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PubMed1999

[The upper ankle joint. Biomechanics and functional anatomy].

Dorsoplantar motion in the upper ankle joint is around one "transverse" rotational axis. In relation to the lower leg this axis is oblique joining the tips of the malleoli. Talocrural motion is highly precise compared to other human joints. Most of the stability and undisturbed motion in the loaded joint is afforded by the intimate osteocartilagineous contact. The rule of the collateral ligaments is secondary stabilisation, buffering of abnormal stresses and centering the talus in the extremes of motion. The posterior talofibular ligament is the universal lateral stabilizer, the deep portion of the deltoid ligament is the predominant medial ligament structure. Ligament tension without strain and under valgusabduction load as a rule makes only a difference in a quantitative way. Under varusadduction-stress load patterns are usually changed. Fibula and the distal syndesmotic ligaments, in the presence of valgusabduction- and external rotation stress, predominate over the medial joints structures. Remaining joint steps, especially in Volkmanns triangle (posterior malleolus) are prearthritic deformities. Nevertheless primary traumatic lesion of the cartilage has a major prognostic meaning. In cadaver joints as in vivo permanent lesions of only a singular fasciculus of the deltoid or lateral collateral ligament result in clearly detectable motion abnormalities. Concerning clinical therapy at present as in the past complete reconstruction of all that damaged singular structures must be claimed for. There is generally only a small tolerance against instability and malposition in the upper ankle joint. Even after one hundred years of research today factors defining the individual breadth of tolerance are not fully understood. In the presence of treatment regimes, that stood the test of time, it is therefore difficult to recommend treatment alternatives, relaying on individual biomechanical tolerance.

Ankle Injuries↗
PubMed1989

Mediators of the plasma extravasation response to silver nitrate in the rat skin, subplantar region and ankle joint.

Plasma extravasation responses to silver nitrate (AgNO3), histamine, 5-hydroxytryptamine (5-HT), bradykinin and prostaglandin E1 (PGE1) in the abdominal skin, hindpaw ankle joint and subplantar region of rats have been investigated using the Evans blue dye leakage technique. All substances tested produced plasma extravasation and combination of low doses (5 x 10(-10) mol) of either histamine or bradykinin with PGE1 (5 x 10(-10) mol) exhibited potentiation of responses of all regions. Responses to AgNO3 (1 x 10(-6) mol) were significantly reduced by the H1 receptor antagonist, mepyramine, only in the abdominal skin, but the H2 receptor antagonist metiamide reduced the responses at subplantar and ankle joint regions. Indomethacin significantly reduced the AgNO3 responses at the ankle joint only, but aprotinin reduced it at the other two regions. In rats pretreated with a combination of all antagonists the residual plasma extravasation response to AgNO3 was very small, indicating that the response could be almost totally accounted for by the combined actions of mast cell amines, kinins and prostanoids. The finding that prostanoids played a major role in the plasma extravasation response of the rat ankle joint to AgNO3 indicated that this model would be useful for the screening of non-steroidal anti-inflammatory drugs.

Alprostadil↗
PubMed2006

Effect of contraction form and contraction velocity on the differences between resultant and measured ankle joint moments.

During a maximal isometric plantar flexion effort the moment measured at the dynamometer differs from the resultant ankle joint moment. The present study investigated the effects of contraction form and contraction velocity during isokinetic plantar/dorsal flexion efforts on the differences between resultant and measured moments due to the misalignment between ankle and dynamometer axes. Eleven male subjects (age: 31+/-6 years, mass: 80.6+/-9.6 kg, height: 178.4+/-7.4 cm) participated in this study. All subjects performed isometric-shortening-stretch-isometric contractions induced by electrical stimulation at three different angular velocities (25 degrees /s, 50 degrees /s and 100 degrees /s) on a customised dynamometer. The kinematics of the leg were recorded using the vicon 624 system with eight cameras operating at 250 Hz. The resultant moments at the ankle joint were calculated through inverse dynamics. The relative differences between resultant and measured ankle joint moments due to axis misalignment were fairly similar in all phases of the isometric-shortening-stretch-isometric contraction (in average 5-9% of the measured moment). Furthermore these findings were independent of the contraction velocity. During dynamic plantar/dorsal flexion contractions the differences between measured and resultant joint moment are high enough to influence conclusions regarding the mechanical response of ankle extensor muscles. However the relative differences were not increased during dynamic contractions as compared to isometric contractions.

Adult↗
PubMed1993

[Musculoplasty of the peroneus brevis in ankle joint injuries].

Six patients with ankle joint's injuries had with muscle transposition by peroneus brevis. We observed them for three months. The important point was functional state of sort tissue. Wound healing of these patients were per primam except one of them. None of the patients had functional deficit.

Ankle Injuries↗
PubMed1987

[Osteochondral fracture in the area of the ankle joint].

In diagnostic assessment of a trauma in the ankle joint region, it is important to think of a possible chondral or osteochondral fracture of the upper ankle joint, although the incidence of such fractures is relatively low. Besides the conventional diagnostic procedures, computed tomography becomes more and more important in the assessment of accidental injuries, especially with regard to chondral and osteochondral fractures.

Adult↗
PubMed1990

[Ligament injuries of the upper ankle joint: 10 years experience with a stable shoe].

To avoid cast fixation after injuries of the ankle ligaments, in 1980 we presented a new high top sports-boot with stabilizing plastic sticks on both sides of the shoe as a new method of after treatment; The original Stabil-S shoe. The follow up after 5 and 10 years experience shows good results and cast immobilisation of the ankle joint is practically not used any more for the above mentioned indication. Patients go back to work after 25 days on an average which is about 3 weeks earlier then with cast immobilisation. This is the reason why insurance companies in Europe cover the costs for this kind of after treatment, the Stabil-S shoe. To verify the fibular ligament lesions we use stressed x-ray examination in addition to the clinical tests and the patients history. The indication of operative or conservative treatment is still discussed. The late results however show better stability and function after operative treatment, especially for the group of young and active sport patients. The further development of the Stabil-S shoe will try to obtain a normal gait as well as sufficient stability around the ankle joint. This means mobility for the patient and stability around the ankle joint.

Ankle Injuries↗
PubMed2005

An algorithm for locating the center of the ankle joint in knee navigation surgery.

The primary aim of computer-assisted knee arthroplasty is to improve the alignment of the implanted prostheses. Accurate component alignment is dependent on the establishment of accurate anatomical reference points. Current techniques for establishing the center of the ankle joint, especially in the coronal plane, rely solely on clinical judgment in relation to the position of the center of the ankle joint. The aim of this study was to determine if an algorithm could be developed, based on establishing the most prominent points on the medial and lateral malleoli on 3D CT scans, to accurately and reproducibly establish the position of the center of the ankle joint. To determine this, images of 20 ankles were obtained and axial, coronal, and sagittal 2D reconstructions were manipulated on a workstation. Two observers independently performed relevant measurements and calculations. The calculated data was found to be reproducible with a very small standard deviation in each plane. This algorithm is able to provide accurate measurements of the ankle joint in knee navigation surgery. Caution must be exercised in anatomically abnormal ankles, as the calculations of the ankle center were found to be significantly different.

Algorithms↗
PubMed2006

Localized nodular pigmented villonodular synovitis of the upper ankle joint--diagnosis and treatment.

This paper introduces a case of local pigmented villonodular synovits (PVNS) of the upper ankle joint in a 37-year old patient. PVNS is a neoplasia of the synovial membrane. Two different entities of PVNS are known: generalized diffuse and local nodular. They differ in their degree of destruction and growth configuration, which is crucial for prognosis and operative treatment. The most common location of the local nodular form is the knee joint, followed by the finger joints. Occurrence in the ankle joint is not common but should be considered if clinical findings are present. MRI is the method of choice for diagnosis and assessment of the bone situation. Treatment consists of radical excision of the neoplasia. Radiosynoviorthesis is recommended as a post-operative treatment to increase the probability of a total removal of persisting PVNS cells. The rate of recurrence seems to be between 8 and 46%.

Adult↗
PubMed1997

Changes in ankle joint proprioception resulting from strips of athletic tape applied over the skin.

OBJECTIVE: In part, the believed effectiveness of taping in preventing injuries may be in the increased proprioception that it provides through stimulation of cutaneous mechanoreceptors. The objective of this study was to examine the effectiveness of strips of athletic tape applied over the skin of the ankle in improving ankle joint movement and position perception. DESIGN AND SETTING: The study consisted of a single-group, repeated-measures design, where all subjects were tested under all conditions presented in a fully randomized order. Testing was performed in the biomechanics laboratory at Marquette University. SUBJECTS: Twenty healthy males (mean age = 20.3 +/- 1.5 yr) participated in this study. MEASUREMENTS: Ankle joint movement and position perception for plantar flexion and dorsiflexion were tested using a specially designed apparatus. Each individual was tested with and without two 12.7-cm (5-inch) strips of tape applied in a distal-proximal direction directly to the skin in front of and behind the subject's talocrural joint. RESULTS: Data were analyzed with repeated-measures analyses of variance (ANOVA) models. Our results indicate that under the nonweightbearing condition, taping significantly improved (p < .05) the ability of the subjects to perceive ankle joint position, especially for a 10 degrees plantar-flexed position. In the weightbearing condition, the use of tape did not significantly alter (p > .05) the ability of the subjects to perceive ankle position. Similarly, taping did not alter ankle movement perception in either the weightbearing or nonweightbearing condition (p > .05). CONCLUSIONS: We concluded that increased cutaneous sensory feedback provided by strips of athletic tape applied across the ankle joint of healthy individuals can help improve ankle joint position perception in nonweightbearing, especially for a midrange plantar-flexed ankle position.

Journal Article↗
PubMed2001

Stretching at the ankle joint: viscoelastic responses to holds and continuous passive motion.

PURPOSE: To compare the effect of static holds and continuous passive motion on stiffness and force relaxation of the soft tissue structures resisting ankle joint dorsiflexion. METHODS: This study used a randomized repeated measures trial design. Twenty-four asymptomatic subjects (15 males and 8 females) with a mean age of 26 yr participated. A Kin-Com dynamometer was used to measure the stiffness and force relaxation response of tissues about the ankle joint in response to a plantar flexor stretch. A comparison was made of the response for a 1 x 60-s hold, 2 x 30-s holds, 4 x 15-s holds, and continuous passive motion for 60 s. All subjects undertook all conditions. The main outcome measures were 1) stiffness at the ankle joint as it moved to 80% of the maximum range of dorsiflexion, and 2) the decrease in force at 80% of the maximum range of motion of the ankle joint. RESULTS: Stiffness was decreased significantly (P < 0.05) for the continuous passive motion condition only. The mean magnitude of the decrease in stiffness was 16%. Across hold times, force decreased significantly (P < 0.05). Bonferonni contrasts indicated that there was a significant difference (P < 0.05) between the continuous passive motion condition and all other hold conditions. There were no significant differences (P > 0.05) between the 4 x 15-s, 2 x 30-s, and 1 x 60-s holds. The magnitude of the decline in force was 10.5%, 21.5%, 21.7%, and 19% for the 0-, 15-, 30-, and 60-s holds, respectively. The greatest decreases in tension were achieved in the first 20 s of a hold. CONCLUSION: If decreasing stiffness is a key aim of a stretching program, the findings indicate that continuous motion is more effective than holds. In contrast, if relaxation of peak tension is the main aim, then holds are most effective.

Adult↗
PubMed1999

[Treatment of the ankle joint in rheumatoid arthritis with surgical and radiation synovectomy].

Results of surgical synovectomy and radiation synovectomy (radiosynoviorthesis) of the tibiotalar joint in rheumatoid patients are reported. The staged concept for management of the rheumatoid ankle joint is presented which is based on the radiographic appearance of disease progression. Results of 16 rheumatoid patients with disease to the ankle joint suggest that pain and walking capability is positively influenced by synovectomy and radiosynoviorthesis. Follow-up of 30 months revealed no deterioration of postoperative clinical improvement. In the absence of contraindications to radiosynoviorthesis it is suggested to combine arthroscopic synovectomy with radiosynoviorthesis for the treatment of early stages of rheumatoid disease of the ankle joint. Open synovectomy is preferred to arthroscopic synovectomy, if tenosynovectomy is simultaneously required.

Ankle Joint↗
PubMed1985

[Arthrodesis of the upper ankle joint following trauma. Follow-up study].

During a period of more than 20 years, 63 patients having undergone a trauma were submitted to arthrodesis of the upper ankle joint. 31 out of them could be followed up from autumn 1982 through spring 1983. The primary reasons and the individual courses making necessary the arthrodesis varied to such an extent that there were no identical anamneses in any of the patients. The destruction of the upper ankle joint by high kinetic energy was apparently an essential factor in the anamnesis of arthrodesis of the upper ankle joint. There is no correlation between the number of posttraumatic arthrodeses and the number of fractures of the ankle joint treated by surgery during the same period. A "good" or "satisfactory" result was achieved in nine out of ten cases submitted to arthrodesis, and it seemed to be unimportant which of the usual techniques was applied. The high complication rate reported in literature, too, has possibly to be considered as a consequence of the gravity of the disease. It seems to be independent of the previously existing risk factors. The follow-up period is very long.

Adult↗
PubMedDate not supplied

Chondroneutrality of meloxicam in rats with spontaneous osteoarthrosis of the ankle joint.

The effect of meloxicam, a new non-steroidal anti-inflammatory drug, on spontaneous osteoarthrosis of the ankle joint in Crl: CDBR rats was investigated. The drug was administered in the feed at doses of 0.4, 0.6 and 0.8 mg/kg/day over a period of 2 years to 50 males and 50 females per dose. 100 male rats and 100 female rats were used as controls. Histological examination revealed osteoarthrotic changes of varying degrees of severity in the hip, knee and ankle joints of both treated and untreated animals. The incidence and severity of these changes was greatest in the ankle joints. There was little difference between treated and untreated animals as regards the site, incidence, severity and histological appearance of the osteoarthrotic changes. At the doses tested, meloxicam does not affect the processes involved in spontaneous osteoarthrosis in the rat and can therefore be regarded as chondroneutral in this species.

Animals↗