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PubMedDate not supplied

Proprioception in classical ballet dancers. A prospective study of the influence of an ankle sprain on proprioception in the ankle joint.

We studied prospectively the influence of ankle sprains on proprioception as measured by recording the postural sway of classical ballet dancers. Excellent balance and coordination are important for classical ballet dancers, and postural stability requires adequate proprioception from the ankle joint. Fifty-three professional dancers from the Royal Swedish Ballet, Stockholm, and 23 nonathletes, the control group, participated in the investigation. Postural sway was recorded and analyzed with a stabilimeter using a specially designed, portable, computer-assisted force plate. Six dancers sustained ankle sprains during followup. The recordings were obtained of these dancers before and after the injuries. The stabilometry results differed among the male and female dancers and the control group as follows: 1) the male dancers demonstrated a smaller total area of sway, and 2) both the male and female dancers had a smaller mean sway on the left foot than on the right (no mean difference in sway was found between the left and right foot in the control group). In comparison with the condition before injury and with the uninjured foot, the postural stability of the dancer was impaired for several weeks after the ankle sprain. Postural stability gradually improved during rehabilitation and improvement still occurred several weeks after professional dancing had resumed.

Adult↗
PubMed2003

Cartilage lesions in the ankle joint: comparison of MR arthrography and CT arthrography.

OBJECTIVE: To compare MR arthrography and CT arthrography for the evaluation of cartilage lesions in the ankle joint. DESIGN AND PATIENTS: Thirty-six consecutive patients with clinically suspected cartilage lesions were prospectively included in the study. A 1:1 mixture of diluted gadoteridol (4 mmol/l) and iopamidol (300 mg iodine/ml) was injected. The articular cartilages of the talus, tibia, and fibula were analyzed separately by two musculoskeletal radiologists. A review panel consisting of two musculoskeletal radiologists and an orthopedic surgeon represented the standard of reference. RESULTS: For reader 1 accuracy of MR arthrography in the talus/tibia/fibula (88%/88%/94%) was slightly inferior to CT arthrography (90%/94%/92%). For reader 2, the accuracy was 76%/78%/83% for MR arthrography, and 92%/93%/92% for CT arthrography, respectively. Interobserver agreement for MR arthrography was 79%/74%/89% (kappa 0.47/0.34/0.27), while interobserver agreement for CT arthrography was 89%/90%/89% (kappa 0.69/0.54/0.54). CONCLUSION: CT arthrography appears to be more reliable than MR arthrography for the detection of cartilage lesions in the ankle joint.

Adolescent↗
PubMed2005

Two ankle joint laxity testers: reliability and validity.

Two test devices were manufactured to objectively measure ankle joint laxity: the dynamic anterior ankle tester (DAAT) and the quasi-static anterior ankle tester (QAAT). The primary aim was to analyse the reliability of both testers; The secondary aim was to assess validity in correlation with TELOS stress test and manual anterior drawer test. Twenty-four normal subjects and 14 patients 1 year after acute lateral ankle ligament injury were included. Both ankles were tested with the DAAT and QAAT by two different observers; one experienced orthopaedic surgeon performed the manual test; the TELOS stress X-rays were evaluated by one observer. Intra observer reliability for the DAAT varied between 0.81 and 0.94; for the QAAT between 0.71 and 0.94. Inter observer reliability for the DAAT varied between 0.84 and 0.94; for the QAAT between 0.76 and 0.82. Concurrent validity showed fair correlation between DAAT and QAAT for the first couple observers (0.71); however, a poor correlation was observed for the second couple (0.42). No significant correlations were found between neither DAAT and the TELOS and the manual test, nor QAAT and the TELOS and the manual test. In conclusion, reliability of both testers is high. Validity of the testers needs further investigation.

Adult↗
PubMed1981

[Plastic repair of the lateral ligament of the upper ankle joint: methods and results (author's transl)].

A review is given about common techniques for plastic repair of the lateral ligament of the upper ankle joint. Own experiences are presented. Indications for plastic repair age: old injury of the ligaments with clinical symptoms; fresh lesions of the ligament; if the tissues of the articular capsule or of the ligament are completely destroyed or if during surgery a chronic insufficiency of the ligaments becomes evident. Contraindications against plastic repair are: a marked arthrosis of the ankle joint, a permanent valgar displacement of the talus, old age and a high risk for surgery. The results of 13 plastic operations of the lateral ligament could be classified as "very good" in ten cases and as "good" in three cases (evaluation according to Marti). In seven cases a modified technique of Watson-Jones has been used, twice Weber's method and in four cases a direct ligament plastic. Those procedures are favoured which come close to the original anatomy, are easy to perform without destroying functional structures and which do not cause an unnecessary restriction of movement.

Adolescent↗
PubMed2001

The influence of stimulation frequency and ankle joint angle on the moment exerted by human dorsiflexor muscles.

The purpose of this study was to investigate the force-frequency relationships and the post-tetanic twitch potentiation as a function of joint angle (i.e. muscle length) in human skeletal muscles under isometric conditions. The dorsiflexor muscles of healthy subjects were stimulated at different ankle joint angles by means of constant frequency bursts at seven submaximal frequencies (50, 33, 25, 20, 16, 12, 8 Hz) with a duration of two seconds. Particular attention has been focused on the stability of recruitment in the range of joint angles examined. The results show that moment-frequency curves of human dorsiflexors change as a function of ankle angle: especially for the lower stimulation frequency range (8, 12, 16, 20 Hz), the normalized moment increases from dorsiflexion to plantar flexion (i.e. with increasing muscle length) resulting in a leftward shift of the normalized moment-frequency curves. Post-tetanic twitch potentiation is shown to be ankle joint dependent as well.

Adult↗
PubMed1991

[The surgical treatment of postburn deformities of the foot and ankle joint].

The results of surgical treatment of 82 patients with postburn deformity of a foot and an ankle joint are presented. For elimination of the deformity and contracture, the tightening scars were excised, autodermoplasty of a defect was used, in severe contracture of the ankle joint, the Ilizarov's apparatus was applied, trophic ulcers of a stump of the foot were closed by means of a migrating Filatov's graft. In 80.5% of the patients, a contracture was eliminated, the weight-bearing function of a foot improved.

Ankle Injuries↗
PubMed2001

Arthrodesis after osteosynthesis and infection of the ankle joint.

Nineteen patients with a severely infected ankle joint after previous osteosynthesis were treated with arthrodesis in our institution. Their notes and X-rays were reviewed. Goals of treatment were eradication of infection by aggressive débridement of infected tissues, obtaining adequate soft-tissue coverage, preservation/restoration of bonelength, and finally consolidation of the arthrodesis. Thirteen men and six women were treated, with a median age of 46 (17-69) years. Arthrodesis took place after a median of 6 months (0.5-40) post-accident, and after one to six earlier operative procedures. Primarily there had been four bimalleolar, five trimalleolar and ten pilon tibial fractures. Fifteen fractures were open with severe soft tissue damage. Seven free muscle transfers were performed, and ten cancellous bone graftings. Finally 29 attempts at arthrodesis were performed. Ultimately we had to perform two amputations. After a mean follow up of 3.5 years, one patient has an aseptic but asymptomatic pseudarthrosis, for which no further surgery is scheduled. Sixteen extremities are free from infection while full weightbearing is possible. The limb-threatening problem of deep infection after osteosynthesis of an ankle fracture can be resolved by consistent but prolonged treatment. After successful arthrodesis a weightbearing extremity without infection remains in the majority of cases.

Adolescent↗
PubMed1999

Chondromatosis of the ankle joint (Reichel syndrome).

A case of chondromatosis of the upper ankle joint in childhood is described. It is a monoarticular disease with a good prognosis, frequently without known prior trauma or inflammation, although often free fragments of cartilage are seen in the joint cavities. It originates from the synovium of the joint, and is known in the literature as Reichel syndrome.

Acute Disease↗
PubMed1996

Arthroscopic assessment of the chronic unstable ankle joint.

The purpose of this study was to evaluate prospectively the findings during arthroscopy in patients with chronic instability of the ankle joint. One hundred and ten consecutive patients who had suffered at least two ankle sprains and were symptomatic for at least 6 months were included in this study. A complete rupture of the anterior talofibular ligament was found in 64%, of the calcaneofibular ligament in 41% and of the deltoid ligament in 6%. Cartilage lesions of the talus were seen in 54% of the joints, more of them medial (56%) than lateral (15%) or ventral (20%). Other frequently observed findings were synovialitis (38%), rupture of the syndesmosis (7%), and ventral scarring (6%). While cartilage damage was found independently of the lateral ligament injuries, all complete tears of the deltoid ligament were associated with cartilage injury of the talus. Medial instability was assessed in five ankles clinically and found arthroscopically in 23 ankle joints. Our arthroscopic findings show that chronic instability of the ankle joint is associated with various pathological conditions of ligaments, capsule and cartilage. It can therefore give essential information about the status of the chronic unstable joint with regard to the choice of operative or conservative treatment.

Adolescent↗
PubMed2001

Relationship of ankle joint involvement with subtalar destruction in patients with rheumatoid arthritis. A 20-year follow-up study.

AIMS: In the present study we evaluated radiographically involvement of the ankle joint and its relationship to destruction of the subtalar joint in rheumatoid arthritis (RA). METHODS: An inception cohort of 103 patients with seropositive RA was followed over a period of 20 years. Follow-up examinations were conducted after onset, 1, 3, 8, 15, and 20 years from entry. A total of 83 patients attended the 15-year and 68 patients the 20-year follow-up. Radiographic evaluation was performed using a lateral weight-bearing ankle radiograph. A simplified grading was applied for the talocrural joint, in which the ankles (patients) were divided into three groups: no changes, minor changes and major changes. In the end-point analysis the last radiograph was assigned. Subtalar destruction was recorded (Larsen grade > or = 2). Severity of RA in different groups was evaluated using the Larsen score of 0-100 of hands and feet. Difference between patient groups was evaluated using Cuzick's test. RESULTS: At the endpoint major changes of the ankles were detected in seven patients (7%) only, minor changes were observed in 17 patients (16%). The first minor involvement of the ankle was observed at the three-year follow-up in two patients. First major changes were detected at the 15-year follow-up in three ankles of two patients. Subtalar pathology preceded that of TC joint in all ankles with major changes. In 17 patients with minor changes, simultaneous subtalar pathology was observed in all but two ankles, while preceding subtalar involvement was radiographically manifest in 13 of 21 ankles. The means of Larsen scores of 0-100 were in the three ankle grading groups 40, 54 and 63, respectively. Cuzick's test for the trend was highly significant (P < 0.001). No reconstructive surgery was performed on the ankle joint during the follow-up, whereas the subtalar joint complex was fused cumulatively in 12 patients. CONCLUSIONS: The ankle joint is involved in a late stage of RA and is usually affected only in the patients with severe disease. Subtalar pathology precedes the changes in the talocrural joint almost regularly.

Adolescent↗
PubMed1977

[Chronic fibular instability of the ankle-joint -- x-ray diagnostic and ligamentous graft (author's transl)].

It was tried to find out how many radiographs are necessary to show instabilities of the ankle-joint with ruptures of the ligamentum talofibulare anterius alone (which is the most common ligamentous lesion) and in combination with other fibular ligaments. Therefore stress views of anatomical speciems of ankle-joints with previous artifically coused lesions were done. It was found that one lateral view with the talus stressed in subluxation and one a.p. view with stressed pes equinus and supination with slight internal rotation of the foot are enough in comparison with the other side. The mostly used plastic reconstructions of old fibular ligament teares by Watson-Jones and Evans act as a tenodesis for the subtalar joint, because the natural anatomical position of the ligamentum calcaneofibulare, which should be replaced, is not respected. We looked for the best positioning of a graft as a replacement of the ligamentum calcaneofibulare by help of a string model in anatomical speciems. Only the straight graft of this ligament gives the best chance of free mobility in the subtalar joint. Other directions of this ligamentous graft lead either to a tenodesis or to an outwear of the graft without a stabilizing effect. Postoperative examinations of nine patients with ligamentous grafts stress this point.

Ankle Joint↗
PubMed1990

[Monolateral external compression arthrodesis of the upper ankle joint].

A new method of compression-arthrodesis of the ankle joint using monolateral external fixation is introduced. After bimalleolar incision and resection of the tibio-talar joint-surfaces, compression fixation was achieved by the Monofixateur placed ventromedially. The lateral malleolus was used as a bar-chip fixed with two screws. Between 1985 and 1988 this operation was performed on ten patients, mostly because of posttraumatic joint destruction. On the average the hospital stay was 17 days. Walking with crutches was allowed on the third postop. day with partial weight bearing after one week. Two patients developed a pin-tract infection with one of them needing operative revision. Except in a case of primary arthrodesis done in a severely open talus dislocation fracture bony fusion was achieved between 8 to 12 weeks postoperatively. Eight patients were followed up after an average of 2.5 years. Four patients were completely painfree and showed an almost normal gait. Four patients were able to walk 2 to 3 hours without serious complains. Five patients classified the result as good, two as fair and one as poor. In the poor result the distal Schanz-screws had partially penetrated the subtalar joint with consecutive joint deterioration. The tarsal mobility had a mean value of 23 degrees. The length of the operated leg was on the average one cm shorter. Due to the favourable results we recommend monolateral external compression-arthrodesis as a useful procedure.

Adolescent↗
PubMed1986

Arthroscopy of the ankle joint.

The technique and results of 11 arthroscopies of the ankle joint are presented. The main indications were post-traumatic pain and osteochondritis dissecans of the talus. As a result of arthroscopy, a radionegative loose body was found, exploratory arthrotomy was avoided in one case, incisions and operative procedures were changed, and loose bodies were removed by arthroscopic operation in one case.

Adolescent↗
PubMed1987

[Primary plastic reconstruction of a lateral ligament injury of the upper ankle joint].

The article introduces a new aspect in the treatment of ruptures of the lateral ligaments of the ankle. We used the modification of tenodesis according to Castaing and Meunier (3) in the operation of the acute lesions of the fibular ligament. The wearing of a cast for 6-7 weeks after operation is generally not necessary because stability of ankle joint ligaments is obtained. The disadvantages of complete immobilization and trophic changes as well as tenodesis effect are avoided. The patients begin with functional physiotherapy after wound healing (10th postoperative day). Careful extremity loading of the selected, active patient is possible four weeks after operation. 118 reconstructions of the ankle joint ligaments (96 with the abovementioned method) have been performed in the Department of Surgery of Witten-Herdecke University between 1970-1982. Of 43 patients checked in follow-up examination (mean postoperative period three years) 5 showed unsatisfactory balance (tenodesis effect).

Adult↗
PubMed1999

Tibiotalar joint arthrodesis for the treatment of severe ankle joint degeneration secondary to rheumatoid arthritis.

The technical aspects of fusion of the rheumatoid ankle do not deviate from those in the post-traumatic or osteoarthritic ankle. Screw fixation can usually be achieved, and rarely is fixation failure a problem in rheumatoid ankle arthrodesis. If fixation is difficult because of deformity or bone quality, external fixation or locking intramedullary nails should be used. The placement of cannulated screws and adequacy of screw fixation has not been a problem (Fig. 13). Screw fixation provides compression and prevents rotation. The surgeon, however, needs to be assured that no screws invade the subtalar joint and that all threads are beyond the arthrodesis site. A washer may be necessary for further stability if this screw is not inserted at too great an angle. The authors have found that troughing out of the cortical surface of the tibia with a power bur aids in screw insertion. Not only does the trough act as a countersink, but it also provides a path for screw insertion and prevents palpable screw irritation. Malalignment is unforgiving. The foot must be placed neutral to dorsiflexion and plantarflexion. Equinus positioning places added stress on the tibia and a back-knee gait occurs. Approximately 5 degrees of valgus is recommended, and varus positioning is unforgiving. Internal and external rotation is determined by the position of the contralateral extremity. Nonunion does not seem to be a problem with rigid internal fixation to any greater degree in patients with RA. Despite this, patients may continue to have pain despite solid fusion, which can be caused by incomplete correction of deformity, painful internal fixation, or adjacent joint pathology. Additionally, patients may experience supramalleolar pain above the fusion site consistent with tibial stress fracture, which is more common if the subtalar or midtarsal joint is rigid or if the patient is obese. A rocker sole shoe with impact-absorbing soles used after brief periods of guarded mobilization in a removable walking cast alleviates this stress on the tibia. Neurovascular insult can be avoided with careful dissection direct to bone, incisions placed in nerve-free zones, and avoidance of plunging deep posteriorly-medially and anteriorly when dissecting and resecting surfaces. Arthrodesis of the tibiotalar joint in the patient with RA should be performed to relieve severe pain caused by advanced arthrosis. Achieving a solid arthrodesis does not seem to be a problem and provides the patient with pain relief; however, marked improvement in patient function and level of activity remains limited by the nature of RA and adjacent joint involvement.

Ankle Joint↗
PubMed1985

[Stress to the lateral ankle joint ligament complex in confined imaging with an a.-p. radiation path].

Physical definition and laws of rotating systems will be stated. The application for supination in ankle joint shows, that lever action increases the force applied up to four times in case of stress X-rays in the a.-p. view. As quoted in literature, the test power of up to 25 kp means a loading of the lateral collaterals up to 100 kp. An additional iatrogenic rupture of already traumatically partially sprained structures seems possible. The critical judgement of five different methods producing stress X-rays of the ankle joint shows the weak points of this test system. Beck's method seems sufficient for precise statements and judgement of the stress X-ray tests without endangering ligaments so far unsprained.

Ankle Injuries↗
PubMed1996

Improving the detection of radiographically occult ankle fractures: positive predictive value of an ankle joint effusion.

OBJECTIVE: To assess the value of an ankle effusion on plain radiographs as a predictor of radiographically occult fracture after acute ankle trauma. PATIENTS: Consecutive patients with acute ankle trauma and radiographic evidence of an ankle joint effusion. Patients were excluded if ankle trauma was sustained more than 48 h previously or if a fracture was visible on initial photographs. METHODS: All subjects (n = 26) underwent computed tomography (CT) of the ankle in sagittal and coronal planes. Ankle effusion size was measured from initial lateral ankle radiographs. RESULTS: Twelve patients (46%) had radiographically occult fractures identified with CT. Fracture sites included: posterior or lateral malleoli (n = 4), calcaneus (n = 1), or talus (n = 7). Ankle effusion size was 11.2 mm in the group without fracture and 17.1 mm in the group with fracture (P < 0.0001). The positive predictive value of an effusion 15 mm or greater was 83%. CT detected significant soft-tissue injuries in four (15%) patients including peroneal retinaculum tear (n = 1), anterior talofibular ligament avulsion (n = 1), and tears of the peroneus longus (n = 1) and tibialis posterior (n = 1) tendons. CONCLUSIONS: The presence of a large ankle effusion of radiographs after acute ankle trauma suggests an underlying fracture. An ankle effusion of > or = 15 mm is a reasonable threshold to prompt additional imaging. Computed tomography provides good visualization of subtle bone injuries and may detect clinically imported soft-tissue injuries.

Adult↗