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At least 343 records · Page 19Linked to original sources

Arthroprosthesis of the ankle joint.

The authors report the results obtained with arthroprostheses of the ankle joint in twelve patients. The surgical indications were severe post-traumatic degenerative, lesions, rheumatoid arthritis and post-traumatic necrosis of the talus. The types of prosthesis used were the St. Georg-Buchholz, Smith and TPR designs. The joint was exposed in the majority of cases by an antero-medial approach. The results (at a minimum of one year and a maximum of two and a half years) were satisfactory, being excellent in eight cases, fair in three and negative in one. The one failure was partly due to the surgical exposure, which involved osteotomy of the distal third of the fibula.

Ankle Joint↗

[Arthrographic diagnosis of rupture of the anterior syndesmosis of the upper ankle joint].

We describe 114 cases based on 2020 arthrographies of the ankle joint for diagnosing fresh tears of the tibio-fibula syndesmosis without bone lesions. Comparison of the arthrographical diagnosis with the intra-operative diagnosis showed good agreement. Diagnosis of the isolated tear of the tibio-fibular syndesmosis revealed a sensitivity of 90% and a specificity of 67%. The technical procedure and the isolated tear of the tibiofibular syndesmosis in combination with other capsuleligament lesions are presented, using typical x-ray images as examples.

Ankle Injuries↗

The contribution of foot deformation to the changes of muscular length and angle in the ankle joint during standing in man.

This study was designed to evaluate the extent of foot deformation in healthy subjects during standing on an immobile support and during slow tilts of the support platform by 1 deg. The angle in ankle joint was evaluated by two methods: as an angle of skin inclination relative to the platform and as an angle, calculated on the basis of recording of the projective length of the soleus muscle. It was shown that the real changes of the angle in ankle joint during standing on an immobile platform were up to 2 times smaller than the changes of angular position of the shin relative to vertical axis. However, considerable intersubject variability was observed in this respect. During slow tilts of the support platform a marked divergence was observed in the shape of recordings of two "ankle angles" in subjects with high foot compliance. The vertical displacements of the calcaneus recorded by means of a clamp rigidly fixed at the heel were 0.5 +/- 0.3 mm (the range 0.1-1 mm) for each degree of body deviation in the forward or backward direction. In 12 subjects, the average foot compliance was 0.04 +/- 0.03 deg/Nm (maximal value 0.1 deg/Nm). It can be assumed that the mechanical properties of the foot can appreciably influence the afferent outflow during maintenance of orthograde posture in man.

Ankle Joint↗

[Experiences in the after treatment of surgically treated ligament rupture of the ankle joint using a special shoe].

Early surgical reconstruction of lesions of ankle joint ligaments is generally accepted and yields best functional results. The wearing of a cast for 6-7 weeks limits movement to a greater extent than required for ligament healing. Functional physiotherapy and the use of a special shoe results in healing equal to that obtained with casts, but without the disadvantages of prolonged wearing of a cast. The high laced, laterally reinforced shoe permits physiotherapy and limited movement. The disadvantages of complete immobilization and trophic changes are avoided, while the ligament can be mobilized without undue strain. Extreme movements such as supination, adduction and maximal extension and flexion are prevented as effectively as with a cast. The time during which the patient is unable to work is reduced for most vocations, which also reduces insurance costs. This postoperative physiotherapy of a selected, active patient group is an effective alternative to conventional cast immobilization.

Adolescent↗

MRI scores of ankle joints in children with haemophilia--comparison with clinical data.

Fifty-six ankle joints in 38 haemophilic boys were investigated by magnetic resonance imaging (MRI) and the findings were classified according to both the Denver- and the European scoring schemes. The different MRI scores were compared with each other and with clinical data on number of joint bleeds and the orthopaedic joint score. MRI changes that were more advanced than a small effusion were found in 33 (59%) of the ankles and osteochondral changes were observed in 20 (36%). The total number of bleeds in individual ankles ranged from 0 to 80 (mean: 11). The orthopaedic joint score was 0 for 49 ankles and ranged from one to four for seven ankles. There was a significant and strong correlation between the assessment results obtained with the two MRI scoring methods (correlation coefficients ranged from 0.80 to 0.95, P < 0.001), and both types of MRI scores were weakly but significantly correlated with the clinical data on the number of joint bleeds and the orthopaedic joint score (correlation coefficients: 0.32-0.39, P < 0.01 or P < 0.05). MRI is useful for evaluating early joint changes in patients with haemophilia. The European scoring method differentiates the arthropathic changes further than the Denver scale does, but the two different scoring methods have similar correlation to the number of joint bleeds and the orthopaedic joint score.

Adolescent↗

Adaptations to long-term strength training of ankle joint muscles in old age.

The aim of this study was to enquire whether older adults, who continue plantar-flexion (PF) strength training for an additional 6-month period, would achieve further improvements in neuromuscular performance, in the ankle PFs, and in the antagonist dorsi-flexors (DFs). Twenty-three healthy older volunteers (mean age 77.4 +/- 3.7 years) took part in this investigation and 12 of them followed a 1-year strength-training program. Both neural and muscular factors were examined during isometric maximal voluntary contraction (MVC) torques in ankle PF and DF pre-training, post 6 and post 12 months. The main finding was that 6 months of additional strength training of the PFs, beyond 6 months, allowed further improvements in neuromuscular performance at the ankle joint in older adults. Indeed, during the first 6 months of progressive resistance training, there was an increase in the PF MVC torque of 11.1 +/- 19.9 N m, and then of 11.1 +/- 17.9 N m in the last 6-month period. However, it was only after 1 year that there was an improvement in the evoked contraction at rest in PF (+ 8%). The strength training of the agonist PF muscles appeared to have an impact on the maximal resultant torque in DF. However, it appeared that this gain was first due to modifications occurring in the trained PFs muscles, then, it seemed that the motor drive of the DFs per se was altered. In conclusion, long-term strength training of the PFs resulted in continued improvements in neuromuscular performance at the ankle joint in older adults, beyond the initial 6 months.

Adaptation, Physiological↗

[Haemarthros of the upper ankle joint (author's transl)].

34 patients with isolated, non-dislocated fractures of the medial malleolus and consecutive haemarthros of the upper ankle joint were followed up at an average of 8 years after the trauma. Special attention was given to arthrotic deformities and complaints. The results of this study seem to point to the conclusion that postraumatic haemarthros itself is of no special importance in the development of arthrotic changes of the upper ankle joint in man. This was judged from the pathophysiological reactions of articular cartilage due to haemarthros as shown in animal experiments.

Adult↗

A mechanical equinometer to measure the range of motion of the ankle joint: interobserver and intraobserver reliability.

BACKGROUND: Clinical measurement of passive dorsiflexion of the ankle joint is essential for the diagnosis of various pathologic conditions of the foot and ankle but is of unreliable precision with high interobserver variability in nonweightbearing tests. This work was designed to develop and test a precise, standardized, and reliable technique for measurement of passive and active ankle range of motion. METHODS: The proposed measurement tool is composed of two mobile parallelograms, one attached to the tibia, the second one to the plantar surface of the foot. The parallelograms are connected with a hinge with an angular scale to measure the angle between the foot and tibia. RESULTS: Interobserver correlation between clinical measurements for maximal passive foot dorsiflexion were 0.03 with knee extension and 0.38 with knee flexion, while for measurements with the proposed tool they reached 0.89 and 0.97, respectively, with a mean measurement error of 0.9 degrees. Intraobserver correlations reached values of r = 0.98 and 0.99. CONCLUSIONS: The proposed tool allows measurement of the ankle range of motion with very high precision and reproducibility far superior to clinical measurements. CLINICAL RELEVANCE: Precise measurement of ankle range of motion is clinically challenging. With the use of the proposed tool, measurement precision and reliability are decisively improved.

Adult↗

[Indication, technic and value of arthroscopy of the upper ankle joint].

The authors demonstrate on several joint preparations that essential parts of the upper ankle joint can be directly looked at by endoscopic examination with access at three different points. In case of osteochondrous fractures such as osteochondrosis dissecans, arthroscopy can be a means to determine the therapeutically relevant stages. A series of clinical examples is presented in order to demonstrate that this method, which is still seldom employed, represents a considerable extension of diagnostic and also therapeutic possibilities.

Ankle Joint↗

The medial collateral ligaments of the human ankle joint: anatomical variations.

This study aimed to investigate anatomical variations within the medial collateral ligament complex of the human ankle joint. Osteoligamentous preparations of 40 ankles from 20 cadavers were studied. Six different component bands of the medial collateral ligament complex were observed: four superficial bands (tibiospring, tibionavicular, superficial posterior tibiotalar, and tibiocalcaneal ligaments), of which only the tibiospring and tibionavicular ligaments were constant, and two deep bands (deep posterior tibiotalar and deep anterior tibiotalar ligaments), of which only the deep posterior tibiotalar ligament was constant. No pattern was observed in the distribution of additional bands. A consistent and universally accepted system for naming the various bands of the medial collateral ligament is necessary to enable easy and accurate comparisons between studies. We suggest that this system should be based on the attachments of the ligaments.

Aged↗

[Arthrography as a diagnostic measure in injuries of ligament and capsule of the ankle joint (author's transl)].

The application of monocontrast arthrography in examining the ankle joint is demonstrated by means of an extensive series of examinations. It is evident that this method of examination is more reliable than x-ray films of the forced extreme joint position, especially in combined injuries of the ligamentous apparatus, so that it enables better planning of the necessary therapeutic procedure.

Adolescent↗

[Diagnosis and treatment of injuries to the lateral ligaments of the ankle joint].

Injury to the lateral ligaments of the ankle joint is one of commonest injuries seen in the casualty department. The diagnostic routines and treatment vary considerably from one hospital to another. The methods for precise diagnosis and treatment are reviewed and discussed and the main emphasis is placed on major prospective investigations. The authors suggest that the diagnosis should be made on the basis of the clinical examination and that, regardless of the degree of ligamental injury, treatment should consist of adhesive strapping. Primary identification of patients with prolonged symptoms is an unsolved problem since the degree of ligamental injury is not a reliable predictor.

Ankle Injuries↗

[Therapy of ankle joint fractures (author's transl)].

Even severely dislocated ankle joint fractures can be fixed in the right position and healed by immediate reposition. Irreponible fractures, ruptures of the syndesmosis, shortening of the fibula and abruptions of tibial edges require timely operative treatment with osteosynthesis, the individual forms of which are demonstrated. The screws fixing the syndesmosis must be removed in time in order to prevent their loosening or breaking. Fixations in hypercorrective position have proved to be unphysiological. Walking plaster, however, are better than training with crutches without the possibility of loading. The combination of osteosynthesis and walking plaster will contribute to the development of an early self-sufficiency on the part of the operated patient.

Adult↗

Arthrography of the ankle joint: problems in diagnosis of acute lateral ligament injuries.

Arthrography of the ankle joint is a reasonably accurate and helpful method of delineating the extent of injuries to the lateral ligament. Forty-six arthrograms were obtained following acute injuries, with 26 patients having operative evaluation. Eight false negative results were encountered, all in combination with fairly massive capsular tears. Although ankle arthrography in acute injuries is useful, it is not infallible. An explanation for the large number of false negative results is offered and additional suggestions are made about the technique of examination.

Acute Disease↗

[Deformities and trauma sequelae of the ankle joint in children and adolescents].

Knowledge of the normal development of the ankle joint is mandatory to understand the mechanism of injuries in children and adolescents. Some fractures (juvenile Tillaux's or two-fragment triplane fracture) occur only within a particular period of growth, which is determined by the degree of epiphyseal fusion. Tarsal coalitions are the deformities seen most frequently. Special radiographic techniques must be applied for the diagnosis. Ball and socket joint, tibiotalar slant and Trevor's disease are rare deformities, each of which is associated with a pathognomonic radiographic pattern. Some typical joint deformities may be seen in patients with neuromuscular disease. This has to be considered when nothing else is found in the clinical history.

Adolescent↗

Identification of nonlinear model of ankle joint dynamics during electrical stimulation of soleus.

The mechanical impedance of the ankle joint was estimated in two conditions: during submaximal surface electrical stimulation of the soleus muscle, and with no stimulation applied. Both neurologically intact (n = 5) and spinal cord injured subjects (n = 4) were used. The mechanical impedance was measured by applying angular step and constant velocity (13-100 degrees s-1) perturbations at 10 degrees to the ankle and measuring the resulting changes in torque. A five-element lumped model consisting of an inertial element, a parallel elastic element, and an elastic element in series with a viscous element and a pure tension generator produced a good fit for predicting the compliance characteristics of the ankle for both the relaxed and stimulated conditions. The elastic elements were piecewise linear with different values for the dorsiflexion and plantarflexion directions. The viscous element was velocity-dependent and it decreased in value as the velocity increased. The average torque error between the measured and model's response during soleus stimulation was 10.56% for the dorsiflexed and 11.93% for the plantarflexed perturbations. However, the average error was skewed by several subjects who had excessive error, due to volitional intervention or flexor withdrawal reflex. The average model error for the perturbations without stimulation was 7.12% for dorsiflexed and 5.58% for plantarflexed perturbations.

Ankle Joint↗

[Combined tibial and ankle joint fractures].

The authors report upon 773 fractures of the lower leg investigated from 1979 to 1989. They included 38 tibial fractures combined with fractures of the ankle joint. According to the mechanism of the fractures they were divided into: isolated tibial shaft fractures, transverse, segmental and communicated fractures and external rotation fractures of the tibial shaft combined with additional lesions of the ankle joint.

Adolescent↗