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Sample records for acute ankle ligamentous

  1. Deltoid ligament in acute ankle injury: MR imaging analysis

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Min Sun; Choi, Yun Sun; Kim, Yun Jung; Jung, Yoon Young [Eulji University, Department of Radiology, Eulji Hospital, Seoul (Korea, Republic of); Kim, Jin Su; Young, Ki Won [Eulji University, Department of Orthopedic Surgery, Eulji Hospital, Seoul (Korea, Republic of)

    2014-05-15

    To identify the pattern of deltoid ligament injury after acute ankle injury and the relationship between ankle fracture and deltoid ligament tear by magnetic resonance imaging (MRI). Thirty-six patients (32 male, and 4 female; mean age, 29.8 years) with acute deltoid ligament injury who had undergone MRI participated in this study. The deltoid ligament was classified as having 3 superficial and 2 deep components. An image analysis included the integrity and tear site of the deltoid ligament, and other associated injuries. Association between ankle fracture and deltoid ligament tear was assessed using Fisher's exact test (P < 0.05). Of the 36 patients, 21 (58.3 %) had tears in the superficial and deep deltoid ligaments, 6 (16.7 %) in the superficial ligaments only, and 4 (11.1 %) in the deep ligaments only. The most common tear site of the three components of the superficial deltoid and deep anterior tibiotalar ligaments was their proximal attachments (94 % and 91.7 % respectively), and that of the deep posterior tibiotalar ligament (pTTL) was its distal attachment (82.6 %). The common associated injuries were ankle fracture (63.9 %), syndesmosis tear (55.6 %), and lateral collateral ligament complex tear (44.4 %). All the components of the deltoid ligament were frequently torn in patients with ankle fractures (tibionavicular ligament, P = 0.009). The observed injury pattern of the deltoid ligament was complex and frequently associated with concomitant ankle pathology. The most common tear site of the superficial deltoid ligament was the medial malleolar attachment, whereas that of the deep pTTL was near its medial talar insertion. (orig.)

  2. [PARTICULAR QUALITIES OF DIAGNOSTIC ACUTE LATERAL ANKLE LIGAMENT INJURIES].

    Science.gov (United States)

    Krasnoperov, S N; Shishka, I V; Golovaha, M L

    2015-01-01

    Delayed diagnosis of acute lateral ankle ligaments injury and subsequent inadequate treatment leads to the development of chronic instability and rapid progression of degenerative processes in the joint. The aim of our work was to improve treatment results by developing an diagnostic algorithm and treatment strategy of acute lateral ankle ligament injuries. The study included 48 patients with history of acute inversion ankle injury mechanism. Diagnostic protocol included clinical and radiological examination during 48 hours and after 7-10 days after injury. According to the high rate of inaccurate clinical diagnosis in the first 48 hours of the injury a short course of conservative treatment for 7-10 days is needed with follow-up and controlling clinical and radiographic instability tests. Clinical symptoms of ankle inversion injury showed that the combination of local tenderness in the projection of damaged ligaments, the presence of severe periarticular hematoma in the lateral department and positive anterior drawer and talar tilt tests in 7-10 days after the injury in 87% of cases shows the presence of ligament rupture. An algorithm for diagnosis of acute lateral ankle ligament injury was developed, which allowed us to determine differential indications for surgical repair of the ligaments and conservative treatment of these patients.

  3. Understanding acute ankle ligamentous sprain injury in sports

    Directory of Open Access Journals (Sweden)

    Fong Daniel TP

    2009-07-01

    Full Text Available Abstract This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing – a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms. Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60–90 ms. The failure supination or inversion torque is about 41–45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative

  4. Ankle ligament injuries

    Directory of Open Access Journals (Sweden)

    Per A.F.H. Renström

    1998-06-01

    Full Text Available Acute ankle ligament sprains are common injuries. The majority of these occur during athletic participation in the 15 to 35 year age range. Despite the frequency of the injury, diagnostic and treatment protocols have varied greatly. Lateral ligament complex injuries are by far the most common of the ankle sprains. Lateral ligament injuries typically occur during plantar flexion and inversion, which is the position of maximum stress on the anterotalofibular liagment (ATFL. For this reason, the ATFL is the most commonly torn ligament during an inversion injury. In more severe inversion injuries the calcaneofibular (CFL, posterotalofibular (PTFL and subtalar ligament can also be injured. Most acute lateral ankle ligament injuries recover quickly with nonoperative management. The treatment program, called "functional treatment," includes application of the RICE principle (rest, ice, compression, and elevation immediately after the injury, a short period of immobilization and protection with an elastic or inelastic tape or bandage, and early motion exercises followed by early weight bearing and neuromuscular ankle training. Proprioceptive training with a tilt board is commenced as soon as possible, usually after 3 to 4 weeks. The purpose is to improve the balance and neuromuscular control of the ankle. Sequelae after ankle ligament injuries are very common. As much as 10% to 30% of patients with a lateral ligament injury may have chronic symptoms. Symptoms usually include persistent synovitis or tendinitis, ankle stiffness, swelling, and pain, muscle weakness, and frequent giving-way. A well designed physical therapy program with peroneal strengthening and proprioceptive training, along with bracing and/or taping can alleviate instability problems in most patients. For cases of chronic instability that are refractory to bracing and external support, surgical treatment can be explored. If the chronic instability is associated with subtalar instability

  5. Mechanical instability after acute ankle ligament injury: randomized prospective comparison of two forms of conservative treatment

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    Marcelo Pires Prado

    2013-08-01

    Full Text Available OBJECTIVE: This trial has the objective to investigate the incidence of mechanical ankle instability after the conservative treatment of first episode, severe ankle ligamentar lesions. This common lesion affects young, professional and physical active patients, causing important personal and economic consequences. There are difficulties related to adequate diagnosis and treatment for these lesions. METHOD: 186 patients with severe ankle ligament lesions were included in this trial. They were randomized in two treatment options. In group A patients were treated using ankle long orthoosis, weight bearing allowed as confortable, pain care, ice, elevation with restricted joint mobilization for three weeks. After that they were maintained in short, functional orthosis (air cast, starting the reabilitation program. In group B patients were immobilized using a functional orthosis (air cast, following the same other sequences that patients in group A. RESULTS: We did not find significant differences in relation to the residual mechanical ankle instability between both groups. We did not find differences in the intensity of pain, but the functional evaluation using AOFAS score system showed better results in the functional treatment group. CONCLUSION: The functional treatment (Group B had better AOFAS score and few days off their professional activities, comparing with patients treated with rigid orthosis (Group A, without increased chance in developing ankle mechanical instability.

  6. Acute traumatic open posterolateral dislocation of the ankle without tearing of the tibiofibular syndesmosis ligaments: a case report.

    Science.gov (United States)

    Demiralp, Bahtiyar; Komurcu, Mahmut; Ozturk, Cagatay; Ozturan, Kutay; Tasatan, Ersin; Erler, Kaan

    2008-01-01

    Pure open dislocation of the ankle, or dislocation not accompanied by rupture of the tibiofibular syndesmosis ligaments or fractures of the malleoli or of the posterior border of the tibia, is an extremely rare injury. A 62-year-old man injured his right ankle in a motor vehicle accident. Besides posterolateral ankle dislocation, there was a 7-cm transverse skin cut on the medial malleolus, and the distal end of the tibia was exposed. After reduction, we made a 2- to 2.5-cm longitudinal incision on the lateral malleolus; the distal fibular fracture was exposed. Two Kirschner wires were placed intramedullary in a retrograde manner, and the fracture was stabilized. The deltoid ligament and the medial capsule were repaired. The tibiofibular syndesmosis ligaments were intact. At the end of postoperative year 1, right ankle joint range of motion had a limit of approximately 5 degrees in dorsiflexion, 10 degrees in plantarflexion, 5 degrees in inversion, and 0 degrees in eversion. The joint appeared normal on radiographs, with no signs of osteoarthritis or calcification. The best result can be obtained with early reduction, debridement, medial capsule and deltoid ligament restoration, and early rehabilitation. Clinical and radiographic features at long-term follow-up also confirm good mobility of the ankle without degenerative change or mechanical instability.

  7. Analysis of 3-dimensional finite element after reconstruction of impaired ankle deltoid ligament

    OpenAIRE

    Ji, Yunhan; Tang, Xianzhong; Li, Yifan; Xu, Wei; Qiu, Wenjun

    2016-01-01

    We compared four repair techniques for impaired ankle ligament deltoideum, namely Wiltberger, Deland, Kitaoka and Hintermann using a 3-dimensional finite element. We built an ankle ligament deltoideum model, including six pieces of bone structures, gristles and main ligaments around the ankle. After testing the model, we built an impaired ligament deltoideum model plus four reconstruction models. Subsequently, different levels of force on ankles with different flexion were imposed and ankle b...

  8. Analysis of the Effects of Normal Walking on Ankle Joint Contact Characteristics After Acute Inversion Ankle Sprain.

    Science.gov (United States)

    Bae, Ji Yong; Park, Kyung Soon; Seon, Jong Keun; Jeon, Insu

    2015-12-01

    To show the causal relationship between normal walking after various lateral ankle ligament (LAL) injuries caused by acute inversion ankle sprains and alterations in ankle joint contact characteristics, finite element simulations of normal walking were carried out using an intact ankle joint model and LAL injury models. A walking experiment using a volunteer with a normal ankle joint was performed to obtain the boundary conditions for the simulations and to support the appropriateness of the simulation results. Contact pressure and strain on the talus articular cartilage and anteroposterior and mediolateral translations of the talus were calculated. Ankles with ruptured anterior talofibular ligaments (ATFLs) had a higher likelihood of experiencing increased ankle joint contact pressures, strains and translations than ATFL-deficient ankles. In particular, ankles with ruptured ATFL + calcaneofibular ligaments and all ruptured ankles had a similar likelihood as the ATFL-ruptured ankles. The push off stance phase was the most likely situation for increased ankle joint contact pressures, strains and translations in LAL-injured ankles.

  9. MORPHOMETRIC STUDY OF MEDIAL COLLATERAL LIGAMENTS OF ANKLE

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    Neelu Prasad

    2016-06-01

    Full Text Available BACKGROUND The ankle joint is one of the most frequently injured joint. A sprained ankle results due to tear of anterior talofibular and calcaneofibular ligaments when the foot is twisted in lateral direction. In forcible eversion of the foot, the deltoid ligament may be torn. At times, the deltoid ligament pulls the medial malleolus thereby causing avulsion fracture of the malleolus. The strong eversion pull on the deltoid ligament causes transverse fracture of medial malleolus. If the tibia is carried anteriorly, the posterior margin of the distal end of the tibia is also broken by the talus producing a trimalleolar fracture. The talocrural joint is a major weight bearing joint of the body. The weight of the body is transmitted from the tibia and fibula to the talus which distributes the weight anteriorly and posteriorly within the foot. One sixth of the static load of the leg is carried by the fibula at the tibiofibular joint. These require a high degree of stability which is determined by the passive and dynamic factors. A sprained ankle results due to tear of anterior talofibular and calcaneofibular ligaments when the foot is twisted in lateral direction. In forcible eversion of the foot, the deltoid ligament may be torn. At times, the deltoid ligament pulls the medial malleolus thereby causing avulsion fracture of the malleolus. The strong eversion pull on the deltoid ligament causes transverse fracture of medial malleolus. If the tibia is carried anteriorly, the posterior margin of the distal end of the tibia is also broken by the talus producing a trimalleolar fracture. Conventionally, X-ray techniques have been used to diagnose ligament injuries. Magnetic resonance (MR imaging has opened new horizons in the diagnosis and treatment of many musculoskeletal diseases of the ankle and foot. It demonstrates abnormalities in the bones and soft tissues before they become evident at other imaging modalities. The anatomy of the deltoid ligament

  10. Common Types and Countermeasures of Ankle Ligament Injury ...

    African Journals Online (AJOL)

    2017-09-14

    Sep 14, 2017 ... different hospitals from June 2011 to June 2015 for stochastic ... injury of basketball players and promote physical rehabilitation of ... prone to ankle ligament injury in training or competition, which has a direct ... causing intense repeated impact of articular surface, ... However, without effective treatment,.

  11. Acute paediatric ankle trauma: MRI versus plain radiography

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    Lohman, M. [Helsinki Univ. Central Hospital (Finland). Dept. of Radiology; Radiological Dept., Helsinki University Central Hospital (Finland); Kivisaari, A.; Kivisaari, L. [Helsinki Univ. Central Hospital (Finland). Dept. of Radiology; Kallio, P.; Puntila, J. [Dept. of Paediatric Surgery, Hospital for Children and Adolescents, Helsinki Univ. Central Hospital, Helsinki (Finland); Vehmas, T. [Finnish Institute of Occupational Health, Helsinki (Finland)

    2001-09-01

    Objective: To evaluate the diagnosis of acute physeal ankle fractures on plain radiographs using MRI as the gold standard. Methods: Sixty consecutive children, 29 with a clinical diagnosis of lateral ligament injury and 31 with physeal ankle fractures, were examined using both radiographs and MRI in the acute period. The imaging data were reviewed by three ''masked'' radiologists. The fracture diagnosis and Slater-Harris classification of radiographs were compared with findings on MRI. Results: Plain radiography produced five of 28 (18%) false negative and 12 of 92 (13%) false positive fracture diagnoses compared with MRI. Six of the 12 false positive fractures were due to a misclassification of lateral ligament disruption as SH1 fractures. Altogether a difference was found in 21% of cases in either the diagnosis or the classification of the fractures according to Salter- Harris. All bone bruises in the distal tibia and fibula and 64% of bone bruises in the talus were seen in association with lateral ligament injuries. Talar bone bruises in association with fractures occurred on the same side as the malleolar fracture; talar bone bruises in association with lateral ligament disruption were seen in different locations. The errors identified on radiographs by MRI did not affect the management of the injury. Conclusions: The incidence of false negative ankle fractures in plain radiographs was small and no complex ankle fractures were missed on radiographs. The total extent of complex fractures was, however, not always obvious on radiographs. In an unselected series of relatively mild ankle injuries, we were unable to show a single case where the treatment or prognosis based on plain radiography should have been significantly altered after having done a routine MRI examination. Plain radiography is still the diagnostic cornerstone of paediatric ankle injuries. (orig.)

  12. Acute Ankle Sprains in Primary Care

    NARCIS (Netherlands)

    R.M. van Rijn (Rogier)

    2010-01-01

    textabstractOf all injuries of the musculoskeletal system, 25% are acute lateral ankle sprains.1 In the USA and the UK there are about 23,000 and 5000 ankle sprains, respectively, each day. In the Netherlands approximately 600,000 people sustain an ankle injury each year, of those 120,000 occur duri

  13. Analysis of 3-dimensional finite element after reconstruction of impaired ankle deltoid ligament.

    Science.gov (United States)

    Ji, Yunhan; Tang, Xianzhong; Li, Yifan; Xu, Wei; Qiu, Wenjun

    2016-12-01

    We compared four repair techniques for impaired ankle ligament deltoideum, namely Wiltberger, Deland, Kitaoka and Hintermann using a 3-dimensional finite element. We built an ankle ligament deltoideum model, including six pieces of bone structures, gristles and main ligaments around the ankle. After testing the model, we built an impaired ligament deltoideum model plus four reconstruction models. Subsequently, different levels of force on ankles with different flexion were imposed and ankle biomechanics were compared. In the course of bending, from plantar flexion 20° to back flexion 20°, the extortion of talus decreased while the eversion increased. Four reconstruction models failed to bring back the impaired ankle to normal, with an obvious increase of extortion and eversion. The Kitaoka technique was useful to reduce the extortion angle in a consequential manner. Compared with the other three techniques, the Kitaoka technique produced better results for extortion angle and the difference was statistically significant. However, in case of eversion, there was no significant difference among the four techniques (P>0.05). Lateral ligament's stress in all the four models was different from the normal one. When the ankle was imposed with extortion moment of force, stress of anterior talofibular ligament with the Kitaoka reconstruction method was close to that of the complete deltoid ligament. When ankle was imposed with eversion moment of force, stress of anterior talofibular ligament with Kitaoka and Deland reconstruction methods were close to that of the complete deltoid ligament. We concluded that Kitaoka and Deland tendon reconstruction technique could recover impaired ankle deltoid ligament and re-established its normal biomechanics characteristics.

  14. [Variations in the calcaneo-fibular ligament (lig. calcaneofibulare). Application to the kinematics of the ankle].

    Science.gov (United States)

    Trouilloud, P; Dia, A; Grammont, P; Gelle, M C; Autissier, J M

    1988-03-01

    The authors observe variations in the calcaneo-fibular ligament because this ligament controls two articulations, the talo-crural and the subtalar. This study is based on the dissection of the ankle of 20 specimens. The calcaneo-fibular ligament is reinforced by the ventral and lateral talo-calcaneus ligaments with variations. 3 types of disposition have been described. Type A: A lateral talo-calcaneal ligament reinforces the calcaneo-fibular ligament. These two ligaments are divergent on the proximal, medial, or distal part. Type B: There is an independent lateral talo-calcaneal ligament forward of the calcaneo-fibular ligament. Type C: A ventral talo-calcaneal ligament is observed, parallel to the interosseous ligament. The authors consider the consequences of variation in the lateral ligaments of the ankle for the functioning of the tibio-tarsal articulation, the subtalar articulation and the astragalo-scaphoid articulation in order to propose specific radiographic examination of the kinematics of the ankle.

  15. Assessment of acute foot and ankle sprains.

    Science.gov (United States)

    Lynam, Louise

    2006-07-01

    Acute ankle and foot trauma is a regular emergency presentation and prompt strategic assessment skills are required to enable nurses to categorise and prioritise these injuries appropriately. This article provides background information on the anatomy and physiology of the lower limb to help nurses to identify various grades of ankle sprain as well as injuries that are limb threatening

  16. Dynamic high-resolution US of ankle and midfoot ligaments: normal anatomic structure and imaging technique.

    Science.gov (United States)

    Sconfienza, Luca Maria; Orlandi, Davide; Lacelli, Francesca; Serafini, Giovanni; Silvestri, Enzo

    2015-01-01

    The ankle is the most frequently injured major joint in the body, and ankle sprains are frequently encountered in individuals playing football, basketball, and other team sports, in addition to occurring in the general population. Imaging plays a crucial role in the evaluation of ankle ligaments. Magnetic resonance imaging has been proven to provide excellent evaluation of ligaments around the ankle, with the ability to show associated intraarticular abnormalities, joint effusion, and bone marrow edema. Ultrasonography (US) performed with high-resolution broadband linear-array probes has become increasingly important in the assessment of ligaments around the ankle because it is low cost, fast, readily available, and free of ionizing radiation. US can provide a detailed depiction of normal anatomic structures and is effective for evaluating ligament integrity. In addition, US allows the performance of dynamic maneuvers, which may contribute to increased visibility of normal ligaments and improved detection of tears. In this article, the authors describe the US techniques for evaluation of the ankle and midfoot ligaments and include a brief review of the literature related to their basic anatomic structures and US of these structures. Short video clips showing dynamic maneuvers and dynamic real-time US of ankle and midfoot structures and their principal pathologic patterns are included as supplemental material. Use of a standardized imaging technique may help reduce the intrinsic operator dependence of US. Online supplemental material is available for this article.

  17. Comparison of Plain MRI and MR Arthrography in the Evaluation of Lateral Ligamentous Injury of the Ankle Joint

    Directory of Open Access Journals (Sweden)

    Mei-Chun Chou

    2006-01-01

    Conclusion: For evaluating ankle disability, using plain MRI alone is not adequate for correctly detecting lateral collateral ligamentous injury of the ankle joint. MR arthrography improves the sensitivity and the accuracy for ATaF and CF ligament injuries. It also helps in assessing coexisting pathologic lesions of ankle joints, especially impingement syndromes and osteochondral lesions, and provides more information for therapeutic decision making.

  18. Ultrasonography as a diagnostic tool in assessing deltoid ligament injury in supination external rotation fractures of the ankle.

    LENUS (Irish Health Repository)

    Henari, Shwan

    2011-10-01

    The medial deltoid ligament is the primary stabilizing structure in the ankle joint following lateral malleolar fracture. However, medial deltoid ligament ruptures are difficult to diagnose using current imaging modalities. We hypothesized that ultrasonography can be used to accurately allow early clinical assessment of ankle fracture stability, thereby negating the need to perform plain film stress views of the acutely injured ankle. This prospective study included 12 patients (age range, 18-72) with supination external rotation fractures requiring operative fixation. Following induction of anesthesia, ultrasonography examination was performed, followed by an arthrogram under fluoroscopic screening. Radiographs, ultrasonography, and arthrographic findings were compared. There was 100% correlation between ultrasonography and arthrogram findings. Ultrasonography accurately diagnosed medial deltoid rupture with a sensitivity of 100% and specificity of 100%. Plain film radiographs of the ankle had a sensitivity of 57.1% and a specificity of 60%. The difference between these was significant (χ(2)=.0091). This study demonstrates diagnostic ultrasonography to be an accurate diagnostic modality in assessing medial deltoid ligament integrity in patients with supination external rotation fractures. It offers the same sensitivity and specificity as arthrography without the need for additional invasive procedures. Its relative ease of use and lack of ionizing radiation make it a potentially useful tool, particularly in a busy trauma service.

  19. Biomechanical analysis of ankle ligamentous sprain injury cases from televised basketball games: Understanding when, how and why ligament failure occurs.

    Science.gov (United States)

    Panagiotakis, Emmanouil; Mok, Kam-Ming; Fong, Daniel Tik-Pui; Bull, Anthony M J

    2017-05-25

    Ankle sprains due to landing on an opponent's foot are common in basketball. There is no analysis to date that provides a quantification of this injury mechanism. The aim of this study was to quantify the kinematics of this specific injury mechanism and relate this to lateral ankle ligament biomechanics. Case series. The model-based image-matching technique was used to quantify calcaneo-fibular-talar kinematics during four ankle inversion sprain injury incidents in televised NBA basketball games. The four incidents follow the same injury pattern in which the players of interest step onto an opponent's foot with significant inversion and a diagnosed ankle injury. A geometric analysis was performed to calculate the in vivo ligament strains and strain rates for the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL). Despite the controlled selection of cases, the results show that there are two distinct injury mechanisms: sudden inversion and internal rotation with low levels of plantarflexion; and a similar mechanism without internal rotation. The first of these mechanisms results in high ATFL and CFL strains, whereas the second of these strains the CFL in isolation. The injury mechanism combined with measures of the ligament injury in terms of percentage of strain to failure correlate directly with the severity of the injury quantified by return-to-sport. The opportunity to control excessive internal rotation through proprioceptive training and/or prophylactic footwear or bracing could be utilised to reduce the severity of common ankle injuries in basketball. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  20. Ankle Cheilectomy

    Science.gov (United States)

    ... your primary doctor. Treatments of the Ankle Achilles Tendinosis Surgery Achilles Tendon Rupture Surgery Ankle Arthrodesis Ankle ... for Osteochondral Lesions of the Talus Insertional Achilles Tendinosis Surgery Lateral Ankle Ligament Reconstruction Lateral Ankle Stabilization ...

  1. Mobility of the ankle joint: recording of rotatory movements in the talocrural joint in vitro with and without the lateral collateral ligaments of the ankle.

    Science.gov (United States)

    Rasmussen, O; Tovborg-Jensen, I

    1982-02-01

    A method for graphic recording of rotatory movements in osteoligamentous ankle preparations is described. By this method it is possible to record characteristic mobility patterns in two planes at the same time. The ankle is affected by a known torque, so that the individual mobility patterns are reproducible with unchanged condition of the ligaments. Six amputated legs were investigated in the sagittal and horizontal planes and another six in the sagittal and frontal planes. Mobility patterns were recorded with intact ligaments and after successive cutting of the lateral collateral ligaments of the ankle in the anteroposterior direction. In the sagittal plane increased dorsiflexion was observed after total cutting of the lateral ligaments, while plantar flexion remained unchanged. In the horizontal plane the internal rotation of the talus increased in step with increasing injury to the ligament, particularly when the ankle was plantar flexed. When all collateral ligaments had been cut, an increase in external rotation occurred, especially in dorsiflexion. In the frontal plane the talar tilt increased gradually with increasing injury to the ligaments. Talar tilt was at a maximum in the neutral position of the ankle or in plantar flexion. After total severing of the collateral ligaments, however, talar tilt was most marked in dorsiflexion of the ankle.

  2. Peroneal tendinosis as a predisposing factor for the acute lateral ankle sprain in runners.

    Science.gov (United States)

    Ziai, Pejman; Benca, Emir; Wenzel, Florian; Schuh, Reinhard; Krall, Christoph; Auffahrt, Alexander; Hofstetter, Martin; Windhager, Reinhard; Buchhorn, Tomas

    2016-04-01

    A painful episode in the region of the peroneal tendons, within the retromalleolar groove, is a common precipitating event of an acute lateral ankle sprain. A forefoot striking pattern is suspected to cause peroneal tendinosis. The aim of this study is to analyse the role of peroneal tendinosis as a predisposing factor for ankle sprain trauma in runners. Fifty-eight runners who had experienced acute ankle sprain trauma, with pre-existing pain episodes for up to 4 weeks in the region of the peroneal tendons, were assessed clinically. Fractures were excluded by conventional radiography. An magnetic resonance imaging (MRI) scan had been performed within 14 days after the traumatic event and was subsequently evaluated by two experienced radiologists. MRI revealed peroneal tendinosis in 55 patients (95% of the total study population). Peroneus brevis (PB) tendinosis was found in 48 patients (87% of all patients with peroneal tendinosis), and peroneus longus (PL) tendinosis was observed in 42 cases (76%). Thirty-five patients (64%) had combined PB and PL tendinosis. A lesion of the anterior talofibular ligament was found to be the most common ligament injury associated with peroneal tendinosis (29 cases; 53%), followed by a lesion of the calcaneofibular ligament (16 cases; 29%) and a lesion of the posterior tibiofibular ligament (13 cases; 24%). The results of this study reflect the correlation between peroneal tendinosis and ankle sprain trauma. Injuries of one or more ligaments are associated with further complications. A period of rest or forbearance of sports as well as adequate treatment of the peroneal tendinosis is essential to prevent subsequent ankle injuries, especially in runners. Modification of the running technique would also be beneficial. IV.

  3. Elastic properties of Thiel-embalmed human ankle tendon and ligament.

    Science.gov (United States)

    Liao, Xiaochun; Kemp, Sandy; Corner, George; Eisma, Roos; Huang, Zhihong

    2015-10-01

    Thiel embalming is recommended as an alternative to formalin-based embalming because it preserves tissue elasticity, color, and flexibility in the long term, with low infection and toxicity risk. The degree to which Thiel embalming preserves elasticity has so far been assessed mainly by subjective scoring, with little quantitative verification. The aim of this study is to quantify the effect of Thiel embalming on the elastic properties of human ankle tendons and ligament. Biomechanical tensile tests were carried out on six Thiel-embalmed samples each of the peroneus longus, peroneus brevis, and calcaneal tendons, and the calcaneofibular ligament, with strain rates of 0.25%s(-1), 2%s(-1), and 8%s(-1). The stress-strain relationship was calculated from the force-extension response with cross-sectional area and gauge length. Young's modulus was determined from the stress-strain curve. The results showed that the tendon and ligament elasticity were lower after Thiel embalming than the literature values for fresh nonembalmed tendons and ligament. The biomechanical tensile test showed that the measured elasticity of Thiel-embalmed tendons and ligaments increased with the strain rate. The Thiel embalming method is useful for preserving human ankle tendons and ligaments for anatomy and surgery teaching and research, but users need to be aware of its softening effects. The method retains the mechanical strain rate effect on tendons and ligament. © 2015 Wiley Periodicals, Inc.

  4. Arthroscopic anatomical reconstruction of the lateral ankle ligaments: A technical simplification.

    Science.gov (United States)

    Lopes, R; Decante, C; Geffroy, L; Brulefert, K; Noailles, T

    2016-12-01

    Anatomical reconstruction of the lateral ankle ligaments has become a pivotal component of the treatment strategy for chronic ankle instability. The recently described arthroscopic version of this procedure is indispensable to ensure that concomitant lesions are appropriately managed, yet remains technically demanding. Here, we describe a simplified variant involving percutaneous creation of the calcaneal tunnel for the distal attachment of the calcaneo-fibular ligament. The rationale for this technical stratagem was provided by a preliminary cadaver study that demonstrated a correlation between the lateral malleolus and the distal footprint of the calcaneo-fibular ligament. The main objectives are simplification of the operative technique and decreased injury to tissues whose function is crucial to the recovery of proprioception. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  5. Is there a Relationship between Bone Morphology and Injured Ligament on Imaging Studies and Laxity on Ankle Stress Radiographs?

    Science.gov (United States)

    Lee, S Y; Kwon, S-S; Park, M S; Chung, M K; Kim, K B; Koo, S; Lee, K M

    2016-12-01

    This study aimed to investigate the relationship between bone morphology and injured ligaments on imaging studies and laxity on ankle stress radiographs in patients with lateral ankle instability. 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. Age (p=0.041), sex (p=0.014), degree of anterior talofibular ligament injury (pcorrelated with tibiotalar tilt angle. Fibular position and degree of posterior talofibular ligament injury were factors significantly related to anterior translation of the talus. 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. © Georg Thieme Verlag KG Stuttgart · New York.

  6. Treatment for acute anterior cruciate ligament tear

    DEFF Research Database (Denmark)

    Frobell, Richard B; Roos, Harald P; Roos, Ewa M

    2013-01-01

    To compare, in young active adults with an acute anterior cruciate ligament (ACL) tear, the mid-term (five year) patient reported and radiographic outcomes between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed ACL...

  7. Treatment for acute anterior cruciate ligament tear

    DEFF Research Database (Denmark)

    Frobell, Richard B; Roos, Harald P; Roos, Ewa M

    2015-01-01

    STUDY QUESTION: In young active adults with an acute anterior cruciate ligament (ACL) rupture, do patient reported or radiographic outcomes after five years differ between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed ACL...

  8. Predicting functional recovery after acute ankle sprain.

    Directory of Open Access Journals (Sweden)

    Sean R O'Connor

    Full Text Available INTRODUCTION: Ankle sprains are among the most common acute musculoskeletal conditions presenting to primary care. Their clinical course is variable but there are limited recommendations on prognostic factors. Our primary aim was to identify clinical predictors of short and medium term functional recovery after ankle sprain. METHODS: A secondary analysis of data from adult participants (N = 85 with an acute ankle sprain, enrolled in a randomized controlled trial was undertaken. The predictive value of variables (age, BMI, gender, injury mechanism, previous injury, weight-bearing status, medial joint line pain, pain during weight-bearing dorsiflexion and lateral hop test recorded at baseline and at 4 weeks post injury were investigated for their prognostic ability. Recovery was determined from measures of subjective ankle function at short (4 weeks and medium term (4 months follow ups. Multivariate stepwise linear regression analyses were undertaken to evaluate the association between the aforementioned variables and functional recovery. RESULTS: Greater age, greater injury grade and weight-bearing status at baseline were associated with lower function at 4 weeks post injury (p<0.01; adjusted R square=0.34. Greater age, weight-bearing status at baseline and non-inversion injury mechanisms were associated with lower function at 4 months (p<0.01; adjusted R square=0.20. Pain on medial palpation and pain on dorsiflexion at 4 weeks were the most valuable prognostic indicators of function at 4 months (p< 0.01; adjusted R square=0.49. CONCLUSION: The results of the present study provide further evidence that ankle sprains have a variable clinical course. Age, injury grade, mechanism and weight-bearing status at baseline provide some prognostic information for short and medium term recovery. Clinical assessment variables at 4 weeks were the strongest predictors of recovery, explaining 50% of the variance in ankle function at 4 months. Further

  9. Joint mobilization acutely improves landing kinematics in chronic ankle instability.

    Science.gov (United States)

    Delahunt, Eamonn; Cusack, Kim; Wilson, Laura; Doherty, Cailbhe

    2013-03-01

    The objective of this study is to examine the acute effect of ankle joint mobilizations akin to those performed in everyday clinical practice on sagittal plane ankle joint kinematics during a single-leg drop landing in participants with chronic ankle instability (CAI). Fifteen participants with self-reported CAI (defined as mobilizations performed included Mulligan talocrural joint dorsiflexion mobilization with movement, Mulligan inferior tibiofibular joint mobilization, and Maitland anteroposterior talocrural joint mobilization. Three CODA cx1 units (Charnwood Dynamics Ltd., Leicestershire, UK) were used to provide information on ankle joint sagittal plane angular displacement. The dependent variable under investigation was the angle of ankle joint plantarflexion at the point of initial contact during the drop landing. There was a statistically significant acute decrease in the angle of ankle joint plantarflexion from premobilization (34.89° ± 4.18°) to postmobilization (31.90° ± 5.89°), t(14) = 2.62, P mobilization was 2.98° with a 95% confidence interval ranging from 0.54 to 5.43. The eta squared statistic (0.32) indicated a large effect size. These results indicate that mobilization acted to acutely reduce the angle of ankle joint plantarflexion at initial contact during a single-leg drop landing. Mobilization applied to participants with CAI has a mechanical effect on the ankle joint, thus facilitating a more favorable positioning of the ankle joint when landing from a jump.

  10. Magnetic resonance imaging of ankle ligaments and tendon injuries; Trauma von Bandapparat und Sehnen. Untersuchungstechnik und Nachweis in der MRT

    Energy Technology Data Exchange (ETDEWEB)

    Breitenseher, M. [Abt. fuer Osteoradiologie, Universitaetsklinik und MR-Institut der Medizinischen Fakultaet, Univ. Wien (Austria)]|[Ludwig Boltzmann-Institut fuer Radiologische Tumordiagnostik, Wien (Austria); Trattnig, S. [Abt. fuer Osteoradiologie, Universitaetsklinik und MR-Institut der Medizinischen Fakultaet, Univ. Wien (Austria)]|[Ludwig Boltzmann-Institut fuer Radiologische Tumordiagnostik, Wien (Austria); Kukla, C. [Universitaetsklinik fuer Unfallchirurgie, Wien (Austria); Daebler, C. [Universitaetsklinik fuer Unfallchirurgie, Wien (Austria); Helbich, T. [Abt. fuer Osteoradiologie, Universitaetsklinik und MR-Institut der Medizinischen Fakultaet, Univ. Wien (Austria)]|[Ludwig Boltzmann-Institut fuer Radiologische Tumordiagnostik, Wien (Austria); Haller, J. [Abt. fuer Osteoradiologie, Universitaetsklinik und MR-Institut der Medizinischen Fakultaet, Univ. Wien (Austria)]|[Ludwig Boltzmann-Institut fuer Osteologie, Wien (Austria); Imhof, H. [Abt. fuer Osteoradiologie, Universitaetsklinik und MR-Institut der Medizinischen Fakultaet, Univ. Wien (Austria)]|[Ludwig Boltzmann-Institut fuer Radiologische Tumordiagnostik, Wien (Austria)

    1995-07-01

    Today MRI allows evaluation of the integrity of injured ankle ligaments. The major difficulty in MRI is inconsistency in visualization by inadequate appreciation of the three-dimensional orientation of each ankle ligament. Using this technique, 52 patients with sprained ankles underwent MRI. The integrity of rupture of the collateral lateral ligaments was obtained in all 52 ankles. Full-lenght visualization is essential for evaluation of the ankle ligaments with MRI. In these 52 patients the angle of tilt on the stress X-ray was compared with the rate of MRI findings showing an injury affecting two ligaments. We found that none of the patients in whom the angle of lateral tilt was less than 5 had rupture of two laterial ligaments, while 32% of patients with angles of tilt of 6-14 and 42% of those with angles of tilt over 15 on stress X-ray had two ruptured lateral ligaments. The advantages of MRI are that it offers the best visualization of the extent of the tendon lesion. MRI, however, seems to be superior to US in detecting and quantifying lesions of the Achilles tendon. Therefore, MRI may be indicated in particularly difficult cases of tendons injuries in the foot. (orig.) [Deutsch] Die MRT erlaubt die ausgezeichnete direkte Darstellung und sicheren Nachweis der Bandverletzung. Mit dieser Methode wurden 52 Patienten untersucht. In allen Faellen konnten die lateralen Sprunggelenkbaender bzw. Bandrupturen nachgewiesen werden. Zur optimalen Banddarstellung am Sprunggelenk ist es notwendig, die Untersuchungsebene dem Banverlauf anzupassen. Bei diesen 52 Patienten wurde der Winkel der Aufklappbarkeit in der Stressradiographie mit der Rate von Zeibandverleztungen in der MRT verglichen. Es zeigte sich, dass in der Gruppe mit einer lateralen Aufklappbarkeit {<=}5 keine Zweibandverletzung, in der Gruppe von 6-14 in 32% Zweibandverletzungen und in der Gruppe von {>=}15 42% Zweibandverletzungen vorlagen. Bei inkonklusivem Ultraschall und komplexen Sehnenveraenderungen ist

  11. Unrecognised Acute Rupture of the Achilles Tendon in Severe Ankle Sprain

    Directory of Open Access Journals (Sweden)

    Kin Wai Lam

    2015-12-01

    Full Text Available Inversion ankle sprain is a common sport injury. It commonly refers to the injury of lateral collateral ligaments of the ankle. Failure to detect the concomitant injuries would lead to inappropriate treatment and suboptimal result. A case of unrecognised rupture of the Achilles tendon in a patient with severe inversion ankle sprain is reported.

  12. Operative versus non-operative treatments of acute injury to the lateral ankle ligaments: a systematic review%急性踝关节外侧副韧带损伤手术与非手术治疗的Meta分析

    Institute of Scientific and Technical Information of China (English)

    吴显奎; 孙永建; 金丹

    2012-01-01

    Objective To systematically compare the operative and non-operative treatments of acute injury to the lateral ankle ligaments in terms of efficacy and complications.Methods The databases of MEDLINE (From January 1966 to October 2011 ),EMBASE (From January 1988 to October 2011 ),CBMdisc (From January 1978 to October 2011) and CNKI (From January 1980 to October 2011 ) were researched for eligible randomized-controlled trials (RCTs),controlled clinical trials,quasi randomized controlled trials and cohort study which compared operative and non-operative treatments for acute injury to the lateral ankle ligaments.The methodological quality of the eligible studies collected was evaluated.The data of the studies included were extracted for a Meta analysis to compare the motional recovery,functional stability,re-injury,residual pain and post-treatment complications of the ankle between operative and non-operative treatments.RevMan 5.0 software was used for statistical analysis.Results In all the eligible 13 studies included,713 patients were treated operatively and 817 patients non-operatively.The functional stability of the ankle was significantly better in the operative treatment group than in the non-operative treatment group [ OR =0.72,95% CI,(0.52,0.99),P < 0.05].The incidence of ankle arthrocleisis in the operative treatment group was significantly higher than in the non-operative treatment group [ OR =3.41,95% CI (1.56,7.44),P =0.002].There were no statistical differences in the motional recovery [ OR =1.14,95% CI (0.58,2.21),P> 0.05],incidence ofre-injury [OR=0.68,95% CI (0.35,1.31),P>0.05],residual pain [ OR =0.81,95% CI(0.56,1.16),P> 0.05],or ankle dyskinesia [ OR =2.38,95% CI (0.91,6.25),P> 0.05]between the 2 groups.The incidences,scar tenderness [01R=7.46,95%CI(1.32,42.08),P <0.05]and sensory nerve loss [OR=12.16,95% CI(2.24,66.02),P <0.05]were significantly higher in the operative treatment group than in the non-operative treatment

  13. Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature

    NARCIS (Netherlands)

    van den Bekerom, M.P.J.; Mutsaerts, E.L.A.R.; van Dijk, C.N.

    2009-01-01

    BACKGROUND AND PURPOSE: Review the literature concerning modalities to evaluate the integrity of the deltoid ligament in patients with supination external rotation ankle fractures. METHODS: The electronic databases Pubmed/Medline, CINAHL and Embase were searched from 1987 to November 2007 to

  14. Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature

    NARCIS (Netherlands)

    van den Bekerom, M.P.J.; Mutsaerts, E.L.A.R.; van Dijk, C.N.

    2009-01-01

    BACKGROUND AND PURPOSE: Review the literature concerning modalities to evaluate the integrity of the deltoid ligament in patients with supination external rotation ankle fractures. METHODS: The electronic databases Pubmed/Medline, CINAHL and Embase were searched from 1987 to November 2007 to identif

  15. Acute inversion injury of the ankle without radiological abnormalities: assessment with high-field MR imaging and correlation of findings with clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Langner, Inga; Frank, Matthias; Hinz, Peter; Ekkernkamp, Axel [Ernst-Moritz-Arndt-University Greifswald, Department of Trauma and Orthopedic Surgery, Emergency Department, Greifswald (Germany); Kuehn, Jens Peter; Hosten, Norbert; Langner, Soenke [Ernst-Moritz-Arndt-University Greifswald, Institute for Diagnostic Radiology and Neuroradiology, Greifswald (Germany)

    2011-04-15

    Acute inversion injuries of the ankle are the most common sports accidents, accounting for approximately 10% of emergency room admissions. In up to 85%, an injury of the lateral collateral ligaments is observed. Classically, the assessment of these injuries has relied on clinical examination and radiographs, including stress views. The aim of our study was to correlate prospectively the findings of high-field 3 T MRI in acute ankle distortion with clinical outcome. During a 6-month period, 38 patients were prospectively included. MRI was performed within 48 h of trauma and clinical examination using a protocol consisting of axial T2-weighted and coronal and sagittal T1-weighted images and a sagittal proton density (PDw) sequence. Each ligament injury was graded on a three-point scale. Functional outcome was evaluated using the AOFAS ankle-hindfoot scale. In 24/38 patients (63.12%), ligament injury was observed. In 22/24 cases, this was an injury of the lateral ligaments and in 2/24 cases of the medial ligaments. Injury of the syndesmosis occurred in three patients, a bone bruise in four, and an osteochondral lesion in three cases. Patients with an injury of two or more ligaments or a bone bruise had a lower AOFAS score and returned to sports activities and full weight-bearing later (P < 0.01). MR imaging at 3 Tesla is an independent predictor for clinical outcome. Therefore MRI may be beneficial in those cases where the findings influence further treatment. (orig.)

  16. Anatomy of the inferior extensor retinaculum and its role in lateral ankle ligament reconstruction: a pictorial essay.

    Science.gov (United States)

    Dalmau-Pastor, M; Yasui, Y; Calder, J D; Karlsson, J; Kerkhoffs, G M M J; Kennedy, J G

    2016-04-01

    The inferior extensor retinaculum (IER) is an aponeurotic structure, which is in continuation with the anterior part of the sural fascia. The IER has often been used to augment the reconstruction of the lateral ankle ligaments, for instance in the Broström-Gould procedure, with good outcomes reported. However, its anatomy has not been described in detail and only a few studies are available on this structure. The presence of a non-constant oblique supero-lateral band appears to be important. This structure defines whether the augmentation of the lateral ankle ligaments reconstruction is performed using true IER or only the anterior part of the sural fascia. It is concluded that the use of this structure will have an impact on the resulting ankle stability.

  17. Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature.

    Science.gov (United States)

    van den Bekerom, Michel P J; Mutsaerts, Eduard L A R; van Dijk, C Niek

    2009-02-01

    Review the literature concerning modalities to evaluate the integrity of the deltoid ligament in patients with supination external rotation ankle fractures. The electronic databases Pubmed/Medline, CINAHL and Embase were searched from 1987 to November 2007 to identify all published original studies concerning diagnostic modalities to evaluate the integrity of the deltoid ligament in adult ankle fractures. This review included nine studies involving 423 ankle fractures. Three trails investigated medial tenderness; two studies, ecchymosis; two studies, swelling; one study, an injury radiograph; six studies, a type of radiographic stress view; one study, the Lauge-Hansen classification; one study, MRI; and one article studied arthroscopy in the evaluation of the deltoid ligament integrity. Swelling, ecchymosis, medial tenderness, initial injury radiographs and the Lauge-Hansen classification are less adequate predictors of the integrity of the deltoid ligament. Manual or the less painful variant, the gravity external rotation stress radiographs are considered the gold standard. The amount of medial clear space widening indicative of a positive external rotation stress test has been somewhat variable in the literature but > or =5 mm is generally regarded as most reliable. Achieving adequate external rotation of the foot when obtaining stress radiographs is more important than positioning the ankle in the appropriate degree of ankle flexion. The amount of applied force necessary when performing an external rotation stress radiograph is not well defined and mainly determined by the patient's pain level. The indication for surgery should not be based on the absolute value of one parameter but on the combination of several parameters. If nonoperative treatment is chosen despite a positive stress radiograph, close follow-up is critical because subluxation of the ankle joint is still possible. MRI could be useful in individual cases.

  18. Electrical stimulation as a treatment intervention to improve function, edema or pain following acute lateral ankle sprains: A systematic review.

    Science.gov (United States)

    Feger, Mark A; Goetschius, John; Love, Hailey; Saliba, Sue A; Hertel, Jay

    2015-11-01

    The purpose of this systematic review was to assess whether electrical stimulation (ES), when used in conjunction with a standard treatment, can reduce levels of functional impairment, edema, and pain compared to a standard treatment alone, in patients following a lateral ankle sprain. We searched PubMed, CINAHL, SportDiscus, and Medline (OVID) databases through June 2014 using the terms "ankle sprain or ankle sprains or ligament injury or ligamentous injury," and "electric stimulation or electric stimulation or electrotherapy." Our search identified four randomized control trials, of which, neuromuscular ES and high-voltage pulsed stimulation were the only two ES modalities utilized. Effect sizes and 95% confidence intervals (CI) were estimated using Cohen's d for comparison between treatment groups. Three of four effect sizes for function had 95% CI that crossed zero. Twenty-four of the thirty-two effect sizes for edema had 95% CI that crossed zero. All effect sizes for pain had 95% CI that crossed zero. Therefore, the use of ES is not recommended as a means to improve function, reduce edema, or decrease pain in the treatment of acute lateral ankle sprains.

  19. [Long-term results of active-passive ligament repair of the external lateral ligament of the ankle].

    Science.gov (United States)

    Farizon, F; Paris, D; Azoulai, J J; Bousquet, G

    1996-03-01

    We reviewed 95 ankles at an average of 9 years after an "activo-passive" operation performed for chronic lateral instability. All the patients had suffered recurrent ankle sprain or instability, with pain in 67 patients. Ten ankles showed a subtalar injury at operation. Degenerative changes were noted in 11 ankle joints. On review, 81 ankles (85%) were stable. The 14 cases with persistent instability had developed the problem one to five years after operation. Two cases presented with limitation in mobility. Osteoarthritis, found in 15 ankles, was severe in only two, and had been present on preoperative films. We found no correlation between functional results (talar tilt, anterior-drawer test) and radiological evaluation. The "activo-passive" operation provides long-term stabilization with preservation of the ankle and of subtalar mobility without severe osteoarthritis.

  20. Round ligament lipoma mimicking acute appendicitis in a 24-week pregnant female: a case report.

    Science.gov (United States)

    Miller, T J; Paulk, D G

    2013-04-01

    An exhaustive search of the literature using the Pub Med database revealed no reports of round ligament lipomas mimicking acute appendicitis in pregnant patients. There are relatively few articles on round ligament lipomas and even less on round ligament lipomas during pregnancy. This case report is on a 27-year-old 24-week pregnant female who presented with signs and symptoms similar to acute appendicitis who in fact had a large right pelvic round ligament lipoma that was causing her pain.

  1. Acute longitudinal ligament rupture following acute spinal trauma

    Directory of Open Access Journals (Sweden)

    Donald Hansom

    2014-06-01

    Full Text Available The authors present a rare case of anterior longitudinal ligament (ALL rupture in a 47- year-old gentleman following a bicycle accident. The ALL is a continuous band of a variable thickness that acts as a primary spinal stabiliser. Stress, strain or rupture of the ALL usually occurs as a result of hyperextension, with the primary perpetrator being whiplash injuries. Such injuries have been shown to result in cervical spine instability during extension, axial rotation, and lateral bending modes. Spine radiographs of such patients may be routinely assessed as normal, therefore this specific type of injury does not lend itself to identification by traditional imaging methods. This account demonstrates the importance of having a high index of suspicion of a ligamentous neck injury in the setting of normal plain radiographs but abnormal clinical examination.

  2. Clinical observation of acupuncture treatment combination of functional exercise on acute grade Ⅲ ankle lateral collateral ligament injury%推拿按摩联合功能锻炼治疗运动所致Ⅲ度急性踝外侧副韧带损伤临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    黄雅雯

    2012-01-01

    OBJECTIVE To evaluate the effect of Chinese Massage combined with functional exercises in the treatment acute grade Ⅲ ankle sprain injury caused by football sport. METHODS 160 cases acute grade Ⅲ ankle sprain injury caused by football sport were selected from our college during September 2004 to September 2009, and they were randomly divided into experimental and control group. Joint functional exercise alone was used to the control group, acupuncture combined with func?tional exercises were administrated to the experiment group, and the treatment cycle was defined to 24 weeks. AOFAS score and the efficacy were compared after 3 months or 1 year treatment. RESULTS After 3 months or 1 year treatment, the AOFAS score of experimental group was significantly higher than that of the control group (P < 0.05), and the fineness rate of soft tissue injury of the experimental group had significantly higher than that of the control group (P< 0.05). CONCLUSION Chinese Massage combined with functional exercises has remarkable effect on treatment of acute ankle sprain Ⅲ.%目的 研究推拿按摩联合功能锻炼在足球运动所致Ⅲ度急性踝扭伤功能治疗中的作用.方法 2004年9月~2009年9月,从某校选取160例由于足球运动所致Ⅲ度踝扭伤患者,随机分为实验组和对照组,实验组采用推拿按摩联合功能锻炼,对照组恢复期单纯应用功能锻炼疗法治疗,治疗周期均为24周.采用AOFAS评分和软组织损伤疗效标准比较治疗效果.结果 治疗后3个月或1年后,实验组的AOFAS评分均明显优于对照组,差异有统计学意义(P<0.05),且实验组的软组织损伤疗效优良率明显高于对照组,差异有统计学意义(P< 0.05).结论 推拿按摩联合功能锻炼治疗对Ⅲ度急性踝扭伤效果显著,并可减少后遗症的发生.

  3. TO COMPARE THE EFFECTIVENESS OF CRYOTHERAPY WITH EXERCISES VERSUS TAPING WITH EXERCISES IN TREATING ACUTE LATERAL ANKLE SPRAIN

    Directory of Open Access Journals (Sweden)

    Suresh

    2014-12-01

    Full Text Available BACKGROUND: Ankle sprain is a common form of sport injuries and it is a leading cause of pain and disability in common man and sportsman worldwide. Rate of this injury is 1 per 10, 000 persons in common man whereas lateral ligament injuries account for 15 to 25% of all sports injuries. Lateral ankle sprains are one of the most common injuries sustained in sports and exercise activities. It is one of the most common soft tissue injury encountered in clinical practice. Complications such as prolonged ankle pain, a high recurrence rate, and chronic laxity underline the importance of careful diagnosis and treatment of ankle sprain. Physical therapy such as cryotherapy and taping technique are frequently used and have been cited that use of cryotherapy and taping technique have shown significant improvement in relieving pain and improving functional ability. OBJECTIVES: This study is intended to find and compare the effectiveness of Cryotherapy and exercises versus taping and exercises in acute lateral ankle sprain. DESIGN: A comparative study. SETTING: Kempegowda department of Orthopaedics and Rehabilitation unit-Kempegowda institute of physiotherapy. SUBJECTS: 40 patients (20 in each group. INTERVENTION: Forty males and female patients with lateral ankle sprain belonging to an age group of 15-35 years were selected for the study who fulfilled the inclusion and exclusion criteria and were divided into two groups. Group A was treated with Cryotherapy and exercises and group B was treated with taping and exercises with a frequency of 7 sittings for one week. Treatment outcomes were assessed using VAS, ROM, and LEFS for pain and functional ability. OUTCOME MEASURES: VAS to measure pain intensity, ROM for stiffness and Lower extremity functional scale for functional ability. RESULT: In comparison with VAS, ROM and LEFS, Group B shows significant improvement of all the parameters than Group A. INTERPRETATION & CONCLUSION: Study findings concluded that

  4. Surgical Reconstruction with the Remnant Ligament Improves Joint Position Sense as well as Functional Ankle Instability: A 1-Year Follow-Up Study

    Directory of Open Access Journals (Sweden)

    Kamizato Iwao

    2014-01-01

    Full Text Available Introduction. Chronic functional instability—characterized by repeated ankle inversion sprains and a subjective sensation of instability—is one of the most common residual disabilities after an inversion sprain. However, whether surgical reconstruction improves sensorimotor control has not been reported to date. The purpose of this study was to assess functional improvement of chronic ankle instability after surgical reconstruction using the remnant ligament. Materials and Methods. We performed 10 cases in the intervention group and 20 healthy individuals as the control group. Before and after surgical reconstruction, we evaluated joint position sense and functional ankle instability by means of a questionnaire. Results and Discussion. There was a statistically significant difference between the control and intervention groups before surgical reconstruction. Three months after surgery in the intervention group, the joint position sense was significantly different from those found preoperatively. Before surgery, the mean score of functional ankle instability in the intervention group was almost twice as low. Three months after surgery, however, the score significantly increased. The results showed that surgical reconstruction using the remnant ligament was effective not only for improving mechanical retensioning but also for ameliorating joint position sense and functional ankle instability.

  5. Effects of soft bracing or taping on a lateral ankle sprain : a non-randomised controlled trial evaluating recurrence rates and residual symptoms at one year

    NARCIS (Netherlands)

    Kemler, Ellen; van de Port, Ingrid; Schmikli, Sandor; Huisstede, Bionka; Hoes, Arno; Backx, Frank

    2015-01-01

    Background: After sustaining an ankle sprain, taping is often the standard treatment in primary care. Ankle braces are sometimes used as an alternative. This study aimed to compare the effects of four weeks of soft bracing or taping following acute lateral ankle ligamentous sprain (ALALS) on sprain

  6. Anterolateral ligament abnormalities in patients with acute anterior cruciate ligament rupture are associated with lateral meniscal and osseous injuries

    Energy Technology Data Exchange (ETDEWEB)

    Dyck, Pieter van; Smet, Eline de; Gielen, Jan L.; Parizel, Paul M. [Antwerp University Hospital and University of Antwerp, Department of Radiology, Antwerp (Belgium); Clockaerts, Stefan [University College Hospitals, Department of Orthopaedics, London (United Kingdom); Vanhoenacker, Filip M. [Antwerp University Hospital and University of Antwerp, Department of Radiology, Antwerp (Belgium); Ghent University Hospital and University of Ghent, Department of Radiology, Ghent (Belgium); AZ St-Maarten, Department of Radiology, Antwerp (Belgium); Lambrecht, Valerie [Ghent University Hospital and University of Ghent, Department of Radiology, Ghent (Belgium); Wouters, Kristien [Antwerp University Hospital and University of Antwerp, Department of Biostatistics, Antwerp (Belgium)

    2016-10-15

    To determine the frequency of anterolateral ligament (ALL) injury in patients with acute anterior cruciate ligament (ACL) rupture and to analyse its associated injury patterns. Ninety patients with acute ACL rupture for which MRI was obtained within 8 weeks after the initial trauma were retrospectively identified. Two radiologists assessed the status of the ALL on MRI by consensus. The presence or absence of an ALL abnormality was compared with the existence of medial and lateral meniscal tears diagnosed during arthroscopy. Associated collateral ligament and osseous injuries were documented with MRI. Forty-one of 90 knees (46 %) demonstrated ALL abnormalities on MRI. Of 49 knees with intact ALL, 15 (31 %) had a torn lateral meniscus as compared to 25 torn lateral menisci in 41 knees (61 %) with abnormal ALL (p = 0.008). Collateral ligament (p ≤ 0.05) and osseous injuries (p = 0.0037) were more frequent and severe in ALL-injured as compared with ALL-intact knees. ALL injuries are fairly common in patients with acute ACL rupture and are statistically significantly associated with lateral meniscal, collateral ligament and osseous injuries. (orig.)

  7. Posterior ankle impingement.

    Science.gov (United States)

    Giannini, Sandro; Buda, Roberto; Mosca, Massimiliano; Parma, Alessandro; Di Caprio, Francesco

    2013-03-01

    Posterior ankle impingement is a common cause of chronic ankle pain and results from compression of bony or soft tissue structures during ankle plantar flexion. Bony impingement is most commonly related to an os trigonum or prominent trigonal process. Posteromedial soft tissue impingement generally arises from an inversion injury, with compression of the posterior tibiotalar ligament between the medial malleolus and talus. Posterolateral soft tissue impingement is caused by an accessory ligament, the posterior intermalleolar ligament, which spans the posterior ankle between the posterior tibiofibular and posterior talofibular ligaments. Finally, anomalous muscles have also been described as a cause of posterior impingement.

  8. 踝关节内侧韧带损伤及其病理机制初探%Preliminary investigation on the medial ankle ligament injury and its pathomechanism

    Institute of Scientific and Technical Information of China (English)

    徐向阳; 刘津浩; 朱渊; 王碧菠

    2010-01-01

    目的 探讨踝关节内韧带损伤后内侧不稳定的病理机制.方法 患者15例,男8例,女7例;年龄22~58岁,平均40岁.其中踝关节急性扭伤患者2例,踝关节慢性损伤3例,先天性平足3例,胫后肌腱失能5例,旋前外旋骨折1例,陈旧性的内踝撕脱骨折1例.所有患者均行三角韧带修补术,同时行跟骨延长术8例,内侧楔骨闭合截骨5例,跟骨截骨内移术1例.全部患者术后随访7~56个月,运用美国足踝外科协会(America Orthopedic Foot and Ankle Society,AOFAS)踝-后足功能评分进行评估,统计学分析采用t检验.结果 1例踝关节急性骨折患者,由于术前无法评分,不放在统计分析内.其余14例患者术前评分为(42.4±10.6)分,术后评分(89.8±6.2)分(P<0.05).结论 三角韧带是一个重要的解剖结构,在以下几种情况下须注意其修复:(1)三角韧带损伤范围较广,涉及前部的胫弹簧韧带和胫舟韧带.(2)先天性的平足以及获得性的胫后肌腱失能患者.(3)以往有经常的踝关节扭伤,有外侧韧带的损伤,此次发生了伴有内侧韧带损伤的骨折.%Objective To discuss the pathomechanism of medial ankle instability after medial ligament injury. Methods The study involved 15 patients including eight males and seven females, at average age of 40 years (range 22-58 years). There were two patients with acute ankle sprain, three with chronic ankle injury, three with congenital pes planus, five with posterior tibial tendon dysfunction, one with pronation external rotation ankle fracture and one with old avulsion medial malleolus. All patients were treated surgically with deltoid ligament repair, when eight patients further received calcaneal lengthing osteotomy, five received medial cuneiform close wedge osteotomy and one received medial shift calcaneal osteotomy. All patients were followed up for 7-56 months. American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale was used for pre- and post

  9. Gait analysis associated with ankle ligament reconstruction%踝关节重建手术前后的步态分析

    Institute of Scientific and Technical Information of China (English)

    崔大平; 赵德伟; 孙强; 于小光

    2013-01-01

    [ Objective]The aim of this study is to determine how selected gait parameters, measured by three-dimensional motion capture system, may change as a result of ankle ligament deficiency and following ankle ligament reconstruction. [ Method] The study was performed on 39 ankle ligament-deficient subjects prior to and 6 months, 12 months, 18months and 24 for months after ankle ligament reconstructive surgery by the four stranded hamstring tendon technique. The group was examined an average of 2. 6 months after injury ( ranging from 2 weeks to 16 months) , but before surgery. Gait analysis was performed using the DorealSoft DVMC-8801 three-dimensional motion capture system (Doreal Software Co. ,Ltd. , China). Kinematic data were recorded for the lower limb. The results obtained from the injured subjects were compared with those of 58 individuals without ankle ligament damage. Each subject was asked to walk on a motorized treadmill (ECON USA) with different slope and perform-after six minutes of familiarization time-at least 2 minutes of walking at a constant speed of 1.9 km/h. [ Result ] The ankle ligament-deficient patients exhibited a quadriceps avoidance pattern prior to and 6 months after surgery. In the individuals operated on, the spatial-temporal parameters and the ankle angle had already regained a normal pattern for the ankle ligament-deficient limb during gait 12 months after surgery. However, the relative ankle ligament movement parameter-which describes the tibial translation into the direction of ankle ligament-and the angular acceleration showed no significant statistical difference compared with the values of healthy control group just 18 months after surgery. [Conclusion]The data from this study suggest that ANKLE LIGAMENT surgical repair significantly alters lower-extremity gait patterns, and that the establishment of pre-injury gait patterns takes at least 18 months to occur. 3D gait analysis for assessment of patients undergoing anterior cruciate

  10. TO COMPARE THE EFFECTIVENESS OF CRYOTHERAPY WITH EXERCISES VERSUS TAPING WITH EXERCISES IN TREATING ACUTE LATERAL ANKLE SPRAIN

    OpenAIRE

    Suresh; Ranganath; Sridhar; Rohit; Rajeev; Afrin

    2014-01-01

    BACKGROUND: Ankle sprain is a common form of sport injuries and it is a leading cause of pain and disability in common man and sportsman worldwide. Rate of this injury is 1 per 10, 000 persons in common man whereas lateral ligament injuries account for 15 to 25% of all sports injuries. Lateral ankle sprains are one of the most common injuries sustained in sports and exercise activities. It is one of the most common soft tissue injury encountered in clinical practice. Compl...

  11. The acute effects of local vibration therapy on ankle sprain and hamstring strain injuries.

    Science.gov (United States)

    Peer, Kimberly S; Barkley, Jacob E; Knapp, Danielle M

    2009-12-01

    The purpose of this study was to determine if biomechanical muscle stimulation (BMS) applied directly to different segments of the body using the Swisswing device results in acute improvements in range of motion and perceived stiffness in physically active adults with acute or subacute ankle sprain and hamstring strain injuries. Two separate groups of individuals with grade I or II ankle sprain (n = 5; 21.2 +/- 1.9 years) or hamstring strain (Nn= 5; 20.6 +/- 1.8 year) underwent 20 minutes of a controlled therapy consisting of ice, compression, and elevation, and 10 minutes of segmental BMS using the Swisswing at 20 Hz. Ankle (dorsiflexion, plantar flexion, inversion, eversion), hamstring flexibility, and subjective ratings of stiffness were assessed prior to control treatment (baseline), post-control treatment, and post-Swisswing treatment. Relative to the post-control condition, Swisswing treatment significantly (P < 0.03 for all) increased ankle dorsiflexion and eversion and hamstring flexibility, and significantly (P ankle and hamstring stiffness. Segmental BMS therapy using the Swisswing device appears to have significant acute benefits for improving flexibility and reducing perceived stiffness in healthy adults with ankle or hamstring injury. Future research is needed to determine the duration of these effects and if repeated periods of segmental BMS therapy aid in long-term injury recovery.

  12. Acute neck pain caused by pseudogout attack of calcified cervical yellow ligament: a case report.

    Science.gov (United States)

    Kobayashi, Takashi; Miyakoshi, Naohisa; Abe, Toshiki; Abe, Eiji; Kikuchi, Kazuma; Noguchi, Hideaki; Konno, Norikazu; Shimada, Yoichi

    2016-05-30

    Calcification of the yellow ligament sometimes compresses the spinal cord and can induce myelopathy. Usually, the calcification does not induce acute neck pain. We report a case of a patient with acute neck pain caused by calcium pyrophosphate dihydrate in a calcified cervical yellow ligament. A 70-year-old Japanese woman presented with acute neck pain. She had a moderately high fever (37.5 °C), and her neck pain was so severe that she could not move her neck in any direction. Computed tomography showed a high-density area between the C5 and C6 laminae suspicious for calcification of the yellow ligament. Magnetic resonance imaging showed intermediate-signal intensity on T1-weighted imaging and high-signal intensity on T2-weighted imaging surrounding a low-signal region on both T1- and T2-weighted imaging with cord compression. There was a turbid, yellow fluid collection in the yellow ligament at the time of operation. Histologically, calcium pyrophosphate dihydrate crystals were found in the fluid, and she was diagnosed as having a pseudogout attack of the yellow ligament. Pseudogout attack of the cervical yellow ligament is rare, but this clinical entity should be added to the differential diagnosis of acute neck pain, especially when calcification of the yellow ligament exists.

  13. The use of Bioptron light (polarized, polychromatic, non-coherent) therapy for the treatment of acute ankle sprains.

    Science.gov (United States)

    Stasinopoulos, Dimitrios; Papadopoulos, Costas; Lamnisos, Dimitrios; Stasinopoulos, Ioannis

    2017-03-01

    Purpose The purpose of this study was to investigate the efficacy of Bioptron light therapy for the treatment of acute ankle sprains. Method A parallel group, single-blind, controlled study was carried out in patients with grade II acute ankle sprains. Patients were randomly allocated into two treatment groups (n = 25 for each). Both groups received cryotherapy, and the test group also received Bioptron light therapy. All treatments were performed daily for 5 d. Evaluations included self-reported pain via a visual analogue scale, degree of ankle edema, and ankle range of motion via goniometry carried out before the treatment and at the end of the treatment. Results The test group showed the largest magnitude of improvement for all evaluations at treatment five, and the between-group differences observed were statistically significant (p light therapy supplemented with cryotherapy for the treatment of acute ankle sprains; however, larger studies are required to confirm these results. Implications for Rehabilitation Ankle sprains are common acute injuries among professional and recreational sports players but also among people in general. Cryotherapy is the first-standard treatment of acute ankle sprains. Phototherapy such as Bioptron light has been recommended supplement to cryotherapy to reduce the symptoms of ankle sprains. The results of the present trial showed that using BIOPTRON LIGHT and cryotherapy the rehabilitation period of acute ankle sprains can be reduced.

  14. Supervised exercises for adults with acute lateral ankle sprain: a randomised controlled trial

    NARCIS (Netherlands)

    R.M. van Rijn (Rogier); A.G. van Os (Anton); G.J. Kleinrensink (Gert Jan); R.M.D. Bernsen (Roos); J.A.N. Verhaar (Jan); B.W. Koes (Bart); S.M. Bierma-Zeinstra (Sita)

    2007-01-01

    textabstractBACKGROUND: During the recovery period after acute ankle sprain, it is unclear whether conventional treatment should be supported by supervised exercise. AIM: To evaluate the short- and long-term effectiveness of conventional treatment combined with supervised exercises compared with con

  15. Acupuncture Treatment for Acute Ankle Injury in the Emergency Department: A Preliminary Case Report.

    Science.gov (United States)

    Tantivesruangdet, Nopmanee

    2016-02-01

    Acupuncture is an ancient medical treatment that is increasingly attracting the interest of the public. It is a complementary therapy that is widely used for management of pain, especially chronic discomfort caused by migraine, low-back pain and osteoarthritis of the knee(¹⁻³). The evidence base for the effectiveness of acupuncture and its clinical applications is controversial, and although its efficacy and safety in the management of acute pain have been demonstrated, the quality of this modality is still questionable. The present study reports a case of acute ankle injury, which was treated with acupuncture. A 33-year-old man presented with acute twisted ankle injury. He had pain with swelling around the ankle, and he was experiencing difficulty in walking. His clinical diagnosis was acute ankle sprain with severe pain. Several drug treatments are used for pain control, but in this case, we used acupuncture. After treatment, his pain diminished significantly with a decrease in VAS pain level from 8 to 4 in 20 minutes. At follow-up after one month, we found no skin infection in this case.

  16. Total ankle arthroplasty in end-stage ankle arthritis

    OpenAIRE

    Demetracopoulos, Constantine A.; Halloran, James P.; Maloof, Paul; Samuel B Adams; Parekh, Selene G.

    2013-01-01

    Recent advancements in ankle prosthesis design, combined with improved surgical techniques for correction of coronal plane deformity and ligamentous balancing, have led to a resurgence of interest in total ankle arthroplasty for the treatment of end-stage ankle arthritis. Although ankle arthrodesis has long been considered the gold standard treatment for ankle arthritis, recent studies have shown that patients who undergo total ankle replacement have equivalent pain relief and improved functi...

  17. Return to Sports after Acute Simultaneous Reconstruction of Anterior Cruciate Ligament Injury and Grade III Medial Collateral Ligament Injury

    Science.gov (United States)

    Bertona, Agustin; Zicaro, Juan Pablo; Viescas, Juan Manuel Gonzalez; Atala, Nicolas; Yacuzzi, Carlos; Costa-Paz, Matias

    2017-01-01

    Objectives: Combined Anterior Cruciate Ligament (ACL) injury and Medial Collateral Ligament (MCL) injury account for 20% of knee ligament lesions. Conservative treatment of MCL and surgical ACL reconstruction are generally recommended. Significant medial instability after non-surgical management of MCL can lead to ACL reconstruction failure. The optimal management for athletes with combined ACL-MCL injuries remains controversial. The purpose of this study was to analyze the functional and clinical evolution of patients who underwent combined ACL-MCL surgery and their return-to-sport level with minimum 2-years follow-up. Methods: A total of 20 athletes with acute simultaneous ACL/Grade III MCL reconstructions were treated between March 2006 and January 2014. The minimum follow-up time was 24 months. Subjective functional results (IKDC, Lysholm), range of motion, anterior-medial and rotational stability (Lachmann, Pivot Shift, valgus stress) were evaluated. The ability to return to sport (Tegner) and the level achieved was recorded. Results: All patients significantly improved functional scores and stability tests. The mean subjective IKDC score improved from 37.7 ± 12.9 (range 21-69) preoperatively to 88.21 ± 4.47 (range 80-96) postoperatively (P sports; 90% reached the level they had prior to the ligamentous injury. Of all competitive athletes, 66% achieved the same level of sport. Conclusion: In athletes with acute ACL-Grade III MCL lesions, an early simultaneous reconstruction can significantly improve the medial and sagittal stability of the knee. This procedure resulted in excellent functional outcomes, with return to the same level of sports in the majority of patients at short-term follow-up.

  18. Applied anatomy of ankle lateral ligament reconstruction with periostum-patellar tendon-bone autogenous graft%自体髌骨膜-髌韧带-骨瓣重建踝外侧韧带的应用解剖

    Institute of Scientific and Technical Information of China (English)

    孙强; 周捍东; 郑加法

    2011-01-01

    目的 为自体髌骨膜-髌韧带-骨瓣重建踝关节外侧韧带提供解剖学基础.方法 在6侧经防腐同定的成人下肢标本及6侧新鲜标本上观测踝关节外侧韧带起止点及走行径路、髌韧带的解剖形态与起止点,在新鲜标本上摹拟重建手术.结果 髌韧带位置恒定,解剖层次表浅,切取方便,髌骨膜-髌韧带一骨瓣的髌韧带长度(4.1±0.4)cm,距腓前韧带长度(2.4±0.5)cm,跟腓韧带长度(3.1±0.4)cm.结论 (1)髌骨膜-髌韧带-骨瓣的髌韧带具有足够的长度,可形成移植供体;(2)髌骨膜-髌韧带-骨瓣复合体两端分别与骨及软骨创面固定,容易成活和恢复功能;(3)采用自体髌骨膜-髌韧带-骨瓣重建踝外侧韧带具有可行性.%Objective To provide anatomic basis for free autogenous periostum- patellar tendon-bone grafts to reconstruct the lateral ankle ligament.Methods The anatomic properties of lateral ankle and patellar ligaments were observed and measured on 12 adult cadavers, and the reconstruction of the lateral ankle ligament were simulated on 6 fresh specimens.Results The constant locations of the patellar ligament were easy to be incised; The lengths of the patellar ligaments and the calacaneofibular and anterior talofibular ligaments were (41.0 ±4.0)mm, (24.3 ±4.6)mm and (31.3 ±4.2)mm, respectively.Conclusions The anatomic properties of periostum-patellar tendon-bone was similar to that of lateral ankle ligaments, There were periostum-patellar tendon-bone ligament tissue with enough length for the lateral ankle joint ligaments reconstruction.The grafted periostum- patellar tendon-bone easily can survive on recipient site.Autogenous periostum- patellar tendon-bone Grafts could to be used to reconstruct the lateral ankle joint ligaments.

  19. Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation.

    Science.gov (United States)

    Stiell, I G; Greenberg, G H; McKnight, R D; Nair, R C; McDowell, I; Reardon, M; Stewart, J P; Maloney, J

    1993-03-03

    To validate and refine previously derived clinical decision rules that aid the efficient use of radiography in acute ankle injuries. Survey prospectively administered in two stages: validation and refinement of the original rules (first stage) and validation of the refined rules (second stage). Emergency departments of two university hospitals. Convenience sample of adults with acute ankle injuries: 1032 of 1130 eligible patients in the first stage and 453 of 530 eligible patients in the second stage. Attending emergency physicians assessed each patient for standardized clinical variables and classified the need for radiography according to the original (first stage) and the refined (second stage) decision rules. The decision rules were assessed for their ability to correctly identify the criterion standard of fractures on ankle and foot radiographic series. The original decision rules were refined by univariate and recursive partitioning analyses. In the first stage, the original decision rules were found to have sensitivities of 1.0 (95% confidence interval [CI], 0.97 to 1.0) for detecting 121 maleolar zone fractures, and 0.98 (95% CI, 0.88 to 1.0) for detecting 49 midfoot zone fractures. For interpretation of the rules in 116 patients, kappa values were 0.56 for the ankle series rule and 0.69 for the foot series rule. Recursive partitioning of 20 predictor variables yielded refined decision rules for ankle and foot radiographic series. In the second stage, the refined rules proved to have sensitivities of 1.0 (95% CI, 0.93 to 1.0) for 50 malleolar zone fractures, and 1.0 (95% CI, 0.83 to 1.0) for 19 midfoot zone fractures. The potential reduction in radiography is estimated to be 34% for the ankle series and 30% for the foot series. The probability of fracture, if the corresponding decision rule were "negative," is estimated to be 0% (95% CI, 0% to 0.8%) in the ankle series, and 0% (95% CI, 0% to 0.4%) in the foot series. Refinement and validation have shown the

  20. 踝关节三角韧带损伤的诊疗进展%Diagnosis and treatment of ankle deltoid ligament injury

    Institute of Scientific and Technical Information of China (English)

    李鹏

    2016-01-01

    三角韧带是踝关节内侧柱的一部分,在维持踝关节的稳定性和力学传导上有重要作用,其发病机制主要为外旋、外展暴力,而损伤的诊断及治疗还没有统一的标准.目前诊断主要依据踝关节内侧间隙和临床检查,核磁与关节镜有助于明确诊断,却没有得到早期应用,治疗上存在保守和手术两大分歧,手术方式的选择也有所不同,国内倾向于断裂韧带的修复,国外则更加注重三角韧带的重建.本文就目前国内外有关踝关节三角韧带的研究,在解剖、生物力学、诊断和治疗上做一综述.%Deltoid ligament is part of the medial ankle.It plays an important role in maintaining the stability of the ankle and biomechanical conduction.Deltoid ligament injury is always caused by the violence of external rotation and abduction.However,the consistent standard for its diagnosis and treatment has not yet formed.At present diagnosis relies mainly on the medial clear space and clinical examination.Magnetic resonance imaging and arthroscopic contribute to the diagnosis,but did not get an early application.The conservative treatment and surgical treatment has been existing two major differences.The choice of surgical treatment is different,too.Domestic scholars prefer to repair the fractured ligament,while foreign experts emphasis in reconstructing it.According to research of ankle deltoid ligament at home and abroad,this paper do a review on the anatomy,biomechanics,diagnosis and treatment.

  1. Modular Ankle Robotics Training in Early Sub-Acute Stroke: A Randomized Controlled Pilot Study

    Science.gov (United States)

    Forrester, Larry W.; Roy, Anindo; Krywonis, Amanda; Kehs, Glenn; Krebs, Hermano Igo; Macko, Richard F.

    2014-01-01

    Background Modular lower extremity (LE) robotics may offer a valuable avenue for restoring neuromotor control after hemiparetic stroke. Prior studies show that visually-guided and visually-evoked practice with an ankle robot (anklebot) improves paretic ankle motor control that translates into improved overground walking. Objective Assess the feasibility and efficacy of daily anklebot training during early sub-acute hospitalization post-stroke. Methods Thirty-four inpatients from a stroke unit were randomly assigned to anklebot (N=18) or passive manual stretching (N=16) treatments. All suffered a first stroke with residual hemiparesis (ankle manual muscle test grade 1/5 to 4/5), and at least trace muscle activation in plantar- or dorsiflexion. Anklebot training employed an “assist-as-needed” approach during > 200 volitional targeted paretic ankle movements, with difficulty adjusted to active range of motion and success rate. Stretching included >200 daily mobilizations in these same ranges. All sessions lasted 1 hour and assessments were not blinded. Results Both groups walked faster at discharge, however the robot group improved more in percent change of temporal symmetry (p=0.032) and also of step length symmetry (p=0.038), with longer nonparetic step lengths in the robot (133%) vs. stretching (31%) groups. Paretic ankle control improved in the robot group, with increased peak (p≤ 0.001) and mean (p≤ 0.01) angular speeds, and increased movement smoothness (p≤ 0.01). There were no adverse events. Conclusion Though limited by small sample size and restricted entry criteria, our findings suggest that modular lower extremity robotics during early sub-acute hospitalization is well tolerated and improves ankle motor control and gait patterning. PMID:24515923

  2. Acute finger injuries: part I. Tendons and ligaments.

    Science.gov (United States)

    Leggit, Jeffrey C; Meko, Christian J

    2006-03-01

    Improper diagnosis and treatment of finger injuries can cause deformity and dysfunction over time. A basic understanding of the complex anatomy of the finger and of common tendon and ligament injury mechanisms can help physicians properly diagnose and treat finger injuries. Evaluation includes a general musculoskeletal examination as well as radiography (oblique, anteroposterior, and true lateral views). Splinting and taping are effective treatments for tendon and ligament injuries. Treatment should restrict the motion of injured structures while allowing uninjured joints to remain mobile. Although family physicians are usually the first to evaluate patients with finger injuries, it is important to recognize when a referral is needed to ensure optimal outcomes.

  3. Compliance with the guidelines for acute ankle sprain for physiotherapists is moderate in the Netherlands: an observational study.

    NARCIS (Netherlands)

    Leemrijse, C.J.; Plas, G.M.; Hofhuis, H.; Ende, C.H.M. van den

    2006-01-01

    Question: What is the compliance with guidelines for acute ankle sprain for physiotherapists? Design: Survey of random sample of physiotherapists. Participants: 400 physiotherapists working in extramural health care in the Netherlands. Outcome measures: Questions covered attitude towards guidelines

  4. Isolated syndesmotic injury in acute ankle trauma: Comparison of plain film radiography with 3 T MRI

    Energy Technology Data Exchange (ETDEWEB)

    Schoennagel, B.P., E-mail: b.schoennagel@uke.uni-hamburg.de [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Karul, M.; Avanesov, M.; Bannas, P.; Gold, G. [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Großterlinden, L.G. [Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Rupprecht, M. [Department of Pediatric Orthopedics, Children' s Hospital Hamburg-Altona, Bleickenallee 38, 22763 Hamburg (Germany); Adam, G.; Yamamura, J. [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany)

    2014-10-15

    Highlights: • Isolated syndesmotic injury is a frequent finding after acute ankle trauma. • Cut-off values and accuracy of plain film radiograph measurements were determined. • The TFCS and the MCS have the potential to detect isolated syndesmotic injury. • Appropriate cut-off values allow detection of isolated syndesmotic injury. • Only MRI reveals severity of isolated syndesmotic injury and concomitant injuries. - Abstract: Objectives: To determine cut-off values and the accuracy of plain film measurements for the detection of isolated syndesmotic injury after acute ankle trauma and to investigate MRI findings of concomitant ankle injury. Methods: Eighty-four consecutive patients with absent fracture in plain film radiographs were prospectively evaluated for isolated syndesmotic injury after acute ankle trauma. The tibiofibular clear space (TFCS), the tibiofibular overlap (TFO), and the medial clear space (MCS) were independently assessed in plain radiographs by two readers. MRI performed at 3 T within 24 h served as the reference standard. MRI was evaluated for syndesmotic injury, using a four-scale grading system (0 = normal syndesmosis, 1a = periligamentous edema, 1b = intraligamentous edema, 2 = partial rupture, 3 = complete rupture), and for concomitant ankle injury. Inter-observer variability for x-ray measurements was assessed using Bland–Altman diagrams. ROC analyses were performed to determine cut-off values and sensitivity and specificity for TFCS, TFO, and MCS. Results: Eleven of 84 patients (13.1%) revealed syndesmotic injury (Grade 2 or 3) according to MRI. Between patients with and without syndesmotic injury significantly different measurements were obtained for TFCS (p = 0.003) and MCS (p = 0.04). ROC derived cut-off values were 5.3 mm for TFCS, 2.8 mm for TFO, and 2.8 mm for MCS. Sensitivity and specificity was 82% and 75% for TFCS, 36% and 78% for TFO, and 73% and 59% for MCS. The bias and limits of agreement were −0.04 mm and [−1

  5. Salvage of a Failed Agility Total Ankle Replacement System Associated with Acute Traumatic Periprosthetic Midfoot Fractures.

    Science.gov (United States)

    Roukis, Thomas S

    2015-10-01

    This article presents a rare case involving combined revision of a failed Agility Total Ankle Replacement System (DePuy Orthopaedics, Warsaw, Indiana) and open reduction with internal fixation of periprosthetic midfoot fractures secondary to acute traumatic injury. The rationale for these procedures, the operative sequence of events, and recovery course are presented in detail. Causes for concern regarding subsequent revision, should this be required, are raised.

  6. A randomized trial of treatment for acute anterior cruciate ligament tears

    DEFF Research Database (Denmark)

    Frobell, Richard B; Roos, Ewa M; Roos, Harald P

    2010-01-01

    BACKGROUND: The optimal management of a torn anterior cruciate ligament (ACL) of the knee is unknown. METHODS: We conducted a randomized, controlled trial involving 121 young, active adults with acute ACL injury in which we compared two strategies: structured rehabilitation plus early ACL reconst...

  7. Nonoperative treatment of acute knee ligament injuries. A review with special reference to indications and methods.

    Science.gov (United States)

    Kannus, P; Järvinen, M

    1990-04-01

    Nonoperative treatment has received little attention in the numerous scientific reports on knee ligament injuries. Great controversy still exists concerning the proper treatment of a knee with a ruptured ligament, especially the anterior cruciate ligament. However, according to the studies of the authors and an extensive review of the literature the indications for conservative management can be established to be all grade I and II sprains (partial tears) of knee ligaments as well as an isolated grade III sprain (complete tear) of the posterior cruciate ligament. In addition, an isolated complete rupture of an anterior cruciate, or medial or lateral collateral ligament may be treated nonoperatively in an older sedentary person. Other injuries obviously call for an operative approach at the acute stage. Nonoperative therapy protocols must be based on the knowledge of the biological phenomenon occurring during connective tissue healing process. In the first phase of ligament healing the injured knee needs 2 to 3 weeks immobilisation for undisturbed fibroblast invasion and proliferation of collagen fibres. This is achieved by immobilising the knee in a rehabilitative knee brace locked in 40 to 45 degrees of flexion. Thereafter, a gradually increasing controlled mobilisation is allowed in the brace to avoid the deleterious effects of immobilisation to cartilage, bone, muscles, tendons and ligaments, and to enhance the orientation of collagen fibres to the stress lines of the healing ligament. After 4 to 8 weeks the goal for rehabilitation is rapid and full recovery to work and sports. A functional knee brace may be used at this phase to give extra protection before final strengthening of the injured ligament. During the mobilisation and muscle training of the therapy protocol various specific techniques can be used for strengthening of the hamstring and quadriceps muscles, including isometric, isotonic, isokinetic and eccentric exercises with or without resistive

  8. Resistance Training With Ankle Weight Cuffs Is Feasible in Patients With Acute Exacerbation of COPD

    DEFF Research Database (Denmark)

    Kofod, Linette Marie; Døssing, Martin; Steentoft, Johnna;

    2017-01-01

    PURPOSE: Quadriceps muscle weakness is a serious complication of physical inactivity following hospitalization due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Preventing strength loss during AECOPD is therefore a high priority. We aimed to evaluate the feasibility...... of progressive knee-extension resistance training, using ankle weight cuffs on patients with AECOPD, based on prespecified criteria for feasibility. METHODS: Thirty-four patients (18 men, mean age 74 years, forced expiratory volume in 1 second = 33% predicted) with AECOPD participated in daily knee......-extension strength training. During training, the patients were seated on the bedside and performed 3 sets of 10-repetition maximum loads, using ankle weight cuffs. The primary outcome was the change in load from the first to last training sessions. The secondary outcomes were changes in maximal isometric knee...

  9. The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    McKean, D.; Thomee, E.; Grant, D.; Teh, J.L.; Mansour, R. [Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Headington, Oxford (United Kingdom); Yoong, P. [Royal Berkshire NHS Foundation Trust, Royal Berkshire Hospital, Reading (United Kingdom); Yanny, S. [Buckinghamshire Healthcare NHS Trust, Stoke Mandeville Hospital, Aylesbury (United Kingdom)

    2015-10-15

    To describe the patterns of injury associated with injury to the popliteofibular ligament injury. A retrospective review was performed of 180 MRI scans undertaken for acute knee trauma. Scans were excluded if the time of injury was over 4 weeks from the time of the scan, or if there was a history of septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. An agreed criterion for assessing the structures of the posterolateral ligamentous complex was defined and in each scan, the popliteofibular ligament (PFL) was scored as normal or injured. The menisci, ligaments, and tendons of each knee were also assessed. The mean age was 25.7 years (range, 9-65 years) and 72.2 % (n = 130) patients were male. The PFL was injured in 36 cases (20 %). There is a significant association between PFL injury and ACL rupture (p = 0.0001), ITB injury (p = 0.0001), PCL injury (p = 0.0373), in addition to associations with injury to other posterolateral corner structures including the lateral collateral ligament (p = 0.0001), biceps femoris tendon (p = 0.0014), and popliteus tendon (p = 0.0014). Of our series of PFL injuries, nine cases (25 %) were associated with further injuries of posterolateral corner structures and in 27 cases (75 %) the PFL was the only posterolateral corner structure torn. PFL injury is not uncommon in acute knee trauma and is associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, and injury to other structures within the posterolateral corner. (orig.)

  10. A Systematic Review on the Treatment of Acute Ankle Sprain Brace versus Other Functional Treatment Types

    NARCIS (Netherlands)

    E. Kemler; I. van de Port; F. Backx; C.N. van Dijk

    2011-01-01

    Ankle injuries, especially ankle sprains, are a common problem in sports and medical care. Ankle sprains result in pain and absenteeism from work and/or sports participation, and can lead to physical restrictions such as ankle instability. Nowadays, treatment of ankle injury basically consists of ta

  11. High resolution ultrasonography and magnetic resonance imaging in the evaluation of tendino-ligamentous injuries around ankle joint

    Directory of Open Access Journals (Sweden)

    Nevien El-Liethy

    2016-06-01

    Conclusion: US is an excellent tool for imaging soft tissue abnormalities, as it allows rapid, in-expensive detailed examination of the structures of the ankle joint. US and MRI are two complementary tools of investigation with the former being used as primary effective tool of investigation and the latter is done to confirm the diagnosis.

  12. Isolated medial foot compartment syndrome after ankle sprain.

    Science.gov (United States)

    Cortina, Josep; Amat, Carles; Selga, Jordi; Corona, Pablo Salvador

    2014-03-01

    Foot compartment syndrome is a serious potential complication of foot crush injury, fractures, surgery, and vascular injury. An acute compartment syndrome isolated to the medial compartment of the foot after suffering an ankle sprain is a rare complication. We report the case of a 31-year-old man who developed a medial foot compartment syndrome after suffering a deltoid ligament rupture at ankle while playing football. The patient underwent a medial compartment fasciotomy with resolution of symptoms. Compartment syndromes of the foot are rare and have been reported to occur after severe trauma. But, there are some reports in the literature of acute exertional compartment syndrome. In our case, the compartment syndrome appeared after an ankle sprain without vascular injuries associated. Copyright © 2013 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  13. Recent developments on models and inclusion criteria for chronic ankle instability

    Institute of Scientific and Technical Information of China (English)

    Songning; Zhang

    2012-01-01

    <正>In the most recent report of injury data on 15 sports from the U.S.National Collegiate Athletic Association(NCAA) Injury Surveillance System over a span of 16 years (1988-2004),ankle ligament sprains were the most common injury.Residual symptoms such as recurrent sprains,pain, instability,and giving way are common after an initial,acute ligament sprain.Chronic ankle instability(CAI) is one of these common problems,and has enjoyed increased interest in the recent literature.However,CAI remains a poorly-defined and understood condition.

  14. Dual-energy computed tomography of cruciate ligament injuries in acute knee trauma

    Energy Technology Data Exchange (ETDEWEB)

    Peltola, Erno K. [Helsinki University Hospital, Toeoeloe Trauma Center, Department of Radiology, Helsinki Medical Imaging Center, Helsinki (Finland); Koskinen, Seppo K. [Karolinska Universitetssjukhuset, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm (Sweden)

    2015-09-15

    To examine dual-energy computed tomography (DECT) in evaluating cruciate ligament injuries. More specifically, the purpose was to assess the optimal keV level in DECT gemstone spectral imaging (GSI) images and to examine the usefulness of collagen-specific color mapping and dual-energy bone removal in the evaluation of cruciate ligaments and the popliteus tendon. At a level 1 trauma center, a 29-month period of emergency department DECT examinations for acute knee trauma was reviewed by two radiologists for presence of cruciate ligament injuries, visualization of the popliteus tendon and the optimal keV level in GSI images. Three different evaluating protocols (GSI, bone removal and collagen-specific color mapping) were rated. Subsequent MRI served as a reference standard for intraarticular injuries. A total of 18 patients who had an acute knee trauma, DECT and MRI were found. On MRI, six patients had an ACL rupture. DECT's sensitivity and specificity to detect ACL rupture were 79 % and 100 %, respectively. The DECT vs. MRI intra- and interobserver proportions of agreement for ACL rupture were excellent or good (kappa values 0.72-0.87). Only one patient had a PCL rupture. In GSI images, the optimal keV level was 63 keV. GSI of 40-140 keV was considered to be the best evaluation protocol in the majority of cases. DECT is a usable method to evaluate ACL in acute knee trauma patients with rather good sensitivity and high specificity. GSI is generally a better evaluation protocol than bone removal or collagen-specific color mapping in the evaluation of cruciate ligaments and popliteus tendon. (orig.)

  15. [Treatment of acute scapholunate ligament tears with simple wiring and arthroscopic assistance].

    Science.gov (United States)

    Mathoulin, C; Messina, J

    2010-04-01

    Scapholunate ligament tears give chronic instability leading in SLAC. The wrist arthroscopy allows to see the lesions, even in early stage, and to treat them, with a simple K-Wires fixation in acute cases. The patients were operated on in outpatient basis with tourniquet and local general anaesthesia. In acute cases, the scapholunate dissociation was reduced by external and internal manoeuvres. The fixation was done with two pins under arthroscopic and fluoroscopic controls. We report a series of 66 acute cases (less than 45 days after trauma). Forty-four patients were males and 22 females. The average age was 39 years old (range 19-46). Our average follow-up in acute cases was 36 months (range 14-61). According the "Mayo Wrist Score", we obtained 92 % of good or excellent results. The wrist arthroscopy is the best technique for early diagnosis, guarantee of best functional results.

  16. Como o ortopedista brasileiro trata entorse lateral aguda do tornozelo? How does the brazilian orthopedic surgeon treat acute lateral ankle sprain?

    Directory of Open Access Journals (Sweden)

    Paulo Santoro Belangero

    2010-01-01

    questionnaire was developed which addressed the main aspects related to the treatmentof acute lateral ankle sprains (ALAS. The questionnaire was made available from June 15 to August 1, 2004, at the Official site of the Brazilian Society of Orthopedics and Traumatology. RESULTS: 444 questionnaires were included in the analysis. The results showed agreement among most of those interviewed in the following regards: 90.8% use some classification to guide treatment of the sprain; 59% classify the ankle sprain with certainty; 63.7% use the immobilization in cases of totally ruptured ligaments; 60.6% use anti-inflammatory medication in partial ligament ruptures; 75.9% reported that residual pain was the most frequent complication. There was no consensus regarding treatment of partial ALAS, as immobilization and functional treatment were chosen with the same frequency (47% each. There was no significant difference between the answers of residents and orthopedists. CONCLUSIONS: Orthopedic surgeons and orthopedic residents in Brazil have difficulty classifying ALAS and there is no consensus about the best therapeutic option for partial ALAS.

  17. Ankle replacement

    Science.gov (United States)

    Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery ... You may not be able to have a total ankle replacement if you have had ankle joint infections in ...

  18. A literature-based guide to the conservative and surgical management of the acute Charcot foot and ankle.

    Science.gov (United States)

    Schade, Valerie L; Andersen, Charles A

    2015-01-01

    Acute Charcot neuroarthropathy of the foot and ankle presents with the insidious onset of a unilateral acutely edematous, erythematous, and warm lower extremity. The acute stages are typically defined as Eichenholtz Stage 1, or Stage 0, which was first described by Shibata et al. in 1990. The ultimate goal of treatment is maintenance of a stable, plantigrade foot which can be easily shod, minimizing the risk of callus, ulceration, infection, and amputation. The gold standard of treatment is non-weight-bearing immobilization in a total contact cast. Surgical intervention remains controversial. A review of the literature was performed to provide an evidenced-based approach to the conservative and surgical management of acute Charcot neuroarthropathy of the foot and ankle.

  19. A literature-based guide to the conservative and surgical management of the acute Charcot foot and ankle

    Directory of Open Access Journals (Sweden)

    Valerie L. Schade

    2015-03-01

    Full Text Available Acute Charcot neuroarthropathy of the foot and ankle presents with the insidious onset of a unilateral acutely edematous, erythematous, and warm lower extremity. The acute stages are typically defined as Eichenholtz Stage 1, or Stage 0, which was first described by Shibata et al. in 1990. The ultimate goal of treatment is maintenance of a stable, plantigrade foot which can be easily shod, minimizing the risk of callus, ulceration, infection, and amputation. The gold standard of treatment is non-weight-bearing immobilization in a total contact cast. Surgical intervention remains controversial. A review of the literature was performed to provide an evidenced-based approach to the conservative and surgical management of acute Charcot neuroarthropathy of the foot and ankle.

  20. Ultrasound of ankle and foot: overuse and sports injuries.

    Science.gov (United States)

    Khoury, Viviane; Guillin, Raphaël; Dhanju, Jag; Cardinal, Etienne

    2007-06-01

    Sports and overuse injuries of the ankle and foot are commonly encountered in clinical practice. Ultrasound (US) has been established as an excellent diagnostic modality for foot and ankle injuries, providing a rapid noninvasive, economical, and readily available tool that is well tolerated by the patient with acute or chronic pain. The opportunity for dynamic examination is another advantage of US in evaluating ankle and foot pathology, where maneuvers such as muscle contraction and stressing of the joint may be particularly helpful. In many cases, US can be used as a first-line and only imaging modality for diagnosis. This article focuses on ankle disorders related to sports or overuse that affect tendons, including tendinosis, tenosynovitis, paratendinitis, rupture, dislocation, and ligaments that are commonly torn. The sonographic features of certain common foot disorders related to physical activity and overuse are also discussed, including plantar fasciitis, Morton's neuroma, stress fractures, and plantar plate injury.

  1. Clinical and Arthroscopic Findings of Acute Anterior Cruciate Ligament Tears of the Knee

    Directory of Open Access Journals (Sweden)

    Kenji Shirakura

    1995-01-01

    Full Text Available Clinical, arthrographic, and arthroscopic findings in 53 patients with acutely torn anterior cruciate ligaments (ACLs were documented. Arthroscopy and instability tests under anesthesia were performed on all patients within 2 weeks after the initial injury. Twenty-three patients complained of extension blocks, and localized tenderness on the medial side was revealed in 26 patients at the initial examination. Aspiration from joints exhibited hemarthrosis in 52 patients. Arthroscopy revealed ACL ruptures in all patients. Four Segond's fractures, 26 meniscus tears (8 medial and 18 lateral, 1 osteochondral fracture, and 19 medial collateral ligament ruptures were revealed. Arthroscopy detected only 1 of the 5 ruptures of the posteromedial corner of the medial meniscus, which were noted on arthrography. Three ACL stumps were protruding among the femorotibial joint, which seemed to be restricting full extension. Statistical analysis showed that tenderness on the medial side was not revealed more frequently in knees with medial collateral ligament injuries than in the others. The volume of aspirated fluids in knees with no leakage in arthrography significantly increased over those with leakages (p < 0.05. Diagnosis of ACL injuries should be completed by clinical, arthrographic, and arthroscopic examinations.

  2. Assessment of Ankle Injuries

    Science.gov (United States)

    Mai, Nicholas; Cooper, Leslie

    2009-01-01

    School nurses are faced with the challenge of identifying and treating ankle injuries in the school setting. There is little information guiding the assessment and treatment of these children when an injury occurs. It is essential for school nurses to understand ankle anatomy, pathophysiology of the acute ankle injury, general and orthopedic…

  3. A Study of H-Reflexes in Subjects with Acute Ankle Inversion Injuries

    Science.gov (United States)

    1996-12-09

    evertor musculature. Review of Relevant Anatomy Ligamentous structures As described by Kapandji , the lateral ligament complex or "collateral ligament...injuries. Am J Sports Med 22(4):462-469, 1994 52. Kapandji IA: The Lower Limb, (Volume 2), (5th Ed), New York, NY: Churchill Livingstone, 1987 53. Kennedy

  4. Efficacy of early controlled motion of the ankle compared with no motion after non-operative treatment of an acute Achilles tendon rupture

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner; Hansen, Maria Swennergren; Holmich, Per;

    2016-01-01

    BACKGROUND: Early controlled ankle motion is widely used in the non-operative treatment of acute Achilles tendon rupture, though its safety and efficacy have never been investigated in a randomized setup. The objectives of this study are to investigate if early controlled motion of the ankle affe...

  5. Reverse Evans peroneus brevis medial ankle stabilization for balancing valgus ankle contracture during total ankle replacement.

    Science.gov (United States)

    Roukis, Thomas S; Prissel, Mark A

    2014-01-01

    Medial ankle instability secondary to deltoid ligament insufficiency is frequently encountered when performing total ankle replacement and remains a challenge. In the present techniques report, we describe a "reverse" Evans peroneus brevis tendon nonanatomic deltoid ligament reconstruction for medial ankle stabilization harvested through limited incisions using simple topographic anatomic landmarks. The harvested peroneus brevis tendon is brought through a drill hole in the talus from laterally to medially, aiming for the junction of the talar neck and body plantar to the midline. The tendon is the brought superiorly and obliquely to the anterior medial aspect of the distal tibia where it is secured under a plate and screw construct. This modified Evans peroneus brevis tendon nonanatomic deltoid ligament reconstruction is useful in providing medial ankle stability during or after primary and revision total ankle replacement.

  6. Stresses in the ankle joint and total ankle replacement design.

    Science.gov (United States)

    Kakkar, Rahul; Siddique, M S

    2011-06-01

    The ankle is a highly congruent joint with a surface area of 11-13 cm(2). Total ankle replacements have been attempted since the early 1970s and design has continually evolved as the early designs were a failure. This was because the stresses involved and the mutiaxial motion of the ankle has not been understood until recently. It has been shown that the talus slides as well as rolls during the ankle arc of motion from plantarflexion to dorsiflexion. Furthermore, the articular surfaces and the calcaneofibular and tibiocalcaneal ligaments have been shown to form a four bar linkage dictating ankle motion. A new design ankle replacement has been suggested recently which allows multiaxial motion at the ankle while maintaining congruency throughout the arc of motion. The early results of this ankle replacement have been encouraging without any reported failures due to mechanical loosening.

  7. Five-year follow-up of knee joint cartilage thickness changes after acute anterior cruciate ligament rupture

    DEFF Research Database (Denmark)

    Eckstein, F; Wirth, W; Lohmander, Stefan

    2015-01-01

    Objective: Anterior cruciate ligament (ACL) rupture involves increased risk of osteoarthritis. We explored cartilage thickness changes over five years after ACL rupture. Methods: 121 young active adults (26% women, age 18-35 years) with acute traumatic ACL rupture were studied (the KANON...

  8. Low ankle-brachial index predicts cardiovascular risk after acute ischemic stroke or transient ischemic attack.

    Science.gov (United States)

    Busch, Markus A; Lutz, Katrin; Röhl, Jens-Eric; Neuner, Bruno; Masuhr, Florian

    2009-12-01

    A low ankle-brachial blood pressure index (ABI) is an established risk marker for cardiovascular disease and mortality in the general population, but little is known about its prognostic value in individuals with acute ischemic stroke or transient ischemic attack (TIA). An inception cohort of 204 patients with acute ischemic stroke or TIA was followed up for a mean of 2.3 years. At baseline, patients underwent ABI measurement and were assessed for risk factors, cardiovascular comorbidities, and cervical or intracranial artery stenosis. The association between low ABI (stroke, myocardial infarction, or death was examined by Kaplan-Meier and Cox regression analyses. A low ABI was found in 63 patients (31%) and was associated with older age, current smoking, hypertension, peripheral arterial disease, and cervical or intracranial stenosis. During a total of 453.0 person-years of follow-up, 37 patients experienced outcome events (8.2% per person-year), with a higher outcome rate per person-year in patients with low ABI (12.8% vs 6.3%, P=0.03). In survival analysis adjusted for age and stroke etiology, patients with a low ABI had a 2 times higher risk of stroke, myocardial infarction, or death than those with a normal ABI (hazard ratio=2.2; 95% CI, 1.1 to 4.5). Additional adjustment for risk factors and cardiovascular comorbidities did not attenuate the association. A low ABI independently predicted subsequent cardiovascular risk and mortality in patients with acute stroke or TIA. ABI measurement may help to identify high-risk patients for targeted secondary stroke prevention.

  9. Comparison of results between hook plate fixation and ligament reconstruction for acute unstable acromioclavicular joint dislocation.

    Science.gov (United States)

    Yoon, Jong Pil; Lee, Byoung-Joo; Nam, Sang Jin; Chung, Seok Won; Jeong, Won-Ju; Min, Woo-Kie; Oh, Joo Han

    2015-03-01

    In the present study, we aimed to compare clinical and radiographic outcomes between hook plate fixation and coracoclavicular (CC) ligament reconstruction for the treatment of acute unstable acromioclavicular (AC) joint dislocation. Forty-two patients who underwent surgery for an unstable acute dislocation of the AC joint were included. We divided them into two groups according to the treatment modality: internal fixation with a hook plate (group I, 24 cases) or CC ligament reconstruction (group II, 18 cases). We evaluated the clinical outcomes using a visual analog scale (VAS) for pain and Constant-Murley score, and assessed the radiographic outcomes based on the reduction and loss of CC distance on preoperative, postoperative, and final follow-up plain radiographs. The mean VAS scores at the final follow-up were 1.6 ± 1.5 and 1.3 ± 1.3 in groups I and II, respectively, which were not significantly different. The mean Constant-Murley scores were 90.2 ± 9.9 and 89.2 ± 3.5 in groups I and II, respectively, which were also not significantly different. The AC joints were well reduced in both groups, whereas CC distance improved from a mean of 215.7% ± 50.9% preoperatively to 106.1% ± 10.2% at the final follow-up in group I, and from 239.9% ± 59.2% preoperatively to 133.6% ± 36.7% at the final follow-up in group II. The improvement in group I was significantly superior to that in group II (p < 0.001). Furthermore, subluxation was not observed in any case in group I, but was noted in six cases (33%) in group II. Erosions of the acromion undersurface were observed in 9 cases in group I. In cases of acute unstable AC joint dislocation, hook plate fixation and CC ligament reconstruction yield comparable satisfactory clinical outcomes. However, radiographic outcomes based on the maintenance of reduction indicate that hook plate fixation is a better treatment option.

  10. Outcome and patients' satisfaction after functional treatment of acute lateral ankle injuries at emergency departments versus family doctor offices

    Directory of Open Access Journals (Sweden)

    Zimmermann Heinz

    2008-12-01

    Full Text Available Abstract Background In some Western countries, more and more patients seek initial treatment even for minor injuries at emergency units of hospitals. The initial evaluation and treatment as well as aftercare of these patients require large amounts of personnel and logistical resources, which are limited and costly, especially if compared to treatment by a general practitioner. In this study, we investigated whether outsourcing from our level 1 trauma center to a general practitioner has an influence on patient satisfaction and compliance. Methods This prospective, randomized study, included n = 100 patients who suffered from a lateral ankle ligament injury grade I-II (16, 17. After radiological exclusion of osseous lesions, the patients received early functional treatment and were shown physical therapy exercises to be done at home, without immobilization or the use of stabilizing ortheses. The patients were randomly assigned into two groups of 50 patients each: Group A (ER: Follow-up and final examination in the hospital's emergency unit. Group B (GP: Follow-up by general practitioner, final examination at hospital's emergency unit. The patients were surveyed regarding their satisfaction with the treatment and outcome of the treatment. Results Female and male patients were equally represented in both groups. The age of the patients ranged from 16 – 64 years, with a mean age of 34 years (ER and 35 years (GP. 98% (n = 98 of all patients were satisfied with their treatment, and 93% (n = 93 were satisfied with the outcome. For these parameters no significant difference between the two groups could be noted (p = 0.7406 and 0.7631 respectively. 39% of all patients acquired stabilizing ortheses like ankle braces (Aircast, Malleoloc etc. on their own initiative. There was a not significant tendency for more self-acquired ortheses in the group treated by general practicioners (p = 0,2669. Conclusion Patients who first present at the ER with a lateral

  11. Study on Fuzzy Stochastic Damage Mathematic Model on Lateral Ligament of the Ankle%踝关节外侧韧带模糊随机损伤数学模型研究

    Institute of Scientific and Technical Information of China (English)

    孟庆华; 鲍春雨

    2012-01-01

    踝关节是人体重要的负重关节,踝关节外侧韧带损伤是常见的运动损伤之一,严重影响人们日常生活质量,早期预防具有重要意义.踝关节外侧韧带损伤的概念和存在的描述是不确定的,这种不确定性一表现在损伤概念与定义中被忽略的模糊性,二表现在描述损伤存在与发生时被忽略的随机性.分析了损伤变量的模糊性和随机性二者在[0,1]区间上的一致性,基于损伤变量的广义非确定性提出了模糊随机损伤模型.%The ankle jiont is the important loading joint for human, the injury of lateral ligament of the ankle is one of the most ordinary injuries, which affects our quality of daily life, it's dubious to describe the concept and existence of injury of ankle lateral ligament, firstly, the fuzziness is neglected in the concept and definition of injury, secondly, the randomicity is neglected to describe existence and happening of injury. The author analyzed the coherence about injury variable fuzziness and randomicity in [0,1], the fuzzy stochastic injury model was established based on injury variable generalized uncertainness.

  12. 兔踝关节外侧韧带Brostr(o)m重对韧带本体感觉的影响%The effect on the proprioception after Brostr(o)m reconstruction for lateral ankle ligament in rabbit

    Institute of Scientific and Technical Information of China (English)

    彭岳文; 宋卫东

    2011-01-01

    Objective To study the effect on the proprioception after Brostr(o)m reconstruction for lateral ankle ligament in rabbit. Methods Six-three adult New Zealand white rabbits were used in this study. Nine rabbits were random selected as the blank control group, these rabbits were sacrificed and the lateral ankle ligaments were taken. The rest were all cut the lateral ankle ligament. Twenty-seven rabbits were performed Brostr(o)m reconstruction as the experimental group, and the other were left the apocoptic ligament as the experimental control group. At 2, 6, and 12 weeks after operation, 9 rabbits of each experimental group were sacrificed, and the lateral ligament of ankle were taken randomly for observation. All the lateral ligaments of ankle were stained with a modification of gold-chloride method. We counted the mechanoreceptors under light microscope. Results We identified the four mechanoreceptors: Ruffini receptors, Pacini receptors, Golgi tendon organ-like receptors and free nerve endings, and the first three of them were counted.The amount of mechanoreceptors in blank control group was 21.0±3.5, in experiment group at 2, 6, and 12weeks after operation were 12.7±2.1, 13.0±3.0, and 16.0±2.0 respectively, and in experiment control group was 7.7±1.5, 4.7±1.5, and 6.3±0.6 respectively. The difference among the 2, 6 and 12 weeks after operation in experiment group were statistically significant (F=7.53, P=0.00) and similarly in experiment control group (F=16.27, P=0.00), as time goes on, the amount of mechanoreceptors were increasing gradually. The difference among three group at the 2, 6 and 12 weeks after operation separately were statistically significant (F=88.75, 102.91, 122.53, P=0.00), the amount of mechanoreceptors in experiment group were more than in experiment control group, and lesser than in blank control group. Conclusion After rupture of the lateral ankle ligament of rabbit, whether operation or not, the ligament's mechanoreceptors will be

  13. Are MRI high-signal changes of alar and transverse ligaments in acute whiplash injury related to outcome?

    Directory of Open Access Journals (Sweden)

    Eide Geir E

    2010-11-01

    Full Text Available Abstract Background Upper neck ligament high-signal changes on magnetic resonance imaging (MRI have been found in patients with whiplash-associated disorders (WAD but also in non-injured controls. The clinical relevance of such changes is controversial. Their prognostic role has never been evaluated. The purpose of this study was to examine if alar and transverse ligament high-signal changes on MRI immediately following the car accident are related to outcome after 12 months for patients with acute WAD grades 1-2. Methods Within 13 days after a car accident, 114 consecutive acute WAD1-2 patients without prior neck injury or prior neck problems underwent upper neck high-resolution proton-weighted MRI. High-signal changes of the alar and transverse ligaments were graded 0-3. A questionnaire including the impact of event scale for measuring posttraumatic stress response and questions on patients' expectations of recovery provided clinical data at injury. At 12 months follow-up, 111 (97.4% patients completed the Neck Disability Index (NDI and an 11-point numeric rating scale (NRS-11 on last week neck pain intensity. Factors potentially related to these outcomes were assessed using multiple logistic regression analyses. Results Among the 111 responders (median age 29.8 years; 63 women, 38 (34.2% had grades 2-3 alar ligament changes and 25 (22.5% had grades 2-3 transverse ligament changes at injury. At 12 months follow-up, 49 (44.1% reported disability (NDI > 8 and 23 (20.7% neck pain (NRS-11 > 4. Grades 2-3 ligament changes in the acute phase were not related to disability or neck pain at 12 months. More severe posttraumatic stress response increased the odds for disability (odds ratio 1.46 per 10 points on the impact of event scale, p = 0.007 and so did low expectations of recovery (odds ratio 4.66, p = 0.005. Conclusions High-signal changes of the alar and transverse ligaments close after injury did not affect outcome for acute WAD1-2 patients

  14. Are MRI high-signal changes of alar and transverse ligaments in acute whiplash injury related to outcome?

    Science.gov (United States)

    2010-01-01

    Background Upper neck ligament high-signal changes on magnetic resonance imaging (MRI) have been found in patients with whiplash-associated disorders (WAD) but also in non-injured controls. The clinical relevance of such changes is controversial. Their prognostic role has never been evaluated. The purpose of this study was to examine if alar and transverse ligament high-signal changes on MRI immediately following the car accident are related to outcome after 12 months for patients with acute WAD grades 1-2. Methods Within 13 days after a car accident, 114 consecutive acute WAD1-2 patients without prior neck injury or prior neck problems underwent upper neck high-resolution proton-weighted MRI. High-signal changes of the alar and transverse ligaments were graded 0-3. A questionnaire including the impact of event scale for measuring posttraumatic stress response and questions on patients' expectations of recovery provided clinical data at injury. At 12 months follow-up, 111 (97.4%) patients completed the Neck Disability Index (NDI) and an 11-point numeric rating scale (NRS-11) on last week neck pain intensity. Factors potentially related to these outcomes were assessed using multiple logistic regression analyses. Results Among the 111 responders (median age 29.8 years; 63 women), 38 (34.2%) had grades 2-3 alar ligament changes and 25 (22.5%) had grades 2-3 transverse ligament changes at injury. At 12 months follow-up, 49 (44.1%) reported disability (NDI > 8) and 23 (20.7%) neck pain (NRS-11 > 4). Grades 2-3 ligament changes in the acute phase were not related to disability or neck pain at 12 months. More severe posttraumatic stress response increased the odds for disability (odds ratio 1.46 per 10 points on the impact of event scale, p = 0.007) and so did low expectations of recovery (odds ratio 4.66, p = 0.005). Conclusions High-signal changes of the alar and transverse ligaments close after injury did not affect outcome for acute WAD1-2 patients without previous

  15. ANNUAL FORECAST IN PATIENTS WITH ACUTE ISCHEMIC STROKE: ROLE OF PATHOLOGICAL ANKLE-BRACHIAL INDEX

    Directory of Open Access Journals (Sweden)

    A. N. Sumin

    2016-01-01

    Full Text Available Aim. To study the factors associated with a poor annual prognosis in patients with acute stroke and prognostic role of pathological ankle-brachial index (ABI.Material and methods. The study included 345 patients (age 63.6±7.8 years, 181 males and 164 females with ischemic stroke that were observed for 1 year. All patients were divided into 2 groups: Group 1 included patients with favorable annual outcome of stroke; Group 2 included patients that during a year had any clinical events including death. All patients underwent a standard neurological and instrumental examination including assessment of peripheral arteries status by sphygmomanometry.Results. Both groups did not differ by age and sex. The frequency of unfavorable outcomes (death, re-stroke, cardiovascular events 1 year after ischemic stroke was 29.5%. Chronic heart failure, atrial fibrillation, previous cardiovascular events, presence of peripheral atherosclerosis, overweight were identified most commonly in Group 2. Patients of Group 2 initially had a rough neurological deficit. The pathological ABI was detected in 70.7% of patients in Group 2 vs 33.8% of patients in Group 1 (p=0.000001. A strong relationship of pathological ABI with a poor outcome of stroke was found by regression analysis.Conclusions. Detection of pathological ABI in patients with ischemic stroke makes it possible to reveal peripheral atherosclerosis and to carry out the targeted preventive measures in these patients. Risk stratification can contribute to more individual and effective secondary prevention in patients with cerebrovascular disease. 

  16. Can Chronic Ankle Instability be Prevented? Rethinking Management of Lateral Ankle Sprains.

    Science.gov (United States)

    Denegar, Craig R.; Miller, Sayers J., III

    2002-01-01

    Investigates whether chronic ankle instability can be prevented, discussing: the relationship between mechanical and functional instability; normal ankle mechanics, sequelae to lateral ankle sprains, and abnormal ankle mechanics; and tissue healing, joint dysfunction, and acute lateral ankle sprain management. The paper describes a treatment model…

  17. Use of infrared thermography for the diagnosis and grading of sprained ankle injuries

    Science.gov (United States)

    Oliveira, João; Vardasca, Ricardo; Pimenta, Madalena; Gabriel, Joaquim; Torres, João

    2016-05-01

    Ankle joint sprains are a common medical condition estimated to be responsible for 15-25% of all musculoskeletal injuries worldwide. The pathophysiology of the lesion can represent considerable time lost to injury, as well as long-term disability in up to 60% of patients. A percentage between 10% and 20% may complicate with chronic instability of the ankle joint and disability in walking, contributing to morbidity and poor life quality. Ankle sprains can be classified as grade I, II, or III, based on the extent of damage and number of ligaments affected. The diagnostic grading is important for setting further treatment and rehabilitation, since more severe injuries carries risk of recurrence, added morbidity and decrease in life quality. The aim of this work was to evaluate the adequacy of infrared thermography as a potential complimentary diagnostic tool of the distinct lesions grades. Evaluation of different thermographic values of the ankle region (in both affected and non-affected foot) was conducted for this purpose. The principal results to be highlighted are that some of the regions, namely anterior view for non defined time after injury analysis, and anterior, frontal, posterior and anterior talofibular ligament regions and proximal calcaneofibular ligament regions in acute lesions (herein defined as less than 6 h post-traumatic event) presented consistent profiles of variation. The analyses were performed considering affected and non-affected ankles results on plotted graphics representing termographic evaluation and grading of these lesions performed using ultrasound by experimented medical radiologists. An increase in temperature values was observed when progressing from mild to severe ankle sprain injuries, with these regions presenting lower values for the affected ankle when compared to the non-affected ankle in all the analysis performed. The remaining analysed regions did not present the same variations. Statistical analysis using Kruskal

  18. Acute botulinum toxin-induced muscle weakness in the anterior cruciate ligament-deficient rabbit.

    Science.gov (United States)

    Longino, David; Frank, Cy; Herzog, Walter

    2005-11-01

    We established botulinum type-A toxin (BTX-A) injections as a powerful tool to cause knee extensor weakness in New Zealand White (NZW) rabbits. The purpose of this study was to determine if BTX-A induced quadriceps weakness causes muscle dysfunction beyond that caused by anterior cruciate ligament (ACL) transection in the knee of NZW rabbits. Twenty animals were randomly divided into four study groups (n=5 each); uninjected controls, BTX-A injection alone, ACL transection alone, BTX-A injection and ACL transection combined. Isometric knee extensor torque, quadriceps muscle mass, and vertical and anterior-posterior ground reaction forces were measured four weeks post single (BTX-A and ACL), unilateral intervention. Muscle weakness, muscle atrophy and decrease in ground reaction forces were all significantly greater for the experimental compared to the untreated contralateral legs. BTX-A injection produced a greater deficit in quadriceps mass and knee extensor torque than ACL transection alone, but produced smaller deficits in the ground reaction forces. ACL transection superimposed on BTX-A injection did not change either knee extensor torque production or muscle mass. Together these results suggest that BTX-A injection causes great force and muscle mass deficits, and affects functional gait in a significant manner, but it has no measurable functional effect when superimposed on ACL transection, at least not in the acute protocol tested here. Hopefully, BTX-A injection for acutely enhancing the degree of muscle weakness in otherwise untreated animals, or in experimental models of osteoarthritis, will help in investigating the role of muscle weakness in joint degeneration.

  19. The Scandinavian Total Ankle Replacement and the ideal biomechanical requirements of ankle replacements.

    Science.gov (United States)

    Robati, Shibby; Salih, Alan; Ghosh, Koushik; Vinayakam, Parthiban

    2016-03-01

    The complex anatomy of the articular bone surfaces, ligaments, tendon attachments and muscles makes the ankle joint difficult to replicate in prosthetic replacements. Ever since the early 1970s, which saw the dawn of the first total ankle replacements, there have been numerous other attempts at replicating the joint, often with poor clinical outcomes. The anatomy of the ankle is discussed, followed by evidence of the normal ankle biomechanics and the ideal requirements of an ankle replacement. We focus on the Scandinavian Total Ankle Replacement and evaluate whether these requirements have been met.

  20. Ultrasound of the coracoclavicular ligaments in the acute phase of an acromioclavicular disjunction: Comparison of radiographic, ultrasound and MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Faruch Bilfeld, Marie; Lapegue, Franck; Chiavassa Gandois, Helene; Bayol, Marie Aurelie; Sans, Nicolas [CHU Toulouse-Purpan, Service de Radiologie, Toulouse Cedex 9 (France); Bonnevialle, Nicolas [CHU Toulouse-Purpan, Service d' Orthopedie, Toulouse Cedex 9 (France)

    2017-02-15

    Acromioclavicular joint injuries are typically diagnosed by clinical and radiographic assessment with the Rockwood classification, which is crucial for treatment planning. The purpose of this study was to describe how the ultrasound findings of acromioclavicular joint injury compare with radiography and MRI findings. Forty-seven patients with suspected unilateral acromioclavicular joint injury after acute trauma were enrolled in this prospective study. All patients underwent digital radiography, ultrasound and 3T MRI. A modified Rockwood classification was used to evaluate the coracoclavicular ligaments. The classifications of acromioclavicular joint injuries diagnosed with radiography, ultrasound and MRI were compared. MRI was used as the gold standard. The agreement between the ultrasound and MRI findings was very good, with a correlation coefficient of 0.83 (95 % CI: 0.72-0.90; p < 0.0001). Ultrasound detected coracoclavicular ligament injuries with a sensitivity of 88.9 %, specificity of 90.0 %, positive predictive value of 92.3 % and negative predictive value of 85.7 %. The agreement between the ultrasound and radiography findings was poor, with a correlation coefficient of 0.69 (95 % CI: 0.51-0.82; p < 0.0001). Ultrasound is an effective examination for the diagnostic work-up of lesions of the coracoclavicular ligaments in the acute phase of an acromioclavicular injury. (orig.)

  1. The proportion of distal fibula Salter-Harris type I epiphyseal fracture in the paediatric population with acute ankle injury: a prospective MRI study.

    Science.gov (United States)

    Hofsli, Mikael; Torfing, Trine; Al-Aubaidi, Zaid

    2016-03-01

    Ankle injuries are common among the paediatric population. There are few prospective studies utilizing MRI to diagnose a clinically suspected Salter-Harris type I of the distal fibula (SH1FDF). The aim of this study was to examine the proportion of clinically suspected SH1FDF in children. All paediatric patients with ankle injury, seen at the emergency room from September 2012 to May 2013 at a single institution, underwent a standardized clinical examination, and their radiographs were obtained if found necessary. All images and data were recorded prospectively and patients suspected of having SH1FDF were referred for MRI of the ankle joint. Out of 391 paediatric patients seen at the emergency room with ankle injury, 38 patients had a clinical suspicion of SH1FDF. A total of 31 patients, 18 male and 13 female, with a mean age of 10 ± 2.86 years, were included in the study. Only seven patients were excluded from the study. MRI was obtained on an average of 6.9 ± 2.87 days. None of the included patients had evidence of SH1FDF on MRI. Our study and review of the literature verifies the high false-positive rate of clinically suspected SH1FDF. Most children had ligamentous lesions, bone contusion or joint effusion, rather than SH1FDF.

  2. Ultrasound of the coracoclavicular ligaments in the acute phase of an acromioclavicular disjonction: Comparison of radiographic, ultrasound and MRI findings.

    Science.gov (United States)

    Faruch Bilfeld, Marie; Lapègue, Franck; Chiavassa Gandois, Hélène; Bayol, Marie Aurélie; Bonnevialle, Nicolas; Sans, Nicolas

    2017-02-01

    Acromioclavicular joint injuries are typically diagnosed by clinical and radiographic assessment with the Rockwood classification, which is crucial for treatment planning. The purpose of this study was to describe how the ultrasound findings of acromioclavicular joint injury compare with radiography and MRI findings. Forty-seven patients with suspected unilateral acromioclavicular joint injury after acute trauma were enrolled in this prospective study. All patients underwent digital radiography, ultrasound and 3T MRI. A modified Rockwood classification was used to evaluate the coracoclavicular ligaments. The classifications of acromioclavicular joint injuries diagnosed with radiography, ultrasound and MRI were compared. MRI was used as the gold standard. The agreement between the ultrasound and MRI findings was very good, with a correlation coefficient of 0.83 (95 % CI: 0.72-0.90; p acromioclavicular injury. • Ultrasound is appropriate for acute acromioclavicular trauma due to its accessibility. • Ultrasound contributes to the diagnostic work-up of acute lesions of the coracoclavicular ligaments. • Ultrasound is appropriate in patients likely to benefit from surgical treatment. • Ultrasound could be a supplement to standard radiography in acute acromioclavicular trauma.

  3. Acute mobilization and migration of bone marrow-derived stem cells following anterior cruciate ligament rupture.

    Science.gov (United States)

    Maerz, T; Fleischer, M; Newton, M D; Davidson, A; Salisbury, M; Altman, P; Kurdziel, M D; Anderson, K; Bedi, A; Baker, K C

    2017-08-01

    Little is known regarding acute local and systemic processes following anterior cruciate ligament (ACL) rupture. No study has elucidated whether bone marrow-derived mesenchymal stem cells (MSCs) are mobilized into circulation and recruited to the injured joint. In Part 1, Lewis rats were randomized to noninvasive ACL rupture (Rupture) or non-injured (Control) (n = 6/group). After 72 h, whole blood MSC concentration was assessed using flow cytometry. Synovial fluid and serum were assayed for stromal cell-derived factor (SDF)-1α and cartilage degeneration biomarkers, respectively. In Part 2, 12 additional rats were randomized and intravenously-injected with fluorescently-labeled allogenic MSCs. Cell tracking was performed using longitudinal, in vivo and ex vivo near-infrared (NIR) imaging and histology. Synovium SDF-1α and interleukin (IL)-17A immunostaining was performed. Serum was assayed for SDF-1α and 29 other cytokines. In Part 1, there was a significant increase in MSC concentration and synovial fluid SDF-1α in Rupture. No differences in cartilage biomarkers were observed. In Part 2, Rupture had significantly higher NIR signal at 24, 48, and 72 h, indicating active recruitment of MSCs to the injured joint. Ex vivo cell tracking demonstrated MSC localization in the synovium and myotendinous junction (MTJ) of the quadriceps. Injured synovia exhibited increased synovitis grade and higher degree of IL-17A and SDF-1α immunostaining. ACL rupture induced peripheral blood mobilization of MSCs and migration of intravenously-injected allogenic MSCs to the injured joint, where they localized in the synovium and quadriceps MTJ. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  4. ACUTE EFFECTS OF TWO MASSAGE TECHNIQUES ON ANKLE JOINT FLEXIBILITY AND POWER OF THE PLANTAR FLEXORS

    Directory of Open Access Journals (Sweden)

    Grant J.B. McKechnie

    2007-12-01

    Full Text Available The purpose of this study was to determine if three minutes of petrissage and tapotement forms of massage would influence plantar flexors' flexibility, and muscle power. Nineteen participants were randomly subjected to three conditions (control and two massages before performing two power tests. Prior to the intervention, subjects completed ankle joint flexibility assessments. The conditions were; (1 control, where subjects lay prone and had a therapist's hands resting, (2 vigorous petrissage, and (3 tapotement applied at a rate of 4Hz; all on the triceps surae. Following completion of the intervention, subjects immediately completed a post- ankle joint flexibility test, followed by a drop-jump and concentric calf raise. The power measures were; concentric peak force, rate of force development, and drop-jump height / contact time. The data showed a significant increase (p < 0.05 in ankle joint angle on the right leg and a corresponding tendency on the left. No significant change was seen with the power measures. Results suggest that massage can increase plantar flexors' flexibility without a change in power and thus may be an alternative to static stretching during an athletic warm-up

  5. Loss of reduction and complications of coracoclavicular ligament reconstruction with autogenous tendon graft in acute acromioclavicular dislocations.

    Science.gov (United States)

    Choi, Nam Hong; Lim, Seok Min; Lee, Sang Young; Lim, Tae Kang

    2017-04-01

    This study was conducted to report loss of reduction and complications after single-tunnel coracoclavicular (CC) ligament reconstruction with autogenous semitendinosus tendon graft for acute acromioclavicular (AC) joint dislocations. This retrospective study included patients with acute, unstable AC dislocations (surgery within 6 weeks after trauma). We excluded patients with chronic injury and distal clavicle fractures with CC ligaments disruption. We measured the CC distance on anteroposterior radiographs of both clavicles, preoperatively, immediately postoperatively, and at the final follow-up visit. We evaluated clinical outcomes using the American Shoulder and Elbow Surgeons Shoulder Assessment and the University of California, Los Angeles Shoulder Rating Scale scores and perioperative complications. There were 30 patients (27 men and 3 women) with mean age of 41 years (range, 19-70 years). The mean follow-up period was 31 months (range, 12-186 months). Mean CC distance was 15.5 ± 3.7 mm (84% ± 14% of the contralateral shoulder) preoperatively, 8.9 ± 2.6 mm (9% ± 40%) immediately postoperatively (P 25% increase of CC distance) developed in 14 patients (47%), and complications occurred in 6 patients (20%), including 3 distal clavicle fractures through the tunnel. Final clinical scores were significantly lower in patients with complications (27 vs. 33 of the University of California, Los Angeles assessment [P < .001] and 81 vs. 95 of the American Shoulder and Elbow Surgeons Shoulder assessment [P < .001]). In acute AC joint dislocation, single-tunnel CC ligament reconstruction using autogenous tendon graft resulted in loss of reduction rate of 47% and a complication rate of 20%. The development of complications adversely affected clinical outcomes. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  6. Efficacy of thrust and nonthrust manipulation and exercise with or without the addition of myofascial therapy for the management of acute inversion ankle sprain: a randomized clinical trial.

    Science.gov (United States)

    Truyols-Domí Nguez, Sebastián; Salom-Moreno, Jaime; Abian-Vicen, Javier; Cleland, Joshua A; Fernández-de-Las-Peñas, César

    2013-05-01

    Randomized clinical trial. To compare the effects of thrust and nonthrust manipulation and exercises with and without the addition of myofascial therapy for the treatment of acute inversion ankle sprain. Studies have reported that thrust and nonthrust manipulations of the ankle joint are effective for the management of patients post-ankle sprain. However, it is not known whether the inclusion of soft tissue myofascial therapy could further improve clinical and functional outcomes. Fifty patients (37 men and 13 women; mean ± SD age, 33 ± 10 years) post-acute inversion ankle sprain were randomly assigned to 2 groups: a comparison group that received a thrust and nonthrust manipulation and exercise intervention, and an experimental group that received the same protocol and myofascial therapy. The primary outcomes were ankle pain at rest and functional ability. Additionally, ankle mobility and pressure pain threshold over the ankle were assessed by a clinician who was blinded to the treatment allocation. Outcomes of interest were captured at baseline, immediately after the treatment period, and at a 1-month follow-up. The primary analysis was the group-by-time interaction. The 2-by-3 mixed-model analyses of variance revealed a significant group-by-time interaction for ankle pain (Pthrust manipulation and myofascial intervention experiencing a greater improvement in pain and function than those who received the nonthrust and thrust manipulation intervention alone. Significant group-by-time interactions were also observed for ankle mobility (P0.85) for all outcomes. This study provides evidence that, in the treatment of individuals post-inversion ankle sprain, the addition of myofascial therapy to a plan of care consisting of thrust and nonthrust manipulation and exercise may further improve outcomes compared to a plan of care solely consisting of thrust and nonthrust manipulation and exercise. However, though statistically significant, the difference in improvement in

  7. 磁共振三维脂肪抑制T2加权快速回波序列在评估健康受试者踝关节韧带解剖结构的应用研究%Application of MR 3D FSE CUBE sequence in evaluation of anatomy of ligament ankle joint of healthy volunteers

    Institute of Scientific and Technical Information of China (English)

    刘磊

    2014-01-01

    目的:分析3.0 T磁共振三维脂肪抑制T2加权快速回波(3D FSE CUBE)序列与常规检查技术2D FSE序列对健康受试者踝关节韧带解剖细节显示的价值。方法选取36名健康受试者踝关节进行磁共振成像(MRI),使用GE HDXT 3.0 T磁共振扫描仪及高分辨率膝关节专用线圈。本研究所使用的MRI序列为二维脂肪抑制T2加权(2D-FSE-T2WI)和3D FSE CUBE。扫描范围包括踝关节的冠状位、矢状位和轴位。分别计算上述2个序列对于踝关节联合韧带、外侧副韧带、三角韧带的显示率。从而评价上述2个序列对于踝关节韧带的显示能力。结果3D FSE CUBE序列对于踝关节韧带的显示优于常规2D序列,二者之间的差异具有统计学意义(P<0.05)。3D FSE CUBE序列对于踝关节各韧带的显示能力要明显高于普通FSE序列。结论3D FSE CUBE是一种新的磁共振序列,可以进行不同的加权图像扫描,对于踝关节韧带正常解剖结构的显示清晰,可以满足临床诊断的需要。%Objective To analyse the value of MR 3D FSE CUBE sequence and conventional 2D FSE T 2WI sequence in evaluation of anatomy of ligament ankle joint of healthy volunteers at 3T MR scanner. Methods The ankles in 36 cases were examined with MR imaging spin echo-T2 weighted imaging (2D T2WI FSE) and 3D FSE CUBE. Sweep range ankle coronal and sagittal and axial position. The above two sequences were calculated respectively for the ankle joint ligament, the detection rate of the lateral collateral ligament, deltoid ligament, to evaluate these two sequences for the ankle ligaments show ability. Results 3D FSE CUBE sequence provided a significantly higher rate for all ligament ankle joint compared with conventional 2D sequence , there was significant difference between them (P<0.05). Conclusion 3D FSE CUBE is a new technique for examination of ankle joint, which can be different weighted image scanning.It can clearly show the

  8. 一期韧带修复联合拉力螺钉固定治疗踝关节不稳的疗效观察%Efficacy of phase Ⅰ ligament repair combined with lag screw fixation for ankle instability

    Institute of Scientific and Technical Information of China (English)

    罗静涛; 韩铭

    2015-01-01

    Objective To evaluate the clinical efficacy of phase Ⅰ ligament repair combined with lag screw fixation for ankle instability. Methods From Jan. 2011 to Jun. 2013, 34 patients with acute ankle sprain, including 18 males and 16 females, aged 28. 0 to 69. 0 years (mean 49. 3 years), were randomly divid-ed into external fixation group and screw fixation group (n=17 each), given external fixation with plaster or brace, and phase Ⅰ line of rivets in-situ repair combined with lag screw, respectively. All lesion limbs were not weight-bearing and followed up for 3 months. Hospital costs and complications were observed. Therapeutic effect was evaluated by AOFAS and VAS score. Results The cost of hospitalization was (1. 72±0. 30) ten thousand yuan in screw fixation group, and (0. 68±0. 20) ten thousand yuan in external fixation group (P<0. 05). AOFAS scores at 1st, 2nd, and 3rd month during the followed-up period were (66. 2±1. 3), (88. 5±2. 1) and (97. 2 ±1. 9) in screw fixation group, and (46. 8±1. 6), (53. 5±2. 7) and (75. 6±1. 2) in external fixation group (P<0. 05), respectively. VAS scores at 1st, 2nd, and 3rd month during the followed-up period were (3. 2 ± 0. 8), (2. 5±0. 6) and (1. 2±0. 2) in screw fixation group, and (4. 0±0. 7), (3. 1±0. 6) and (2. 6±0. 4) in external fixation group (P<0. 05), respectively. There was no screw cut out, nails broken, traumatic arthritis, inferior tibiofibular instability and other complications in screw fixation group. In external fixation group, 2 patients complained of ankle stiffness that eased after exercise and physiotherapy, and 4 patients administered phase Ⅱ ankle ligament reconstruction due to pain and instability in the knee. Conclusion Phase Ⅰ ligament repair combined with lag screw fixation for acute ankle instability manifests excellent postop-erative ankle function and fewer complications, although the cost of hospitalization is higher. It is a practicable procedure for ankle sprains.%目的:

  9. Low ankle-brachial index predicts early risk of recurrent stroke in patients with acute cerebral ischemia.

    Science.gov (United States)

    Tsivgoulis, Georgios; Bogiatzi, Chrysi; Heliopoulos, Ioannis; Vadikolias, Konstantinos; Boutati, Eleni; Tsakaldimi, Soultana; Al-Attas, Omar S; Charalampidis, Paris; Piperidou, Charitomeni; Maltezos, Efstratios; Papanas, Nikolaos

    2012-02-01

    Low ankle-brachial blood pressure index (ABI) identifies patients with symptomatic and asymptomatic peripheral arterial disease (PAD). We sought to investigate the association of low ABI with early risk of stroke recurrence in patients with acute cerebral ischemia (ACI) and without history of symptomatic PAD. Consecutive patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) and no previous history of PAD were prospectively evaluated with ABI measurements. Demographic characteristics, vascular risk factors and secondary prevention therapies were documented. An ABI ≤0.90 in either leg was considered as evidence of asymptomatic PAD, and an ABI >0.90 was considered as normal. Patients with elevated ABI (>1.30) were excluded. The outcome of interest was recurrent stroke during 30-day follow-up. A total of 176 patients with acute cerebral ischemia (mean age 64±14 years, 59.1% men, 76.7% AIS) were evaluated. Asymptomatic PAD was detected in 14.8% (95%CI: 10.2-20.8%) of the studied population. The following factors were independently associated with low ABI on multivariate logistic regression models, after adjustment for potential confounders: coronary artery disease (p=0.008), diabetes mellitus (p=0.017) and increasing age (p=0.042). The cumulative 30-day recurrence rate was higher in patients with low ABI (19.2%; 95%CI: 4.1-34.3) compared to the rest (3.3%; 95%CI: 0.4-6.2%; p=0.001). Atherothrombotic stroke (ASCO grade I; pstroke recurrence on multivariate Cox regression models adjusting for confounders. Low ABI appears to be associated with a higher risk of early recurrent stroke in patients with ACI and no history of symptomatic PAD. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  10. The Acute Effects of Unilateral Ankle Plantar Flexors Static- Stretching on Postural Sway and Gastrocnemius Muscle Activity During Single-Leg Balance Tasks

    Directory of Open Access Journals (Sweden)

    Bráulio N. Lima, Paulo R.G. Lucareli, Willy A. Gomes, Josinaldo J. Silva, Andre S. Bley, Erin H. Hartigan, Paulo H. Marchetti

    2014-09-01

    Full Text Available The aim of this study was to investigate the acute effects of unilateral ankle plantar flexors static- stretching on surface electromyography (sEMG and the center of pressure (COP during a single-leg balance task in both lower limbs. Fourteen young healthy, non-athletic individuals performed unipodal quiet standing for 30s before and after (stretched limb: immediately post-stretch, 10 and 20 minutes and non-stretched limb: immediately post-stretch a unilateral ankle plantar flexor static- stretching protocol [6 sets of 45s/15s, 70-90% point of discomfort (POD]. Postural sway was described using the COP area, COP speed (antero-posterior and medio-lateral directions and COP frequency (antero-posterior and medio-lateral directions. Surface EMG (EMG integral [IEMG] and Median frequency[FM] was used to describe the muscular activity of gastrocnemius lateralis. Ankle dorsiflexion passive range of motion increased in the stretched limb before and after the static-stretching protocol (mean ± SD: 15.0° ± 6.0 and 21.5° ± 7.0 [p < 0.001]. COP area and IEMG increased in the stretch limb between pre-stretching and immediately post-stretching (p = 0.015 and p = 0.036, respectively. In conclusion, our static- stretching protocol effectively increased passive ankle ROM. The increased ROM appears to increase postural sway and muscle activity; however these finding were only a temporary or transient effect.

  11. The clinical features of ankle syndesmosis injuries: a general review.

    Science.gov (United States)

    Kellett, John J

    2011-11-01

    To review the research conclusions relating to clinical aspects of syndesmosis, the incidence and prognosis of syndesmosis injuries, and the effectiveness of the history and clinical examination to reliably diagnose ankle syndesmosis injury. Google Scholar search: Syndesmosis paired with incidence, prognosis, history, and examination in turn. There was no time limit for the search. Articles were selected by reading titles, abstracts, and the full article, if indicated, seeking original articles determining these clinical aspects of syndesmosis injuries. Further articles were derived from the references of the primary articles. The prognosis for isolated syndesmosis injuries, including the time to functional recovery, is unknown. The incidence of acute syndesmosis injury in moderate to severe ankle injuries requiring imaging is of the order of 5%. Historical features and special clinical tests of syndesmosis injury have not been proven reliable by clinical studies using evidence-based diagnostic criteria. Acute local tenderness of the anterior inferior tibiofibular ligament will indicate significant syndesmosis injury in only approximately half of nonspecific ankle injuries. There is limited, evidence-based, standard, published literature from which to draw conclusions regarding the validity or reliability of various clinical special tests for syndesmosis injury. Literature assessing the incidence, prognosis, and clinical features is generally not based on definitively confirmed syndesmosis injuries, which is a critical aspect of evidence-based medicine before valid conclusions can be drawn.

  12. Surgical treatment of acute and chronic anterior and posterior cruciate ligament and lateral side injuries of the knee.

    Science.gov (United States)

    Levy, Bruce A; Boyd, Joel L; Stuart, Michael J

    2011-06-01

    Combined anterior cruciate ligament, posterior cruciate ligament, and lateral-sided injuries of the knee most often occurs secondary to a forced varus moment or after knee dislocation. Management controversies include the optimal timing of surgery, operative techniques, and postoperative rehabilitation. Recent systematic literature reviews have demonstrated higher rates of failure with repair of the lateral and posterolateral corner structures, as opposed to reconstruction. However, the ideal ligament reconstruction techniques remain unclear. This chapter will review the combined anterior cruciate ligament/posterior cruciate ligament/lateral-sided injury pattern, including the physical examination findings, imaging, timing of surgery, graft selection, operative techniques, and postoperative rehabilitation protocols.

  13. Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR.

    Science.gov (United States)

    Zhang, Guang-Ying; Zheng, Lei; Ding, Hong-Yu; Li, En-Miao; Sun, Bai-Sheng; Shi, Hao

    2015-01-01

    The purpose of this study was to compare the diagnostic performance of high-frequency ultrasound with MR in the evaluation of medial patellofemoral ligament (MPFL) lesions after acute lateral patellar dislocation (LPD). High-frequency ultrasound and MR images were prospectively obtained in 97 consecutive patients with acute LPD. Images were acquired using standardised protocols and were independently evaluated by two radiologists. The MPFL was assessed at three sites (patellar insertion, femoral attachment, and mid-substance) for signs of injury. Of a total of 291 sites in 97 MPFLs, 127 showed proven MPFL tear at surgery, including 51 sites of complete tear and 76 sites of partial tear. In a site-based analysis, the sensitivity, specificity, and accuracy of high-frequency ultrasound was 90.8%, 96.3%, and 94.6%, respectively, for partial MPFL tear and 86.3%, 96.3%, and 94%, respectively, for complete tear. For MR, the sensitivity, specificity, and accuracy was 81.6%, 95.7%, and 91.3%, respectively, for partial MPFL tear and 80.4%, 95.7%, and 92.1%, respectively, for complete tear. There was no statistical difference between high-frequency ultrasound and MR in the assessment of partial (P = 0.1, 0.777, 0.155) or complete (P = 0.425, 0.777, 0.449) MPFL lesions. Interobserver agreement was very good for high-frequency ultrasound and good for MR. Data suggest that high-frequency ultrasound and MR have similar diagnostic performance in the evaluation of MPFL lesions after acute LPD. • High-frequency ultrasound and MR were able to detect MPFL lesions after acute lateral patellar dislocation. • High-frequency ultrasound and MR showed similarly high accuracy in diagnosing MPFL lesions. • Interobserver agreement was very good for high-frequency ultrasound and good for MR.

  14. Healing of the Acutely Injured Anterior Cruciate Ligament: Functional Treatment with the ACL-Jack, a Dynamic Posterior Drawer Brace.

    Science.gov (United States)

    Jacobi, Matthias; Reischl, Nikolaus; Rönn, Karolin; Magnusson, Robert A; Gautier, Emanuel; Jakob, Roland P

    2016-01-01

    Background. The injured anterior cruciate ligament (ACL) has a limited healing capacity leading to persisting instability. Hypothesis/Purpose. To study if the application of a brace, producing a dynamic posterior drawer force, after acute ACL injury reduces initial instability. Study Design. Cohort study. Methods. Patients treated with the ACL-Jack brace were compared to controls treated with primary ACL reconstruction und controls treated nonsurgically with functional rehabilitation. Measurements included anterior laxity (Rolimeter), clinical scores (Lysholm, Tegner, and IKDC), and MRI evaluation. Patients were followed up to 24 months. Results. Patients treated with the ACL-Jack brace showed a significant improvement of anterior knee laxity comparable to patients treated with ACL reconstruction, whereas laxity persisted after nonsurgical functional rehabilitation. The failure risk (secondary reconstruction necessary) of the ACL-Jack group was however 21% (18 of 86) within 24 months. Clinical scores were similar in all treatment groups. Conclusion. Treatment of acute ACL tears with the ACL-Jack brace leads to improved anterior knee laxity compared to nonsurgical treatment with functional rehabilitation.

  15. Healing of the Acutely Injured Anterior Cruciate Ligament: Functional Treatment with the ACL-Jack, a Dynamic Posterior Drawer Brace

    Science.gov (United States)

    Reischl, Nikolaus; Rönn, Karolin; Magnusson, Robert A.; Gautier, Emanuel; Jakob, Roland P.

    2016-01-01

    Background. The injured anterior cruciate ligament (ACL) has a limited healing capacity leading to persisting instability. Hypothesis/Purpose. To study if the application of a brace, producing a dynamic posterior drawer force, after acute ACL injury reduces initial instability. Study Design. Cohort study. Methods. Patients treated with the ACL-Jack brace were compared to controls treated with primary ACL reconstruction und controls treated nonsurgically with functional rehabilitation. Measurements included anterior laxity (Rolimeter), clinical scores (Lysholm, Tegner, and IKDC), and MRI evaluation. Patients were followed up to 24 months. Results. Patients treated with the ACL-Jack brace showed a significant improvement of anterior knee laxity comparable to patients treated with ACL reconstruction, whereas laxity persisted after nonsurgical functional rehabilitation. The failure risk (secondary reconstruction necessary) of the ACL-Jack group was however 21% (18 of 86) within 24 months. Clinical scores were similar in all treatment groups. Conclusion. Treatment of acute ACL tears with the ACL-Jack brace leads to improved anterior knee laxity compared to nonsurgical treatment with functional rehabilitation. PMID:28053787

  16. Pooled analysis of clinical trial data evaluating the safety and effectiveness of diclofenac epolamine topical patch 1.3% for the treatment of acute ankle sprain

    Directory of Open Access Journals (Sweden)

    Lionberger DR

    2011-07-01

    Full Text Available David R Lionberger1, Eric Joussellin2, Jillmarie Yanchick3, Merrell Magelli3,4, Arturo Lanzarotti51Southwest Orthopedic Group, LLP, Houston, TX, USA; 2Institut National du Sport, Paris, France; 3Formerly Alpharma Pharmaceuticals LLC, Piscataway, NJ, USA; 4GTx, Inc., Memphis, TN, USA; 5Institut Biochimique SA, SwitzerlandAbstract: This pooled analysis assessed the efficacy and safety of the diclofenac epolamine topical patch 1.3% (DETP for the treatment of acute mild-to-moderate ankle sprain. Data from 2 randomized, double-blind, placebo-controlled studies enrolling 274 male and female patients aged 18 to 65 years with acute ankle sprain were pooled and evaluated. The primary end point was pain reduction on movement assessed using a 100 mm visual analog scale (VAS. Safety and tolerability were also assessed. Beginning approximately 3 hours after initial treatment, DETP-treated patients experienced statistically significant and sustained lower mean VAS scores in pain intensity on movement (mean ± SD, 54.1 ± 20.0 mm versus 60.3 ± 16.8 mm compared with placebo-treated patients, representing a 20% versus 13% reduction in VAS pain scores from baseline (P = 0.012. This statistically significant difference in mean VAS score was maintained through day 7 (9.4 ± 14.4 mm versus 18.4 ± 18.2 mm, P < 0.0001. The DETP and placebo patches were well tolerated. These results further confirm the efficacy and safety of DETP for the treatment of acute pain from ankle sprains.Keywords: soft tissue injury, acute pain, visual analog scale, clinical trial, double-blind, safety

  17. Vascular Physiology according to Clinical Scenario in Patients with Acute Heart Failure: Evaluation using the Cardio-Ankle Vascular Index.

    Science.gov (United States)

    Goto, Toshihiko; Wakami, Kazuaki; Mori, Kento; Kikuchi, Shohei; Fukuta, Hidekatsu; Ohte, Nobuyuki

    2016-01-01

    Increased aortic stiffness may be an important cause of acute heart failure (AHF). Clinical scenario (CS), which classifies the pathophysiology of AHF based on the initial systolic blood pressure (sBP), was proposed to provide the most appropriate therapy for AHF patients. In CS, elevated aortic stiffness, vascular failure, has been considered as a feature of patients categorized as CS1 (sBP > 140 mmHg at initial presentation). However, whether elevated aortic stiffness, vascular failure, is present in such patients has not been fully elucidated. Therefore, we assessed aortic stiffness in AHF patients using the cardio-ankle vascular index (CAVI), which is considered to be independent of instantaneous blood pressure. Sixty-four consecutive AHF patients (mean age, 70.6 ± 12.8 years; 39 men) were classified with CS, based on their initial sBP: CS1: sBP > 140 mmHg (n = 29); CS2: sBP 100-140 mmHg (n = 22); and CS3: sBP 100 mmHg (n = 13). There were significant group differences in CAVI (CS1 vs. CS2 vs. CS3: 9.7 ± 1.4 vs. 8.4 ± 1.7 vs. 8.3 ± 1.7, p = 0.006, analysis of variance). CAVI was significantly higher in CS1 than in CS2 (p = 0.02) and CS3 (p = 0.04). CAVI did not significantly correlate with sBP at the time of measurement of CAVI (r = 0.24 and p = 0.06). Aortic stiffness assessed using blood pressure-independent methodology apparently increased in CS1 AHF patients. We conclude that vascular failure is a feature of CS1 AHF initiation.

  18. The Effect of Bee Venom Acupuncture(BVA on acute Ankle Sprain : A Randomized Controlled Trial and double blinding - Pilot study

    Directory of Open Access Journals (Sweden)

    Song, Ho-Seub

    2005-06-01

    Full Text Available Objective : The aim of the study was to investigate the therapeutic effect of BVA in the treatment of patients with acute ankle sprain. Design : A prospective randomized double-blind study of BVA was conducted. Setting : The study was done in the Kyungwon University Seoul Hospital from August 1st, 2004 to June 15th, 2005. Patients : 30 patients diagnosed with acute ankle sprain, especially 2nd degree on the Ankle grade pain chart(AGPC participated in the study, who were divided into two groups (A and B randomly by a coordinator flipping a coin. Group A and B were relevant to control and BVA group respectively, of which a coordinator never informed any other participant involved. eventually 13 of 17 in group A and 11 of 13 in Group B finished all the process of the clinical trial. Intervention : In both group A and B, The Procedure of acupuncture treatment was made similar by appearance that four acupoints such as 坵墟(GB40, 中封(LR4, 商丘(SP5, 解谿(ST41 of the injured side were selected and Normal saline aqua-acupuncture(control, as a placebo or BVA was done and then acupuncture at 坵墟(GB40, 中封(LR4, 商丘(SP5, 解谿(ST41, 足三里(ST36, 陽陵泉(G34 of the affected side was given again. the needles were retained for 20 minutes under the infrared rays. The treatment was given daily for a week. Outcome Measures : Ankle-Hindfoot Scale (AHS and Visual Analogue Scale(VAS were followed by three treatments. Statistical Analysis : Analysis regarding variations in AHS and VAS is carried out by applying Mann-Whitney test and Wilcoxon signed rank test sign test with level of significance at 5%. Results : At the end of the treatment, there was significant statistical differences between the two groups in VAS and AHS as well, while at the 3rd day only a VAS showed statistical significance. In each group, both VAS and AHS showed statistical significance along with duration of treatment. Conclusions : BVA was thought to be effective

  19. 带线锚钉在11例慢性踝关节外侧不稳韧带重建中的应用%With wire anchors application in the ligament reconstruction of 11 pa-tients with chronic lateral ankle instability

    Institute of Scientific and Technical Information of China (English)

    王波; 武亚娟; 侯勇

    2014-01-01

    Objective To investigate the value of with wire anchors in the treatment of cable anchors with chronic lat-eral ankle instability. Methods Selected 11 patients with chronic lateral ankle instability from January 2009 to Decem-ber 2012,7 males and 4 females,average age were(24.8±6.5) years,all implemented with wire anchors surgery to anatomi-cal reconstruction lateral ligaments,follow-up of 3 to 12 months postoperative,used a modified American Orthopaedic Foot and Ankle Society(AOFAS) scale to evaluate ankle function. Results Modified AOFAS ankle score excellent in 6 cases,good in 3 cases, fine in 1 case, poor in 1 case,good rate was 81.82%.AOFAS ankle scores were higher than preoperative after 3 months (P<0.05 or P<0.01); postoperative talar tilt angle,talar shift distance,ankle medial joint space was less than before(P<0.01). Conclusion With wire anchors application in the anatomical reconstruction of lat-eral ankle ligaments,the ligaments can restore the stability of the ankle, joint function recovered well, worthy of pro-motion apply.%目的:探讨带线锚钉在慢性踝关节外侧不稳治疗中的应用价值。方法选取2009年1月~2013年12月收治的慢性踝关节外侧不稳定患者11例,男7例,女4例;平均年龄(24.8±6.5)岁;均实施带线锚钉手术解剖重建外侧韧带,术后随访3~12个月,采用改良美国足踝骨科协会(AOFAS)足踝评分评价踝关节功能。结果改良AOFAS足踝评分优6例,良3例,可1例,差1例,优良率为81.82%。术后3个月改良AOFAS足踝评分均高于术前(P<0.05或P<0.01);术后距骨倾斜角度、距骨移位距离、踝关节内侧间隙均小于术前(P<0.01)。结论带线锚钉解剖重建踝关节外侧韧带能恢复韧带稳定性,踝关节功能恢复良好,值得临床推广适用。

  20. Injury patterns of the acromioclavicular ligament complex in acute acromioclavicular joint dislocations: a cross-sectional, fundamental study.

    Science.gov (United States)

    Maier, Dirk; Jaeger, Martin; Reising, Kilian; Feucht, Matthias J; Südkamp, Norbert P; Izadpanah, Kaywan

    2016-09-06

    Horizontal instability impairs clinical outcome following acute acromioclavicular joint (ACJ) reconstruction and may be caused by insufficient healing of the superior acromioclavicular ligament complex (ACLC). However, characteristics of acute ACLC injuries are poorly understood so far. Purposes of this study were to identify different ACLC tear types, assess type-specific prevalence and determine influencing cofactors. This prospective, cross-sectional study comprised 65 patients with acute-traumatic Rockwood-5 (n = 57) and Rockwood-4 (n = 8) injuries treated operatively by means of mini-open ACJ reduction and hook plate stabilization. Mean age at surgery was 38.2 years (range, 19-57 years). Standardized pre- and intraoperative evaluation included assessment of ACLC tear patterns and cofactors related to the articular disc, the deltoid-trapezoidal (DT) fascia and bony ACJ morphology. Articular disc size was quantified as 0 = absent, 1 = remnant, 2 = meniscoid and 3 = complete. All patients showed complete ruptures of the superior ACLC, which could be assigned to four different tear patterns. Clavicular-sided (AC-1) tears were observed in 46/65 (70.8 %), oblique (AC-2) tears in 12/65 (18.5 %), midportion (AC-3) tears in 3/65 (4.6 %) and acromial-sided (AC-4) tears in 4/65 (6.1 %) of cases. Articular disc size manifestation was significantly (P < .001) more pronounced in patients with AC-1 tears (1.89 ± 0.57) compared to patients with AC-2 tears (0.67 ± 0.89). Other cofactors did not influence ACLC tear patterns. ACLC dislocation with incarceration caused mechanical impediment to anatomical ACJ reduction in 14/65 (21.5 %) of cases including all Rockwood-4 dislocations. Avulsion "in continuity" was a consistent mode of failure of the DT fascia. Type-specific operative strategies enabled anatomical ACLC repair of all observed tear types. Acute ACLC injuries follow distinct tear patterns. There exist clavicular-sided (AC-1

  1. Use of Soft-Tissue Procedures for Managing Varus and Valgus Malalignment with Total Ankle Replacement.

    Science.gov (United States)

    Roukis, Thomas S; Elliott, Andrew D

    2015-10-01

    Achieving frontal plane alignment of the ankle joint during total ankle replacement is essential for long-term success. Tendon and ligament lengthening, ligament reinforcement, tendon transfer, nonanatomic tendon transfer ligament reconstruction, and periarticular osteotomies are safe, straightforward, minimally invasive, and reproducible procedures to correct varus and valgus deformities associated with end-stage degenerative joint disease. Using reproducible topographic anatomic landmarks is essential to these techniques properly and limit complications. The approach to frontal plane deformities is stepwise, with liberal use of tendon and ligament lengthening and reconstruction, a low threshold for nonanatomic tendon transfer ligament reconstructions, and tendon transfers and/or periarticular osteotomies.

  2. The acute effects of unilateral ankle plantar flexors static- stretching on postural sway and gastrocnemius muscle activity during single-leg balance tasks.

    Science.gov (United States)

    Lima, Bráulio N; Lucareli, Paulo R G; Gomes, Willy A; Silva, Josinaldo J; Bley, Andre S; Hartigan, Erin H; Marchetti, Paulo H

    2014-09-01

    The aim of this study was to investigate the acute effects of unilateral ankle plantar flexors static- stretching on surface electromyography (sEMG) and the center of pressure (COP) during a single-leg balance task in both lower limbs. Fourteen young healthy, non-athletic individuals performed unipodal quiet standing for 30s before and after (stretched limb: immediately post-stretch, 10 and 20 minutes and non-stretched limb: immediately post-stretch) a unilateral ankle plantar flexor static- stretching protocol [6 sets of 45s/15s, 70-90% point of discomfort (POD)]. Postural sway was described using the COP area, COP speed (antero-posterior and medio-lateral directions) and COP frequency (antero-posterior and medio-lateral directions). Surface EMG (EMG integral [IEMG] and Median frequency[FM]) was used to describe the muscular activity of gastrocnemius lateralis. Ankle dorsiflexion passive range of motion increased in the stretched limb before and after the static-stretching protocol (mean ± SD: 15.0° ± 6.0 and 21.5° ± 7.0 [p stretch limb between pre-stretching and immediately post-stretching (p = 0.015 and p = 0.036, respectively). In conclusion, our static- stretching protocol effectively increased passive ankle ROM. The increased ROM appears to increase postural sway and muscle activity; however these finding were only a temporary or transient effect. Key PointsThe postural control can be affected by static- stretching protocol.The lateral gastrocnemius muscle action was increased after the static- stretching protocol.The static- stretching effects remain for less than 10 minutes.

  3. Dual-Energy Computed Tomography of the Knee, Ankle, and Foot: Noninvasive Diagnosis of Gout and Quantification of Monosodium Urate in Tendons and Ligaments.

    Science.gov (United States)

    Fritz, Jan; Henes, Joerg C; Fuld, Matthew K; Fishman, Elliot K; Horger, Marius S

    2016-02-01

    Gout is a true crystal deposition arthropathy caused by the precipitation of monosodium urate into joints and periarticular soft tissues. It is the most common inflammatory arthropathy in men and women of older age with a male-to-female ratio of 3 to 8:1. The disease may progress from asymptomatic hyperuricemia through symptomatic acute gout attacks with asymptomatic periods into chronic symptomatic tophaceous gout. Although invasive arthrocentesis and demonstration of monosodium urate crystals on polarized light microscopy is definitive for the diagnosis of gout, dual-energy computed tomography (CT) allows for noninvasive visualization and reproducible volume quantification of monosodium urate crystals. Based on the high diagnostic performance, dual-energy CT has been included in the 2015 American College of Rheumatology/European League Against Rheumatism Collaborative Initiative Classification Criteria for Gout. Increasing evidence indicates the usefulness of dual-energy CT to guide the management of patients with suspected gout and monitor the effectiveness of urate-lowering medical therapy.

  4. Accuracy of simple plain radiographic signs and measures to diagnose acute scapholunate ligament injuries of the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Dornberger, Jenny E. [Unfallkrankenhaus Berlin, Department of Plastic Surgery and Burn Care, Berlin (Germany); Rademacher, Grit; Mutze, Sven [Unfallkrankenhaus Berlin, Institute of Radiology, Berlin (Germany); Eisenschenk, Andreas [Unfallkrankenhaus Berlin, Department of Hand-, Replantation- and Microsurgery, Berlin (Germany); University Medicine Greifswald, Department of Hand Surgery and Microsurgery, Greifswald (Germany); Stengel, Dirk [Unfallkrankenhaus Berlin, Centre for Clinical Research, Berlin (Germany); Charite Medical University Centre, Julius Wolff Institute, Centre for Musculoskeletal Surgery, Berlin (Germany)

    2015-12-15

    To determine the accuracy of common radiological indices for diagnosing ruptures of the scapholunate (SL) ligament, the most relevant soft tissue injury of the wrist. This was a prospective diagnostic accuracy study with independent verification of index test findings by a reference standard (wrist arthroscopy). Bilateral digital radiographs in posteroanterior (pa), lateral and Stecher's projection were evaluated by two independent expert readers. Diagnostic accuracy of radiological signs was expressed as sensitivity, specificity, positive (PPV) and negative (NPV) predictive values with 95 % confidence intervals (CI). The prevalence of significant acute SL tears (grade ≥ III according to Geissler's classification) was 27/72 (38 %, 95 % CI 26-50 %). The SL distance on Stecher's projection proved the most accurate index to rule the presence of an SL rupture in and out. SL distance on plain pa radiographs, Stecher's projection and the radiolunate angle contributed independently to the final diagnostic model. These three simple indices explained 97 % of the diagnostic variance. In the era of computed tomography and magnetic resonance imaging, plain radiographs remain a highly sensitive and specific primary tool to triage patients with a suspected SL tear to further diagnostic work-up and surgical care. (orig.)

  5. Maisonneuve-hyperplantarflexion variant ankle fracture.

    Science.gov (United States)

    Hinds, Richard M; Tran, Wesley H; Lorich, Dean G

    2014-11-01

    Maisonneuve fractures are rare ankle injuries, accounting for up to 7% of all ankle fractures. They consist of a proximal third fibula fracture, syndesmotic disruption, and medial ankle injury (either a deltoid ligament disruption or a medial malleolus fracture), and are often successfully managed with nonoperative treatment of the proximal fibula fracture and open reduction and internal fixation (ORIF) of the medial ankle injury and syndesmotic disruption. The hyperplantarflexion variant ankle fracture comprises approximately 7% of all ankle fractures and features dual posterior tibial lip fractures featuring a posterolateral fragment and a posteromedial fragment. Good functional results have been reported in the literature after ORIF of both the posterolateral and posteromedial fragments of this variant fracture that is not described by the Lauge-Hansen classification. In this report, the authors present the unique case of an isolated ankle fracture demonstrating characteristics of both a Maisonneuve fracture and a hyperplantarflexion variant ankle fracture. They also highlight the diagnostic imaging characteristics, including magnetic resonance imaging (MRI) and preoperative radiograph findings, surgical treatment, and postoperative clinical outcome for this patient with a Maisonneuve-hyperplantarflexion variant ankle fracture. To the authors' knowledge, this unique fracture pattern has not been reported previously in the literature. The authors conclude that although good results were seen postoperatively in this case, the importance of ORIF of both the posteromedial and posterolateral fragments of variant fractures cannot be overstated. They also found MRI to be a particularly helpful adjunct in formulating the correct diagnosis and treatment plan.

  6. Ankle pain

    Science.gov (United States)

    ... which cushions joints) Infection in the ankle joint Osteoarthritis , gout , rheumatoid arthritis , Reiter syndrome , and other types ... Ma, MD, assistant professor, chief, sports medicine and shoulder service, UCSF Department of Orthopaedic Surgery, San Francisco, ...

  7. Tibialis posterior tendon and deltoid and spring ligament injuries in the elite athlete.

    Science.gov (United States)

    Ribbans, William John; Garde, Ajit

    2013-06-01

    The tibialis posterior tendon and the spring and deltoid ligament complexes combine to provide dynamic and passive stabilization on the medial side of the ankle and hindfoot. Some of the injuries will involve acute injury to previous healthy structures, but many will develop insidiously. The clinician must be aware of new treatment strategies and the level of accompanying scientific evidence regarding injuries sustained by athletes in these areas, while acknowledging that more traditional management applied to nonathletic patients is still likely to be appropriate in the setting of treatment for elite athletes.

  8. The proportion of distal fibula Salter-Harris type I epiphyseal fracture in the paediatric population with acute ankle injury

    DEFF Research Database (Denmark)

    Hofsli, Mikael; Torfing, Trine; Al-Aubaidi, Zaid

    2016-01-01

    Ankle injuries are common among the paediatric population. There are few prospective studies utilizing MRI to diagnose a clinically suspected Salter-Harris type I of the distal fibula (SH1FDF). The aim of this study was to examine the proportion of clinically suspected SH1FDF in children. All...

  9. An EMG-Controlled SMA Device for the Rehabilitation of the Ankle Joint in Post-Acute Stroke

    Science.gov (United States)

    Pittaccio, S.; Viscuso, S.

    2011-07-01

    The capacity of flexing one's ankle is an indispensible segment of gait re-learning, as imbalance, wrong compensatory use of other joints and risk of falling may depend on the so-called drop-foot. The rehabilitation of ankle dorsiflexion may be achieved through active exercising of the relevant musculature (especially tibialis anterior, TA). This can be troublesome for patients affected by weakness and flaccid paresis. Thus, as needs evolve during patient's improvements, a therapeutic device should be able to guide and sustain gradual recovery by providing commensurate aid. This includes exploiting even initial attempts at voluntary motion and turns those into effective workout. An active orthosis powered by two rotary actuators containing NiTi wire was designed to obtain ankle dorsiflexion. A computer routine that analyzes the electromyographic (sEMG) signal from TA muscle is used to control the orthosis and trigger its activation. The software also provides instructions and feed-back for the patient. Tests on the orthosis proved that it can produce strokes up to 36° against resisting torques exceeding 180 Ncm. Three healthy subjects were able to control the orthosis by modulating their TA sEMG activity. The movement produced in the preliminary tests is interesting for lower limb rehabilitation, and will be further improved by optimizing body-orthosis interface. It is hoped that this device will enhance early rehabilitation and recovery of ankle mobility in stroke patients.

  10. Management of Osseous and Soft-Tissue Ankle Equinus During Total Ankle Replacement.

    Science.gov (United States)

    Roukis, Thomas S; Simonson, Devin C

    2015-10-01

    Obtaining functional alignment of a total ankle replacement, including physiologic sagittal plane range of motion, is paramount for a successful outcome. This article reviews the literature on techniques available for correction of osseous and soft-tissue equinus at the time of index total ankle replacement. These techniques include anterior tibiotalar joint cheilectomy, posterior superficial muscle compartment lengthening, posterior ankle capsule release, and release of the posterior portions of the medial and lateral collateral ligament complexes. The rationale for these procedures and the operative sequence of events for these procedures are presented.

  11. Hook plate fixation for acute acromioclavicular dislocations without coracoclavicular ligament reconstruction: a functional outcome study in military personnel.

    Science.gov (United States)

    Kumar, Narinder; Sharma, Vyom

    2015-08-01

    The aim of our study was to evaluate the shoulder function after clavicular hook plate fixation of acute acromioclavicular dislocations (Rockwood type III) in a population group consisting exclusively of high-demand military personnel. This prospective study was carried out at a tertiary care military orthopaedic centre during 2012-2013 using clavicular hook plate for management of acromioclavicular injuries without coracoclavicular ligament reconstruction in 33 patients. All patients underwent routine implant removal after 16 weeks. The functional outcome was assessed at 3, 6 and 12 months after hook plate removal and 2 years from the initial surgery using the Constant Murley and UCLA Scores. All the patients were male serving soldiers and had sustained acromioclavicular joint dislocation (Rockwood type III). Mean age of the patient group was 34.24 years (21-55 years). The mean follow-up period in this study was 23.5 months (20-26 months) after hook plate fixation and an average of 19.9 months (17-22 months) after hook plate removal. The average Constant Score at 3 months after hook plate removal was 60.3 as compared to 83.7 and 90.3 at 6 months and 1 year, respectively, and an average of 91.8 at the last follow-up that was approximately 2 years after initial surgery which was statistically significant (p value acromioclavicular dislocations producing excellent medium-term functional results in high-demand soldiers.

  12. Five-Year Outcomes After Treatment for Acute Instability of the Tibiofibular Syndesmosis Using a Suture-Button Fixation System.

    Science.gov (United States)

    Förschner, Paul F; Beitzel, Knut; Imhoff, Andreas B; Buchmann, Stefan; Feuerriegel, Georg; Hofmann, Felix; Karampinos, Dimitrios C; Jungmann, Pia; Pogorzelski, Jonas

    2017-04-01

    Suture-button repair is a widely accepted surgical treatment for acute and isolated ankle syndesmosis injuries. To our knowledge, midterm results have not previously been reported. To evaluate the clinical, qualitative, and quantitative radiological midterm outcomes of suture-button repair after acute isolated ankle syndesmosis injuries. Retrospective case series; Level of evidence, 4. Clinical outcomes were measured using the Foot and Ankle Disability Index (FADI) and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Three-tesla magnetic resonance imaging (MRI) was performed bilaterally at the ankle. Besides morphological sequences for evaluation of the syndesmosis and degenerative changes of the ankle using the Ankle Osteoarthritis Scoring System (AOSS), the MR protocol included a coronal 2-dimensional multislice multiecho sequence for quantitative cartilage T2-weighted mapping. Spearman correlations and paired t tests were used for statistical analysis. This retrospective study included 19 consecutive patients (mean age, 29.7 ± 11.5 years) with acute isolated syndesmosis injuries treated with a suture-button system between January 2006 and June 2014, with a mean follow-up of 5.1 ± 2.6 years. Postoperatively, the median FADI score was 136 (range, 78-136), and the median AOFAS score was 100 (range, 87-100). Seventeen (89.5%) patients reported to have reached their preinjury level of sports activities. MRIs of 16 patients were obtained and all showed intact anterior and posterior syndesmotic ligaments; however, in most patients, the previously injured syndesmotic ligament was thickened compared with the uninjured ankle. Average width of the anterior (P = .81) and posterior (P = .60) syndesmosis was not significantly different between the ipsilateral (3.2 ± 1.2 and 4.4 ± 0.9 mm) and contralateral ankles (3.0 ± 0.6 and 4.2 ± 0.7 mm). The median AOSS score was 1.5 (range, 0-11) for the ipsilateral ankle and 0 (range, 0-6) for the contralateral ankle

  13. Ligament reconstruction.

    Science.gov (United States)

    Glickel, Steven Z; Gupta, Salil

    2006-05-01

    Volar ligament reconstruction is an effective technique for treating symptomatic laxity of the CMC joint of the thumb. The laxity may bea manifestation of generalized ligament laxity,post-traumatic, or metabolic (Ehler-Danlos). There construction reduces the shear forces on the joint that contribute to the development and persistence of inflammation. Although there have been only a few reports of the results of volar ligament reconstruction, the use of the procedure to treat Stage I and Stage II disease gives good to excellent results consistently. More advanced stages of disease are best treated by trapeziectomy, with or without ligament reconstruction.

  14. Acupuncture as analgesia for non-emergent acute non-specific neck pain, ankle sprain and primary headache in an emergency department setting: a protocol for a parallel group, randomised, controlled pilot trial

    OpenAIRE

    2014-01-01

    Introduction This study aims to assess the feasibility of acupuncture as an add-on intervention for patients with non-emergent acute musculoskeletal pain and primary headache in an emergency department (ED) setting. Methods and analysis A total of 40 patients who present to the ED and are diagnosed to have acute non-specific neck pain, ankle sprain or primary headache will be recruited by ED physicians. An intravenous or intramuscular injection of analgesics will be provided as the initial st...

  15. MR arthrography of the ankle joint; MR-Arthrographie des Sprunggelenkes

    Energy Technology Data Exchange (ETDEWEB)

    Trattnig, S.; Rand, T.; Breitenseher, M.; Ba-Ssalamah, A.; Schick, S.; Imhof, H. [Universitaetsklinik fuer Radiodiagnostik, AKH-Wien (Austria)

    1999-01-01

    Due to its superior soft tissue contrast conventional MRI is the imaging method of choice in the evaluation of ankle joint disorders. Conventional MR imaging can accurately demonstrate normal or acutely injured ligaments; however, in subacute and chronic injury joint fluid necessary for delineation of injured ligaments is absent and MR arthrography should be performed. MR arthrography uses the intraarticular injection of contrast material to distend the joint, yielding improved discrimination of intraarticular structures. This joint distension with MR arthrography is also helpful in the staging of osteochondritis dissecans, since in cases of unstable lesions tracking of contrast material into the interface can be more easily demonstrated. Finally, high contrast and joint distension by MR arthrography improves the detection of intraarticular loose bodies, which often require surgery. MR artrography, although invasive, may provide additional information in various ankle joint disorders. (orig.) [Deutsch] Aufgrund des ausgezeichneten Weichteilkontrastes ist die konventionelle MRT die bildgebende Methode der Wahl in der Beurteilung von Sprunggelenkserkrankungen. Die konventionelle MRT kann zuverlaessig normale und akut verletzte Ligamente darstellen. Im subakuten und chronischen Stadium der Verletzung fehlt jedoch oft die Gelenksfluessigkeit die fuer eine exakte Abgrenzung der verletzten Ligamente notwendig ist. Die MR-Arthrographie sollte in diesen Faellen durchgefuehrt werden, da die intraartikulaere KM-Applikation den Gelenksraum distendiert mit verbesserter Unterscheidbarkeit intraartikulaerer Strukturen. Diese Gelenksdistension mit der MR-Arthrographie ist auch in der Stadiumbeurteilung der Osteochondritis dissecans hilfreich, da in Faellen von instabilen Laesionen eine KM-Umspuelung des Dissekats leichter dargestellt werden kann. Schliesslich verbessert die MR-Arthrographie aufgrund des hohen Kontrastes und der Gelenksdistension auch den Nachweis von

  16. Surgical treatment of acute and chronic anterior and posterior cruciate ligament and medial-side injuries of the knee.

    Science.gov (United States)

    Hubert, Mark G; Stannard, James P

    2011-06-01

    KD-IIIM knee injuries are challenging injuries that can do well when anatomic reconstruction techniques are used. This article describes the authors preferred reconstructions, timing of surgery, and rehabilitation techniques. The reconstructions are generally initiated 3 or 4 weeks after the injury when the local soft tissue injury allows and associated fractures have already been stabilized. The posterior cruciate ligament, posteromedial corner, and meniscus injuries are addressed in the initial operation. The corresponding author prefers to come back 6 weeks later and reconstruct the anterior cruciate ligament and assure that acceptable progress has been made regarding knee motion.

  17. Chinese Massage Therapy for Ankle Injury

    Institute of Scientific and Technical Information of China (English)

    CHEN Ming-xia; LI Nian-qun; HUANG Guo-qi

    2003-01-01

    Purpose: To explore the therapeutic methods and effects in the treatment of acute and chronic injuries of the ankle joint by Chinese massage therapy in combination with external application of Chinese herbal drugs and functional exercises. Methods: Totally, 36 cases of the patients with acute soft tissue injury, chronic soft tissue injury and post-fracture sequelae of the ankle joint were treated by Chinese massage therapy, external application or external wash of Chinese herbal drugs, and exercises of dorsal flexion and extension of the ankle joint, to observe the restoration of the ankle functions.Results: In 36 cases of the patients, the results showed remarkable effect in 18 cases, effect in 16 cases, failure in 2 cases and the effective rate in 94.4%. Conclusion: The combined use of Chinese massage therapy, external application of Chinese herbal drugs and functional exercises can produce precise effect in the treatment of soft tissue injury of the ankle joint.

  18. Comparison of Ankle Proprioception Between Pregnant and Non Pregnant Women

    OpenAIRE

    Preetha R; John Solomon M

    2011-01-01

    Pregnant women report falls especially during their third trimester. Physiological changes along with ligament laxity can affect the joint proprioception in this population. This study was conducted to compare the ankle proprioception between pregnant and non pregnant women. Thirty pregnant and 30 non pregnant women were included in the study and the position of ankles were recorded by a digital camera placed 60 cms away from the feet of the subject. UTHSCSA Image tool software version 3.0. w...

  19. Comparing etoricoxib and celecoxib for preemptive analgesia for acute postoperative pain in patients undergoing arthroscopic anterior cruciate ligament reconstruction: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Glabglay Prapakorn

    2010-10-01

    Etoricoxib is more effective than celecoxib and placebo for using as preemptive analgesia for acute postoperative pain control in patients underwent arthroscopic anterior cruciate ligament reconstruction. Trial registration number NCT01017380

  20. Recalcitrant Lateral Premalleolar Bursitis of the Ankle Associated with Lateral Ankle Instability

    Directory of Open Access Journals (Sweden)

    Masashi Naito

    2017-01-01

    Full Text Available Lateral premalleolar bursitis of the ankle is a rarely reported disorder in the English literature although it is not uncommon in Asian countries where people commonly sit on their feet. Here, we present the case of a 66-year-old woman with recalcitrant lateral premalleolar bursitis associated with lateral ankle instability which was successfully treated with surgical resection of the bursa and repair of the anterior talofibular ligament. Operative findings revealed a communication between the bursa and articular cavity of the ankle joint via the sheath of the extensor digitorum longus tendon, which was considered to act as a check valve leading to a large and recalcitrant bursitis. This report provides a novel concept about the etiology of recalcitrant lateral premalleolar bursitis of the ankle.

  1. Reconstruction of the medial patellofemoral ligament in cases of acute traumatic dislocation of the patella: current perspectives and trends in Brazil1,

    Directory of Open Access Journals (Sweden)

    Gustavo Gonçalves Arliani

    2014-10-01

    Full Text Available Objective:To evaluate the approaches and procedures used by knee surgeons in Brazil for treating medial patellofemoral lesions (MPFL of the knee in cases of acute traumatic dislocation of the patella.Materials and methods:A questionnaire comprising 15 closed questions on topics relating to treating MPFL of the knee following acute dislocation of the patella was used. It was applied to Brazilian knee surgeons during the three days of the 44th Brazilian Congress of Orthopedics and Traumatology, in 2012.Results:106 knee surgeons completely filled out the questionnaire and formed part of the sample analyzed. Most of them were from the southeastern region of Brazil. The majority (57% reported that they perform fewer than five MPFL reconstruction procedures per year. Indication of non-surgical treatment after a first episode of acute dislocation of the patella was preferred and done by 93.4% of the sample. Only 9.1% of the participants reported that they had never observed postoperative complications. Intraoperative radioscopy was used routinely by 48%. The professionals who did not use this tool to determine the point of ligament fixation in the femur did not have a statistically greater number of postoperative complications than those who used it (p > 0.05.Conclusions:There are clear evolutionary trends in treatments and rehabilitation for acute dislocation of the patella due to MPFL, in Brazil. However, further prospective controlled studies are needed in order to evaluate the clinical and scientific benefit of these trends.

  2. Arthroscopically Assisted Reconstruction of Acute Acromioclavicular Joint Dislocations: Anatomic AC Ligament Reconstruction With Protective Internal Bracing—The “AC-RecoBridge” Technique

    Science.gov (United States)

    Izadpanah, Kaywan; Jaeger, Martin; Ogon, Peter; Südkamp, Norbert P.; Maier, Dirk

    2015-01-01

    An arthroscopically assisted technique for the treatment of acute acromioclavicular joint dislocations is presented. This pathology-based procedure aims to achieve anatomic healing of both the acromioclavicular ligament complex (ACLC) and the coracoclavicular ligaments. First, the acromioclavicular joint is reduced anatomically under macroscopic and radiologic control and temporarily transfixed with a K-wire. A single-channel technique using 2 suture tapes provides secure coracoclavicular stabilization. The key step of the procedure consists of the anatomic repair of the ACLC (“AC-Reco”). Basically, we have observed 4 patterns of injury: clavicular-sided, acromial-sided, oblique, and midportion tears. Direct and/or transosseous ACLC repair is performed accordingly. Then, an X-configured acromioclavicular suture tape cerclage (“AC-Bridge”) is applied under arthroscopic assistance to limit horizontal clavicular translation to a physiological extent. The AC-Bridge follows the principle of internal bracing and protects healing of the ACLC repair. The AC-Bridge is tightened on top of the repair, creating an additional suture-bridge effect and promoting anatomic ACLC healing. We refer to this combined technique of anatomic ACLC repair and protective internal bracing as the “AC-RecoBridge.” A detailed stepwise description of the surgical technique, including indications, technical pearls and pitfalls, and potential complications, is given. PMID:26052493

  3. Chronic ankle instability: Arthroscopic anatomical repair.

    Science.gov (United States)

    Arroyo-Hernández, M; Mellado-Romero, M; Páramo-Díaz, P; García-Lamas, L; Vilà-Rico, J

    Ankle sprains are one of the most common injuries. Despite appropriate conservative treatment, approximately 20-40% of patients continue to have chronic ankle instability and pain. In 75-80% of cases there is an isolated rupture of the anterior talofibular ligament. A retrospective observational study was conducted on 21 patients surgically treated for chronic ankle instability by means of an arthroscopic anatomical repair, between May 2012 and January 2013. There were 15 men and 6 women, with a mean age of 30.43 years (range 18-48). The mean follow-up was 29 months (range 25-33). All patients were treated by arthroscopic anatomical repair of anterior talofibular ligament. Four (19%) patients were found to have varus hindfoot deformity. Associated injuries were present in 13 (62%) patients. There were 6 cases of osteochondral lesions, 3 cases of posterior ankle impingement syndrome, and 6 cases of peroneal pathology. All these injuries were surgically treated in the same surgical time. A clinical-functional study was performed using the American Orthopaedic Foot and Ankle Society (AOFAS) score. The mean score before surgery was 66.12 (range 60-71), and after surgery it increased up to a mean of 96.95 (range 90-100). All patients were able to return to their previous sport activity within a mean of 21.5 weeks (range 17-28). Complications were found in 3 (14%) patients. Arthroscopic anatomical ligament repair technique has excellent clinical-functional results with a low percentage of complications, and enables patients to return to their previous sport activity within a short period of time. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Total ankle replacement for posttraumatic arthritis

    Science.gov (United States)

    Weme, Rebecca A Nieuwe; van Solinge, Guido; N Doornberg, Job; Sierevelt, Inger; Haverkamp, Daniël; Doets, H Cornelis

    2015-01-01

    Background and purpose Most studies on total ankle replacement (TAR) have used a case mix of patients. We evaluated the outcome of TAR performed for end-stage arthritis either because of fracture or ligamentous injury. Patients and methods We prospectively followed 88 consecutive patients (50 postfracture ankles and 40 ankles with instability arthritis (2 bilateral)) who underwent TAR between 2001 and 2009. Mean follow-up for both groups was 5 years. Results Preoperative varus deformity of 10° or more was present in 23 ankles in the instability group. At 6 years, survival with revision or salvage fusion as an endpoint was 87% (95% CI: 74–99) in the postfracture group and 79% (95% CI: 63–94) in the instability group. Progressive periprosthetic osteolysis was seen in 23 ankles, and required salvage fusion in 6. The number of reoperations was similar in both groups. Clinical outcome, as assessed with 2 ankle scores and 2 questionnaires, showed good results and was similar at the latest follow-up. Interpretation The outcome was similar in the postfracture and instability groups and also similar to that reported in series including a case mix of patients. In contrast to earlier reports, preoperative frontal plane deformity in this series was not identified as a risk factor for failure. PMID:25772269

  5. The clinimetric qualities of patient-assessed instruments for measuring chronic ankle instability: A systematic review

    Directory of Open Access Journals (Sweden)

    Asman Sara

    2007-01-01

    Full Text Available Abstract Background The assessment of outcomes from the patient's perspective becomes more recognized in health care. Also in patients with chronic ankle instability, the degree of present impairments, disabilities and participation problems should be documented from the perspective of the patient. The decision about which patient-assessed instrument is most appropriate for clinical practice should be based upon systematic reviews. Only rating scales constructed for patients with acute ligament injuries were systematically reviewed in the past. The aim of this study was to review systematically the clinimetric qualities of patient-assessed instruments designed for patients with chronic ankle instability. Methods A computerized literature search of Medline, Embase, Cinahl, Web of Science, Sport Discus and the Cochrane Controlled Trial Register was performed to identify eligible instruments. Two reviewers independently evaluated the clinimetric qualities of the selected instruments using a criteria list. The inter-observer reliability of both the selection procedure and the clinimetric evaluation was calculated using modified kappa coefficients. Results The inter-observer reliability of the selection procedure was excellent (k = .86. Four instruments met the eligibility criteria: the Ankle Joint Functional Assessment Tool (AJFAT, the Functional Ankle Outcome Score (FAOS, the Foot and Ankle Disability Index (FADI and the Functional Ankle Ability Measure (FAAM. The inter-observer reliability of the quality assessment was substantial to excellent (k between .64 and .88. Test-retest reliability was demonstrated for the FAOS, the FADI and the FAAM but not for the AJFAT. The FAOS and the FAAM met the criteria for content validity and construct validity. For none of the studied instruments, the internal consistency was sufficiently demonstrated. The presence of floor- and ceiling effects was assessed for the FAOS but ceiling effects were present for all

  6. Air acupuncture therapy combined with manipulation on 90 cases of acute sprain and bruising of ankle joint%气针加手法治疗急性踝关节扭挫伤90例

    Institute of Scientific and Technical Information of China (English)

    王永红; 李斌

    2003-01-01

    @@ BACKGROUND: Air acupuncture therapy is to make use of time and space stimuli of air in acupoint and promote blood circulation to remove blood stasis, relieve swelling and pain through interstitial osmosis and absorption. Manipulation to acute sprain and bruising of ankle joint can achieve anatomic reduction as soon as possible, clear incarceration of synovium, promote circulation of qi and relieve pain and increase blood circulation of affected tissue.

  7. Review of ankle inversion sprain simulators in the biomechanics laboratory

    Directory of Open Access Journals (Sweden)

    Sophia Chui-Wai Ha

    2015-10-01

    Full Text Available Ankle inversion ligamentous sprain is one of the most common sports injuries. The most direct way is to investigate real injury incidents, but it is unethical and impossible to replicate on test participants. Simulators including tilt platforms, trapdoors, and fulcrum devices were designed to mimic ankle inversion movements in laboratories. Inversion angle was the only element considered in early designs; however, an ankle sprain is composed of inversion and plantarflexion in clinical observations. Inversion velocity is another parameter that increased the reality of simulation. This review summarised the simulators, and aimed to compare and contrast their features and settings.

  8. Ultrasound-guided interventions of the foot and ankle.

    Science.gov (United States)

    Yablon, Corrie M

    2013-02-01

    Ultrasound (US) provides excellent delineation of tendons and ligaments in the foot and ankle and provides real-time visualization of a needle during interventions, yielding greater accuracy and efficacy than the traditional blind approach using anatomical landmarks. For this reason, US is rapidly gaining acceptance as the preferred modality for guiding interventions in the foot and ankle where the anatomy is complex, neurovascular structures should be identified, and precise technique is demanded. In the foot and ankle, US is especially useful to guide tendon sheath, bursal, and Achilles paratenon injections, Morton neuroma injections, plantar fascial injections, and joint aspirations and injections.

  9. Prevalence and association between risk factors, stroke subtypes, and abnormal ankle brachial index in acute ischemic stroke.

    Science.gov (United States)

    Ratanakorn, Disya; Keandoungchun, Jesada; Tegeler, Charles H

    2012-08-01

    Abnormal ankle brachial index (ABI) identifies a stroke subgroup with high risk of subsequent stroke and other vascular events. There are few data regarding the prevalence of abnormal ABI in ischemic stroke in Asian countries. We evaluated the prevalence of abnormal ABI in 747 Thai patients with ischemic stroke or transient ischemic attack and assessed the correlation of abnormal ABI with stroke risk factors and stroke subtypes. The prevalence of abnormal ABI (≤0.9) in ischemic stroke patients was 18.1%. Abnormal ABI in ischemic stroke patients was significantly correlated with female gender (odds ratio [OR], 1.61; confidence interval [CI], 1.09-2.40; P = .017), age ≥ 60 years (OR, 3.54; CI, 2.14-5.85; P ischemic events, including coronary artery disease (OR, 2.55; CI, 1.47-4.43; P = .001), cerebrovascular disease (OR, 2.15; CI, 1.37-3.55; P = .002), and atrial fibrillation (OR, 1.71; CI, 1.03-2.82; P = .036). There was a significant difference in the prevalence of abnormal ABI among stroke subtypes (P stroke (29.2%), and undetermined etiology (20.6%). An ABI examination should be considered in patients with ischemic stroke to facilitate the early detection and treatment of asymptomatic peripheral arterial disease and identification of excess risk for subsequent stroke or other vascular events. Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  10. Position versus force control: using the 2-DOF robotic ankle trainer to assess ankle's motor control.

    Science.gov (United States)

    Farjadian, Amir B; Nabian, Mohsen; Hartman, Amber; Corsino, Johnathan; Mavroidis, Constantinos; Holden, Maureen K

    2014-01-01

    An estimated of 2,000,000 acute ankle sprains occur annually in the United States. Furthermore, ankle disabilities are caused by neurological impairments such as traumatic brain injury, cerebral palsy and stroke. The virtually interfaced robotic ankle and balance trainer (vi-RABT) was introduced as a cost-effective platform-based rehabilitation robot to improve overall ankle/balance strength, mobility and control. The system is equipped with 2 degrees of freedom (2-DOF) controlled actuation along with complete means of angle and torque measurement mechanisms. Vi-RABT was used to assess ankle strength, flexibility and motor control in healthy human subjects, while playing interactive virtual reality games on the screen. The results suggest that in the task with 2-DOF, subjects have better control over ankle's position vs. force.

  11. Effects of Acupuncture-moxibustion Intervention on Proprioception in Athletes with Lateral Collateral Ligament Injury of Ankle Joint%针灸对踝关节外侧韧带损伤后期本体感觉恢复的影响

    Institute of Scientific and Technical Information of China (English)

    唐文江; 蒋垂刚; 陈丽容; 庞勇; 李杰; 黄昀

    2013-01-01

    Objective To compare the efficacy differences between acupuncture-moxibustion and physiotherapy interventions in improving proprioception of athletes with lateral collateral ligament injury of the ankle joint.Methods Thirty patients with injured lateral collateral ligament of ankle joint were randomly divided into acupuncture group (n =15) and physiotherapy group (n =15).Patients of the acupuncture group were treated by acupuncture and moxibustion stimulation of Qiuxu(GB 40),Kunlun(BL 60),Shenmai (BL 62),Jiexi (ST 41),and Ashi-points,etc.,and those of the physiotherapy group treated with TDP irradiation of the regional lateral malleolus.The treatment of the two groups was conducted once the other day,3 times each week,continuously for 8 weeks.Before and after the treatment,the ankle-joint's active and passive repositioning error angles were measured by using a joint angle ruler.Results The average error angle values of active and passive reposition tests of the injured ankle-joint were 4.98 ± 1.11 and 4.78± 1.13 before the treatment,and 3.67± 0.58 and 3.51 ± 0.64 after the treatment,respectively in the acupuncture group,being reduced significantly after the treatment (both P<0.01).No significant changes of the average error angle values of both active and passive reposition tests of the ankle-joint were found after the treatment in the physiotherapy group (P>0.05).Comparison between two groups showed that the average error angle,average active and passive reposition angles of the injured ankle in the acupuncture group were evidently lower than those in the physiotherapy group (P<0.01).Conclusion Acupuncture and moxibustion can effectively improve the proprioception of the injured lateral collateral ligament of the ankle joint in athletes,which is superior to conventional physiotherapy in the therapeutic effect.%目的:观察针灸与常规理疗对踝关节外侧韧带损伤后本体感觉恢复影响的差异.方法:30例踝关节外侧韧带损伤后

  12. Total ankle joint replacement.

    Science.gov (United States)

    2016-02-01

    Ankle arthritis results in a stiff and painful ankle and can be a major cause of disability. For people with end-stage ankle arthritis, arthrodesis (ankle fusion) is effective at reducing pain in the shorter term, but results in a fixed joint, and over time the loss of mobility places stress on other joints in the foot that may lead to arthritis, pain and dysfunction. Another option is to perform a total ankle joint replacement, with the aim of giving the patient a mobile and pain-free ankle. In this article we review the efficacy of this procedure, including how it compares to ankle arthrodesis, and consider the indications and complications.

  13. Acute fatigue impairs neuromuscular activity of anterior cruciate ligament-agonist muscles in female team handball players

    DEFF Research Database (Denmark)

    Zebis, M K; Bencke, J; Andersen, L L

    2011-01-01

    In sports, like team handball, fatigue has been associated with an increased risk of anterior cruciate ligament (ACL) injury. While effects of fatigue on muscle function are commonly assessed during maximal isometric voluntary contraction (MVC), such measurements may not relate to the muscle...... for neuromuscular activity [electromyography (EMG)] during a sidecutting maneuver on a force plate, pre and post a simulated handball match. MVC was obtained during maximal isometric quadriceps and hamstring contraction. The simulated handball match consisted of exercises mimicking handball match activity. Whereas...... the simulated handball match induced a decrease in MVC strength for both the quadriceps and hamstring muscles (P

  14. Arthrography, talar tilt and surgical findings after inversion trauma of the ankle

    Energy Technology Data Exchange (ETDEWEB)

    van Moppes, F.I.; van den Hoogenband, C.R.; van Engelshoven, J.M.; Betts-Brown, A.

    1981-04-01

    Both inversion stress examination under general anesthesia and arthrography are sensitive indicators of lateral ankle ligament pathology (91%, 96% resp.). Arthrography is significantly superior to inversion stress examination done under local anesthesia (96%, 70% resp.). Peroneus tendon sheath filling is always pathological, but although this does not always indicate calcaneo-fibular ligament rupture, such rupture cannot be excluded in its absence. Talar tilt difference cannot be correlated with the extent of ligamentous rupture and therefore inversion stress examination, while providing valuable additional information, must be regarded as a secondary technique to ankle arthrography.

  15. Foot and ankle fractures at the supination line

    NARCIS (Netherlands)

    T. Schepers (Tim); E.M. van Schie- van der Weert; M.R. de Vries (Mark); M. van der Elst (Maarten)

    2011-01-01

    textabstractBackground: The supination line is a fictive line along the foot and ankle, on which over twenty fracture types and approximately ten different ligamentous sprain-injuries have been identified. Objective: The current study was conducted to evaluate the incidence of different types of

  16. Acute changes in intra-alveolar tooth position and local clearance of /sup 125/I from the periodontal ligament

    Energy Technology Data Exchange (ETDEWEB)

    Edwall, B.; Berg, J.O.; Gazelius, B.; Edwall L.; Aars, H.

    1987-01-01

    Changes in intra-alveolar tooth position and local /sup 125/I clearance from the periodontal ligament (PDL) were monitored simultaneously in cats. Axial tooth movements, reflecting periodontal ligament volume changes, were measured with an ultrasonic transit time technique. Local blood flow changes in the PDL were studied indirectly by measuring the local clearance of /sup 125/I. Stimulation of the cervical sympathetic trunk caused an intrusive movement of the tooth with a concomitant reduction of the /sup 125/I-clearance. Infusion of noradrenaline induced a similar respone. Stimulation of the inferior alveolar nerve during systemic treatment with phentolamine caused an extrusive movement of the tooth with a concomitant increase in the clearance of the tracer from the PDL. Intra-arterial infusion of the vasodilator substance P mimicked that response. Fization of the tooth to the jaw bone, thus preventing an intrusive movement, did not change the reductions in clearance seen on sympathetic stimulation, indicating that this blood flow reduction was not dependent on tooth movement. A qualitative relation between PDL blood flow (as measured by local /sup 125/I clearance) and PDL volume (as measured by tooth position) in shown. The two variables measured are suggested to reflect two aspects of blood flow in the PDL. 22 refs.

  17. Foot and ankle injuries in theatrical dancers.

    Science.gov (United States)

    Hardaker, W T; Margello, S; Goldner, J L

    1985-10-01

    The theatrical dancer is a unique combination of athlete and artist. The physical demands of dance class, rehearsal, and performance can lead to injury, particularly to the foot and ankle. Ankle sprains are the most common acute injury. Chronic injuries predominate and relate primarily to the repeated impact loading of the foot and ankle on the dance floor. Contributing factors include anatomic variation, improper technique, and fatigue. Early and aggressive conservative management is usually successful and surgery is rarely indicated. Orthotics play a limited but potentially useful role in treatment. Following treatment, a structured rehabilitation program is fundamental to the successful return to dance.

  18. Injury patterns of medial patellofemoral ligament after acute lateral patellar dislocation in children: Correlation analysis with anatomical variants and articular cartilage lesion of the patella

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Guang-ying; Ding, Hong-yu [Shandong Provincial Qianfoshan Hospital of Shandong University, Department of Ultrasonography, Jinan (China); Zheng, Lei; Ji, Bing-jun [Shandong Provincial Corps Hospital of Chinese People' s Armed Police Force, Department of Radiology, Jinan (China); Shi, Hao [Shandong Provincial Qianfoshan Hospital of Shandong University, Department of Radiology, Jinan (China); Feng, Yan [Affiliated Hospital of Binzhou Medical College, Department of Radiology, Binzhou (China)

    2017-03-15

    To assess the relationship between injury patterns of medial patellofemoral ligament (MPFL) and anatomical variants and patellar cartilage lesions after acute lateral patellar dislocation (LPD) in children. MR images were obtained in 140 children with acute LPD. Images were acquired and evaluated using standardised protocols. Fifty-eight cases of partial MPFL tear and 75 cases of complete MPFL tear were identified. Injuries occurred at an isolated patellar insertion (PAT) in 52 cases, an isolated femoral attachment (FEM) in 42 cases and an isolated mid-substance (MID) in five cases. More than one site of injury was identified in 34 cases. Compared with Wiberg patellar type C, Wiberg patellar type B predisposed to complete MPFL tear (P = 0.042). No correlations were identified between injury patterns of MPFL and trochlear dysplasia, patellar height and tibial tuberosity-trochlear groove distance (P > 0.05). Compared with partial MPFL tear, complete MPFL tear predisposed to Grade-IV and Grade-V patellar chondral lesion (P = 0.02). There were no correlations between incidence of patellar cartilage lesion and injury locational-subgroups of MPFL (P = 0.543). MPFL is most easily injured at the PAT in children. Wiberg patellar type B predisposes to complete MPFL tear. Complete MPFL tear predisposes to a higher grade of patellar chondral lesion. (orig.)

  19. Radiographic Evaluation of the Ankle Mortise

    Directory of Open Access Journals (Sweden)

    Hamid Mirbagheri

    2010-05-01

    Full Text Available The ankle joint is the most frequently injured joint in adults. Decisions on management are usually based on clinical examination and interpretation of the x-rays. Stability of the ankle mortise relies on the configuration of the osseous structures and the ligaments. A basic radiographic examination consists of a mortise-view and a lateral view. Some add the AP-view. The Mortise view is an AP-view with 15-25 degrees endorotation of the foot. "nThe view clearly demonstrates both lateral and medial joint spaces. On a true AP-view the talus overlaps a portion of the lateral malleolus obscuring the lateral aspect of the ankle joint. However, the AP-view will give you an extra view on both malleoli from a different angle. The lateral radiograph of the ankle should include the base of the fifth metatarsal because of the frequency of fractures at this side that clinically mimic a fracture of the ankle.

  20. [The effects of electro-acupuncture on the signaling pathway of TLR/MYD88 in ankle joint synovial tissue of acute gouty arthritis rats].

    Science.gov (United States)

    Zhang, Chao-nan; Huang, Xue-kuan; Luo, Yan; Jiang, Juan; Wan, Lei; Wang, Ling

    2014-11-01

    To investigate the effects of electro-acupuncture ( EA) on the related protein expression of the signaling pathway of the toll-like receptor2 (TLR2)/myeloid differentiation factor (MYD) 88 in ankle joint synovial tissue of acute gouty arthritis (AGA) rats. Fifty male SD rats were randomly divided into 5 groups: normal group, SMD group, AGA model group, medication group and EA group, 10 rats in each group. SMD group established model by inducing SMD, other groups established AGA model by inducing monosodium urate, except the normal group. Two days before model was established, normal and SMD and AGA model groups were lavaged with normal saline (20 mL/kg), medication group was lavaged with colchicine solution (1 mg/kg), EA (1. 5-2 Hz, D.-D. wave, 9 V, 1-3 mA) was applied to"Sanyinjiao" (SP6),"Jiexi"(ST41) and "kunlun" (BL60) for 20 min, once daily, continuously for 9 days. Then the join sewlling index was observed periodically, the protein expression of TLR2 and MYD88 was determined by immunohistochemistry. Compared to the normal group, the join sewlling of the SMD group in test join increased significantly (P0.05), the oin sewlling and protein expression of TLR2 and MYD88 in synovial tissue of model group increased significantly P0.05). EA can alleviate the symptoms of AGA, which may be related to regulation of the protein expression Y TRI and MYD88 in the TLR/MYD88 signaling pathway.

  1. The treatment of the acute acromioclavicular joint dislocation with LARS artificial ligament:a preliminary report%应用LARS人工韧带治疗急性肩锁关节脱位的初步报告

    Institute of Scientific and Technical Information of China (English)

    陈爱民; 鹿楠; 叶添文; 杨鹏; 朱磊; 李菁

    2014-01-01

    Background Currently,the clinical perspectives of surgical treatment for Tossy Ⅲacromioclavicular(AC)joint dislocations are relatively identical.Due to the post-traumatic ruptures of the acromioclavicular ligament and coracoclavicular(CC)ligament which are used to maintain stability of the joint,the clavicle moves backward and upward,and the upper arm and the scapula drops downward for the gravity of the upper arm and the influence of the sternocleidomastoid muscle.Since such complications as reduction difficulties,redislocation after external fixation,pressure ulcers of the skin,and so forth are particularly prone to occur in the conservative therapy,the operative treatment is more inclined to be adopted for the Tossy Ⅲ dislocation of the AC joint.With the single repair and fixation of the CC ligament,redislocation is likely to happen after implant removal because the ruptured ligaments healed as scar tissue.Therefore,this study uses an operative method of reconstructing and augmenting the CC ligament with LARS artificial ligament for the treatment of Tossy Ⅲ AC joint dislocation,and evaluates its clinical effect.Methods From November 2006 to July 2009,8 patients with acute AC joint dislocation of Tossy Ⅲ were admitted into our hospital.Five patients were male and 3 were female,and their ages ranged from 21 to 45.Sides:3 injuries were on the left and 5 were on the right.Seven patients suffered from falling on the ground,and 1 patient was inj ured in a traffic accident.All the patients were treated with LARS artificial ligaments to reconstruct the CC ligament.Constant score and VAS score were adopted in clinical evaluation.Zanca view of the bilateral AC joint and the axillary radiograph of the affected shoulder joint were employed for imaging evaluation.All the patients were simple Tossy Ⅲ dislocation of AC joint with no trauma of other parts and skin breakdown.Regular pre-operative examinations and evaluations were carried out after admission,and LARS

  2. Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS)

    DEFF Research Database (Denmark)

    Roemer, Frank W; Frobell, Richard; Lohmander, Stefan

    2014-01-01

    OBJECTIVE: To develop a whole joint scoring system, the Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS), for magnetic resonance imaging (MRI)-based assessment of acute anterior cruciate ligament (ACL) injury and follow-up of structural sequelae, and to assess its reliability. DESIGN...... and longitudinal changes including osteoarthritis (OA) features. Joint features assessed were acute osteochondral injury, traumatic and degenerative bone marrow lesions (BMLs), meniscus morphology and extrusion, osteophytes, collateral and cruciate ligaments including ACL graft, Hoffa-synovitis and effusion...

  3. THE EFFECTS OF KINESIO TAPING ON PROPRIOCEPTION AT THE ANKLE

    Directory of Open Access Journals (Sweden)

    Mark DeBeliso

    2004-03-01

    Full Text Available An experiment was designed to determine if KinesioTM taping the anterior and lateral portion of the ankle would enhance ankle proprioception compared to the untaped ankle. 30 subjects, 15 men, 15 women, ages 18-30 participated in this study. Exclusion criteria: Ankle injury < 6 months prior to testing, significant ligament laxity as determined through clinical evaluation by an ATC, or any severe foot abnormality. Experiment utilized a single group, pretest and posttest. Plantar flexion and inversion with 20° of plantar flexion reproduction of joint position sense (RJPS was determined using an ankle RJPS apparatus. Subjects were barefooted, blindfolded, and equipped with headphones playing white noise to eliminate auditory cues. Subjects had five trials in both plantar flexion and inversion with 20° plantar flexion before and after application of the KinesioTM tape to the anterior/lateral portion of the ankle. Constant error and absolute error were determined from the difference between the target angle and the trial angle produced by the subject. The treatment group (KinesioTM taped subjects showed no change in constant and absolute error for ankle RJPS in plantar flexion and 20º of plantar flexion with inversion when compared to the untaped results using the same motions. The application of KinesioTM tape does not appear to enhance proprioception (in terms of RJPS in healthy individuals as determined by our measures of RJPS at the ankle in the motions of plantar flexion and 20º of plantar flexion with inversion.

  4. Techniques for managing varus and valgus malalignment during total ankle replacement.

    Science.gov (United States)

    Choi, Woo Jin; Yoon, Hang Seob; Lee, Jin Woo

    2013-01-01

    The ultimate goal of primary total ankle replacement is to provide a well-balanced soft-tissue envelope around a well-aligned, well-fixated implant. Some surgeons have emphasized that good outcomes in total ankle replacement are more dependent on ligament balancing, along with the procedure itself, than the extent of preoperative coronal deformity in the ankle. Thus, it is imperative that the surgeon be familiar with additional procedures to address the varus, valgus, and other associated deformities commonly encountered in primary total ankle replacement.

  5. The Clinical Analysis of MRI Examination of Acute Anterior Cruciate Ligament Injury%急性前交叉韧带损伤的MRI检查临床分析

    Institute of Scientific and Technical Information of China (English)

    李明勇

    2014-01-01

    Objective To explore the clinical value of MRI examination in patients with acute anterior cruciate ligament injury. Methods Take two clinical examination of drawer test and Lachman conducted tests and MRI examination for 75 cases of acute traumatic knee hematoma anterior the patient in our hospital, and then the ifnal check arthroscopy. Check the results of arthroscopic judgment based on pre-clinical examination and MRI diagnostic accuracy of acute ligament injury crossover comparative analysis. Results The analysis of results 75 cases of arthroscopic knee hematoma in patients with acute traumatic acute anterior cruciate ligament injury in 53 cases, 22 cases of normal;clinical examination were found in acute anterior cruciate ligament injury really positive in 28 cases, 21 cases of true negatives , 5 cases of false-positive and false-negative number of 21 cases , the accuracy was 65.3%;MRI diagnosis was true positive in 48 cases, the number of true negative in 23 cases, one case of false-positive and false-negative number three cases, the accuracy was 94.7%. MRI for diagnostic accuracy of acute anterior cruciate ligament injuries was signiifcantly higher than clinical examination,with statistical signiifcance (P<0.01). Conclusion MRI examination can accurately make a diagnosis of acute anterior cruciate ligament injury.The diagnostic accuracy was superior to clinical examination. Clinical examination should be the main choice before the early diagnosis of acute ligament damage in cross examination.%目的:探讨MRI检查在急性前交叉韧带损伤患者诊断中的临床实用价值。方法对我们医院的75例急性创伤性膝关节血肿的患者进行前抽屉试验及Lachman试验的两项临床检查和MRI的检查,最后进行关节镜的检查。以关节镜的检查结果为判断依据,对临床检查和MRI检查诊断急性前交叉韧带损伤的准确率进行比较分析。结果经关节镜分析得出75例急性创伤性膝关节

  6. Bilateral ankle edema with bilateral iritis.

    Science.gov (United States)

    Kumar, Sunil

    2007-07-01

    I report two patient presented to me with bilateral symmetrical ankle edema and bilateral acute iritis. A 42-year-old female of Indian origin and 30-year-old female from Somalia both presented with bilateral acute iritis. In the first patient, bilateral ankle edema preceded the onset of bilateral acute iritis. Bilateral ankle edema developed during the course of disease after onset of ocular symptoms in the second patient. Both patients did not suffer any significant ocular problem in the past, and on systemic examination, all clinical parameters were within normal limit. Lacrimal gland and conjunctival nodule biopsy established the final diagnosis of sarcoidosis in both cases, although the chest x-rays were normal.

  7. Tratamento da luxação femoro-patelar aguda pelo reparo do ligamento femoro-patelar medial Treatment of acute patellofemoral dislocation through medial patellofomoral ligament repair

    Directory of Open Access Journals (Sweden)

    Gilberto Luis Camanho

    2005-01-01

    Full Text Available Os autores avaliaram a evolução de 17 pacientes que tiveram luxação femoropatelar aguda e foram tratados pela sutura do ligamento femoropatelar medial. A sutura do ligamento foi feita por via artroscópica em 9 pacientes que apresentaram a lesão do ligamento próxima à patela. Nos oito pacientes restantes a lesão do ligamento femoropatelar ocorreu próxima ao epicôndilo femoral e foi tratada pela reinserção no epicôndilo femoral com âncoras. Os pacientes foram acompanhados por um tempo médio de 40 meses e não houve nenhuma recidiva da luxação femoropatelar durante este período.The authors evaluated the evolution of seventeen patients with acute patellofemoral dislocation. Patients were treated through medial patellar ligament suture. The suture of the ligament was performed by arthroscopy in nine patients with ligament lesion near to the patella. The other eight patients, with patellofemoral ligament lesion occurring near to the femoral epicondyle, were treated by reinsertion at the femoral epicondyle with anchors. The patients had a mean follow-up period of forty months and there was no femoropatellar dislocation recurrence.

  8. Acute fatigue impairs neuromuscular activity of anterior cruciate ligament-agonist muscles in female team handball players.

    Science.gov (United States)

    Zebis, M K; Bencke, J; Andersen, L L; Alkjaer, T; Suetta, C; Mortensen, P; Kjaer, M; Aagaard, P

    2011-12-01

    In sports, like team handball, fatigue has been associated with an increased risk of anterior cruciate ligament (ACL) injury. While effects of fatigue on muscle function are commonly assessed during maximal isometric voluntary contraction (MVC), such measurements may not relate to the muscle function during match play. The purpose of this study was to investigate the effect of muscle fatigue induced by a simulated handball match on neuromuscular strategy during a functional sidecutting movement, associated with the incidence of ACL injury. Fourteen female team handball players were tested for neuromuscular activity [electromyography (EMG)] during a sidecutting maneuver on a force plate, pre and post a simulated handball match. MVC was obtained during maximal isometric quadriceps and hamstring contraction. The simulated handball match consisted of exercises mimicking handball match activity. Whereas the simulated handball match induced a decrease in MVC strength for both the quadriceps and hamstring muscles (Phandball match play. Thus, screening procedures should involve functional movements to reveal specific fatigue-induced deficits in ACL-agonist muscle activation during high-risk phases of match play.

  9. 扬刺法针刺配合燃酒疗法治疗急性踝关节扭伤疗效观察%Efficacy Observation on Multiple Superficial Needling Combined with Alcohol Burning Method Treating Acute Ankle Sprain

    Institute of Scientific and Technical Information of China (English)

    高锋

    2016-01-01

    目的:观察扬刺法针刺配合燃酒疗法治疗急性踝关节扭伤的临床疗效.方法:86例急性踝关节扭伤患者随机分为治疗组和对照组各43例,治疗组采用扬刺法针刺配合燃酒疗法,对照组采用刺络拔罐治疗,观察两组疗效.结果:治疗组总有效率为100.00%,显著高于对照组的88.37%(P<0.01).结论:扬刺法针刺配合燃酒疗法治疗急性踝关节扭伤疗效肯定,值得临床推广应用.%Objective: To observe the clinical effect of multiple superficial needling combined with alcohol burning method treating acute ankle sprain. Methods:86 cases of acute ankle sprain were randomly divided into treatment group and control group with each of 43 cases, treatment group adopted multiple superficial needling combined with alcohol burning method, control group with bloodletting puncture and cupping therapy, the cura-tive effect of the two groups were observed. Results:The total effective rate of treatment group was 100.00%, significantly higher than that of control group by 88.37% (P<0.01). Conclusion:The efficacy of multiple superficial needling combined with alcohol burning method treating acute ankle sprain is definite, being worthy of clinical application.

  10. Modified Blair ankle fusion for ankle arthritis

    Institute of Scientific and Technical Information of China (English)

    Wang Shuangli; Huang Zhang; Xiong Gaoxin; Chen Guang; Yin Zhongxiang; Jiang Hua

    2014-01-01

    Objective:To investigate the clinical outcome of modified Blair ankle fusion for ankle arthritis.Methods:Between November 2009 and June 2012,28 patients with ankle arthritis were treated,among whom 11 had obvious foot varus deformity,and 17 were almost normal in appearance.There were 13 males and 15 females with an average age of 49.4 years (range,23-67 years).The main symptoms included swelling,pain,and a limited range of motion of the ankles.The ankle joints functions were assessed by American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and visual analog scale (VAS) preoperatively and at 1 year follow-up.Results:Twenty-eight patients were followed up for 19.8 months on average (range,1-2 years).Superficial wound infection occurred in 3 cases,and was cured after debridement; the other incisions healed by first intention without complications.All ankles were fused at 1 year follow-up after operation.The symptom was relieved completely in all patients at last follow-up without complication of implant failure,or nonunion.The postoperative AOFAS ankle and hindfoot score was 83.13±3.76,showing significant difference when compared with the preoperative score (45.38±3.21,P<0.01).VAS was significantly decreased from 8.01±0.63 to 2.31±1.05 at 1 year follow-up (P<0.05).Conclusion:Modified Blair ankle fusion has the advantages of high feasiblity,less cost and rigid fixation.It shows high reliability in pain relief and may obtain a good clinical effectiveness.

  11. Pain and knee function in relation to degree of bone bruise after acute anterior cruciate ligament rupture

    DEFF Research Database (Denmark)

    Szkopek, K; Warming, Torsten; Neergaard, K;

    2012-01-01

    and the bone bruise volume of the lateral femoral condyle. Patients with bone bruise of the medial tibia and patients with meniscal lesions had more pain. It is suggested that pain and decreased function after acute ACL injury most likely is related to soft tissue and cartilage injury and not to bone bruise....

  12. Annular lipoatrophy of the ankles.

    Science.gov (United States)

    Dimson, Otobia G; Esterly, Nancy B

    2006-02-01

    Lipoatrophic panniculitis likely represents a group of disorders characterized by an inflammatory panniculitis followed by lipoatrophy. It occurs locally in a variety of settings and has been reported in the literature under various terms, including annular atrophic connective tissue panniculitis of the ankles, annular and semicircular lipoatrophy, abdominal lipoatrophy, and connective tissue panniculitis. Herein, a case of annular lipoatrophy of the ankles is described in a 6-year-old girl with autoimmune thyroid disease. Histologically, a mixed lobular panniculitis with lipophages was present. This pattern resembles that seen in lipoatrophic panniculitis. After a single, acute episode of an inflammatory process with subsequent lipoatrophy, her skin lesions have stabilized for 2 years requiring no treatment.

  13. MRI of the ankle. Comparison of 0.2-T and 1.0-T units; MRT des Sprunggelenks. Vergleich eines Ganzkoerper-Mittelfeldgeraets (1,0T) mit einem dedizierten Niederfeldgeraet (0,2T)

    Energy Technology Data Exchange (ETDEWEB)

    Merhemic, Z. [Universitaetsklinik fuer Radiodiagnostik, AKH Wien (Austria). Abt. fuer Osteologie und Einrichtung Magnetic Resonanz]|[Sarajevo Univ. (Bosnia and Herzegovina). Inst. of Radiology; Breitenseher, M.; Trattnig, S.; Happel, B.; Rand, T.; Imhof, H. [Universitaetsklinik fuer Radiodiagnostik, AKH Wien (Austria). Abt. fuer Osteologie und Einrichtung Magnetic Resonanz; Kukla, C. [Universitaetsklinik fuer Unfallchirurgie, Wien (Austria)

    1999-01-01

    Purpose: Comparison of ankle joint injuries with different MR systems and at different field strengths. Method: Ten patients with acute ankle injuries were examined using mid-field (1.0 T) and dedicated low-field (0.2 T) MR units. Findings of ligamentous injury, sinus tarsi involvement, bone injury, and tendon injury were correlated. Results: There was no significant difference between mid- and low-field MR imaging for ligamentous injuries ({chi}{sup 2}=0.0395), sinus taris changes bone injuries ({chi}{sup 2}=0.0507; critical value=5,991). Conclusion: This study showed good agreement in pathological findings in ankle injury on mid-field and low-field MR imaging. (orig.) [Deutsch] Das Ziel der Studie war ein Vergleich verschiedener Feldstaerken in der Kernspintomographie bei Sprunggelenksverletzungen. Methode: Zehn Patienten mit frischen Sprunggelenksverletzungen wurden mittels Ganzkoerper-Mittelfeldgeraet (1,0 T) und dediziertem Niederfeldgeraet (0,2 T) untersucht. Befunde von Bandverletzungen, Sinustarsi-, Knochen- und Weichteilverletzungen wurden verglichen. Ergebnisse: Es fand sich kein statistisch signifikanter Unterschied zwischen Mittel- und Niederfeldgeraet im Nachweis von Bandverletzungen ({chi}{sup 2}=0,0395), Sinus-tarsi- und Knochenverletzungen ({chi}{sup 2}=0,0407) [({chi}{sup 2}Test, Signifikanzniveau p=0,05, Kritische Wert=5,991)]. Schlussfolgerung: Diese Studie zeigte eine gute Uebereinstimmung im Nachweis von Sprunggelenksverletzungen von Mittel- und Niederfeldgeraet in der Kernspintomograhie. (orig.)

  14. Design of a simple, lightweight, passive-elastic ankle exoskeleton supporting ankle joint stiffness

    Science.gov (United States)

    Kim, Seyoung; Son, Youngsu; Choi, Sangkyu; Ham, Sangyong; Park, Cheolhoon

    2015-09-01

    In this study, a passive-elastic ankle exoskeleton (PEAX) with a one-way clutch mechanism was developed and then pilot-tested with vertical jumping to determine whether the PEAX is sufficiently lightweight and comfortable to be used in further biomechanical studies. The PEAX was designed to supplement the function of the Achilles tendon and ligaments as they passively support the ankle torque with their inherent stiffness. The main frame of the PEAX consists of upper and lower parts connected to each other by tension springs (N = 3) and lubricated hinge joints. The upper part has an offset angle of 5° with respect to the vertical line when the springs are in their resting state. Each spring has a slack length of 8 cm and connects the upper part to the tailrod of the lower part in the neutral position. The tailrod freely rotates with low friction but has a limited range of motion due to the stop pin working as a one-way clutch. Because of the one-way clutch system, the tension springs store the elastic energy only due to an ankle dorsiflexion when triggered by the stop pin. This clutch mechanism also has the advantage of preventing any inconvenience during ankle plantarflexion because it does not limit the ankle joint motion during the plantarflexion phase. In pilot jumping tests, all of the subjects reported that the PEAX was comfortable for jumping due to its lightweight (approximately 1 kg) and compact (firmly integrated with shoes) design, and subjects were able to nearly reach their maximum vertical jump heights while wearing the PEAX. During the countermovement jump, elastic energy was stored during dorsiflexion by spring extension and released during plantarflexion by spring restoration, indicating that the passive spring torque (i.e., supportive torque) generated by the ankle exoskeleton partially supported the ankle joint torque throughout the process.

  15. Functional bandage for ankle sprains. Recommendations for nursing

    Directory of Open Access Journals (Sweden)

    Mª Isabel Arcos Cirauqui

    2011-11-01

    Full Text Available Three quarters of ankle injuries are diagnosed as sprains. For the most part sprains are caused by a forced inversion movement with involvement of the lateral collateral ligament (LCL. One of the recommended guidelines is immobilization by taping. The aim of this article is to unify the recommendations for nursing, on taping in the treatment of ankle sprains. The methodology used was a literature review, analyzing the information found in books and journals in hospital libraries and nursing databases on the Internet. The main results are a set of guidelines for the most accurate and therapeutic taping.

  16. Predisposing factors to lateral ankle injury in male comrades marathon runners

    Directory of Open Access Journals (Sweden)

    J. Hiemstra

    2009-02-01

    Full Text Available Introduction: More than two million people experience ankle ligament traumaeach year in the United States. Half of these are severe ligament sprains, however verylittle is known about the factors that predispose individuals to these injuries. The purpose of this study, (which was conducted as an undergraduate research project,was to find a correlation between the characteristics of height, weight and limbdominance and lateral ankle ligament injuries. Method: A  retrospective study was conducted on 114 ultra distance runners whoparticipated in the 2006 Comrades Marathon. During race registration, the runners’ height and weight were measuredafter answering a questionnaire regarding their training. Results: 114 runners responded to the questionnaire. From this cohort, 38 (33.3% had sustained previous lateral ankle injuries. Of these 38 injuries, 47.4% of the injuries occurred on the runner’s dominant limb and 36.8% occurred on thenon-dominant side. 15.8% of the runners sustained previous ankle injuries to both ankles. There was a low negative correlation coefficient of 0.24 with regards to weight as a risk factor. This indicated that the power of the correlationwas 5.93%. The study demonstrates that there is no correlation between an increase in weight and an increase in theincidence of ankle injury. The correlation coefficient indicated a low correlation between an increase in height and the incidence of ankle injury. However, the power of the correlation at 18.37% makes inaccurate any attempt to predict the height at which a runner would be at most risk for lateral ankle injury. Conclusion: Height and weight are not risk factors predisposing subjects to lateral ankle injury. In addition, the studyillustrated that there was no effect of limb dominance on the incidence of lateral ankle injury.

  17. A noninvasive biomechanical treatment as an additional tool in the rehabilitation of an acute anterior cruciate ligament tear: A case report

    Directory of Open Access Journals (Sweden)

    Avi Elbaz

    2014-01-01

    Full Text Available Objectives: Conservative treatments for anterior cruciate ligament (ACL tears may have just as good an outcome as invasive treatments. These include muscle strengthening and neuromuscular proprioceptive exercises to improve joint stability and restore motion to the knee. The Purpose of the current work presents was to examine the feasibility of a novel non-invasive biomechanical treatment to improve the rehabilitation process following an ACL tear. This is a single case report that presents the effect of this therapy in a patient with a complete ACL rupture who chose not to undergo reconstructive surgery. Methods: A 29-year old female athlete with an acute indirect injury to the knee who chose not to undergo surgery was monitored. Two days after injury the patient began AposTherapy. A unique biomechanical device was specially calibrated to the patient’s feet. The therapy program was initiated, which included carrying out her daily routine while wearing the device. The subject underwent a gait analysis at baseline and follow-up gait analyses at weeks 1, 2, 4, 8, 12 and 26. Results: A severe abnormal gait was seen immediately after injury, including a substantial decrease in gait velocity, step length and single limb support. In addition, limb symmetry was substantially compromised following the injury. After 4 weeks of treatment, patient had returned to normal gait values and limbs asymmetry reached the normal range. Conclusions: The results of this case report suggest that this conservative biomechanical therapy may have helped this patient in her rehabilitation process. Further research is needed in order to determine the effect of this therapy for patients post ACL injuries.

  18. Acute spontaneous cervical disc herniation causing rapidly progressive myelopathy in a patient with comorbid ossified posterior longitudinal ligament: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Harrison J Westwick

    2014-01-01

    Full Text Available Background: Ossification of the posterior longitudinal ligament (OPLL and cervical disc herniation are commonly encountered neurosurgical conditions. Here we present an unusual case of nontraumatic rapidly progressive myelopathy due to cervical disc herniation with comorbid OPLL and conduct a literature review focusing on the frequency and management of disc herniations with OPLL. Case Description: A 52-year-old healthy female presented with a 72-h history of rapid progression of dense quadriparesis with sensory deficits, with a precedent 4-week history of nontraumatic midline neck pain. Clinical examination revealed profound motor deficits below the C5 myotome. Spinal neuroimaging revealed OPLL (computed tomography [CT] and a cervical disc herniation spanning from C4/5 to C5/6 with significant retrovertebral disease (magnetic resonance imaging [MRI]. Operative management involved an anterior cervical corpectomy and instrumented fusion, with removal of both the sequestered disc material and the locally compressive OPLL. The patient recovered full motor function and independent ambulation with no residual signs or symptoms of myelopathy at the time of discharge. Conclusion: This unique case of a spontaneous cervical disc herniation in the context of OPLL causing rapidly progressive myelopathy illustrates the complementarity of CT and MRI in diagnosing the underlying cause of a rapidly progressive neurologic deficit in the absence of antecedent trauma. Though the optimal surgical management of such pathology remains uncertain; in this case, the anterior approach was motivated by the significant retrovertebral ventrally compressive sequestrum, and provided for excellent neurologic outcome. This article also reviews the occurrence/management of such acute cervical discs with OPLL.

  19. Simulated activity but real trauma: a systematic review on Nintendo Wii injuries based on a case report of an acute anterior cruciate ligament rupture.

    Science.gov (United States)

    Müller, Sebastian A; Vavken, Patrick; Pagenstert, Geert

    2015-03-01

    Video gaming injuries are classically regarded as eccentric accidents and novelty diagnoses. A case of an anterior cruciate ligament (ACL) tear sustained during Wii boxing spurned us to review the literature for other Wii-related injuries and Wii-based posttraumatic rehabilitation. The English literature listed in PubMed was systematically reviewed by searching for "Wii (trauma or injury or fracture)." Full-text articles were included after duplicate, blinded review. The type and treatment of injury as well as the Wii-based rehabilitation programs found were analyzed. Additionally, a new case of an acute ACL tear-sustained playing, Wii boxing, is additionally presented. After exclusion of irrelevant articles, 13 articles describing Wii-related injuries were included reporting on 3 fractures, 6 nonosseous, 2 overuse injuries, and 2 rehabilitation programs using Wii for posttraumatic rehabilitation. Among the presented Wii-related injuries, only 12.5% were treated conservatively, whereas 87.5% underwent either surgical or interventional treatment. Because of the reported case, the literature search was limited to Wii-related injuries excluding other video games. Another limitation of this article lies in the fact that mainly case reports but no controlled trials exist on the topic. Assumingly, primarily the more severe injuries are reported in the literature with an unknown number of possibly minor injuries. Motion-controlled video games, such as Wii, are becoming increasingly popular as a recreational entertainment. Because of their wide acceptance and entertaining nature, they are also increasingly recognized as a tool in rehabilitation. However, although the activity is simulated, injuries are real. Our systematic review shows that Wii gaming can lead to severe injuries, sometimes with lasting limitations.

  20. The PRICE study (Protection Rest Ice Compression Elevation: design of a randomised controlled trial comparing standard versus cryokinetic ice applications in the management of acute ankle sprain [ISRCTN13903946

    Directory of Open Access Journals (Sweden)

    Rocke Laurence G

    2007-12-01

    Full Text Available Abstract Background Cryotherapy (the application of ice for therapeutic purposes is one of the most common treatment modalities employed in the immediate management of acute soft tissue injury. Despite its widespread clinical use, the precise physiological responses to therapeutic cooling have not been fully elucidated, and effective evidence-based treatment protocols are yet to be established. Intermittent ice applications are thought to exert a significant analgesic effect. This could facilitate earlier therapeutic exercise after injury, potentially allowing for a quicker return to activity. The primary aim of the forthcoming study is therefore to examine the safety and effectiveness of combining intermittent ice applications with periods of therapeutic exercise in the first week after an acute ankle sprain. Methods/Design The study is a randomised controlled trial. 120 subjects with an acute grade I or grade II ankle sprain will be recruited from Accident & Emergency and a University based Sports Injury Clinic. Subjects will be randomised under strict double-blind conditions to either a standard cryotherapy (intermittent ice applications with compression or cryokinetic treatment group (intermittent ice applications with compression and therapeutic exercise. After the first week, treatment will be standardised across groups. Assessor blinding will be maintained throughout the trial. Primary outcome will be function, assessed using the Lower Extremity Functional Scale (LEFS. Additional outcomes will include pain (10 cm Visual Analogue Scale, swelling (modified figure-of-eight method and activity levels (activPAL™ physical activity monitor, PAL Technologies, Glasgow, UK. Diagnostic Ultrasound (Episcan-1-200 high frequency ultrasound scanning system, Longport International Ltd, PA will also be used to assess the degree of soft tissue injury. After baseline assessment subjects will be followed up at 1, 2, 3 & 4 weeks post injury. All data will

  1. Sonography on injury of the medial patellofemoral ligament after acute traumatic lateral patellar dislocation: Injury patterns and correlation analysis with injury of articular cartilage of the inferomedial patella.

    Science.gov (United States)

    Zhang, Guang-Ying; Zheng, Lei; Shi, Hao; Qu, Su-Hui; Ding, Hong-Yu

    2013-12-01

    The purpose of this study was to investigate the accuracy of high-frequency ultrasonography in the diagnosis of injuries of medial patellofemoral ligaments (MPFLs), analyse the characteristics of MPFL injury and correlations between injury of the MPFL and articular cartilage of the inferomedial patella in patients with acute traumatic lateral patellar dislocation. High-frequency sonographic images of 49 patients with acute traumatic lateral patellar dislocations treated surgically were reviewed. The χ(2) tests were performed for statistical analysis. Twenty-eight cases of complete MPFL tear and 21 cases of partial MPFL tear were identified in operation, with 27 cases of MPFL tear located at their femoral attachment, 21 cases of tear at the patellar attachment and one case of midsubstance tear. The diagnostic accuracy of sonography regarding partial MPFL tear and complete MPFL tear was 89.8% and 89.8%. Among the patients with MPFL tear at the patellar attachment, eight and six cases were concomitant with chondral and osteochondral lesions in the inferomedial patella, respectively, in contrast to nine and six cases in patients with MPFL tear at the femoral attachment, respectively. There was no significant difference between the two locations described above regarding the prevalence rates of chondral or osteochondral lesions of the inferomedial patella (P=0.732, P=0.614). Among the patients with complete MPFL tear, 12 and 10 cases were concomitant with chondral and osteochondral lesions in the inferomedial patella, respectively, while six and two cases were concomitant with partial MPFL tear. There was no significant difference between the two types of injuries discussed above on the prevalence rates of chondral lesions of the inferomedial patella (P=0.305), but the prevalence rate of osteochondral lesions between the two types of injuries discussed above was statistically different (P=0.035). The MPFL is most easily injured at the femoral attachment, secondly at

  2. Therapeutic Interventions for Increasing Ankle Dorsiflexion After Ankle Sprain: A Systematic Review

    Science.gov (United States)

    Terada, Masafumi; Pietrosimone, Brian G.; Gribble, Phillip A.

    2013-01-01

    Context: Clinicians perform therapeutic interventions, such as stretching, manual therapy, electrotherapy, ultrasound, and exercises, to increase ankle dorsiflexion. However, authors of previous studies have not determined which intervention or combination of interventions is most effective. Objective: To determine the magnitude of therapeutic intervention effects on and the most effective therapeutic interventions for restoring normal ankle dorsiflexion after ankle sprain. Data Sources: We performed a comprehensive literature search in Web of Science and EBSCO HOST from 1965 to May 29, 2011, with 19 search terms related to ankle sprain, dorsiflexion, and intervention and by cross-referencing pertinent articles. Study Selection: Eligible studies had to be written in English and include the means and standard deviations of both pretreatment and posttreatment in patients with acute, subacute, or chronic ankle sprains. Outcomes of interest included various joint mobilizations, stretching, local vibration, hyperbaric oxygen therapy, electrical stimulation, and mental-relaxation interventions. Data Extraction: We extracted data on dorsiflexion improvements among various therapeutic applications by calculating Cohen d effect sizes with associated 95% confidence intervals (CIs) and evaluated the methodologic quality using the Physiotherapy Evidence Database (PEDro) scale. Data Synthesis: In total, 9 studies (PEDro score = 5.22 ± 1.92) met the inclusion criteria. Static-stretching interventions with a home exercise program had the strongest effects on increasing dorsiflexion in patients 2 weeks after acute ankle sprains (Cohen d = 1.06; 95% CI = 0.12, 2.42). The range of effect sizes for movement with mobilization on ankle dorsiflexion among individuals with recurrent ankle sprains was small (Cohen d range = 0.14 to 0.39). Conclusions: Static-stretching intervention as a part of standardized care yielded the strongest effects on dorsiflexion after acute ankle sprains. The

  3. THE FEATURES OF TIBIOFIBULAR INJURY IN PATENTS WITH ANKLE FRACTURES

    Directory of Open Access Journals (Sweden)

    N. F. Fomin

    2010-01-01

    Full Text Available The role of interposition of soft tissues into tibiofibular syndesmosis is analyzed as a cause of unsatisfactory outcomes in the ankle joint pronation fracture treatment. The study is based on clinical (452 patients and experimental material (36 experiments including unfixed anatomic objects. The elevator for minimal invasive operative elimination of interposition of stumps of distal tibiofibular syndesmosis anterior and posterior ligaments is developed and tested.

  4. Founder's lecture of the ISS 2006: borderlands of normal and early pathological findings in MRI of the foot and ankle

    Energy Technology Data Exchange (ETDEWEB)

    Zanetti, Marco [University Hospital Balgrist, Radiology, Zurich (Switzerland)

    2008-10-15

    The purpose of this article is to highlight the anatomical variants, technical pitfalls, and the prevalence of abnormal conditions in the asymptomatic population in magnetic resonance imaging of the foot and ankle. Special attention is drawn to the complex anatomy of the deltoid ligament (the superficial tibionavicular ligament, tibiospring ligament, the tibiocalcaneal ligament, and the deep anterior and posterior tibiotalar ligaments) and the posterior tibial tendon insertion including the magic angle artifact and the high prevalence of asymptomatic findings such as ''hypertrophied'' peroneal tubercle (abnormal only when larger than 5 mm), peroneus quartus (prevalence 17%), and cysts (vascular remnants) just inferior to the angle of Gissane. (orig.)

  5. The effect of talo-crural joint manipulation on range of motion at the ankle joint in subjects with a history of ankle injury.

    Science.gov (United States)

    Andersen, Skye; Fryer, Gary A; McLaughlin, Patrick

    2003-07-01

    Introduction: There is little research available on the effects of peripheral joint manipulation. Only a few studies have examined the effect of manipulation on ankle range of motion, with conflicting results. This study aimed to determine whether a single high-velocity, low-amplitude (HVLA) thrust manipulation to the talo-crural joint altered ankle range of motion in subjects with a history of lateral ligament sprain.Methods: Male and female volunteers (N=52) with a history of lateral ligament sprain were randomly assigned into either an experimental group (n=26) or a control group (n=26). Those in the experimental group received a single HVLA thrust to the talo-crural joint, whilst those in the control group received no treatment intervention. Pre-test and post-test measurements of passive dorsiflexion range of motion were taken.Results: No significant changes in dorsiflexion range of motion were detected between manipulated ankles and those of control subjects using dependent and independent t-tests. Ankles that cavitated displayed a greater mean DFR and large effect size (d=0.8) compared to those that did not gap and cavitate, but analysis with ANOVA revealed these differences to be not significant.Conclusion: HVLA manipulation of the ankle did not increase dorsiflexion range of motion in subjects with a history of lateral ligament sprain.

  6. Arthrofibrosis of the knee following ligament surgery.

    Science.gov (United States)

    DeHaven, Kenneth E; Cosgarea, Andrew J; Sebastianelli, Wayne J

    2003-01-01

    Arthrofibrosis of the knee is one of the most serious complications that can result from ligament surgery. Reported incidence of arthrofibrosis following anterior cruciate ligament reconstruction ranges from 4% to 35%. The loss of motion caused by arthrofibrosis can be even more disabling than the instability for which the reconstruction was performed, often requiring extensive physical therapy and/or surgical lysis of adhesions. With aggressive rehabilitation and modifications in the bracing of knees undergoing ligament reconstruction, the incidence of this complication has decreased significantly. Additionally, delaying anterior cruciate ligament reconstruction until the acute inflammatory period has resolved has also been shown to be a significant factor in the reduction of postoperative knee stiffness.

  7. Efeito agudo do calçado de diferentes alturas sobre o comportamento angular do tornozelo Acute effect of shoes with different heights on the ankle angular behavior

    Directory of Open Access Journals (Sweden)

    Mirieli Denardi Limana

    2012-09-01

    Full Text Available Estudos descrevem que o uso de salto alto exige do corpo uma série de ajustes compensatórios, a fim de manter os seus movimentos e equilíbrio próximos à normalidade. No andar, a interferência do salto alto sobre o pé e sobre a articulação do tornozelo parece desencadear uma postura diferente da posição anatômica. O presente estudo teve como objetivos comparar a cinemática sagital do tornozelo em diferentes calçados e verificar a existência de um limite de altura de salto que possa levar a articulação do tornozelo a adaptações durante o andar. Esta pesquisa, caracterizada como experimental, foi constituída por uma análise cinemática bidimensional do tornozelo no plano sagital. A amostra foi composta por dez universitárias, com média de idade de 19,2 (±1,8 anos, que caminharam sobre uma esteira utilizando um tênis e três sandálias do tipo tamanco, com saltos de 3, 7 e 10 cm. Para cada ciclo de passada, foram identificados picos de movimento do tornozelo referentes à dorsiflexão e à flexão plantar. Os resultados mostraram que na flexão plantar, com o aumento da altura do salto, há uma tendência de acentuação do pico angular do tornozelo. Concluiu-se que saltos acima de 3 cm de altura induzem a articulação do tornozelo a realizar uma flexão plantar sustentada, mudando as características da marcha na fase de apoio e de balanço. Tais evidências sugerem alturas de saltos menores de 3 cm como limites de segurança para manutenção do padrão normal da marcha em mulheres jovens.Studies have described that using high heels requires a series of compensatory adjustments of the body to keep its movements and balance close to normality. When walking, the interference of high heels on the foot and on the ankle joint seems to initiate a different posture from the anatomical position. The present study aimed at comparing the sagittal kinematics of the ankle in different shoes and at verifying the existence of a height

  8. Effects of Ankle Braces Upon Agility Course Performance in High School Athletes

    OpenAIRE

    Beriau, Mark R.; Cox, William B.; Manning, James

    1994-01-01

    The purpose of this study was to compare the effects of wearing the AircastTM Sports Stirrup, AircastTM Training brace, Swede-OTM brace, and DonJoyTM Ankle Ligament Protector while running an agility course. Eighty-five high school athletes with no history of ankle injury and no experience in wearing any ankle support served as subjects. Each subject participated in four separate testing sessions. During sessions 1 and 4, subjects ran the agility course under the control (unbraced) conditions...

  9. 全关节镜下距腓前韧带解剖重建治疗慢性踝关节不稳定的疗效观察%All-inside Arthroscopic Anterior Talofibular Ligament Anatomic Reconstruction for Chronic Ankle Instability

    Institute of Scientific and Technical Information of China (English)

    魏世隽; 蔡贤华; 黄继锋; 徐峰; 刘曦明; 齐凤宇; 兰生辉; 汤明; 陈家

    2016-01-01

    目的 探讨全关节镜下自体股薄肌腱解剖重建距腓前韧带(anterior talofibular ligament,ATFL)治疗慢性踝关节不稳定的方法及临床疗效.方法 将作者医院2015-12/2016-04月收治的9例慢性踝关节不稳定患者纳入研究,其中男性8例,女性1例,年龄20~43岁,平均32.3岁;术前踝关节应力位片提示距骨倾斜平均14.3°(13~19°),关节镜下探查清理,经踝关节镜前外侧入口观察,前外侧辅助入口于腓骨远端和距骨颈外侧面ATFL足印区制作骨隧道,取自体股薄肌腱经骨隧道解剖重建ATFL,5.0mm×15mm界面螺钉固定,术后功能支具固定踝关节于中立位,早期功能锻炼,术后6周在护踝保护下行走,末次随访采用美国足踝外科学会(American Orthopedic Foot and Ankle Society,AOFAS)评分标准及视觉模拟评分(visual analogue scale,VAS)评估疗效.结果 术后随访3~9个月(平均4.9个月),无患者感染及切口延迟愈合,9例患者均于术后3个月恢复体育活动;至末次随访时未观察到踝关节不稳定征象,AOFAS评分平均89.4分(85~96分),VAS评分平均1.4分(1~4分).结论 全关节镜下自体股薄肌肌腱解剖重建ATFL治疗慢性踝关节不稳定,初期疗效理想.

  10. 关节镜下喙锁韧带增强术治疗肩锁关节脱位%Arthroscopic treatment of acute acromioclavicular joint dislocations by coracoacromial ligament augmentation and suture

    Institute of Scientific and Technical Information of China (English)

    皇甫小桥; 赵金忠; 何耀华; 杨星光; 刘旭东; 刘闻欣; 王海明

    2013-01-01

    ,nine patients with acute AC joint dislocation type Ⅲ and three patients with type V were treated arthroscopically to augment the reconstructed CC ligaments (conoid ligament and trapezoid ligament ) by the suture plate (ASCULAP Company, Germany,B′Braun)used to reconstruct ligaments of knee joint.Patients were pre and postoperatively evaluated with X-ray examinations,American Shoulder and Elbow Surgeons′Form (ASES)and Constant-Murley Score (CMS).Results All 1 2 patients were followed up for at least 1 2 months (range,1 2 to 1 8 months).The average ASES score significantly increased from 28.7 preoperatively to 86.9 postoperatively, and the mean CMS score from 24 to 91,respectively.X-ray data showed a good reduction of the AC joint in the treated group.9 1 .7% of patients (1 1 patients)obtained an obvious therapeutic effect after operation. 83.3% of patients (10 patients)returned to their pre-injury level of athletics.Acromioclavicular subluxation was only found in one case.Discussion AC joint dislocation usually appears in youth and adults with obvious traumatic history,and often results from the direct violence on the adducted shoulder.The stable structure of AC joint is achieved by the connection between the scapula and the clavicle,and the integrity of the sternoclavicular articulation and the scapulothoracic joint.According to the injury level of acromioclavicular stability,AC joint injuries can be classified into six types by Rockwood,type Ⅲ、Ⅳ、Ⅴ、Ⅵ should be fixed through operation for its disruption of stable structures.The goal of surgical procedure on AC joint dislocation is to reconstruct its anatomy and function. Activity of AC joint and its postoperative rehabilitation training will be inevitably affected by any operation of strict limitation on its flexibility. Arthroscopically assisted augmentation of reconstructed CC ligaments with the suture plate button technique is an effective method in treating AC joint dislocation,which restores its

  11. Modified Evans peroneus brevis lateral ankle stabilization for balancing varus ankle contracture during total ankle replacement.

    Science.gov (United States)

    Roukis, Thomas S

    2013-01-01

    Lateral ankle instability is frequently encountered when performing total ankle replacement and remains a challenge. In the present techniques report, I have described a modification of the Evans peroneus brevis tendon lateral ankle stabilization harvested through limited incisions using simple topographic anatomic landmarks. The harvested peroneus brevis is then transferred either to the anterior distal tibia concomitantly with total ankle replacement or through the tibia when performed after total ankle replacement and secured with plate and screw fixation. This modified Evans peroneus brevis tendon is useful in providing lateral ankle stability during or after primary and revision total ankle replacement.

  12. Transient superficial peroneal nerve palsy after anterior cruciate ligament reconstruction

    OpenAIRE

    Majed Alrowaili

    2016-01-01

    A 19-year-old male subject was diagnosed with medial meniscal, lateral meniscal and anterior cruciate ligament (ACL) tear. The symptoms did not subside after 4 months of physical therapy, and he underwent arthroscopic partial medial and lateral meniscectomy and ACL reconstruction. Immediately after the patient woke up from general anesthesia, he started experience loss of sensation in the area of superficial peroneal nerve with inverted dorsiflexion of foot and ankle. Instantly, the bandage a...

  13. Artificial Ligaments: Promise or Panacea?

    Science.gov (United States)

    Lubell, Adele

    1987-01-01

    The Food and Drug Administration has approved a prosthetic ligament for limited use in persons with damaged anterior cruciate ligaments (ACL). This article addresses ligament repair, ACL tears, current treatment, development of the Gore-Tex artificial ligament, other artificial ligaments in process, and arguments for and against their use.…

  14. Early intra-articular complement activation in ankle fractures

    DEFF Research Database (Denmark)

    Schmal, Hagen; Salzmann, Gian M; Niemeyer, Philipp;

    2014-01-01

    osteochondritis dissecans (OCD) of the ankle. All fractures needed external fixation during which joint effusions were collected. Fluid analysis was done by ELISA measuring aggrecan, bFGF, IL-1 β, IGF-1, and the complement components C3a, C5a, and C5b-9. The time periods between occurrence of fracture...... and OCD patients, bFGF, IGF-1, and all complement components were significantly higher concentrated in ankle joints with fractures (P Complement activation and inflammatory cell infiltration characterize the joint biology following acute ankle fractures....

  15. The Use of Model Matching Video Analysis and Computational Simulation to Study the Ankle Sprain Injury Mechanism

    Directory of Open Access Journals (Sweden)

    Daniel Tik-Pui Fong

    2012-10-01

    Full Text Available Lateral ankle sprains continue to be the most common injury sustained by athletes and create an annual healthcare burden of over $4 billion in the U.S. alone. Foot inversion is suspected in these cases, but the mechanism of injury remains unclear. While kinematics and kinetics data are crucial in understanding the injury mechanisms, ligament behaviour measures ‐ such as ligament strains ‐ are viewed as the potential causal factors of ankle sprains. This review article demonstrates a novel methodology that integrates model matching video analyses with computational simulations in order to investigate injury‐producing events for a better understanding of such injury mechanisms. In particular, ankle joint kinematics from actual injury incidents were deduced by model matching video analyses and then input into a generic computational model based on rigid bone surfaces and deformable ligaments of the ankle so as to investigate the ligament strains that accompany these sprain injuries. These techniques may have the potential for guiding ankle sprain prevention strategies and targeted rehabilitation therapies.

  16. Posterior tibial tendon displacement behind the tibia and its interposition in an irreducible isolated ankle dislocation: a case report and literature review

    Science.gov (United States)

    ORTOLANI, ALESSANDRO; BEVONI, ROBERTO; RUSSO, ALESSANDRO; MARCACCI, MAURILIO; GIROLAMI, MAURO

    2016-01-01

    Isolated posteromedial ankle dislocation is a rare condition thanks to the highly congruent anatomical configuration of the ankle mortise, in which the medial and lateral malleoli greatly reduce the rotational movement of the talus, and the strength of the ligaments higher than the malleoli affords protection against fractures. However, other factors, like medial malleolus hypoplasia, laxity of the ligaments, peroneal muscle weakness and previous ankle sprains, could predispose to pure dislocation. In the absence of such factors, only a complex high-energy trauma, with a rotational component, can lead to this event. Irreducibility of an ankle dislocation, which is rarely encountered, can be due to soft tissue interposition. Dislocation of the posterior tibial tendon can be the cause of an irreducible talar dislocation; interposition of this tendon, found to have slid posteriorly to the distal tibia and then passed through the tibioperoneal syndesmosis, is reported in just a few cases of ankle fracture-dislocation. PMID:27900312

  17. Hypertrophy of Ligament of Treitz

    Directory of Open Access Journals (Sweden)

    Siddharth P. Dubhashi

    2015-04-01

    Full Text Available Congenital duodenal obstruction commonly occurs due to malrotation, atresia, stenosis and annular pancreas in decreasing order of frequency. This is a case report of a 12 year old male child who presented with complaints of non-projectile vomiting and abdominal distension and pain after meals since 7 years. Barium study showed narrowing of the Duodeno-jejunal(DJ junction due to hypertrophied ligament of Treitz. Exploratory laparotomy revealed a dilated stomach and collapsed bowel loops. There were adhesions at DJ junction and other parts of the small intestine. Adhesiolysis was done. The followup revealed a weight gain of 2 kg. The barium study was repeated which also revealed a normal study. Congenital obstruction of duodeno-jejunal junction due to extrinsic band or due to narrower attachment of ligament of Treitz at duodeno-jejunal flexure is a rare cause of bilious vomiting in the newborn period. A broad attachment of the ligament of Treitz makes a smooth obtuse angle at the duodeno-jejunum junction whereas a narrower insertion creates an acute angle that predisposes to obstruction.Duodenal obstruction may rarely occur in the presence of a normally rotated gut.

  18. Multiple-ligament injured knee

    Institute of Scientific and Technical Information of China (English)

    SUN Lei; NING Zhi-jie; ZHANG Hui; TIAN Min; NING Tin-min

    2006-01-01

    Objective: To explore the clinical characteristic of the multiple-ligament injured knee and evaluate the protocol,technique and outcome of treatment for the multipleligament injured knee.Methods: From October 2001 to March 2005, 9 knees with combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears in 9 patients were identified with clinical and arthroscopic examinations. Of them, 5 knees were combined with ruptures of posteromedial corner (PMC) and medial collateral ligament (MCL), 4 with disruptions of posterolateral corner ( PLC), 2 with popliteal vascular injuries and 1 with peroneal nerve injuries. Six patients were hospitalized in acute phase of trauma, 2 received repairs of popliteal artery and 4 had repairs of PMC and MCL. Reconstructions of ACL and PCL with autografts under arthroscope were performed in all patients at 4 to 10 weeks after trauma,including reconstruction of PLC with the posterior half of biceps femoris tendon tenodesis in 4 patients and reconstructions of PMC and MCL with femoral fascia in 1 patient.Results: No severe complications occurred at early stage after operation in the 9 patients. All of them were followed up for 10-39 months with an average of 23. 00 months ± 9.46 months. Lysholm score was 70-95 with an average of 85.00 ± 8.29. International Knee Documentation Committee (IKDC) score was from severely abnormal (Grade D) in 9 knees at initial examination to normal (Grade A) in 2 knees, nearly normal (Grade B ) in 6 knees and abnormal in 1 knee at the last follow-up. Of the 9 patients, 7 returned to the same activity level before injury and 2 were under the level.Conclusions: The multiple-ligament injured knee with severe instability is usually combined with other important structure damages. Therefore, careful assessment and treatment of the combined injuries are essential. Reconstructions of ACL and PCL under arthroscope, combined with repairs or reconstructions of the extraarticular ligaments

  19. What Is a Foot and Ankle Surgeon?

    Science.gov (United States)

    ... Foot & Ankle Surgeon? A A A | Print | Share What is a Foot & Ankle Surgeon? Foot and ankle ... of conditions that affect people of every age. What education has a foot and ankle surgeon received? ...

  20. Anterolateral Drawer Versus Anterior Drawer Test for Ankle Instability: A Biomechanical Model.

    Science.gov (United States)

    Miller, Adam G; Myers, Stuart H; Parks, Brent G; Guyton, Gregory P

    2016-04-01

    The addition of unconstrained internal rotation to the physical examination could allow for detection of more subtle degrees of ankle instability. We hypothesized that a simulated anterolateral drawer test allowing unconstrained internal rotation of the ankle would provoke greater displacement of the lateral talus in the mortise versus the anterior drawer test. Ten cadaveric lower extremities were tested in a custom apparatus designed to reproduce the anterior drawer test and the anterolateral drawer test, in which the ankle was allowed to internally rotate about the intact deep deltoid ligament while being subluxed anteriorly. Specimens were tested intact and with anterior tibiofibular ligament sectioned. A differential variable reluctance transducer was used to measure lateral talar displacement with anterior forces of 25 and 50 N. No significant differences in talar displacement or ankle rotation were noted in intact specimens between the groups. Among sectioned specimens, significantly more talar displacement (25 N [6.5 ± 1.7 mm vs 3.8 ± 2.4 mm] and 50 N [8.7 ± 0.9 mm vs 4.5 ± 2.5 mm], P < .001) and ankle rotation (25 N [13.9 ± 8.0 degrees vs 0.0 ± 0.0 degrees] and 50 N [23.7 ± 5.8 degrees vs 0.0 ± 0.0 degrees], P < .001) were found in the anterolateral drawer versus anterior drawer group. In an ankle instability model, the anterolateral drawer test provoked almost twice the lateral talus displacement found with the anterior drawer test. Allowing internal rotation of the ankle while testing for ankle instability may allow the examiner to detect more subtle degrees of ankle instability. © The Author(s) 2015.

  1. Tendon and ligament imaging

    Science.gov (United States)

    Hodgson, R J; O'Connor, P J; Grainger, A J

    2012-01-01

    MRI and ultrasound are now widely used for the assessment of tendon and ligament abnormalities. Healthy tendons and ligaments contain high levels of collagen with a structured orientation, which gives rise to their characteristic normal imaging appearances as well as causing particular imaging artefacts. Changes to ligaments and tendons as a result of disease and injury can be demonstrated using both ultrasound and MRI. These have been validated against surgical and histological findings. Novel imaging techniques are being developed that may improve the ability of MRI and ultrasound to assess tendon and ligament disease. PMID:22553301

  2. Optimal management of ankle syndesmosis injuries

    Directory of Open Access Journals (Sweden)

    Porter DA

    2014-08-01

    Full Text Available David A Porter, Ryan R Jaggers, Adam Fitzgerald Barnes, Angela M Rund Methodist Sports Medicine/The Orthopedic Specialists, Indianapolis, IN, USA Abstract: Syndesmosis injuries occur when there is a disruption of the distal attachment of the tibia and fibula. These injuries occur commonly (up to 18% of ankle sprains, and the incidence increases in the setting of athletic activity. Recognition of these injuries is key to preventing long-term morbidity. Diagnosis and treatment of these injuries requires a thorough understanding of the normal anatomy and the role it plays in the stability of the ankle. A complete history and physical examination is of paramount importance. Patients usually experience an external rotation mechanism of injury. Key physical exam features include detailed documentation about areas of focal tenderness (syndesmosis and deltoid and provocative maneuvers such as the external rotation stress test. Imaging workup in all cases should consist of radiographs with the physiologic stress of weight bearing. If these images are inconclusive, then further imaging with external rotation stress testing or magnetic resonance imaging are warranted. Nonoperative treatment is appropriate for stable injuries. Unstable injuries should be treated operatively. This consists of stabilizing the syndesmosis with either trans-syndesmotic screw or tightrope fixation. In the setting of a concomitant Weber B or C fracture, the fibula is anatomically reduced and stabilized with a standard plate and screw construct. Proximal fibular fractures, as seen in the Maisonneuve fracture pattern, are not repaired operatively. Recent interest is moving toward repair of the deltoid ligament, which may provide increased stability, especially in rehabilitation protocols that involve early weight bearing. Rehabilitation is focused on allowing patients to return to their pre-injury activities as quickly and safely as possible. Protocols initially focus on

  3. Effects of Ankle Arthrodesis on Biomechanical Performance of the Entire Foot.

    Directory of Open Access Journals (Sweden)

    Yan Wang

    Full Text Available Ankle arthrodesis is one popular surgical treatment for ankle arthritis, chronic instability, and degenerative deformity. However, complications such as foot pain, joint arthritis, and bone fracture may cause patients to suffer other problems. Understanding the internal biomechanics of the foot is critical for assessing the effectiveness of ankle arthrodesis and provides a baseline for the surgical plan. This study aimed to understand the biomechanical effects of ankle arthrodesis on the entire foot and ankle using finite element analyses. A three-dimensional finite element model of the foot and ankle, involving 28 bones, 103 ligaments, the plantar fascia, major muscle groups, and encapsulated soft tissue, was developed and validated. The biomechanical performances of a normal foot and a foot with ankle arthrodesis were compared at three gait instants, first-peak, mid-stance, and second-peak.Changes in plantar pressure distribution, joint contact pressure and forces, von Mises stress on bone and foot deformation were predicted. Compared with those in the normal foot, the peak plantar pressure was increased and the center of pressure moved anteriorly in the foot with ankle arthrodesis. The talonavicular joint and joints of the first to third rays in the hind- and mid-foot bore the majority of the loading and sustained substantially increased loading after ankle arthrodesis. An average contact pressure of 2.14 MPa was predicted at the talonavicular joint after surgery and the maximum variation was shown to be 80% in joints of the first ray. The contact force and pressure of the subtalar joint decreased after surgery, indicating that arthritis at this joint was not necessarily a consequence of ankle arthrodesis but rather a progression of pre-existing degenerative changes. Von Mises stress in the second and third metatarsal bones at the second-peak instant increased to 52 MPa and 34 MPa, respectively, after surgery. These variations can provide

  4. X-Ray Exam: Ankle

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old X-Ray Exam: Ankle KidsHealth > For Parents > X-Ray Exam: Ankle A A A What's in ... español Radiografía: tobillo What It Is An ankle X-ray is a safe and painless test that ...

  5. Diclofenac epolamine plus heparin plaster versus diclofenac epolamine plaster in mild to moderate ankle sprain: a randomized, double-blind, parallel-group, placebo-controlled, multicentre, phase III trial.

    Science.gov (United States)

    Costantino, Cosimo; Kwarecki, Jacek; Samokhin, Anatoly V; Mautone, Giuseppe; Rovati, Stefano

    2011-01-01

    In general sports, ankle sprain is the most frequently reported ankle injury and can cause chronic lateral ankle pain and tenderness. Treatment with NSAIDs is preferred, and several topical NSAID formulations are now available, helping to avoid the systemic adverse events typically associated with oral preparations. To compare the efficacy and tolerability of a newly developed fixed-dose diclofenac epolamine (diclofenac hydroxyethylpyrrolidine, DHEP)/heparin plaster (Flectoparin® Tissugel) with that of a DHEP (Flector EP Tissugel®) or placebo plaster in the treatment of mild to moderate ankle sprain in adults. This was a randomized, double-blind, parallel-group, placebo-controlled, multicentre, phase III study conducted in the emergency medical centres of hospitals or private clinics in Europe. Outpatients aged 18-65 years who had suffered an acute ankle sprain (O'Donoghue grade I or II in severity, with external lateral ligament involvement) within the previous 48 hours and had peri-malleolar oedema were eligible for inclusion. A total of 430 patients were randomized to receive a DHEP/heparin 1.3%/5600 IU (n = 142), DHEP 1.3% (n = 146) or placebo (n = 142) plaster, applied once daily to the injured ankle for a total of 7 days. The primary endpoint was the mean change from baseline in pain on movement on day 3, as measured by a visual analogue scale (VAS). The DHEP/heparin plaster was associated with a significantly (p = 0.002) greater mean reduction from baseline in pain on movement after 3 days of treatment than the DHEP plaster (-24.2 vs -18.8 mm VAS), with each active treatment providing significantly (p ≤ 0.005) greater pain relief than placebo (-13.7 mm VAS). Both DHEP/heparin and DHEP were also effective in relieving other measures of pain, with DHEP/heparin recipients experiencing significantly less daily pain while leaning on the injured limb than DHEP recipients (p plaster and DHEP plaster were both well tolerated, with

  6. Acute non-contact anterior cruciate ligament tears are associated with relatively increased vastus medialis to semimembranosus cross-sectional area ratio: a case-control retrospective MR study.

    Science.gov (United States)

    Wieschhoff, Ged G; Mandell, Jacob C; Czuczman, Gregory J; Nikac, Violeta; Shah, Nehal; Smith, Stacy E

    2017-07-15

    Hamstring muscle deficiency is increasingly recognized as a risk factor for anterior cruciate ligament (ACL) tears. The purpose of this study is to evaluate the vastus medialis to semimembranosus cross-sectional area (VM:SM CSA) ratio on magnetic resonance imaging (MRI) in patients with ACL tears compared to controls. One hundred knee MRIs of acute ACL tear patients and 100 age-, sex-, and side-matched controls were included. Mechanism of injury, contact versus non-contact, was determined for each ACL tear subject. The VM:SM CSA was measured on individual axial slices with a novel method using image-processing software. One reader measured all 200 knees and the second reader measured 50 knees at random to assess inter-reader variability. The intraclass correlation coefficient (ICC) was calculated to evaluate for correlation between readers. T-tests were performed to evaluate for differences in VM:SM CSA ratios between the ACL tear group and control group. The ICC for agreement between the two readers was 0.991 (95% confidence interval 0.984-0.995). Acute ACL tear patients have an increased VM:SM CSA ratio compared to controls (1.44 vs. 1.28; p = 0.005). Non-contact acute ACL tear patients have an increased VM:SM CSA ratio compared to controls (1.48 vs. 1.20; p = 0.003), whereas contact acute ACL tear patients do not (1.23 vs. 1.26; p = 0.762). Acute non-contact ACL tears are associated with increased VM:SM CSA ratios, which may imply a relative deficiency in hamstring strength. This study also demonstrates a novel method of measuring the relative CSA of muscles on MRI.

  7. Clinical measurement of mechanical ankle instability.

    Science.gov (United States)

    Parasher, Raju K; Nagy, Dawn R; Em, April L; Phillips, Howard J; Mc Donough, Andrew L

    2012-10-01

    Clinicians commonly use the anterior draw test (ligament laxity) and distal fibular position (lateral malleolus displacement), to measure ankle instability. The purpose of this study was to establish intra-rater and inter-rater reliability for the anterior draw test and distal fibular position in a clinical setting. The anterior draw test (AD) was measured with a plastic Goniometer, and was defined as the linear displacement of the foot as it is drawn anteriorly with the ankle held in 20 degrees of plantar-flexion. Distal fibular position (DFP) was measured in standing using a digital vernier caliper and was the relative linear distance between the lateral and the medial malleoli. 20 participants aged 21-28 volunteered for the study and were measured on both ankles. It was found that Intra-tester reliability (ICC) ranged from 0.88 to 0.97 for AD and DFP; while inter-tester reliability (ICC) was 0.6 for AD and 0.77 for DFP. In addition for measures across trials, the standard error of the measurement (SEM) was, on average 0.66 mm for AD and 1.7 mm for DFP. While the limits of agreement (LOA) was ±0.17 mm for AD and ±4.03 mm for DFP. However, the SEM and LOA between testers was 2.27 mm and ±2.27 mm respectively for AD; and for 3.1 mm and ±10.4 mm for DFP. Overall the results suggest that both measures, as defined in this study exhibit moderate to good reliability and low standard error of measurement, suggesting a high degree of repeatability across trials.

  8. Improving human ankle joint position sense using an artificial tongue-placed tactile biofeedback

    CERN Document Server

    Vuillerme, N; Demongeot, J; Payan, Y; Vuillerme, Nicolas; Chenu, Olivier; Demongeot, Jacques; Payan, Yohan

    2006-01-01

    Proprioception is comprised of sensory input from several sources including muscle spindles, joint capsule, ligaments and skin. The purpose of the present experiment was to investigate whether the central nervous system was able to integrate an artificial biofeedback delivered through electrotactile stimulation of the tongue to improve proprioceptive acuity at the ankle joint. To address this objective, nine young healthy adults were asked to perform an active ankle-matching task with and without biofeedback. The underlying principle of the biofeedback consisted of supplying subjects with supplementary information about the position of their matching ankle position relative to their reference ankle position through a tongue-placed tactile output device (Tongue Display Unit). Measures of the overall accuracy and the variability of the positioning were determined using the absolute error and the variable error, respectively. Results showed more accurate and more consistent matching performances with than withou...

  9. Footballer's ankle: a case report

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    @@ Footballer' s ankle is anterior bony spur or anterior impingement symptom of the ankle with anterior ankle pain, limited and painful dorsiflexion. The cause is commonly seen in athletes and dancers, and is probably due to repetitive minor trauma. The condition was firstly described by Morris;1 McMurray2 reported good results from excision of the spurs, naming it footballer's ankle. Opening resection of osteophytes of the anterior tibial and superior talar is an effective treatment for anterior impingement of the ankle.

  10. Effects of ankle braces upon agility course performance in high school athletes.

    Science.gov (United States)

    Beriau, M R; Cox, W B; Manning, J

    1994-09-01

    The purpose of this study was to compare the effects of wearing the Aircast(TM) Sports Stirrup, Aircast(TM) Training brace, Swede-O(TM) brace, and DonJoy(TM) Ankle Ligament Protector while running an agility course. Eighty-five high school athletes with no history of ankle injury and no experience in wearing any ankle support served as subjects. Each subject participated in four separate testing sessions. During sessions 1 and 4, subjects ran the agility course under the control (unbraced) conditions. Sessions 2 and 3 consisted of randomly wearing the ankle braces while running the agility course. A questionnaire concerning support, comfort, and restriction was completed by each subject after wearing each of the braces. An analysis of variance (ANOVA) with repeated measures revealed that a significant difference existed between the agility times. Tukey's post hoc test indicated that a significant difference existed between each ankle brace and the control 2 agility times as well as a control 1 and control 2 time difference. The control time difference was attributed to a learning effect. An ANOVA with repeated measures of only the four braces revealed that a significant difference existed between the agility times. Tukey's post hoc test showed the only difference was between the DonJoy Ankle Ligament Protector and the Aircast Training brace. We concluded: 1) there is limited practical performance effect upon agility while wearing an ankle brace; and 2) an athlete's perceived comfort, support, and performance restriction are contributing factors that may directly influence the effectiveness of ankle bracing.

  11. Endoscopic Intermetatarsal Ligament Decompression.

    Science.gov (United States)

    Lui, Tun Hing

    2015-12-01

    Morton neuroma is an entrapment of the intermetatarsal nerve by the deep intermetatarsal ligament. It is usually treated conservatively. Surgery is considered if there is recalcitrant pain that is resistant to conservative treatment. The surgical options include resection of the neuroma or decompression of the involved nerve. Decompression of the nerve by release of the intermetatarsal ligament can be performed by either an open or minimally invasive approach. We describe 2-portal endoscopic decompression of the intermetatarsal nerve. The ligament is released by a retrograde knife through the toe-web portal under arthroscopic guidance through the plantar portal.

  12. The effect of anterior cruciate ligament injury on bone curvature

    DEFF Research Database (Denmark)

    Hunter, D J; Lohmander, Stefan; Makovey, J

    2014-01-01

    OBJECTIVE: Investigate the 5-year longitudinal changes in bone curvature after acute anterior cruciate ligament (ACL) injury, and identify predictors of such changes. METHODS: In the KANON-trial (ISRCTN 84752559), 111/121 young active adults with an acute ACL tear to a previously un-injured knee ...

  13. The effectiveness of balance training programs on reducing the incidence of ankle sprains in adolescent athletes.

    Science.gov (United States)

    Valovich McLeod, Tamara C

    2008-08-01

    Ankle sprains are one of the most common sport-related injuries treated by rehabilitation professionals. These injuries often result in lost participation and can lead to subsequent injury episodes. Therefore, it is important to determine appropriate means of preventing these injuries. There has recently been an increase in the popularity of balance training programs for the prevention of knee anterior cruciate ligament (ACL) injury, with some thought that starting these programs in younger athletes may be most beneficial. However, there is the potential that these types of training programs may also be beneficial for decreasing the risk of other lower extremity injuries, including ankle sprains in the adolescent athlete.

  14. [Timing of the surgery of rupture of the anterior cruciate ligament. Effects of acute or delayed surgery on arthrofibrosis rate and work disability].

    Science.gov (United States)

    Berbig, R; Rillmann, P

    2000-09-01

    The optimal time to perform acute ACL reconstruction with respect to arthrofibrosis is discussed. Most authors prefer delayed surgery. The definition of the term "acute" varies between 48 hours and 4 weeks. In this study the limit was set at 60 hours. Acute ACL reconstruction was performed in 39 patients and delayed surgery in 35 patients after they had regained full ROM. The incidence of arthrofibrosis was not higher in the acutely operated group whereas overall inability to work was 44% lower in this population. When the indication is clear, we think that acute ACL reconstruction may be performed within 60 hours without a higher risk of postoperative development of arthrofibrosis. Nowadays, this strategy should also be considered for economic reasons.

  15. Endoscopic Intermetatarsal Ligament Decompression

    OpenAIRE

    Lui, Tun Hing

    2015-01-01

    Morton neuroma is an entrapment of the intermetatarsal nerve by the deep intermetatarsal ligament. It is usually treated conservatively. Surgery is considered if there is recalcitrant pain that is resistant to conservative treatment. The surgical options include resection of the neuroma or decompression of the involved nerve. Decompression of the nerve by release of the intermetatarsal ligament can be performed by either an open or minimally invasive approach. We describe 2-portal endoscopic ...

  16. American Orthopaedic Foot and Ankle Society

    Science.gov (United States)

    ... Statements Publications Foot & Ankle International (FAI) Foot & Ankle Orthopaedics (FAO) In~Stride Newsletter News Center Press Releases ... the best possible care, see a foot & ankle ORTHOPAEDIC surgeon. Find one in your area here. Having ...

  17. Cartilage lesions and ankle osteoarthrosis: review of the literature and treatment algorithm,

    OpenAIRE

    Alexandre Leme de Godoy Santos; Marco Kawamura Demange; Marcelo Pires Prado; Tulio Diniz Fernandes; Pedro Nogueira Giglio; Beat Hintermann

    2014-01-01

    The main etiology of ankle osteoarthrosis is post-traumatic and its prevalence is highest among young individuals. Thus, this disease has a great socioeconomic impact and gives rise to significant losses of patients’ quality of life. The objective of its treatment is to eliminate pain and keep patients active. Therefore, the treatment should be staged according to the degree of degenerative evolution, etiology, joint location, systemic condition, bone quality, lower-limb alignment, ligament s...

  18. Anterior crucate ligament (ACL) injury

    Science.gov (United States)

    ... An anterior cruciate ligament injury is the over-stretching or tearing of the anterior cruciate ligament (ACL) ... may be injured. This is a medical emergency. Prevention Use proper techniques when playing sports or exercising. ...

  19. Optimal management of ankle syndesmosis injuries.

    Science.gov (United States)

    Porter, David A; Jaggers, Ryan R; Barnes, Adam Fitzgerald; Rund, Angela M

    2014-01-01

    Syndesmosis injuries occur when there is a disruption of the distal attachment of the tibia and fibula. These injuries occur commonly (up to 18% of ankle sprains), and the incidence increases in the setting of athletic activity. Recognition of these injuries is key to preventing long-term morbidity. Diagnosis and treatment of these injuries requires a thorough understanding of the normal anatomy and the role it plays in the stability of the ankle. A complete history and physical examination is of paramount importance. Patients usually experience an external rotation mechanism of injury. Key physical exam features include detailed documentation about areas of focal tenderness (syndesmosis and deltoid) and provocative maneuvers such as the external rotation stress test. Imaging workup in all cases should consist of radiographs with the physiologic stress of weight bearing. If these images are inconclusive, then further imaging with external rotation stress testing or magnetic resonance imaging are warranted. Nonoperative treatment is appropriate for stable injuries. Unstable injuries should be treated operatively. This consists of stabilizing the syndesmosis with either trans-syndesmotic screw or tightrope fixation. In the setting of a concomitant Weber B or C fracture, the fibula is anatomically reduced and stabilized with a standard plate and screw construct. Proximal fibular fractures, as seen in the Maisonneuve fracture pattern, are not repaired operatively. Recent interest is moving toward repair of the deltoid ligament, which may provide increased stability, especially in rehabilitation protocols that involve early weight bearing. Rehabilitation is focused on allowing patients to return to their pre-injury activities as quickly and safely as possible. Protocols initially focus on controlling swelling and recovery from surgery. The protocols then progress to restoration of motion, early protected weight bearing, restoration of strength, and eventually a

  20. Finite element analysis of a total ankle replacement during the stance phase of gait.

    Science.gov (United States)

    Reggiani, B; Leardini, A; Corazza, F; Taylor, M

    2006-01-01

    Total ankle replacement (TAR) designs have still several important issues to be addressed before the treatment becomes fully acceptable clinically. Very little is known about the performance, in terms of the contact pressures and kinematics of TAR when subjected to daily activities such as level gait. For this purpose, an explicit finite element model of a novel 3-component TAR was developed, which incorporated a previously validated mechanical model of the ankle ligament apparatus. The intermediate mobile polyethylene meniscal bearing was modelled as an elastic-plastic continuum while the articulating surfaces of the tibial and talar metal components as rigid bodies. Overall kinematics, contact pressures and ligament forces were analysed during passive, i.e. virtually unloaded, and active, i.e. stance phase of gait, conditions. Simulation of passive motion predicted similar kinematics as reported previously in an analytical four-bar linkage model. The meniscal bearing was observed to move 5.6 mm posteriorly during the simulated stance and the corresponding antero-posterior displacement of the talar component was 8.3 mm. The predicted pattern and the amount (10.6 degrees ) of internal-external rotation of the ankle complex were found to be in good agreement with corresponding in vivo measurements on normal ankles. A peak contact pressure of 16.8 MPa was observed, with majority of contact pressures below 10 MPa. For most ligaments, reaction forces remain within corresponding physiological ranges. A first realistic representation of the biomechanical behaviour of the human ankle when replaced by prosthetic joints is provided. The applied methodology can potentially be applied to other TAR designs.

  1. Ankle and midfoot kinetics during normal gait: a multi-segment approach.

    Science.gov (United States)

    Dixon, Philippe C; Böhm, Harald; Döderlein, Leonhard

    2012-04-01

    Multi-segment foot models are increasingly being used to evaluate intra and inter-segment foot kinematics such as the motion between the hindfoot/tibia (ankle) and the forefoot/hindfoot (midfoot) during walking. However, kinetic analysis have been mainly restricted to one-segment foot models and could be improved by considering a multi-segment approach. Therefore, the aims of this study were to (1) implement a kinetic analysis of the ankle and theoretical midfoot joints using the existing Oxford Foot Model (OFM) through a standard inverse dynamics approach using only marker, force plate and anthropometric data and (2) to compare OFM ankle joint kinetics to those output by the one-segment foot plugin-gait model (PIG). 10 healthy adolescents fitted with both the OFM and PIG markers performed barefoot comfortable speed walking trials over an instrumented walkway. The maximum ankle power generation was significantly reduced by approximately 40% through OFM calculations compared to PIG estimates (psegment foot models overestimate ankle power, and may also overestimate the contribution of the triceps surae. A multi-segment approach may help quantify the important contribution of the midfoot ligaments and musculature to power generation. We therefore recommend the use of multi-segment foot models to estimate ankle and midfoot kinetics, especially when surgical decision-making is based on the results of three-dimensional gait analysis.

  2. 1号新伤药联合低频磁疗机治疗急性踝关节扭伤的临床研究%No. 1 New Drug Combined with Low Frequency Magnetic Therapy for Treatment of Acute Ankle Sprain in Clinical Research

    Institute of Scientific and Technical Information of China (English)

    雷鸣枝; 李俊华

    2012-01-01

    This paper is aimed to observe external application ofl new drug combined withlow frequency magnetic therapy tor treatment of acute ankle sprain clinical effect. 35 cases of acute ankle injury were randomly divided into 2 groups, the experimental group used for No. 1 new drug combined with low frequency magnetic therapy treatment, the control group using a simple a simple external application of No. 1 new drug treatment. The experimental group, in alleviating local pain, eliminating swelling, joint dysfunction and other aspects of recovery was better than the control group. External application of No. 1 new drug with low frequency magnetic therapy for comprehensive treatment of acute ankle sprain, with quick, short course of treatment, the characteristics of a good curative effect, is a kind of effective prevention and treatment of ankle injury in acute after a healing period of activity dysfunction good method.%探讨了外敷l号新伤药联合低频磁疗机治疗急性踝关节扭伤的临床效果.将35例急性踝关节损伤患者随机分为2组,实验组使用外敷1号新伤药联合低频磁疗机治疗,对照组采用单纯外敷1号新伤药治疗.结果表明:实验组,在减轻局部的疼痛、肿胀的消除、关节功能恢复等方面均优于对照组.外敷1号新伤药加用低频磁疗机综合治疗急性踝关节扭伤,具有见效快、疗程短、疗效好的特点,是一种有效防治踝关节损伤急性愈合期后活动功能障碍的好方法.

  3. [Clinical features in the diagnosis and treatment of ankle fracture with Wagsaffe fragment].

    Science.gov (United States)

    Liu, Zhongyu; Xin, Jingyi; Liang, Jun

    2014-02-25

    To explore the methods in the diagnosis and treatment of ankle fracture with Wagsaffe fragment. Among 1 201 patients, there were 18 cases of concurrent Wagstaffe fractures at our hospital between January 2009 to January 2012. There were 11 males and 7 females with an average of 37.4 (17-54) years. The causes of injuries were fall (n = 10), sports-related injury (n = 4), traffic injury (n = 3) and high-altitude fall (n = 1). All of them had lateral malleolar fracture. Other injuries included internal malleolar fracture (n = 16), posterior malleolar fracture (n = 8) and disruption of medial deltoid ligament (n = 3). According to the Lauge-Hansen system, all fractures were of supination-external rotation type. The fractures of fibula and Wagstaffe were explored through an anterolateral approach. The lateral malleolar fracture was fixed with plate While Wagstaffe fragment secured with lag screw or thread. Disrupted anterior tibiofibular ligament was restored. Other treatments included open reduction and internal fixation of medial and posterior malleolus, repair of medial deltoid ligament and screw fixation of disrupted tibiofibular syndesmosis. Ankle function was evaluated by the Baird-Jackson criteria. Wagstaffe fracture occurred at a rate of 1.5% in ankle fractures. Wagstaffe fracture was found in 4.4% of ankle fracture of supination-external rotation type. Seventeen patients were followed up over an average follow-up period of 16.8 (12-25) months. All radiographs showed union of all fractures and normal mortise. Baird-Jackson ankle functional score was from 81 to 99. In all 17 patients, 9 were rated as excellent, 5 as good and 3 as fair. The excellent and good rate was 87.4%. At the latest follow-up, 14 patients resumed their preinjury activities. As an easily misdiagnosed condition, Wagstaffe fracture is associated with ankle diastase and prone to occur in ankle fracture of supination-external rotation type. Accurate reduction and stable fixation facilitate the

  4. The ligament augmentation device: an historical perspective.

    Science.gov (United States)

    Kumar, K; Maffulli, N

    1999-05-01

    Anterior cruciate ligament (ACL) injury is the most common ligament injury in the knee, and a significant number of patients may develop progressive instability and disability despite aggressive rehabilitation. Various materials have been used for its reconstruction. These include autografts, allografts, prosthetic ligaments, and synthetic augmentation of the biological tissue. The concept of ligament augmentation device (LAD) arose from the observation that biological grafts undergo a phase of degeneration and loss of strength before being incorporated. The LAD is meant to protect the biological graft during this vulnerable phase. However, it provokes an inflammatory reaction in the knee, and has been found to delay maturation of autogenous graft in humans. In experimental situations, the LAD has been found to share loads in a composite graft. It has also been found to be substantially stronger than the biological graft. However, in clinical situations no significant advantages have been observed with the use of LAD to augment patellar tendon or hamstring reconstruction of the chronic ACL-deficient knee or in the acute setting to augment repair of the torn ACL. There are very few reports of the use of LAD in reconstruction of the posterior cruciate ligament, and again these do not suggest any advantage in its use. Insertion of the LAD implies the introduction of a foreign material into the knee, has been associated with complications such as reactive synovitis and effusions, and may also be associated with an increased risk of infection. At present, there is no evidence that its routine use should be advocated in uncomplicated reconstructions of the ACL using biological grafts.

  5. Treatment of chronic lateral ankle instability: a modified broström technique using three suture anchors

    Directory of Open Access Journals (Sweden)

    Busconi Brian D

    2009-12-01

    Full Text Available Abstract Ankle sprains are very common injuries seen in the athletic and young population. Majority of patients will improve with a course of rest and physical therapy. However, with conservative management about twenty percent of all patients will go on to develop chronic lateral ankle instability. This manuscript describes our detailed surgical technique of a modification to the original Broström procedure using three suture anchors to anatomically reconstruct the lateral ankle ligaments to treat high demand patients who have developed chronic lateral ankle instability. The rationale for this modification along with patient selection and workup are discussed. Both the functional outcomes at the two year follow up along with the complications and the detailed postoperative rehabilitation protocol for the high demand athletes are also presented. This modified Broström procedure is shown in both illustrative format and intra-operative photos.

  6. Total ankle replacement or ankle fusion in painful advanced hemophilic arthropathy of the ankle.

    Science.gov (United States)

    Rodriguez-Merchan, E Carlos

    2015-12-01

    In advanced painful hemophilic arthropathy of the ankle, the last resort is surgical treatment (ankle arthrodesis [AA] or total ankle replacement [TAR]). There is a controversy in the literature on which of the two procedures is more appropriate. A review of the literature was performed to clarify such a controversy. The first search engine was MedLine (keywords: total ankle replacement, ankle arthrodesis). Seventy articles were found in MedLine. Of these, only 16 were selected and reviewed because they were strictly focused on the topic of this article. The second search engine was the Cochrane Library, where only nine systematic reviews were found on the role of TAR and AA in non-hemophilia patients. TAR and AA provide pain relief and patient satisfaction in hemophilia patients in the short term. The available non-hemophilia literature is insufficient to conclude which treatment is superior. My current view is that AA may be preferable in most hemophilia patients.

  7. Manual therapy of the mandibular accessory ligaments for the management of temporomandibular joint disorders.

    Science.gov (United States)

    Cuccia, Antonino Marco; Caradonna, Carola; Caradonna, Domenico

    2011-02-01

    Temporomandibular joint disorders are characterized by chronic or acute musculoskeletal or myofascial pain with dysfunction of the masticatory system. Treatment modalities include occlusal splints, patient education, activity modification, muscle and joint exercises, myofascial therapy, acupuncture, and manipulative therapy. In the physiology of the temporomandibular joint, accessory ligaments limit the movement of the mandible. A thorough knowledge of the anatomy of accessory ligaments is necessary for good clinical management of temporomandibular joint disorders. Although general principles regarding the anatomy of the ligaments are relatively clear, very little substantiated information on the dimension, orientation, and function of the ligaments has been published, to the authors' knowledge. The authors review the literature concerning the accessory ligaments of the temporomandibular joint and describe treatment options, including manual techniques for mobilizing the accessory ligaments.

  8. Cruciate ligament reflexes

    DEFF Research Database (Denmark)

    Krogsgaard, Michael R; Dyhre-Poulsen, Poul; Fischer-Rasmussen, Torsten

    2002-01-01

    The idea of muscular reflexes elicited from sensory nerves of the cruciate ligaments is more than 100 years old, but the existence of such reflexes has not been proven until the recent two decades. First in animal experiments, a muscular excitation could be elicited in the hamstrings when the ant...

  9. Early Intra-Articular Complement Activation in Ankle Fractures

    Directory of Open Access Journals (Sweden)

    Hagen Schmal

    2014-01-01

    Full Text Available Cytokine regulation possibly influences long term outcome following ankle fractures, but little is known about synovial fracture biochemistry. Eight patients with an ankle dislocation fracture were included in a prospective case series and matched with patients suffering from grade 2 osteochondritis dissecans (OCD of the ankle. All fractures needed external fixation during which joint effusions were collected. Fluid analysis was done by ELISA measuring aggrecan, bFGF, IL-1β, IGF-1, and the complement components C3a, C5a, and C5b-9. The time periods between occurrence of fracture and collection of effusion were only significantly associated with synovial aggrecan and C5b-9 levels (P<0.001. Furthermore, synovial expressions of both proteins correlated with each other (P<0.001. Although IL-1β expression was relatively low, intra-articular levels correlated with C5a (P<0.01 and serological C-reactive protein concentrations 2 days after surgery (P<0.05. Joint effusions were initially dominated by neutrophils, but the portion of monocytes constantly increased reaching 50% at day 6 after fracture (P<0.02. Whereas aggrecan and IL-1β concentrations were not different in fracture and OCD patients, bFGF, IGF-1, and all complement components were significantly higher concentrated in ankle joints with fractures (P<0.01. Complement activation and inflammatory cell infiltration characterize the joint biology following acute ankle fractures.

  10. Treatment of Unstable Ankle Fractures

    Directory of Open Access Journals (Sweden)

    Yaniel Truffín Rodríguez

    2015-11-01

    Full Text Available Patients with unstable ankle fractures frequently attend the emergency rooms. It is estimated that there are 122 ankle fractures per 100 000 people a year. Surgical treatment of those that are unstable is inevitable since they can not be corrected in a conservative way. Several surgical procedures for repair of such lesions have been described and all of them constitute important tools for the orthopedic surgeon. Therefore, we conducted a literature review to discuss the current management of unstable ankle fractures based on the analysis of the published literature and the experiences in the Dr. Gustavo Aldereguía Lima University General Hospital of Cienfuegos.

  11. Arthroscopically assisted anatomical coracoclavicular ligament reconstruction using tendon graft.

    Science.gov (United States)

    Yoo, Yon-Sik; Seo, Young-Jin; Noh, Kyu-Cheol; Patro, Bishu Prasad; Kim, Do-Young

    2011-07-01

    We describe a method of arthroscopically assisted, mini-open, anatomical reconstruction of the coracoclavicular ligament. This method restores both components of the native ligament with the aim of achieving maximum stability with minimal disruption of the normal anatomy. Using the same principles of ligament reconstruction that are employed in other joints, transosseous tunnels are created following the native footprints of the conoid and trapezoid ligaments and an autologous graft is fixed using a PEEK screw. Adequate healing of the ligament occurs within the bone, to prevent stress risers with an appropriate working length. This procedure is unique, as it replaces the torn ligament with a natural substitute, in the appropriate location, through a minimally invasive procedure. This technique would be suitable for treatment of patients with either grade III or V acute acromioclavicular dislocations. Clinical outcomes for the first 13 consecutive patients treated with this procedure are reported, revealing excellent satisfaction rates with a Constant score of 96.6 at final follow-up.

  12. Plantar talar head contusions and osteochondral fractures: associated findings on ankle MRI and proposed mechanism of injury

    Energy Technology Data Exchange (ETDEWEB)

    Gorbachova, Tetyana; Wang, Peter S.; Hu, Bing [Einstein Medical Center Philadelphia, Department of Radiology, Philadelphia, PA (United States); Horrow, Jay C. [Drexel University, Department of Anesthesiology and Perioperative Medicine, Philadelphia, PA (United States)

    2016-06-15

    To evaluate the significance of plantar talar head injury (PTHI) in predicting osseous and soft tissue injuries on ankle MRI. The IRB approved this HIPAA-compliant retrospective study. The study group consisted of 41 ankle MRIs with PTHI that occurred at our institution over a 5 1/2 year period. Eighty MRIs with bone injuries in other locations matched for age, time interval since injury, and gender formed a control group. Injuries to the following structures were recorded: medial malleolus, lateral malleolus/distal fibula, posterior malleolus, talus, calcaneus, navicular, cuboid, lateral, medial and syndesmotic ligaments, spring ligament complex, and extensor digitorum brevis (EDB) muscle. Twenty separate logistic regressions determined which injuries PTHI predicted, using the Holm procedure to control for family-wise alpha at 0.05. PTHI strongly predicted the occurrence of injuries involving the anterior process of the calcaneus [24 % of cases, odds ratio (OR) 12.66], plantar components of the spring ligament (27 %, OR 9.43), calcaneal origin of the EDB and attachment of the dorsolateral calcaneocuboid ligament (22 %, OR 7.22), cuboid (51 %, OR 6.58), EDB (27 %, OR 5.49), anteromedial talus (66 %, OR 4.78), and posteromedial talus (49 %, OR 4.48). PTHI strongly predicted lack of occurrence of syndesmotic ligament injury (OR 19.6). The PTHI group had a high incidence of lateral ligamentous injury (78 %), but not significantly different from the control group (53 %). PTHI is strongly associated with injury involving the transverse tarsal joint complex. We hypothesize it results from talo-cuboid and/or talo-calcaneal impaction from a supination injury of the foot and ankle. (orig.)

  13. 酒灸配合手法整复治疗急性踝关节扭伤112例临床观察%Clinical Observation on Wine Moxibustion Combined with Manipulative Reduction Treating 112 Cases of Acute Ankle Sprain

    Institute of Scientific and Technical Information of China (English)

    宋宏文

    2013-01-01

      目的:观察酒灸配合手法整复治疗急性踝关节扭伤的临床疗效。方法:112例患者在发病起始即采用酒灸法配合手法整复治疗,观察其临床疗效。结果:治愈83例,显效29例,无效0例,总有效率100%。结论:酒灸配合手法整复治疗急性踝关节扭伤疗效肯定,无明显副作用,值得临床推广应用。%Objective:To observe the clinical curative effects of wine moxibustion combined with manipulative reduction treating acute ankle sprain. Methods:112 cases of patients all received wine moxibustion combined with manipulation therapy after the onset, to observe the clinical curative ef-fects. Results:83 cases were cured, 29 cases were effective, none was ineffective, the total efficiency was 100%. Conclusion:Wine moxibustion com-bined with manipulative reduction is certainly effective in treating acute ankle sprain, without significant side effects, being worthy of clinical appli-cation.

  14. [Traumatology of the alar ligaments].

    Science.gov (United States)

    Saternus, K S; Thrun, C

    1987-10-01

    A postmortem study of craniocerebral traumas of varying severity was done to determine the pattern of injury of the alar ligaments. It was found that in the entire group of patients (n = 30) the alar ligaments were ruptured or suffused with blood 11 times. No close relationship was found between the massive nature of the cranial trauma and the severity of the injury of the alar ligaments. In some cases the alar ligaments were not at all involved even though the skull had suffered extensive osseous lesions, whereas on the other hand the ligaments were injured even though only soft parts had been involved (e.g., haematoma or dehiscent wounds of the scalp). Ruptures of the alar ligaments were typically involved in extended ruptures of the ligamentous apparatus (see Figure 6a involving the ligamentum apicis dentis, ligamentum transversum atlantis, m.atlanto-occipitalis anterior, m.tectoria, m.atlanto-axialis anterior et posterior). In some cases the pattern of injury of the alar ligaments was found to be decisive in enabling reconstruction of the course of the accident. Damage to the alar ligaments near the dens axis represent rotation injuries. On the other hand, insertion tears out of the condyli occipitales must be related to a lateral thrust tendency in indirect fracture of the skull (bursting fracture). Within this overall framework a new mechanism of fracture of the condylus occipitalis is described. As a matter of principle, the alar ligaments can become involved in consequence of rotation, traction and compression of the cranium.

  15. Broken Ankle/Broken Foot

    Science.gov (United States)

    ... so that your doctor can examine your gait. Imaging tests Not all foot and ankle injuries require ... an orthopedic surgeon may need to use pins, plates or screws to maintain proper position of your ...

  16. The trAPP-study: Cost-effectiveness of an unsupervised e-health supported neuromuscular training program for the treatment of acute ankle sprains in general practice: Design of a randomized controlled trial

    NARCIS (Netherlands)

    A.K.E. Mailuhu (Adinda); E.A.L.M. Verhagen (Evert); J.M. van Ochten (John); P.J.E. Bindels (Patrick); S.M. Bierma-Zeinstra (Sita); M. van Middelkoop (Marienke)

    2015-01-01

    textabstractBackground: Ankle sprains are one of the most frequent injuries of the musculoskeletal system, with yearly around 680.000 new sprains in the Netherlands. Of these, about 130.000 people will visit the general practitioner (GP) each year. In addition, patients have an increased risk of a r

  17. Effects of ankle balance taping with kinesiology tape for a patient with chronic ankle instability

    Science.gov (United States)

    Kim, Byeong-Jo; Lee, Jung-Hoon; Kim, Chang-Tae; Lee, Sun-Min

    2015-01-01

    [Purpose] To report the effects of ankle balance taping for a patient with chronic ankle instability (CAI). [Subject] A 33-year-old man with a 10 year history of chronic ankle stability. [Methods] ABT with kinesiology tape was performed for 2 months (average, 16 h/day) around the right ankle. [Results] At the end of two months, no ankle instability was noted when ascending and descending the stairs, jumping, turning, operating the pedals while driving, and lifting heavy objects. [Conclusion] The repeated use of kinesiology tape in ankle balance taping may be an effective treatment for recovering the ankle stability of patients with chronic ankle instability. PMID:26311206

  18. Effects of ankle balance taping with kinesiology tape for a patient with chronic ankle instability.

    Science.gov (United States)

    Kim, Byeong-Jo; Lee, Jung-Hoon; Kim, Chang-Tae; Lee, Sun-Min

    2015-07-01

    [Purpose] To report the effects of ankle balance taping for a patient with chronic ankle instability (CAI). [Subject] A 33-year-old man with a 10 year history of chronic ankle stability. [Methods] ABT with kinesiology tape was performed for 2 months (average, 16 h/day) around the right ankle. [Results] At the end of two months, no ankle instability was noted when ascending and descending the stairs, jumping, turning, operating the pedals while driving, and lifting heavy objects. [Conclusion] The repeated use of kinesiology tape in ankle balance taping may be an effective treatment for recovering the ankle stability of patients with chronic ankle instability.

  19. Total ankle replacement. Design evolution and results.

    Science.gov (United States)

    van den Heuvel, Alexander; Van Bouwel, Saskia; Dereymaeker, Greta

    2010-04-01

    The ankle joint has unique anatomical, biomechanical and cartilaginous structural characteristics that allow the joint to withstand the very high mechanical stresses and strains over years. Any minor changes to any of these features predispose the joint to osteoarthritis. Total ankle replacement (TAR) is evolving as an alternative to ankle arthrodesis for the treatment of end-stage ankle osteoarthritis. Initial implant designs from the early 1970s had unacceptably high failure and complication rates. As a result many orthopaedic surgeons have restricted the use of TAR in favour of ankle arthrodesis. Long term follow-up studies following ankle arthrodesis show risks of developing adjacent joint osteoarthritis. Therefore research towards a successful ankle replacement continues. Newer designs and longer-term outcome studies have renewed the interest in ankle joint replacement. We present an overview of the evolution, results and current concepts of total ankle replacement.

  20. Roentgenologic diagnostics of capsular ligament lesions

    Energy Technology Data Exchange (ETDEWEB)

    Wirth, C.J.; Jaeger, M.

    1981-10-01

    The X-ray diagnostic is of obvious importance and relevance in the detection of acute or old capsular ligament lesions of the limb joint. On the one hand it serves as the plain radiograph (roentgenogram without contrast medium) for the assessment of osseous secondary lesions, for the documentation of luxationary positions of the joint partners, and in old capsular ligament lesions for the detection of an already existing arthrosis. On the other hand the X-ray images are of main importance, which are made from the hand-held limb in order to permit a comparison of the two sides, and which beyond the clinical detection of a joint instability indicate the extent and the direction of this instability and which also document it, and which allow in adolescents to recognize a separation of the epiphysis as an alternative to the capsular ligament rupture. Only in particular cases arthrography can provide some additional information, so for example in the case of an isolated syndesmosis rupture, ruptures of the rosette of the rotator muscle or of a damaged triangular disk in the hand. Angiography is only required in cases of traumatic luxations of the knee in order to exclude an intimal lesion of the popliteal artery.

  1. Physiotherapy Treatment in Patients with Hemophilia and Chronic Ankle Arthropathy: A Systematic Review

    OpenAIRE

    Rubén Cuesta-Barriuso; Antonia Gómez-Conesa; José Antonio López-Pina

    2013-01-01

    Haemophilic arthropathy of the ankle causes pain and deterioration in gait, causing disability. Although some physiotherapy modalities are effective in the management of acute bleeding, the results are unknown in chronic arthropathy. Our objective was to determine the most effective physiotherapy procedures for treating the haemophilic arthropathy of the ankle and to assess the methodological quality of the studies. A systematic review was carried out in the Cochrane Database, PubMed, MEDLINE...

  2. Ankle Brachial Index

    Energy Technology Data Exchange (ETDEWEB)

    Wikstroem, J.; Hansen, T.; Johansson, L.; Lind, L.; Ahlstroem, H. (Dept. of Radiology and Dept. of Medical Sciences, Uppsala Univ. Hospital, Uppsala (SE))

    2008-03-15

    Background: Whole-body magnetic resonance angiography (WBMRA) permits noninvasive vascular assessment, which can be utilized in epidemiological studies. Purpose: To assess the relation between a low ankle brachial index (ABI) and high-grade stenoses in the pelvic and leg arteries in the elderly. Material and Methods: WBMRA was performed in a population sample of 306 subjects aged 70 years. The arteries below the aortic bifurcation were graded after the most severe stenosis according to one of three grades: 0-49% stenosis, 50-99% stenosis, or occlusion. ABI was calculated for each side. Results: There were assessable WBMRA and ABI examinations in 268 (right side), 265 (left side), and 258 cases (both sides). At least one >=50% stenosis was found in 19% (right side), 23% (left side), and 28% (on at least one side) of the cases. The corresponding prevalences for ABI <0.9 were 4.5%, 4.2%, and 6.6%. An ABI cut-off value of 0.9 resulted in a sensitivity, specificity, and positive and negative predictive value of 20%, 99%, 83%, and 84% on the right side, and 15%, 99%, 82%, and 80% on the left side, respectively, for the presence of a >= 50% stenosis in the pelvic or leg arteries. Conclusion: An ABI <0.9 underestimates the prevalence of peripheral arterial occlusive disease in the general elderly population

  3. Incidental Anterior Cruciate Ligament Calcification: Case Report.

    Science.gov (United States)

    Hayashi, Hisami; Fischer, Hans

    2016-03-01

    The calcification of knee ligaments is a finding noted only in a handful of case reports. The finding of an anterior cruciate ligament calcification has been reported once in the literature. Comparable studies involving the posterior cruciate ligament, medial collateral ligament and an ossicle within the anterior cruciate ligament are likewise discussed in reports of symptomatic patients. We report a case of incidentally discovered anterior cruciate ligament calcification. We discuss the likely etiology and clinical implications of this finding.

  4. Posterior Ankle Structure Injury During Total Ankle Replacement.

    Science.gov (United States)

    Reb, Christopher W; McAlister, Jeffrey E; Hyer, Christopher F; Berlet, Gregory C

    2016-01-01

    Total ankle replacement studies have focused on reporting complications that are directly observed clinically or radiographically, including wound problems, technical errors, implant loosening, subsidence, infection, bone fractures, and heterotopic ossification. However, patients can still experience unresolved pain even when these problems have been ruled out. We initiated a study to more clearly define the relative risk of injury to the anatomic structures in the posterior ankle during total ankle replacement using a third-generation implant system. Ten fresh-frozen adult cadaveric below-the-knee specimens were positioned in the intraoperative positioning frame of an approved total ankle replacement system and adjusted to achieve proper foot alignment using fluoroscopic imaging. The relationship between the tibial cutting guide pins and the posterior neurovascular and tendon structures was measured using digital calipers. High rates of posterior structural injury were found. Nearly all proximal-medial pins encountered a posteromedial neurovascular structure, most commonly the tibial nerve. The distal-medial pins mainly encountered posteromedial tendinous structures, in particular, the flexor digitorum longus tendon. The proximal lateral pins were highly likely to encounter the Achilles tendon and the sural nerve. Our results support our hypothesis that the tibial neurovascular structures are at the greatest risk when preparing for and completing the bony resection, particularly with the medial and proximal cuts. Posterior ankle soft tissue structure injuries can occur during implantation but currently with unknown frequency and undetermined significance. Further study of posterior structural injuries could result in a more informed approach to post-total ankle replacement complications and management.

  5. Closed medial total subtalar joint dislocation without ankle fracture: a case report

    Science.gov (United States)

    2014-01-01

    Introduction Total subtalar dislocation without fracture of the ankle is a rare clinical entity; it is usually due to a traumatic high-energy mechanism. Standard treatment is successful closed reduction under general anesthesia followed by non-weight bearing and ankle immobilization with a below-knee cast for 6 weeks. Case presentation We present the case of a 30-year-old Moroccan woman who was involved in a road traffic accident. She subsequently received a radiological assessment that objectified a total subtalar dislocation without fracture of her ankle. She was immediately admitted to the operating theater where an immediate reduction was performed under sedation, and immobilization in a plaster boot was adopted for 8 weeks. The management of this traumatic lesion is discussed in the light of the literature. Conclusions Medial subtalar dislocation is a rare dislocation and is not commonly seen as a sports injury because it requires transfer of a large amount of kinetic energy. The weaker talocalcaneal and talonavicular ligaments often bear the brunt of the energy and are more commonly disrupted, compared to the relatively stronger calcaneonavicular ligament. Urgent reduction is important, and closed reduction under general anesthesia is usually successful, often facilitated by keeping the knee in flexion to relax the gastrocnemius muscle. Long-term sequelae include talar avascular necrosis and osteochondral fracture, as well as chronic instability and pain. PMID:25240955

  6. Anterior cruciate ligament - updating article

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius Malheiros Luzo

    2016-08-01

    Full Text Available ABSTRACT This updating article on the anterior cruciate ligament (ACL has the aim of addressing some of the most interesting current topics in this field. Within this stratified approach, it contains the following sections: ACL remnant; anterolateral ligament and combined intra and extra-articular reconstruction; fixation devices; and ACL femoral tunnel creation techniques.

  7. Anterior cruciate ligament - updating article.

    Science.gov (United States)

    Luzo, Marcus Vinicius Malheiros; Franciozi, Carlos Eduardo da Silveira; Rezende, Fernando Cury; Gracitelli, Guilherme Conforto; Debieux, Pedro; Cohen, Moisés

    2016-01-01

    This updating article on the anterior cruciate ligament (ACL) has the aim of addressing some of the most interesting current topics in this field. Within this stratified approach, it contains the following sections: ACL remnant; anterolateral ligament and combined intra and extra-articular reconstruction; fixation devices; and ACL femoral tunnel creation techniques.

  8. Hindlimb unloading alters ligament healing

    Science.gov (United States)

    Provenzano, Paolo P.; Martinez, Daniel A.; Grindeland, Richard E.; Dwyer, Kelley W.; Turner, Joanne; Vailas, Arthur C.; Vanderby, Ray Jr

    2003-01-01

    We investigated the hypothesis that hindlimb unloading inhibits healing in fibrous connective tissue such as ligament. Male rats were assigned to 3- and 7-wk treatment groups with three subgroups each: sham control, ambulatory healing, and hindlimb-suspended healing. Ambulatory and suspended animals underwent surgical rupture of their medial collateral ligaments, whereas sham surgeries were performed on control animals. After 3 or 7 wk, mechanical and/or morphological properties were measured in ligament, muscle, and bone. During mechanical testing, most suspended ligaments failed in the scar region, indicating the greatest impairment was to ligament and not to bone-ligament insertion. Ligament testing revealed significant reductions in maximum force, ultimate stress, elastic modulus, and low-load properties in suspended animals. In addition, femoral mineral density, femoral strength, gastrocnemius mass, and tibialis anterior mass were significantly reduced. Microscopy revealed abnormal scar formation and cell distribution in suspended ligaments with extracellular matrix discontinuities and voids between misaligned, but well-formed, collagen fiber bundles. Hence, stress levels from ambulation appear unnecessary for formation of fiber bundles yet required for collagen to form structurally competent continuous fibers. Results support our hypothesis that hindlimb unloading impairs healing of fibrous connective tissue. In addition, this study provides compelling morphological evidence explaining the altered structure-function relationship in load-deprived healing connective tissue.

  9. 急性前交叉韧带损伤合并内侧副韧带损伤的治疗选择%Treatment of acute anterior cruciate and medial collateral ligament injuries of knee

    Institute of Scientific and Technical Information of China (English)

    姚建华; 李海鹏; 黄炎; 薛元锁

    2011-01-01

    目的 探讨急性前交叉韧带(ACL)损伤合并内侧副韧带(MCL)损伤的治疗时机及方法.方法 2002年12月-2008年10月,治疗急性ACL损伤合并MCL损伤58例.MCL损伤Ⅰ度7例,Ⅱ度25例,Ⅲ度26例.MCL Ⅰ、Ⅱ度损伤共32例经3-4周制动,待关节活动功能恢复后行ACL重建;Ⅲ度损伤7例经制动6周,伤后9-10周行ACL重建.19例伤后两周内行ACL重建,术后在伸直位和屈膝30°位用支具制动6-8周,11例阴性,8例阳性,6例有后内侧关节囊撕裂,于损伤部位小切口用缝合铆钉原位修复后内侧结构,术后用支具制动6-8周.结果 平均随访15月(6-34月),Ⅰ-Ⅱ度损伤32例外翻应力试验阴性,前抽屉试验(+)2例,术后Lysholm评分91.2.18例MCL Ⅲ度损伤保守治疗,外翻应力试验Ⅰ度3例、Ⅱ度1例,前抽屉试验(+)2例、(++)1例,术后Lysholm评分86.5.MCLⅢ度损伤8例经手术修复治疗,外翻应力试验Ⅰ度2例,前抽屉试验(+)1例,术后Lysholm评分89.3.结论 急性ACL损伤合并Ⅲ度MCL损伤应早期手术,ACL重建后外翻应力试验不稳者需早期手术修复MCL.%Objective To study the treatment modalities for acute anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries. Methods Fifty-eight patients with acute ACL and MCL injuries (including grade I in 7, grade II in 25 and grade III in 26 cases) were treated in our department from December 2002 to October 2008. ACL was reconstructed when the knee function was recovered in 32 patients with grade I and grade II MCL injury after they were immobilized for 3-4 weeks, in 7 patients with grade M MCL injury after they were immobilized for 6 weeks, in 19 patients with grade 1H MCL injury after they were immobilized for 2 weeks. Valgus stress testing for full extension and 300 of flexion was negative in 11 patients and positive in 8 patients after they were immobilized for 6-8 weeks. Posterior knee capsule tear in 6 patients was repaired with its posteromedial structure

  10. Effects of ankle eversion taping using kinesiology tape in a patient with ankle inversion sprain.

    Science.gov (United States)

    Lee, Sun-Min; Lee, Jung-Hoon

    2016-01-01

    [Purpose] The aim of this study was to report the effects of ankle eversion taping using kinesiology tape on ankle inversion sprain. [Subject] The subject was a 21-year-old woman with Grade 2 ankle inversion sprain. [Methods] Ankle eversion taping was applied to the sprained left ankle using kinesiology tape for 4 weeks (average, 15 h/day). [Results] Ankle instability and pain were reduced, and functional dynamic balance was improved after ankle eversion taping for 4 weeks. The Cumberland Ankle Instability Tool score and reach distances in the Y-Balance and lunge tests were increased. [Conclusion] Repeated ankle eversion taping may be an effective treatment intervention for ankle inversion sprain.

  11. Scapholunate interosseus ligament reconstruction on a cadaver A technique

    Directory of Open Access Journals (Sweden)

    Joan Arenas Prat

    2014-01-01

    Full Text Available Background: Acute rupture of the scapholunate interosseus ligament is a relatively frequent occurrence which can be repaired primarily by direct suturing. However, patients are often seen a few weeks after injury when most of the ligament fibers have degenerated. This poses a challenge because direct repair can be difficult and long term results have not been satisfying. In the present study, a technique is presented to address this problem and its possible advantages are discussed. Materials and Methods: A fresh frozen wrist cadaver specimen, thawed to room temperature, was used to carry out the procedure. The scapholunate joint was exposed through a dorsal approach and stabilized using two percutaneous Kirschner wires. Using a U shaped chisel, a groove along the scapholunate articular margin was created to accommodate a strip from the extensor retinaculum as a ligament plasty. This has been secured using six anchor sutures and several pictures taken during the procedure to expose the key steps. Results: The ligamentoplasty presented in this article preserves most of the articular surface of proximal carpus and at the same time stabilizes the scapholunate joint. However, more in vivo research should be carried out to validate this treatment. Conclusion: The technique suggests a possible way to repair a ruptured scapholunate interosseus ligament that cannot be repaired primarily. Because osteointegration of the ligament strips is not possible in the present experiment, biomechanics of the construct cannot be fully tested.

  12. The Incidence of Ankle Sprains in Orienteering.

    Science.gov (United States)

    Ekstrand, Jan; And Others

    1990-01-01

    Investigates relationship between ankle sprains and participation time in competitive orienteering. Examined 15,474 competitors in races in the Swedish O-ringen 5-day event in 1987. Injuries requiring medical attention were analyzed, showing 137 (23.9 percent) ankle sprains. Injury incidence was 8.4/10,000 hours. Incidence of ankle sprains was…

  13. Acromioclavicular joint reconstruction with coracoacromial ligament transfer using the docking technique

    Directory of Open Access Journals (Sweden)

    Gobezie Reuben

    2009-01-01

    Full Text Available Abstract Background Symptomatic Acromioclavicular (AC dislocations have historically been surgically treated with Coracoclavicular (CC ligament reconstruction with transfer of the Coracoacromial (CA ligament. Tensioning the CA ligament is the key to success. Methods Seventeen patients with chronic, symptomatic Type III AC joint or acute Type IV and V injuries were treated surgically. The distal clavicle was resected and stabilized with CC ligament reconstruction using the CA ligament. The CA ligament was passed into the medullary canal and tensioned, using a modified 'docking' technique. Average follow-up was 29 months (range 12–57. Results Postoperative ASES and pain significantly improved in all patients (p = 0.001. Radiographically, 16 (94% maintained reduction, and only 1 (6% had a recurrent dislocation when he returned to karate 3 months postoperatively. His ultimate clinical outcome was excellent. Conclusion The docking procedure allows for tensioning of the transferred CA ligament and healing of the ligament in an intramedullary bone tunnel. Excellent clinical results were achieved, decreasing the risk of recurrent distal clavicle instability.

  14. Diagnostic Value of High Frequency Ultrasound in Acute and Chronic Injury of Tendon and Medial Collateral Ligament of Knee Joint%高频超声对膝关节肌腱及内侧副韧带急慢性损伤的诊断价值

    Institute of Scientific and Technical Information of China (English)

    赖荣仙

    2016-01-01

    Objective To explore the highfrequency ultrasound for knee tendon and the diagnostic value of the medial vice toughening of acute or chronic injury.Methods Our hospital 96 knee tendon or medial vice toughening of acute or chronic injury patients using high frequency ultrasound examination,the record of high frequency ultrasound image analysis.Results All 96 patients was diagnosed,including 44 patients with injury of medial collateral ligament,accounting for 45.8%of the total number of patients.Patellar tendon,tendon disease 31,accounting for 32.3%of the total.15 patients with injury of meniscus,accounting for 15.6%of the total.Damage to the iliotibial band six,accounting for 6.25%of the total patients.Conclusion High frequency ultrasound on knee tendon and medial collateral ligament acute or chronic damage diagnosis accuracy is higher,it can be used as knee tendon and medial collateral ligament best methods for the diagnosis of acute or chronic damage image.%目的探究高频超声波对膝关节肌腱及内侧副韧急慢性损伤的诊断价值.方法对本院的96例膝关节肌腱或内侧副韧急慢性损伤的患者利用高频超声进行检查,对记录的高频超声图像进行分析研究.结果96例患者的病情全部确诊,其中内侧副韧带损伤患者44例,占患者总人数中的45.8%.髌腱肌腱病31例,占总人数的32.3%.半月板损伤患者15例,占总人数的15.6%.髂胫束损伤6例,占总患者的6.25%.结论高频超声对膝关节肌腱及内侧副韧带急慢性损伤的诊断准确率较高,其可作为膝关节肌腱及内侧副韧带急慢性损伤影像诊断的最佳方法.

  15. Initial evaluation of posterior cruciate ligament injuries: history, physical examination, imaging studies, surgical and nonsurgical indications.

    Science.gov (United States)

    Lopez-Vidriero, Emilio; Simon, David A; Johnson, Donald H

    2010-12-01

    Compared with anterior cruciate ligament injuries, posterior cruciate ligament injuries are a rare event. The mechanisms are predictable and a thorough physical examination is mandatory to rule out or define combined injury patterns. Stress radiography and magnetic resonance imaging studies are very helpful adjuncts. Acute and chronic injuries require slightly different approaches. As our understanding of normal and pathologic knee joint kinematics develops, nonoperative rehabilitation goals and operative techniques continue to evolve.

  16. Possible factors for ankle fractures

    Directory of Open Access Journals (Sweden)

    Tabaković Dejan

    2010-01-01

    Full Text Available Background/Aim. Classification of ankle fractures is commonly used for selecting an appropriate treatment and prognosing an outcome of definite management. One of the most used classifications is the Danis-Weber classification. To the best of our knowledge, in the available literature, there are no parameters affecting specific types of ankle fractures according to the Danis-Weber classification. The aim of this study was to analyze the correlation of the following parameters: age, body weight, body mass index (BMI, height, osteoporosis, osteopenia and physical exercises with specific types of ankle fractures using the Danis-Weber classification. Methods. A total of 85 patients grouped by the Danis-Weber classification fracture types were analyzed and the significance of certain parameters for specific types of ankle fractures was established. Results. The proportion of females was significantly higher (p < 0.001 with a significantly higher age (59.9 years, SD ± 14.2 in relation to males (45.1 years, SD ± 12.8 (p < 0.0001. Type A fracture was most frequent in the younger patients (34.2 years, SD ± 8.6, and those with increased physical exercises (p = 0.020. In type B fracture, the risk factor was osteoporosis (p = 0.0180, while in type C fracture, body weight (p = 0.017 and osteoporosis (p = 0.004 were significant parameters. Conclusion. Statistical analysis using the Danis-Weber classification reveals that there are certain parameters suggesting significant risk factors for specific types of ankle fractures.

  17. Bone stress injury of the ankle in professional ballet dancers seen on MRI

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    Besser Marcus P

    2008-03-01

    Full Text Available Abstract Background Ballet Dancers have been shown to have a relatively high incidence of stress fractures of the foot and ankle. It was our objective to examine MR imaging patterns of bone marrow edema (BME in the ankles of high performance professional ballet dancers, to evaluate clinical relevance. Methods MR Imaging was performed on 12 ankles of 11 active professional ballet dancers (6 female, 5 male; mean age 24 years, range 19 to 32. Individuals were imaged on a 0.2 T or 1.5 T MRI units. Images were evaluated by two musculoskeletal radiologists and one orthopaedic surgeon in consensus for location and pattern of bone marrow edema. In order to control for recognized sources of bone marrow edema, images were also reviewed for presence of osseous, ligamentous, tendinous and cartilage injuries. Statistical analysis was performed to assess the strength of the correlation between bone marrow edema and ankle pain. Results Bone marrow edema was seen only in the talus, and was a common finding, observed in nine of the twelve ankles imaged (75% and was associated with pain in all cases. On fluid-sensitive sequences, bone marrow edema was ill-defined and centered in the talar neck or body, although in three cases it extended to the talar dome. No apparent gender predilection was noted. No occult stress fracture could be diagnosed. A moderately strong correlation (phi = 0.77, p= 0.0054 was found between edema and pain in the study population. Conclusion Bone marrow edema seems to be a specific MRI finding in the talus of professional ballet dancers, likely related to biomechanical stress reactions, due to their frequently performed unique maneuvers. Clinically, this condition may indicate a sign of a bone stress injury of the ankle.

  18. Foot and ankle fractures during childhood: review of the literature and scientific evidence for appropriate treatment

    Directory of Open Access Journals (Sweden)

    Stefan Rammelt

    Full Text Available ABSTRACT Foot and ankle fractures represent 12% of all pediatric fractures. Malleolar fractures are the most frequent injuries of the lower limbs. Hindfoot and midfoot fractures are rare, but inadequate treatment for these fractures may results in compartment syndrome, three-dimensional deformities, avascular necrosis and early post-traumatic arthritis, which have a significant impact on overall foot and ankle function. Therefore, the challenges in treating these injuries in children are to achieve adequate diagnosis and precise treatment, while avoiding complications. The objective of the treatment is to restore normal anatomy and the correct articular relationship between the bones in this region. Moreover, the treatment needs to be planned according to articular involvement, lower-limb alignment, ligament stability and age. This article provides a review on this topic and presents the scientific evidence for appropriate treatment of these lesions.

  19. Ankle inversion taping using kinesiology tape for treating medial ankle sprain in an amateur soccer player.

    Science.gov (United States)

    Lee, Sun-Min; Lee, Jung-Hoon

    2015-07-01

    [Purpose] The purpose of this study was to report the effects of ankle inversion taping using kinesiology tape in a patient with a medial ankle sprain. [Subject] A 28-year-old amateur soccer player suffered a Grade 2 medial ankle sprain during a match. [Methods] Ankle inversion taping was applied to the sprained ankle every day for 2 months. [Results] His symptoms were reduced after ankle inversion taping application for 2 months. The self-reported function score, the reach distances in the Star Excursion Balance Test, and the weight-bearing ankle dorsiflexion were increased. [Conclusion] This study showed that ankle inversion taping using kinesiology tape may be an effective therapy for a patient with a medial ankle sprain.

  20. Generalized Joint Laxity and Ligament Injuries in High School–Aged Female Volleyball Players in Japan

    Science.gov (United States)

    Sueyoshi, Ted; Emoto, Gen; Yuasa, Tomoki

    2016-01-01

    Background: Generalized joint laxity has been linked to ligamentous injuries such as anterior cruciate ligament tear and ankle sprain. Purpose/Hypothesis: The purpose of this study was to investigate generalized joint laxity and incidence of ligament injuries in high school–aged female volleyball players. It was hypothesized that volleyball players with a past history of sprains would have increased generalized joint laxity compared with those without any history and that athletes with multiple sprains would demonstrate with a higher generalized joint laxity score than those who had only 1 sprain. Study Design: Case-control study; Level of evidence, 3. Methods: Forty-seven subjects were tested for generalized joint laxity using the Beighton and Horan Joint Mobility Index (BHJMI). They were categorized into 2 groups based on the presence of past ligament injury: injury group (IG) and noninjury group (NG). The IG group was further divided into 2 groups based on whether they had a single ligamentous injury (IGS) or multiple injuries (IGM) in the past to study whether there was any difference in scores between the subgroups. The collected data were analyzed statistically with 1-way analysis of variance. Results: Subjects in the IG group scored significantly higher on the BHJMI than those in the NG group. The mean score for the IG group was 2.40 ± 1.42, as opposed to 1.24 ± 1.09 for the NG group (P = .006). Eleven subjects in the IG group had suffered multiple injuries or recurrent injuries (IGM) and scored significantly higher than the remaining 19 individuals in the IG group, who had only sustained a single injury (IGS). The mean BHJMI scores were 3.18 ± 1.47 and 1.95 ± 1.22 for IGM and IGS, respectively (P = .02). Conclusion: Female athletes with a high generalized joint laxity score may be more prone to ligament injury and potentially to recurrent ligament injuries. PMID:27761474

  1. Predictive Behavior of a Computational Foot/Ankle Model through Artificial Neural Networks

    Science.gov (United States)

    Hargraves, Rosalyn Hobson

    2017-01-01

    Computational models are useful tools to study the biomechanics of human joints. Their predictive performance is heavily dependent on bony anatomy and soft tissue properties. Imaging data provides anatomical requirements while approximate tissue properties are implemented from literature data, when available. We sought to improve the predictive capability of a computational foot/ankle model by optimizing its ligament stiffness inputs using feedforward and radial basis function neural networks. While the former demonstrated better performance than the latter per mean square error, both networks provided reasonable stiffness predictions for implementation into the computational model. PMID:28250804

  2. Predictive Behavior of a Computational Foot/Ankle Model through Artificial Neural Networks.

    Science.gov (United States)

    Chande, Ruchi D; Hargraves, Rosalyn Hobson; Ortiz-Robinson, Norma; Wayne, Jennifer S

    2017-01-01

    Computational models are useful tools to study the biomechanics of human joints. Their predictive performance is heavily dependent on bony anatomy and soft tissue properties. Imaging data provides anatomical requirements while approximate tissue properties are implemented from literature data, when available. We sought to improve the predictive capability of a computational foot/ankle model by optimizing its ligament stiffness inputs using feedforward and radial basis function neural networks. While the former demonstrated better performance than the latter per mean square error, both networks provided reasonable stiffness predictions for implementation into the computational model.

  3. Predictive Behavior of a Computational Foot/Ankle Model through Artificial Neural Networks

    Directory of Open Access Journals (Sweden)

    Ruchi D. Chande

    2017-01-01

    Full Text Available Computational models are useful tools to study the biomechanics of human joints. Their predictive performance is heavily dependent on bony anatomy and soft tissue properties. Imaging data provides anatomical requirements while approximate tissue properties are implemented from literature data, when available. We sought to improve the predictive capability of a computational foot/ankle model by optimizing its ligament stiffness inputs using feedforward and radial basis function neural networks. While the former demonstrated better performance than the latter per mean square error, both networks provided reasonable stiffness predictions for implementation into the computational model.

  4. A finite element model of the foot and ankle for automotive impact applications.

    Science.gov (United States)

    Shin, Jaeho; Yue, Neng; Untaroiu, Costin D

    2012-12-01

    A finite element (FE) model of the foot and leg was developed to improve understanding of injury mechanisms of the ankle and subtalar joints during vehicle collisions and to aid in the design of injury countermeasures. The FE model was developed based on the reconstructed geometry of a male volunteer close to the anthropometry of a 50th percentile male and a commercial anatomical database. While the forefoot bones were defined as rigid bodies connected by ligament models, the surrounding bones of the ankle and subtalar joints and the leg bones were modeled as deformable structures. The material and structural properties were selected based on a synthesis of current knowledge of the constitutive models for each tissue. The whole foot and leg model was validated in different loading conditions including forefoot impact, axial rotation, dorsiflexion, and combined loadings. Overall results obtained in the model validation indicated improved biofidelity relative to previous FE models. The developed model was used to investigate the injury tolerance of the ankle joint under brake pedal loading for internally and externally rotated feet. Ligament failures were predicted as the main source of injury in this loading condition. A 12% variation of failure moment was observed in the range of axial foot rotations (±15°). The most vulnerable position was the internally rotated (15°) posture among three different foot positions. Furthermore, the present foot and ankle model will be coupled together with other body region FE models into the state-of-art human FE model to be used in the field of automotive safety.

  5. Infections after reconstructions of anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Ristić Vladimir

    2014-01-01

    Full Text Available Introduction. Infections after anterior cruciate ligament reconstructions are rare, but, on the other hand, they are difficult to be treated. The aim of this study was to analyze causes of infections, risk factors, diagnostics, and possibilities of their prevention. Material and Methods. Seventeen deep infections (1.2% were found in 1425 patients who had undergone anterior cruciate ligament reconstructions. Fifteen patients were males and two were females. Out of 475 professional athletes nine (1.9% had this postoperative complication. Eleven patients with septic arthritis were allergic to penicillin. Three of them had immunosuppressive diseases. Results. Staphylococcus aureus was isolated in eleven cases (65%, other Staphylococcus and Streptococcus groups were found in four and three patients, respectively; while one patient had infection although the punctate was negative. Out of 965 patients with the patellar tendon grafts, ten (1.03% had this complication, while the incidence was 1.52% (7/460 in those with the hamstring grafts. Fifteen infections were acute with obvious symptoms within 14 days after surgery. Severe pain, limited range of motion, swelling of the knee joint and fever were the most common symptoms, while rubor and pus developed rarely. The infection was three times more frequent in the patients who had undergone surgery lasting more than 1.5 hour. Discussion and Conclusion. The following population groups are at risk of developing septic arthritis after anterior cruciate ligament reconstructions: professional athletes, those who are allergic to penicillin, and those with immunosuppressive diseases. Staphyllococus aureus is the most common cause of infection. The patients with the hamstring autografts have a higher risk than those with the patellar tendon grafts. Preventive measures that should be performed include aseptic conditions in operative rooms, irrigation of the graft before its placement into the bone tunnels

  6. Medial Collateral Ligament (MCL) Injuries

    Science.gov (United States)

    ... THIS TOPIC Jumper's Knee Safety Tips: Basketball Knee Injuries Sports and Exercise Safety Slipped Capital Femoral Epiphysis (SCFE) Anterior Cruciate Ligament (ACL) Injuries Contact Us Print Resources Send to a friend ...

  7. Anterior Cruciate Ligament (ACL) Injuries

    Science.gov (United States)

    ... knee injury, especially for athletes. Ligaments are long, rope-like bands that fasten bones together. The ACL ... re used to doing all the time, like jumping and landing hard on the feet. If the ...

  8. Transient Superficial Peroneal Nerve Palsy After Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Alrowaili, Majed

    2016-04-26

    A 19-year-old male subject was diagnosed with medial meniscal, lateral meniscal and anterior cruciate ligament (ACL) tear. The symptoms did not subside after 4 months of physical therapy, and he underwent arthroscopic partial medial and lateral meniscectomy and ACL reconstruction. Immediately after the patient woke up from general anesthesia, he started experience loss of sensation in the area of superficial peroneal nerve with inverted dorsiflexion of foot and ankle. Instantly, the bandage and knee brace was removed and a diagnosis of compartment syndrome was ruled out. After eight hours, post-operatively, the patient started receiving physiotherapy. He complained of numbness and tingling in the same area. After 24 h, post-operatively, the patient started to regain dorsiflexion and eversion gradually. Two days after the surgery, the patient exhibited complete recovery of neurological status.

  9. Transient superficial peroneal nerve palsy after anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Majed Alrowaili

    2016-06-01

    Full Text Available A 19-year-old male subject was diagnosed with medial meniscal, lateral meniscal and anterior cruciate ligament (ACL tear. The symptoms did not subside after 4 months of physical therapy, and he underwent arthroscopic partial medial and lateral meniscectomy and ACL reconstruction. Immediately after the patient woke up from general anesthesia, he started experience loss of sensation in the area of superficial peroneal nerve with inverted dorsiflexion of foot and ankle. Instantly, the bandage and knee brace was removed and a diagnosis of compartment syndrome was ruled out. After eight hours, post-operatively, the patient started receiving physiotherapy. He complained of numbness and tingling in the same area. After 24 h, post-operatively, the patient started to regain dorsiflexion and eversion gradually. Two days after the surgery, the patient exhibited complete recovery of neurological status.

  10. Diclofenac epolamine topical patch relieves pain associated with ankle sprain

    Directory of Open Access Journals (Sweden)

    David R Lionberger

    2011-03-01

    Full Text Available David R Lionberger1, Eric Joussellin2, Arturo Lanzarotti3, Jillmarie Yanchick4, Merrell Magelli5 1Southwest Orthopedic Group, LLP, Houston, Texas, USA; 2Institut National du Sport, Paris, France; 3Institut Biochimique SA, Pambionoranco, Switzerland; 4Alpharma Pharmaceuticals LLC, a wholly owned subsidiary of King Pharmaceuticals®, Inc, Piscataway, New Jersey, USA; 5GTx, Inc, Memphis, Tennessee, USABackground: Sports-related injuries, such as sprains and strains, commonly occur during exercise and athletic events. Current therapy includes nonsteroidal anti-inflammatory drugs (NSAIDs, which have a high incidence of upper gastrointestinal side effects. The present study assessed the efficacy and safety of the diclofenac epolamine topical patch (DETP, 1.3%, a topical NSAID for the treatment of acute minor sprains and strains.Methods: This multicenter, randomized, placebo-controlled clinical study enrolled adult patients (n = 134 with acute ankle pain (due to a minor sprain occurring less than 48 hours prior to entering the study. Patients were treated with either the DETP or a placebo topical patch daily for seven days. Pain intensity was evaluated during the first six hours after application of the patch, and on treatment days 1, 2, 3, and 7.Results: Patients treated with the DETP experienced a significantly greater reduction in pain associated with their ankle injury compared with placebo, beginning four hours after the first patch application (P = 0.02. The DETP was well tolerated and was comparable with placebo in terms of safety.Conclusion: Overall, the results of this study demonstrate that the DETP is an effective analgesic for local treatment of pain in mild acute ankle sprain.Keywords: soft tissue injury, acute pain, visual analog scale, efficacy, tolerability 

  11. Isokinetic profile of subjects with the ruptured anterior cruciated ligament

    OpenAIRE

    Drapšin Miodrag; Lukač Damir; Rašović Predrag; Drid Patrik; Klašnja Aleksandar; Lalić Ivica

    2016-01-01

    Background/Aim. All changes in the knee that appear after anterior cruciate ligament (ACL) lesion lead to difficulties in walking, running, jumping especially during sudden changes of the line of movement. This significantly impairs quality of life of these subjects and leads to decrease in physical activity. Knee injuries make 5% of all most severe acute sport injuries. The aim of the study was to determine strength of the thigh muscles in persons with uni...

  12. 关节镜内侧髌骨支持带缝合与石膏固定治疗急性髌骨脱位比较%Comparison of Arthroscopy Medial Patella Ligament Strengthening and Plaster Immobilization in Treating Acute Patellar Luxation

    Institute of Scientific and Technical Information of China (English)

    张虎; 叶明钧; 叶挺

    2016-01-01

    Objective To investigate the clinical effect of arthroscopy medial patela ligament strengthening and plaster immobilization in treating acute patelar luxation.Methods82 cases with acute patelar luxation in our hospital from August 2013 to August 2014 were selected as study objects.They were divided into two groups,41 cases in each group. Control group was given plaster immobilization treatment and observation group was given arthroscopy medial patela ligament strengthening. Compared the clinical effect of the two groups.Results Patela slant angle of observation group was obviously better than control group after 1 year treatment,the difference was statisticaly significant(P<0.05). Lysholm score of observation group was obviously higher than control group, the difference was statisticaly significant(P<0.05).Conclusion Compared with plaster immobilization, arthroscopy medial patela ligament strengthening in treating acute patelar luxation has better significant effect.%目的:研究分析关节镜内侧髌骨支持带缝合和石膏固定治疗急性髌骨脱位的临床效果。方法选取2013年8月~2014年8月我院收治的急性髌骨脱位患者82例,随机分为两组,各41例。对照组采用石膏外固定治疗,观察组采用关节镜内侧髌骨支持带缝合术治疗,对比两组临床治疗效果。结果观察组在治疗后1年髌骨倾斜角优于对照组,差异有统计学意义(P<0.05);观察组各项Lysholm评分均高于对照组,差异有统计学意义(P<0.05)。结论相比于石膏外固定治疗,关节镜内侧髌骨支持带缝合术治疗急性髌骨脱位效果良好,可提高治疗效果。

  13. Health care consumption and costs due to foot and ankle injuries in the Netherlands, 1986-2010.

    Science.gov (United States)

    De Boer, A Siebe; Schepers, Tim; Panneman, Martien J M; Van Beeck, Ed F; Van Lieshout, Esther M M

    2014-04-12

    Foot and ankle injuries account for a large proportion of Emergency Department attendance. The aim of this study was to assess population-based trends in attendances due to foot and ankle injuries in the Netherlands since 1986, and to provide a detailed analysis of health care costs in these patients. Age- and gender-standardized emergency attendance rates and incidence rates for hospital admission were calculated for each year of the study. Injury cases and hospital length of stay were extracted from the National Injury Surveillance System (non-hospitalized patients) and the National Medical Registration (hospitalized patients). Data were grouped into osseous and ligamentous injuries for foot and ankle separately. An incidence-based cost model was applied to calculate associated direct health care costs. Since 1986 the overall emergency attendance rate decreased from 858 to 640 per 100,000 person years. In non-admitted patients (90% of cases), ligamentous injuries approximately halved, whereas osseous injuries increased by 28% (foot) and 25% (ankle). The incidence rate for hospital admission increased by 35%, mainly due to an almost doubling of osseous injuries. Attendance rates showed a peak in adolescents and adults until ~45 years of age in males and (less pronounced) in females. The total number of hospital days decreased to 58,708 days in 2010. Hospital length of stay (HLOS) increased with age and was highest for osseous injuries. HLOS was unaffected by gender, apart for longer stay in elderly females with an osseous ankle injury. Health care costs per case were highest for osseous injuries of the ankle (€ 3,461). Costs were higher for females and increased with age to € 6,023 in elderly males and € 10,949 in elderly females. Main cost determinants were in-hospital care (56% of total costs), rehabilitation/nursing care (15%), and physical therapy (12%). Since 1986, the emergency attendance rate of foot and ankle injuries in the Netherlands decreased by

  14. Finite element analysis of effect of ankle ligment injury on stability of talus%踝关节周围韧带损伤对距骨稳定性影响的有限元分析

    Institute of Scientific and Technical Information of China (English)

    戴海飞; 余斌; 张凯瑞; 熊小龙; 陈志刚; 崔壮; 卢昌怀

    2012-01-01

    Objective To explore the biomechanical properties of the talus in different ankle ligament injury through finite element analysis and therefore to provide theoretical basis for the clinic treatment of ankle ligament injury. Methods CT scan data, three-dimensional anatomically detailed finite element models was used to simulate human ankle joint internal rotation, external rotation stress state of the finite element analysis. The contact pressure and Von Mises stress distribution of the talar articular surface were compared in different ankle ligament injury. Results The three-dimensional finite element model of bone, cartilage and ligaments of the normal human ankle was established. The biomechanical stability of the talus which influenced by the ankle ligament was different in the internal rotation and external rotation force. Conclusion The anterior tibio-talar ligament playes an important role in ankle stability under external rotation force while under internal rotation force, calca-neofibular ligament playes an important role.%目的 有限元法分析踝关节周围韧带损伤对距骨生物力学稳定性的影响,为临床踝关节周围韧带损伤的治疗提供理论依据.方法 基于正常男性的足踝部螺旋CT扫描数据,运用三维重建软件,建立足踝部三维几何模型,最后导人Abaqus 6.9软件中,模拟人体踝关节内旋、外旋的受力状况,分析踝关节周围韧带损伤后距骨各关节面的接触压力及Von Mises应力分布.结果 建立包括骨、软骨、韧带在内的正常人体足踝部三维有限元模型,踝关节周围韧带在踝关节内旋、外旋时对距骨的生物力学影响不同.结论 在外旋作用力下胫距后韧带对踝关节的稳定性具有重要作用,而在内旋作用力下跟腓韧带对踝关节的稳定性具有重要作用.

  15. Hydrocolonotherapy ankle joints after injuries

    Directory of Open Access Journals (Sweden)

    Volodymyr Muchin

    2016-02-01

    Full Text Available Purpose: to improve efficiency of gydrokinesitherapy by means of specially designed devices and monolasts for patients after ankle joint injuries. Material & Methods: there are pedagogical methods, clinical and radiological methods, anthropometric measurements and goniometry were used. Results: the author's technique of hydrokinesitherapy with application hydrokinesimechanotherapy device in the program of physical rehabilitation which provides optimum conditions for the recovery process was developed. Conclusions: the specially designed hydrokinesomechanotherapeutic device and monolasts are allow strictly controlled movement in all planes of the ankle joint, which contributes to the acceleration of the recovery; the conducted anthropometric and goniometric studies were indicate more rapid elimination of edema, increase movement amplitude, carries opposition to the development of contractures and muscle atrophy.

  16. Hydrocolonotherapy ankle joints after injuries

    OpenAIRE

    Volodymyr Muchin; Oleksandr Zviriaka

    2016-01-01

    Muchin V., Zviriaka O. Purpose: to improve efficiency of gydrokinesitherapy by means of specially designed devices and monolasts for patients after ankle joint injuries. Material & Methods: there are pedagogical methods, clinical and radiological methods, anthropometric measurements and goniometry were used. Results: the author's technique of hydrokinesitherapy with application hydrokinesimechanotherapy device in the program of physical rehabilitation which provides optimum conditions for...

  17. Total Ankle Arthroplasty: A Brief Review

    Directory of Open Access Journals (Sweden)

    Roger A. Mann

    2012-12-01

    Full Text Available Ankle fusion has long been the standard of treatment for end-stage ankle arthritis, and a successful arthroplasty has been a long sought alternative. It is a motion sparing procedure and may greatly reduce the potential for adjacent level degeneration as seen with arthrodesis. The typical candidate for arthroplasty is a healthy low demand patient, although the indications are widening as the success of the procedure has increased. Nevertheless, it is not fail-safe, technical expertise and experience are necessary to achieve a successful result. We have been treating ankle arthritis with the Scandinavian Total Ankle Replacement (STAR ankle replacement prosthesis for over ten years. We believe that arthroplasty will surpass arthrodesis as the standard of care for severe ankle arthritis.

  18. PROSPECTIVE EPIDEMIOLOGICAL STUDY OF BASKETBALL INJURIES DURING ONE COMPETITIVE SEASON: ANKLE SPRAINS AND OVERUSE KNEE INJURIES

    Directory of Open Access Journals (Sweden)

    Elke Cumps

    2007-06-01

    Full Text Available This prospective cohort study aims to assess the overall incidence of acute and overuse basketball injuries and identifies risk factors associated with ankle sprains and knee overuse injuries. In total, 164 senior players (23.7 years ± 7.0 of all levels of play, and including both men and women, participated voluntarily during one season. A total of 139 acute and 87 overuse injuries were reported, resulting in an overall injury incidence of 9.8 (8.5 to 11.1 per 1,000 hours. The incidence of acute injuries was 6.0/1,000 hours. Ankle sprains (n = 34 accounted for most acute injuries, and 52.9% of all players with ankle sprains reported a previous ankle sprain. Relative Risks (RR and Odds Ratio (OR with their 95% Confidence Intervals (CI were calculated to determine significant differences. Landing on an opponent's foot was the major inciting event, significantly more so than non contact mechanisms (RR=2.1 [95% CI: 1.0-4.2]. Acute knee injuries resulted in the highest playing absence (7 weeks 2 days ± 9 weeks 1 day. Overuse injury incidence was 3.8/1,000 hours. The knee (1.5/1,000 hours was the most common site. Forward players sustained less knee overuse injuries than players of all other playing positions, and significantly less than center players (OR=0.5 [95% CI: 0.2-0.9]. This study showed that ankle sprains and overuse knee injuries are the most common injuries in basketball, both accounting for 14.8%. Injury prevention programmes however should not concentrate on those injuries only, but might one to consider that acute knee injuries, in spite of the fact that they occur less frequently, also merit further research.

  19. Outcome of ankle arthrodesis in posttraumatic arthritis

    Directory of Open Access Journals (Sweden)

    B S Narayana Gowda

    2012-01-01

    Full Text Available Background: Ankle arthrodesis is still a gold standard salvage procedure for the management of ankle arthritis. There are several functional and mechanical benefits of ankle arthrodesis, which make it a viable surgical procedure in the management of ankle arthritis. The functional outcomes following ankle arthrodesis are not very well known. The purpose of this study was to perform a clinical and radiographic evaluation of ankle arthrodesis in posttraumatic arthritis performed using Charnley′s compression device. Materials and Methods: Between January 2006 and December 2009 a functional assessment of 15 patients (10 males and 5 females who had undergone ankle arthrodesis for posttraumatic arthritis and/or avascular necrosis (AVN talus (n=6, malunited bimalleolar fracture (n=4, distal tibial plafond fractures (n=3, medial malleoli nonunion (n=2. All the patients were assessed clinically and radiologically after an average followup of 2 years 8 months (range 1-5.7 years. Results: All patients had sound ankylosis and no complications related to the surgery. Scoring the patients with the American Orthopaedic Foot and Ankle Society (AOFAS Ankle-Hindfoot scale, we found that 11 of the 15 had excellent results, two had good, and two showed fair results. They were all returned to their preinjury activities. Conclusion: We conclude that, the ankle arthrodesis can still be considered as a standard procedure in ankle arthritis. On the basis of these results, patients should be counseled that an ankle fusion will help to relieve pain and to improve overall function. Still, one should keep in mind that it is a salvage procedure that will cause persistent alterations in gait with a potential for deterioration due to the development of subtalar arthritis.

  20. Patella fracture following anterior cruciate ligament reconstruction: A case report

    Directory of Open Access Journals (Sweden)

    Milankov Miroslav

    2003-01-01

    Full Text Available Introduction The most frequent procedure in treatment of acute or chronic anterior cruciate ligament (ACL rupture is the so called bone-tendon-bone reconstruction. A transverse dislocated patella fracture is a rare complication of this procedure with an incidence of 0.23%-2.3%. In a five year period, (1998-2002, 407 arthroscopic reconstructions of the anterior cruciate ligaments were done at our Clinic, and there was only one case of patella fracture. Case report An 18-year-old female patient, a handball player, suffered an acute rupture of anterior cruciate ligament of the left knee, so arthroscopic bone-tendon-bone reconstruction of the anterior cruciate ligament was performed. After adequate skin incision, a bone graft was taken from the patella and upper part of trapezoid tibia, which was 25 mm long, 10 mm wide and 5 mm thick, together with a part of patellar ligament. After the remains of the anterior cruciate ligament had been arthroscopically removed, tunnels were made in tibia and femur and a graft was inserted and fixed with two metal interference screws. Knee stability was tested, and drainage was put in the knee joint. The wound was closed by layers. The quadriceps exercises and passive knee movements started immediately. Full range of movements was accomplished six weeks later when the patient started to walk with full weight-bearing on her operated leg. Three weeks later, (nine weeks after the operation, the patient has accidentally lost her balance and fell. A transverse, dislocated fracture of the left patella was diagnosed and osteosynthesis of the fractured patella with two Kirschner wires and a metallic loop was performed. Postoperatively, full range of movement was allowed. Six months later, the patient felt no pain, there was no swelling, full range of knee movement was achieved, while the Lachman Test was identical in both knees and the pivot shift test was negative. Discussion Fracture of patella after ACL reconstruction is

  1. Total ankle arthroplasty: An imaging overview

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Da Rae; Choi, Yun Sun; Chun, Ka Young; Jung, Yoon Young; Kim, Jin Su; Young, Ki Won [Eulji Hospital, Eulji University, Seoul (Korea, Republic of); Potter, Hollis G.; Li, Angela E. [Dept. of Radiology and Imaging, Hospital for Special Surgery, New York (United States)

    2016-06-15

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice.

  2. Total Ankle Arthroplasty: An Imaging Overview.

    Science.gov (United States)

    Kim, Da-Rae; Choi, Yun Sun; Potter, Hollis G; Li, Angela E; Chun, Ka-Young; Jung, Yoon Young; Kim, Jin-Su; Young, Ki-Won

    2016-01-01

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice.

  3. Fusion following failed total ankle replacement.

    Science.gov (United States)

    Wünschel, Markus; Leichtle, Ulf G; Leichtle, Carmen I; Walter, Christian; Mittag, Falk; Arlt, Eva; Suckel, Andreas

    2013-04-01

    Although mid- to long-term results after total ankle replacement have improved because of available second- and third-generation devices, failure of total ankle replacement is still more common compared with total hip replacement and total knee replacement. The portfolio of available total ankle replacement revision component options is small. Furthermore, the bone stock of the tibiotalar region is scarce making it difficult and in some situations impossible to perform revision total ankle replacement. In these cases tibiotalar and tibiotalocalcaneal fusions are valuable options. This article describes which surgical procedures should be performed depending on the initial situation and gives detailed advice on surgical technique, postoperative care, and clinical results.

  4. Ankle and knee kinetics between strike patterns at common training speeds in competitive male runners.

    Science.gov (United States)

    Kuhman, Daniel; Melcher, Daniel; Paquette, Max R

    2016-01-01

    The purpose of this study was to investigate the interaction of foot strike and common speeds on sagittal plane ankle and knee joint kinetics in competitive rear foot strike (RFS) runners when running with a RFS pattern and an imposed forefoot strike (FFS) pattern. Sixteen competitive habitual male RFS runners ran at two different speeds (i.e. 8 and 6 min mile(-1)) using their habitual RFS and an imposed FFS pattern. A repeated measures analysis of variance was used to assess a potential interaction between strike pattern and speed for selected ground reaction force (GRF) variables and, sagittal plane ankle and knee kinematic and kinetic variables. No foot strike and speed interaction was observed for any of the kinetic variables. Habitual RFS yielded a greater loading rate of the vertical GRF, peak ankle dorsiflexor moment, peak knee extensor moment, peak knee eccentric extensor power, peak dorsiflexion and sagittal plane knee range of motion compared to imposed FFS. Imposed FFS yielded greater maximum vertical GRF, peak ankle plantarflexor moment, peak ankle eccentric plantarflexor power and sagittal plane ankle ROM compared to habitual RFS. Consistent with previous literature, imposed FFS in habitual RFS reduces eccentric knee extensor and ankle dorsiflexor involvement but produce greater eccentric ankle plantarflexor action compared to RFS. These acute differences between strike patterns were independent of running speeds equivalent to typical easy and hard training runs in competitive male runners. Current findings along with previous literature suggest differences in lower extremity kinetics between habitual RFS and imposed FFS running are consistent among a variety of runner populations.

  5. Find an Orthopaedic Foot and Ankle MD/DO

    Science.gov (United States)

    ... Content AOFAS / FootCareMD / Find a Surgeon Find an Orthopaedic Foot & Ankle Surgeon Page Content The Orthopaedic Distinction Who are Orthopaedic Foot & Ankle Surgeons? Orthopaedic foot and ankle surgeons ...

  6. SHADE: A Shape-Memory-Activated Device Promoting Ankle Dorsiflexion

    Science.gov (United States)

    Pittaccio, S.; Viscuso, S.; Rossini, M.; Magoni, L.; Pirovano, S.; Villa, E.; Besseghini, S.; Molteni, F.

    2009-08-01

    Acute post-stroke rehabilitation protocols include passive mobilization as a means to prevent contractures. A device (SHADE) that provides repetitive passive motion to a flaccid ankle by using shape memory alloy actuators could be of great help in providing this treatment. A suitable actuator was designed as a cartridge of approximately 150 × 20 × 15 mm, containing 2.5 m of 0.25 mm diameter NiTi wire. This actuator was activated by Joule’s effect employing a 7 s current input at 0.7 A, which provided 10 N through 76 mm displacement. Cooling and reset by natural convection took 30 s. A prototype of SHADE was assembled with two thermoplastic shells hinged together at the ankle and strapped on the shin and foot. Two actuators were fixed on the upper shell while an inextensible thread connected each NiTi wire to the foot shell. The passive ankle motion (passive range of motion, PROM) generated by SHADE was evaluated optoelectronically on three flaccid patients (58 ± 5 years old); acceptability was assessed by a questionnaire presented to further three flaccid patients (44 ± 11.5 years old) who used SHADE for 5 days, 30 min a day. SHADE was well accepted by all patients, produced good PROM, and caused no pain. The results prove that suitable limb mobilization can be produced by SMA actuators.

  7. Anterior cruciate ligament tears: MRI versus arthroscopy. Vordere Kreuzbandruptur: MRT versus Arthroskopie

    Energy Technology Data Exchange (ETDEWEB)

    Tosch, U.; Felix, R. (Strahlenklinik und Poliklinik, Universitaetsklinik Rudolf Virchow, Berlin (Germany)); Schauwecker, W.; Dreithaler, B. (Chirurgische Klinik und Poliklinik, Universitaetsklinik Rudolf Virchow, Berlin (Germany))

    1992-05-01

    Because of suspected rupture of the anterior cruciate ligament sixteen acute traumatised patients were investigated by MR and arthroscopy. The MR diagnosis of a lesion of the anterior cruciate ligament proved to be correct by arthroscopy in fifteen of sixteen cases. Diagnostic criteria for lesions of the anterior cruciate ligament were: increased signal intensity in T[sub 1]- and T[sub 2] weighted images, increased volume and discontinuity of ligamentous structures. Additional MR findings of meniscal tears were correct in three of four cases laterally and in four of four cases medially. Femoral cartilage lesions were correctly identified by MR in three cases. MR normal findings proved to be correct by arthroscopy in another five cases. (orig.).

  8. Deformation and stress distribution of the human foot after plantar ligaments release: a cadaveric study and finite element analysis.

    Science.gov (United States)

    Liang, Jun; Yang, Yunfeng; Yu, Guangrong; Niu, Wenxin; Wang, Yubin

    2011-03-01

    The majority of foot deformities are related to arch collapse or instability, especially the longitudinal arch. Although the relationship between the plantar fascia and arch height has been previously investigated, the stress distribution remains unclear. The aim of this study was to explore the role of the plantar ligaments in foot arch biomechanics. We constructed a geometrical detailed three-dimensional (3-D) finite element (FE) model of the human foot and ankle from computer tomography images. The model comprised the majority of joints in the foot as well as bone segments, major ligaments, and plantar soft tissue. Release of the plantar fascia and other ligaments was simulated to evaluate the corresponding biomechanical effects on load distribution of the bony and ligamentous structures. These intrinsic ligaments of the foot arch were sectioned to simulate different pathologic situations of injury to the plantar ligaments, and to explore bone segment displacement and stress distribution. The validity of the 3-D FE model was verified by comparing results with experimentally measured data via the displacement and von Mise stress of each bone segment. Plantar fascia release decreased arch height, but did not cause total collapse of the foot arch. The longitudinal foot arch was lost when all the four major plantar ligaments were sectioned simultaneously. Plantar fascia release was compromised by increased strain applied to the plantar ligaments and intensified stress in the midfoot and metatarsal bones. Load redistribution among the centralized metatarsal bones and focal stress relief at the calcaneal insertion were predicted. The 3-D FE model indicated that plantar fascia release may provide relief of focal stress and associated heel pain. However, these operative procedures may pose a risk to arch stability and clinically may produce dorsolateral midfoot pain. The initial strategy for treating plantar fasciitis should be non-operative.

  9. 肌内效布贴扎联合 Aircast加压冷疗系统对急性踝关节扭伤的临床疗效%The clinical efficacy of Kinesio taping cloth joint Aircast pressurized cold therapy system for acute ankle sprain

    Institute of Scientific and Technical Information of China (English)

    王自力

    2014-01-01

    Objective To explore the clinical efficacy of Kinesio taping cloth joint Aircast pressurized cold therapy system for acute ankle sprain .Methods From January 2012 to June 2013 in our hospital 74 patients of the early acute ankle sprain were randomly divided into observation group and control group ,the control group accepted Kinesio taping cloth , conventional cold and compression therapy , on the basis the observation group accepted Aircast pressurized cold therapy system .After treatment ,48 h ,1 week ,efficacy ,VAS score ,assess the degree of swelling were assessed .Results In the control group after treatment ,the total effective rate at 48 h efficacy and one week efficacy than the control group showed significant statistical difference (P0 .05) .Swelling time of the observation group than in the control group were significantly reduced ( P<0 .05) .Conclusion Kinesio taping cloth joint Air‐cast pressurized cold therapy system can effectively promote the recovery of patients with acute ankle sprains and re‐lieve pain compared with single using Kinesio taping therapy .%目的:探讨肌内效布贴扎联合Aircast加压冷疗系统对急性踝关节扭伤的临床疗效。方法选择2012年1月至2013年6月就诊于本院的早期急性踝关节扭伤患者74例,随机分为观察组及对照组,对照组采用肌内效布贴扎、常规冷敷及加压治疗,观察组在此基础上采用Aircast加压冷疗系统进行治疗。治疗后48 h、1周对疗效、VAS评分、肿胀程度进行评估。结果对照组治疗后48 h总有效率、48 h疗效及1周疗效较对照组均存在统计学意义( P<0.05)。对照组治疗后重度疼痛2例,观察组治疗后无重度疼痛患者。两组患者治疗后疼痛程度,观察组较对照组存在统计学意义(P<0.05)。治疗48 h、4 d后观察组跟骨围减少程度较对照组具有统计学意义(P<0.05),治疗1周后观察组跟骨围变化较对

  10. Accuracy and Measurement Error of the Medial Clear Space of the Ankle.

    Science.gov (United States)

    Metitiri, Ogheneochuko; Ghorbanhoseini, Mohammad; Zurakowski, David; Hochman, Mary G; Nazarian, Ara; Kwon, John Y

    2017-04-01

    Measurement of the medial clear space (MCS) is commonly used to assess deltoid ligament competency and mortise stability when managing ankle fractures. Lacking knowledge of the true anatomic width measured, previous studies have been unable to measure accuracy of measurement. The purpose of this study was to determine MCS measurement error and accuracy and any influencing factors. Using 3 normal transtibial ankle cadaver specimens, deltoid and syndesmotic ligaments were transected and the mortise widened and affixed at a width of 6 mm (specimen 1) and 4 mm (specimen 2). The mortise was left intact in specimen 3. Radiographs were obtained of each cadaver at varying degrees of rotation. Radiographs were randomized, and providers measured the MCS using a standardized technique. Lack of accuracy as well as lack of precision in measurement of the medial clear space compared to a known anatomic value was present for all 3 specimens tested. There were no significant differences in mean delta with regard to level of training for specimens 1 and 2; however, with specimen 3, staff physicians showed increased measurement accuracy compared with trainees. Accuracy and precision of MCS measurements are poor. Provider experience did not appear to influence accuracy and precision of measurements for the displaced mortise. This high degree of measurement error and lack of precision should be considered when deciding treatment options based on MCS measurements.

  11. Effect of high-voltage pulsed current plus conventional treatment on acute ankle sprain Efeito da adição da estimulação de alta voltagem ao tratamento convencional do entorse de tornozelo numa etapa aguda

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    Maria Cristina Sandoval

    2010-06-01

    Full Text Available BACKGROUND: The effectiveness of high-voltage pulsed current (HVPC treatments in humans as a means of controlling edema and post-traumatic pain has not yet been established. Objective: To analyze the effects of HVPC plus conventional treatment on lateral ankle sprains. METHODS: This was a randomized, controlled, double-blind clinical trial with three intervention groups: CG (control group with conventional treatment; HVPC(- group (conventional treatment plus negative polarity HVPC; HVPC(+ group (conventional treatment plus positive polarity HVPC. Twenty-eight participants with lateral ankle sprain (2 to 96h post-trauma were evaluated. Conventional treatment consisted of cryotherapy (20min plus therapeutic exercises. Additionally, the HVPC(- and HVPC(+ groups received 30min of electrical stimulation (submotor level; 120 pps. Pain, edema, range of motion (ROM and gait were assessed before the first treatment session and after the last treatment session. RESULTS: At the final evaluation, there were no significant differences between groups. Nevertheless, the HVPC(- group had greater values in all assessed parameters. The data analysis showed that the HVPC(- group had greater reductions in volume and girth, and greater recovery of ROM and gait velocity. This group also reached the end of the treatment (1.7 weeks; range 1.2-2.2 faster than the HVPC(+ group and the CG (2.2 weeks; range 1.8-2.6. CONCLUSIONS: There were no differences between the study groups, but the results suggest that HVPC(- can accelerate the initial phase of recovery from ankle sprain.CONTEXTUALIZAÇÃO: A eficácia da estimulação elétrica de alta voltagem (EEAV em humanos, como uma forma de tratamento para controlar o edema e a dor pós-traumáticos, ainda não foi estabelecida. OBJETIVO: Analisar o efeito da adição da EEAV ao tratamento convencional do pós-entorse de tornozelo em humanos. MÉTODOS: Ensaio clínico controlado e aleatorizado, duplo cego com três grupos de

  12. Current concepts review: ankle fractures.

    Science.gov (United States)

    Arastu, M H; Demcoe, R; Buckley, R E

    2012-01-01

    Ankle fractures are common injuries that require meticulous technique in order to optimise outcome. The Lauge-Hansen and Danis-Weber classifications in addition to careful evaluation of the injury mechanism can help guide treatment but surgeons must be aware that there are injury patterns that will not always fit the afore mentioned patterns. The principles of atraumatic soft tissue handling, rigid internal fixation and early range of motion exercises are critical for successfully treating these injuries. There are still areas of treatment uncertainty and future directed research is needed in order to address some of these questions.

  13. Haemophilic arthropathy of the ankle treated by total ankle replacement: a case series.

    Science.gov (United States)

    Barg, A; Elsner, A; Hefti, D; Hintermann, B

    2010-07-01

    The standard treatment for end-stage osteoarthritis of the ankle joint in haemophilic patients has been fusion of the ankle joint. Total ankle replacement is still controversial as a treatment option. The objective of this prospective study was to evaluate the mid-term outcome in patients treated with total ankle replacement using an unconstrained three-component ankle implant. Ten haemophilic ankles in eight patients (mean age: 43.2 years, range 26.7-57.5) treated with total ankle replacement were followed up for a minimum of 2.7 years (mean: 5.6, range 2.7-7.6). The outcome was measured with clinical and radiological evaluations. There were no intra- or peri-operative complications. The AOFAS-hindfoot-score increased from 38 (range 8-57) preoperatively to 81 (range 69-95) postoperatively. All patients were satisfied with the results. Four patients became pain free; in the whole patient cohort pain level decreased from 7.1 (range 4-9) preoperatively to 0.8 (range 0-3) postoperatively. All categories of SF-36 score showed significant improvements in quality of life. In one patient, open ankle arthrolysis was performed because of painful arthrofibrosis. For patients with haemophilic osteoarthritis of the ankle joint, total ankle replacement is a valuable alternative treatment to ankle fusion.

  14. Radiological aspects of sprained ankle syndrome

    NARCIS (Netherlands)

    Sijbrandij, E.S.

    2002-01-01

    This thesis addresses several problems related to sprained ankle syndrome. The purpose of this thesis is to evaluate the imaging features of sprained ankles, found on new radiological modalities, and to assess the additional diagnostic understanding and treatment planning of helical CT as well as M

  15. Osteochondral defects in the ankle: why painful?

    NARCIS (Netherlands)

    van Dijk, C.N.; Reilingh, M.L.; Zengerink, M.; van Bergen, C.J.A.

    2010-01-01

    Osteochondral defects of the ankle can either heal and remain asymptomatic or progress to deep ankle pain on weight bearing and formation of subchondral bone cysts. The development of a symptomatic OD depends on various factors, including the damage and insufficient repair of the subchondral bone pl

  16. Osteochondral defects in the ankle: why painful?

    NARCIS (Netherlands)

    van Dijk, C.N.; Reilingh, M.L.; Zengerink, M.; van Bergen, C.J.A.

    2010-01-01

    Osteochondral defects of the ankle can either heal and remain asymptomatic or progress to deep ankle pain on weight bearing and formation of subchondral bone cysts. The development of a symptomatic OD depends on various factors, including the damage and insufficient repair of the subchondral bone pl

  17. The Effect of Lace-up Ankle Braces on Injury Rates in High School Football Players

    Science.gov (United States)

    McGuine, Timothy A.; Hetzel, Scott; Wilson, John; Brooks, Alison

    2013-01-01

    Background Although a nkle injuries occur frequently in high school football players no prospective studies have been performed to determine if wearing lace-up ankle braces will reduce the incidence and severity of ankle and other lower extremity injuries in these athletes. Purpose Determine if lace-up ankle braces reduce the incidence and severity of lower extremity injuries sustained by high school football players. Design Cluster randomized controlled trial. Methods 2081 players from 50 high schools were randomly-assigned to braced or control group. Braced group subjects wore lace-up ankle braces during the 2010 football season. Athletic trainers recorded brace compliance, athletic exposures and injuries. Cox Proportional Hazards models were utilized to compare injury rates between groups. Injury severity (days lost) was tested with Wilcoxon Rank Sum. Results The rate of acute ankle injury (per 1,000 exposures) was 0.48 in the braced group compared to 1.12 in the control group (Cox Hazard Ratio (HR)=0.39, 95% Confidence Interval [CI] 0.24, 0.65, pinjuries was the same (5 days) in both groups (p=0.985). The rate of acute knee injury was 0.70 in the braced group compared to 0.69 in the control group, (HR=0.92 [0.57, 1.47], p=0.721). There was no difference (p=0.242) in the severity of knee injuries between the groups (controls 11.5 days, braced =17 days. The rate of other lower extremity injuries was 0.95 in the braced group and 1.32 in the control group, (HR=0.72 [0.48, 1.09], p=0.117) while the severity was similar in both groups (6 days versus 7 days, p=0.295). Conclusions Players who used lace-up ankle braces had a lower incidence of acute ankle injuries but no difference in the incidence of acute knee or other lower extremity injuries. Braces did not reduce the severity of ankle, knee or other lower extremity injuries. PMID:21926383

  18. Common injuries of the foot and ankle in the child and adolescent athlete.

    Science.gov (United States)

    Malanga, Gerard A; Ramirez-Del Toro, Jose A

    2008-05-01

    A myriad problems in the foot and ankle are specific to child and adolescent athletes. The anatomy of young athletes with respect to the presence of a growth plate makes their injury patterns different from those seen in adults. The main general injury patterns seen in the feet and ankles of children are related to growth and development or occur from overuse syndromes or acute trauma. In this article we outline in an anatomically oriented manner most of the common problems in this population.

  19. Anterior cruciate ligament allograft transplantation for intraarticular ligamentous reconstruction.

    Science.gov (United States)

    Goertzen, M; Dellmann, A; Gruber, J; Clahsen, H; Bürrig, K F

    1992-01-01

    A multiplicity of surgical operations have been developed in an attempt to achieve satisfactory function after anterior cruciate ligament (ACL) repair. None of these procedures have been able to reproduce the fiber organization anatomy of attachment site, vascularity, or function of the ACL. Twenty-nine foxhounds received a deep-frozen bone-ACL-bone allograft and a ligament augmentation device (LAD). Biomechanical, microvascular, and histological changes were evaluated 3, 6, and 12 months following implantation. The maximum loads of the allograft/LADs were 34.3% (387.2 N) after 3 months, 49.3% (556.6 N) after 6 months, and 61.1% (698.8 N) after a year. The maximum load was 69.1% (780 N). In general, after 6 months the allografts showed normal collagen orientation. The allografts demonstrated no evidence of infection or immune reaction. No bone ingrowth into the LAD was observed. Polarized light microscopy and periodic acid-schiff staining showed that the new bone-ligament substance interface had intact fiber orientation at the area of the ligament insertion. Microvascular examination using the Spalteholtz technique revealed revascularization and the importance of an infrapatellar fat pad for the nourishment of ACL allografts.

  20. Total ankle replacement - surgical treatment and rehabilitation.

    Science.gov (United States)

    Prusinowska, Agnieszka; Krogulec, Zbigniew; Turski, Piotr; Przepiórski, Emil; Małdyk, Paweł; Księżopolska-Orłowska, Krystyna

    2015-01-01

    Functions of the ankle joint are closely connected with the gait and ability to maintain an upright position. Degenerative lesions of the joint directly contribute to postural disorders and greatly restrict propulsion of the foot, thus leading to abnormal gait. Development of total ankle replacement is connected with the use of the method as an efficient treatment of joint injuries and continuation of achievements in hip and knee surgery. The total ankle replacement technique was introduced as an alternative to arthrodesis, i.e. surgical fixation, which made it possible to preserve joint mobility and to improve gait. Total ankle replacement is indicated in post-traumatic degenerative joint disease and joint destruction secondary to rheumatoid arthritis. In this paper, total ankle replacement and various types of currently used endoprostheses are discussed. The authors also describe principles of early postoperative rehabilitation as well as rehabilitation in the outpatient setting.

  1. Severe open ankle sprain (SOAS): a lesion presenting as a penetrating soft tissue injury.

    Science.gov (United States)

    Soubeyrand, Marc; Vincent-Mansour, César; Guidon, Julie; Asselineau, Alain; Ducharnes, Gildas; Molina, Véronique

    2010-01-01

    The objective of this retrospective case study was to describe the incidence and clinical features of severe open ankle sprain (SOAS), defined as a tear of the lateral or medial collateral ligaments with an associated transverse tear of the skin over the corresponding malleolus. To this end, we reviewed the medical records of patients with SOAS managed between January 2005 and January 2009, using the databases of 3 different orthopedic trauma centers. Our review revealed 9 patients with SOAS, 7 (77.77%) of which involved the lateral ligaments and 2 (22.22%) of which involved the medial ligaments. The median age was 32 (range 21 to 45) years, and the injury occurred as a result of a motor vehicle accident in 6 (66.67%) patients, and as a result of a fall from a height in 3 (33.33%) patients. Two tendons were damaged in 2 (22.22%) patients, the deep fibular nerve (deep peroneal nerve) in 2 (22.22%) patients, and the anterior tibial artery in 1 (11.11%) patient. The only abnormality on plain radiographs was pneumarthrosis, which was present in 5 (55.56%) patients. The incidence of SOAS is rare, accounting for 0.002% (9/438,000) of all trauma cases and 0.22% (9/4142) of all cases of ankle trauma. The diagnosis was confirmed by intraoperative stress-maneuvers in all 9 patients. In conclusion, SOAS should be suspected in patients who present with a traumatic skin wound over the malleolus.

  2. 神效散联合交变脉冲磁疗仪治疗急性踝关节扭伤的临床研究%Clinical Treatment of Acute Ankle Sprains by Special Powder Combined with Therapeutic Equipment of Alternating Impulse

    Institute of Scientific and Technical Information of China (English)

    王琳珏; 郑昆仑; 谷福顺

    2014-01-01

    目的:观察神效散联合交变脉冲磁疗仪治疗急性踝关节扭伤的临床疗效。方法:将125例Ⅰ、Ⅱ度急性踝关节损伤患者依就诊顺序分为两组,对照组单纯外敷神效散治疗,观察组应用神效散联合交变脉冲磁疗仪治疗。结果:118例获得随访,对照组治愈率51.7%、总有效率79.3%,观察组治愈率75.0%、总有效率95.0%;对照组恢复工作平均时间(20.66±7.59)d,观察组平均(14.10±4.96)d;对照组满意度53.45%,观察组满意度86.67%(均P<0.05)。结论:神效散联合交变脉冲磁疗仪联合治疗急性踝关节扭伤,具有见效快、疗程短、疗效好的特点。%Objective To observe clinical effect of treatment for acute ankle sprains by special powder combined with the therapeutic equipment of alternating impulse. Methods One hundred and 25 patients with I or II degree of iacute ankle sprains were divided into two groups, the control group was simply treated with spe-cial powder and the observation group treated by special powder combined with therapeutic equipment of alter-nating impulse. Results One hundred and 18 pa-tients had been followed up.In the control group,the cure rate was 51.72%,the total effective rate was 79.31%,while in the observation group,the cure rate was 75%,the total effective rate was 95%.The average recov-ery time in the control group was 20.66 ± 7.59 days,while in the observation group 14.10 ± 4.96 days.Satisfaction rate of the control group was 53.45%,and that of the other group was 86.67%. The two groups had statistically significant differences in average cure rate, total efficient rate, recovery time and satisfaction. Conclusion By the Special Powder combined with the therapeutic equipment of alternating impulse,the treatment of acute ankle sprains is effective with special characteristics.

  3. Treatment of a Fracture-dislocation of the Ankle Using RALCA® External Fixator

    Directory of Open Access Journals (Sweden)

    Yaniel Truffin Rodriguez

    2016-06-01

    Full Text Available The association of ankle fractures with a dislocation modifies their therapeutic management since the joint must not remain in such abnormal position for more than six hours and therefore, urgent surgical treatment is needed. The case of a 30-year-old woman treated at the Dr. Gustavo Aldereguía Lima Hospital in Cienfuegos is presented. The patient presented with a severe fracture-dislocation of the right ankle with a supra-syndesmotic fibular fracture, a syndesmotic injury, a deltoid ligament injury and a tibial plafond fracture resulting from a bicycle fall. The fracture-dislocation was stabilized by using a RALCA® external mini-fixator. Full recovery was achieved five months after surgery. In our service, we may not have the devices most commonly used for fixation of ankle injuries at a given moment; therefore, external fixation becomes a viable option to correct this type of fractures. For this reason, we decided to present this case that demonstrates the effectiveness of the RALCA® external fixator.

  4. ANKLE SPRAIN: WHO IS MOST FREQUENTLY INJURED AND HOW LONG ATHLETES ARE ABSENT FROM THE FIELD?

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    Ljiljana Cvejanov Kezunović

    2011-09-01

    Full Text Available Some sports, such as basketball and soccer, have very high incidence of ankle sprains. Because of this, a seemingly trivial injury, gained in the prime of their health and strength, active athletes were sidelined in the past for the entire half-season at the peak of their competitive form. Also, recreational athletes lose continuity in the maintenance of their form and often temporarily or permanently cease their activities, sometimes just because of fear from new injuries. The aim of this study was to examine whether the specific demands of different sports and other parameters such as gender and age, had an effect on the incidence of ankle sprains in athletes. Results: Among the injured athletes there were nine times more men than women, out of which half were soccer players. Volleyball and basketball players are often injured during the landing, soccer and tennis players during the running. It is usually diagnosed with stage III sprains (rupture of lateral ligaments. Temporary absence from the field lasted between 14 days for light sprains, 47 days for severe and over 69 days for avulsions. Conclusion: It would be necessary to put more effort in order to improve prevention, establish doctrine and recommendations in the application of treatment protocols for ankle sprains in athletes.

  5. Three-dimensional finite element stress analysis of the polypropylene, ankle-foot orthosis: static analysis.

    Science.gov (United States)

    Chu, T M; Reddy, N P; Padovan, J

    1995-07-01

    An asymmetric 3-dimensional finite element model (FEM) of the ankle-foot orthosis (AFO) together with the ankle-foot complex was developed using the computer aided design (CAD) program PATRAN. Static analysis of normal and pathological motions of the ankle-foot complex such as the "drop-foot" problem were conducted using the FEM program ADINA. A total of 313 three dimensional solid elements and 10 truss elements were used. Heel strike and toe-off condition were simulated. Results revealed that the peak compressive stress (1.6 MPa) in the AFO model occurred in the heel regions of the AFO and the maximum tensile stress (0.8 MPa) occurred in the neck region of the AFO during toe-off. Parametric analyses revealed that the model was sensitive to the elastic moduli of the AFO and of the soft tissue, but was relatively insensitive to the ligament stiffness. The results confirmed the hypothesis that peak stresses in the orthosis occur in the heal and neck regions of the orthosis.

  6. Anatomy of the alar ligament.

    Science.gov (United States)

    Iwanaga, Joe; Sardi, Juan P; Laws, Tyler; Chapman, Jens R; Oskouian, Rod J; Tubbs, R Shane

    2017-08-18

    There are four layers of ligamentous stabilizers at the cranio-cervical junction and the second layer is comprised of the apical and paired alar ligaments. The purpose of this study is to establish the tensile strength of the alar ligaments for better understanding the implications that can arise from trauma and other pathologies in the craniocervical region. Nineteen sides from ten fresh frozen adult cadaveric Caucasian heads were used in this study. The specimens were derived from six males and four females, and the age of the cadavers at death ranged from 67 to 90-years-old to measure the tensile strength, a tensile testing machine (M2-200, Mark-10 corporation, USA) was used in this study. The force (N) necessary until failure for all alar ligaments ranged from 87 to 346 N with a mean of 186.9±69.7 N. There was a significant difference when comparing tensile strength between males and females. Further studies will be needed to determine their importance as secondary stabilizers and measure their ability to support similar forces when subject to rotation and lateral bending forces, as well as with flexion-extension. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Ligament-mediated spray formation

    NARCIS (Netherlands)

    Villermaux, E.; Marmottant, Ph.; Duplat, J.

    2004-01-01

    The spray formed when a fast gas stream blows over a liquid volume presents a wide distribution of fragment sizes. The process involves a succession of changes of the liquid topology, the last being the elongation and capillary breakup of ligaments torn off from the liquid surface. The coalescence o

  8. Chronic ankle instability: evaluation with stress radiography, CT and CT arthrography; Instabilite chronique externe de la cheville. Apport des radiographies dynamiques, de la tomodensitometrie et de l`arthro-tomodensitometrie

    Energy Technology Data Exchange (ETDEWEB)

    Faure, Ch.; Deplus, F.; Bochu, M. [Hopital Edouard-Herriot, 69 - Lyon (France); Besse, J.L.; Moyen, B. [Centre Hospitalier Lyon-Sud, 69 -Pierre-Benite (France)

    1997-09-01

    We retrospectively evaluated the anterior talo-fibular ligament and the tarsal sinus of 17 patients who had complained of chronic ankle external instability. This study based on both surgery and CT-arthrography findings shows the pathologic or normal aspects of the talo-fibular anterior ligament (normal, lax, fibrosis residue, ruptured). It confirms the good anatomic analysis of the tarsal sinus, i particular the anterior talo-calcaneal interosseous ligament and the search for fibrosis. We underline that capsular distension due to subtalar laxity is not detected with medical imaging. Compared with surgery (all patients), CT arthrography demonstrated the different aspects of the anterior talo fibular ligament injuries (normal, lax, discontinuous). (authors). 12 refs.

  9. Status and headway of the clinical application of artificial ligaments

    Directory of Open Access Journals (Sweden)

    Tianwu Chen

    2015-01-01

    Full Text Available The authors first reviewed the history of clinical application of artificial ligaments. Then, the status of clinical application of artificial ligaments was detailed. Some artificial ligaments possessed comparable efficacy to, and fewer postoperative complications than, allografts and autografts in ligament reconstruction, especially for the anterior cruciate ligament. At the end, the authors focused on the development of two types of artificial ligaments: polyethylene glycol terephthalate artificial ligaments and tissue-engineered ligaments. In conclusion, owing to the advancements in surgical techniques, materials processing, and weaving methods, clinical application of some artificial ligaments so far has demonstrated good outcomes and will become a trend in the future.

  10. Revision of the aseptic and septic total ankle replacement.

    Science.gov (United States)

    Espinosa, Norman; Wirth, Stephan Hermann

    2013-04-01

    Total ankle replacement has become a popular treatment of symptomatic end-stage ankle osteoarthritis. Contemporary total ankle replacement systems provide more anatomic and biomechanically sound function. However, longevity is still limited and long-term results of modern total ankle replacement designs are not available. In the case of failure, conversion into arthrodesis has remained the treatment of choice but at the cost of hindfoot function and potential degeneration of the adjacent joints. Thus, revision total ankle replacement by exchange of the prosthetic components represents an attractive solution. This article focuses on revision total ankle replacement and conversion to ankle arthrodesis.

  11. FATIGUE DEVICE FOR TESTING ANKLE JOINT ENDOPROSTHESES

    Directory of Open Access Journals (Sweden)

    Cristian TOADER-PASTI

    2012-05-01

    Full Text Available The paper proposes a model of a fatigue device for testing dedicated to ankle prostheses. The concept of the testing device relies on two aspects: almost any type of ankle prosthesis can be tested on it and it has to work on INSTRON axial-torsion testing machine. Starting from these requirements, a 3D functional assembly that reproduces the real movement of the ankle joint during gait cycle has been designed. The device is based on a cam-follower mechanism.

  12. Conversion of ankle autofusion to total ankle replacement using the Salto XT revision prosthesis.

    Science.gov (United States)

    Williamson, Emilie R C; Demetracopoulos, Constantine A; Ellis, Scott J

    2016-09-01

    Few reports in the literature have described the conversion of a surgically fused ankle to a total ankle replacement. The takedown of an autofusion and conversion to a prosthesis has not been described. We report the case of a patient with severe rheumatoid arthritis with an ankle autofusion fixed in equinus and severe talonavicular arthritis that was converted to ankle replacement using the Salto XT revision system. We describe the reasons why the decision was made to perform total ankle arthroplasty while concomitantly fusing the talonavicular joint, and discuss the rationale of the various surgical treatment options considered. We describe the clinical and radiographic outcomes achieved in this case. At 12 months post-operatively the patient reported significant reduction of pain, increased FAOS scores and had increased ankle range of motion.

  13. Biomechanics of the ankle joint and clinical outcomes of total ankle replacement.

    Science.gov (United States)

    Michael, Junitha M; Golshani, Ashkahn; Gargac, Shawn; Goswami, Tarun

    2008-10-01

    Until the 1970s ankle arthrodesis was considered to be the "gold-standard" to treat arthritis. But the low fusion rate of ankle arthrodeses along with the inability to achieve normal range of motion led to the growing interest in the development of total ankle replacements. Though the short-term outcomes were good, their long-term outcomes were not as promising. To date, most models do not exactly mimic the anatomical functionality of a natural ankle joint. Therefore, research is being conducted worldwide to either enhance the existing models or develop new models while understanding the intricacies of the joint more precisely. This paper reviews the anatomical and biomechanical aspects of the ankle joint. Also, the evolution and comparison of clinical outcomes of various total ankle replacements are presented.

  14. Ultrasound appearance of the normal Lisfranc ligament.

    Science.gov (United States)

    Kaicker, Jatin; Zajac, Mercedes; Shergill, Ravi; Choudur, Hema N

    2016-12-01

    This study aims to prospectively evaluate the ultrasound appearance of the normal Lisfranc's ligament in 50 patients (100 ft) with no prior or current ligament injury. Fifty normal asymptomatic patients between the ages of 18 and 80 years were assessed. Three key features were recorded: ultrasound appearance, thickness, and length of the Lisfranc's ligament. Patients excluded from this study included pediatric patients and those with history of injury or symptoms related to the foot. The mean right- and left-sided ligament (RT) thickness were 0.096 (0.021) and 0.104 (0.023), respectively. The mean right- and left-sided ligament RT length was 0.54 (0.11) and 0.57 (0.11), respectively. The appearance of the ligament was similar in all patients with a central thin band of hypoechogenicity lined by hyperechoic lines on either side. Understanding the normal appearance, thickness, and length of the Lisfranc's ligament in a large sample is imperative to diagnose abnormal appearances of this ligament including sprains and tears by ultrasound. Ultrasound, with its easy accessibility, can be used in the emergency department to rapidly exclude injury of the ligament. Increased understanding and awareness of the Lisfranc's ligament on ultrasound can allow for more accurate diagnosis and treatment.

  15. Follow-up MR imaging of the alar and transverse ligaments after whiplash injury: a prospective controlled study.

    Science.gov (United States)

    Vetti, N; Kråkenes, J; Ask, T; Erdal, K A; Torkildsen, M D N; Rørvik, J; Gilhus, N E; Espeland, A

    2011-01-01

    The cause and clinical relevance of upper neck ligament high signal intensity on MR imaging in WAD are controversial. The purpose of this study was to explore changes in the signal intensity of the alar and transverse ligaments during the first year after a whiplash injury. Dedicated high-resolution upper neck proton attenuation-weighted MR imaging was performed on 91 patients from an inception WAD1-2 cohort, both in the acute phase and 12 months after whiplash injury, and on 52 controls (noninjured patients with chronic neck pain). Two blinded radiologists independently graded alar and transverse ligament high signal intensity 0-3, compared initial and follow-up images to assess alterations in grading, and solved any disagreement in consensus. The Fisher exact test was used to compare proportions. Alar and transverse ligament grading was unchanged from the initial to the follow-up images. The only exceptions were 1 alar ligament changing from 0 to 1 and 1 ligament from 1 to 0. The prevalence of grades 2-3 high signal intensity in WAD was thus identical in the acute phase and after 12 months, and it did not differ from the prevalence in noninjured neck pain controls (alar ligaments 33.0% versus 46.2%, P = .151; transverse ligament 24.2% versus 23.1%, P = 1.000). Alar and transverse ligament high signal intensity in patients with WAD1-2 observed within the first year after injury cannot be explained by the trauma. Dedicated upper neck MR imaging cannot be recommended as a routine examination in these patients.

  16. Transfibular ankle arthrodesis: A novel method for ankle fusion - A short term retrospective study

    Directory of Open Access Journals (Sweden)

    S Muthukumar Balaji

    2017-01-01

    Full Text Available Background: Ankle arthrodesis has long been the traditional operative treatment for posttraumatic arthritis, rheumatoid arthritis, infection, neuromuscular conditions, and salvage of failed ankle arthroplasty. It remains the treatment of choice for patients in whom heavy and prolonged activity is anticipated. We present our short term followup study of functional outcome of patients who underwent transfibular ankle arthrodesis for arthritis of ankle due to various indications. Materials and Methods: 29 transfibular ankle arthrodesis in 29 patients performed between April 2009 and April 2014 were included in this study. The mean age was 50 years (range 22-75 years. The outcome analysis with a minimum of 1-year postoperative followup were included. All the patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS Hindfoot scale. Results: All cases of ankle fusions (100% progressed to solid union in a mean postoperative duration of 3.8 months (range 3-6 months. All patients had sound arthrodesis. The mean followup period was 32.52 months (standard deviation ± 10.34. The mean AOFAS score was 74 (pain score = 32, functional score = 42. We found that twenty patients (68.96% out of 29, had excellent results, 7 (24.13% had good, and 2 (6.89% showed fair results. Conclusion: Transfibular ankle arthrodesis is a simple and effective procedure for ankle arthritis. It achieves a high rate of union and good functional outcome on midterm followup.

  17. Transfibular ankle arthrodesis: A novel method for ankle fusion – A short term retrospective study

    Science.gov (United States)

    Balaji, S Muthukumar; Selvaraj, V; Devadoss, Sathish; Devadoss, Annamalai

    2017-01-01

    Background: Ankle arthrodesis has long been the traditional operative treatment for posttraumatic arthritis, rheumatoid arthritis, infection, neuromuscular conditions, and salvage of failed ankle arthroplasty. It remains the treatment of choice for patients in whom heavy and prolonged activity is anticipated. We present our short term followup study of functional outcome of patients who underwent transfibular ankle arthrodesis for arthritis of ankle due to various indications. Materials and Methods: 29 transfibular ankle arthrodesis in 29 patients performed between April 2009 and April 2014 were included in this study. The mean age was 50 years (range 22-75 years). The outcome analysis with a minimum of 1-year postoperative followup were included. All the patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot scale. Results: All cases of ankle fusions (100%) progressed to solid union in a mean postoperative duration of 3.8 months (range 3–6 months). All patients had sound arthrodesis. The mean followup period was 32.52 months (standard deviation ± 10.34). The mean AOFAS score was 74 (pain score = 32, functional score = 42). We found that twenty patients (68.96%) out of 29, had excellent results, 7 (24.13%) had good, and 2 (6.89%) showed fair results. Conclusion: Transfibular ankle arthrodesis is a simple and effective procedure for ankle arthritis. It achieves a high rate of union and good functional outcome on midterm followup. PMID:28216754

  18. Primary ankle arthrodesis for neglected open weber B ankle fracture dislocation.

    LENUS (Irish Health Repository)

    Thomason, Katherine

    2014-07-01

    Primary ankle arthrodesis used to treat a neglected open ankle fracture dislocation is a unique decision. A 63-year-old man presented to the emergency department with a 5-day-old open fracture dislocation of his right ankle. After thorough soft tissue debridement, primary arthrodesis of the tibiotalar joint was performed using initial Kirschner wire fixation and an external fixator. Definitive soft tissue coverage was later achieved using a latissimus dorsi free flap. The fusion was consolidated to salvage the limb from amputation. The use of primary arthrodesis to treat a compound ankle fracture dislocation has not been previously described.

  19. 急性前交叉韧带实质部完全断裂的发生部位及有关因素研究%Position of Acute Completely Substantial Tears of the Anterior Cruciate Ligament and Related Factors

    Institute of Scientific and Technical Information of China (English)

    杨渝平; 敖英芳; 刘晓鹏; 安华; 安玉洁; 刘瑞兰; 王丽; 于燕领

    2011-01-01

    目的 探讨急性前交叉韧带( anterior cruciate ligament,ACL)实质部完全断裂的发生部位,及其与5种主要损伤有关因素的关系. 方法 1988年5月~2005年12月,144例急性ACL损伤(受伤时间1~21 d)经关节镜探查确认韧带实质部完全断裂,按照长度将实质部三等分分为上、中、下三部分,观察断裂部位与年龄、性别、损伤侧别、损伤机制(接触性、非接触性)和损伤时膝关节位置(伸直、屈曲)的关系. 结果 上、中、下三段断裂的发生率分别为:72.2% (104/144)、26.4%(38/144)、1.4% (2/144),两两比较均有统计学差异(P<0.05).上段和中段断裂在不同年龄、性别、损伤侧别、损伤机制和损伤时膝关节位置的发生率比较均无统计学差异(P>0.05). 结论 急性ACL实质部完全断裂近3/4发生在上段,1/4左右发生在中段,下段极少发生;断裂部位与年龄、性别、损伤侧别、损伤机制以及损伤时膝关节位置均无关.%Objective To investigate the position of acute complete substance tears of the anterior cruciate ligament (ACL) and five relevant factors. Methods A total of 144 cases with acute ACL injuries (1-21 days after the injuries) were confirmed having sustained complete substance tears by arthroscopy and received arthroscopic reconstruction from May 1988 to December 2005. Each ligamentous substance was divided into three portions with equal length; proximal, middle and distal portion. The torn position of each case was recorded. The age, gender, affected side, mechanism of the injury and knee joint direction when injury occurred,as well as relationship between torn positions and each of the five relevant factors were tested using the Chi-square test. Results Incidences of occurrence of proximal, middle and distal injury were 72. 2% (104/144 ) , 26. 4% ( 38/144) , and 1. 4% ( 2/144), respectively (P 0.05 ) Conclusions Acute complete substance tears of the ACL mostly happen in the proximal

  20. Characteristics of the three ligaments of human spring ligament complex from a viewpoint of elements.

    Science.gov (United States)

    Tohno, Yoshiyuki; Tohno, Setsuko; Taniguchi, Akira; Azuma, Cho; Minami, Takeshi; Mahakkanukrauh, Pasuk

    2012-06-01

    To elucidate characteristics of the three ligaments constituting the spring ligament complex from a viewpoint of elements, the authors investigated age-related changes of elements, relationships among their elements, relationships among ligaments in the elements, and gender differences in the three ligaments of the spring ligament complex, the superomedial calcaneonavicular (SMCN), inferoplantar longitudinal calcaneonavicular (ICN), and third or medioplantar oblique calcaneonavicular (TCN) ligaments. After ordinary dissection at Nara Medical University was finished, the SMCN, ICN, and TCN ligaments of the spring ligament complex were removed from the subjects. The subjects consisted of 10 men and 12 women, ranging in age from 62 to 99 years (average age = 80.5 ± 9.7 years). After incineration with nitric acid and perchloric acid, the element contents were determined by inductively coupled plasma-atomic emission spectrometry. It was found that although the Ca and P content hardly changed in the SMCN ligament with aging, the Ca and P content in the ICN ligament increased to about three and five times higher in the 80s in comparison with the 60s, respectively, whereas in the TCN ligament, it increased about 40% and 90% higher in the 80s compared with the 60s, respectively. Regarding the relationships among elements, significant direct correlations were found among the contents of Ca, P, and Mg in all the three ligaments of the spring ligament complex. This finding was in agreement with the previous finding obtained with the three ligaments of the anterior cruciate ligament, posterior longitudinal ligament, and ligamentum capitis femoris. Whether there were significant correlations among the three ligaments of the spring ligament complex with regard to the Ca, P, S, Mg, Zn, and Fe contents was examined using Pearson's correlation. It was found that there were significant direct correlations between the SMCN and TCN ligaments in all the Ca, P, Mg, and Zn contents and

  1. Lichen simplex chronicus on the ankle (image)

    Science.gov (United States)

    Lichen simplex chronicus on the ankle: Lichen simplex chronicus is also known as neurodermatitis. A minor itch may encourage scratching which increases the irritation, leading to more scratching. This ...

  2. Glossary of Foot and Ankle Terms

    Science.gov (United States)

    ... of Charcot fractures in the foot and ankle. Orthopaedics/Orthopedics - The medical and surgical specialty focused on treating, repairing and reconstructing the human musculoskeletal system. Orthopaedist /Orthopaedic Surgeon - A surgeon whose specialty is treating, repairing ...

  3. Compression therapy after ankle fracture surgery

    DEFF Research Database (Denmark)

    Winge, R; Bayer, L; Gottlieb, H

    2017-01-01

    PURPOSE: The main purpose of this systematic review was to investigate the effect of compression treatment on the perioperative course of ankle fractures and describe its effect on edema, pain, ankle joint mobility, wound healing complication, length of stay (LOS) and time to surgery (TTS). The aim...... undergoing surgery, testing either intermittent pneumatic compression, compression bandage and/or compression stocking and reporting its effect on edema, pain, ankle joint mobility, wound healing complication, LOS and TTS. To conclude on data a narrative synthesis was performed. RESULTS: The review included...... eight studies (451 patients). Seven studies found a significant effect on edema, two studies described a significant reduction in pain, one a positive effect on ankle movement, two a positive effect on wound healing, one a reduction in LOS and finally two studies reported reduction in TTS. A systematic...

  4. American College of Foot and Ankle Surgeons

    Science.gov (United States)

    ... Practice Management Education Opportunities Practice Management e-Learning e-Learning CME Transcripts Corporate Relations Faculty Application Research & Publications Journal of Foot and Ankle Surgery ACFAS Update Read ...

  5. Bioreactor Design for Tendon/Ligament Engineering

    Science.gov (United States)

    Wang, Tao; Gardiner, Bruce S.; Lin, Zhen; Rubenson, Jonas; Kirk, Thomas B.; Wang, Allan; Xu, Jiake

    2013-01-01

    Tendon and ligament injury is a worldwide health problem, but the treatment options remain limited. Tendon and ligament engineering might provide an alternative tissue source for the surgical replacement of injured tendon. A bioreactor provides a controllable environment enabling the systematic study of specific biological, biochemical, and biomechanical requirements to design and manufacture engineered tendon/ligament tissue. Furthermore, the tendon/ligament bioreactor system can provide a suitable culture environment, which mimics the dynamics of the in vivo environment for tendon/ligament maturation. For clinical settings, bioreactors also have the advantages of less-contamination risk, high reproducibility of cell propagation by minimizing manual operation, and a consistent end product. In this review, we identify the key components, design preferences, and criteria that are required for the development of an ideal bioreactor for engineering tendons and ligaments. PMID:23072472

  6. Therapeutic Effectiveness of Kinesio Taping plus Conventional Physiotherapy for Relieving Swelling and Pain in Patients with Acute Ankle Sprain%肌内效布贴扎辅助理疗治疗急性踝关节扭伤患者肿胀疼痛疗效观察

    Institute of Scientific and Technical Information of China (English)

    余波; 王人卫; 陈文华; 王会儒; 祁奇; 刘合建; 瞿强; 屠霞芬

    2012-01-01

    目的:观察肌内效布贴扎辅助理疗治疗急性踝关节扭伤患者肿胀和疼痛症状的临床疗效.方法:急性踝关节扭伤患者共40例,按身高体重指数(BMI)及损伤程度1∶1配对,随机分为以肌内效布贴扎(以自然拉力的爪形贴布为主)+局部常规理疗组(以冷疗及无热量超短波为主,以下称治疗组)和局部常规理疗组(对照组),每组各20例.分别于入选时和治疗1、3及5天后测量两组患者踝关节周长、疼痛度视觉模拟评分(Visual Analogue Scale,VAS)及进行踝关节损伤后下肢功能自我功能评定(Self Assessed Function for Lower Quarter,SAF)量表评分,同时对肌内效布贴扎的过敏性进行评价.结果:治疗前两组一般情况及病情比较差异无统计学意义,治疗第1天、第3天,治疗组踝关节周长较对照组显著减小,差异有统计学意义(第1天:38.31±1.24 cm,39.80±0.84 cm,t=4.449,P<0.01;第3天:37.22±1.17,38.83±1.02,t=4.638,P<0.01),治疗第5天,两组患者周长差异无统计学意义(P>0.05),而与治疗前比较均有显着差异.治疗第1天、第3天,治疗组主观疼痛度较对照组减轻,差异有统计学意义(第1天:3.35±0.49,4.13±0.54,t=4.783,P< 0.01;第3天:2.25±0.64,3.06±0.60,t=4.129,P<0.01),治疗第5天两组比较差异无统计学意义.治疗第1天、第3天,治疗组SAF功能评定评分较对照组无显著差异,第5天治疗组(87.52±6.30)与对照组(81.75±9.94)比较有显着性差异(t=2.193,P<0.05).治疗组无过敏事件发生.结论:肌内效布贴扎结合常规理疗能快速改善急性踝关节扭伤患者肿胀、疼痛等症状,改善踝关节功能评定得分,其机制尚待探讨.%Objective The purpose of this pilot study was to investigate the effectiveness of kinesio taping (KT) combined with conventional physiotherapy (CP) for relieving major complaints of patients with acute ankle sprain (AAS). Methods 40 AAS patients were randomly and equally divided into

  7. Non-traumatic Thickening of the Anterior Cruciate Ligament

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Hyun Jun; Park, Jin Gyoon; Song, Sang Gook [Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2009-08-15

    To describe the magnetic resonance (MR) imaging findings of non-traumatic thickening of the anterior cruciate ligament (ACL) and to evaluate the associated lesions. Between January 2003 and August 2005, 44 knees of 44 patients who had thickened ACLs on MR images and had no history of knee trauma were analyzed retrospectively. The normal thickness of the ACL was measured on axial T2-weighted images of 40 healthy adult knees. The MR imaging findings of the thickened ACLs and associated lesions were analyzed. In 40 cases of healthy knees, the thickness of the proximal ACL was 3-6 mm. In 44 cases of non-traumatic thickening of the ACL, the thickness of the proximal ACL was 8-14 mm. There was an increased signal intensity and ill-defined border in all cases of thickened ACLs, linear low-signal intensity fibers parallel to the long axis of the thickened ACL (celery stalk appearance) in 24 cases, and entrapment in 10 cases. With respect to associated lesions, there was osteoarthritis in 40 cases, meniscal tears in 42 cases, and degeneration of the posterior cruciate ligament in 7 cases. Non-traumatic thickening of the ACL was associated with osteoarthritis and meniscal tears in almost all cases and showed increased signal intensity and ill-defined borders simulating acute ligamentous tears

  8. Postoperative infection in the foot and ankle.

    LENUS (Irish Health Repository)

    Chan, Victoria O

    2012-07-01

    Our discussion highlights the commonly performed surgical procedures in the foot and ankle and reviews the various imaging modalities available for the detection of infection with graphic examples to better enable radiologists to approach the radiological evaluation of postoperative infection in the foot and ankle. Discrimination between infectious and noninfectious inflammation remains a diagnostic challenge usually needing a combination of clinical assessment, laboratory investigations, and imaging studies to increase diagnostic accuracy.

  9. Salvage arthrodesis for failed total ankle arthroplasty

    Science.gov (United States)

    Zürcher, Arthur W

    2010-01-01

    Background and purpose Total ankle arthroplasty (TAA) has gained popularity in recent years. If it fails, however, salvage arthrodesis must be reliable as a rescue procedure. We therefore investigated the clinical, radiographic, and subjective outcome after salvage arthrodesis in a consecutive group of patients, and concentrated on the influence of the method of fixation on union rate and on salvage in inflammatory joint disease. Patients and methods Between 1994 and 2005, salvage arthrodesis was performed on 18 ankles (18 patients). Diagnosis was inflammatory joint disease (IJD) in 15 cases and osteoarthritis (OA) in 3. Tibio-talar fusion was performed in 7 ankles, and tibio-talocalcaneal fusion in 11. Serial radiographs were studied for time to union. Clinical outcome at latest follow-up was measured by the AOFAS score, the foot function index (FFI) and by VAS scores for pain, function, and satisfaction. Results Blade plates were used in 7 ankles (4 IJD, 3 OA); all united. Nonunion developed in 7 of the 11 rheumatic ankles stabilized by other methods. 11 patients (8 fused ankles, 3 nonunions) were available for clinical evaluation. Their mean AOFAS score was 62 and mean overall FFI was 70. VAS score for pain was 20, for function 64, and for satisfaction 74. The scores were similar in united and non-united ankles. Interpretation Blade plate fixation is successful in salvage arthrodesis for failed TAA. A high nonunion rate was found after salvage ankle arthrodesis in IJD with other methods of fixation. Clinical results were fair to good. PMID:20175648

  10. Total Ankle Arthroplasty: A Brief Review

    OpenAIRE

    Mann, Roger A.; Harrison, Matthew J.

    2012-01-01

    Ankle fusion has long been the standard of treatment for end-stage ankle arthritis, and a successful arthroplasty has been a long sought alternative. It is a motion sparing procedure and may greatly reduce the potential for adjacent level degeneration as seen with arthrodesis. The typical candidate for arthroplasty is a healthy low demand patient, although the indications are widening as the success of the procedure has increased. Nevertheless, it is not fail-safe, technical expertise and exp...

  11. An epidemiological survey on ankle sprain.

    OpenAIRE

    Yeung, M S; Chan, K. M.; So, C H; Yuan, W Y

    1994-01-01

    Ankle sprain is a common sports injury and is often regarded as trivial by athletes and coaches. This epidemiological study was conducted among three categories of Hong Kong Chinese athletes: national teams, competitive athletes and recreational athletes. This study shows that as much as 73% of all athletes had recurrent ankle sprain and 59% of these athletes had significant disability and residual symptoms which led to impairment of their athletic performance. This study indicates that a pro...

  12. Posterior cruciate ligament and posterolateral corner reconstruction.

    Science.gov (United States)

    Fanelli, Gregory C; Edson, Craig J; Reinheimer, Kristin N; Garofalo, Raffaele

    2007-12-01

    The keys to successful posterior cruciate ligament reconstruction are to identify and treat all pathology, use strong graft material, accurately place tunnels in anatomic insertion sites, minimize graft bending, use a mechanical graft-tensioning device, use primary and backup graft fixation, and employ the appropriate postoperative rehabilitation program. Adherence to these technical points results in successful single and double bundle arthroscopic transtibial tunnel posterior cruciate ligament reconstruction documented with stress radiography, arthrometer, knee ligament rating scales, and patient satisfaction measurements.

  13. TOTAL ANKLE REPLACEMENT: WHY, WHEN AND HOW?

    Science.gov (United States)

    Bonasia, Davide Edoardo; Dettoni, Federico; Femino, John E; Phisitkul, Phinit; Germano, Margherita; Amendola, Annunziato

    2010-01-01

    Total ankle replacement (TAR) was first attempted in the 1970s, but poor results led to its being considered inferior to ankle fusion until the late 1980s and early 1990s. By that time, newer designs which more closely replicated the natural anatomy of the ankle, showed improved clinical outcomes.1 Currently, even though controversy still exists about the effectiveness of TAR compared to ankle fusion, TAR has shown promising mid-term results and should no longer be considered an experimental procedure. Factors related to improved TAR outcomes include: 1) better patient selection, 2) more precise knowledge and replication of ankle biomechanics, 3) the introduction of less-constrained designs with reduced bone resection and no need for cementation, and 4) greater awareness of soft-tissue balance and component alignment. When TAR is performed, a thorough knowledge of ankle anatomy, pathologic anatomy and biomechanics is needed along with a careful pre-operative plan. These are fundamental in obtaining durable and predictable outcomes. The aim of this paper is to outline these aspects through a literature review. PMID:21045984

  14. Functional anatomy of the alar ligaments.

    Science.gov (United States)

    Dvorak, J; Panjabi, M M

    1987-03-01

    Nineteen upper cervical spine specimens were dissected to examine the macroscopic and functional anatomy of alar ligaments. They are on both sides, symmetrically placed, approximately 10-13 mm long and elliptical in cross-section 3 X 6 mm in diameter. The fiber orientation is dependent on the height of dens axis, mostly in the cranial caudal direction. In 12 specimens there was a ligamentous connection between dens and lateral mass of the atlas as a part of the alar ligament. In 2 specimens anterior atlanto-dental ligament was identified. The computerized tomographic (CT) images can clearly show alar ligaments in axial, coronal, and sagittal planes. The ligaments limit the axial rotation in the occipito-atlanto-axial complex (to the right by left alar and vice versa) as well as in side bending. The ligament is most stretched, and consequently most vulnerable, when the head is rotated and in addition flexed. This mechanism, common in whiplash injuries, could lead to irreversible overstretching or rupture of the ligaments especially as the ligaments consist of mainly collagen fibers.

  15. Tradução e validação do questionário FAOS - FOOT and ankle outcome score para língua portuguesa Translation, cultural adaptation and validation of FOOT and ankle outcome score (FAOS questionnaire into portuguese

    Directory of Open Access Journals (Sweden)

    Aline Mizusaki Imoto

    2009-01-01

    Full Text Available OBJETIVOS: (1 traduzir e validar a versão original da avaliação funcional de tornozelo e pé Foot and Ankle Outcome Score (FAOS da língua inglesa para a portuguesa em pacientes com história de entorse de tornozelo em inversão, (2 adaptar culturalmente à população brasileira e (3 correlacionar com o questionário de qualidade de vida SF-36. MÉTODO: O método de tradução e validação utilizado seguiu os critérios descritos por Guillemin et al. Foram incluídos 50 indivíduos com diagnóstico clínico de lesão ligamentar lateral do tornozelo por entorse. RESULTADOS: O questionário FAOS mostrou-se com reprodutibilidade de grau forte para todos os domínios intra e inter-examinador (pOBJECTIVE: (1 to translate and validate the original version of the Foot and Ankle Outcome Score (FAOS questionnaire from English into Portuguese in patients with diagnosis of lateral ligament injuries with ankle sprain history,(2 to provide cultural adaptation for Brazilian patients (3 to correlate it with the quality of life SF_36 questionnaire. METHOD: The method of translation and validation followed the criteria described by Guillemin et al. Fifty patients with ankle sprain were included. RESULTS AND CONCLUSION: FAOS questionnaire showed good reproducibility for patients with ankle sprain and good reliability for all intraand inter-interviewer sub-scales (p<0.05. The translation and cultural adaptation of FAOS questionnaire had its properties of assessment, reliability and validity measured, showing that this questionnaire is suitable for use in Brazilian patients with lateral ligament ankle injuries.

  16. Integrated Weber and Lauge-Hansen classification of ankle injuries%踝关节损伤Weber与Lauge-Hansen综合分型分度读片法

    Institute of Scientific and Technical Information of China (English)

    刘经武; 谭利华; 田雨; 刘翠丽; 屈长征; 高劲松

    2014-01-01

    目的:介绍Danis-Weber与Lauge-Hansen综合分型分度法对踝关节损伤平片诊断的应用。方法:应用Danis-Weber与Lauge-Hansen综合分型分度法对287例踝关节创伤的平片重新读片,总结综合分型分度法对踝关节骨折与韧带损伤的诊断价值。结果:287例踝关节损伤照片常规平片共报告骨折343处,韧带损伤176处,应用综合分型分度法读片新发现骨折19处,新发现韧带损伤36处。结论:应用Danis-Weber与Large-Hansen综合分型分度读片法有利于提高影像学医师对踝关节损伤平片诊断的病变发现率。%To intrduce the integrated Danis-Weber and Lauge-Hansen classification of ankle injuries Methods:287 digital ra-diographies with ankle injuries were reviewed and sorted again with integrated Weber and Lauge -Hansen classification.Results:343 fractures and 176 ligamental injuries were found on the conventional ankle digital radiographic reports, and other 19 fractures and 36 ligamental injuries were confirmed with integrated Weber and Lauge-Hansen classification.Conclusion:It would increase the findings of the fractures and ligamen-tal injuries of the ankle joint when the imaging doctors report the injuries with the integrated Weber and Lauge-Hansen classification.

  17. Clinical application of a modular ankle robot for stroke rehabilitation

    Science.gov (United States)

    Forrester, Larry W.; Roy, Anindo; Goodman, Ronald N.; Rietschel, Jeremy; Barton, Joseph E.; Krebs, Hermano Igo; Macko, Richard F.

    2015-01-01

    Background Advances in our understanding of neuroplasticity and motor learning post-stroke are now being leveraged with the use of robotics technology to enhance physical rehabilitation strategies. Major advances have been made with upper extremity robotics, which have been tested for efficacy in multi-site trials across the subacute and chronic phases of stroke. In contrast, use of lower extremity robotics to promote locomotor re-learning has been more recent and presents unique challenges by virtue of the complex multi-segmental mechanics of gait. Objectives Here we review a programmatic effort to develop and apply the concept of joint-specific modular robotics to the paretic ankle as a means to improve underlying impairments in distal motor control that may have a significant impact on gait biomechanics and balance. Methods An impedance controlled ankle robot module (anklebot) is described as a platform to test the idea that a modular approach can be used to modify training and measure the time profile of treatment response. Results Pilot studies using seated visuomotor anklebot training with chronic patients are reviewed, along with results from initial efforts to evaluate the anklebot's utility as a clinical tool for assessing intrinsic ankle stiffness. The review includes a brief discussion of future directions for using the seated anklebot training in the earliest phases of sub-acute therapy, and to incorporate neurophysiological measures of cerebro-cortical activity as a means to reveal underlying mechanistic processes of motor learning and brain plasticity associated with robotic training. Conclusions Finally we conclude with an initial control systems strategy for utilizing the anklebot as a gait training tool that includes integrating an Internal Model-based adaptive controller to both accommodate individual deficit severities and adapt to changes in patient performance. PMID:23949045

  18. Can textured insoles improve ankle proprioception and performance in dancers?

    Science.gov (United States)

    Steinberg, Nili; Waddington, Gordon; Adams, Roger; Karin, Janet; Begg, Rezaul; Tirosh, Oren

    2016-08-01

    With the aim of determining both the acute and the chronic effects of textured insoles on the ankle discrimination and performance ability of dancers, 60 ballet dancers from the Australian Ballet School, aged 14-19 years, were divided into three groups (two intervention groups and a control group), age- and level-matched. In the first 5 weeks (weeks 1 to 5), the first intervention group (GRP1) was asked to wear textured insoles in their ballet shoes and the second intervention group (GRP2) was not given textured insoles to wear. In the next 5 weeks (weeks 6 to 10), GRP2 was asked to wear the same type of textured insoles and GRP1 did not wear the textured insoles. The control group (CTRL) did not wear textured insoles during the whole 10 weeks. All participants were tested preintervention, after 5 weeks and after 10 weeks for ankle discrimination score (AUC scores). Dance performance was assessed by 5-7 dance teachers. Pre-to-post change in AUC scores was significantly greater for the groups wearing insoles than for the controls (P = .046) and the size of pre-to-post changes did not differ between the two intervention groups (P = .834). Significant correlation was found between ankle discrimination score and performance scores, using the textured insoles (r = .412; P = .024). In conclusion, the stimulation to the proprioceptive system arising from textured insoles worn for five weeks was sufficient to improve the proprioceptive ability and performance ability of ballet dancers.

  19. Clinical application of a modular ankle robot for stroke rehabilitation.

    Science.gov (United States)

    Forrester, Larry W; Roy, Anindo; Goodman, Ronald N; Rietschel, Jeremy; Barton, Joseph E; Krebs, Hermano Igo; Macko, Richard F

    2013-01-01

    Advances in our understanding of neuroplasticity and motor learning post-stroke are now being leveraged with the use of robotics technology to enhance physical rehabilitation strategies. Major advances have been made with upper extremity robotics, which have been tested for efficacy in multi-site trials across the subacute and chronic phases of stroke. In contrast, use of lower extremity robotics to promote locomotor re-learning has been more recent and presents unique challenges by virtue of the complex multi-segmental mechanics of gait. Here we review a programmatic effort to develop and apply the concept of joint-specific modular robotics to the paretic ankle as a means to improve underlying impairments in distal motor control that may have a significant impact on gait biomechanics and balance. An impedance controlled ankle robot module (anklebot) is described as a platform to test the idea that a modular approach can be used to modify training and measure the time profile of treatment response. Pilot studies using seated visuomotor anklebot training with chronic patients are reviewed, along with results from initial efforts to evaluate the anklebot's utility as a clinical tool for assessing intrinsic ankle stiffness. The review includes a brief discussion of future directions for using the seated anklebot training in the earliest phases of sub-acute therapy, and to incorporate neurophysiological measures of cerebro-cortical activity as a means to reveal underlying mechanistic processes of motor learning and brain plasticity associated with robotic training. Finally we conclude with an initial control systems strategy for utilizing the anklebot as a gait training tool that includes integrating an Internal Model-based adaptive controller to both accommodate individual deficit severities and adapt to changes in patient performance.

  20. Septic arthritis of the knee following anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Matjaz Sajovic

    2009-04-01

    Full Text Available Septic arthritis of the knee is a rare complication after arthroscopic anterior cruciate ligament reconstruction, and the most appropriate treatment is unclear. All case series reported so far have been retrospective, and case numbers of septic arthritis have ranged from 4 to 11. From a consecutive case series of 1,283 patients who underwent arthroscopic anterior cruciate ligament reconstruction between January 1997 and May 2008, we report on 3 patients (0.23% with post-operative septic arthritis. All patients had acute infection (≤ 2 weeks, bacterial cultures showed Staphylococcus species in 2 patients, while the bacterial culture was negative in the third. All of them underwent immediate arthroscopic debridement and lavage with continuous irrigation, as well as antibiotic treatment. The results were evaluated with physical and radiographic examination, functional testing, KT-2000, Lysholm and Tegner scales. The infection was successfully eradicated without further surgical treatment and the ligament graft was retained in all patients. Follow-up, at an average of 33 months, revealed that the patients had full symmetric knee range of motion and no effusion. The average Lysholm score was 91 points. In the patient with a lower subjective score, radiographs demonstrated patellofemoral joint-space narrowing, which is most probably in correlation with his anterior knee pain problems and lower activity level. The 134 N KT-2000 arthrometer side-to-side differences averaged 13 mm. Their performance in the single-legged hop test gave excellent results. The goals of treatment for septic arthritis after anterior cruciate ligament reconstruction are, primarily, to protect the articular cartilage and, secondly, to protect the graft. Through early diagnosis and prompt treatment, the infection can be successfully eradicated, with stability of the knee and full range of motion achieved.

  1. A modified surgical technique for reconstruction of an acute acromioclavicular joint dislocation

    Science.gov (United States)

    Marchie, Anthony; Kumar, Arun; Catre, Melanio

    2009-01-01

    We report a modified surgical technique for reconstruction of coracoclavicular and acromioclavicular ligaments after acute dislocation of acromioclavicular joint using suture anchors. We have repaired 3 consecutive type III acromioclavicular dislocations with good results. This technique is simple and safe and allows anatomical reconstruction of the ligaments in acute dislocations. PMID:20671868

  2. Three-dimensional volume rendering of the ankle based on magnetic resonance images enables the generation of images comparable to real anatomy

    Science.gov (United States)

    Anastasi, Giuseppe; Cutroneo, Giuseppina; Bruschetta, Daniele; Trimarchi, Fabio; Ielitro, Giuseppe; Cammaroto, Simona; Duca, Antonio; Bramanti, Placido; Favaloro, Angelo; Vaccarino, Gianluigi; Milardi, Demetrio

    2009-01-01

    We have applied high-quality medical imaging techniques to study the structure of the human ankle. Direct volume rendering, using specific algorithms, transforms conventional two-dimensional (2D) magnetic resonance image (MRI) series into 3D volume datasets. This tool allows high-definition visualization of single or multiple structures for diagnostic, research, and teaching purposes. No other image reformatting technique so accurately highlights each anatomic relationship and preserves soft tissue definition. Here, we used this method to study the structure of the human ankle to analyze tendon–bone–muscle relationships. We compared ankle MRI and computerized tomography (CT) images from 17 healthy volunteers, aged 18–30 years (mean 23 years). An additional subject had a partial rupture of the Achilles tendon. The MRI images demonstrated superiority in overall quality of detail compared to the CT images. The MRI series accurately rendered soft tissue and bone in simultaneous image acquisition, whereas CT required several window-reformatting algorithms, with loss of image data quality. We obtained high-quality digital images of the human ankle that were sufficiently accurate for surgical and clinical intervention planning, as well as for teaching human anatomy. Our approach demonstrates that complex anatomical structures such as the ankle, which is rich in articular facets and ligaments, can be easily studied non-invasively using MRI data. PMID:19678857

  3. [Revision arthroplasty of the ankle joint].

    Science.gov (United States)

    Hintermann, B; Barg, A; Knupp, M

    2011-11-01

    In the last 20 years total ankle replacement has become a viable alternative to arthrodesis for end-stage osteoarthritis of the ankle. Numerous ankle prosthesis designs have appeared on the market in the past and attracted by the encouraging intermediate results reported in the literature, many surgeons have started to perform this procedure. With increased availability on the market the indications for total ankle replacement have also increased in recent years. In particular, total ankle replacement may now be considered even in younger patients. Therefore, despite progress in total ankle arthroplasty the number of failures may increase. Up to now, arthrodesis was considered to be the gold standard for salvage of failed ankle prostheses. Because of extensive bone loss on the talar side, in most instances tibiocalcaneal fusion is the only reliable solution. An alternative to such extended hindfoot fusions would be revision arthroplasty. To date, however, there are no reported results of revision arthroplasty for salvage of a failed ankle replacement.Based on our experience prosthetic components with a flat undersurface are most likely to be able to find solid support on remaining bone stock. The first 83 cases (79 patients, 46 males, 33 females, average age 58.9 years, range 30.6-80.7 years) with a average follow-up of 5.4 years (range 2-11 years) showed excellent to good results in 69 cases (83%), a satisfactory result in 12 cases (15%) and a fair result in 2 cases (2%) and 47 patients (56%) were pain free. Primary loosening was noted in three cases and of these two cases were successfully revised by another total ankle replacement and in one case with arthrodesis. Another case with hematogenous infection was also revised by arthrodesis. At the last follow-up control two components were considered to be loose and the overall loosening rate was thus 6%.This series has proven that revision arthroplasty can be a promising option for patients with failed total

  4. Do Ankle Orthoses Improve Ankle Proprioceptive Thresholds or Unipedal Balance in Older Persons with Peripheral Neuropathy?

    Science.gov (United States)

    Son, Jaebum; Ashton-Miller, James A.; Richardson, James K.

    2010-01-01

    Objective To determine whether ankle orthoses that provide medial and lateral support, and have been found to decrease gait variability in older persons with peripheral neuropathy, decrease (improve) frontal plane ankle proprioceptive thresholds or increase unipedal stance time in that same population. Design Observational study in which unipedal stance time was determined with a stopwatch, and frontal plane ankle (inversion and eversion) proprioceptive thresholds were quantified during bipedal stance with and without the ankle orthoses, in 11 older diabetic subjects with peripheral neuropathy (8 men; age 72 ± 7.1 years) using a foot cradle system which presented a series of 100 rotational stimuli. Results The subjects demonstrated no change in combined frontal plane (inversion + eversion) proprioceptive thresholds or unipedal stance time with versus without the orthoses (1.06 ± 0.56 versus 1.13 ± 0.39 degrees, respectively; p = 0.955 and 6.1 ± 6.5 versus 6.2 ± 5.4 seconds, respectively; p = 0.922). Conclusion Ankle orthoses which provide medial-lateral support do not appear to change ankle inversion/eversion proprioceptive thresholds or unipedal stance time in older persons with diabetic peripheral neuropathy. Previously identified improvements in gait variability using orthoses in this population are therefore likely related to an orthotically-induced stiffening of the ankle rather than a change in ankle afferent function. PMID:20407302

  5. Measurement of blood pressure, ankle blood pressure and calculation of ankle brachial index in general practice

    DEFF Research Database (Denmark)

    Nexøe, Jørgen; Damsbo, Bent; Lund, Jens Otto

    2012-01-01

    BACKGROUND: Low ankle brachial index (ABI) is a sensitive measure of 'burden' of atherosclerosis, indicating cardiovascular risk of the asymptomatic patient. Conventionally, ABI values......BACKGROUND: Low ankle brachial index (ABI) is a sensitive measure of 'burden' of atherosclerosis, indicating cardiovascular risk of the asymptomatic patient. Conventionally, ABI values...

  6. The results of ankle arthrodesis with screws for end stage ankle arthrosis.

    Science.gov (United States)

    Torudom, Yingyong

    2010-02-01

    Aim of this study was to evaluate the results of ankle arthrodesis with screws in patients with ankle arthrosis. The author studied 19 patients (20 feet) who had been treated by ankle arthrodesis with screws from 2003 to 2008. Ten patients were men (11 feet) and nine (9 feet) were women. Their mean age was 56 years (30 to 65), and the average duration of follow-up was four years (2 to 6). Two compression screws were used in all feet. Union was achieved in 19 of the 20 feet (95%). Average scores for pain and clinical condition are increase after operation. One re-operation was performed for nonunion. Author conclude that ankle arthrodesis with screws was effective treatment for ankle arthrosis.

  7. Arthroscopic Management of Complications Following Total Ankle Replacement.

    Science.gov (United States)

    Lui, Tun Hing; Roukis, Thomas S

    2015-10-01

    There is great potential of managing the complications of total ankle replacement arthroscopically and endoscopically, and these procedures can be summarized into 3 groups. Group 1 includes procedures of the ankle joint proper with close proximity to the articular components of the total ankle replacement. Group 2 includes procedures of the tibia and talus with close proximity to the nonarticular parts of the total ankle replacement. Group 3 includes procedures that are away from the total ankle replacement. However, these remain master arthroscopist procedures and should be performed by foot and ankle surgeons who perform them with regularity.

  8. [Ankle joint arthritis--etiology, diagnosis and treatment].

    Science.gov (United States)

    Uri, Ofir; Haim, Amir

    2008-11-01

    Ankle joint arthritis causes functional limitation and affects the quality of life many patients. It follows traumatic injuries, inflammatory joint arthritis, primary osteoarthritis, hemochromatosis and infections. Understanding the unique anatomy and biomechanics of the ankle is important for diagnosis and treatment of ankle joint pathology. The treatment of ankle joint arthritis has advanced considerably in recent years and it is still a surgical challenge. Total ankle replacement seems to be a promising form of treatment, even though current data does not demonstrate advantages over ankle joint arthrodesis.

  9. Prospective study of ankle and foot fractures in elderly women

    Directory of Open Access Journals (Sweden)

    Yadagiri Surender Rao

    2015-01-01

    Full Text Available The epidemiology of ankle fractures in old people is changing as time passes on. The incidence of ankle fractures increases with advancing age. The study conducted was among a rural popula-tion which comprised of 68 women (32 women with ankle fractures & 36 women with foot fractures. Patients studied were in the age group more than 50 years. The study highlights the etiological & risk factors for fractures of ankle & foot. The commonest ankle fracture was the lateral malleolar fracture & the commonest foot fracture was the 5th Metatarsal fracture. Diabetes is a risk factor which increases the occurrence of ankle and foot injuries.

  10. MR imaging of alar and transverse atlantal ligament injuries

    Energy Technology Data Exchange (ETDEWEB)

    Echigoya, Naoki; Harata, Seiko; Ueyama, Kazumasa (Hirosaki Univ., Aomori (Japan). School of Medicine); Nakano, Keisuke

    1992-06-01

    Autopsy findings of ligaments of the upper cervical spine were compared with magnetic resonance imaging (MRI) findings. Ligaments were clearly shown as hypointensity on T1-weighted images and proton density images. Transverse images were useful in diagnosing alar and transverse atlantal ligament injuries. When there is a bilateral difference in the alar ligaments, ruptured ligament is suspected. Transverse ligament rupture was shown on interrupted hypointensity and as hyperintensity. MRI was capable of diagnosing alar ligament rupture in 8 of 11 patients, and transverse ligament rupture in all 3 patients. In 2 patients having Jefferson's fracture and injuried atlanoaxial subluxation encountered in the clinical practice, transverse ligament rupture was similarly observed as that in autopsy cases on MR images. Hyperintensity in the transverse ligament rupture area was seen even one year after injury. Injured transverse ligament was seen as swollen hyperintensity on sagittal images; and the hyperintensity was gradually decreased with the process of healing. (N.K.).

  11. Inter-Segmental Coordination Pattern in Patients with Anterior Cruciate Ligament Deficiency during a Single-Step Descent.

    Science.gov (United States)

    Nematollahi, Mohammadreza; Razeghi, Mohsen; Mehdizadeh, Sina; Tabatabaee, Hamidreza; Piroozi, Soraya; Rojhani Shirazi, Zahra; Rafiee, Ali

    2016-01-01

    Anterior cruciate ligament injury is a debilitating pathology which may alter lower limb coordination pattern in both intact and affected lower extremities during activities of daily living. Emerging evidence supports the notion that kinematic variables may not be a good indicator to differentiate patients with anterior cruciate ligament deficiency during step descent task. The aim of the present study was to examine alterations in kinematics as well as coordination patterns and coordination variability of both limbs of these patients during a single step descent task. Continuous relative phase technique was used to measure coordination pattern and coordination variability between a group of anterior cruciate ligament deficient (n = 23) and a healthy control group (n = 23). A third order polynomial Curve fitting was utilized to provide a curve that best fitted to the data points of coordination pattern and coordination variability of the healthy control group. This was considered as a reference to compare to that of patient group using nonlinear regression analysis. The results of the present study demonstrated an altered coordination pattern of the supporting shank-thigh and the stepping foot-shank couplings in anterior cruciate ligament deficient subjects. It was further noticed that there was an increased coordination variability in foot-shank and shank-thigh couplings of both supporting and stepping legs. There was no significant difference in the hip, knee and ankle joints kinematics in either side of these patients. Anterior cruciate ligament deficient individuals showed altered strategies in both intact and affected legs, with increased coordination variability. Kinematic data did not indicate any significant difference between the two groups. It could be concluded that more sophisticated dynamic approach such as continuous relative phase would uncover discrepancies between the healthy and anterior cruciate ligament deficient individuals.

  12. Variations in meniscofemoral ligaments at anatomical study and MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Cho, J.M.; Suh, J.S. [Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Na, J.B. [Department of Diagnostic Radiology, Kyungsang National University, College of Medicine, Jinju (Korea, Republic of); Cho, J.H. [Department of Diagnostic Radiology, Ajou University College of Medicine, Suwon (Korea, Republic of); Kim, Y.; Yoo, W.K. [Department of Rehabilitation, Yonsei University College of Medicine, Seoul (Korea, Republic of); Lee, H.Y.; Chung, I.H. [Department of Anatomy, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1999-04-01

    Purpose To demonstrate variations in the meniscofemoral ligaments (ligaments of Wrisberg and Humphrey) at anatomical study and magnetic resonance (MR) imaging. Design Twenty-eight cadaveric knees were partially dissected for the examination of the meniscofemoral ligaments. One hundred knee MR examinations were reviewed by two experienced musculoskeletal radiologists. Proximal variations in the meniscofemoral ligaments at MR imaging were classified into three types according to the attachment site: type I, medial femoral condyle; type II, proximal half of the posterior cruciate ligament (PCL); type III, distal half of the PCL. Distal variations were classified into vertical or oblique types according to the orientation of the intermediate signal at the interface of the ligament and lateral meniscus. Results At anatomical study, six cases showed variations in the proximal insertion site of the meniscofemoral ligaments. At MR imaging 93 cases had one or more meniscofemoral ligaments, giving a total of 107 ligaments: 90 ligaments of Wrisberg and 17 ligaments of Humphrey. Forty-one ligaments of Wrisberg were type I, 28 type II, 19 type III, and with two indeterminate type, while 6 ligaments of Humphrey were type I and the remaining 11 were indeterminate. Seven cases showed no meniscofemoral ligament. Of the 107 meniscofemoral ligaments, the distal insertion orientation was of vertical type in 10 ligaments, oblique type in 70 and unidentified in 27. Conclusion An understanding of the high incidence of meniscofemoral ligament variations may help in the interpretation of knee MR studies. (orig.) With 7 figs., 1 tab., 16 refs.

  13. Postoperative rehabilitation of the posterior cruciate ligament.

    Science.gov (United States)

    Edson, Craig J; Fanelli, Gregory C; Beck, John D

    2010-12-01

    Diagnosis and management of posterior cruciate ligament injuries has evolved, and now the treatment often includes surgical intervention. The purpose of this paper is to define the current approach to postsurgical management after the posterior cruciate ligament reconstruction, review conservative management, and discuss surgical outcomes using a specified program.

  14. Instructive materials for tendon and ligament augmentation

    NARCIS (Netherlands)

    Ribeiro Pereira Simões Crispim, João Francisco

    2016-01-01

    Tendons and ligaments (T/L) are the connective tissue that connect muscles to bone and bone to bone, respectively. The main function of tendons is to translate muscle contractions into join motion and consequently generate movement. Ligaments function to stabilize joints and guide them during their

  15. The sacroiliac part of the iliolumbar ligament

    NARCIS (Netherlands)

    A.L. Pool-Goudzwaard (Annelies); G.J. Kleinrensink (Gert Jan); C.J. Snijders (Chris); C.A. Entius; R. Stoeckart (Rob)

    2001-01-01

    textabstractThe iliolumbar ligament has been described as the most important ligament for restraining movement at the lumbosacral junction. In addition, it may play an important role in restraining movement in the sacroiliac joints. To help understand its presumed restraining effec

  16. Cartilage lesions and ankle osteoarthrosis: review of the literature and treatment algorithm,

    Directory of Open Access Journals (Sweden)

    Alexandre Leme Godoy Santos

    2014-12-01

    Full Text Available The main etiology of ankle osteoarthrosis is post-traumatic and its prevalence is highest amongyoung individuals. Thus, this disease has a great socioeconomic impact and gives rise to significant losses of patients' quality of life. The objective of its treatment is to eliminate pain and keep patients active. Therefore, the treatment should be staged according to the degree of degenerative evolution, etiology, joint location, systemic condition, bone quality, lower-limb alignment, ligament stability and age. The treatment algorithm is divided into non-surgical therapeutic methods and options for surgical treatment. Joint preservation, joint replacement and arthrodesis surgical procedures have precise indications. This article presents a review on this topic and a proposal for a treatment algorithm for this disease.

  17. Pseudo-aneurysm of the anterior tibial artery, a rare cause of ankle swelling following a sports injury

    Directory of Open Access Journals (Sweden)

    McAteer Eamon

    2005-10-01

    Full Text Available Abstract Background Ankle pain and swelling following sports injuries are common presenting complaints to the accident and emergency department. Frequently these are diagnosed as musculoskeletal injuries, even when no definitive cause is found. Vascular injuries following trauma are uncommon and are an extremely rare cause of ankle swelling and pain. These injuries may however be limb threatening and are important to diagnose early, in order that appropriate treatment can be delivered. We highlight the steps to diagnosis of these injuries, and methods of managing these injuries. It is important for clinicians to be aware of the potential for this injury in patients with seemingly innocuous trauma from sports injuries, who have significant ankle pain and swelling. Case presentation A young, professional sportsman presented with a swollen, painful ankle after an innocuous hyper-plantar flexion injury whilst playing football, which was initially diagnosed as a ligamentous injury after no bony injury was revealed on X-Ray. He returned 2 days later with a large ulcer at the lateral malleolus and further investigation by duplex ultrasound and transfemoral arteriogram revealed a Pseudo-Aneurysm of the Anterior Tibial Artery. This was initially managed with percutaneous injection of thrombin, and later open surgery to ligate the feeding vessel. The patient recovered fully and was able to return to recreational sport. Conclusion Vascular injuries remain a rare cause of ankle pain and swelling following sports injuries, however it is important to consider these injuries when no definite musculo-skeletal cause is found. Ultrasound duplex and Transfemoral arteriogram are appropriate, sensitive modalities for investigation, and may allow novel treatment to be directed percutaneously. Early diagnosis and intervention are essential for the successful outcome in these patients.

  18. Simultaneous bicompartmental bucket-handle meniscal tears with intact anterior cruciate ligament: a case report

    Directory of Open Access Journals (Sweden)

    Beris Alexandros E

    2010-02-01

    Full Text Available Abstract Introduction Bucket handle tear of the menisci is a common type of lesion resulting from injury to the knee joint. Bucket handle injury of both menisci in almost all cases is associated with a lesion to either the anterior or the posterior cruciate ligament of the knee joint. We describe a case of acute bucket-handle tear of the medial and lateral menisci with intact anterior and posterior cruciate ligaments in a dancer. To the best of our knowledge, there are no previous reports of this type of injury in the literature. Case presentation A 28-year-old Caucasian Greek woman presented to the emergency department after sustaining an injury to her right knee during dancing. An MRI evaluation demonstrated tears in both menisci of the right knee, while the anterior and posterior cruciate ligaments were found to be intact. A partial medial and lateral meniscectomy was then performed. At a follow-up examination six months after her injury, clinical tests demonstrated that our patient's right knee was stable, had a full range of motion and had no tenderness. She was satisfied with the outcome of the operation and returned to her pre-injury activities. Conclusion We present the first case in the literature that describes a combined bucket-handle injury of both the medial and lateral menisci with an intact anterior cruciate ligament. The clinical examination of the anterior cruciate ligament was unremarkable, with no signs of deficiency or rupture. The posterior cruciate ligament was also intact. On magnetic resonance imaging, the ligaments were visualised as intact in all their length. These findings were confirmed by arthroscopic evaluation.

  19. Complications after ankle and hindfoot arthroscopy.

    Science.gov (United States)

    Blázquez Martín, T; Iglesias Durán, E; San Miguel Campos, M

    To evaluate the percentage of complications associated with ankle and hindfoot arthroscopy in our hospital and to compare the results with those reported in the literature. A retrospective descriptive review was conducted on the complications associated with ankle and hindfoot arthroscopy performed between May 2008 and April 2013. A total of 257 arthroscopy were performed, 23% on subtalar joint, and 77% of ankle joint. An anterior approach was used in 69%, with 26% by a posterior approach, and the remaining 5% by combined access. A total of 31 complications (12.06%) were found. The most common complication was neurological damage (14 cases), with the most affected nerve being the superficial peroneal nerve (8 cases). Persistent drainage through the portals was found in 10 cases, with 4 cases of infection, and 3 cases of complex regional pain syndrome type 1. There have been substantial advances in arthroscopy of ankle and hindfoot in recent years, expanding its indications, and also the potential risk of complications. The complication rate (12.06%) found in this study is consistent with that described in the literature (0-17%), with neurological injury being the most common complication. Ankle and hindfoot arthroscopy is a safe procedure. It is important to make a careful preoperative planning, to use a meticulous technique, and to perform an appropriate post-operative care, in order to decrease the complication rates. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Current concepts review: the posterior cruciate ligament.

    Science.gov (United States)

    Fanelli, Gregory C; Beck, John D; Edson, Craig J

    2010-06-01

    Injuries to the posterior cruciate ligament (PCL) and methods of treatment of the injured PCL have historically been surrounded by controversy in the orthopedic community. The infrequent occurrence of PCL injuries and PCL-based, multiple ligament knee injuries has led to limitations in clinical studies and a subsequent lag in basic science and clinical research compared with that for other ligamentous injuries. In recent years, new studies have elucidated the biomechanical function and complex anatomy of the PCL leading to an increased interest in research, understanding, and treatment of these complex injuries. In addition to improved understanding of knee ligament structure and biomechanics, technical advancements in allograft tissue, surgical instrumentation, and graft tensioning and fixation methods and improved surgical techniques and postoperative rehabilitation methods have enhanced the results in PCL reconstruction and PCL-based, multiple ligament knee surgical outcomes.

  1. Vascular Complications in Arthroscopic Repair Of Posterior Cruciate Ligament

    Science.gov (United States)

    Agotegaray, Juan Ignacio; Comba, Ignacio; Bisiach, Luciana; Grignaffini, María Emilia

    2017-01-01

    evolution of the wounds, patient is discharged from hospital with Sulfamethoxazole/trimethoprim 160mg/800mg to be taken orally for 14 days. Results: After treatment with oral antibiotic is completed, wounds progress positively. Foot in equinus position, has positive distal pulses with distal sensibility. Use of a thermoforming brace is indicated for movement. Vascular Surgery Services are currently following patient’s evolution. An ankle arthrodesis surgery is evaluated for the future. Conclusion: Combined injuries that result in a posterior tibial translation over 15 mm and, those that come along with injuries in the anterior cruciate ligament or posterior lateral structures of the knee, should be repaired through surgery. Vascular lesion caused by laceration, thrombosis or injury of the intima of the popliteal artery, mainly during perforation and preparation of tibial tunnel, is a serious lesion. Although these vascular lesions during arthroscopy are complications relatively rare, a potential risk should be considered, with consequences that could be fatal for the extremity and for patient’s life when bleeding is involved. In those cases, urgent treatment is imperative, that is the reason we believe it is safe to coordinate with Vascular Surgery Services before the surgery is carried out.

  2. Single leg balance test to identify risk of ankle sprains

    National Research Council Canada - National Science Library

    Trojian, T H; McKeag, D B

    2006-01-01

    .... The association between a positive SLB test and future ankle sprains was significant. Controlling for confounding variables, the relative risk for an ankle sprain with a positive SLB test was 2.54 (95...

  3. Dynamic knee joint mechanics after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Clarke, Sarah B; Kenny, Ian C; Harrison, Andrew J

    2015-01-01

    There is scarcity of information on the long-term adaptations in lower limb biomechanics during game-specific movements after anterior cruciate ligament (ACL) reconstruction. Particularly, variables such as knee abduction moments and transverse plane knee motion have not been studied during a game-specific landing and cutting task after ACL reconstruction. The purpose of this study was to compare the hip and knee mechanics between the ACL-reconstructed (ACLr) group and a healthy control group. Thirty-eight reconstructed athletes (18 ACLr, 18 control) participated in the study. Three-dimensional hip, knee, and ankle angles were calculated during a maximal drop jump land from a 0.30-m box and unanticipated cutting task at 45°. During the landing phase, ACLr participants had increased hip flexion (P knee range of motion (P = 0.027). During the cutting phase, the ACLr participant's previously injured limb had increased internal knee abduction moment compared with that of the control group (P = 0.032). No significant differences were reported between the previously injured and contralateral uninjured limb. Previously injured participants demonstrated higher knee abduction moment and transverse plane range of motion when compared with those of control participants during a game-specific landing and cutting task.

  4. Cutaneous mechanisms of isometric ankle force control

    DEFF Research Database (Denmark)

    Choi, Julia T; Jensen, Jesper Lundbye; Leukel, Christian

    2013-01-01

    output. We used repetitive electrical stimulation of the superficial peroneal (foot dorsum) and medial plantar nerves (foot sole) to disrupt cutaneous afferent input in 8 healthy subjects. We measured the effects of repetitive nerve stimulation on (1) tactile thresholds, (2) performance in an ankle force......-matching and (3) an ankle position-matching task. Additional force-matching experiments were done to compare the effects of transient versus continuous stimulation in 6 subjects and to determine the effects of foot anesthesia using lidocaine in another 6 subjects. The results showed that stimulation decreased...... of transient stimulation on force error were greater when compared to continuous stimulation and lidocaine injection. Position-matching performance was unaffected by peroneal nerve or plantar nerve stimulation. Our results show that cutaneous feedback plays a role in the control of force output at the ankle...

  5. Primary meningococcal septic arthritis of the ankle joint: a case report.

    Science.gov (United States)

    Gee, Christopher; Tandon, Tarang; Avasthi, Adish; Jerwood, Susie; Rao, Biyyam M; Cavanagh, Simon

    2014-01-01

    We present the case of a healthy 18-year-old female who presented with history of an acute onset, painful, swollen right ankle joint. Microbiologic samples from the ankle aspirate grew Neisseria meningitidis. She had had no previous contact with a patient with meningitis nor any existing or preceding clinical symptoms of meningitis. She was treated with surgical drainage with mini-open arthrotomy and a repeat washout at 48 hours. The identification of the organism was expedited using the Analytical Profiling Index (bioMérieux UK, Basingstoke, UK). Our patient was treated with 2 weeks of third-generation cephalosporin antibiotics. At the final follow-up visit, the inflammatory markers had returned to normal, with a normal ankle joint and no evidence of long-term sequelae of septic arthritis. Primary septic arthritis with N. meningitidis is exceptionally rare in the adult population and has been most often reported in the knee. To the best of our knowledge, this is the first reported case of primary septic arthritis of the native adult ankle joint in a healthy individual due to N. meningitides that was diagnosed and treated appropriately with no residual sequelae of the disease.

  6. Supination external rotation ankle fractures A simpler pattern with better outcomes

    Directory of Open Access Journals (Sweden)

    Nirmal C Tejwani

    2015-01-01

    Full Text Available Background: Rotational injuries are the most common and usually classified as per the Lauge Hansen classification; with the most common subgroup being the supination external rotation (SER mechanism. Isolated fractures of the distal fibula (SE2 without associated ligamentous injury are usually treated with a splint or brace and the patient may be allowed to weight bear as tolerated. This study reports the functional outcomes following a stable, low energy, rotational ankle fracture supination external rotation (SER2 when compared to unstable SER4 fractures treated operatively. Materials and Methods: 64 patients who were diagnosed and treated nonoperatively for a stable SER2 ankle fracture were followed prospectively. In the comparison group, 93 operatively treated fibular fractures were extracted from a prospectively collected database and evaluated comparison. Baseline characteristics obtained by trained interviewers at the time of injury included: Patient demographics, short form-36, short musculoskeletal functional assessment (SMFA and American Orthopedic Foot and Ankle Society (AOFAS questionnaires. Patients were followed at 3, 6 and 12 months postsurgery. Additional information obtained at each followup point included any complications or evidence on fracture healing. Data were analyzed by the Student′s t-test and theFisher′s Exact Test to compare demographic and functional outcomes between the two cohorts. P < 0.05 was considered to be significant. Results: The average of patients′ age in the stable fracture cohort was 43 versus 45 in the SER4 group. Nearly 64% of the patient population was female when compared with 37% in the operative group. In the SER2 by 6 months all patients had returned to baseline functional status. There were 18 delayed unions (all healed by 6 months. Based on the functional outcome scores all patients had returned to preoperative level. In comparison, SE4 patients had less functional recovery at 3 and 6

  7. Foot and Ankle Injuries in American Football.

    Science.gov (United States)

    Hsu, Andrew R; Anderson, Robert B

    Physicians need to be aware of a variety of foot and ankle injuries that commonly occur in American football, including turf toe, Jones fractures, Lisfranc injuries, syndesmotic and deltoid disruption, and Achilles ruptures. These injuries are often complex and require early individual tailoring of treatment and rehabilitation protocols. Successful management and return to play requires early diagnosis, a thorough work-up, and prompt surgical intervention when warranted with meticulous attention to restoration of normal foot and ankle anatomy. Physicians should have a high suspicion for subtle injuries and variants that can occur via both contact and noncontact mechanisms.

  8. Characterization of ankle function during stair ambulation

    OpenAIRE

    Gates, Deanna H.; Lelas, Jennifer L.; Della Croce, Ugo; Herr, Hugh; Bonato, Paolo

    2004-01-01

    The aim of this study was to examine the ankle joint during level walking, stair ascent, and stair descent to determine models for use in the design of prosthetic and orthotic systems. Ten healthy subjects were asked to walk (1) across a level walkway, (2) up, and (3) down an instrumented stairway. Sagittal plane kinematic and kinetic data were analyzed to obtain ankle biomechanics during the stance phase of each task. Each stance phase was broken down into sub-phases based on the power traje...

  9. Ankle fusion using a 2-incision, 3-screw technique

    NARCIS (Netherlands)

    R.P.M. Hendrickx; G.M.M.J. Kerkhoffs; S.A.S. Stufkens; C.N. van Dijk; R.K. Marti

    2011-01-01

    Reliable fusion and optimal correction of the alignment of the ankle joint using a 2-incision, 3-screw technique. Symptomatic osteoarthritis of the ankle joint after insufficient other treatment, severe deformity of the osteoarthritic ankle joint, or salvation procedure after failed arthroplasty. Ac

  10. Transverse ligament of the knee in humans.

    Science.gov (United States)

    Ratajczak, Wojciech; Jakubowicz, Marian; Pytel, Andrzej

    2003-01-01

    The purpose of this study was to trace the histological structure of the transverse ligament of the knee and its relation to the inferior lateral genicular artery. Investigations were carried out on 20 lower limbs (10 males, and 10 females) from the Department of Anatomy. It was found that close to the attachment of the transverse ligament to the menisci, bundles of fibres pass in vertical, oblique and horizontal directions, occupying a wide area on the anterior margin of the menisci. These fibres intermingle with bundles of the fibrocartilage of the menisci. In the area of the lateral attachment the inferior lateral genicular artery passes anteriorly to the transverse ligament, giving off numerous branches to the ligament. The medial part of the transverse ligament presents a thick rounded structure, surrounded by loose connective tissue. The fibres are arranged irregularly in bundles running horizontally on a tortuous course and with single spindle-like cells with darkly stained nuclei. The cells are not found at the ends of the ligament. Numerous blood vessels are observed between the bundles of fibres and on the periphery of the ligament.

  11. Functional tissue engineering of ligament healing

    Directory of Open Access Journals (Sweden)

    Hsu Shan-Ling

    2010-05-01

    Full Text Available Abstract Ligaments and tendons are dense connective tissues that are important in transmitting forces and facilitate joint articulation in the musculoskeletal system. Their injury frequency is high especially for those that are functional important, like the anterior cruciate ligament (ACL and medial collateral ligament (MCL of the knee as well as the glenohumeral ligaments and the rotator cuff tendons of the shoulder. Because the healing responses are different in these ligaments and tendons after injury, the consequences and treatments are tissue- and site-specific. In this review, we will elaborate on the injuries of the knee ligaments as well as using functional tissue engineering (FTE approaches to improve their healing. Specifically, the ACL of knee has limited capability to heal, and results of non-surgical management of its midsubstance rupture have been poor. Consequently, surgical reconstruction of the ACL is regularly performed to gain knee stability. However, the long-term results are not satisfactory besides the numerous complications accompanied with the surgeries. With the rapid development of FTE, there is a renewed interest in revisiting ACL healing. Approaches such as using growth factors, stem cells and scaffolds have been widely investigated. In this article, the biology of normal and healing ligaments is first reviewed, followed by a discussion on the issues related to the treatment of ACL injuries. Afterwards, current promising FTE methods are presented for the treatment of ligament injuries, including the use of growth factors, gene delivery, and cell therapy with a particular emphasis on the use of ECM bioscaffolds. The challenging areas are listed in the future direction that suggests where collection of energy could be placed in order to restore the injured ligaments and tendons structurally and functionally.

  12. Balance in single-limb stance after surgically treated ankle fractures: a 14-month follow-up

    Directory of Open Access Journals (Sweden)

    Ageberg Eva

    2006-04-01

    Full Text Available Abstract Background The maintenance of postural control is fundamental for different types of physical activity. This can be measured by having subjects stand on one leg on a force plate. Many studies assessing standing balance have previously been carried out in patients with ankle ligament injuries but not in patients with ankle fractures. The aim of this study was to evaluate whether patients operated on because of an ankle fracture had impaired postural control compared to an uninjured age- and gender-matched control group. Methods Fifty-four individuals (patients operated on because of an ankle fracture were examined 14 months postoperatively. Muscle strength, ankle mobility, and single-limb stance on a force-platform were measured. Average speed of centre of pressure movements and number of movements exceeding 10 mm from the mean value of centre of pressure were registered in the frontal and sagittal planes on a force-platform. Fifty-four age- and gender-matched uninjured individuals (controls were examined in the single-limb stance test only. The paired Student t-test was used for comparisons between patients' injured and uninjured legs and between side-matched legs within the controls. The independent Student t-test was used for comparisons between patients and controls. The Chi-square test, and when applicable, Fisher's exact test were used for comparisons between groups. Multiple logistic regression was performed to identify factors associated with belonging to the group unable to complete the single-limb stance test on the force-platform. Results Fourteen of the 54 patients (26% did not manage to complete the single-limb stance test on the force-platform, whereas all controls managed this (p Conclusion One in four patients operated on because of an ankle fracture had impaired postural control compared to an age- and gender-matched control group. Age over 45 years and decreased strength in the ankle plantar flexors and dorsiflexors

  13. Rehabilitation after treatment of acute anterior cruciate and medial collateral ligament injuries of knee%急性前交叉韧带损伤合并内侧副韧带损伤治疗后的康复训练

    Institute of Scientific and Technical Information of China (English)

    柳东旭; 姚建华; 孙天胜; 孙维

    2013-01-01

    Objective To compare the effects of accelerated rehabilitation and conservative rehabilitation after treatment of acute anterior cruciate and medial collateral ligament injuries of knee.Methods 32 patients with acute anterior cruciate and medial collateral ligament injuries of knee in Beijing Army General Hospital from November 2006 to October 2010 were treated under arthroscope for anterior cruciate ligament reconstruction and medial collateral ligament conservative treatment.These patients were done rehabilitation after operation,and randomly divided into accelerated rehabilitation training group (n =16) and conservative rehabilitation training group (n =16).One year after operation,the knee muscle strength,stability,scope of activites and Lysholm function score were detected,and the therapeutic effect was assessed.Results Comparing with conservative rehabilitation training group and accelerated rehabilitation training group,more joint swelling and effusion were found early after operation.15 cases of the accelerated rehabilitation training group and 8 cases of conservative rehabilitation training group needed to puncture and aspirate effusion.The average volume of effusion was detected (49.87±18.96) mL in the accelerated rehabilitation training group and (18.13±5.72) mL in the conservative rehabilitation training group,and there were significant differences in the average volume of effusion between the two groups (P < 0.05).One year after operation,the average difference value of leg circumference was detected (1.41±0.61) cm in the accelerated rehabilitation training group and (3.28±0.79) cm in the conservative rehabilitation training group,and there were significant differences in muscle strength between the two groups (P < 0.05).There was negative in the physical examination of stability in the two groups.There were no significant differences in the knee scope of activites and Lysholm function score between the two groups (P > 0.05).The training time

  14. Reliability and Validity Study of the Chamorro Assisted Gait Scale for People with Sprained Ankles, Walking with Forearm Crutches.

    Directory of Open Access Journals (Sweden)

    Gema Chamorro-Moriana

    Full Text Available The aim of this study was to design and validate a functional assessment scale for assisted gait with forearm crutches (Chamorro Assisted Gait Scale-CHAGS and to assess its reliability in people with sprained ankles.Thirty subjects who suffered from sprained ankle (anterior talofibular ligament first and second degree were included in the study. A modified Delphi technique was used to obtain the content validity. The selected items were: pelvic and scapular girdle dissociation(1, deviation of Center of Gravity(2, crutch inclination(3, steps rhythm(4, symmetry of step length(5, cross support(6, simultaneous support of foot and crutch(7, forearm off(8, facing forward(9 and fluency(10. Two raters twice visualized the gait of the sample subjects which were recorded. The criterion-related validity was determined by correlation between CHAGS and Coding of eight criteria of qualitative gait analysis (Viel Coding. Internal consistency and inter and intra-rater reliability were also tested.CHAGS obtained a high and negative correlation with Viel Coding. We obtained a good internal consistency and the intra-class correlation coefficients oscillated between 0.97 and 0.99, while the minimal detectable changes were acceptable.CHAGS scale is a valid and reliable tool for assessing assisted gait with crutches in people with sprained ankles to perform partial relief of lower limbs.

  15. Use of Platelet Rich Plasma in an Isolated Complete Medial Collateral Ligament Lesion in a Professional Football (Soccer) Player: A Case Report

    OpenAIRE

    Eirale, Cristiano; Mauri, Eduardo; Hamilton, Bruce

    2012-01-01

    Purpose Platelet-rich plasma (PRP) is derived from centrifuging whole blood to obtain a high platelet concentration containing numerous growth factors. Despite its widespread use, there is still a lack of high-level evidence regarding randomized clinical trials assessing the efficacy of PRP in treating ligament injuries. Although there is research showing an improvement in the early stages of healing in the animal model of acute medial collateral ligament (MCL) injury of the knee, there is no...

  16. The impact of lifestyle risk factors on the rate of infection after surgery for a fracture of the ankle

    DEFF Research Database (Denmark)

    Olsen, L L; Møller, A M; Brorson, S

    2017-01-01

    risk factors for the development of infection following surgery for a fracture of the ankle. This large study brings new evidence concerning these common risk factors; although prospective studies are needed to confirm causality. Cite this article: Bone Joint J 2017;99-B:225-30.......AIMS: Lifestyle risk factors are thought to increase the risk of infection after acute orthopaedic surgery but the evidence is scarce. We aimed to investigate whether smoking, obesity and alcohol overuse are risk factors for the development of infections after surgery for a fracture of the ankle....... PATIENTS AND METHODS: We retrospectively reviewed all patients who underwent internal fixation of a fracture of the ankle between 2008 and 2013. The primary outcome was the rate of deep infection and the secondary outcome was any surgical site infection (SSI). Associations with the risk factors...

  17. Short-term ankle motor performance with ankle robotics training in chronic hemiparetic stroke.

    Science.gov (United States)

    Roy, Anindo; Forrester, Larry W; Macko, Richard F

    2011-01-01

    Cerebrovascular accident (stroke) often results in impaired motor control and persistent weakness that may lead to chronic disability, including deficits in gait and balance function. Finding ways to restore motor control may help reduce these deficits; however, little is known regarding the capacity or temporal profile of short-term motor adaptations and learning at the hemiparetic ankle. Our objective was to determine the short-term effects of a single session of impedance-controlled ankle robot ("anklebot") training on paretic ankle motor control in chronic stroke. This was a double-arm pilot study on a convenience sample of participants with chronic stroke (n = 7) who had residual hemiparetic deficits and an equal number of age- and sex-matched nondisabled control subjects. Training consisted of participants in each group playing a target-based video game with the anklebot for an hour, for a total of 560 movement repetitions in dorsiflexion/plantar flexion ranges followed by retest 48 hours later. Task difficulty was adjusted to ankle range of motion, with robotic assistance decreased incrementally across training. Assessments included robotic measures of ankle motor control on unassisted trials before and after training and at 48 hours after training. Following exposure to the task, subjects with stroke improved paretic ankle motor control across a single training session as indexed by increased targeting accuracy (21.6 +/- 8.0 to 31.4 +/- 4.8, p = 0.05), higher angular speeds (mean: 4.7 +/- 1.5 degrees/s to 6.5 +/- 2.6 degrees/s, p 0.05) at 48 hours in both groups. Robust maintenance of motor adaptation in the robot-trained paretic ankle over 48 hours may be indicative of short-term motor learning. Our initial results suggest that the anklebot may be a flexible motor learning platform with the potential to detect rapid changes in ankle motor performance poststroke.

  18. Short-term ankle motor performance with ankle robotics training in chronic hemiparetic stroke

    Directory of Open Access Journals (Sweden)

    Anindo Roy, PhD

    2011-05-01

    Full Text Available Cerebrovascular accident (stroke often results in impaired motor control and persistent weakness that may lead to chronic disability, including deficits in gait and balance function. Finding ways to restore motor control may help reduce these deficits; however, little is known regarding the capacity or temporal profile of short-term motor adaptations and learning at the hemiparetic ankle. Our objective was to determine the short-term effects of a single session of impedance-controlled ankle robot (“anklebot” training on paretic ankle motor control in chronic stroke. This was a double-arm pilot study on a convenience sample of participants with chronic stroke (n = 7 who had residual hemiparetic deficits and an equal number of age- and sex-matched nondisabled control subjects. Training consisted of participants in each group playing a target-based video game with the anklebot for an hour, for a total of 560 movement repetitions in dorsiflexion/plantar flexion ranges followed by retest 48 hours later. Task difficulty was adjusted to ankle range of motion, with robotic assistance decreased incrementally across training. Assessments included robotic measures of ankle motor control on unassisted trials before and after training and at 48 hours after training. Following exposure to the task, subjects with stroke improved paretic ankle motor control across a single training session as indexed by increased targeting accuracy (21.6 +/– 8.0 to 31.4 +/– 4.8, p = 0.05, higher angular speeds (mean: 4.7 +/– 1.5 degrees/s to 6.5 +/– 2.6 degrees/s, p 0.05 at 48 hours in both groups. Robust maintenance of motor adaptation in the robot-trained paretic ankle over 48 hours may be indicative of short-term motor learning. Our initial results suggest that the anklebot may be a flexible motor learning platform with the potential to detect rapid changes in ankle motor performance poststroke.

  19. An examination of ankle, knee, and hip torque production in individuals with chronic ankle instability.

    Science.gov (United States)

    Gribble, Phillip A; Robinson, Richard H

    2009-03-01

    There is some debate in the literature as to whether strength deficits exist at the ankle in individuals with chronic ankle instability (CAI). Additionally, there is evidence to suggest that knee and hip performance is altered in those with CAI. Therefore, the purpose of this study was to determine whether CAI is associated with deficits in ankle, knee, and hip torque. Fifteen subjects with unilateral CAI and fifteen subjects with healthy ankles participated. Subjects reported to the laboratory for one session during which the torque production of ankle plantar flexion/dorsiflexion, knee flexion/extension, and hip flexion/extension were measured with an isokinetic device. Subjects performed 5 maximum-effort repetitions of a concentric/concentric protocol at 60 degrees .s for both extremities. Average peak torque (APT) values were calculated. The subjects with CAI demonstrated significantly less APT production for knee flexion (F1,28 = 5.40; p = 0.03) and extension (F1,28 = 5.34; p = 0.03). Subjects with CAI exhibited significantly less APT for ankle plantar flexion in the injured limb compared with their noninjured limb (F1,28 = 6.51; p = 0.02). No significant difference in ankle dorsiflexion or hip flexion/extension APT production existed between the 2 groups. Individuals with CAI, in addition to deficits in ankle plantar flexion torque, had deficits in knee flexor and extensor torque, suggesting that distal joint instability may lead to knee joint neuromuscular adaptations. There were no similar deficits at the hip. Future research should determine what implications this has for prevention and rehabilitation of lower-extremity injury. Clinicians may need to consider including rehabilitation efforts to address these deficits when rehabilitating patients with CAI.

  20. Cutaneous mechanisms of isometric ankle force control.

    Science.gov (United States)

    Choi, Julia T; Lundbye-Jensen, Jesper; Leukel, Christian; Nielsen, Jens Bo

    2013-07-01

    The sense of force is critical in the control of movement and posture. Multiple factors influence our perception of exerted force, including inputs from cutaneous afferents, muscle afferents and central commands. Here, we studied the influence of cutaneous feedback on the control of ankle force output. We used repetitive electrical stimulation of the superficial peroneal (foot dorsum) and medial plantar nerves (foot sole) to disrupt cutaneous afferent input in 8 healthy subjects. We measured the effects of repetitive nerve stimulation on (1) tactile thresholds, (2) performance in an ankle force-matching and (3) an ankle position-matching task. Additional force-matching experiments were done to compare the effects of transient versus continuous stimulation in 6 subjects and to determine the effects of foot anesthesia using lidocaine in another 6 subjects. The results showed that stimulation decreased cutaneous sensory function as evidenced by increased touch threshold. Absolute dorsiflexion force error increased without visual feedback during peroneal nerve stimulation. This was not a general effect of stimulation because force error did not increase during plantar nerve stimulation. The effects of transient stimulation on force error were greater when compared to continuous stimulation and lidocaine injection. Position-matching performance was unaffected by peroneal nerve or plantar nerve stimulation. Our results show that cutaneous feedback plays a role in the control of force output at the ankle joint. Understanding how the nervous system normally uses cutaneous feedback in motor control will help us identify which functional aspects are impaired in aging and neurological diseases.

  1. Osteoarthritis of the Foot and Ankle

    Science.gov (United States)

    ... that creates an increased risk of arthritis. Symptoms People with osteoarthritis in the foot or ankle experience, in varying degrees, one or more of the following: Pain and stiffness in the joint Swelling in or near the joint Difficulty walking or bending the joint Some patients with osteoarthritis ...

  2. Malignant melanoma of the foot and ankle.

    Science.gov (United States)

    John, K J; Hayes, D W; Green, D R; Dickerson, J

    2000-04-01

    Malignant melanoma is a serious and devastating skin disease that podiatrists may be called upon to treat. It is pertinent that delays in diagnosis and treatment of malignant melanoma be avoided. Some of the topics discussed in this article are causes, clinical features, classification, and treatment of malignant melanoma, focusing on the foot and ankle.

  3. Surgical Management and Treatment of the Anterior Cruciate Ligament/Medial Collateral Ligament Injured Knee.

    Science.gov (United States)

    Dale, Kevin M; Bailey, James R; Moorman, Claude T

    2017-01-01

    The medial collateral ligament (MCL) is the most commonly injured ligament of the knee. The anterior cruciate ligament (ACL) is the most commonly injured ligament in conjunction with the MCL. Most MCL injuries can be treated nonoperatively, whereas the ACL often requires reconstruction. A good physical examination is essential for diagnosis, whereas radiographs and MRI of the knee confirm diagnosis and help guide treatment planning. Preoperative physical therapy should be completed before surgical management to allow for return of knee range of motion and an attempt at MCL healing.

  4. Hip-ankle coordination during gait in individuals with chronic ankle instability.

    Science.gov (United States)

    Yen, Sheng-Che; Chui, Kevin K; Corkery, Marie B; Allen, Elizabeth A; Cloonan, Caitlin M

    2017-03-01

    Individuals with chronic ankle instability (CAI) may have sensorimotor impairments that affect control at the hip in addition to the ankle. The purpose of this study was to compare hip-ankle coordination and coordination variability between individuals with CAI and healthy individuals during walking. Ten healthy subjects and 10 subjects with CAI were recruited to walk on a treadmill. Hip-ankle coordination was quantified using vector coding, and coordination variability was quantified using coefficient of correspondence. We found significant between-group differences in hip-ankle coordination in the frontal plane around loading response (Control: 165.9±18.4°; CAI: 127.6±48.6°, p=0.04) and in the sagittal plane around the first half of mid stance (Control: 307.2±9.8°; CAI: 291.8±11.4°, pcoordination variability in the frontal plane around the second half of mid stance (Control: 0.54±0.06; CAI: 0.45±0.07, Pcoordination and coordination variability in stance phase during walking. Gait training is important in CAI rehabilitation, and the training should address altered hip-ankle coordination to reduce the risk of recurrent injuries. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. 低场 MR 斜冠状位 GRE T2∗WI 序列对急性前交叉韧带损伤的诊断价值%Diagnostic value of GRE T2 * WI sequences in low field strength MR with oblique coronal plane in acute anterior cruciate ligament injury

    Institute of Scientific and Technical Information of China (English)

    李杰; 陈京美; 陈钰辉; 王永述

    2015-01-01

    Objective To explore the diagnostic value of GRE T2 ∗ WI sequences in low field strength MR with oblique coronal plane in patients with acute anterior cruciate ligament (ACL)injury.Methods 68 cases of acute traumatic hemarthrosis of the knee joint proved surgically were reviewed.The cases were divided into two groups:conventional MR group (axial image,standard coro-nal image and sagittal oblique image),and conventional with oblique coronal MR group.The diagnostic results with surgical and path-ological results were compared.The diagnostic accuracy of two images were evaluated respectively.Results For conventional MR group and conventional with oblique coronal MR group,the sensitivities in diagnosing ACL were 72.9% and 97.9%,the specificities were 80% and 85%,the positive predictive values were 89.7% and 94%,the negative predictive values were 55.2% and 85%,the accuracies were 52.9% and 82.9%,the misdiagnosis rates were 20% and 1 5%,the missed diagnosis rates were 27.1% and 2.1%, and the coincidence rates was 75% and 94.1%,respectively.The difference in diagnosis rates between two groups were statistically significant(P <0.05).Conclusion GRE T2 ∗ WI sequences with oblique coronal plane can significantly improve the diagnostic rate of anterior cruciate ligament injury.%目的:探讨低场 MR 梯度回波(GRE)T2∗ WI 序列斜冠状位扫描对急性前交叉韧带(ACL)损伤的诊断价值。方法对68例经手术证实的膝关节急性损伤病例进行回顾性分析,将病例分为常规扫描组(轴位、冠状位、斜矢状位)及常规+斜冠状位扫描组,将成像结果与手术结果对比,分别评价常规扫描与常规+斜冠位扫描对 ACL 有无损伤诊断的准确性。结果常规扫描组诊断ACL 损伤的敏感度为72.9%,特异度为80%,阳性预测值为89.7%,阴性预测值为55.2%,正确指数为52.9%,误诊率为20%,漏诊率为27.1%,诊断符合率为75%;常规+斜冠状位扫描组诊断 ACL 损伤的敏感度为97.9%,

  6. Total Ankle Arthroplasty: An Overview of the Canadian Experience.

    Science.gov (United States)

    Latham, Warren C W; Lau, Johnny T C

    2016-06-01

    Total ankle arthroplasty use has increased across Canada over the last two decades. Multiple implant designs are readily available and implanted across Canada. Although arthrodesis is a reliable procedure for treating end-stage ankle arthritis, ankle replacement is often the preferred surgical treatment by patients. A recent prospective study evaluated intermediate-term outcomes of ankle replacement and arthrodesis at multiple centers across Canada, with variability in prosthesis type, surgeon, and surgical technique. Intermediate-term clinical outcomes of total ankle replacement and ankle arthrodesis were comparable in a diverse cohort in which treatment was tailored to patient presentation; however, rates of reoperation and major complications were higher after ankle replacement.

  7. Measuring Ankle Instability in Pediatric Charcot-Marie-Tooth Disease.

    Science.gov (United States)

    Mandarakas, Melissa; Hiller, Claire E; Rose, Kristy J; Burns, Joshua

    2013-11-01

    Children with Charcot-Marie-Tooth disease frequently suffer ankle sprain and experience chronic ankle instability; however, no pediatric self-reported measures of chronic ankle instability exist. The aim was to modify and validate the most reliable measure of chronic ankle instability in adults: the Cumberland Ankle Instability Tool. The Cumberland Ankle Instability Tool-Youth was tested for reliability, construct validity, and sensitivity to discriminate between 104 children aged 8 to 16 years: 31 children with Charcot-Marie-Tooth disease, 31 unaffected children with a history of ankle sprains, and 42 controls. Children with Charcot-Marie-Tooth disease had lower scores compared to unaffected children with a history of sprains (χ(2) = 15.10; P Charcot-Marie-Tooth disease.

  8. Round Ligament Varicosities During Pregnancy: Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Chang Kyu; Oh, Young Taik; Jung, Dae Chul [Yonsei University Health System, Seoul (Korea, Republic of)

    2011-12-15

    There are various causes of a painful palpable mass in the groin during pregnancy. The differential diagnoses of an inguinal mass include hernia, lymphadenopathy, mesothelial cyst, cystic lymphangioma, neoplasms (lipoma, leiomyoma and sarcoma), endometriosis, embryonic remnants and round ligament varicosities. Among them, round ligament varicosities can be easily misdiagnosed as an inguinal hernia in a pregnant woman. These lesions should be managed conservatively because they resolve spontaneously during the postpartum period. Ultrasonography can help make the diagnosis of round ligament varicosities and so prevent unnecessary surgical intervention and the associated morbidity. Herein we report on a case of round ligament varicosities that presented during pregnancy and this condition was readily diagnosed via Doppler sonography

  9. Guideline on anterior cruciate ligament injury

    NARCIS (Netherlands)

    D.E. Meuffels (Duncan); M.T. Poldervaart (Michelle T.); R.L. Diercks (Ron L.); A.W.F.M. Fievez (Alex W.F.M.); T.W. Patt (Thomas W.); C.P. van der Hart (Cor P.); E.R. Hammacher (Eric); F. van der Meer (Fred); E.A. Goedhart (Edwin A.); A.F. Lenssen (Anton F); S.B. Muller-Ploeger (Sabrina B); M.A. Pols (Margreet); D.B.F. Saris (Daniel)

    2012-01-01

    textabstractThe Dutch Orthopaedic Association has a long tradition of development of practical clinical guidelines. Here we present the recommendations from the multidisciplinary clinical guideline working group for anterior cruciate ligament injury. The following 8 clinical questions were formulate

  10. Effect of External Ankle Support on Ankle and Knee Biomechanics During the Cutting Maneuver in Basketball Players.

    Science.gov (United States)

    Klem, Nardia-Rose; Wild, Catherine Y; Williams, Sian A; Ng, Leo

    2017-03-01

    Despite the high prevalence of lower extremity injuries in female basketball players as well as a high proportion of athletes who wear ankle braces, there is a paucity of research pertaining to the effects of ankle bracing on ankle and knee biomechanics during basketball-specific tasks. To compare the effects of a lace-up brace (ASO), a hinged brace (Active T2), and no ankle bracing (control) on ankle and knee joint kinematics and joint reaction forces in female basketball athletes during a cutting maneuver. Controlled laboratory study. Twenty healthy, semi-elite female basketball players performed a cutting task under both ankle brace conditions (lace-up ankle brace and hinged ankle brace) and a no-brace condition. The 3-dimensional kinematics of the ankle and knee during the cutting maneuver were measured with an 18-camera motion analysis system (250 Hz), and ground-reaction force data were collected by use of a multichannel force plate (2000 Hz) to quantify ankle and knee joint reaction forces. Conditions were randomized using a block randomization method. Compared with the control condition, the hinged ankle brace significantly restricted peak ankle inversion (mean difference, 1.7°; P = .023). No significant difference was found between the lace-up brace and the control condition ( P = .865). Compared with the lace-up brace, the hinged brace significantly reduced ankle and knee joint compressive forces at the time of peak ankle dorsiflexion (mean difference, 1.5 N/kg [ P = .018] and 1.4 N/kg [ P = .013], respectively). Additionally, the hinged ankle brace significantly reduced knee anterior shear forces compared with the lace-up brace both during the deceleration phase and at peak ankle dorsiflexion (mean difference, 0.8 N/kg [ P = .018] and 0.9 N/kg [ P = .011], respectively). The hinged ankle brace significantly reduced ankle inversion compared with the no-brace condition and reduced ankle and knee joint forces compared with the lace-up brace in a female

  11. Evaluation of anterior talofibular ligament injury with stress radiography, ultrasonography and MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Oae, Kazunori; Uchio, Yuji [Shimane University School of Medicine, Department of Orthopaedics, Shimane, Izumo (Japan); Takao, Masato [Teikyo University, Department of Orthopaedic Surgery, Tokyo, Itabashi-ku (Japan); Ochi, Mitsuo [Hiroshima University, Department of Orthopaedic Surgery, Hiroshima, Minami-ku (Japan)

    2010-01-15

    The purpose of this study was to clarify the efficacy of stress radiography (stress X-P), ultrasonography (US), and magnetic resonance (MR) imaging in the detection of the anterior talofibular ligament (ATFL) injury. Thirty-four patients with ankle sprain were involved. In all patients, Stress X-P, US, MR imaging, and arthroscopy were performed. The arthroscopic results were considered to be the gold standard. The imaging results were compared with the arthroscopic results, and the accuracy calculated. Arthroscopic findings showed ATFL injury in 30 out of 34 cases. The diagnosis of ATFL injury with stress X-P, US, MR imaging were made with an accuracy of 67, 91 and 97%. US and MR imaging demonstrated the same location of the injury as arthroscopy in 63 and 93%. We have clarified the diagnostic value of stress X-P, US, and MR imaging in diagnosis of ATFL injury. We obtained satisfactory results with US and MR imaging. (orig.)

  12. Osseous Injury Associated With Ligamentous Tear of the Knee.

    Science.gov (United States)

    Lee, Chee Hwee; Tan, Chih Feng; Kim, Okwha; Suh, Kyung Jin; Yao, Min-Szu; Chan, Wing P; Wu, Jim S

    2016-11-01

    One of the most common knee injuries is ligament tear, which may initially manifest as an osseous injury in radiographs. Radiologists should therefore be able to recognize ligament tears of the knee as osseous abnormalities in images. This review focuses on the imaging features of knee ligament injuries and their related osseous injuries: anterior cruciate ligament (ACL) tear with Segond fracture; associated marrow contusion; ACL avulsion fracture; posterior cruciate ligament (PCL) tear with osseous avulsion of the ligament including arcuate sign; reverse Segond fracture; PCL avulsion fracture; medial collateral ligament tear with Pellegrini-Stieda disease; lateral collateral ligament tear with avulsion fracture of the fibular head; and patellar ligament injuries with Osgood-Schlatter and Sinding-Larsen-Johansson.

  13. Immediate effect of walking with talus-stabilizing taping on ankle kinematics in subjects with limited ankle dorsiflexion.

    Science.gov (United States)

    Kang, Min-Hyeok; Kim, Ji-Won; Choung, Sung-Dae; Park, Kyue-Nam; Kwon, Oh-Yun; Oh, Jae-Seop

    2014-08-01

    To determine the effects of walking with talus-stabilizing taping (TST) on ankle dorsiflexion (DF) and heel-off time in the stance phase of gait and ankle DF passive range of motion (PROM). Pre- and post-intervention study. University motion analysis laboratory. Ten subjects participated in this study. Sixteen ankles with limited ankle DF PROM were tested. Ankle DF PROM was measured using a goniometer, and maximum ankle DF before heel-off and time to heel-off in the stance phase of gait were measured using a 3D motion analysis system before and after walking with TST. Data were analyzed using a paired t-test. Ankle maximum DF before heel-off (p = 0.001), time to heel-off during the stance phase of gait (p = 0.005), and ankle DF PROM (p Walking with TST is an effective self-exercise for improving ankle kinematics during gait and increasing ankle DF PROM in individuals with limited ankle DF PROM. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Tissue Engineering Strategies in Ligament Regeneration

    Directory of Open Access Journals (Sweden)

    Caglar Yilgor

    2012-01-01

    Full Text Available Ligaments are dense fibrous connective tissues that connect bones to other bones and their injuries are frequently encountered in the clinic. The current clinical approaches in ligament repair and regeneration are limited to autografts, as the gold standard, and allografts. Both of these techniques have their own drawbacks that limit the success in clinical setting; therefore, new strategies are being developed in order to be able to solve the current problems of ligament grafting. Tissue engineering is a novel promising technique that aims to solve these problems, by producing viable artificial ligament substitutes in the laboratory conditions with the potential of transplantation to the patients with a high success rate. Direct cell and/or growth factor injection to the defect site is another current approach aiming to enhance the repair process of the native tissue. This review summarizes the current approaches in ligament tissue engineering strategies including the use of scaffolds, their modification techniques, as well as the use of bioreactors to achieve enhanced regeneration rates, while also discussing the advances in growth factor and cell therapy applications towards obtaining enhanced ligament regeneration.

  15. Effects of function improvement in acute knee- joint ligament injury between knee orthosis and dynamic action plaster immobilization%膝关节韧带损伤早期应用膝矫形器与动态石膏固定对膝关节功能恢复的影响

    Institute of Scientific and Technical Information of China (English)

    张毅; 黄东锋; 毛玉容; 伍丹

    2001-01-01

    Objective: To explore the different effect to function improvement of acute knee- joint ligament injure after rehabilitation therapy with hinge-locked knee orthosis or dynamic action plaster immobilization. Method: Orthosis or dynamic action plaster immobilization were used 4 weeks after acute injure in two groups. Rehabilitation therapy were arranged during immobilization and free periods, Function assessment comparison were conducted 3 months later. Result:ROM active and ROM passive were significantly different between the two groups (P<0.001, P<0.01 ). The Lysholmp scorings of the two groups were also significantly different (P<0.01). Couclusion: Dynamic action plaster immobilization could gently prevent contraction, but could not obviously improve muscle weakness and instability of the joint. Hinge-locked keen orthosis provided not only safe training within protective ROM. Stable immobilization could obviously improve ROM and function of the knee-joint.%目的:探讨膝韧带损伤急性期康复治疗中配置加锁膝关节绞链矫形器与动态石膏固定对膝关节功能恢复的不同影响。方法:两组伤后即分别配置矫形器与动态石膏固定4周,固定期间及拆除固定后进行康复治疗,3月后进行功能评估比较疗效。结果:矫形器组与动态石膏组膝关节主动ROM与被动ROM差异在统计学上有显著性(t值分别为4.59及3.23,P分别<0.001及<0.01),膝关节功能Lyshdmp评分差异在统计学上亦有显著性(t值为2.93,P<0.01)。结论:动态石膏固定在一定程度上可预防关节挛缩,但肌无力及关节不稳不能解除。加锁膝关节绞链矫形器配置有利于膝关节在保护范围内进行功能训练,有效地解决了制动与功能训练之间的矛盾,可显著改善膝关节ROM与综合功能。

  16. MR imaging of anterior cruciate ligament tears: is there a gender gap?

    Energy Technology Data Exchange (ETDEWEB)

    Fayad, Laura M. [Morgan Department of Radiology and Radiological Science, John Hopkins Medical Institutions, Baltimore, MD (United States); Parellada, J.Antoni; Parker, Laurence; Schweitzer, Mark E. [Department of Radiology, Thomas Jefferson University Hospital, Gibbon Building Suite 3390, 111 South 11th St., 19107-5098, Philadelphia, PA (United States)

    2003-11-01

    Clinically, females receive anterior cruciate ligament (ACL) tears more commonly than males. We explored whether gender differences exist in MR imaging patterns of ACL tears. At 1.5T, two observers evaluated MR examinations of 84 consecutive age-matched patients (42 males, 42 females, aged 16-39) with ACL tears, for mechanism of injury, extent and type of tear, the presence of secondary signs and associated osseous, meniscal and ligamentous injuries. The most common mechanism of injury for both females and males was the pivot shift mechanism (67 and 60%, respectively). Females were more commonly imaged in the acute stage of tear than males (98 and 67%, respectively, p=0.001) and more commonly possessed the typical posterolateral tibial bone contusion pattern (88 and 62%, respectively, p=0.0131). Males exhibited a deeper femoral notch sign (2.7 and 2.0 mm, p=0.007) and medial meniscal, lateral collateral ligament and posterior cruciate ligament injuries more commonly than females (48 and 24%, p=0.009, 30 and 7%, p=0.035, 17 and 0%, p=0.035). There was no significant difference between genders for the presence of other secondary signs and contusion patterns, associated lateral meniscal tears, presence of O'Donoghue's triad or associated medial collateral ligament injuries. Gender differences in MR imaging patterns of ACL tears exist: females are more commonly imaged in the acute stage and more commonly possess posterolateral tibial bone contusions; males have a more severe presentation than females, associated with more severe lateral femoral condyle and soft tissue injuries. (orig.)

  17. Visibility of Anterolateral Ligament Tears in Anterior Cruciate Ligament-Deficient Knees With Standard 1.5-Tesla Magnetic Resonance Imaging.

    Science.gov (United States)

    Hartigan, David E; Carroll, Kevin W; Kosarek, Frank J; Piasecki, Dana P; Fleischli, James F; D'Alessandro, Donald F

    2016-10-01

    To attempt to visualize the ligament with standard 1.5-tesla magnetic resonance imaging (MRI) in the acute anterior cruciate ligament (ACL)-torn knee, and if it is visible, attempt to characterize it as torn or intact at its femoral, meniscal, and tibial attachment sites. This was a retrospective MRI study based on arthroscopic findings of a known ACL tear in 72 patients between the years 2006 and 2010. Patients all had hamstring ACL reconstructions, no concomitant lateral collateral ligament, or posterolateral corner injury based on imaging and physical examination, and had a preoperative 1.5-tesla MRI scan with standard sequences performed within 3 weeks of the injury. Two fellowship-trained musculoskeletal radiologists retrospectively reviewed the preoperative MRI for visualization of the anterolateral ligament (ALL) for concomitant tears. Inter- and intraobserver reliability was calculated. Learning effect was analyzed to determine if radiologists' agreement improved as reads progressed. Both radiologists were able to visualize the ALL in 100% of the scans. Overall, ALL tears were noted in 26% by radiologist 1 and in 62% by radiologist 2. The agreement between the ligament being torn or not had a kappa of 0.54 between radiologists. The agreements in torn or not torn between radiologists in the femoral, meniscal, and tibial sites were 0.14, 0.15, and 0.31. The intraobserver reliability by radiologist 1 for femoral, meniscal, and tibial tears was 0.04, 0.57, and 0.54 respectively. For radiologist 2, they were 0.75, 0.61, and 0.55. There was no learning effect noted. ALL tears are currently unable to be reliably identified as torn or intact on standard 1.5-tesla MRI sequences. Proper imaging sequences are of crucial importance to reliably follow these tears to determine their clinical significance. Level IV, therapeutic case series study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  18. MAGNETIC RESONANCE IMAGING EVALUATION OF LIGAMENTOUS TEARS OF THE KNEE JOINT AND ASSOCIATION OF MENISCAL TEARS WITH ANTERIOR CRUCIATE LIGAMENT TEARS

    Directory of Open Access Journals (Sweden)

    Bommandapalli Madhaiah

    2016-05-01

    Full Text Available Anterior cruciate ligament tears are most commonly sustained sports injury, often occurring in association with meniscal tears and trauma to other ligamentous structures around the knee. Magnetic resonance imaging is vital in assessing acute knee injuries and plays an important role in deciding treatment options and planning surgical intervention. Magnetic Resonance (MR imaging has emerged as investigation of choice to evaluate the status of the ACL and other associated structures in the knee. AIMS AND OBJECTIVES The purpose of this study is to determine the association of subtle meniscal injury in the presence of anterior cruciate ligament injury and other associated pathology on MR imaging. MATERIAL AND METHODS A prospective cross-sectional case study done on 40 patients including both the sexes in age group of 15 to 35 years presenting with knee joint injuries and subsequently underwent MRI of the knee joint. The data was analysed and the findings on MRI were correlated with that of arthroscopy and/or operative findings. RESULTS The commonest soft tissue injury identified on MRI of the knee joint was ACL injury and it was associated with injuries of medial meniscus followed by of lateral meniscus, medial collateral ligament and lateral collateral ligament. CONCLUSION MRI is an excellent, non-invasive, radiation free imaging modality with multiplanar capabilities and excellent soft tissue delineation. It can accurately detect, localize and characterize various internal derangements of the knee joint and help in arriving at a correct anatomical diagnosis, thereby guiding further management of the patient. Medial meniscal tears were more commonly associated with ACL tear. Various patterns of meniscal injuries were identified in this study, out of which bucket handle pattern was more common among medial meniscal tears and radial pattern was common in the lateral meniscal injuries. Radiologists while interpreting MR studies of knee injuries

  19. A multimodal approach to ankle instability: Interrelations between subjective and objective assessments of ankle status in athletes.

    Science.gov (United States)

    Golditz, Tobias; Welsch, Goetz H; Pachowsky, Milena; Hennig, Friedrich F; Pfeifer, Klaus; Steib, Simon

    2016-03-01

    The aim of this retrospective cohort study is to investigate the association between different subjective and objective assessments of ankle function in a population of athletes with or without functional ankle instability (FAI). 29 athletes with a history of ankle spraining were divided into two groups according to their ankle status: 16 with FAI (initial ankle sprain with residual functional instability) (age 24.6 ± 3.1 years), and 13 COPERS (initial ankle sprain without residual instability) (age 25.3 ± 4.4 years). The assessment of each individual's ankle function was based on three approaches: The "functional-ankle-ability-measure" (FAAM) assessing subjective ankle functionality, measures of sensorimotor control as objective functional measurements and MRI-based T2-mapping as a quantitative marker of compositional joint status. Pearson's product-moment-correlation coefficient, student's t-test and analysis-of-variance were used for statistical analysis. Significant group differences existed for subjective ankle function (FAAM, p = 0.04) and MRI-data mainly in the medial compartment of the ankle joint (p ≤ 0.05). We found unique associations between T2-mapping results and sensorimotor scores in the COPER (r = -0.756-0.849), and "FAI"-group (r = 0.630-0.657). The location and magnitude differed between groups. No correlations existed between these measures and the FAAM. This exploratory study provides preliminary evidence for potential interrelations between various diagnostic measures of ankle function and structure in individuals with and without FAI. We found associations between MRI-results and selected measures of sensorimotor control, indicating a potential link between loss of ankle function and early joint degeneration. Despite these interrelations, each of the different assessment options appears to contain unique information on ankle functionality important in a clinical assessment. © 2015 Orthopaedic Research Society. Published by Wiley

  20. Radiology of chronic diseases of the ankle joint; Chronische Krankheitsbilder am Sprunggelenk

    Energy Technology Data Exchange (ETDEWEB)

    Rand, T. [Vienna Univ. (Austria). Einrichtung fuer Magnetresonanztomographie]|[Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria); Trattnig, S.; Breitenseher, M.; Imhof, H. [Vienna Univ. (Austria). Einrichtung fuer Magnetresonanztomographie; Kreuzer, S. [Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria); Wagesreither, S. [Vienna Univ. (Austria). Klinik fuer Zahn-, Mund- und Kieferheilkunde

    1999-01-01

    The etiology of chronic diseases of the ankle joint comprises a wide spectrum including chronic inflammatory processes and chronic degenerative, tumorous and neuropathic processes, as well as some specific syndromes based on chronic changes of the ankle joint. Of the inflammatory processes, chronic juvenile arthritis (JVC) is the most common disease. However, also Reiter disease, psoriasis or chronic monoarthritid diseases such as gout, as well as granulomatous diseases (tuberculosis, sarcoidosis) and fungal infections, may affect the ankle joint in a chronic course. Chronic degenerative changes are usually secondary due to abnormal positioning of the joint constituents or repetitive trauma. Neuropathic changes, as frequently seen in the course of diabetes, present with massive osseous destruction and malposition of the articular constituents. Chronic osseous as well as cartilaginous and synovial changes are seen in hemoplici patients. Chronic traumatic changes are represented by pigmented villonodular synovitis (PVNS), and chondromatosis, both with a predilection for the ankle joint. Due to the possibilities of magnetic resonance imaging (MRI), diagnosis of chronic ankle changes includes chronic ligamentous, tendinous and soft tissue changes. With the use MRI, specific syndromes can be defined which particularly affect the ankle joint in a chronic way, such as the os trigonum syndrome, the anterolateral impingement syndrome and the sinus tarsi syndrome. Nevertheless, plain film radiographs are still the basic element of any investigation. MRI, however, can be potentially used as a second investigation, saving an unnecessary cascade of investigations with ultrasound and CT. The latter investigations are used only with very specific indications, for instance CT for subtle bone structures and sonography for a limited investigation of tendons or evaluation of fluid. Particularly due to the possibilities of MRI and the development of special gradient-echo imaging or

  1. Diminished Foot and Ankle Muscle Volumes in Young Adults With Chronic Ankle Instability

    Science.gov (United States)

    Feger, Mark A.; Snell, Shannon; Handsfield, Geoffrey G.; Blemker, Silvia S.; Wombacher, Emily; Fry, Rachel; Hart, Joseph M.; Saliba, Susan A.; Park, Joseph S.; Hertel, Jay

    2016-01-01

    Background: Patients with chronic ankle instability (CAI) have demonstrated altered neuromuscular function and decreased muscle strength when compared with healthy counterparts without a history of ankle sprain. Up to this point, muscle volumes have not been analyzed in patients with CAI to determine whether deficits in muscle size are present following recurrent sprain. Purpose: To analyze intrinsic and extrinsic foot and ankle muscle volumes and 4-way ankle strength in young adults with and without CAI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Five patients with CAI (mean age, 23.0 ± 4 years; 1 male, 4 females) and 5 healthy controls (mean age, 23.8 ± 4.5 years; 1 male, 4 females) volunteered for this study. Novel fast-acquisition magnetic resonance imaging (MRI) was used to scan from above the femoral condyles through the foot and ankle. The perimeter of each muscle was outlined on each axial slice and then the 2-dimensional area was multiplied by the slice thickness (5 mm) to calculate the muscle volume. Plantar flexion, dorsiflexion, inversion, and eversion isometric strength were measured using a handheld dynamometer. Patients with CAI were compared with healthy controls on all measures of muscle volume and strength. Extrinsic muscle volumes of patients with CAI were also compared with a normative database of healthy controls (n = 24) by calculating z scores for each muscle individually for each CAI subject. Results: The CAI group had smaller total shank, superficial posterior compartment, soleus, adductor hallucis obliqus, and flexor hallucis brevis muscle volumes compared with healthy controls as indicated by group means and associated 90% CIs that did not overlap. Cohen d effect sizes for the significant group differences were all large and ranged from 1.46 to 3.52, with 90% CIs that did not cross zero. The CAI group had lower eversion, dorsiflexion, and 4-way composite ankle strength, all with group means and associated 90

  2. The effects of ankle Kinesio taping on ankle stiffness and dynamic balance.

    Science.gov (United States)

    Fayson, Shirleeah D; Needle, Alan R; Kaminski, Thomas W

    2013-01-01

    The purpose of this study was to determine the effects of Kinesio® taping on static restraint and dynamic postural control of the ankle joint. Thirty female subjects with no history of ankle injury participated in this study. Subjects were tested for passive ankle laxity and stiffness, and time to stabilization following forward, backward, medial, and lateral hops. Subjects were tested prior to tape application, immediately following application, and following 24 hours of use. Differences between taping conditions were investigated using analyses of variance and pairwise comparisons. Stiffness increased following initial application and 24 hours of Kinesio® tape use (F = 6.99, p = .003), despite no observed changes in ankle laxity (F = 0.77, p = .49); however, no changes were observed in time-to-stabilization (F = 0.03, p = .97). Our results suggest that Kinesio® tape may improve static restraint in the ankle joint without altering peak motion or dynamic postural control. A future investigation into Kinesio® tape efficacy in injury prevention or rehabilitation is warranted.

  3. Charcot foot and ankle with osteomyelitis

    OpenAIRE

    Donegan, Ryan; Sumpio, Bauer; Peter A. Blume

    2013-01-01

    This paper presents a review of the current literature discussing topics of Charcot osteoarthropathy, osteomyelitis, diagnosing osteomyelitis, antibiotic management of osteomyelitis, and treatment strategies for management of Charcot osteoarthropathy with concurrent osteomyelitis.Keywords: Charcot foot; osteomyelitis; diabetes mellitus; infection; neuropathy(Published: 1 October 2013)Citation: Diabetic Foot & Ankle 2013, 4: 21361 - http://dx.doi.org/10.3402/dfa.v4i0.21361

  4. [Ankle joint prosthesis for bone defects].

    Science.gov (United States)

    Lampert, C

    2011-11-01

    Large defects of the talus, i.e. due to tumors, large areas of osteolysis in total ankle replacement (TAR) and posttraumatic talus body necrosis are difficult to manage. The gold standard in these circumstances is still tibiocalcaneal arthrodesis with all the negative aspects of a completely rigid hindfoot. We started 10 years ago to replace the talus by a custom-made, all cobalt-chrome implant (laser sintering). The first patient with a giant cell tumor did very well but the following patients showed all subsidence of the metal talus into the tibia due to missing bony edges. Therefore, we constructed a custom-made talus (mirrored from the healthy side) and combined it with a well functioning total ankle prosthesis (Hintegra). So far we have implanted this custom-made implant into 3 patients: the first had a chondrosarcoma of the talus (1 year follow-up), the second had massive osteolysis/necrosis of unknown origin (6 months follow-up) and the third massive osteolysis following a correct TAR (2 months follow-up). The results are very encouraging as all of the patients are practically pain free and have a good range of movement (ROM): D-P flexion 15°-0-20° but less motion in the lower ankle joint: ROM P-S 5°-0-5°. No subsidence was detected in the tibia or the calcaneus. The custom-made talus combined with the Hintegra total ankle replacement will probably be an interesting alternative to a tibiocalcaneal arthrodesis in selected cases with massive defects of the talus.

  5. Symptomatic anterior subtalar arthrosis after ankle arthrodesis.

    Science.gov (United States)

    Lui, Tun Hing

    2014-05-13

    A 76-year-old man reported right lateral heel pain 11 years after ankle arthrodesis. Clinically, there was tenderness in the right sinus tarsi and over the junction point between the talonavicular and calcaneocuboid joints. Radiographs showed that the joint spaces of the posterior subtalar joint and the talonavicular joint were preserved although there were osteophytes at both joints. Arthroscopic findings showed degeneration of the anterior subtalar and talonavicular joints. The symptoms subsided after arthroscopic debridement. 2014 BMJ Publishing Group Ltd.

  6. Anterior cruciate ligament injury about 20 years post-treatment: A kinematic analysis of one-leg hop.

    Science.gov (United States)

    Tengman, E; Grip, H; Stensdotter, Ak; Häger, C K

    2015-12-01

    Reduced dynamic knee stability, often evaluated with one-leg hops (OLHs), is reported after anterior cruciate ligament (ACL) injury. This may lead to long-standing altered movement patterns, which are less investigated. 3D kinematics during OLH were explored in 70 persons 23 ± 2 years after ACL injury; 33 were treated with physiotherapy in combination with ACL reconstruction (ACL(R)) and 37 with physiotherapy alone (ACL(PT)). Comparisons were made to 33 matched controls. We analyzed (a) maximal knee joint angles and range of motion (flexion, abduction, rotation); (b) medio-lateral position of the center of mass (COM) in relation to knee and ankle joint centers, during take-off and landing phases. Unlike controls, ACL-injured displayed leg asymmetries: less knee flexion and less internal rotation at take-off and landing and more lateral COM related to knee and ankle joint of the injured leg at landing. Compared to controls, ACL(R) had larger external rotation of the injured leg at landing. ACL(PT) showed less knee flexion and larger external rotation at take-off and landing, and larger knee abduction at Landing. COM was more medial in relation to the knee at take-off and less laterally placed relative to the ankle at landing. ACL injury results in long-term kinematic alterations during OLH, which are less evident for ACL(R).

  7. Acromioclavicular dislocation: postoperative evaluation of the coracoclavicular ligaments using magnetic resonance

    Directory of Open Access Journals (Sweden)

    Rafael Salomon Silva Faria

    2015-04-01

    Full Text Available OBJECTIVE: To radiologically evaluate the healing of the coracoclavicular ligaments after surgical treatment for acromioclavicular dislocation.METHODS: Ten patients who had undergone surgical treatment for acromioclavicular dislocation via a posterosuperior route at least one year earlier were invited to return for radiological assessment using magnetic resonance. This evaluation was done by means of analogy with the scale described in the literature for studying the healing of the anterior cruciate ligament of the knee and for measuring the healed coracoclavicular ligaments.RESULTS: A scar structure of fibrous appearance had formed in 100% of the cases. In 50% of the cases, the images of this structure had a good appearance, while the other 50% were deficient.CONCLUSION: Late postoperative evaluation using magnetic resonance, on patients who had been treated for acute acromioclavicular dislocation using a posterosuperior route in the shoulder, showed that the coracoclavicular ligaments had healed in 100% of the cases, but that this healing was deficient in 50%.

  8. Forces predicted at the ankle during running.

    Science.gov (United States)

    Burdett, R G

    1982-01-01

    A biomechanical model of the ankle joint was developed and was used to predict the forces at the ankle during the stance phase of running. Measurements from five cadavers were averaged to obtain insertion points and directions of pull of equivalent tendons with respect to the assumed center of the ankle joint. A minimum joint force solution was obtained by assuming that only two equivalent muscle groups could exert force at one time. Three subjects ran at 4.47 m/s across a force platform that recorded the external forces and moments acting on the foot. Cinematography was used to measure the foot and leg positions during stance. Peak resultant joint forces ranging from 9.0 to 13.3 times body weight and peak Achilles tendon forces ranging from 5.3 to 10.0 times body weight were predicted. Small variations in some cases resulted in large differences in predicted forces. The highest tendon forces predicted exceeded those reported to cause damage to cadaver tendons in other studies.

  9. Total ankle replacement. Early experiences with STAR prosthesis.

    Science.gov (United States)

    Murnaghan, J. M.; Warnock, D. S.; Henderson, S. A.

    2005-01-01

    Early designs of Total Ankle Replacement (TAR) had a high failure rate. More recent experience with the 3-piece, meniscal bearing, total ankle replacement has been more promising. We report a review of the early results of our first 22 prostheses in 20 patients undergoing Scandinavian Total Ankle Replacement (STAR) in Northern Ireland. There was a mean follow-up time of 26 months. Seventeen patients are pain-free at the ankle joint during normal daily activities. Two of the early cases have required revision surgery due to technical errors. Other complications have included malleolar fractures, poor wound healing and postoperative stiffness. These early results show high levels of patient satisfaction, and we are encouraged to continue with total ankle arthroplasty. There is a steep initial learning curve and use of TAR should be restricted to foot and ankle surgeons. Images Fig 1 Figs 2a and b Figs 2 c and d PMID:16022128

  10. Control method for exoskeleton ankle with surface electromyography signals

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zhen; WANG Zhen; JIANG Jia-xin; QIAN Jin-wu

    2009-01-01

    This paper is concerned with a control method for an exoskeleton ankle with clectromyography (EMG) signals.The EMG signals of human ankle and the exoskeleton ankle are introduced.Then a control method is proposed to control the exoskeleton ankle using the EMG signals.The feed-forward neural network model applied here is composed of four layers and uses the back-propagation training algorithm.The output signals from neural network are processed by the wavelet transform.Finally the control orders generated from the output signals are passed to the motor controller and drive the exoskeleton to move.Through experiments,the equality of neural network prediction of ankle movement is evaluated by giving the correlation coefficient.It is shown from the experimental results that the proposed method can accurately control the movement of ankle joint.

  11. Talar Osteochondroma Fracture Presenting as Posterior Ankle Impingement.

    Science.gov (United States)

    Ercin, Ersin; Bilgili, Mustafa Gokhan; Gamsizkan, Mehmet; Avsar, Serdar

    2016-05-01

    Osteochondromas are the most common benign bone tumors. They are usually asymptomatic and found incidentally. When symptomatic, the symptoms are usually due to its location and size. Fracture of an osteochondroma presenting as posterior ankle impingement is a rare condition. We describe a 22-year-old man with solitary exostosis who presented with a posterior ankle mass and posterior ankle impingement with 2 years of follow-up. Surgical intervention was the treatment of choice in this patient, and histologic examination revealed a benign osteochondroma. Osteochondromas found in the posterior aspect of the talus can be complicated by fracture due to persistent motion of the ankle. Talar osteochondroma should be included in the differential diagnosis of posterior ankle impingement causes. Posterior talar osteochondromas, especially when a stalk is present, should be treated surgically before it is more complicated by a fracture and posterior ankle impingement.

  12. Ligament strain on the iliofemoral, pubofemoral, and ischiofemoral ligaments in cadaver specimens: biomechanical measurement and anatomical observation.

    Science.gov (United States)

    Hidaka, Egi; Aoki, Mitsuhiro; Izumi, Tomoki; Suzuki, Daisuke; Fujimiya, Mineko

    2014-10-01

    The iliofemoral, pubofemoral, and ischiofemoral ligaments are major structures that stabilize the hip joint. We have sought evidence on which to base more effective hip stretching positions. The purpose of this study was to measure strains on these ligaments and to observe them. Eight fresh/frozen translumbar cadaver specimens were used. Clinically available stretching positions for these ligaments were adopted. Strain on each ligament was measured by a displacement sensor during passive torque to the hip joint. Hip motion was measured using an electromagnetic tracking device. The strained ligaments were captured on clear photographs. Significantly, high strains were imposed on the superior iliofemoral ligament by external rotation of the hip (3.48%); on the inferior iliofemoral ligament by maximal extension and 10° or 20° of external rotation with maximal extension (1.86%, 1.46%, 1.25%); on the pubofemoral ligament by maximal abduction and 10°, 20°, or 30° of external rotation with maximal abduction (3.18%, 3.28%, 3.11%, 2.99%); and on the ischiofemoral ligament by 10° or 20° of abduction with maximal internal rotation (7.11%, 7.83%). Fiber direction in each ligament was clearly identified. Significantly, high strains on hip ligaments corresponded with the anatomical direction of the ligament fibers. Positions were identified for each ligament that imposed maximal increase in strain on it.

  13. Advanced imaging of the scapholunate ligamentous complex.

    Science.gov (United States)

    Shahabpour, Maryam; Staelens, Barbara; Van Overstraeten, Luc; De Maeseneer, Michel; Boulet, Cedric; De Mey, Johan; Scheerlinck, Thierry

    2015-12-01

    The scapholunate joint is one of the most involved in wrist injuries. Its stability depends on primary and secondary stabilisers forming together the scapholunate complex. This ligamentous complex is often evaluated by wrist arthroscopy. To avoid surgery as diagnostic procedure, optimization of MR imaging parameters as use of three-dimensional (3D) sequences with very thin slices and high spatial resolution, is needed to detect lesions of the intrinsic and extrinsic ligaments of the scapholunate complex. The paper reviews the literature on imaging of radial-sided carpal ligaments with advanced computed tomographic arthrography (CTA) and magnetic resonance arthrography (MRA) to evaluate the scapholunate complex. Anatomy and pathology of the ligamentous complex are described and illustrated with CTA, MRA and corresponding arthroscopy. Sprains, mid-substance tears, avulsions and fibrous infiltrations of carpal ligaments could be identified on CTA and MRA images using 3D fat-saturated PD and 3D DESS (dual echo with steady-state precession) sequences with 0.5-mm-thick slices. Imaging signs of scapholunate complex pathology include: discontinuity, nonvisualization, changes in signal intensity, contrast extravasation (MRA), contour irregularity and waviness and periligamentous infiltration by edema, granulation tissue or fibrosis. Based on this preliminary experience, we believe that 3 T MRA using 3D sequences with 0.5-mm-thick slices and multiplanar reconstructions is capable to evaluate the scapholunate complex and could help to reduce the number of diagnostic arthroscopies.

  14. Advanced imaging of the scapholunate ligamentous complex

    Energy Technology Data Exchange (ETDEWEB)

    Shahabpour, Maryam; Maeseneer, Michel de; Boulet, Cedric; Mey, Johan de [Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Brussels (Belgium); Staelens, Barbara; Scheerlinck, Thierry [Universitair Ziekenhuis Brussel (UZ Brussel), Department of Orthopaedics and Traumatology, Brussels (Belgium); Overstraeten, Luc van [Hand and Foot Surgery Unit (HFSU), Tournai (Belgium)

    2015-12-15

    The scapholunate joint is one of the most involved in wrist injuries. Its stability depends on primary and secondary stabilisers forming together the scapholunate complex. This ligamentous complex is often evaluated by wrist arthroscopy. To avoid surgery as diagnostic procedure, optimization of MR imaging parameters as use of three-dimensional (3D) sequences with very thin slices and high spatial resolution, is needed to detect lesions of the intrinsic and extrinsic ligaments of the scapholunate complex. The paper reviews the literature on imaging of radial-sided carpal ligaments with advanced computed tomographic arthrography (CTA) and magnetic resonance arthrography (MRA) to evaluate the scapholunate complex. Anatomy and pathology of the ligamentous complex are described and illustrated with CTA, MRA and corresponding arthroscopy. Sprains, mid-substance tears, avulsions and fibrous infiltrations of carpal ligaments could be identified on CTA and MRA images using 3D fat-saturated PD and 3D DESS (dual echo with steady-state precession) sequences with 0.5-mm-thick slices. Imaging signs of scapholunate complex pathology include: discontinuity, nonvisualization, changes in signal intensity, contrast extravasation (MRA), contour irregularity and waviness and periligamentous infiltration by edema, granulation tissue or fibrosis. Based on this preliminary experience, we believe that 3 T MRA using 3D sequences with 0.5-mm-thick slices and multiplanar reconstructions is capable to evaluate the scapholunate complex and could help to reduce the number of diagnostic arthroscopies. (orig.)

  15. Design, modelling and simulation aspects of an ankle rehabilitation device

    Science.gov (United States)

    Racu, C. M.; Doroftei, I.

    2016-08-01

    Ankle injuries are amongst the most common injuries of the lower limb. Besides initial treatment, rehabilitation of the patients plays a crucial role for future activities and proper functionality of the foot. Traditionally, ankle injuries are rehabilitated via physiotherapy, using simple equipment like elastic bands and rollers, requiring intensive efforts of therapists and patients. Thus, the need of robotic devices emerges. In this paper, the design concept and some modelling and simulation aspects of a novel ankle rehabilitation device are presented.

  16. Assessment and management of patients with ankle injuries.

    Science.gov (United States)

    Walker, Jennie

    2014-08-19

    Foot and ankle injuries are common and can have a significant effect on an individual's daily activities. Nurses have an important role in the assessment, management, ongoing care and support of patients with ankle injuries. An understanding of the anatomy and physiology of the ankle enables nurses to identify significant injuries, which may result in serious complications, and communicate effectively with the multidisciplinary team to improve patient care and outcomes.

  17. Characteristics of bone tunnel changes after anterior cruciate ligament reconstruction using Ligament Advanced Reinforcement System artificial ligament

    Institute of Scientific and Technical Information of China (English)

    HUANG Jian-ming; LIU Hao-yuan; CHEN Feng-rong; JIAN Guo-jian; CHEN Qi; WANG Zi-min; KANG Yi-fan

    2012-01-01

    Background There are different materials used for anterior cruciate ligament(ACL)reconstruction.It has been reported that both autologous grafts and allografts used in ACL reconstruction can cause bone tunnel enlargement.This study aimed to observe the characteristics of bone tunnel changes and possible causative factors following ACL reconstruction using Ligament Advanced Reinforcement System(LARS)artificial ligament.Methods Forty-three patients underwent ACL reconstruction using LARS artificial ligament and were followed up for 3 years.X-ray and CT examinations were performed at 1,3,6,12,24,and 36 months after surgery,to measure the width of tibial and femoral tunnels.Knee function was evaluated according to the Lysholm scoring system.The anterior and posterior stability of the knee was measured using the KT-1000 arthrometer.Results According to the Peyrache grading method,grade 1 femoral bone tunnel enlargement was observed in three cases six months after surgery.No grade 2 or grade 3 bone tunnel enlargement was found.The bone tunnel enlargement in the three cases was close to the articular surface with an average tunnel enlargement of(2.5±0.3)mm.Forty cases were evaluated as grade 0.The average tibial and femoral tunnel enlargements at the last follow-up were(0.8±0.3)and(1.1±0.3)mm,respectively.There was no statistically significant difference in bone tunnel width changes at different time points(P>0.05).X-ray and CT measurements were consistent.Conclusions There was no marked bone tunnel enlargement immediately following ACL reconstruction using LARS artificial ligament.Such enlargement may,however,result from varying grafting factors involving the LARS artificial ligament or from different fixation methods.

  18. Bone-patellar tendon-bone autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Pan, Xiaoyun; Wen, Hong; Wang, Lide; Ge, Tichi

    2013-10-01

    The optimized graft for use in anterior cruciate ligament (ACL) reconstruction is still in controversy. The bone-patellar tendon-bone (BPTB) autograft has been accepted as the gold standard for ACL reconstruction. However, donor site morbidities cannot be avoided after this treatment. The artificial ligament of ligament advanced reinforcement system (LARS) has been recommended for ACL reconstruction. The purpose of this study is to compare the midterm outcome of ACL reconstruction using BPTB autografts or LARS ligaments. Between July 2004 and March 2006, the ACL reconstruction using BPTB autografts in 30 patients and LARS ligaments in 32 patients was performed. All patients were followed up for at least 4 years and evaluated using the Lysholm knee score, Tegner score, International Knee Documentation Committee (IKDC) score, and KT-1000 arthrometer test. There were no significant differences between the two groups with respect to the data of Lysholm scores, Tegner scores, IKDC scores, and KT-1000 arthrometer test at the latest follow-up. Our study demonstrates that the similarly good clinical results are obtained after ACL reconstruction using BPTB autografts or LARS ligaments at midterm follow-up. In addition to BPTB autografts, the LARS ligament may be a satisfactory treatment option for ACL rupture.

  19. Benign and malignant tumors of the foot and ankle

    Energy Technology Data Exchange (ETDEWEB)

    Singer, Adam D.; Datir, Abhijit; Langley, Travis [Emory University Hospital, Department of Radiology, Section of Musculoskeletal Imaging, Atlanta, GA (United States); Tresley, Jonathan [University of Wisconsin, Department of Radiology, Madison, WI (United States); Clifford, Paul D.; Jose, Jean; Subhawong, Ty K. [University of Miami, Department of Radiology, Miami, FL (United States)

    2016-03-15

    Pain and focal masses in the foot and ankle are frequently encountered and often initiate a workup including imaging. It is important to differentiate benign lesions from aggressive benign or malignant lesions. In this review, multiple examples of osseous and soft tissue tumors of the foot and ankle will be presented. Additionally, the compartmental anatomy of the foot and ankle will be discussed in terms of its relevance for percutaneous biopsy planning and eventual surgery. Finally, a general overview of the surgical management of benign, benign aggressive and malignant tumors of the foot and ankle will be discussed. (orig.)

  20. Energetics and passive dynamics of the ankle in downhill walking.

    Science.gov (United States)

    Holm, Jonathan K; Contakos, Jonas; Lee, Sang-Wook; Jang, John

    2010-11-01

    This study investigated the energetics of the human ankle during the stance phase of downhill walking with the goal of modeling ankle behavior with a passive spring and damper mechanism. Kinematic and kinetic data were collected on eight male participants while walking down a ramp with inclination varying from 0° to 8°. The ankle joint moment in the sagittal plane was calculated using inverse dynamics. Mechanical energy injected or dissipated at the ankle joint was computed by integrating the power across the duration of the stance phase. The net mechanical energy of the ankle was approximately zero for level walking and monotonically decreased (i.e., became increasingly negative) during downhill walking as the slope decreased. The indication is that the behavior of the ankle is energetically passive during downhill walking, playing a key role in dissipating energy from one step to the next. A passive mechanical model consisting of a pin joint coupled with a revolute spring and damper was fit to the ankle torque and its parameters were estimated for each downhill slope using linear regression. The passive model demonstrated good agreement with actual ankle dynamics as indicated by low root-mean-square error values. These results indicate the stance phase behavior of the human ankle during downhill walking may be effectively duplicated by a passive mechanism with appropriately selected spring and damping characteristics.

  1. Subtalar Fusion Rate in Patients With Previous Ipsilateral Ankle Arthrodesis.

    Science.gov (United States)

    Zanolli, Diego H; Nunley, James A; Easley, Mark E

    2015-09-01

    Isolated subtalar arthrodesis is generally successful, with reported fusion rates of 84% to 100%. However, alteration of subtalar joint mechanics and talar body vasculature after ankle fusion may negatively influence subsequent ipsilateral subtalar joint fusion. Because there is very limited information on the subtalar fusion rate in patients with previous ipsilateral ankle fusion, the purpose of this study was to describe fusion rates in subtalar joint arthrodesis with and without preexisting ankle fusion in a large consecutive series of primary subtalar arthrodesis cases. All primary subtalar fusions performed between January 2000 and December 2010 were reviewed. Thirteen of 151 consecutive cases were in patients with existing ipsilateral ankle fusions. All patients were evaluated for clinical and radiographic evidence of nonunion at follow-up, and fusion rates in the groups with and without previous ipsilateral ankle fusion were compared. Five nonunions occurred in the 13 cases with prior ipsilateral ankle arthrodesis, a 61.5% fusion rate. Twelve nonunions were identified in the 138 cases without prior ankle arthrodesis, a significantly higher fusion rate of 91.3% (P = .007). In our series, the subtalar fusion rate in patients with previous ipsilateral ankle arthrodesis was significantly lower than that for subtalar arthrodesis in the absence of ipsilateral ankle arthrodesis. Level III, retrospective comparative study. © The Author(s) 2015.

  2. 针刺健侧太溪穴治疗急性踝关节外侧副韧带损伤的对照观察%Control observation on treatment of acute ankle joint lateral collateral ligament injury by acupuncture at Taixi (KI 3) point of the healthy side

    Institute of Scientific and Technical Information of China (English)

    魏北星; 金春兰; 陈文琴

    2004-01-01

    目的:探讨巨刺法对急性踝关节外侧副韧带损伤的治疗作用.方法:将67例患者随机分为针刺组和对照组,针刺组针刺健侧太溪穴,对照组患处外用关节止痛膏、正骨水.结果:针刺组治愈30例,占81.1%,平均治疗时间2.1±0.8天;对照组治愈15例,占50.0%,平均治疗时间7.5±2.3天.疼痛消失时间针刺组2.5±1.5天,对照组8.3±2.1天.经统计学处理,P<0.01.结论:针刺健侧太溪穴治疗急性踝关节外侧副韧带损伤疗效确切.

  3. EFFICACY OF WEIGHT BEARING DISTAL TIBIOFIBULAR JOINT MOBILIZATION WITH MOVEMENT (MWM IN IMPROVING PAIN, DORSIFLEXION RANGE AND FUNCTION IN PATIENTS WITH POSTACUTE LATERAL ANKLE SPRAIN

    Directory of Open Access Journals (Sweden)

    Kumari Nisha

    2014-06-01

    Full Text Available Background: Various treatments in physiotherapy are available for ankle sprain with no consensus like taping, bracing, splinting, cryotherapy, electrotherapy modality like ultrasound, laser therapy, interferential therapy and HVGS, joint mobilization. Mulligan’s mobilizations-with movement (MWM have been proposed as novel manual therapy technique to improve joint ROM by combining physiological and accessory joint movements. He developed a suite of treatment techniques on the basis of his theory of positional faults and altered joint kinematics following injuries affecting spinal and peripheral joints. Objective: To find out the efficacy of distal tibiofibular joint MWM in conjunction with conventional treatment over conventional treatment alone for improving pain , dorsiflexion range and lower extremity function in patients with post acute lateral ankle sprain. Subject and methods: 30 lateral ankle sprain subjects were randomized into 2 groups:- Group 1(n=15 were received distal tibiofibular joint MWM along with conventional treatment and Group 2 (n=15 subjects were received conventional treatment only. Treatment consist of 3 sessions spread over 1 week, each session 48 hours apart and data is recorded at beginning and end of treatment regimen. Results: Independent t-test showed statistical significant improvement in only weight bearing lunge measure for dorsiflexion (p=0.008 in group 1 over group 2 and paired t-test was used for within group analysis which showed significant improvement in both the groups in all the outcome variables (p=0.000 Discussion and conclusion: Both the groups demonstrated significant improvement in pain, range and lower extremity function in lateral ankle sprain and distal tibiofibular joint mobilization with movement in conjunction with conventional treatment will be significantly more effective than conventional treatment alone in improving weight bearing ankle dorsiflexion range (Weight bearing lunge measure in

  4. Surgical treatment of anterior cruciate ligament injury in adults.

    Science.gov (United States)

    Alazzawi, Sulaiman; Sukeik, Mohamed; Ibrahim, Mazin; Haddad, Fares S

    2016-04-01

    Anterior cruciate ligament injury is among the most common soft tissue injuries of the knee joint and reconstruction of the anterior cruciate ligament is the gold standard treatment for young active symptomatic patients. This review summarizes the surgical treatment of anterior cruciate ligament injury.

  5. The influence of high-heeled shoes on strain and tension force of the anterior talofibular ligament and plantar fascia during balanced standing and walking.

    Science.gov (United States)

    Yu, Jia; Wong, Duo Wai-Chi; Zhang, Hongtao; Luo, Zong-Ping; Zhang, Ming

    2016-10-01

    High-heeled shoes have the capability to alter the strain and tension of ligamentous structures between the foot and ankle, which may result in ankle instability. However, high-heeled shoes can also reduce the strain on plantar fascia, which may be beneficial for the treatment of plantar fasciitis. In this study, the influence of heel height on strain and tension force applied to the anterior talofibular ligament (ATL) and plantar fascia were investigated. A three-dimensional finite element model of coupled foot-ankle-shoe complex was constructed. Four heel heights were studied in balanced standing: 0 in. (0cm), 1 in. (2.54cm), 2 in. (5.08cm), and 3 in. (7.62cm). A walking analysis was performed using 2-in. (5.08cm) high-heeled shoes. During balanced standing, the tension force on the ATL increased from 14.8N to 97.0N, with a six-fold increase in strain from 0 in. to 3 in. (0-7.62cm). The tension force and the average strain on the plantar fascia decreased from 151.0N (strain: 0.74%) to 59.6N (strain: 0.28%) when the heel height increased from 0 in. to 2 in. (0-5.08cm). When heel height reached 3 in. (7.62cm), the force and average strain increased to 278.3N (strain: 1.33%). The walking simulation showed that the fascia stretched out while the ATL loading decreased during push off. The simulation outcome demonstrated the influence of heel height on ATL alteration and plantar fascia strain, which implies risks for ankle injury and suggests guidance for the treatment of plantar fasciitis.

  6. Negative pressure wound therapy for soft tissue injuries around the foot and ankle

    Directory of Open Access Journals (Sweden)

    Oh Jong-Keon

    2009-05-01

    Full Text Available Abstract Background This study was performed to evaluate the results of negative pressure wound therapy (NPWT in patients with open wounds in the foot and ankle region. Materials and methods Using a NPWT device, 16 patients were prospectively treated for soft tissue injuries around the foot and ankle. Mean patient age was 32.8 years (range, 3–67 years. All patients had suffered an acute trauma, due to a traffic accident, a fall, or a crush injury, and all had wounds with underlying tendon or bone exposure. Necrotic tissues were debrided before applying NPWT. Dressings were changed every 3 or 4 days and treatment was continued for 18.4 days on average (range, 11–29 days. Results Exposed tendons and bone were successfully covered with healthy granulation tissue in all cases except one. The sizes of soft tissue defects reduced from 56.4 cm2 to 42.9 cm2 after NPWT (mean decrease of 24%. In 15 of the 16 cases, coverage with granulation tissue was achieved and followed by a skin graft. A free flap was needed to cover exposed bone and tendon in one case. No major complication occurred that was directly attributable to treatment. In terms of minor complications, two patients suffered scar contracture of grafted skin. Conclusion NPWT was found to facilitate the rapid formation of healthy granulation tissue on open wounds in the foot and ankle region, and thus, to shorten healing time and minimize secondary soft tissue defect coverage procedures.

  7. Physiotherapy Treatment in Patients with Hemophilia and Chronic Ankle Arthropathy: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Rubén Cuesta-Barriuso

    2013-01-01

    Full Text Available Haemophilic arthropathy of the ankle causes pain and deterioration in gait, causing disability. Although some physiotherapy modalities are effective in the management of acute bleeding, the results are unknown in chronic arthropathy. Our objective was to determine the most effective physiotherapy procedures for treating the haemophilic arthropathy of the ankle and to assess the methodological quality of the studies. A systematic review was carried out in the Cochrane Database, PubMed, MEDLINE, ISI Web of Knowledge, PEDro, TESEO, and specialized journals (Haemophilia and Haematologica. It included articles with at least one group undergoing any kind of physiotherapy treatment and with pretest and posttest evaluation, published before April 2013. An analysis of variables was performed and assessed the methodological quality of studies. Five studies met the criteria for inclusion. Hydrotherapy treatments, strength training and balance strength, balance training, and sports therapy, have improved range of movement, pain, balance, and subjective physical performance. The proposed methodological analysis was not possible due to the low quality of the studies. Although the results are positive, they lack rigorous evidence on the effects of treatments. Studies are needed to establish the efficacy of the various forms of physiotherapy in the haemophilic arthropathy of the ankle.

  8. Comparison of total ankle replacement and ankle arthrodesis in patients with haemophilia using gait analysis: two case reports

    OpenAIRE

    Dauty, Marc; Gross, Raphael; Leboeuf, Fabien; Trossaert, Marc

    2015-01-01

    Background Severe hemophilia is an inherited, lifelong bleeding disorder characterized by spontaneous bleeding, which results in painful joint deformities. Currently two surgical treatments are available to treat haemophilia-related ankle joint destruction: ankle arthrodesis and total ankle replacement. The aim of the present study was to compare these two surgical procedures in haemophiliac subjects. Case presentation Kinematic and dynamic parameters were quantified using a three-dimensional...

  9. Is End-Stage Ankle Arthrosis Best Managed with Total Ankle Replacement or Arthrodesis? A Systematic Review

    OpenAIRE

    Jordan, Robert W.; Chahal, Gurdip S.; Anna Chapman

    2014-01-01

    Introduction. End-stage ankle osteoarthritis is a debilitating condition. Traditionally, ankle arthrodesis (AA) has been the surgical intervention of choice but the emergence of total ankle replacement (TAR) has challenged this concept. This systematic review aims to address whether TAR or AA is optimal in terms of functional outcomes. Methods. We conducted a systematic review according to PRISMA checklist using the online databases Medline and EMBASE after January 1, 2005. Participants must ...

  10. Macroscopic and microscopic analysis of the thumb carpometacarpal ligaments: a cadaveric study of ligament anatomy and histology.

    Science.gov (United States)

    Ladd, Amy L; Lee, Julia; Hagert, Elisabet

    2012-08-15

    Stability and mobility represent the paradoxical demands of the human thumb carpometacarpal joint, yet the structural origin of each functional demand is poorly defined. As many as sixteen and as few as four ligaments have been described as primary stabilizers, but controversy exists as to which ligaments are most important. We hypothesized that a comparative macroscopic and microscopic analysis of the ligaments of the thumb carpometacarpal joint would further define their role in joint stability. Thirty cadaveric hands (ten fresh-frozen and twenty embalmed) from nineteen cadavers (eight female and eleven male; average age at the time of death, seventy-six years) were dissected, and the supporting ligaments of the thumb carpometacarpal joint were identified. Ligament width, length, and thickness were recorded for morphometric analysis and were compared with use of the Student t test. The dorsal and volar ligaments were excised from the fresh-frozen specimens and were stained with use of a triple-staining immunofluorescent technique and underwent semiquantitative analysis of sensory innervation; half of these specimens were additionally analyzed for histomorphometric data. Mixed-effects linear regression was used to estimate differences between ligaments. Seven principal ligaments of the thumb carpometacarpal joint were identified: three dorsal deltoid-shaped ligaments (dorsal radial, dorsal central, posterior oblique), two volar ligaments (anterior oblique and ulnar collateral), and two ulnar ligaments (dorsal trapeziometacarpal and intermetacarpal). The dorsal ligaments were significantly thicker (p histologic appearance of capsular tissue with low cellularity. The dorsal deltoid ligament complex is uniformly stout and robust; this ligament complex is the thickest morphometrically, has the highest cellularity histologically, and shows the greatest degree of sensory nerve endings. The hypocellular anterior oblique ligament is thin, is variable in its location, and

  11. Tissue engineering of ligaments for reconstructive surgery.

    Science.gov (United States)

    Hogan, MaCalus V; Kawakami, Yohei; Murawski, Christopher D; Fu, Freddie H

    2015-05-01

    The use of musculoskeletal bioengineering and regenerative medicine applications in orthopaedic surgery has continued to evolve. The aim of this systematic review was to address tissue-engineering strategies for knee ligament reconstruction. A systematic review of PubMed/Medline using the terms "knee AND ligament" AND "tissue engineering" OR "regenerative medicine" was performed. Two authors performed the search, independently assessed the studies for inclusion, and extracted the data for inclusion in the review. Both preclinical and clinical studies were reviewed, and the articles deemed most relevant were included in this article to provide relevant basic science and recent clinical translational knowledge concerning "tissue-engineering" strategies currently used in knee ligament reconstruction. A total of 224 articles were reviewed in our initial PubMed search. Non-English-language studies were excluded. Clinical and preclinical studies were identified, and those with a focus on knee ligament tissue-engineering strategies including stem cell-based therapies, growth factor administration, hybrid biomaterial, and scaffold development, as well as mechanical stimulation modalities, were reviewed. The body of knowledge surrounding tissue-engineering strategies for ligament reconstruction continues to expand. Presently, various tissue-engineering techniques have some potential advantages, including faster recovery, better ligamentization, and possibly, a reduction of recurrence. Preclinical research of these novel therapies continues to provide promising results. There remains a need for well-designed, high-powered comparative clinical studies to serve as a foundation for successful translation into the clinical setting going forward. Level IV, systematic review of Level IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  12. Nerve growth factor improves ligament healing.

    Science.gov (United States)

    Mammoto, Takeo; Seerattan, Ruth A; Paulson, Kent D; Leonard, Catherine A; Bray, Robert C; Salo, Paul T

    2008-07-01

    Previous work has shown that innervation participates in normal ligament healing. The present study was performed to determine if exogenous nerve growth factor (NGF) would improve the healing of injured ligament by promoting reinnervation, blood flow, and angiogenesis. Two groups of 30 Sprague-Dawley rats underwent unilateral medial collateral ligament transection (MCL). One group was given 10 microg NGF and the other was given PBS via osmotic pump over 7 days after injury. After 7, 14, and 42 days, in vivo blood flow was measured using laser speckle perfusion imaging (LSPI). Morphologic assessments of nerve density, vascularity, and angiogenesis inhibitor production were done in three animals at each time point by immunohistochemical staining for the pan-neuronal marker PGP9.5, the endothelial marker vWF, and the angiogenesis inhibitor thrombospondin-2 (TSP-2). Ligament scar material and structural mechanical properties were assessed in seven rats at each time point. Increased nerve density was promoted by NGF at both 14 and 42 days. Exposure to NGF also led to increased ligament vascularity, as measured by histologic assessment of vWF immunohistochemistry, although LSPI-measured blood flow was not significantly different from controls. NGF treatment also led to decreased expression of TSP-2 at 14 days. Mechanical testing revealed that exposure to NGF increased failure load by 40%, ultimate tensile strength by 55%, and stiffness by 30% at 42 days. There were no detectable differences between groups in creep properties. The results suggest that local application of NGF can improve ligament healing by promoting both reinnervation and angiogenesis, and results in scars with enhanced mechanical properties.

  13. Injuries of the scapholunate ligament in children.

    Science.gov (United States)

    Alt, Volker; Gasnier, Jacky; Sicre, Gérard

    2004-09-01

    Wrist arthroscopy was performed in three children (9, 11 and 12 years old) after persisting pain over the dorsal scapholunate region and revealed intraligamentous tear of the scapholunate ligament in two cases and its avulsion from the scaphoid border in one case. Open surgical repair of all lesions was performed after arthroscopy during the same session. After an average follow-up of 2.4 years all patients were pain free and resumed all sports activities. This study shows that different kind of injuries can occur to the scapholunate ligament in the skeletally immature carpus. Surgical repair leads to good results.

  14. Biological fixation in anterior cruciate ligament surgery

    Directory of Open Access Journals (Sweden)

    Chih-Hwa Chen

    2014-04-01

    Full Text Available Successful anterior cruciate ligament (ACL reconstruction with tendon graft requires extensive tendon-to-bone healing in the bone tunnels and progressive graft ligamentization for biological, structural, and functional recovery of the ACL. Improvement in graft-to-bone healing is crucial for facilitating early, aggressive rehabilitation after surgery to ensure an early return to pre-injury activity levels. The use of various biomaterials for enhancing the healing of tendon grafts in bone tunnels has been developed. With the biological enhancement of tendon-to-bone healing, biological fixation of the tendon graft in the tunnel can be achieved in ACL reconstruction.

  15. Avulsion fracture of the posterior cruciate ligament in an uncommon location associated with distal injury to the patellar ligament

    Directory of Open Access Journals (Sweden)

    Rodrigo Pires e Albuquerque

    2015-12-01

    Full Text Available ABSTRACT Avulsion fractures of the posterior cruciate ligament in unusual locations are rare injuries. We report the first case in the literature of an avulsion fracture of the posterior cruciate ligament associated with distal injury to the patellar ligament. The aim of this study was to present a novel case, the therapy used and the clinical follow-up.

  16. Total ankle prostheses in rheumatoid arthropathy

    Science.gov (United States)

    Schutte, Bernard; Louwerens, Jan Willem K; van den Hoogen, Frank H J; de Waal Malefijt, Maarten C

    2009-01-01

    Background and purpose The first generations of total ankle replacements (TARs) showed a high rate of early failure. In the last decades, much progress has been made in the development of TARs, with the newer generation showing better results. We evaluated TARs implanted with rheumatoid arthritis (RA) or juvenile inflammatory arthritis (JIA) as indication. Patients and methods 58 total ankle prostheses (Buechel-Pappas and STAR type) were implanted in patients with RA (n = 53) or JIA (n = 5) in 54 patients (4 bilateral). After a mean follow-up of 2.7 (1–9) years, all patients were reviewed by two orthopedic surgeons who were not the surgeons who performed the operation. Standard AP and lateral radiographs were taken and a Kofoed ankle score was obtained; this is a clinical score ranging from 0–100 and consists of sub-scores for pain, disability, and range of motion. Results 2 patients died of unrelated causes. Of the 52 patients who were alive (56 prostheses), 51 implants were still in place and showed no signs of loosening on the most recent radiographs. The mean Kofoed score at follow-up was 73 points (SD 16, range 21–92). 4 patients showed a poor result (score < 50) with persistent pain for which no obvious reason could be found. 5 implants were removed, 4 because of infection and 1 because of aseptic loosening. Interpretation Medium-term results of the STAR and BP types of TAR in RA were satisfactory. The main reason for failure of the implant was infection. PMID:19634020

  17. 10-year survival of total ankle arthroplasties

    Science.gov (United States)

    2011-01-01

    Background and purpose There is an ongoing need to review large series of total ankle replacements (TARs) for monitoring of changes in practice and their outcome. 4 national registries, including the Swedish Ankle Register, have previously reported their 5-year results. We now present an extended series with a longer follow-up, and with a 10-year survival analysis. Patients and methods Records of uncemented 3-component TARs were retrospectively reviewed, determining risk factors such as age, sex, and diagnosis. Prosthetic survival rates were calculated with exchange or removal of components as endpoint—excluding incidental exchange of the polyethylene meniscus. Results Of the 780 prostheses implanted since 1993, 168 (22%) had been revised by June 15, 2010. The overall survival rate fell from 0.81 (95% CI: 0.79–0.83) at 5 years to 0.69 (95% CI: 0.67–0.71) at 10 years. The survival rate was higher, although not statistically significantly so, during the latter part of the period investigated. Excluding the STAR prosthesis, the survival rate for all the remaining designs was 0.78 at 10 years. Women below the age of 60 with osteoarthritis were at a higher risk of revision, but age did not influence the outcome in men or women with rheumatoid arthritis. Revisions due to technical mistakes at the index surgery and instability were undertaken earlier than revisions for other reasons. Interpretation The results have slowly improved during the 18-year period investigated. However, we do not believe that the survival rates of ankle replacements in the near future will approach those of hip and knee replacements—even though improved instrumentation and design of the prostheses, together with better patient selection, will presumably give better results. PMID:22066551

  18. Tendinopathies of the foot and ankle.

    Science.gov (United States)

    Simpson, Michael R; Howard, Thomas M

    2009-11-15

    Because our understanding of tendinopathy has evolved in recent years, the condition is now considered a degenerative process; this affects the approach to treatment. Initial therapy should always involve relative rest and modification of physical activity, use of rehabilitative exercises, and evaluation of intrinsic and extrinsic causes of injury. The posterior tibial tendon is a dynamic arch stabilizer; injury to this tendon can cause a painful flat-footed deformity with hindfoot valgus and midfoot abduction (characterized by the too many toes sign). Treatment of posterior tibial tendinopathy is determined by its severity and can include immobilization, orthotics, physical therapy, or subspecialty referral. Because peroneal tendinopathy is often misdiagnosed, it can lead to chronic lateral ankle pain and instability and should be suspected in a patient with either of these symptoms. Treatment involves physical therapy and close monitoring for surgical indications. Achilles tendinopathy is often caused by overtraining, use of inappropriate training surfaces, and poor flexibility. It is characterized by pain in the Achilles tendon 4 to 6 cm above the point of insertion into the calcaneus. Evidence from clinical trials shows that eccentric strengthening of the calf muscle can help patients with Achilles tendinopathy. Flexor hallucis longus tendinopathy is most common among ballet dancers. Patients may complain of an insidious onset of pain in the posteromedial aspect of the ankle; treatment involves correcting physical training errors, focusing on body mechanics, and strengthening the body's core. Anterior tibial tendinopathy is rare, but is typically seen in patients older than 45 years. It causes weakness in dorsiflexion of the ankle; treatment involves short-term immobilization and physical therapy.

  19. Evaluation and treatment of posterior cruciate ligament injuries: revisited.

    Science.gov (United States)

    Wind, William M; Bergfeld, John A; Parker, Richard D

    2004-01-01

    Current knowledge and treatment of posterior cruciate ligament injuries continue to lag behind that of anterior cruciate ligament injuries. This is the result of the relative infrequency of posterior cruciate ligament injuries and the lack of consensus with respect to its natural history, surgical indications, technique, and postoperative rehabilitation. Recent anatomical and biomechanical studies have improved our understanding of the posterior cruciate ligament in an attempt to reproduce its anatomy and function during reconstruction. The following is a comprehensive review on the evaluation and treatment of posterior cruciate ligament injuries with special focus on the current surgical techniques.

  20. Imaging study of ankle injury in professional soccer player of males%男性职业足球运动员踝关节损伤影像学特征分析

    Institute of Scientific and Technical Information of China (English)

    李绍林; 赵文吉; 郝帅; 胡绍勇; 张锐; 张鑫涛

    2015-01-01

    Objective To analyze the imaging abnormal findings of ankle injuries in professional soccer player of males.Methods The thirty-two professional soccer players in local region soccer club had been selected as research objects from March 2014 to January 2015,and all were men.Average age was 22.03 + 3.0 years old (19-33 years);the average age was 8.6 + 2.0 years old that began to engage in professional football training,and average time of engaged in football sports was 13 ±+4 years(7-27 years).X-ray examination was used VM DR (Philips Co.),anteroposterior and lateral position of ankle joints.CT scan was used MSCT of 64 rows detector(Aquilion 64,TOSHIBA Co.).After routine scan,raw data was transmitted to the workstation and then reconstructed to be axial,sagittal,coronal imaging.MR examination was used 1.5 T superconducting equipment system(Achieva Dual,Philips Co.) and with ankle joint special phased array coil.TSE sequence be used to scan routine axial T2-weighted imaging;coronal T1-weighted imaging;coronal PWI;and sagittal T2-weighted imaging with fat suppressed.The sagittal PWI scan was used with Isotropic with fat suppressed FFE sequence.Results The X-ray examination was finished for 28 person and 51 ankle joints.26 person and 52 ankle joints were completed CT scan and reconstructed imaging for all joints.MR examination was finished in 30 person and 51 ankle joints.On X-ray and CT display that the abnormal changes of the talus is most commonly found that the incidence of "dolphin mouth" like protrusion at posterior edge was 35 ankles (rate of occurrence was 68.6%),the triangle prominence at out edge was 45 ankles (rate of occurrence was 88.2%).It also was found that 8 lateral malleolus have osteophytes,5 ankles have medial malleolus osteophytes and 12 ankles have loose bodies at posterior ankle.MRI showed that 30 ankles were the anterior talofibular ligaments injury and incidence was 58.82%,26 ankles were posterior talofibular ligaments injury (incidence

  1. Could failure of the spring ligament complex be the driving force behind the development of the adult flatfoot deformity?

    Science.gov (United States)

    Williams, Geraint; Widnall, James; Evans, Paul; Platt, Simon

    2014-01-01

    We conducted an investigation into the relative associations of magnetic resonance imaging (MRI)-defined pathologic features of the spring ligament and/or tibialis posterior tendon with radiographic evidence of a planovalgus foot position. A total of 161 patient images (MRI and plain radiographs) obtained from the foot and ankle clinic (2008 to 2011) were retrospectively reviewed. All 161 patients (64 male and 97 female; mean age 45.9 years, range 18 to 86) were included in the analysis. Lateral weightbearing radiographs were analyzed for the talo-first metatarsal angle ≥ 5°, calcaneal pitch ≤ 20°, and talocalcaneal angle ≥ 45°. A positive finding for ≥ 1 measurements identified a radiographic planovalgus position of the foot. The radiographic deformity was analyzed against the MRI evidence of either spring ligament or tibialis posterior tendon pathologic features for significance (p < .05). Evidence of a spring ligament abnormality was strongly associated with a planovalgus foot position, reaching high levels of statistical significance in all 3 categories of radiographic deformity (odds ratio 9.2, p < .0001). Abnormalities of the tibialis posterior tendon failed to demonstrate significance, unless grade I changes were excluded, and grade II and III appearances were analyzed in isolation (odds ratio 2.9, p = .04). Although absolute causal relationships were not tested, this investigation has clearly demonstrated that MRI-defined abnormalities of the spring ligament complex are possibly of at least equal importance to tibialis posterior dysfunction for the presence of a moderate to severe radiographic planovalgus foot position.

  2. Robotic Ankle for Omnidirectional Rock Anchors

    Science.gov (United States)

    Parness, Aaron; Frost, Matthew; Thatte, Nitish

    2013-01-01

    Future robotic exploration of near-Earth asteroids and the vertical and inverted rock walls of lava caves and cliff faces on Mars and other planetary bodies would require a method of gripping their rocky surfaces to allow mobility without gravitational assistance. In order to successfully navigate this terrain and drill for samples, the grippers must be able to produce anchoring forces in excess of 100 N. Additionally, the grippers must be able to support the inertial forces of a moving robot, as well gravitational forces for demonstrations on Earth. One possible solution would be to use microspine arrays to anchor to rock surfaces and provide the necessary load-bearing abilities for robotic exploration of asteroids. Microspine arrays comprise dozens of small steel hooks supported on individual suspensions. When these arrays are dragged along a rock surface, the steel hooks engage with asperities and holes on the surface. The suspensions allow for individual hooks to engage with asperities while the remaining hooks continue to drag along the surface. This ensures that the maximum possible number of hooks engage with the surface, thereby increasing the load-bearing abilities of the gripper. Using the microspine array grippers described above as the end-effectors of a robot would allow it to traverse terrain previously unreachable by traditional wheeled robots. Furthermore, microspine-gripping robots that can perch on cliffs or rocky walls could enable a new class of persistent surveillance devices for military applications. In order to interface these microspine grippers with a legged robot, an ankle is needed that can robotically actuate the gripper, as well as allow it to conform to the large-scale irregularities in the rock. The anchor serves three main purposes: deploy and release the anchor, conform to roughness or misalignment with the surface, and cancel out any moments about the anchor that could cause unintentional detachment. The ankle design contains a

  3. A Survey of Parachute Ankle Brace Breakages

    Science.gov (United States)

    2008-01-10

    reduced since it was subject to abrasion from the concrete in the harness shed, asphalt on the loading ramp, and dirt on the drop zone. b. DJ...strap was also directly under the heel and subject to abrasion from concrete in the harness shed, asphalt on the loading ramp, and dirt on the drop...airborne injuries), airborne students who did not wear the brace were 1.90 times more likely to experience an ankle sprain, 1.47 times more likely to

  4. Charcot neuroarthropathy of the foot and ankle: a review.

    Science.gov (United States)

    Varma, Ajit Kumar

    2013-01-01

    Charcot neuroarthropathy is a limb-threatening, destructive process that occurs in patients with neuropathy associated with medical diseases such as diabetes mellitus. Clinicians' treating diabetic patients should be vigilant in recognizing the early signs of acute Charcot neuroarthropathy, such as pain, warmth, edema, or pathologic fracture in a neuropathic foot. Early detection and prompt treatment can prevent joint and bone destruction, which, if untreated, can lead to morbidity and high-level amputation. A high degree of suspicion is necessary. Once the early signs have been detected, prompt immobilization and offloading are important. Treatment should be determined on an individual basis, and it must be determined whether a patient can be treated conservatively or will require surgical intervention when entering the chronic phase. If diagnosed early, medical and conservative measures only will be required. Surgery is indicated for patients with severe or unstable deformities that, if untreated, will result in major amputations. A team approach that includes a foot and ankle surgeon, a diabetologist, a physiotherapist, a medical social councilor, and, most importantly, the patient and immediate family members is vital for successful management of this serious condition.

  5. Editorial Commentary: Renaissance of Primary Anterior Cruciate Ligament Repair: Is History Repeating Itself?

    Science.gov (United States)

    Hohmann, Erik

    2016-12-01

    In a comparative Level III study, Achtnich et al. compared suture anchor repair of acute proximal anterior cruciate ligament avulsion tears with single-bundle anterior cruciate ligament reconstruction with the quadrupled semitendinosus tendon. Short-term follow-up at a mean of 28 months showed that the between-group differences were not different. These results are encouraging but not different from other published series 25+ years ago. Only time will tell whether the long-term outcomes are identical and whether these techniques will also die a slow death. Hopefully history is not repeating itself. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  6. [Influence of Ankle Braces on the Prevalence of Ankle Inversion Injuries in the Swiss Volleyball National League A].

    Science.gov (United States)

    Jaggi, J; Kneubühler, S; Rogan, S

    2016-06-01

    Ankle inversion is a common injury among volleyball players. The injury rate during a game is 2.1 times higher than during training. As a result, the preventive use of ankle braces is frequently observed in Swiss volleyball leagues. Studies have shown that ankle braces have a preventive effect on the prevalence of ankle inversion. In Switzerland there has been no investigation into the preventive use of braces and their influence on prevalence. For this reason, the goals of this study are 1) to determine when, why and by whom ankle braces are worn and 2) to evaluate the injury rate of users and non-users of ankle braces. A modified questionnaire was sent to 18 men's and women's teams of the Swiss National League A. The questionnaire included questions about injury rates and the circumstances of ankle inversion injuries. The data were statistically analysed with Microsoft Excel 2012 and SPSS Version 20. The overall response rate was 61 %, allowing data from 181 players to be analysed. 33 % (59 of 181) of the players used an ankle brace. There was a statistically significant difference in the prevalence of ankle inversion between users (12 injured) and non-users (8 injured) (p = 0.006). Wearing an ankle brace during training or during a game made no difference in the prevention of injuries (p = 0.356). More athletes were injured during training (n = 13) than during a game (n = 7). The results of the present study indicate that volleyball players preferably wear ankle braces to prevent injury. More than one third of the players in the study wore an ankle brace, 60 % for primary prevention and 40 % for secondary prevention due to a previous injury. The study shows that significantly more users than non-users of ankle braces were injured. This is contrary to literature. Furthermore it was shown that more injuries occur during training than during a game. This finding results from the fact that ankle braces were rarely worn during training. It is

  7. Cruciate ligament loading during common knee rehabilitation exercises.

    Science.gov (United States)

    Escamilla, Rafael F; Macleod, Toran D; Wilk, Kevin E; Paulos, Lonnie; Andrews, James R

    2012-09-01

    Cruciate ligament injuries are common and may lead to dysfunction if not rehabilitated. Understanding how to progress anterior cruciate ligament and posterior cruciate ligament loading, early after injury or reconstruction, helps clinicians prescribe rehabilitation exercises in a safe manner to enhance recovery. Commonly prescribed therapeutic exercises include both weight-bearing exercise and non-weight-bearing exercise. This review was written to summarize and provide an update on the available literature on cruciate ligament loading during commonly used therapeutic exercises. In general, weight-bearing exercise produces smaller loads on the anterior cruciate ligament and posterior cruciate ligament compared with non-weight-bearing exercise. The anterior cruciate ligament is loaded less at higher knee angles (i.e. 50-100 degrees). Squatting and lunging with a more forward trunk tilt and moving the resistance pad proximally on the leg during the seated knee extension unloads the anterior cruciate ligament. The posterior cruciate ligament is less loaded at lower knee angles (i.e. 0-50 degrees), and may be progressed from level ground walking to a one-leg squat, lunges, wall squat, leg press, and the two-leg squat (from smallest to greatest). Exercise type and technique variation affect cruciate ligament loading, such that the clinician may prescribe therapeutic exercises to progress ligament loading safely, while ensuring optimal recovery of the musculoskeletal system.

  8. Revisiting the clinical anatomy of the alar ligaments.

    Science.gov (United States)

    Osmotherly, Peter G; Rivett, Darren A; Mercer, Susan R

    2013-01-01

    The morphology of the alar ligaments has been inconsistently described, particularly with regard to the existence of an atlantal portion. Despite these inconsistencies, these descriptions have been used to develop physical tests for the integrity of these ligaments in patients with cervical spine problems. The purpose of this study was to describe the detailed macrostructure of the alar ligaments. The alar ligaments of 11 cervical spine specimens from embalmed adult cadavers were examined by fine dissection. A detailed description of the macrostructure of these ligaments and their attachment sites was recorded. Measurements were performed with respect to ligament dimensions and relations with selected bony landmarks. No atlantal portion of the alar ligament was viewed in any specimen. The attachment of the ligaments on the odontoid process occurred on its lateral and posterolateral aspects, frequently below the level of the apex. The occipital attachment was on the medial surface of the occipital condyles in close proximity to the atlanto-occipital joints. The orientation of the ligaments was primarily horizontal. The presence of transverse bands extending occiput to occiput with minimal or no attachment to the odontoid process was a common variant. The absence of findings with respect to the atlantal portion of the alar ligament suggests that it may be considered an anatomical variant, not an essential component for stability of the craniocervical complex. These findings may inform the use and interpretation of clinical tests for alar ligament integrity.

  9. Mechanically induced ankle inversion during human walking and jumping.

    NARCIS (Netherlands)

    Nieuwenhuijzen, P.H.J.A.; Grüneberg, C.; Duysens, J.E.J.

    2002-01-01

    A new method to study sudden ankle inversions during human walking and jumping is presented. Ankle inversions of 25 degrees were elicited using a box containing a trap door. During the gait task, subjects walked at a speed of 4 km/h. At a pre-programmed delay after left heel strike, an electromagnet

  10. Hindfoot endoscopy for posterior ankle impingement. Surgical technique

    NARCIS (Netherlands)

    van Dijk, C.N.; de Leeuw, P.A.J.; Scholten, P.E.

    2009-01-01

    BACKGROUND: The surgical treatment of posterior ankle impingement is associated with a high rate of complications and a substantial time to recover. An endoscopic approach to the posterior ankle (hindfoot endoscopy) may lack these disadvantages. We hypothesized that hindfoot endoscopy causes less mo

  11. Dislocated ankle fracture complicated by near total distal ischaemia

    Science.gov (United States)

    Duygun, Fatih; Sertkaya, Omer; Aldemir, Cengiz; Dogan, Ali

    2013-01-01

    Total arterial ischaemia is rarely seen following a dislocated ankle fracture but if it does and intervention is not made, it can lead to serious morbidity. We present a 39-year-old woman with almost total occlusion in the arteria tibialis and arteria dorsalis pedis following a dislocated ankle fracture as a result of a bicycle fall. PMID:24248319

  12. Simultaneous bilateral total ankle replacement using a 3-component prosthesis

    Science.gov (United States)

    2011-01-01

    Background and purpose Total ankle replacement is an established surgical procedure in patients with end-stage ankle osteoarthritis. We analyzed complications and medium-term results in patients with simultaneous bilateral total ankle replacement. Patients and methods 10 women and 16 men, mean age 60 (SD 13) years, were followed for a median of 5 (2–10) years. Results There were no intraoperative or perioperative complications, with the exception of 1 patient with prolonged wound healing. Major revision surgery was necessary in 6 of the 52 ankles, including 4 revisions of prosthetic components. The average pain score decreased from 6.9 (4−10) to 1.8 (0−4) points. The American Orthopaedic Foot and Ankle Society hindfoot score increased from 32 (SD 14) points preoperatively to 74 (SD 12) points postoperatively. The average range of motion increased from 28° (SD 12) preoperatively to 38° (SD 9) postoperatively. All 8 categories of SF-36 score improved. Interpretation Simultaneous bilateral total ankle replacement is a suitable method for restoration of function and attainment of pain relief in patients with bilateral end-stage ankle osteoarthritis. The results of this procedure, including complication rates, revision rates, and functional outcome, are comparable to those reported in patients with unilateral total ankle replacement. PMID:21999622

  13. Review on design and control aspects of ankle rehabilitation robots.

    Science.gov (United States)

    Jamwal, Prashant K; Hussain, Shahid; Xie, Sheng Q

    2015-03-01

    Ankle rehabilitation robots can play an important role in improving outcomes of the rehabilitation treatment by assisting therapists and patients in number of ways. Consequently, few robot designs have been proposed by researchers which fall under either of the two categories, namely, wearable robots or platform-based robots. This paper presents a review of both kinds of ankle robots along with a brief analysis of their design, actuation and control approaches. While reviewing these designs it was observed that most of them are undesirably inspired by industrial robot designs. Taking note of the design concerns of current ankle robots, few improvements in the ankle robot designs have also been suggested. Conventional position control or force control approaches, being used in the existing ankle robots, have been reviewed. Apparently, opportunities of improvement also exist in the actuation as well as control of ankle robots. Subsequently, a discussion on most recent research in the development of novel actuators and advanced controllers based on appropriate physical and cognitive human-robot interaction has also been included in this review. Implications for Rehabilitation Ankle joint functions are restricted/impaired as a consequence of stroke or injury during sports or otherwise. Robots can help in reinstating functions faster and can also work as tool for recording rehabilitation data useful for further analysis. Evolution of ankle robots with respect to their design and control aspects has been discussed in the present paper and a novel design with futuristic control approach has been proposed.

  14. Mechanically induced ankle inversion during human walking and jumping.

    NARCIS (Netherlands)

    Nieuwenhuijzen, P.H.J.A.; Grüneberg, C.; Duysens, J.E.J.

    2002-01-01

    A new method to study sudden ankle inversions during human walking and jumping is presented. Ankle inversions of 25 degrees were elicited using a box containing a trap door. During the gait task, subjects walked at a speed of 4 km/h. At a pre-programmed delay after left heel strike, an electromagnet

  15. Medium- to long-term outcome of ankle arthrodesis

    NARCIS (Netherlands)

    R.P.M. Hendrickx; S.A.S. Stufkens; E.E. de Bruijn; I.N. Sierevelt; C.N. van Dijk; G.M.M.J. Kerkhoffs

    2011-01-01

    Despite improvement in outcome after ankle arthroplasty, fusion of the ankle joint is still considered the gold standard. A matter of concern is deterioration of clinical outcome as a result of loss of motion and advancing degeneration of adjacent joints. We performed a long-term study to address th

  16. Recycling energy to restore impaired ankle function during human walking.

    Directory of Open Access Journals (Sweden)

    Steven H Collins

    Full Text Available BACKGROUND: Humans normally dissipate significant energy during walking, largely at the transitions between steps. The ankle then acts to restore energy during push-off, which may be the reason that ankle impairment nearly always leads to poorer walking economy. The replacement of lost energy is necessary for steady gait, in which mechanical energy is constant on average, external dissipation is negligible, and no net work is performed over a stride. However, dissipation and replacement by muscles might not be necessary if energy were instead captured and reused by an assistive device. METHODOLOGY/PRINCIPAL FINDINGS: We developed a microprocessor-controlled artificial foot that captures some of the energy that is normally dissipated by the leg and "recycles" it as positive ankle work. In tests on subjects walking with an artificially-impaired ankle, a conventional prosthesis reduced ankle push-off work and increased net metabolic energy expenditure by 23% compared to normal walking. Energy recycling restored ankle push-off to normal and reduced the net metabolic energy penalty to 14%. CONCLUSIONS/SIGNIFICANCE: These results suggest that reduced ankle push-off contributes to the increased metabolic energy expenditure accompanying ankle impairments, and demonstrate that energy recycling can be used to reduce such cost.

  17. Recycling Energy to Restore Impaired Ankle Function during Human Walking

    NARCIS (Netherlands)

    Collins, S.H.; Kuo, A.D.

    2010-01-01

    Background: Humans normally dissipate significant energy during walking, largely at the transitions between steps. The ankle then acts to restore energy during push-off, which may be the reason that ankle impairment nearly always leads to poorer walking economy. The replacement of lost energy is nec

  18. The mechanical properties of the human hip capsule ligaments.

    Science.gov (United States)

    Hewitt, John D; Glisson, Richard R; Guilak, Farshid; Vail, T Parker

    2002-01-01

    The human hip capsule is adapted to facilitate upright posture, joint stability, and ambulation, yet it routinely is excised in hip surgery without a full understanding of its mechanical contributions. The objective of this study was to provide information about the mechanical properties of the ligaments that form the hip capsule. Cadaver bone-ligament-bone specimens of the iliofemoral, ischiofemoral, and femoral arcuate ligaments were tested to failure in tension. The hip capsule was found to be an inhomogeneous structure and should be recognized as being composed of discrete constituent ligaments. The anterior ligaments, consisting of the 2 arms of the iliofemoral ligament, were much stronger than the posterior ischiofemoral ligament, withstanding greater force at failure and exhibiting greater stiffness. Knowledge of the anatomy and mechanical properties of the capsule may help the hip surgeon choose an appropriate surgical approach or repair strategy.

  19. Estudo prospectivo e comparativo entre o tratamento conservador e o cirúrgico (reparo do ligamento femoropatelar medial nas luxações agudas de patela Prospective and comparative study between conservative and surgical treatment (medial petellofemoral ligament repair in patellar acute dislocations

    Directory of Open Access Journals (Sweden)

    Gilberto Luis Camanho

    2006-01-01

    Full Text Available Foram avaliados dois grupos de pacientes com o primeiro episódio de luxação aguda femoropatelar traumática e acompanhados prospectivamente em relação às recidivas e aos fatores predisponentes à luxação. No Grupo I, 17 pacientes com média de idade de 24,6 anos, sendo 11 do sexo feminino, foram submetidos ao reparo do ligamento femoropatelar medial com menos de um mês de trauma. O tempo médio de seguimento foi de 40,4 meses e o mínimo de 18 meses. Como resultados, não houve nenhuma recidiva da luxação,houve dois episódios de subluxação . Nove pacientes apresentavam fatores predisponentes à luxação. No Grupo II, 15 pacientes com média de idade de 26,8 anos, sendo oito do sexo feminino, foram submetidos ao tratamento conservador com média de 18,5 dias de imobilização. O tempo de seguimento médio foi de 35,7 meses e o mínimo de 11 meses. Oito joelhos tiveram recidiva da luxação, apenas dois joelhos foram considerados estáveis . Neste grupo, 14 pacientes apresentavam fatores predisponentes. Concluímos que o tratamento cirúrgico das luxações agudas femoropatelares traumáticas apresenta resultados superiores quanto à recidiva em relação ao tratamento conservador no período estudado. A presença de fatores predisponentes em nossa série de pacientes não influenciou as recidivas das luxações femoropatelares.Two groups of patients with their first episode of traumatic patellofemoral acute dislocation were studied and prospectively followed up regarding recurrences and predisposing factors to dislocation. In Group I, 17 patients with mean age of 24.6 years old, being 11 females, were submitted to medial patellofemoral ligament repair within less than a month after trauma. The mean follow up time was 40.4 months and the least, 18 months. As a result, there was no recurrence of the dislocation, and two episodes of subdislocation. Nine patients presented predisposing factors to dislocation. In Group II, 15 patients

  20. Complete acromioclavicular joint dislocation treated with reconstructed ligament by trapezius muscle fascia and observation of fascial metaplasia.

    Science.gov (United States)

    Wang, Chaoliang; Huang, Sufang; Wang, Yingzhen; Sun, Xuesheng; Zhu, Tao; Li, Qiang; Lin, Chu

    2015-01-01

    We evaluated the long-term clinical results of acute complete acromioclavicular dislocations treated by reconstruction of the acromioclavicular and coracoclavicular ligament using trapezius muscle fascia. Open reduction and internal fixation was performed using the clavicular hook plate in 12 patients with acute complete acromioclavicular joint dislocation, and the acromioclavicular and coracoclavicular ligaments were reconstructed using trapezius muscle fascia. Radiographic evaluations were conducted postoperatively. We evaluated the functional results with constant scoring system and radiological results at the final follow-up visit. The mean Constant score at the final follow-up visit was 91.67 (range, 81 to 100). The results were excellent in eight patients (66.7%) and good in four patients (33.3%). Three patients with scores from 80 to 90 had mild pain during activity, but this did not affect the range of motion of the shoulder. All patients have returned to their preoperative work without any limitations. Compared with the contralateral side, radiography showed anatomical reposition in the vertical plane in all cases. The hook-plate fixation with ligament reconstruction was successful in treating AC dislocations. The acromioclavicular and coracoclavicular ligament were reconstructed by trapezius muscle fascia that keep the distal clavicle stable both vertically and horizontally after type III injuries.

  1. Complete acromioclavicular joint dislocation treated with reconstructed ligament by trapezius muscle fascia and observation of fascial metaplasia

    Directory of Open Access Journals (Sweden)

    Wang Chaoliang

    2015-01-01

    Full Text Available We evaluated the long-term clinical results of acute complete acromioclavicular dislocations treated by reconstruction of the acromioclavicular and coracoclavicular ligament using trapezius muscle fascia. Open reduction and internal fixation was performed using the clavicular hook plate in 12 patients with acute complete acromioclavicular joint dislocation, and the acromioclavicular and coracoclavicular ligaments were reconstructed using trapezius muscle fascia. Radiographic evaluations were conducted postoperatively. We evaluated the functional results with constant scoring system and radiological results at the final follow-up visit. The mean Constant score at the final follow-up visit was 91.67 (range, 81 to 100. The results were excellent in eight patients (66.7% and good in four patients (33.3%. Three patients with scores from 80 to 90 had mild pain during activity, but this did not affect the range of motion of the shoulder. All patients have returned to their preoperative work without any limitations. Compared with the contralateral side, radiography showed anatomical reposition in the vertical plane in all cases. The hook-plate fixation with ligament reconstruction was successful in treating AC dislocations. The acromioclavicular and coracoclavicular ligament were reconstructed by trapezius muscle fascia that keep the distal clavicle stable both vertically and horizontally after type III injuries.

  2. Septic arthritis following arthroscopic reconstruction of cruciate ligaments of the knee: retrospective case review.

    Science.gov (United States)

    Erice, Alejo; Neira, M Inmaculada; Vargas-Prada, Sergio; Chiaraviglio, Ana; Gutiérrez-Guisado, Javier; Rodríguez de Oya, Ricardo

    2017-06-23

    Rupture of cruciate ligaments of the knee is a common injury that is repaired by arthroscopic reconstruction, which can give rise to septic arthritis. The objective of this article is to describe the clinical and microbiological aspects of this entity. Retrospective review of cases of septic arthritis following arthroscopic reconstruction of cruciate ligaments of the knee that occurred at a single institution from 2000-2015. According to time elapsed from surgery, infections were classified as acute ( 14 days and 30 days). A descriptive and comparative analysis stratified by type of infection and causative microorganism was performed. 3,219 patients underwent arthroscopic reconstruction of cruciate ligaments of the knee and 30 (0.9%) developed septic arthritis. Seventeen (57%) were acute infections and 12 (40%) subacute; there was one late infection. The causative microorganisms were coagulase-negative Staphylococci (n=13; 43%), Staphylococcus aureus (n=12; 40%), other grampositive cocci (n=3; 10%), and gramnegative bacilli (n=2; 7%). All patients underwent arthroscopic debridement; no grafts were removed. All patients received antibiotic therapy for a median of 23.5 days (range: 14 - 78 days); all infections were cured. No significant differences were found in any of the variables analysed among the infection type or the causative microorganism. Septic arthritis after arthroscopic reconstruction of cruciate ligaments of the knee is uncommon. It generally presents within 4 weeks of surgery and is caused by Staphylococci. Its treatment consists of arthroscopic debridement (without necessarily removing the graft) and antibiotic therapy. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  3. [Posterior longitudinal ligament ossification: case report].

    Science.gov (United States)

    Tella, Oswaldo Inácio de; Herculano, Marco Antonio; Paiva Neto, Manoel Antonio; Faedo Neto, Atílio; Crosera, João Francisco

    2006-03-01

    Posterior longitudinal ligament ossification of cervical spine is a rare condition among caucasians. A 42 years old japanese patient with progressive walking difficulty was diagnosed with this pathology by CT scan and MRI and treated surgically by an anterior approach with arthrodesis. Pathophysiology, racial prevalence, clinical picture, radiological characteristics and surgical approaches options are revised.

  4. Isolated unilateral rupture of the alar ligament.

    Science.gov (United States)

    Wong, Sui-To; Ernest, Kimberly; Fan, Grace; Zovickian, John; Pang, Dachling

    2014-05-01

    Only 6 cases of isolated unilateral rupture of the alar ligament have been previously reported. The authors report a new case and review the literature, morbid anatomy, and pathogenesis of this rare injury. The patient in their case, a 9-year-old girl, fell head first from a height of 5 feet off the ground. She presented with neck pain, a leftward head tilt, and severe limitation of right rotation, extension, and right lateral flexion of the neck. Plain radiographs and CT revealed no fracture but a shift of the dens toward the right lateral mass of C-1. Magnetic resonance imaging of the cervical spine showed signal hyperintensity within the left dens-atlas space on both T1- and T2-weighted sequences and interruption of the expected dark signal representing the left alar ligament, suggestive of its rupture. After 12 weeks of immobilization in a Guilford brace, MRI showed lessened dens deviation, and the patient attained full and painless neck motion. Including the patient in this case, the 7 patients with this injury were between 5 and 21 years old, sustained the injury in traffic accidents or falls, presented with marked neck pain, and were treated with external immobilization. All patients had good clinical outcome. The mechanism of injury is hyperflexion with rotation. Isolated unilateral alar ligament rupture is a diagnosis made by excluding associated fracture, dislocation, or disruption of other major ligamentous structures in the craniovertebral junction. CT and MRI are essential in establishing the diagnosis. External immobilization is adequate treatment.

  5. Causes of anterior cruciate ligament injuries

    Directory of Open Access Journals (Sweden)

    Ristić Vladimir

    2010-01-01

    Full Text Available In order to prevent anterior cruciate ligament injuries it is necessary to define risk factors and to analyze the most frequent causes of injuries - that being the aim of this study. The study sample consisted of 451 surgically treated patients, including 400 sportsmen (65% of them being active and 35% recreational sportsmen, 29% female and 71% male; of whom 90% were younger than 35. Sports injuries, as the most frequent cause of anterior cruciate ligament injuries, were recorded in 88% of patients (non-contact ones in 78% and contact ones in 22%, injuries occurring in everyday activities in 11% and in traffic in 1%. Among sportsmen, reconstruction of the anterior cruciate ligament was most frequently performed in football players (48%, then in handball players (22%, basketball players (13%, volleyball players (8%, martial arts fighters (4%. However, the injury incidence was the highest among the active basketball players (1 injured among 91 active players. Type of footwear, warming up before the activity, genetic predisposition and everyday therapy did not have a significant influence on getting injured. Anterior cruciate ligament injuries happened three times more often during matches, in the middle and at the end of a match and training session (79%, at landing after the jump or when changing direction of movement (75% without a contact with other competitors, on dry surfaces (79%, among not so well prepared sportsmen.

  6. Guideline on anterior cruciate ligament injury

    NARCIS (Netherlands)

    Meuffels, Duncan E; Poldervaart, Michelle T; Diercks, Ronald; Fievez, Alex W F M; Patt, Thomas W; Hart, Cor P van der; Hammacher, Eric R; Meer, Fred van der; Goedhart, Edwin A; Lenssen, Anton F; Muller-Ploeger, Sabrina B; Pols, Margreet A; Saris, Daniel B F

    2012-01-01

    The Dutch Orthopaedic Association has a long tradition of development of practical clinical guidelines. Here we present the recommendations from the multidisciplinary clinical guideline working group for anterior cruciate ligament injury. The following 8 clinical questions were formulated by a steer

  7. Novel Insights into Anterior Cruciate Ligament Injury

    NARCIS (Netherlands)

    D.E. Meuffels (Duncan)

    2011-01-01

    textabstractAnterior cruciate ligament (ACL) injury is one of the most common sports injuries of the knee. ACL reconstruction has become, standard orthopaedic practice worldwide with an estimated 175,000 reconstructions per year in the United States.6 The ACL remains the most frequently studied liga

  8. Technique of Arthroscopic Treatment of Impingement After Total Ankle Arthroplasty.

    Science.gov (United States)

    Gross, Christopher E; Neumann, Julie A; Godin, Jonathan A; DeOrio, James K

    2016-04-01

    Rates of medial and/or lateral gutter impingement after total ankle replacement are not insignificant. If impingement should occur, it typically arises an average of 17 months after total ankle replacement. Our patient underwent treatment for right ankle medial gutter bony impingement with arthroscopic debridement 5 years after her initial total ankle replacement. Standard anteromedial and anterolateral portals and a 30° 2.7-mm-diameter arthroscope were used. An aggressive soft-tissue and bony resection was performed using a combination of curettes, a 3.5-mm shaver, a 5.5-mm unsheathed burr, a drill, and a radiofrequency ablator. This case shows that arthroscopic treatment is an effective and potentially advantageous alternative to open treatment of impingement after total ankle replacement. In addition, symptoms of impingement often improve in a short amount of time after arthroscopic debridement of the medial and/or lateral gutter.

  9. Total ankle replacement – surgical treatment and rehabilitation

    Science.gov (United States)

    Krogulec, Zbigniew; Turski, Piotr; Przepiórski, Emil; Małdyk, Paweł; Księżopolska-Orłowska, Krystyna

    2015-01-01

    Functions of the ankle joint are closely connected with the gait and ability to maintain an upright position. Degenerative lesions of the joint directly contribute to postural disorders and greatly restrict propulsion of the foot, thus leading to abnormal gait. Development of total ankle replacement is connected with the use of the method as an efficient treatment of joint injuries and continuation of achievements in hip and knee surgery. The total ankle replacement technique was introduced as an alternative to arthrodesis, i.e. surgical fixation, which made it possible to preserve joint mobility and to improve gait. Total ankle replacement is indicated in post-traumatic degenerative joint disease and joint destruction secondary to rheumatoid arthritis. In this paper, total ankle replacement and various types of currently used endoprostheses are discussed. The authors also describe principles of early postoperative rehabilitation as well as rehabilitation in the outpatient setting. PMID:27407223

  10. Finite element analysis of a composite artificial ankle

    Science.gov (United States)

    Perkins, Leigh Ann; Johnston, Lawrence; Denniston, Charles; Czekalski, Blaise E.

    1993-01-01

    Ultra-light carbon fiber composite materials are being utilized in artificial limbs with increasing frequency in recent years. Dr. Arthur Copes, an orthotist from Baton Rouge, Louisiana, has developed a graphite expoxy composite material artificial ankle (Copes/Bionic Ankle) that is intended to be used by amputees who require the most advanced above-and-below-the-knee prosthetic devices. The Copes/Bionic Ankle is designed to reproduce the function of the natural ankle joint by allowing the composite material to act as a spring mechanism without the use of metal mechanical parts. NASA Marshall Space Flight Center has agreed to participate in the design effort by providing the structural analysis of the artificial ankle design.

  11. Ankle tuberculosis. A case in childhood.

    Science.gov (United States)

    Navarrete, F E; Gómez-Alessandri, J; Tintó, M; Sánchez-González, M; Vicent, V

    Articular tuberculosis of the ankle joint is a rare presentation of skeletal tuberculosis (10% of cases). This unusual location and the low index of clinical suspicion leads to delays in diagnosis and treatment. Radiographic and analytic studies are unspecific in the first stage. CAT and MRI are useful in diagnosis. Chemotherapy is the mainstay of treatment and surgery is often required to establish the diagnosis and in the treatment. We report a case of ankle tuberculosis in a 22 month-old child. The diagnosis was confirmed by synovial biopsy. There was no patient or family contact with tuberculosis patients. There was no risk factor. There was no lung disease. Diagnosis was made 1 year after onset of symptoms. The treatment was with chemotherapy and surgery was performed as preventive treatment of equinus deformity and osteoarthritis. Good clinical and functional outcome was achieved after 20 years of follow up. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. A chemical application method with underwater dissection to improve anatomic identification of cadaveric foot and ankle structures in podiatric education.

    Science.gov (United States)

    Dilandro, Anthony C; Chappell, Todd M; Panchani, Prakash N; Kozlowski, Piotr B; Tubbs, R Shane; Khan, Khurram H; D'Antoni, Anthony V

    2013-01-01

    Many cadaver-based anatomy courses and surgical workshops use prosections to help podiatry students and residents learn clinically relevant anatomy. The quality of these prosections is variable and dependent upon the methods used to prepare them. These methods have not been adequately described in the literature, and few studies describe the use of chemicals to prepare prosections of the cadaveric foot and ankle. Recognizing the need for better teaching prosections in podiatric education, we developed a chemical application method with underwater dissection to better preserve anatomic structures of the cadaveric foot and ankle. We used inexpensive chemicals before, during, and after each step, which ultimately resulted in high-quality prosections that improved identification of anatomic structures relevant to the practice of podiatric medicine. Careful preservation of clinically important nerves, vessels, muscles, ligaments, and joints was achieved with these prosections. Although this method required additional preparation time, the resultant prosections have been repeatedly used for several years to facilitate learning among podiatry students and residents, and they have held up well. This method can be used by educators to teach podiatry students throughout their medical training and even into residency.

  13. From the RSNA Refresher Courses. Radiological Society of North America. MR imaging of the ankle and foot.

    Science.gov (United States)

    Rosenberg, Z S; Beltran, J; Bencardino, J T

    2000-10-01

    Magnetic resonance (MR) imaging has opened new horizons in the diagnosis and treatment of many musculoskeletal diseases of the ankle and foot. It demonstrates abnormalities in the bones and soft tissues before they become evident at other imaging modalities. The exquisite soft-tissue contrast resolution, noninvasive nature, and multiplanar capabilities of MR imaging make it especially valuable for the detection and assessment of a variety of soft-tissue disorders of the ligaments (eg, sprain), tendons (tendinosis, peritendinosis, tenosynovitis, entrapment, rupture, dislocation), and other soft-tissue structures (eg, anterolateral impingement syndrome, sinus tarsi syndrome, compressive neuropathies [eg, tarsal tunnel syndrome, Morton neuroma], synovial disorders). MR imaging has also been shown to be highly sensitive in the detection and staging of a number of musculoskeletal infections including cellulitis, soft-tissue abscesses, and osteomyelitis. In addition, MR imaging is excellent for the early detection and assessment of a number of osseous abnormalities such as bone contusions, stress and insufficiency fractures, osteochondral fractures, osteonecrosis, and transient bone marrow edema. MR imaging is increasingly being recognized as the modality of choice for assessment of pathologic conditions of the ankle and foot.

  14. The role of series ankle elasticity in bipedal walking.

    Science.gov (United States)

    Zelik, Karl E; Huang, Tzu-Wei P; Adamczyk, Peter G; Kuo, Arthur D

    2014-04-07

    The elastic stretch-shortening cycle of the Achilles tendon during walking can reduce the active work demands on the plantarflexor muscles in series. However, this does not explain why or when this ankle work, whether by muscle or tendon, needs to be performed during gait. We therefore employ a simple bipedal walking model to investigate how ankle work and series elasticity impact economical locomotion. Our model shows that ankle elasticity can use passive dynamics to aid push-off late in single support, redirecting the body's center-of-mass (COM) motion upward. An appropriately timed, elastic push-off helps to reduce dissipative collision losses at contralateral heelstrike, and therefore the positive work needed to offset those losses and power steady walking. Thus, the model demonstrates how elastic ankle work can reduce the total energetic demands of walking, including work required from more proximal knee and hip muscles. We found that the key requirement for using ankle elasticity to achieve economical gait is the proper ratio of ankle stiffness to foot length. Optimal combination of these parameters ensures proper timing of elastic energy release prior to contralateral heelstrike, and sufficient energy storage to redirect the COM velocity. In fact, there exist parameter combinations that theoretically yield collision-free walking, thus requiring zero active work, albeit with relatively high ankle torques. Ankle elasticity also allows the hip to power economical walking by contributing indirectly to push-off. Whether walking is powered by the ankle or hip, ankle elasticity may aid walking economy by reducing collision losses. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Effects of chronic ankle instability and induced mediolateral muscular fatigue of the ankle on competitive taekwondo athletes.

    Science.gov (United States)

    Lee, Myeounggon; Youm, Changhong; Son, Minji; Kim, Jinhee; Kim, Youkyung

    2017-08-01

    [Purpose] The purpose of this study was to investigate the effects of chronic ankle instability and induced mediolateral muscular fatigue of the ankle on competitive Taekwondo athletes during single-leg drop landing. [Subjects and Methods] Fourteen competitive taekwondo athletes with chronic ankle instability and 14 healthy adults participated, and they performed three single-leg drop landings from a 40-cm height before and after induced fatigue. Ankle angular position, peak vertical ground reaction force, loading rate, eccentric work, and contribution were calculated and analyzed. [Results] Athletes had lower ankle eversion and abduction angle than the controls did at maximum knee flexion both pre- and post-fatigue. Furthermore, athletes had lower eccentric work of the hip than the controls did post-fatigue, and they had lower eccentric work of the knee than controls at both pre- and post-fatigue. The eccentric work of the knee increased while, peak vertical ground reaction force decreased in both, athletes as well as controls post-fatigue. [Conclusion] Taekwondo athletes with chronic ankle instability who participate in a high-intensity training program are continuously exposed to potential injuries of their ankle or knee joints. Therefore, competitive taekwondo athletes with chronic ankle instability should limit their participation in regular training until they complete the rehabilitation process.

  16. Spray-painted human fibronectin coating as an effective strategy to enhance graft ligamentization of a polyethylene terephthalate artificial ligament.

    Science.gov (United States)

    Li, Hong; Chen, Chen; Ge, Yunsheng; Chen, Shiyi

    2014-05-01

    To enhance graft ligamentization after anterior cruciate ligament (ACL) reconstruction, human fibronectin (FN) was coated on polyethylene terephthalate (PET) ligaments by spray painting. The FN-coated PET ligaments were investigated in vitro using rat mesenchymal stromal cells (MSCs). MSCs cultured on FN-coated grafts resulted in similar cell densities and amounts of proliferating cells with control grafts without coating. The FN-coated group not only gave rise to MSC-derived collagen-like tissues but also enhanced the expression of collagen-I gene. Furthermore, rat ACL reconstruction models were used to evaluate the effect of the FN coating in vivo. The FN coating significantly promoted new ligament tissue regeneration into the graft fibers. In conclusion, sprayed FN coating had a positive effect to enhance graft ligamentization of PET artificial ligament.

  17. Magnetic resonance imaging in acute tendon ruptures

    Energy Technology Data Exchange (ETDEWEB)

    Daffner, R.H.; Lupetin, A.R.; Dash, N.; Riemer, B.L.

    1986-11-01

    The diagnosis of acute tendon ruptures of the extensor mechanism of the knee or the Achilles tendon of the ankle may usually be made by clinical means. Massive soft tissue swelling accompanying these injuries often obscures the findings, however. Magnetic resonance imaging (MRI) can rapidly demonstrate these tendon ruptures. Examples of the use of MRI for quadriceps tendon, and Achilles tendon rupture are presented.

  18. Effects of different surgical mananement of the three-column injury of ankle on the peak contact pressure in the tibiotalar joint%不同手术方式治疗踝关节韧带复合体损伤的生物力学评价

    Institute of Scientific and Technical Information of China (English)

    董伟强; 余斌; 白波

    2015-01-01

    Objective To study the effects of different surgical procedures of clinical treatment of the three-column injury of ankle on the peak contact pressure in the tibiotalarjoint. Methods Six fresh cadaveric adult ankles were used for creation of 3 models of different surgical proceduresof treatment for the three-column injury of ankle. In model A, the medial and lateral ligaments of ankle joint were intact(repaired), the broken inferior tibiofibular ligament were not fixed. In model B, the medial and lateral ligaments of ankle joint were intact(repaired),the broken inferior tibiofibular ligament was fixed by a screw. In model C, lateral ligaments of ankle joint were intact(repaired), the broken inferior tibiofibular ligament was fixed by a screw, but the broken medial ligaments were not repaired. The three groups were tested in order A、B、C. The 3 models were tested with an electronic pressure sensor in a BOSE material testing machine, respectively, in 5 positions. The peak values of the compressive stresses of the 3 models in 5 positions were recorded. All data were collected and analyzed using SPSS22.0. Results Model B exhibited the smallest average stress in all 5 positions, followed by model C and model A, with significant differences between B and A groups (P<0.05).There were significant differences between B and C groups (P<0.05)at 10° dorsal extension and 10° valgus position. Conclusion The surgical management of the three-column injury of ankle where the medial and lateral ligaments are intact or repaired, and the tibiofibular syndesmosisis effectively fixed can reduce the peak contact pressure in the tibiotalar joint.%目的:研究不同手术方式治疗踝关节3个韧带复合体同时损伤的生物力学特征。方法选用6例成年新鲜正常踝关节,建立3组模型:A组:模拟内、外侧韧带损伤后予以形态和张力完全修复,下胫腓联合不固定。B组:模拟内、外侧韧带损伤后予以形态和张力完全修

  19. 膝交叉韧带中机械感受器的研究进展%Progress in studies on the mechanoreceptors in the cruciate ligament

    Institute of Scientific and Technical Information of China (English)

    党保平; 闫金洪; 韩一生

    2016-01-01

    Cruciate ligament of the knee lies between tibia intercondylar eminence and femoral condyle nest, presents hinged appearance and has both the function of biomechanics and proprioception, which is processed using mechanoreceptors in the tibial and femoral ligament attachment point. Mechanoreceptors could be divided into 4 groups: Ruffini ending, Pacinian body, Golgi tendon ending, and free nerve ending. The amount of mechanoreceptors of the cruciate ligament after acute injury will change in line with the duration of injury: the longer the time lasts, the less the receptors will be. But some hold the opposite view and consider that the receptors do not have evident atrophy and decline. Due to inflammation in the progression of osteoarthritis, cruciate ligament will gradually degenerate, and knee proprioception will abate as well. However, whether the amount of mechanoreceptors are associated with osteoarthritis progression and severity of the situation is not clear. The number of the damaged cruciate ligament mechanoreceptors and proprioception can recover partly after transplantation and repair, but not fully recover. Therefore, whether separated and cultured cells in vitro can be used in tissue engineering for ligament transplantation and repair, and improve proprioception, is what we need to pay attention to in the future, in order to provide more therapeutic measures for the clinic.

  20. Regional material properties of the human hip joint capsule ligaments.

    Science.gov (United States)

    Hewitt, J; Guilak, F; Glisson, R; Vail, T P

    2001-05-01

    The hip joint capsule functions to constrain translation between the femur and acetabulum while allowing rotational and planar movements. Despite the crucial role it plays in the pathogenesis of hip instability, little is known about its biomechanical properties. The goal of this study was to determine the regional material properties of the iliofemoral and ischiofemoral ligaments of the capsule. Ten human cadaveric specimens of each ligament were tested to failure in tension. The stress at failure, strain at failure, strain energy density at failure, toe- and linear-region elastic moduli, and the Poisson's ratio were measured for each ligament. The strain to failure was greatest in the ischiofemoral ligament, while no significant difference was noted in failure stress by region or ligament. The Young's moduli of elasticity ranged from 76.1 to 285.8 MPa among the different ligaments, and were generally consistent with properties previously reported for the shoulder capsule. The elastic moduli and strain energy density at failure differed by region. No significant differences in Poisson's ratio were found by region or ligament. The average Poisson's ratio was approximately 1.4, consistent with anisotropic behavior of ligamentous tissues. Understanding the material properties of the hip capsule may help the orthopaedic surgeon better understand normal ligament function, and thereby choose a surgical approach or strategy of repair. Furthermore, knowledge of the normal mechanical function of the hip capsule ligaments could assist in the evaluation of the success of a repair.

  1. A powered prosthetic ankle joint for walking and running.

    Science.gov (United States)

    Grimmer, Martin; Holgate, Matthew; Holgate, Robert; Boehler, Alexander; Ward, Jeffrey; Hollander, Kevin; Sugar, Thomas; Seyfarth, André

    2016-12-19

    Current prosthetic ankle joints are designed either for walking or for running. In order to mimic the capabilities of an able-bodied, a powered prosthetic ankle for walking and running was designed. A powered system has the potential to reduce the limitations in range of motion and positive work output of passive walking and running feet. To perform the experiments a controller capable of transitions between standing, walking, and running with speed adaptations was developed. In the first case study the system was mounted on an ankle bypass in parallel with the foot of a non-amputee subject. By this method the functionality of hardware and controller was proven. The Walk-Run ankle was capable of mimicking desired torque and angle trajectories in walking and running up to 2.6 m/s. At 4 m/s running, ankle angle could be matched while ankle torque could not. Limited ankle output power resulting from a suboptimal spring stiffness value was identified as a main reason. Further studies have to show to what extent the findings can be transferred to amputees.

  2. Summary of Human Ankle Mechanical Impedance During Walking

    Science.gov (United States)

    Rouse, Elliott J.; Krebs, Hermano Igo

    2016-01-01

    The human ankle joint plays a critical role during walking and understanding the biomechanical factors that govern ankle behavior and provides fundamental insight into normal and pathologically altered gait. Previous researchers have comprehensively studied ankle joint kinetics and kinematics during many biomechanical tasks, including locomotion; however, only recently have researchers been able to quantify how the mechanical impedance of the ankle varies during walking. The mechanical impedance describes the dynamic relationship between the joint position and the joint torque during perturbation, and is often represented in terms of stiffness, damping, and inertia. The purpose of this short communication is to unify the results of the first two studies measuring ankle mechanical impedance in the sagittal plane during walking, where each study investigated differing regions of the gait cycle. Rouse et al. measured ankle impedance from late loading response to terminal stance, where Lee et al. quantified ankle impedance from pre-swing to early loading response. While stiffness component of impedance increases significantly as the stance phase of walking progressed, the change in damping during the gait cycle is much less than the changes observed in stiffness. In addition, both stiffness and damping remained low during the swing phase of walking. Future work will focus on quantifying impedance during the “push off” region of stance phase, as well as measurement of these properties in the coronal plane. PMID:27766187

  3. [Isokinetic assessment of ankles in patients with rheumatoid arthritis].

    Science.gov (United States)

    Oliveira, Silvia Cristina Gutierrez; Oliveira, Leda Magalhaes; Jones, Anamaria; Natour, Jamil

    2015-01-01

    The foot and ankle in rheumatoid arthritis undergo highly destructive synovitis with loss of muscle strength. To evaluate the muscle strength of ankles in patients with rheumatoid arthritis based on isokinetic dynamometry parameters. Thirty patients with a diagnosis of rheumatoid arthritis involving the ankle(s) and 30 healthy subjects (control group) matched for age, gender, race, body mass index and lower limb dominance were studied. Dorsiflexion, plantarflexion, inversion and eversion were evaluated in all subjects on an isokinetic Cybex Norm dynamometer. The variables were compared between the rheumatoid arthritis and control groups and between the right and left ankles, and the dorsiflexor/plantar flexor and invertor/evertor muscle strength ratio was determined. Patients with rheumatoid arthritis performed statistically worse in the isokinetic dynamometry test for all ankle movements. The muscle strength ratio between dorsiflexors and plantar flexors was different in the two groups. No significant differences were observed in the invertor and evertor ratios. In the two groups the plantar flexor musculature was statistically stronger than dorsiflexors. We conclude that patients with rheumatoid arthritis perform worse in isokinetic dynamometry regarding all ankle movements than control subjects, with similar isokinetic test results being observed for the right and left side in both groups, with few exceptions. Isokinetic evaluation posed no additional risk such as important pain or inflammatory activity to patients with rheumatoid arthritis. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

  4. Influence of distal tibiofibular synostosis on ankle function

    Institute of Scientific and Technical Information of China (English)

    HOU Zhen-hai; ZHOU Ji-hong; YE Hong; SHI Jian-guo; ZHENG Long-bao; YAO Jun; NI Zhi-ming

    2009-01-01

    Objective: To study the influence distal tibiofibular synostosis on ankle function.Methods: From October 1998 to October 2004,a total of 281 consecutive patients underwent operations because of ankle fractures or distal fractures of the tibia and fibula.Distal tibiofibular synostosis occurred after operation in 8 Patients.The duration of follow-up averaged 20.6 months (14-44 months).The ankle function was assessed on the basis of functional rating system described by Mazur.1Results: According to Mazur's ankle evaluation system,4 patients achieved an excellent result,2 a good result and 2 a fair result.The dorsiflexion of the synostosis ankle reduced by 8.26 degrees as compared with that of the contralateral ankle.and there was little influence on the plantar flexion.All the Patients had a normal gait.Conclusion: The distal tibiofibular synostosis after the operation of ankle fractures or distal fractures of the tibia and fibula usually gives rise to few symptoms and needs no specific treatment.

  5. Mobile-bearing total ankle arthroplasty : a fundamental assessment of the clinical, radiographic and functional outcomes

    NARCIS (Netherlands)

    Doets, Hendrik Cornelis

    2009-01-01

    Ankle arthritis often leads to significant impairments for the patient. As total ankle arthroplasty (TAA) with use of fixed-bearing (2-component) total ankle prostheses has a high rate of early failures, fusion of the ankle joint is, until today, considered to be the standard surgical treatment for

  6. Establishment and evaluation of finite element model of human foot and ankle%人体足踝部有限元模型的建立及有效性分析

    Institute of Scientific and Technical Information of China (English)

    吴恺; 杨茂伟; 都承斐

    2012-01-01

    背景:传统的足踝部生物力学研究有其局限性,本文介绍一种足踝部有限元建模方法,使其具有高度的几何相似及物理相似.目的:探讨建立足踝部有限元模型的方法,为生物力学研究提供数字化仿真平台.方法:通过CT扫描1名男性志愿者踝关节获取足踝部影像学资料,将其输入Mimics软件重建骨骼和韧带,通过Geomagic处理并生成关节软骨后导入Ansys的Workbench模块,建立足踝部有限元模型,参考相关文献确定材料属性,划分网格,设置边界条件,模拟踝关节正常站立状态下受力,进行加载分析.结果:本研究建立了一个包含骨、软骨及韧带的足踝部有限元模型,相对客观地反映了人体足踝部的基本解剖结构和力学特性.模拟人体站立状态垂直加载600 N载荷于胫、腓骨下端的上截面,踝关节胫骨下关节面的接触应力主要分布在中部及前外侧,最大接触应力为3.74MPa,接触面积为335.5 mm2.踝关节周围四条主要韧带的位移(拉伸长度)中:胫跟韧带>胫舟韧带>跟腓韧带>下胫腓联合前韧带.结论:本研究所建立的人体足踝部有限元模型经验证结果可靠,可进一步用于足踝部生物力学研究.%Background: To redeem the limitations of experimental foot and ankle biomechanics research, the authors describe a new method that makes the finite element model more similar with human foot and ankle in both geometry and physical character. Objective: The purpose of the present study is to explore how to establish finite element model of normal human foot and ankle which can provide a digital simulation platform for biomechanics research. Methods: CT images were obtained by scanning the foot and ankle of a male volunteer Then the data were imported into Mimics software to reconstruct the three-dimensional structure of bones and ligaments. Articular cartilages were established in Geomagic, and the three components of ankle were integrated

  7. Registry data trends of total ankle replacement use.

    Science.gov (United States)

    Roukis, Thomas S; Prissel, Mark A

    2013-01-01

    Joint arthroplasty registry data are meaningful when evaluating the outcomes of total joint replacement, because they provide unbiased objective information regarding survivorship and incidence of use. Critical evaluation of the registry data information will benefit the surgeon, patient, and industry. However, the implementation and acceptance of registry data for total ankle replacement has lagged behind that of hip and knee implant arthroplasty. Currently, several countries have national joint arthroplasty registries, with only some procuring information for total ankle replacement. We performed an electronic search to identify publications and worldwide registry databanks with pertinent information specific to total ankle replacement to determine the type of prostheses used and usage trends over time. We identified worldwide registry data from 33 countries, with details pertinent to total ankle replacement identified in only 6 countries. The obtained information was arbitrarily stratified into 3 distinct periods: 2000 to 2006, 2007 to 2010, and 2011. Within these study periods, the data from 13 total ankle replacement systems involving 3,980 ankles were identified. The vast majority (97%) of the reported ankle replacements were 3-component, mobile-bearing, uncemented prostheses. Three usage trends were identified: initial robust embracement followed by abrupt disuse, minimal use, and initial embracement followed by sustained growth in implantation. Before the widespread acceptance of new total ankle replacements, the United States should scrutinize and learn from the international registry data and develop its own national joint registry that would include total ankle replacement. Caution against the adoption of newly released prostheses, especially those without readily available revision components, is recommended.

  8. Preoperative gait characterization of patients with ankle arthrosis.

    Science.gov (United States)

    Khazzam, Michael; Long, Jason T; Marks, Richard M; Harris, Gerald F

    2006-08-01

    The purpose of this study was to evaluate the kinematic changes that occur about the foot and ankle during gait in patients with degenerative joint disease (DJD). By comparing a normal adult population with what was found in the DJD population we determined how the motion of theses groups differed, thereby characterizing how this pathology affects foot and ankle motion. A 15-camera Vicon Motion Analysis System was used in conjunction with weight bearing radiographs to obtain three-dimensional motion of the foot and ankle during ambulation. The study was comprised of 34 patients and 35 ankles diagnosed with DJD (19 men and 15 women) of the ankle and 25 patients with normal ankles (13 men and 12 women). Dynamic foot and ankle motion was analyzed using the four-segment Milwaukee Foot Model (MFM). The data from this model resulted in three-dimensional (3D) kinematic parameters in the sagittal, coronal, and transverse planes as well as spatial-temporal parameters. Patient health status was evaluated using the SF-36 Health Survey and American Orthopaedics Foot and Ankle Society (AOFAS) hindfoot scores. The DJD group showed significant differences (pgait. This decreased range of motion may be related to several factors including bony deformity, muscle weakness, and attempts to decrease the pain associated with weight bearing. To date there has not been a study which describes the effect of this disease process on motion of the foot and ankle. These findings may prove to be useful in the pre-operative assessment of these patients.

  9. Use of a trabecular metal implant in ankle arthrodesis after failed total ankle replacement

    Science.gov (United States)

    2010-01-01

    Background and purpose Arthrodesis after failed total ankle replacement is complicated and delayed union, nonunion, and shortening of the leg often occur—especially with large bone defects. We investigated the use of a trabecular metal implant and a retrograde intramedullary nail to obtain fusion. Patients and methods 13 patients with a migrated or loose total ankle implant underwent arthrodesis with the use of a retrograde intramedullary nail through a trabecular metal Tibial Cone. The mean follow-up time was 1.4 (0.6–3.4) years. Results At the last examination, 7 patients were pain-free, while 5 had some residual pain but were satisfied with the procedure. 1 patient was dissatisfied and experienced pain and swelling when walking. The implant-bone interfaces showed no radiographic zones or gaps in any patient, indicating union. Interpretation The method is a new way of simplifying and overcoming some of the problems of performing arthrodesis after failed total ankle replacement. PMID:21067435

  10. Outcome of unilateral ankle arthrodesis and total ankle replacement in terms of bilateral gait mechanics.

    Science.gov (United States)

    Chopra, Swati; Rouhani, Hossein; Assal, Mathieu; Aminian, Kamiar; Crevoisier, Xavier

    2014-03-01

    Previous studies assessed the outcome of ankle arthrodesis (AA) and total ankle replacement (TAR) surgeries; however, the extent of postoperative recovery towards bilateral gait mechanics (BGM) is unknown. We evaluated the outcome of the two surgeries at least 2 years post rehabilitation, focusing on BGM. 36 participants, including 12 AA patients, 12 TAR patients, and 12 controls were included. Gait assessment over 50 m distance was performed utilizing pressure insoles and 3D inertial sensors, following which an intraindividual comparison was performed. Most spatiotemporal and kinematic parameters in the TAR group were indicative of good gait symmetry, while the AA group presented significant differences. Plantar pressure symmetry among the AA group was also significantly distorted. Abnormality in biomechanical behavior of the AA unoperated, contralateral foot was observed. In summary, our results indicate an altered BGM in AA patients, whereas a relatively fully recovered BGM is observed in TAR patients, despite the quantitative differences in several parameters when compared to a healthy population. Our study supports a biomechanical assessment and rehabilitation of both operated and unoperated sides after major surgeries for ankle osteoarthrosis.

  11. Agility to INBONE: anterior and posterior approaches to the difficult revision total ankle replacement.

    Science.gov (United States)

    DeVries, J George; Scott, Ryan T; Berlet, Gregory C; Hyer, Christopher F; Lee, Thomas H; DeOrio, James K

    2013-01-01

    Total ankle replacement is now acknowledged as a viable alternative to ankle arthrodesis for end-stage ankle arthritis. The authors present a series of 14 patients who were converted from the Agility total ankle replacement to an INBONE total ankle replacement. This report is unique in that anterior and posterior approaches are discussed and detailed. Although the authors present successful conversion of the Agility total ankle replacement to an INBONE total ankle replacement, the difficulty of this procedure is demonstrated by the high complication rate and 2 early failures.

  12. Neck ligament strength is decreased following whiplash trauma

    Directory of Open Access Journals (Sweden)

    Rubin Wolfgang

    2006-12-01

    Full Text Available Abstract Background Previous clinical studies have documented successful neck pain relief in whiplash patients using nerve block and radiofrequency ablation of facet joint afferents, including capsular ligament nerves. No previous study has documented injuries to the neck ligaments as determined by altered dynamic mechanical properties due to whiplash. The goal of the present study was to determine the dynamic mechanical properties of whiplash-exposed human cervical spine ligaments. Additionally, the present data were compared to previously reported control data. The ligaments included the anterior and posterior longitudinal, capsular, and interspinous and supraspinous ligaments, middle-third disc, and ligamentum flavum. Methods A total of 98 bone-ligament-bone specimens (C2–C3 to C7-T1 were prepared from six cervical spines following 3.5, 5, 6.5, and 8 g rear impacts and pre- and pos