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PubMed2002

Kinematic behavior of the ankle following malleolar fracture repair in a high-fidelity cadaver model.

BACKGROUND: Previous studies involving axially loaded ankle cadaver specimens undergoing a passive range of motion after fracture have demonstrated rotatory instability patterns consisting of excessive external rotation during plantar flexion. The present study was designed to expand these studies by using a model in which ankle motion is controlled by physiologically accurate motor forces generated through phasic force-couples attached to the muscle-tendon units. METHODS: Eight right unembalmed cadaver feet were tested in a dynamic gait simulator that reproduces the sagittal kinematics of the tibia while applying physiological muscle forces to the tendons of the major extrinsic muscles of the foot. Six-degrees-of-freedom kinematics of the tibia and talus were measured with use of a VICON motion-analysis system. The experimental conditions included all combinations of lateral and medial injury to reproduce the clinical classifications of ankle fracture. Statistical analysis was performed with repeated-measures analyses of variance. RESULTS: The talus of the intact ankles demonstrated coupled external rotation and inversion relative to the tibia as the ankle plantar flexed. Osteotomy of the fibula, simulating a lateral ankle fracture, slightly but significantly increased external rotation and inversion of the talus (p < 0.001), whereas disruption of either the superficial or the deep deltoid ligament increased talar eversion (p < 0.003) and disruption of the deep deltoid ligament increased internal rotation (p < 0.0001). The aberrant motions were corrected by repair of the injured structure. CONCLUSIONS: The predominant coupled rotation of the talus is external rotation associated with plantar flexion. Following progressive ankle destabilization, talar external rotation and inversion increased. CLINICAL RELEVANCE: The clinical decision-making process regarding the treatment of ankle fractures centers on determination of whether the injury is expected to result in abnormal motion, which is thought to predispose to the development of arthritis. The present study demonstrated a remarkable degree of ankle stability during stance phase even when there was severe disruption of medial and lateral structures. This finding suggests that a main determinant of clinical outcome after ankle fracture may be ankle motion during swing phase, when ankle stability is not augmented by the combination of axial loading and active motor control of motion. If swing-phase motion is abnormal, then the ankle may be in a vulnerable position at the point of heel-strike.

Aged↗
PubMed2001

The effect of tape, braces and shoes on ankle range of motion.

Sport injuries are unwanted adverse effects accompanying participation in sports. In a wide variety of sports the most common location of injury is the ankle, frequently resulting from a forced plantar flexed inversion of the foot exceeding the physiological range of motion (ROM). Historically the purpose of external support systems is to prevent acute ankle injuries by restricting abnormal ankle ROM. It is believed that a superior restrictive effect also implies a superior preventive effect. The purpose of this review was to examine the literature regarding the restricting effect of adhesive taping, prophylactic ankle stabilisers (PAS) and high-top shoes on ankle ROM. It has been found that tape restricts ankle eversion and inversion ROM significantly following application. However, tape loosens significantly following standardised exercise and sports activities. Studies regarding PAS reported that both semi-rigid and nonrigid stabilisers give a significant post-application restriction of ankle inversion motion. The nonrigid stabilisers show loosening over time during exercise, while the semi-rigid stabilisers maintain their restrictive effect over the same time span. High-top shoes in comparison to low-top shoes are more effective in restricting mechanically imposed ankle inversion ROM. Low-top shoes, however, also limit mechanically imposed ankle inversion stress with the ankle in the position in which ankle injury occurs most frequently. One must keep in mind, however, that a superior mechanical restriction of ankle ROM does not necessarily imply a superior preventive effect. Only well-controlled randomised studies can show such an effect, and these studies have shown a reduction of ankle injury incidence for all 3 prophylactic measures reviewed.

Ankle Injuries↗
PubMed1999

[Injury of the upper ankle joint in tibial fracture. A frequent, but undervalued combination].

There are 2 types of a combined tibia fracture and ankle injury: in Type I the tibia fracture extends directly into the ankle joint, in Type II the tibia fracture goes along with a fracture of the fibula and disruption of the fibular-tibial syndesmosis. This type of fracture must be distinguished from a pilon tibiale fracture. The typical mechanism for this combined tibia and ankle injury is the indirect torsional trauma with pronation-eversion. From 1995 to 1997 188 patients with fractures of the tibia were treated by internal fixation in our Trauma Department. 27 of these patients (13.6%) had a combined tibia and ankle injury. Most of the tibia fractures were located in the distal third, a spiral fracture (16 patients) or a comminuted fracture (6 patients), and another group extending directly into the ankle (5 patients). The ankle lesion was a distal fibular fracture (Weber Type B + C) in 14 patients, a proximal fibular fracture (Type maisoneuve) in 6 patients, a postero-lateral fragment in 11 cases and a fracture of the medial melleolus in 10 cases. A disrupture of the anterior tibio-fibular syndesmosis was seen in 18 patients, 3 times as an isolated lesion of the ankle joint without fracture of the fibula. The osteosynthesis of the tibia fracture was performed with an unreamed tibia nail in 20 patients, with elastic-biologic plate fixation in 6 and with external fixation in 1 patient. The fibula fractures were stabilized by small fragment titaneum plates, the dorsolateral fragment and the medial malleolus were stabilized by lag-screws, the tibio-fibular ligament was sutured and, in a few cases only, held in place by a positioning screw. The outcome was controlled after 20.7 month according to the Phillip's Score (1996). We found not more than one pour results. It must be considered, that most of the combined injuries of the tibia and the ankle joint concerning 13.6% of all tibia shaft fractures are usually not recognized and may result in an arthrosis of the ankle joint. The attention should be focused to the ankle joint in any spiral fractures of the distal tibia after indirect trauma, especially with a proximal fibular fracture or an intact fibula. Additional X-ray examination of the ankle joint is recommended during internal fixation of the tibia. Posttraumatic arthrosis of the ankle joint can be prevented by diagnosis and adequate anatomical reconstruction of the additional ankle joint injury.

Adolescent↗
PubMed1999

Biomechanics of the unstable ankle joint and clinical implications.

PURPOSE: The aim of this paper is to provide fundamental information about the biomechanics of the unstable ankle joint and to establish a rational for the daily clinic when dealing with patients in both, the acute and chronic unstable condition of the ankle joint complex. METHODS: The problem of the unstable ankle joint is worked up by analyses of the basic anatomy and biomechanics followed by an overview of its clinical manifestation including a differential diagnosis. RESULTS: The ankle joint and its surrounding ligaments represent a complex mechanical structure whose mechanical properties highly depend on ligament integrity. Recent in vitro studies have supported the hypothesis that, besides maintaining lateral ankle stability, the lateral ankle ligaments play a significant role in maintaining rotational ankle stability and in transferring movement between leg and foot. Instability of the ankle results from acute ligament injuries and may become chronic when complete ligament healing does not occur. Chronic instability syndrome may manifest with recurrent injuries with chronic lateral pain, tenderness, swelling, or induration with great difficulties in sports and daily activities. Symptomatic instability can be caused by mechanical instability with demonstrable instability, but it can be also present with no demonstrable instability. Impairment of ankle proprioception has been shown to be a major cause of symptomatic ankle instability. Other conditions may mimic ankle instability. CONCLUSIONS: The cause of chronic functional instability is often not mechanical instability but impairment of ankle proprioception. A history of insecurity, instability, and giving way is far more important in diagnosis than the physical and radiographic examination. If surgical treatment is advised, anatomical reconstruction of the ankle ligaments is mandatory for fear of altering the biomechanics.

Ankle Joint↗
PubMed2006

Primary osteoarthritis in the ankle joint is associated with finger metacarpophalangeal osteoarthritis and the H63D mutation in the HFE gene: evidence for a hemochromatosis-like polyarticular osteoarthritis phenotype.

BACKGROUND AND AIM: Osteoarthritis (OA) can occur in the ankle joint. It also occurs in an appreciable proportion of subjects with hereditary hemochromatosis (HH). Might these conditions have common genetic characteristics? The aim of this study was to test the hypothesis that HFE gene mutations are associated with primary osteoarthritis in the ankle joint. METHODS: Consecutive referred patients who had primary or secondary (posttraumatic) OA of the ankle joint were assessed by a single rheumatologist and had a full physical and joint examination. Plain x-rays of the ankle joint, other clinically involved osteoarthritic joints, iron studies, HFE genotyping, and Hb electrophoresis were performed. The significance of differences was evaluated by 2-tailed Fisher exact test. RESULTS: Fourteen patients met the inclusion criteria for primary ankle OA and 6 met the criteria for secondary ankle OA. One of the 14 had had a previous subtalar joint fusion and was excluded. Among the remaining 13, 7 had OA in the index and/or middle finger metacarpophalangeal joints (MCP2,3 OA) with radiologic features similar to those found in hemochromatotic arthropathy (HA). Furthermore, 11 of the 13 had at least one HFE mutation, one subject in this group was homozygous for H63D, one was compound heterozygous for C282Y and S65C, and one was compound heterozygous for H63D and S65C. Eight were heterozygous for H63D. The 13 subjects were compared with the 6 secondary ankle OA subjects and with a previously studied population cohort (n = 3011) from the town of Busselton in whom HFE genotyping had been performed. A statistically significant increase in the frequency of HFE gene mutations was observed in the group with primary OA of the ankle joint compared with that with secondary ankle joint OA (P = 0.0095) and compared with the Busselton cohort (P = 0.0008). Furthermore, a statistically significant association between finger MCP joint OA and primary ankle joint OA was observed (P = 0.0436). Iron studies were normal in the 13 primary and 6 secondary ankle OA subjects. None of the subjects with ankle OA had clinical signs of hemochromatosis or abnormal liver function tests. CONCLUSIONS: A strong and statistically significant association was observed between HFE gene mutations and primary OA in the ankle joint. The frequent presence of MCP2,3 OA in these patients suggests the existence of a type 2 polyarticular OA phenotype that closely resembles the arthropathy of HH and which appears to be clinically differentiable from type 1 OA or nodal generalized OA (NGOA). HFE gene mutations may be a marker for the type 2 polyarticular OA phenotype and a clue to OA pathogenesis.

Adult↗
PubMed2003

Foot and ankle experience in orthopaedic residency.

BACKGROUND: Dedicated orthopaedic residency training in the musculoskeletal discipline of foot and ankle is an important contribution to the development of a well-rounded orthopaedic surgeon. Current residency training guidelines are vague and do not require specific experience or proficiency in this discipline. METHODS: A one-page questionnaire on commitment to foot and ankle education in American Orthopaedic Surgery residency training programs was completed by all 148 program directors. RESULTS: Eighty of the programs (54.1%) had a single faculty member dedicated to foot and ankle orthopaedics, while 21 (14.2%) did not have a faculty member with a specific interest or commitment to problems related to the foot and ankle. Fifteen programs (10.1%) did not have a committed faculty member, nor did their residents have a clinical rotation dedicated to foot and ankle. Ninety-six programs (64.9%) had at least one clinical rotation dedicated to foot and ankle. Fifty-two (35.1%) did not. Thirty-three (34.7%) of those programs with a dedicated foot and ankle experience assigned residents during at least two periods of their training. Of those programs with a single foot-specific rotation, the most common year for training was in the PGY3 year (27 of 63, 42.9%). Of the 60 months' duration of most orthopaedic residency programs, 39 of 96 (40.6%) programs with a dedicated clinical foot and ankle rotation allocated an average of 12 weeks to foot and ankle. Twenty-six (27.1%) allocated less than 3 total months, and 31 (32.3%) allocated 16 to 24 weeks of dedicated foot and ankle experience. CONCLUSIONS: Current residency training in the United States does not universally require a commitment to foot and ankle education. A large number of residency programs do not have a faculty member committed to foot and ankle education, and almost one-third have no time specifically allocated to foot and ankle education.

Ankle↗
PubMed2004

Uncemented STAR total ankle prostheses.

BACKGROUND: The feasibility of replacing the ankle joint has been a matter of speculation for a long time. In recent years, the designs of ankle prostheses have been improved, and three designs, all used without bone cement, currently dominate the market. However, documentation of the clinical results of the use of these prostheses is sparse. We reviewed the intermediate-term results of fifty-one consecutive Scandinavian Total Ankle Replacements (STAR). METHODS: Between 1993 and 1999, fifty-one consecutive ankles were replaced with an uncemented, hydroxyapatite-coated STAR total ankle prosthesis. Clinical examination for the present study was performed by one surgeon who had not taken part in the operations. Standardized radiographs were used. Complications and failures were recorded, and patient satisfaction and functional outcome scores were determined for all patients with an unrevised implant. RESULTS: Twelve ankles had to be revised. Seven were revised because of loosening of at least one of the components; two, because of fracture of the meniscus; and three, for other reasons. A component was exchanged in seven of the twelve revisions, whereas the ankle was successfully fused in the other five. An additional eight ankles had radiographic signs of loosening. The thirty-nine unrevised ankles (thirty-seven patients) were examined after thirty-six to ninety-seven months (median, fifty-two months). The patient was satisfied with the result after thirty-one of the ankle replacements, somewhat satisfied after two, and not satisfied after six. The median Kofoed score increased from 39 points before the surgery to 70 points at the time of the follow-up examination. A median follow-up score of 74 points was recorded when the system described by Mazur et al. and the AOFAS (American Orthopaedic Foot and Ankle Society) system were used. The median range of motion was approximately the same preoperatively and postoperatively. The estimated five-year survival rate, with revision for any reason as the end point, was 0.70. When radiographic loosening of either component was used as the end point, the estimated five-year radiographic survival rate was significantly better for the last thirty-one ankles treated in the series (p = 0.032). CONCLUSIONS: Total ankle replacement may be a realistic alternative to arthrodesis, provided that the components are correctly positioned and are of the correct size. However, the risks of loosening and failure are still higher than are such risks after total hip or total knee replacement.

Ankle Joint↗
PubMed1999

Weight-bearing immobilization and early exercise treatment following a grade II lateral ankle sprain.

STUDY DESIGN: Case study. OBJECTIVES: To describe a protocol used in the rehabilitation of a grade II lateral ankle sprain, emphasizing brief immobilization with a removable boot, weight bearing as tolerated, and progression of early exercise. BACKGROUND: The optimum conservative treatment of severe grade II ankle sprains remains undefined. Short-term benefits of early mobilization have won favor over immobilization by casting; however, pain and ankle joint instability often linger. The timing of weight bearing as a variable that influences recovery has largely been ignored when either treatment is considered. METHODS AND MEASURES: The patient was a 17-year-old girl who had sustained a left ankle inversion sprain while playing high school basketball. The sprained ankle was placed in an immobilizer boot for 1 week, and weight bearing was encouraged. She received instructions for active exercise and for resistive exercise with elastic tubing. Volumetric and active range of motion measurements and gait observation provided indicators of rehabilitation progress. A digital inclinometer was used to measure active range of motion in the sagittal plane. Vertical ground reaction forces recorded with an instrumented treadmill documented gait symmetry. RESULTS: The patient responded well to the course of treatment, returning to full participation in basketball 2 weeks after the injury. The injured ankle had 29% (19 degrees) less active range of motion than the nonimpaired ankle at the beginning of physical therapy. The injured ankle also displaced 50 mL more water compared with the nonimpaired ankle at the start of treatment. Four weeks after beginning treatment, the sprained ankle had 4 degrees less active range of motion and displaced 5 mL more water compared with the nonimpaired ankle. As a college athlete, the patient has remained free of subjective complaints of ankle pain, instability, and swelling. CONCLUSION: Weight-bearing immobilization combined with early exercise provided safe and effective treatment for this patient, who suffered a grade II lateral ankle sprain.

Adolescent↗
PubMed2002

The effect of lateral ankle sprain on dorsiflexion range of motion, posterior talar glide, and joint laxity.

STUDY DESIGN: Retrospective study. OBJECTIVE: Assess range of motion, posterior talar glide, and residual joint laxity following ankle sprain in a population of athletes who have returned to unrestricted activity. BACKGROUND: Lateral ankle sprains occur frequently in athletic populations and the reinjury rate may be as high as 80%. In an effort to better understand risk factors for reinjury, the sequelae to injury in a sample of college athletes were assessed. METHODS AND MEASURES: Twelve athletes with a history of lateral ankle sprain within the last 6 months and who had returned to sport participation were tested. Only athletes who reported never injuring the contralateral ankle were included. The injured and uninjured ankles of subjects were compared for measures of joint laxity, ankle dorsiflexion range of motion, and posterior talar glide. Friedman's test of rank order was used to analyze the laxity measures and a MANOVA was used to assess the dorsiflexion and posterior talar glide measures. RESULTS: Laxity was significantly greater at the talocrural and subtalar joints of the injured ankles. There were no significant differences in any of the ankle dorsiflexion measurements between injured and uninjured ankles, but posterior talar glide was significantly reduced in injured ankles as compared to uninjured ankles. CONCLUSION: In our sample of subjects, residual ligamentous laxity was commonly found following lateral ankle sprain. Dorsiflexion range of motion was restored in the population studied despite evidence of restricted posterior glide of the talocrural joint. Although restoration of physiological range of motion was achieved, residual joint dysfunction persisted. Further research is warranted to elucidate the role of altered arthrokinematics after lateral ankle sprain.

Adolescent↗
PubMed1992

Arthrodesis of the ankle in patients who have rheumatoid arthritis.

We reviewed thirty-two arthrodeses of the ankle in twenty-six patients who had rheumatoid arthritis. In seventeen patients (eighteen ankles), a compression arthrodesis was done and external fixation was used. In eight patients (twelve ankles), we used internal fixation with 6.5-millimeter cancellous-bone screws. In the remaining patient, an arthrodesis with external fixation was done in one ankle and internal fixation was used in the other ankle; data for the appropriate ankle are included in each group. The patients were followed for an average of thirty-three months. The two groups were comparable with respect to age, sex, preoperative medications, and severity of disease. The average time to fusion was nineteen weeks in the compression arthrodesis group and seventeen weeks in the internal fixation group. Of the nineteen ankles that had a compression arthrodesis, four failed to fuse; all of the failures were associated with infection. Infection developed in two additional patients, there was malposition of the fusion in three patients, and neurapraxia developed in three patients. Of the thirteen ankles that had internal fixation, three ankles failed to fuse; one of the failures was associated with infection. Infection developed in one additional ankle. In two patients, the ankle fused in excessive valgus. Comparison of the two groups revealed comparable rates of fusion: fusion occurred in fifteen of the nineteen ankles in the group that had compression arthrodesis and in ten of the thirteen ankles in the group that had internal fixation. The method of arthrodesis did not affect the time to fusion or the rate of complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Lower tibial osteotomy for osteoarthritis of the ankle.

Ankle arthrodesis is still the treatment of choice for most disabling arthritic ankles. But in spite of its popularity, ankle arthrodesis has many disadvantages, including long immobilization, a high pseudoarthrosis rate, and load shift with increased stress on neighboring joints of ankle. Lower tibial osteotomy is one of the methods which attempts to halt ankle arthritis in the intermediate stage and trying to prevent ankle arthroadesis. From Aug. 1989, we performed 8 operations of lower tibial osteotomy in our hospital on intermediate arthritic ankle which included 4 post-traumatic ankle arthritis and 4 ankle osteoarthritis. The patient's ages ranged from 21y/o to 72y/o with an average of 41.6y/o. The mean time of followed up was 31.7 months. The patients were evaluated by the ankle functional scale preoperatively and during their followed up. The average preoperative functional score was 49.6 and the last follow up score was 88.5 which is increasing year by year. Significant improvement occurred in function and pain relief and there was improvement of ankle motion in most patients except one. Complications included late infection in 1 patient and implant failure with subsequent revision surgery due to overcorrection in 1 patient. No nonunion was noted. Although our series was small, we had encouraging short-term results. We believe lower tibial osteotomy, by pressure redistribution on the joint surface, is an alternative for the treatment of ankle osteoarthritis and may save or delay arthritic ankle from the fate of fusion.

Adult↗
PubMed2000

Balance as a predictor of ankle injuries in high school basketball players.

OBJECTIVE: The purpose of this study was to determine if a preseason measurement of balance while in a unilateral stance could predict susceptibility to ankle injury in a cohort of high school basketball players. Predicting risk for ankle injury could be important in helping to reduce the risk of these injuries and furthermore save health care costs. DESIGN: Cohort study. SETTING: Data were collected at five high schools during the first 2 weeks of the 1997-1998 and 1998-1999 basketball seasons. SUBJECTS: 210 (119 male, age = 16.1 +/- 1.1 yr; height = 182.98 +/- 7.4 cm; weight = 76.4 +/- 10.9 kg; and 91 female, age = 16.3 +/- 1.3 yr; height = 170.9 +/- 7.8 cm; weight = 63.4 +/- 8.4 kg) high school basketball players who did not sustain a time loss ankle or knee injury within the previous 12 months served as subjects. Subjects did not use prophylactic ankle taping or bracing during the season. ASSESSMENT OF RISK FACTORS: Balance was quantified from postural sway scores measured while subjects performed unilateral balance tests with eyes both open and closed. Logistic regression analysis was carried out to determine if gender, dominant leg, and balance scores were related to ankle sprain injuries. In addition, Fischer's exact test was used to determine if the rate of ankle injuries was the same whether the subject had poor, average, or good balance. Balance was assessed by measuring postural sway with the NeuroCom New Balance Master version 6.0 (NeuroCom International, Clackamas, OR, U.S.A.). Testing to determine postural sway consisted of having subjects stand on one leg for three trials of 10 seconds with their eyes open, then repeated with their eyes closed. Subjects then underwent the same assessment while standing on the other leg. Postural sway was defined as the average degrees of sway per second (degrees S/S) for the 12 trials producing a compilation (COMP) score. OUTCOME MEASURES: Ankle injury resulting in missed participation. RESULTS: Subjects who sustained ankle sprains had a preseason COMP score of 2.01 +/- 0.32 (Mean +/- SD), while athletes who did not sustain ankle injuries had a score of 1.74 +/- 0.31. Higher postural sway scores corresponded to increased ankle sprain injury rates (p = 0.001). Subjects who demonstrated poor balance (high sway scores) had nearly seven times as many ankle sprains as subjects who had good balance (low sway scores) (p = 0.0002.) CONCLUSION: In this cohort of high school basketball players, pre-season balance measurement (postural sway) served as a predictor of ankle sprain susceptibility.

Adolescent↗
PubMed2004

Comprehensive reconstruction of the lateral ankle for chronic instability using a free gracilis graft.

PURPOSE: The purpose of this retrospective study was to assess the results of a novel surgical technique for the treatment of chronic lateral ankle instability using both a direct repair of the anterior talofibular ligament and a free gracilis tendon transfer to reconstruct anatomically the anterior talofibular and calcaneofibular ligaments. METHODS: Between December 1998 and February 2002, 28 patients (29 ankles) underwent an anatomic reconstruction of the lateral ankle ligaments for chronic ankle instability. Patients returned for a clinical and radiologic follow-up evaluation at an average of 23 months following surgery (range, 12-52 months). Outcomes were assessed by comparison of preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analog pain scores as well as a postoperative Karlsson score. A subjective self-assessment rating was also obtained. All patients underwent preoperative and postoperative radiographic assessment including talar tilt and anterior drawer stress radiographs. RESULTS: Twenty-eight patients (29 ankles) (100%) returned for final evaluation. Good or excellent outcome was noted on patient subjective self-assessment, pain scores, AOFAS, and Karlsson scores at final follow-up in all patients. Ankle range of motion was not affected by lateral ankle reconstruction. The talar tilt was reduced from a mean of 13 degrees to 3 degrees (p <.0001) and the anterior drawer was reduced from a mean of 10 mm to 5 mm (p <.0001) by the lateral ankle ligamentous reconstruction. CONCLUSION: In the present study, lateral ankle reconstruction with a direct anterior talofibular ligament repair and free gracilis tendon graft augmentation resulted in a high percentage of successful results, excellent ankle stability with a minimal loss of ankle or hindfoot motion, and marked reduction of pain at an average follow-up of almost 2 years.

Adolescent↗
PubMed2004

Quantitative assessment of mechanical laxity in the functionally unstable ankle.

PURPOSE: Delineating between functional and mechanical instability in those with chronic ankle dysfunction is a challenging task. Current methods of assessing ankle ligamentous laxity are subjective in nature and limit our ability to identify the site and extent of instability; therefore, a need exists for objective laxity measurements. The purpose of this study was to determine whether subjects with self-reported, functional ankle instability (FAI) demonstrated increased mechanical laxity when tested with instrumented arthrometry and stress radiography. METHODS: Both ankles were tested in 51 subjects with self-reported unilateral FAI. An instrumented ankle arthrometer measured ankle-subtalar joint motion for total anteroposterior (AP) displacement (mm) during loading at 125 N and total inversion-eversion (I-E) rotation (degrees of ROM) during loading at 4 N x m. The Telos GA-II/E device provided either anterior or lateral stress (15 kp) while fluoroscopic radiographs were recorded for anterior displacement (mm) and talar tilt (degrees). RESULTS: The arthrometry measurements of anterior and total AP displacement and the radiographic measurements of anterior displacement were greater (P < 0.05) in the FAI ankles when compared with the uninjured ankles. There were no differences in total I-E rotation, inversion rotation, or talar tilt between ankles when analyzed with either measurement technique. CONCLUSION: The ability to objectively measure mechanical instability in the functionally unstable ankle is important to understanding the nature and cause of the instability. Ankle arthrometry and stress radiographic measurements are objective assessment tools for mechanical laxity. Despite finding greater laxity in the functionally unstable ankle, the clinical significance of the observed displacement remains unanswered. Further research is needed to determine the amount of laxity that constitutes mechanical instability and how this relates to FAI.

Adult↗
PubMed2004

The Agility total ankle arthroplasty. Seven to sixteen-year follow-up.

BACKGROUND: We previously reported the intermediate-term results with the early version of the Agility total ankle replacement, a unique design that takes advantage of arthrodesis of the tibiofibular syndesmosis for tibial component support. The purpose of this study was to report longer-term results of this procedure in the treatment of disabling ankle arthritis. METHODS: We conducted an independent review of all Agility total ankle replacements performed by a single surgeon between 1984 and 1994. Follow-up evaluation consisted of completion of a validated ankle osteoarthritis scale and a short questionnaire and a review of the radiographs. All radiographs were evaluated for evidence of the development of progressive hindfoot arthritis, nonunion of the tibiofibular syndesmosis, progressive radiolucent lines, osteolysis, and component subsidence. RESULTS: One hundred and thirty-two arthroplasties were performed in 126 patients. After a mean follow-up period of nine years, thirty-three patients (thirty-six implants) had died, fourteen patients (11%) had a revision of the implant or an ankle arthrodesis, and one had the leg amputated because of an unrelated cause. Of the remaining seventy-eight patients (eighty-one ankles), sixty-seven (sixty-nine ankles) were followed clinically. More than 90% of them reported that they had decreased pain and were satisfied with the outcome of the surgery. We found modest differences in a comparison of the pain and disability scores with those of age-matched controls. Of the 117 ankles that had been followed radiographically for a minimum of two years, twenty-two (19%) had progressive subtalar arthritis, seventeen (15%) had progressive talonavicular arthritis, and nine (8%) had a syndesmosis nonunion. Eighty-nine (76%) of the 117 ankles had some evidence of peri-implant radiolucency. CONCLUSIONS: Arthrodesis of the tibiofibular syndesmosis impacts the radiographic and clinical outcomes with the Agility total ankle replacement. The relatively low rates of radiographic hindfoot arthritis and revision procedures at an average of nine years after the arthroplasty are encouraging. Agility total ankle replacement is a viable and durable option for the treatment of ankle arthritis in selected patients.

Ankle Injuries↗
PubMed1996

Taping of the ankle--the effect on postural sway during perturbation, before and after a training session.

The application of adhesive tape to the ankle prevents sprains and is therefore frequently used by athletes with functional instability of that joint. The purpose of the study was to investigate the effect of taping on postural sway during a sudden perturbation in subjects with unilateral functional instability of the ankle joint. Nine Swedish male elite soccer players with unilateral functional instability of the ankle joint after a sprain participated in the study. Their mean age was 25 years. All but one had sustained an ankle sprain during the last 1-12 months, and they applied adhesive tape on one ankle at every practice session and game. Eight moderately active male subjects served as controls (mean age 32 years). Recording and analysis of postural sway was performed by the use of stabilometry. We used a device previously tested for reliability and added a perturbation device. The perturbation device was an ankle disc standing on four bars on top of the force plate. At the start of each recording, the ankle disc was stable. The bars could be removed simultaneously by the test leader. The following parameters were analysed: (1) max sway, the maximal sway amplitude upon perturbation in mediolateral and anteroposterior directions; (2) mean sway, the mean sway during the recording in mediolateral and anteroposterior directions. There was no difference between the right and left ankles before the practice session. The postural sway during perturbation (max sway) decreased when the ankle was taped before the exercise. After the exercise there was no difference between the taped and untaped ankles. The maximum and mean amplitude of sway without tape were smaller after exercise than before exercise. The results in the present study indicate a positive effect of tape on postural sway during perturbation before a practice session. The decreased sway with an untaped ankle after the practice session could mean that the prophylactic effect of taping is most important during the first part of a practice session or a game. Warmer muscle units mean less uncontrolled muscle activity which could result in more effective stabilisation of the ankle joint.

Adult↗
PubMed2005

Comparison of two waist-mounted and two ankle-mounted electronic pedometers.

This study compared two ankle-mounted pedometers [StepWatch 3 (SW-3(Ankle)) and Activity Monitoring Pod 331 (AMP(Ankle))] and two waist-mounted pedometers [New Lifestyles NL-2000 (NL(Waist)) and Digiwalker SW-701 (SW-701(Waist))] under controlled and free-living conditions. In part I, 20 participants walked on a treadmill at speeds of 27-107 m min(-1). Actual steps were counted with a hand counter. In part II, participants performed leg swinging, heel tapping, stationary cycling, and car driving. In part III, 15 participants wore all pedometers for a 24 h period. The SW-3(Ankle) displayed values that were within 1% of actual steps during treadmill walking at all speeds. The other devices underestimated steps at slow speeds but all gave mean values that were within +/-3% of actual steps at 80 m min(-1) and above. The SW-3(Ankle) registered some steps during heel tapping, leg swinging, and cycling, while the AMP(Ankle) was only responsive to leg swinging. During car driving no devices recorded more than eight steps, on average. Over 24 h, the AMP(Ankle) recorded 18% fewer steps than the SW-3(Ankle) (P<0.05), while the SW-701(Waist) and the NL(Waist) recorded 15 and 11% less than the SW-3(Ankle), respectively (NSD). The SW-3(Ankle) has superior accuracy at slow treadmill walking speeds (although it was also more likely to detect "fidgeting" activities). Over 24 h, the SW-3(Ankle) tended to give higher estimates of steps per day than the other ankle- and waist-mounted pedometers.

Adult↗
PubMed2004

The effects of ankle bracing on motion of the knee and the hip joint during trunk rotation tasks.

BACKGROUND: The use of prophylactic ankle braces is common during athletic activities since the ankle is one of the most commonly injured joints. Past studies have focused on the effects of ankle braces on ankle movement restriction, preventing injuries, proprioception, balance and athletic performance. However, the influence of ankle restriction on other joints has not been studied. The constraint of ankle movement may lead to an increased loading on the knee joint, which could be a potential risk of knee injuries during athletic activities. The primary goal of the current study was to determine quantitatively the effect of an ankle brace on the knee axial rotation during two different trunk turning tasks. METHODS: Ten healthy subjects performed trunk turning movements while standing on one leg: turning sideways to catch a ball and turning sideways to touch a target with the shoulder. The tasks were performed with and without an ankle brace worn on the supporting leg. The trunk axial rotation in reference to the floor and three dimensional joint angular motions of the ankle, knee and hip were determined. FINDINGS: The use of an ankle brace resulted in reduced trunk axial rotation during the ball catching tasks, and increased knee axial rotation during the target touching tasks. INTERPRETATION: The results of this study showed that the effect of the ankle brace on the knee axial rotation depended on the context of the tasks performed. Under situations that required forceful trunk turning movement while standing on a single leg, the ankle braces may cause an increase in the knee axial rotation indicating higher risk of knee injury.

Abdomen↗