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PubMed1989

[The incidence, therapy and results of combined ankle joint and tibial shaft fractures].

Forty combined tibial shaft and ankle fractures were admitted to our Trauma Department between 1980 and 1985; these cases were followed up, and the results are presented. Using the classification scheme of Johner/Wruhs for lower-leg fractures and that of Lauge-Hansen for ankle fractures, we found 25 pronation-eversion and 14 supination-eversion lesions combined with pure spiral fractures (A1, 9 cases), spiral bending-type fractures (B1, 25 cases), comminuted spiral lesions (C1, 5 cases), and 1 crush fracture (C3). Although no fibular or ligamentous reconstruction had been done and various methods had been used, overall, the late results were good. In contrast to previous reports about this rare condition, no incongruencies at the ankle joint were found. Only 2 cases of late arthritis due to infection and/or improper reduction were seen. Nevertheless, the importance of thorough analysis of the fracture pathomechanics before treatment cannot be overemphasized. If anatomical reduction of the tibial shaft fracture does not imply congruency at the joint line, reconstruction of the fibular or ligamentous lesion should be undertaken.

Adult↗
PubMed1990

[Results of surgical treatment of dislocation fractures of the ankle joint].

The authors have made evaluation of the surgical treatment of luxation fractures of the ankle in the period 1979-1987 in 105 patients (60 female, 45 male patients) in the age range from seventeen to eighty-one years, with the most frequent representation of the age group ranging from thirty-five to forty-five years. The group comprised 2,70 percent of fractures of type Weber A, 31.53 percent of fractures of type Weber B and 65.77 percent of fractures of type Weber C. 53 percent of patients were operated on the day of injury, 24.8 percent of patients were transferred with a delay from other clinics and in the rest of the patients the timely operation was contraindicated because of the poor local or general condition. The results were processed according to a uniform worksheet by the computer. On the basis of the evaluation there were found out 87.62 percent of successful and 12.38 percent of poor results. 93.3 percent of patients resumed their original jobs and there was no patient eligible for a full disability pension. The main cause of failure was the osteoarthritis of the ankle joint found out in connection with the inaffestable factors (such as defects of cartilage, nature of the bone lesion, luxation of talus, age and sex of the patient) and affectable factors (infection, failure of osteosynthesis, pseudoarthrosis of medial malleolus, non-anatomical position in the area of tibiofibular syndesmosis). The incidence of these negative factors may be reduced by a timely operation, precise surgical strategy and technique and proper post-operative treatment.

Adolescent↗
PubMed1995

Early range of motion training after ligament reconstruction of the ankle joint.

Early range of motion training after ligament reconstruction of the ankle ligaments for chronic ankle joint instability was evaluated. Forty patients were operated on with anatomic reconstruction of the lateral ankle ligaments, i.e. shortening, imbrication and reinsertion. The patients were randomized postoperatively between two groups: (1) immobilization for 6 weeks in a plaster cast and (2) early range of motion training, in a Walker-Boot. Both groups underwent an identical rehabilitation program, with peroneal strengthening and co-ordination training after 6 weeks. The functional results were evaluated using a scoring scale and the mechanical stability with standardized stress radiographs. The minimum follow-up was 2 years. The functional results were satisfactory in 16 (80%) of the patients in group I, and 19 (95%) in group II. The mean values of anterior talar translation and talar tilt were not significantly different between the groups preoperatively nor at follow-up. The mean time period for sick leave was significantly shorter for group II, 6.5 +/- 1.6 weeks compared with 8.5 +/- 1.8 weeks for group I. The mean time period for return to sports activity was significantly shorter for group II, 9.5 +/- 2.2 weeks, compared with 12.5 +/- 2.6 weeks for group I. Early range of motion training is recommended after ligament reconstruction of the ankle, as it will enable earlier return to sports activities, shorter sick leave and preserved mechanical stability.

Adolescent↗
PubMed1981

[Technique and results of arthrodesis of the ankle joint with autocompression plates (author's transl)].

The article describes the technique of arthrodesis of the ankle joint, introduced in 1973 by Mittelmeier, with suitable preparation (freshening) of the joint, resection of syndesmoses and internal osteosynthesis with autocompression angle plates, as well as additional fastening by screwing the fibula against tibia and talus. This method imparts high biomechanical stability to the joint thanks to the internal bracing of the frame; compared with external fixation, this method offers the advantage of avoiding the risk of subsequent infection of the borehole, as well as the possibility of early impaired wearing of trousers and of being able to bathe after superficial wound healing. Treatment results achieved in 14 patients showed (despite 1 reinfection following osteomyelitis caused by a fracture due to a bullet wound) regular, rapid and stable osseous reconstruction of the joint in which arthrodesis had been performed. Hence, this technique seems to be superior to external compression arthrodesis in aseptical cases.

Adult↗
PubMed1999

Reliability of water volumetry and the figure of eight method on subjects with ankle joint swelling.

STUDY DESIGN: Single-group repeated measures with 2 raters. OBJECTIVES: To determine the interrater and intrarater reliability of water volumetry and the figure of eight method on subjects with ankle joint swelling. BACKGROUND: Measurements of ankle swelling are commonly performed to determine the nature and stage of injury and to monitor progress made during rehabilitation. Water volumetry and the figure of eight method are 2 techniques used to measure ankle swelling. METHODS AND MEASURES: Twenty-nine subjects with ankle swelling were measured by 2 raters with the hypothesis that both measurement techniques would be reliable. Each rater performed 3 measurements of the swollen ankle using both measurement techniques during a single test session. The order of the rater and of the measurement technique was randomized, and the raters were blinded to each other's measurements. RESULTS: We found high interrater reliability for both the water volumetry (ICC [intraclass correlation coefficient] = 0.99) and figure of eight methods (ICC = 0.98). Additionally, intrarater reliability was high for both raters using both methods (ICCs = 0.98-0.99). CONCLUSIONS: Both methods are reliable measures of ankle swelling. The authors recommend the figure of eight method because of its ease of use, time efficiency, and cost effectiveness. However, water volumetry may be more appropriate when measuring diffuse lower-extremity swelling. Reliability of these 2 methods was established using subjects with foot or ankle pathology. Therefore, the results are applicable and generalizable to the clinical setting.

Adolescent↗
PubMedDate not supplied

Surgical treatment of chronic lateral instability of the ankle joint. A new procedure.

Sixty patients with chronic lateral functional and mechanical instability of the ankle joint were treated with shortening and reinsertion of the lateral ankle ligaments. All patients were followed prospectively for 2 to 5 years (mean, 3 years 6 months). We found the functional results to be excellent or good in 53 patients (88%). Patients with unsatisfactory results had either generalized joint hypermobility or long-standing ligament insufficiency. Anterior talar translation (ATT) and talar tilt (TT) were measured radiologically on standardized radiographs. Patients with excellent and good functional results had better mechanical stability, both ATT and TT, than those with fair and poor functional results. A good correlation was found between clinical, functional, and radiological results. In conclusion we found that reconstruction of the ankle stability by shortening and reinsertion of the lateral ankle ligaments is a safe and simple method and is a good alternative to other more complex methods of ligament reconstruction. The method should, however, be used with great care in patients with generalized joint hypermobility or in patients with long-standing ligament insufficiency.

Adolescent↗
PubMed1986

[Results of the surgical treatment of ankle joint fractures].

Surgical treatment was applied to 74 cases of ankle joint fractures at the author's hospital, between 1979 and 1984. Follow-up checks were made on 59 patients, within one to seven years from surgery. Luxation fractures accounted for 39 per cent. The rates of wound edge necrosis and bone infection were three per cent each. Results were evaluated by stringent and precisely defined criteria. The worst findings, according to expectation, were recorded from the cases of luxation fractures. Sixty-four per cent of all results were rated good to very good, and 17 per cent were rated poor. The patients' individual assessment was much better, since only three per cent felt that results were inadequate.

Adolescent↗
PubMedDate not supplied

Stenosing tenosynovitis of the flexor hallucis longus at the ankle joint.

The discussion of stenosing tenosynovitis of the flexor hallucis longus at the level of the ankle joint is not found in the literature with frequency. A thorough understanding of the involved anatomy is necessary when considering this condition. A strong clinical suspicion, coupled with appropriate diagnostic tests, is necessary to arrive at a proper diagnosis. Various treatment options may be considered. However, surgical decompression of the stenosed sheath ultimately is recommended by the authors.

Adult↗
PubMed1993

The effect of manipulation on range of movement at the ankle joint.

Manipulation is commonly used by physiotherapists in the treatment of musculoskeletal disorders; however, there have been few studies evaluating its use in peripheral joints. The purpose of this study was to investigate the effect of manipulation on dorsiflexion range of movement at the ankle joint. Twenty asymptomatic subjects participated, one ankle acting as the experimental ankle and receiving the manipulation intervention, while the other ankle acted as the control. The manipulation studied was a longitudinal talocrural manipulation. Dorsiflexion range of movement was measured at 5 consecutive torque levels pre and post manipulation intervention in the experimental ankle and pre and post no intervention in the control ankle. These values were compared using analysis of trend within an analysis of variance framework. There was no statistically significant change in dorsiflexion range of movement following manipulation. It was concluded that in the case of asymptomatic subjects these results did not provide support for the experimental hypothesis that a single talocrural manipulation alters dorsiflexion range of movement. It was suggested that future research investigate the effects of manipulation in a symptomatic population.

Adult↗
PubMed2001

Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint.

The aim of this study was to assess the repair of osteochondral defects of the ankle joint with hyaline cartilage. For this purpose we have been using a technique of autologous chondrocyte transplantation for osteochondral defects of the talus for the last two years. Until the method described in the paper, treatment methods proposed for the repair of cartilaginous defects have not been histologically effective in restoring the hyaline cartilage sheath, and in all cases the neoformation of cartilage was of a fibrocartilaginous nature with varying cellular characteristics. Clinical and histological results obtained using this surgical technique have confirmed its validity. Furthermore, neither subjective nor objective complications have been reported. Less pain and better articular function have also been observed. According to the AOFAS score, an improvement from an average score of 32/100 points pre-op. to 91/100 points at 24 months of follow up was obtained. Laboratory data have confirmed the presence of reconstructed cartilage with chondrocytes and expression of collagen II, characteristic of hyaline cartilage.

Adolescent↗
PubMed1994

The ankle joint prosthetic replacement: clinical performance and research challenges.

This article presents an up-to-date summary of ankle joint biomechanics and various aspects relevant to the endoprosthetic replacement of this joint (specifically, the tibiotalar articulation) when indicated. These aspects are: the design requirements, choice of materials, and clinical studies involving various designs. The reasons for the disappointing in vivo performance of most ankle implants, to date, are suggested and areas for research and development, aimed at introducing a new generation of these implants, are identified.

Ankle Joint↗
PubMed1999

Expression of matrix metalloproteinases in normal and damaged articular cartilage from human knee and ankle joints.

The objectives of this study were the following: (a) describe the appearance of histopathologic changes observed in human articular cartilage from the knee and ankle joints of organ donors with no symptomatic joint disease; (b) compare by in situ hybridization mRNA expression of six matrix metalloproteinases (MMP) in these cartilages; (c) compare MMP mRNA expression with the histology of the cartilage; and (d) test whether the effect of interleukin-1beta (IL-1beta) on the MMP mRNA expression could be detected with in situ hybridization. Human articular cartilages from the knee (tibiofemoral) and ankle (talocrural) joints of 41 different donors (aged 18 to 84 years) were obtained through the Regional Organ Bank of Illinois. The microscopic appearance of the cartilages was graded on a histopathologic scale from 0 to 13 with the highest grade representing severely damaged cartilage. In situ hybridization was performed using oligonucleotide probes to three collagenases (MMP-1, MMP-8, MMP-13), gelatinase A (MMP-2), stromelysin (MMP-3), and matrix type-1 metalloproteinase (MMP-14). Cartilages from some donors were cultured with IL-1beta and then analyzed for MMP expression using in situ hybridization. The histopathology grades of the cartilages from the asymptomatic donors covered the entire scale even in the ankle. Based on their grades, the cartilages were described as either normal (grades 0 to 5) or damaged (grades 6 to 13). The cartilages contained message for all six MMP tested with no detectable differences in expression of MMP-1, -2, -13, and -14 between the normal and damaged cartilages. However the expression of MMP-3 and MMP-8 was elevated in the damaged cartilages. In normal knee cartilage, mRNA expression of MMP-3 and MMP-8 was low, whereas in normal ankle cartilage, MMP-8 expression was below the detection limit. MMP-3 and MMP-8 message was up-regulated in the damaged cartilage from both joints, or if the tissue was cultured in the presence of IL-1beta. From this study we conclude the following: (a) similar histopathologic changes occur in both knee and ankle cartilages; (b) MMP-1, -2, -13, and -14 are constitutively expressed in adult human cartilage; and (c) only up-regulation of mRNA expression of MMP-3 and MMP-8 could be detected with naturally occurring cartilage damage and IL-1beta induction.

Adolescent↗
PubMed1979

External rotation and abduction fractures around the ankle joint treated by internal fixing using AO instrumentation.

One hundred and three displaced malleolar fractures of the ankle joint were treated by one orthopaedic firm between 1968 and 1974. Originally, 150 patients were reviewed, but 47 patients were excluded from the series for the following reasons: associated fractures of the lower tibia (10), associated fractures of the talus (3), inadequate follow-up (15) and patients lost to follow-up (19). Only patients who were followed up for at least one year were included in the series. The purpose of this study is to present the results obtained by treating displaced malleolar fractures using AO instrumentation.

Adolescent↗