaments and tendons) than on the osseous alignment of the subtalar joint.
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Kang, Ho Won, Gil Young Park, Dong-Oh Lee, Yoon A. Ro e Dong Yeon Lee. "Coronal Plane Calcaneal-Talar Orientation in Varus Ankle Osteoarthritis". Foot & Ankle Orthopaedics 7, n.º 4 (outubro de 2022): 2473011421S0071. http://dx.doi.org/10.1177/2473011421s00716.
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Category: Hindfoot; Ankle; Ankle Arthritis Introduction/Purpose: We do not yet fully understand how the subtalar joint position is related to the varus osteoarthritic ankle joint. The purposes of this study were 1) to investigate the coronal orientation of the calcaneus relative to the talus according to the ankle osteoarthritis stage, talar tilt (TT), and 2) to determine if there is a TT threshold at which apparent subtalar compensation begins to fade. Methods: We retrospectively reviewed 132 ankles that underwent WBCT for varus ankle osteoarthritis. The TT, subtalar inclination angle (SIA), and calcaneal inclination angle (CIA) were measured using WBCT. Ankles were divided into 5 groups according to Takakura stage and 2 groups according to the apparent compensation status of the subtalar joint and compared the index of the inclination of the subtalar joint relative to the ankle (SIA) or the index of the inclination of the calcaneus relative to the ankle (CIA). Additionally, we explored the relationship between SIA or CIA and the TT. Results: Apparent subtalar compensation (SIA and CIA) was significantly lower in Takakura stages 3b and 4. The SIA and CIA significantly differed according to the apparent compensation status (p<.001 and p=.030, respectively). The CIA of the noncompensated group varied widely, while the SIA was relatively constant. Furthermore, TT was greater than 9.5, which indicated a high probability of a noncompensated heel. (sensitivity, 92.6%; specificity, 89.7%). Conclusion: The position of the calcaneus has a appears compensatory with coronal plane orientation in varus ankle osteoarthritis when the TT is < than 9.5°.
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Rolfe, Bruce, William Nordt, Julian G. Sallis e Michael Distefano. "Assessing Fibular Length Using Bimalleolar Angular Measurements". Foot & Ankle 10, n.º 2 (outubro de 1989): 104–9. http://dx.doi.org/10.1177/107110078901000210.
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Shortening of the fibula after fracture is common and often difficult to appreciate. Loss of lateral malleolar anatomy causes significant biomechanical changes in the ankle and correlates with poor clinical results. We studied angular measurements of distal fibular length to serve as a guide for assessing fibular reduction after ankle fracture. Mortise view X-rays of 50 normal ankles from 25 healthy volunteers were obtained. The average talocrural angle measured 78.5°. However, individual variation was high with values ranging from 75 to 86°. Comparing contralateral ankles demonstrated an average difference of 1.3° (range 0 to 4°). A new, simpler bimalleolar angle was devised which compares the long axis of the fibula with a line drawn between the tips of the malleoli. The average bimalleolar angle measured 77.8° (range 72 to 86°). The contralateral difference averaged 1.2° (range 0 to 3°). This angle was simpler to use and more reproducible. Angular measurements were tolerant of usual radiographic techniques. Internal or external rotation of the ankle up to 5° caused an insignificant change in the angular measurements. One degree change in the talocrural or bimalleolar angle was found to correspond with a 1 mm change in fibular length for the average ankle, calculated radiographically and confirmed in a cadaver study. Abnormal fibular shortening is detected with an angular difference between injured and contralateral sides of 3.0° using the talocrural angle or 2.5° using the bimalleolar angle (95% confidence limits). Thus, a 2.5 to 3.0° contralateral difference should serve as a minimum value required to direct a change in therapy. We conclude that comparing angular measurements of the injured with the contralateral ankle provides the most accurate guide for assessing fibular length.
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Yoshikawa, Masahiro, Tomoyuki Nakasa, Mikiya Sawa, Yusuke Tsuyuguchi, Munekazu Kanemitsu, Yuki Ota e Nobuo Adachi. "Evaluation of the ankle position sense in the fatigue foot". Foot & Ankle Orthopaedics 3, n.º 3 (1 de julho de 2018): 2473011418S0052. http://dx.doi.org/10.1177/2473011418s00524.
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Category: Ankle Introduction/Purpose: Previous studies have described the damage of sensori-motor control in ankle sprain as being a possible cause of functional instability. The methods to demonstrate the functional instability, have included the postural balance test, peroneal muscle reaction time to sudden ankle inversion, peroneal nerve conduction velocity, and joint position sense of the ankle. On the other hand, isokinetic fatigue of ankle plantar flexion and dorsiflexion exhibits the correlation with postural instability. We hypothesize muscle fatigue around ankle joint causes abnormality of joint position sense, especially inversion at ankle joint, and it will be one of the causes of the ankle sprain. The aim of this study was to evaluate the inversion angle replication errors of before fatigue and after fatigue. Methods: 11 subjects were included in this study. The subjects were placed in a sitting position with the knee flexed at 70°. Each subject placed the foot on a goniometer footplate with the ankle at 20° planter flexion. Subjects were blindfolded to eliminate visual input and to facilitate concentration during testing. The foot was passively rotated internally at random to one of six positions (5°to 30°), always starting from 0°. The footplate was rotated manually to the index angle in approximately 1 s, and held in position for 5 s. Then the ankle was returned to the 0° position. After that, the subjects moved their ankle to match the previous test angle actively. The difference between the index angle and replication angle was measured. Ankles were enforced planter and dorsiflexion according to previous reports, and replication error was measured before and after fatigue. Results: The side-to-side difference of the replication errors was 1.9±1.7° in the before-fatigue group and 2.6±1.8° in the after-fatigue group. There was a statistically significant difference between both the groups (p<0.05). In each inversion angle, there were significant differences of the side-to-side differences of the replication errors at 5°and 10°inversion angles (0.8±0.9°, 1.5±1.4° in the before-fatigue group and 2.2±1.7°, 2.6±1.5° in the after-fatigue group respectively). Conclusion: This study revealed the deficit of joint position sense in ankle inversion induced by fatigue. Fatigue may be one of the risk factor of ankle sprain through the deficit of joint position sense in inversion angle during sports activity.
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Zhou, Yunfeng, e Bin Song. "Arthroscopic anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament for chronic ankle instability". Foot & Ankle Orthopaedics 3, n.º 3 (1 de julho de 2018): 2473011418S0054. http://dx.doi.org/10.1177/2473011418s00540.
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Category: Arthroscopy Introduction/Purpose: To evaluate the clinical results of an anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament under arthroscopy in treatment of chronic ankle instability. Methods From June 2013 to August 2016, 27 patients (28 ankles) with chronic ankle instability were treated with the anatomical reconstruction of anterior talofibular ligaments and calcaneofibular ligaments. All patients were evaluated preoperatively and at the last follow up using the visual analog scale(VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score. The talar tilt angle and anterior translation were assessed radiographically in pre- and postoperative ankle stress views. Methods: From June 2013 to August 2016, 27 patients (28 ankles) with chronic ankle instability were treated with the anatomical reconstruction of anterior talofibular ligaments and calcaneofibular ligaments. All patients were evaluated preoperatively and at the last follow up using the visual analog scale(VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score. The talar tilt angle and anterior translation were assessed radiographically in pre- and postoperative ankle stress views. Results: The operations were lasted for 75.8 minutes(72~104 minutes). 28 cases were received a mean follow up of 14.8 months(range, 12~25 months. The mean VAS pain score decreased from 5.79 to 1.54(t=26.63, P<0.01), and the medial AOFAS score improved from 63.64 to 90.21(t=-16.57, P<0.01). Imageological examination were completed 16.8 months after the operation (range, 12~25 months). The mean talar tilt decreased from 15.6°to 6.01°(t=25.39, P<0.01),and anterior translation of the talar reduced from a mean of 10.82 to 4.03 mm(t=15.79, P<0.01). Conclusion: Arthroscopic anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament could improve the function and stability of ankle joints effectively, providing a valid option for treating chronic ankle instability.
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Peiffer, M. "APPLICATIONS OF WEIGHTBEARING CT IN JOINT INSTABILITY". Orthopaedic Proceedings 106-B, SUPP_2 (2 de janeiro de 2024): 70. http://dx.doi.org/10.1302/1358-992x.2024.2.070.
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Acute syndesmotic ankle injuries continue to impose a diagnostic dilemma and it remains unclear whether weighbearing or external rotation should be exerted rotation during the imaging process. Therefore, we aimed to implement both axial load (weightbearing) and external rotation in the assessment of a clinical cohort of patients with syndesmotic ankle injuries syndesmotic using weightbearing CT imaging. In this retrospective comparative cohort study, patients with an acute syndesmotic ankle injury were analyzed using a WBCT (N= 20; Mean age= 31,64 years; SD= 14,07. Inclusion criteria were an MRI confirmed syndesmotic ankle injury imaged by a bilateral WBCT of the ankle during weightbearing and combined weightbearing-external rotation. Exclusion criteria consisted of fracture associated syndesmotic ankle injuries. Three-dimensional (3D) models were generated from the CT slices. Tibiofibular displacement and Talar Rotation was quantified using automated3D measurements (Anterior TibioFibular Distance (ATFD), Alpha Angle, Posterior TibioFibular Distance (PTFD) and Talar Rotation (TR) Angle) in comparison to a cohort of non-injured ankles.ResultsThe difference in neutral-stressed Alpha° and ATFD showed a significant difference between patients with a syndesmotic ankle lesion and healthy ankles (P = 0.046 and P = 0.039, respectively) The difference in neutral-stressed PTFD and TR° did not show a significant difference between patients with a syndesmotic ankle lesion and healthy ankles (P = 0.492; P = 0.152, respectively).ConclusionApplication of combined weightbearing-external rotation reveals a dynamic anterior tibiofibular widening in patients with syndesmotic ankle injuries. This study provides the first insights based on 3D measurements to support the potential relevance of applying external rotation during WBCT imaging. However, to what extent certain displacement patterns are associated with syndesmotic instability and thus require operative treatment strategies has yet to be determined in future studies.
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Ebaugh, M. Pierce, Greg Grenier, Satbir Singh, Oussama Abousamra e Kevin Klingele. "Ankle Mortise Instability in Multiple Hereditary Exostoses". Foot & Ankle Orthopaedics 4, n.º 4 (1 de outubro de 2019): 2473011419S0016. http://dx.doi.org/10.1177/2473011419s00167.
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Category: Ankle, Ankle Arthritis, Pediatric Foot and Ankle Introduction/Purpose: Ankle valgus has been reported in 50% of patients with multiple hereditary exostoses (MHE) and, untreated, results in early arthrosis. Widening of the ankle mortise has also been reported; however, there has been a lack of data regarding its natural history and management. Alterations of mortise anatomy result in poor functional outcomes and accelerated arthrosis of the ankle. The aim of our study was to report the characteristics and outcomes of mortise widening in a group of patients with MHE. Methods: A total of 13 patients with MHE and mortise widening (16 ankles) were identified. Age, sex, BMI, laterality, origin of osteochondroma, pain, instability, clinical deformity, operative data, and complications were recorded. Mortise (M), Talocrural angle (TC), and Tibiotalar angle (TT) measurements were collected on preoperative and last follow up radiographs. The majority of patients underwent medial distal tibia hemiepiphysiodesis. Post-surgical AOFAS and SF36 scores were collected. Results: Preoperatively, no patient complained of instability, however, 9/16 ankles were painful and 14/16 were clinically in valgus. Patients underwent surgery at an age of 11.8 years (9.7-15). Radiographic and clinical follow up were 2.6 years (0.2-7.3) and 6 years (1.5-11.7), respectively. There were no significant differences between pre/postoperative M, TC, TT angles. Operative patients improved mean M (5.17 to 4.63 mm) and TT (8.71 to 4.54 degrees), neither angle reached normal values. TC (fibular length) was within normal limits (82.2 to 84.8). Questionnaires were obtained for 8/16 ankles, at a mean age of 19 years (13-25.1). The average AOFAS score was 66.7 out of 100. Patients scored 8.6/10 for alignment, 32/40 for pain, 25.6/50 for function. SF-36 scores were excellent. Conclusion: The improvement in M and TT was modest and their values remained outside the normal limits. TC angle was within normal limits but displayed an overall fibular shortening and thus, decreased lateral buttress with potential for talar shift. This was reflected in the mean functional and overall AOFAS score. However, our patients are functionally compensating as evidenced by SF36 scores. More studies are needed to optimize the management of MHE patients with ankle malalignment. Earlier valgus correction and possible addition of fibular lengthening to simultaneously address mortise widening may need to be considered to prevent early ankle arthritis.
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Yi, Zeng, Zhou Zongke, Shen Bin, Yang Jing, Kang Pengde, Zhou Xuan, Zou Ling e Pei Fuxing. "X-ray image characteristics and related measurements in the ankles of 118 adult patients with Kashin-Beck disease". Chinese Medical Journal 127, n.º 13 (5 de julho de 2014): 2479–83. http://dx.doi.org/10.3760/cma.j.issn.0366-6999.20131750.
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Background Kashin-Beck disease (KBD) is a chronic, degenerative osteoarthropathy that causes severe skeletal deformation. Although many researchers have proven that almost all KBD patients who showed an increaseing proximo-distal gradient had radiographic abnormalities of the ankle, few detailed description of radiographic changes in the ankles of patients with KBD has been reported, especially for variable measurements of ankle changes. The purpose of this study was to demonstrate the radiographic characteristics of the ankles of adult KBD patients. Methods One hundred and eighteen adult KBD patients from september to October 2010 in Rongtang county in China were examined with lateral radiographs of the right ankle. The morphological abnormalities in the talus, calcaneus, navicular bone, distal tibia, and joint space were analyzed, and the calcaneus length, height, length-height ratio, tuber angle, front angle, plantar angle, and distal tibia anteroposterior (AP) length were measured using Riepert's method. Results Eighty-one patients (68.6%) had abnormal ankle radiographs; 72 (88.9%) patients had talus changes, 69 (85.2%) patients had calcaneus changes, 28 (34.6%) patients had navicular bone changes, and 48 (59.2%) patients had distal tibia changes. For 118 KBD patients, the average calcaneus length was 7.4 cm, height was 4.3 cm, and the length-height ratio was 1.7. The calcaneus tuber angle was 28.2°, front angle was 38.0° and the plantar angle was 74.2°. The distal tibia anteroposterior length was 4.05 cm. Compared with 50 normal adults (control group), significant differences were found for the calcaneus length, the calcaneus length-height ratio, and the distal tibia AP length. Conclusions Patients with KBD have characteristic abnormalities on ankle radiographs; talus depression and deformity, calcaneus shortening deformity, and distal tibia deformity with AP length widening were the most typical changes.
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Chun, Dong-Il, Jahyung Kim, Sung Hun Won, Jaeho Cho, Jeongku Ha, Minkyu Kil e Young Yi. "Changes in Coronal Alignment of the Knee Joint after Supramalleolar Osteotomy". BioMed Research International 2021 (19 de fevereiro de 2021): 1–8. http://dx.doi.org/10.1155/2021/6664279.
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Background. Assessing knee joint orientation changes after SMO may help clinical advancement in managing patients with ipsilateral ankle and knee joint arthritis. However, knee joint changes after supramalleolar osteotomy (SMO) have not been reported. We investigated changes in coronal alignment of the knee joint after SMO. Methods. In this multicentre study, from January 2014 to December 2018, 47 ankles with varus osteoarthritis treated with SMO were retrospectively identified. Ankle joint changes were assessed using the tibiotalar angle, talar tilt angle, and lateral distal tibial angle (LDTA); knee joint changes using the medial proximal tibial angle (MPTA), medial and lateral joint space widths (mJSW and lJSW, respectively), and medial and lateral joint line convergence angles (JLCA); and lower limb alignment changes using mechanical axis deviation angle (MADA) and the hip-knee-ankle (HKA) angle measured on full-length anteroposterior radiographs of the lower extremity. Correlation analysis and binary logistic regression analysis were performed. Results. Postoperatively, LDTA ( p < 0.001 ) and tibiotalar angle ( p < 0.001 ) significantly changed, indicating meaningful improvement in the ankle joint varus deformity. Regarding the knee joint changes, JLCA significantly changed into valgus direction ( p = 0.044 ). As for lower limb alignment changes, MADA significantly decreased ( p < 0.001 ), whereas the HKA angle significantly increased ( p < 0.001 ). In univariate and multivariate logistic regression analyses, changes in the MADA ( p < 0.001 ) and the HKA angle ( p < 0.001 ) were significantly correlated with the correction angle. Conclusions. SMO remarkably improves ankle joint varus deformity, followed by significant lower limb alignment changes. Despite meaningful changes in JLCA, the relationship between the amount of osteotomy near the ankle joint and improvement in knee joint radiographic parameters was not significant. Radiographic parameters of the knee joint would less likely be changed following SMO.
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Lee, Si Wook. "Transfixing Screw Placement for Syndesmotic Injury". Foot & Ankle Orthopaedics 3, n.º 3 (1 de julho de 2018): 2473011418S0031. http://dx.doi.org/10.1177/2473011418s00313.
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Category: Trauma Introduction/Purpose: The strategy of transfixing screw fixation including screw number, size, material, the number of cortex involved, and penetrating angle is controversial. The purpose of this fresh frozen cadaveric study is to demonstrate the optimal degree of transfixing screw insertion after syndesmotic reduction in the Pronation External Rotation (PER) type ankle fractures, and to study reliable parameters to evaluate the syndesmotic reduction. Methods: Twenty paired fresh frozen anatomic specimens of the ankles were obtained. Before dissection, CT scans were taken preoperatively. Then, preparation was performed by cutting and dissection of anterior interior tibiofibular ligament (AITFL), interosseous ligament and membrane. Two types of screw placement were set. Ten screws were inserted into right ankle at an angle of 25 to 30 degrees from neutral position. The other 10 screws were inserted into the left ankle at a 0 degree angle from neutral position. Postoperative CT scan was performed after screw insertion. Anterior fibular distance(AFD), posterior fibular distance(PFD), anterior translation distance(AT), diastasis, anterior-posterior translation(APT) were measured in 2D axial section and volume of the syndesmotic space were measured in 3D reconstruction data of preoperative and postoperative CT scan. Results: The transfixing screw fixation induce the significant difference in syndesmotic space regardless of insertion angle. There was significant difference only in fibular diastasis between both ankle model. There was no statistically significant difference in AFD, PFD, AT, APT and 3D reconstructed volume according to transfixing screw insertion angle when each measured value was compared through left and right ratio and absolute volume value. Conclusion: In ankle syndesmotic injury, transfixing screw insertion should be considered for the ankle stability. But, regardless of the insertion angle, transfixing screw insertion would have a significant therapeutic effect on ankle syndesmotic injury. Fibular diastasis would be the reliable parameters to evaluate syndesmotic reduction.
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Fu, Amy S. N., e Christina W. Y. Hui-Chan. "Ankle Joint Proprioception and Postural Control in Basketball Players with Bilateral Ankle Sprains". American Journal of Sports Medicine 33, n.º 8 (agosto de 2005): 1174–82. http://dx.doi.org/10.1177/0363546504271976.
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Background Deficiencies in ankle proprioception and standing balance in basketball players with multiple ankle sprains have been reported in separate studies. However, the question of how ankle proprioceptive inputs and postural control in stance are related is still unclear. Hypothesis Ankle repositioning errors and the amount of postural sway in stance are increased in basketball players with multiple ankle sprains. Study Design Controlled laboratory study. Methods Twenty healthy male basketball players and 19 male basketball players who had suffered bilateral ankle sprains within the past 2 years were examined. Both groups were similar in age. Passive ankle joint repositioning errors at 5° of plantar flexion were used to test for ankle joint proprioception. The Sensory Organization Test was applied with dynamic posturography to assess postural sway angle under 6 sensory conditions. Results A significant increase in ankle repositioning errors was demonstrated in basketball players with bilateral ankle sprains (P < .05). The mean errors in the right and left ankles were increased from 1.0° (standard deviation, 0.4°) and 0.8° (standard deviation, 0.2°), respectively, in the healthy players to 1.4° (standard deviation, 0.7°) and 1.1° (standard deviation, 0.5°) in the injured group. A significant increase in the amount of postural sway in the injured subjects was also found in conditions 1, 2, and 5 of the Sensory Organization Test (P < .05). Furthermore, there were positive associations between averaged errors in repositioning both ankles and postural sway angles in conditions 1, 2, and 3 of the Sensory Organization Test (r = 0.39-0.54, P < .05). Conclusions Ankle repositioning errors and postural sway in stance increased in basketball players with multiple ankle sprains. A positive relationship was found between these 2 variables. Clinical Relevance Such findings highlight the need for the rehabilitation of patients with multiple ankle sprains to include proprioceptive and balance training.
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Ciufo, David J., Erin A. Baker e Paul T. Fortin. "Tibial Torsion May Predict Morphology of the Talus". Foot & Ankle Orthopaedics 5, n.º 4 (1 de outubro de 2020): 2473011420S0017. http://dx.doi.org/10.1177/2473011420s00171.
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Category: Ankle Arthritis; Ankle; Hindfoot Introduction/Purpose: The role of implant positioning in total ankle arthroplasty (TAA) has garnered increasing attention, particularly in defining coronal and sagittal plane alignment. With the ongoing developments in patient specific instrumentation, advanced imaging is becoming a more common tool in preoperative planning. Despite this, there is limited information available on axial rotation of the ankle or variations in anatomy of the talus and foot. We aim to evaluate the rotational profile of the distal tibia and its relationship to morphology of the talus, as well as assess tibiotalar tilt, in a cohort of end-stage arthritic ankles. Methods: Computed tomography (CT) scans and plain radiographs were reviewed in 59 patients with end-stage ankle arthritis. Patients with previous tibial or ankle trauma were excluded. Scans were obtained prior to total ankle arthroplasty surgery as part of standard preoperative planning protocol. Demographic data was recorded. Measurements were obtained at the posterior condyles of the tibial plateau and transmalleolar axis to calculate tibial torsion, as well as along the talar neck and body to evaluate talar angle. Tibiotalar tilt angle was measured on weightbearing mortise view radiographs. Linear regression was performed to evaluate statistical associations between tibial torsion and other measured parameters. Results: The mean tibial torsion was 29.5±9.2 degrees external (range 13.6-50.8 degrees), no internal torsion was found. Mean talar neck-body angle was 38.2±8.8 degrees medial (range 24.1-59.5 degrees). Tibiotalar angle ranged from 26.5 degrees varus to 23.5 degree valgus. There was a statistically significant relationship between increasing tibial torsion and decreasing talar neck-body angle (r=-0.49, p<0.001), demonstrating more angulation of the talar neck corresponding to the least tibial torsion as seen in Figure 1. No relationship was found between tibial rotation and tibiotalar angle when assessing varus/valgus tilt on a spectrum (p=.89) or when evaluating absolute angulation from neutral (p=.43). Our cohort had a mean age of 63.1±8.2 years, and 54% were male. Conclusion: Our cohort displayed wide variation in axial anatomy of the ankle. Our analysis identifies a statistically significant correlation between tibial torsion and morphology of the talus. This is a previously unreported association that could help understand development of foot and ankle deformity and pathology. While there was no clear correlation to degree of tibiotalar angulation, these axial deformities surely play a role in altered foot and ankle mechanics and the development of end-stage ankle arthrosis. In patients undergoing ankle arthroplasty, these are important parameters for the surgeon to consider in conjunction with other aspects of the hindfoot deformity.
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Piga, Camilo, Camilla Maccario, Riccardo D’Ambrosi, Fausto Romano e Federico Giuseppe Usuelli. "Total Ankle Arthroplasty With Valgus Deformity". Foot & Ankle International 42, n.º 7 (1 de fevereiro de 2021): 867–76. http://dx.doi.org/10.1177/1071100720985281.
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Background: A substantial coronal plane deformity is common in the context of end-stage ankle osteoarthritis. Recent literature shows a trend toward extending the indication of total ankle arthroplasty in increasingly severe coronal deformities, showing promising results when correct alignment is achieved. Nevertheless, the results of lateral transfibular total ankle replacement (LTTAR) in valgus has not been extensively studied. We aimed to evaluate if the outcomes of LTTAR in ankles with valgus deformity were similar to those with no major deformity at short-term follow-up. Methods: This retrospective cohort study included 228 LTTARs. Patients were classified into 2 groups according to the preoperative coronal plane tibiotalar angle (TTS): neutral (less than 10 degrees of coronal deformity, 209 patients) and valgus (above 10 degrees of valgus, 19 patients). Clinical evaluation was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS), 12-Item Short Form Health Survey 12 (SF-12) regarding its Physical and Mental Component Summary items. The radiographic evaluation considered anteroposterior and lateral ankle radiographs. Complications were also registered and classified as major or minor. The minimum follow-up was 2 years. Results: The average AOFAS, VAS, and SF-12 scores improved significantly postoperatively ( P < .001), without differences between groups. At final radiographic follow-up, the valgus alignment group did not show significant differences with the neutral alignment group regarding TTS, lateral distal tibial angle, or anterior distal tibial angle ( P > .05). Conclusion: LTTAR in cases with valgus deformity achieved and maintained correction at short-term follow-up, as obtained in neutral alignment ankles. Clinical outcomes improved significantly regardless of preoperative valgus deformity. Level of Evidence: Prognostic Level III, retrospective cohort study.
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Benevides, Pedro Costa, Caio Augusto de Souza Nery, Alexandre Leme Godoy-Santos, José Felipe Marion Alloza e Marcelo Pires Prado. "Study of the radiographic parameters of normal ankles". Journal of the Foot & Ankle 14, n.º 1 (30 de abril de 2020): 84–88. http://dx.doi.org/10.30795/jfootankle.2020.v14.1125.
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Objective: The authors carried out a bibliographic search for the radiographic parameters used to determine tibiotalar joint alignment, and suggest a set of parameters that constitute the minimum radiographic evaluation sufficient for the proper assessment of tibiotalar alignment. Methods: The search was conducted between May 2019 and January 2020 on the online platforms PudMed and Google Scholar with the following terms, used separately or jointly: “ankle arthritis, radiographic measurement, ankle alignment, alignment, anterior ankle instability, X-ray, and ankle injury”. Results: We selected twelve studies evaluating radiographic patterns of normal ankles, and identified a total of 15 radiographic measurements. Conclusion: The authors believe that a minimum radiographic assessment of tibiotalar alignment should include the following parameters on the anteroposterior radiograph: the distal tibial articular angle, the talar tilt and talus center migration. On the lateral radiograph, it should include: lateral distal tibial angle and lateral talar station. Level of Evidence V; Diagnostic Study; Expert Opinion.
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Moore, Andrew M., Anish R. Kadakia, Richard E. Hughes e Ramon A. Ruberte Thiele. "Effect of Ankle Flexion Angle on Axial Alignment of Total Ankle Replacement". Foot & Ankle International 31, n.º 12 (dezembro de 2010): 1093–98. http://dx.doi.org/10.3113/fai.2010.1093.
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Lee, Gun-Woo, Asep Santoso e Keun-Bae Lee. "Comparison of Intermediate-term Outcomes of Total Ankle Arthroplasty in Primary and Ligamentous Post-traumatic Osteoarthritis". Foot & Ankle International 40, n.º 11 (13 de setembro de 2019): 1273–81. http://dx.doi.org/10.1177/1071100719866472.
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Background: Ankle ligamentous injuries without fracture can result in end-stage ligamentous post-traumatic osteoarthritis, which may cause ligamentous imbalance after total ankle arthroplasty (TAA). However, outcomes of TAA in these patients are not well known. The purpose of this study was to evaluate intermediate-term clinical and radiographic outcomes of TAA in patients with ligamentous post-traumatic osteoarthritis and compare them with results of TAA for patients with primary osteoarthritis. Methods: We enrolled 114 patients (119 ankles) with consecutive primary TAA using HINTEGRA prosthesis at a mean follow-up duration of 6.0 years (range, 3-13). We divided all patients into 2 groups according to the etiology of osteoarthritis: (1) primary osteoarthritis group (69 ankles) and (2) ligamentous post-traumatic osteoarthritis group (50 ankles). Results: There was no significant intergroup difference in mean Ankle Osteoarthritis Scale (AOS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Short Form-36 Physical Component Summary, visual analog scale pain score, ankle range of motion, or complications at the final follow-up. However, the final tibiotalar angle was less corrected to 4.2 degrees in the ligamentous post-traumatic osteoarthritis group compared to 2.7 degrees in the primary osteoarthritis group ( P = .001). More concomitant procedures were required at the index surgery for the ligamentous post-traumatic osteoarthritis group ( P = .001). The estimated 5-year survivorship was 93.4% (primary osteoarthritis group: 91.3%; ligamentous post-traumatic osteoarthritis group: 95.8%). Conclusions: Clinical outcomes, complication rate, and 5-year survivorship of TAA in ankles with primary and ligamentous post-traumatic osteoarthritis were comparable with intermediate-term follow-up. Our results suggest that TAA would be a reliable treatment in ankles with ligamentous post-traumatic osteoarthritis when neutrally aligned stable ankles are achieved postoperatively. Level of Evidence: Level III, retrospective cohort study.
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Kvarda, Peter, Laszlo Toth, Tamar Horn-Lang, Roman Susdorf, Roxa Ruiz e Beat Hintermann. "Short-Term Outcomes of a Two-Component Total Ankle Replacement in Revision Arthroplasty". Foot & Ankle Orthopaedics 7, n.º 4 (outubro de 2022): 2473011421S0073. http://dx.doi.org/10.1177/2473011421s00739.
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Category: Ankle Arthritis; Ankle; Hindfoot Introduction/Purpose: Given the growing number of primary total ankle replacements (TAR), an increase in the numbers of failed ankles and consecutive revisions might be expected. Achieving a stable and balanced ankle based on stable components while preserving the remaining bone stock as much as possible, are crucial for success in revision TAR. Most reported techniques rely on bulky implants with extended fixation features. Since 2018, we have used a novel 3-component ankle for revision surgery that is converted in situ to a fixed-bearing 2-component ankle once the components have found their position given by the individual anatomy. The purpose of this study was to determine the short-term results of this novel concept in revision TAR. Methods: This single-center retrospective cohort study included 57 patients (57 ankles, mean age 63+-13 years) treated for failed TAR with the semi-constrained HINTERMANN Series H2© (H2) implant between February 2018 and February 2020. Survival analysis was performed and potential risk factors using Cox regression, were assessed. Clinical and radiological outcomes were assessed preoperatively and at the last follow-up. Clinical outcomes included pain on a visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot score and patient satisfaction. Radiological outcomes were tibial articular surface angle (TAS), tibiotalar surface angle (TTS), talar tilt angle (TT) in the coronal plane and anteroposterior offset (AP-Offset) ratio in the sagittal plane, as well as signs of radiolucency and/or loosening on plane weightbearing radiographs. Results: The median follow-up was 2 (2.0 to 4.0) years. The cumulative incidence for secondary revision after 1 and 2 years was 5.1% (95%CI 0-11) and 7.4% (0-14) respectively. Four patients needed a secondary revision (three for pain/arthrofibrosis and one for aseptic loosening). While the AOFAS hindfoot score increased from median 54 (range 9-94) to 75 (19-98) (p=0.00001), satisfaction increased from moderate to good (p=0.0017). Radiographically, all components were stable without signs of increased shear-forces in terms of loosening or radiolucency. Conclusion: Obtained results with the novel customized semi-constrained total ankle implant design at short-term are encouraging, with a satisfactory survival rate and acceptable revision rate. The fixation concept without extended fixation features was shown to last against increased shear forces.
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Teramoto, Atsushi, Hiroaki Shoji, Hideji Kura, Yuzuru Sakakibara, Tomoaki Kamiya, Kota Watanabe e Toshihiko Yamashita. "Factors Related to the Occurrence of Osteochondral Lesions of the Talus by 3-dimensional Bone Morphology of the Ankle". Foot & Ankle Orthopaedics 3, n.º 3 (1 de julho de 2018): 2473011418S0048. http://dx.doi.org/10.1177/2473011418s00487.
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Category: Ankle Introduction/Purpose: Repeated microtrauma is thought to play a major role in the occurrence of osteochondral lesions of the talus (OLTs), but much remains unknown. Two-dimensional assessments of the relationship between ankle bone morphology and OLTs are occasionally seen. The purpose of this study was to evaluate the bone morphology of the ankle in OLT 3-dimensionally using three-dimensional computed tomography (3DCT), and to investigate the factors related to the occurrence of OLTs. Methods: The subjects were 19 patients (19 ankles) who underwent surgery for medial OLTs (OLT group). They included 13 men and 6 women. A healthy group without ankle disease served as a control group with the same number of 19 ankles. Three-dimensional ankle joint models were made based on DICOM data obtained with CT images. In the 3D model, the medial malleolus articular surface and the tibial plafond surface, the medial surface of the trochlea of the talus, and the lateral surface of the trochlea of the talus were defined. The tibial axis-medial malleolus (TMM) angle, the medial malleolus surface area (MMA), the medial malleolus volume (MMV), and the anterior opening angle of the talus were measured 3-dimensionally and compared in the OLT and control groups. Results: The mean TMM angle was significantly larger in the OLT group (34.2 ± 4.4°) than in the control group (29.2 ± 4.8°; p = 0.002). The mean MMA was significantly smaller in the OLT group (219.8 ± 42.4 mm2) than in the control group (280.5 ± 38.2 mm2; p < 0.001). The mean MMV was significantly smaller in the OLT group (2119.9 ± 562.5 mm3) than in the control group (2646.4 ± 631.4 mm3; p = 0.01). The mean anterior opening angle of the talus was significantly larger in the OLT group (15.4 ± 3.9°) than in the control group (10.2 ± 3.6°; p < 0.001). Conclusion: It was shown with 3DCT measurements that, in medial OLT patients, the medial malleolus opens distally, the MMA and MMV are small, and the talus anterior opening angle was significantly larger than in controls. This study suggests the possibility that the 3D bone morphology of both the mortise and tenon of the ankle joint are closely related to the occurrence of OLTs.
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Choi, Ji Hye, Hee Soo Han, Young Jin Park, Seungbum Koo, Taeyong Lee e Kyoung Min Lee. "Relationship between ankle varus moment during gait and radiographic measurements in patients with medial ankle osteoarthritis". PLOS ONE 16, n.º 6 (24 de junho de 2021): e0253570. http://dx.doi.org/10.1371/journal.pone.0253570.
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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.
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Kovaleski, John E., Robert J. Heitman, Larry R. Gurchiek, J. M. Hollis, Wei Liu e Albert W. Pearsall IV. "Joint Stability Characteristics of the Ankle Complex in Female Athletes With Histories of Lateral Ankle Sprain, Part II: Clinical Experience Using Arthrometric Measurement". Journal of Athletic Training 49, n.º 2 (1 de março de 2014): 198–203. http://dx.doi.org/10.4085/1062-6050-49.2.08.
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Context: This is part II of a 2-part series discussing stability characteristics of the ankle complex. In part I, we used a cadaver model to examine the effects of sectioning the lateral ankle ligaments on anterior and inversion motion and stiffness of the ankle complex. In part II, we wanted to build on and apply these findings to the clinical assessment of ankle-complex motion and stiffness in a group of athletes with a history of unilateral ankle sprain. Objective: To examine ankle-complex motion and stiffness in a group of athletes with reported history of lateral ankle sprain. Design: Cross-sectional study. Setting: University research laboratory. Patients or Other Participants: Twenty-five female college athletes (age = 19.4 ± 1.4 years, height = 170.2 ± 7.4 cm, mass = 67.3 ± 10.0 kg) with histories of unilateral ankle sprain. Intervention(s): All ankles underwent loading with an ankle arthrometer. Ankles were tested bilaterally. Main Outcome Measure(s): The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness. Results: Anterior displacement of the ankle complex did not differ between the uninjured and sprained ankles (P = .37), whereas ankle-complex rotation was greater for the sprained ankles (P = .03). The sprained ankles had less anterior and inversion end-range stiffness than the uninjured ankles (P < .01). Conclusions: Changes in ankle-complex laxity and end-range stiffness were detected in ankles with histories of sprain. These results indicate the presence of altered mechanical characteristics in the soft tissues of the sprained ankles.
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Miyasaka, Hayato, Bungo Ebihara, Takashi Fukaya e Hirotaka Mutsuzaki. "Relationship between the Young’s Modulus of the Achilles Tendon and Ankle Dorsiflexion Angle at Maximum Squat Depth in Healthy Young Males". Medicina 59, n.º 6 (7 de junho de 2023): 1105. http://dx.doi.org/10.3390/medicina59061105.
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Background and Objective: Achilles tendon (AT) stiffness can reduce ankle dorsiflexion. However, whether AT stiffness affects the ankle dorsiflexion angle at a maximum squat depth remains unclear. Therefore, we aimed to investigate the relationship between the Young’s modulus of the AT and ankle dorsiflexion angle at the maximum squat depth in healthy young males using shear-wave elastography (SWE). Materials and Methods: This cross-sectional study included 31 healthy young males. AT stiffness was measured using the Young’s modulus through SWE. The ankle dorsiflexion angle at the maximum squat depth was measured as the angle between the vertical line to the floor and the line connecting the fibula head and the lateral malleolus using a goniometer. Results: Multiple regression analysis identified the Young’s modulus of the AT at 10° of ankle dorsiflexion (standardized partial regression coefficient [β] = −0.461; p = 0.007) and the ankle dorsiflexion angle in the flexed knee (β = 0.340; p = 0.041) as independent variables for the ankle dorsiflexion angle at maximum squat depth. Conclusions: The Young’s modulus of the AT may affect the ankle dorsiflexion angle at the maximum squat depth in healthy young males. Therefore, improving the Young’s modulus of the AT may help increase the ankle dorsiflexion angle at maximum squat depth.
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Kernozek, Thomas, Christopher J. Durall, Allison Friske e Matthew Mussallem. "Ankle Bracing, Plantar-Flexion Angle, and Ankle Muscle Latencies During Inversion Stress in Healthy Participants". Journal of Athletic Training 43, n.º 1 (1 de janeiro de 2008): 37–43. http://dx.doi.org/10.4085/1062-6050-43.1.37.
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Abstract Context: Ankle braces may enhance ankle joint proprioception, which in turn may affect reflexive ankle muscle activity during a perturbation. Despite the common occurrence of plantar-flexion inversion ankle injuries, authors of previous studies of ankle muscle latencies have focused on inversion stresses only. Objective: To examine the latency of the peroneus longus (PL), peroneus brevis (PB), and tibialis anterior (TA) muscles in response to various degrees of combined plantar-flexion and inversion stresses in braced and unbraced asymptomatic ankles. Design: Repeated measures. Setting: University biomechanics laboratory. Patients or Other Participants: Twenty-eight healthy females and 12 healthy males (n = 40: mean age = 23.63 years, range = 19 to 30 years; height = 172.75 ± 7.96 cm; mass = 65.53 ± 12.0 kg). Intervention(s): Participants were tested under 2 conditions: wearing and not wearing an Active Ankle T1 brace while dropping from a custom-made platform into 10°, 20°, and 30° of plantar flexion and 30° of inversion. Main Outcome Measure(s): The time between platform drop and the onset of PL, PB, and TA electromyographic activity was measured to determine latencies. We calculated a series of 2-way analyses of variance to determine if latencies were different between the conditions (braced and unbraced) and among the plantar-flexion angles (α = .05). Results: No interaction was found between condition and plantar-flexion angle. No significant main effects were found for condition or plantar-flexion angle. Overall means for braced and unbraced conditions were not significantly different for each muscle tested. Overall means for angle for the PL, PB, and TA were not significantly different. Conclusions: Reflexive activity of the PL, PB, or TA was unaffected by the amount of plantar flexion or by wearing an Active Ankle T1 brace during an unanticipated plantar-flexion inversion perturbation.
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Kondo, Hitoshi. "Changes in the Ground Reaction Force, Lower-Limb Muscle Activity, and Joint Angles in Athletes with Unilateral Ankle Dorsiflexion Restriction During A Rebound-Jump Task". Journal of Functional Morphology and Kinesiology 3, n.º 4 (26 de outubro de 2018): 52. http://dx.doi.org/10.3390/jfmk3040052.
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Background: This study compared differences between a control group and a group with unilateral ankle dorsiflexion restriction in the ground reaction force (GRF), angles of the lower limbs joints, and muscular activity during a rebound-jump task in athletes who continue to perform sports activities with unilateral ankle dorsiflexion restriction. Methods: The athletes were divided into the following two groups: The dorsiflexion group included those with a difference of ≥7° between bilateral ankle dorsiflexion angles (DF), and the control group included those with a difference of <7° between the two ankles (C). An ankle foot orthosis was attached to subjects in group C to apply a restriction on the right-angle dorsiflexion angle. The percentage of maximum voluntary contraction (%MVC) of the legs musculature, components of the GRF, and the hip and knee joint angles during the rebound-jump task were compared between groups DF and C. Results: Group DF showed increased %MVC of the quadriceps muscle, decreased upward component of the GRF, decreased hip flexion, and increased knee eversion angles. Conclusions: This study highlighted that athletes with ankle dorsiflexion restriction had significantly larger knee eversion angles in the rebound-jump task. The reduced hip flexion was likely caused by the restricted ankle dorsiflexion and compensated by the observed increase in quadriceps muscle activation when performing the jump.
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Dao, Duc minh, P.D. Phuoc e T.X. Tuy. "Research control for ankle joint rehabilitation device". Journal of Mechanical Engineering and Sciences 16, n.º 1 (23 de março de 2022): 8743–53. http://dx.doi.org/10.15282/jmes.16.1.2022.08.0691.
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The ankle is one of the joints that is often injured when playing sports or in daily activities. Improper handling due to lack of knowledge about the ankles causes these injuries to last long, cause disability and affect our daily activities. Rehabilitation treatment is important for the purpose of maintaining and improving the mobility of joints. This paper, presenting the experimental results of the training device to rehabilitate ankle joints for human in dorsiflexion/plantarflexion exercises. The PD controller has been applied and controlled device. During the training, the angle of the ankle joint is monitored by the Arduino IDE software. The error of the set angle and the experimental angle is 10. The device manufactured in the workshop of Pham Van Dong university base on aluminum material. Experiments were conducted on both without load mode and with human mode. For human safety, besides the program containing the Arduino Mega controller, the device has mechanical brakes and an emergency button. The device’s tracking performance was determined by comparing the input and output angular position of the device.
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Scheidegger, P., T. Horn Lang, C. Schweizer, L. Zwicky e B. Hintermann. "A flexion osteotomy for correction of a distal tibial recurvatum deformity". Bone & Joint Journal 101-B, n.º 6 (junho de 2019): 682–90. http://dx.doi.org/10.1302/0301-620x.101b6.bjj-2018-0932.r2.
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Aims There is little information about how to manage patients with a recurvatum deformity of the distal tibia and osteoarthritis (OA) of the ankle. The aim of this study was to evaluate the functional and radiological outcome of addressing this deformity using a flexion osteotomy and to assess the progression of OA after this procedure. Patients and Methods A total of 39 patients (12 women, 27 men; mean age 47 years (28 to 72)) with a distal tibial recurvatum deformity were treated with a flexion osteotomy, between 2010 and 2015. Nine patients (23%) subsequently required conversion to either a total ankle arthroplasty (seven) or an arthrodesis (two) after a mean of 21 months (9 to 36). A total of 30 patients (77%), with a mean follow-up of 30 months (24 to 76), remained for further evaluation. Functional outcome, sagittal ankle joint OA using a modified Kellgren and Lawrence Score, tibial lateral surface (TLS) angle, and talar offset ratio (TOR) were evaluated on pre- and postoperative weight-bearing radiographs. Results Postoperatively, the mean score for pain, using a visual analogue scale, decreased significantly from 4.3 to 2.5 points and the mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly from 59 to 75 points (both p < 0.001). The mean TLS angle increased significantly by 6.6°; the mean TOR decreased significantly by 0.24 (p < 0.001). Radiological evaluation showed an improvement or no progression of sagittal ankle joint OA in 32 ankles (82%), while seven ankles (18%) showed further progression. Conclusion A flexion osteotomy effectively improved the congruency of the ankle joint. In 30 patients (77%), the joint could be saved, whereas in nine patients (23%), the treatment delayed a joint-sacrificing procedure. Cite this article: Bone Joint J 2019;101-B:682–690.
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Im, Jemin, Hong-Geun Jung e Jung-Won Lim. "Lateral Joint Distraction Through Distal Fibula Lengthening Osteotomy for Lateral Compartment Ankle Osteoarthritis". Foot & Ankle Orthopaedics 7, n.º 4 (outubro de 2022): 2473011421S0070. http://dx.doi.org/10.1177/2473011421s00702.
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Category: Ankle; Trauma Introduction/Purpose: Lateral compartment ankle OA, commonly due to trauma such as ankle fracture, is not very rare. However there's no definite established surgical treatment option. In this study, we suggest distal fibula lengthening osteotomy for lateral joint distraction as one of treatment surgical option. We have experienced favorable clinical outcome for 3 cases of post- traumatic lateral compartment ankle OA with joint space narrowing treated with distal fibula distraction osteotomy. We report the case series with the surgical technique and the clinical-radiological outcome. Methods: From April 2016 to August 2021, three ankles which underwent distal fibula distraction osteotomy were included in this study. All three ankles had a history of OR/IF due to fractures in the ankle joint and were diagnosed with lateral compartment OA. We defined lateral compartment OA when clinical symptoms and radiologic findings were consistent. Clinically, the point of pain was characterized as the lateral compartment of the ankle joint, not the syndesmosis or peri fibular area. Radiologically, joint space narrowing is showed in X-ray, and CT arthrography or MRI confirmed cartilage denudation of the lateral compartment. Results: 1) Clinical outcomes (Table 1) Case 1: The AOFAS score improved from 69 preoperatively to 93 postoperatively, and the Pain vas score improved from 7 to 0. According to patient's subjective expression, daily activity became 'Boxing available' from 'Hard to run'. Case 2: The AOFAS score improved from 73 preoperatively to 91 postoperatively, and the Pain vas score improved from 5 to 0. According to patient's subjective expression, daily activity became 'No pain on daily activity' from 'Hard to walk'. Case 3 is not described because there has been no progress for more than 1 year after surgery. 2) Radiologic outcomes (Table 2) Lateral joint space, talocrural angle, talar tilt angle and tibia axis-talar dome angle were all changed close to the contralateral ankle index after surgery. Conclusion: Painful ankle OA localized to the lateral compartment in young age is uncommon and there is no definite surgical method. Distal fibula distraction osteotomy is reasonable surgical method that does not burden patients and surgeon. In our study, distal fibula distraction osteotomy showed favorable clinical-radiological outcomes. So, we recommend this method for painful lateral compartment OA in young ages.
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Silvestri, Claudia A. Di, Riccardo D’Ambrosi, Camilla Maccario, Cristian Indino e Federico Giuseppe Usuelli. "Severe Ankle Varus Malalignment Management with a Fix-Bearing Total Ankle Replacement Implant". Foot & Ankle Orthopaedics 5, n.º 4 (1 de outubro de 2020): 2473011420S0019. http://dx.doi.org/10.1177/2473011420s00194.
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Category: Ankle Arthritis; Ankle Introduction/Purpose: Despite Total ankle replacement (TAR) is currently considered a safe procedure and an optimal alternative to ankle fusion in end-stage ankle arthritis, still the precise indications and the limits of TAR are a highly controversial topic. Coronal malalignment correction with TAR is also a widely debated point. Purpose of this work was to confront two patient groups undergoing Total Ankle Replacement (a group of patients with a pre-operative ankle varus misalignment on coronal plane, versus a group of patients with neutral pre-operative ankle alignment) comparing clinical and radiographic results, complications and survival rate of the implant. Methods: 171 patients, all affected by end-stage ankle arthritis and all treated with total ankle replacement with fix-bearing Trabecular Metal Total Ankle System (Zimmer-Biomet, Warsaw IN, USA), were divided in two groups. Group ‘A’ included 159 patients having a normal alignment or a slight valgus or valgus misalignment within 10°. Group ‘B’ included 12 patients with a pre- operative varus malalignment >10°. Each patient of the study was evaluated, clinically and radiologically, before and after surgery, and subsequently at 6 and 12 months follow-up, then once every year. Clinical evaluation comprised some score: visual analogue scale (VAS); American Foot and Ankle Society Score (AOFAS); and the Short Form (SF)-12 Quality of Life, in both of its ‘physical’ (PCS) and ‘mental’ (MCS) components. Radiological evaluated parameters were: tibio-talar surface angle (TTS), lateral distal tibial angle (LDTA-α), and anterior distal tibial angle (ADTA-β). Complications and implant survival rate were evaluated for both groups. Results: At a mean follow up of 2,75 years (range 2.09-5.66 years), improvement was found in all clinical and radiological evaluated parameters of two groups, without statistically significant differences between two groups at last follow-up. In group A most frequent reported complication was the presence of a fibular symptomatic hardware. Major complication were a deep arthroplasty infection and a 3 months post-operative ankle fracture-dislocation/periprostethic fracture. In group B there were 2 delayed wound healing, and one case of loosening of correction. No significant difference in complication and revision rate comparison between two groups was founded. Conclusion: Mid-term results reported in the present show that in patients with varus greater than 10 ° it is possible to obtain a post-operative alignment similar to pre-operative neutral ankles and that the complication rate is not greater. Despite this, is Authors opinion that major and complex misalignment should be approached by skilled surgeons, with an adequate learning curve experience, with a wide range of cases and in highly specialized centers.
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Kwon, Yong. "Static Postural Stability in Chronic Ankle Instability, an Ankle Sprain and Healthy Ankles". International Journal of Sports Medicine 39, n.º 08 (18 de maio de 2018): 625–29. http://dx.doi.org/10.1055/a-0608-4552.
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AbstractTo identify the single leg balance (SLB) test that discriminates among healthy, coper, and chronic ankle instability (CAI) groups and to determine effects of ankle muscles on the balance error scoring system (BESS) among the three populations. 60 subjects (20 per group) performed the SLB test with eyes open (EO) and eyes closed (EC). Normalized mean amplitude (NMA) of the tibia anterior (TA), fibularis longus (FL), and medial gastrocnemius (MG) muscles and BESS were measured while performing the SLB test. The coper group had a lower error score than the CAI group in the EC. NMA was greater in the CAI group compared to in the healthy and coper groups regardless of muscle type. NMA of the TA was less than the PL and MG regardless of the group in the EO. The CAI group demonstrated greater NMAs of the PL and MG than the healthy and coper groups in the EC. The CAI group demonstrated greater NMA of the PL and MG by compensating their ankle muscles in the EO and EC. BESS suggests that the coper group may have coping mechanisms to stabilize static postural control compared to the CAI group. The EC may be better to detect static postural instability in the CAI or coper group.
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Wanner, Philipp, Thomas Schmautz, Felix Kluge, Björn Eskofier, Klaus Pfeifer e Simon Steib. "Ankle angle variability during running in athletes with chronic ankle instability and copers". Gait & Posture 68 (fevereiro de 2019): 329–34. http://dx.doi.org/10.1016/j.gaitpost.2018.11.038.
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KITABATA, Kosuke, Satoshi KOMADA, Daisuke YASHIRO e Kazuhiro YUBAI. "Estimation of ankle torque by plantar flexor muscles using EMG and ankle angle". Proceedings of JSME annual Conference on Robotics and Mechatronics (Robomec) 2019 (2019): 2A1—G09. http://dx.doi.org/10.1299/jsmermd.2019.2a1-g09.
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Jung, Hong-Geun, Na-Ra Kim, Tae-Hoon Kim, Joon-Sang Eom e Dong-Oh Lee. "Magnetic Resonance Imaging and Stress Radiography in Chronic Lateral Ankle Instability". Foot & Ankle International 38, n.º 6 (1 de fevereiro de 2017): 621–26. http://dx.doi.org/10.1177/1071100717693207.
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Background: Studies regarding magnetic resonance imaging (MRI) findings of the lateral ankle ligaments in chronic lateral ankle instability and their clinical relevance for surgery are lacking. This study classified the lateral ankle ligament MRI findings of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in chronic lateral ankle instability (CLAI) and correlated these findings with ankle stress radiographs. Methods: We included 132 ankles with CLAI that underwent ligament reconstructions from 2006 to 2013. The distributions of the ATFL and CFL morphologies were evaluated using the following categories: (1) the amount of thickness: normal/thickened/attenuated/non-visualized, (2) the presence of discontinuity, (3) wavy or irregular contour, and (4) increased signal intensity on T2-weighted images. The relationships between the ligament morphologies and stress radiographs were analyzed. Results: The ATFL was normal in 5 (4%) ankles, thickened in 35 (27%), attenuated in 76 (58%), and non-visualized in 16 (12%), while the CFL was normal in 39 (30%) ankles, thickened in 42 (32%), attenuated in 44 (33%), and non-visualized in 7 (5%). Discontinuity of the ATFL or CFL was observed in 46 (35%) ankles. Wavy or irregular contours were observed in 55 (42%) ATFLs and 37 (28%) CFLs, and signal intensity of both ligaments was increased in 19 (14%) ankles. ATFL ( P < .001) and CFL thickness ( P = .007) correlated with the talar tilt angle. Conclusions: The MRI findings of CLAI showed several morphologies and specific incidences for each morphology. Attenuated, wavy appearance was the most frequent MRI pattern. Thickness was related to the degree of instability. Level of Evidence: Level IV, retrospective case series.
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Kurokawa, Hiroaki, Akira Taniguchi, Takuma Miyamoto e Yasuhito Tanaka. "The Relationship Between the Distal Tibial Fibular Syndesmosis and the Varus Deformity in Patients With Varus Ankle Osteoarthritis". Foot & Ankle Orthopaedics 6, n.º 4 (1 de outubro de 2021): 247301142110411. http://dx.doi.org/10.1177/24730114211041111.
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Background: The impact of varus ankle osteoarthritis (OA) on the distal tibial fibular syndesmosis is poorly described. This study aimed to investigate the possible relationship between the condition of the distal tibial fibular syndesmosis and the degree of the varus deformity using weightbearing simulated computed tomography (CT), in patients with varus ankle OA. Methods: This retrospective comparative study included 155 varus ankles, divided into 4 Takakura-Tanaka groups (stage 2, 3a, 3b, and 4). A control group comprised 35 ankles without prior ankle disorders. The angles between the tibial shaft and the articular surface of the tibial plafond on the anteroposterior view (TAS), and articular surfaces of the tibial plafond and talar dome (TTW) were measured from weightbearing ankle radiographs. The varus angle of the ankle (VA) was defined as 90 – TAS + TTW. On the CT axial view, 1 cm proximal to the tibial plafond, the area of the syndesmosis (“CT-area”) and the distance between the fibula and the tibia (CT-FCS) were measured. Results: The CT area in stages 2, 3a, 3b, 4, and control group were 99, 79, 77, 103, and 97 mm2, respectively. The CT-FCS were 3.5, 3.1, 2.9, 4.3, and 3.9 mm, respectively. In all 155 OA ankles, CT area and CT-FCS were negatively correlated with the VA (correlation coefficient r = –0.38, P < .01; and r = 0.38, P < .01, respectively). Both CT area and CT-FCS were significantly smaller in stages 3a and 3b than in the control group ( P < .01). Conclusion: There may be a relationship between the narrowing of the syndesmosis and the varus deformity in patients with varus ankle OA, especially in stages 3a and 3b. Clinical Relevance: Clinicians should be aware of the impact of varus ankle arthritis on the distal tibial fibular syndesmosis when operatively treating varus ankle OA. For some patients, the isolated treatment for the tibiotalar joint may be insufficient, and treatment for the syndesmosis as well as tibiotalar joint may be needed. Level of Evidence: Level III, retrospective case control study.
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Baumhauer, Judith F. "Ankle Arthrodesis Versus Ankle Replacement for Ankle Arthritis". Clinical Orthopaedics and Related Research 471, n.º 8 (agosto de 2013): 2439–42. http://dx.doi.org/10.1007/s11999-013-3084-6.
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Safaeepour, Zahra, Ali Esteki, Farhad Tabatabai Ghomshe e Mohammad E. Mousavai. "Design and development of a novel viscoelastic ankle-foot prosthesis based on the human ankle biomechanics". Prosthetics and Orthotics International 38, n.º 5 (14 de fevereiro de 2014): 400–404. http://dx.doi.org/10.1177/0309364613505108.
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Background and aim: In the present study, a new approach was applied to design and develop a viscoelastic ankle-foot prosthesis. The aim was to replicate the intact ankle moment–angle loop in the normal walking speed. Technique: The moment–angle loop of intact ankle was divided into four parts, and the appropriate models including two viscoelastic units of spring-damper mechanism were considered to replicate the passive ankle dynamics. The developed prototype was then tested on a healthy subject with the amputee gait simulator. The result showed that prosthetic ankle moment–angle loop was similar to that of intact ankle with the distinct four periods. Discussion: The findings suggest that the prototype successfully provided the human ankle passive dynamics. Therefore, the viscoelastic units could imitate the four periods of a normal gait. Clinical relevance The novel viscoelastic foot prosthesis could provide natural ankle dynamics in a gait cycle. Applying simple but biomechanical approach is suggested in conception of new designs for prosthetic ankle-foot mechanisms.
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Kim, Jaeyoung, Jensen K. Henry, Ji-Beom Kim e Woo-Chun Lee. "Dome Supramalleolar Osteotomies for the Treatment of Ankle Pain with Opposing Coronal Plane Deformities Between Ankle and the Lower Limb". Foot & Ankle International 43, n.º 4 (23 de outubro de 2021): 474–85. http://dx.doi.org/10.1177/10711007211050639.
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Background: The dome-type osteotomy is a powerful technique for deformity correction of the limb. However, there is limited information about the utility of dome supramalleolar osteotomy (SMO) in ankle joint preservation surgery. This study aimed to describe the technique and indications for dome SMO in distal tibial malalignment. Methods: Twenty-three patients (23 ankles) who underwent dome SMO with a 2-year follow-up were reviewed. Dome SMO was indicated when there were opposing deformities in the ankle and lower limb mechanical axis (ie, varus ankle deformity with valgus lower limb alignment and vice versa) where inherent translation following conventional wedge-type osteotomies could worsen the deformity of the entire lower limb. Patients were divided into 2 groups based on preoperative ankle alignment: the varus ankle group (n = 11) and the valgus ankle group (n = 12). The radiographic correction was assessed using 6 parameters from weightbearing ankle and hindfoot alignment views. In addition, the lower limb mechanical axis was assessed with ankle center deviation (ACD) from the hip-knee (HK) line on the whole limb radiograph, and the weightbearing line (WBL) point was measured to identify changes in the weightbearing load within the ankle joint. Results: Preoperatively, the varus ankle group had varus ankle deformity (tibiotalar angle [TTA], 76.5 ± 5.8 degrees) with valgus lower limb mechanical axis, whereas the valgus ankle group had valgus ankle deformity (TTA, 99.1 ± 4.5 degrees) with varus lower limb mechanical axis alignment. Postoperatively, a significant improvement in the ankle alignment and the lower limb mechanical axis was observed in both groups. The ACD significantly changed toward the HK line, suggesting an improved lower limb mechanical axis, and the WBL point showed a significant shift of the weightbearing axis toward the uninvolved area within the ankle joint. Conclusion: Dome SMO demonstrated a successful correction of local deformity while simultaneously realigning the hip-knee-ankle axis toward neutral. Additionally, an effective load shifting toward an uninvolved area within the ankle joint was observed. Level of Evidence: Level IV, case series.
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Liu, Wen, Tarang Jain e Clayton Wauneka. "A New Dimension in the Study of Human Functional Joint Instability". Applied Mechanics and Materials 249-250 (dezembro de 2012): 1271–76. http://dx.doi.org/10.4028/www.scientific.net/amm.249-250.1271.
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Functional joint instability is common after joint soft tissue injuries. We present in this report our pilot finding in a study of functional ankle instability. Although past studies have suggested multiple pathological factors for functional ankle instability, none of those factors has been confirmed in the past studies. More importantly, no known factor can provide an explanation for an ankle giving way phenomenon which is a key element in defining a functional ankle instability. In this pilot study, we tested five subjects with functional ankle instability using a dynamic ankle stretching device combined with nociceptive electrical stimulation. Three out of five subjects showed a drastic reaction in which they totally gave up their control of upright standing after their affected ankles were under the combined ankle stretch and nociceptive stimuli. Such drastic reaction was not observed in the same ankles under only the ankle stretch. There was no such drastic reaction in the unaffected ankle under either testing condition. This pilot finding indicates a possibility of a hyper-reactivity to unloading reaction in the ankles with functional ankle instability
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Brandle, Greggory, Kaitlyn Rizzo, Nicholas A. Cheney e Brian C. Clark. "A Retrospective Chart Review to Determine Lateral Ankle Instability Treatment based off of the Degree of Varus Tilt". Foot & Ankle Orthopaedics 5, n.º 4 (1 de outubro de 2020): 2473011420S0014. http://dx.doi.org/10.1177/2473011420s00143.
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Category: Ankle Introduction/Purpose: One of the most common injuries in the United States is the ankle sprain, accounting for 10-15% of sport injuries. Without proper treatment, about one-third of patients reinjure the same ankle and can progress to chronic lateral ankle instability. An ankle can be clinically evaluated by performing an inversion stress test and measuring the degree of varus tilt. The purpose of this retrospective chart review was to examine if a correlation exists between the degree of varus tilt on a stress x-ray and whether the patients were treated conservatively or surgically. Additionally, this chart review aims to confirm the validity of the guidelines of an abnormal talar tilt value, which is said to be a value greater than 10 degrees. Methods: A total of 584 patients between January 1st, 2016 and June 27th, 2019 were clinically diagnosed with lateral ankle instability and had an inversion stress x-ray. All 584 patients were seen and diagnosed by the same foot and ankle orthopedic surgeon in Columbus, Ohio. Of the 584 patients, 40 had bilateral lateral ankle instability and bilateral stress xrays, given a total of 624 ankles originally included in this chart review. Once the patient’s charts were reviewed, 32 ankles were excluded because their ankle surgery did not involve correction of the lateral ankle instability. A total of 592 ankles (293 left and 299 right) were included in this review. The degree of varus tilt on all 592 ankles were determined by measuring the angle between the tibial plafond and the top of the talus. The angles were compared to the patients with surgical and conservative treatment. Results: The chart review showed that as the degree of varus tilt increases, the more likely the patient is to fail conservative treatment and need surgical correction. The types of conservative treatment that the patients failed were a combination of a brace, boot, physical therapy, orthotics, shoe changes, injection, and casting. The patients who had a varus tilt below 2.5 degrees were treated conservatively 60% of the time, where patients that had a varus tilt over 20.1 degrees were treated surgically 75% of the time. The review also showed a significant number of patients who were treated surgically with a varus tilt value less than 10 degrees (209 of 472 ankles), warranting further evaluation into what is considered an abnormal talar tilt. Conclusion: It is clear that patients with a higher degree of varus tilt have more ankle instability and are more likely to fail conservative treatment and require surgical correction. Additionally, this chart review showed that many patients needed surgical correction even with a low varus tilt value on stress x-ray. Further evaluation needs to be completed to determine what value is considered an abnormal varus tilt. One possible explanation of our findings is that the inversion stress test does not evaluate the subtalar joint, which can contribute to chronic lateral ankle instability.
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Park, Byeong-Seop, Seungbum Koo, Won-keun Park, Ki-bum Kwon e Kyoung Min Lee. "Opposite Association Between Radiographic Lateral Ankle Instability and Osteochondral Lesions of the Talus in Patients with Ankle Inversion Injuries". Foot & Ankle Orthopaedics 4, n.º 4 (1 de outubro de 2019): 2473011419S0033. http://dx.doi.org/10.1177/2473011419s00332.
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Category: Ankle Introduction/Purpose: Insufficient bony coverage surrounding the talus could cause considerable mechanical ankle instability, whereas excessive bony coverage could cause bone contusion at the time of injury and subsequent osteochondral lesions of the talus (OLT). This study aimed to investigate the relationship between radiographic lateral ankle instability and OLT in patients that sustained ankle inversion injuries. Methods: One-hundred-ninety-five patients (113 men and 83 women; mean age, 38.7 years; standard deviation, 8.8 years) with a history of ankle inversion injuries were included. All patients underwent ankle magnetic resonance imaging (MRI) and stress X-ray (varus stress and anterior drawer) examination. The tibiotalar tilt angle on varus stress X-ray, anterior translation of the talus on anterior-drawer lateral X-rays, bimalleolar tilt angle, and fibular position were radiographically determined. The anatomical grade of the lateral ankle ligament injury and the presence of OLTs were determined from MRI findings. Results: A greater lateral ankle ligament grade tends to increase the tibiotalar tilt angle (p=0.074), significantly affecting the anterior translation of the talus (p=0.036). The presence of radiographic lateral ankle instability (tibiotalar tilt angle =10°) showed opposite associations with the presence of OLT in the chi-square test (p=0.003). OLT was a negative significant factor (p=0.011) affecting the tibiotalar tilt angle in the multiple regression analysis (Table 1) and was negatively affected by the tibiotalar tilt angle (p=0.016) in the binary logistic regression analysis. Conclusion: This study showed an opposite association between lateral ankle instability and the development of OLT following ankle inversion injury. The role of bony predisposition in the development of sports injuries in the ankle should be considered and investigated further.
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Shih, Han-Ting, Wei-Jen Liao, Kao-Chang Tu, Cheng-Hung Lee, Shih-Chieh Tang e Shun-Ping Wang. "Poor Correction Capacity of Preexisting Ankle Valgus Deformity after Total Knee Arthroplasty". Journal of Clinical Medicine 10, n.º 16 (17 de agosto de 2021): 3624. http://dx.doi.org/10.3390/jcm10163624.
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This study investigated the differences in ankle alignment changes after TKA in patients with varying preexisting ankle deformities. We retrospectively examined 90 knees with osteoarthritis and varus deformity in 78 patients who underwent TKA. Preoperative and postoperative radiographic parameters were analyzed. According to their preexisting ankle deformity, patients were assigned to the valgus or varus group. Overall, 14 (15.6%) cases were of preoperative valgus ankle deformity; the remainder were of preoperative varus ankle deformity. Hip–knee–ankle angle (HKA), tibial plafond–ground angle (PGA), and talus–ground angle (TGA) all exhibited significant correction in both groups; however, tibial plafond–talus angle (PTA) and superior space of ankle joint (SS) only changed in the varus group. The median PTA and SS significantly decreased from 1.2° to 0.3° (p < 0.001) and increased from 2.5 to 2.6 mm (p = 0.013), respectively. Notably, ∆PTA positively correlated with ∆HKA in the varus group (r = 0.247, p = 0.032) but not in the valgus group. Between-group differences in postoperative PTA (p < 0.001) and ∆PTA (p < 0.001) were significant. The degree of ankle alignment correction after TKA differed between patients with preexisting varus and valgus ankle deformities. TKA could not effectively correct the preexisting ankle valgus malalignment.
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Park, Byeong Seop, Chin Youb Chung, Moon Seok Park, Ki Hyuk Sung, Young Choi, Chulhee Park, Seungbum Koo e Kyoung Min Lee. "Inverse Relationship Between Radiographic Lateral Ankle Instability and Osteochondral Lesions of the Talus in Patients With Ankle Inversion Injuries". Foot & Ankle International 40, n.º 12 (27 de agosto de 2019): 1368–74. http://dx.doi.org/10.1177/1071100719868476.
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Background: Insufficient or excessive bony constraint surrounding the talus might contribute to the occurrence of ligamentous injury or bone contusion, respectively, at the time of ankle inversion injuries. This study aimed to investigate the relationship between radiographic lateral ankle instability and osteochondral lesions of the talus (OLT) following ankle inversion injuries. Methods: A total of 195 patients (113 men and 83 women; mean age, 38.7 years) with a history of ankle inversion injuries were included in this study. All patients underwent ankle magnetic resonance imaging (MRI) and stress radiography. The tibiotalar tilt angle on varus stress radiograph, anterior translation of the talus on anterior-drawer lateral radiographs, bimalleolar tilt angle, and fibular position were radiographically determined. The radiographic lateral ankle instability was defined as tibiotalar tilt angle ≥10 degrees, and the presence of OLT was confirmed on MR images. The relationship between the radiographic lateral ankle instability and the presence of OLT was statistically analyzed. Results: The presence of radiographic lateral ankle instability (tibiotalar tilt angle ≥10 degrees) showed an inverse relationship with that of OLT in the chi-squared test ( P = .003). An increased tibiotalar tilt angle was associated with lower incidence of OLT ( P = .011) in the multiple regression analysis, and the presence of OLT was associated with a decreased tibiotalar tilt angle ( P = .016) in the binary logistic regression analysis. Conclusions: This study showed an inverse relationship between lateral ankle instability and the development of OLT following ankle inversion injury. The role of bony constraint in the development of sports injuries in the ankle should be considered with these injuries. Level of Evidence: Level III, diagnostic, comparative study.
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Isakov, Eli, Joseph Mizrahi, Pablo Solzi, Zev Susak e Moshe Lotem. "Response of the Peroneal Muscles to Sudden Inversion of the Ankle during Standing". International Journal of Sport Biomechanics 2, n.º 2 (maio de 1986): 100–109. http://dx.doi.org/10.1123/ijsb.2.2.100.
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The response of the peroneal muscles to sudden inversion of the ankle during standing was investigated. The variation of the inversion angle with time was measured by means of a potentiometer attached to a specially designed test apparatus. During the tests, volunteers were subjected to sudden and unexpected inversion of their ankle, during which the surface EMG of the peroneal muscles was also recorded. Two groups were tested, one of normal subjects and one consisting of subjects with recurrent ankle sprains. There were 8 females and 3 males in each group. The subjects in the second group, who suffered from recurrent ankle sprains, had been asymptomatic during the last 2 months prior to the tests. For each subject in the two groups, both ankles were tested. The results indicated a latency time ranging from 60 to 80 ms for both groups. It was concluded that the reflex contraction of the peroneal muscles due to a sudden stretch inversion motion has no role in protecting the ankle joint during sprain and that this protection is mainly provided by the passive tissues.