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PubMed1993

Reliability of goniometric measurements and visual estimates of ankle joint active range of motion obtained in a clinical setting.

We examined intratester and intertester reliability for goniometric measurements of ankle dorsiflexion (ADF) and ankle plantar flexion (APF) active range of motion (AROM). Parallel-forms intratester reliability for ankle AROM measurements obtained by the universal goniometer (UG) and by visual estimation (VE) and intertester reliability for VE of ADF and APF were examined. Repeated measurements were obtained on 38 patients with orthopedic problems by 10 physical therapists in a clinical setting. For intratester reliability of measurements obtained with UG, intraclass correlation coefficients (ICC) for all physical therapists were 0.64 to 0.92 (median, 0.825) for ADF and 0.47 to 0.96 (median, 0.865) for APF. Intertester reliability was quantified with use of ICC. ICCs for measurements obtained by UG were 0.28 for ADF and 0.25 for APF; ICC of VE for ADF was 0.34 and was 0.48 for APF. ICC for parallel-forms intratester reliability obtained with UG and VE ranged from 0 to 0.94 (median, 0.58) for ADF and 0 to 0.86 (median, 0.625) for APF. Thus, a physical therapist should use a goniometer when making repeated measurements of ankle joint AROM. Considerable inconsistency exists when two or more physical therapists make repeated goniometric and visual measurements of ankle motion on the same subject. Physical therapists may erroneously conclude that a patient's AROM has changed because of treatment when the change could be attributed to a lack of intertester reliability.

Adolescent↗
PubMed1977

Oscillation of the human ankle joint in response to applied sinusoidal torque on the foot.

1. Low-frequency (3-30 Hz) oscillatory rotation of the ankle joint in plantarflexion-dorsiflexion was generated with a torque motor. Torque, rotation about the ankle and electromyograms (e.m.g.s) for the gastrocnemius-soleus and the anterior tibial muscles were recorded.2. Fourier coefficients at each drive frequency were used to calculate the effective compliance (ratio of rotation and torque). The compliance has a sharp resonance when tonic, voluntary muscle activity is present.3. The resonant frequency of compliance is between 3 and 8 Hz. The location of the resonant frequency and the magnitude of the compliance at resonance depend upon both the degree of tonic muscle activity and the amplitude of the driving torque. The resonant frequency increases with increasing tonic activity.4. With tonic muscle activity, the compliance in the frequency range below resonance increases with increasing amplitudes of driving torque.5. The e.m.g., when evoked by the rhythmic stretch, lags the start of stretching by between 50 and 70 msec.6. When tonic muscle activity is present, the resonant frequency of the stretch reflex is between 5 and 6.5 Hz.7. Following the start of driven oscillation at frequencies near resonance, slowly increasing amplitudes of angular rotation (to a limit) are observed.8. Distortion (from the sinusoidal wave shape) of angular rotation is frequently observed with drive frequencies between 8 and 12 Hz during which there sometimes occur spontaneous recurrences of oscillation at the drive frequency. For the angular rotation, a significant portion of the power may be in subharmonic frequency components of the drive frequency when that frequency is between 8 and 12 Hz.9. Self-sustaining oscillation (clonus) near the resonant frequency of the compliance is sometimes observed after the modulation signal to the motor is turned off. This is most often seen when the gastrocnemius-soleus muscles are fatigued. Clonus may be evoked by driven oscillation at any frequency.10. The hypothesis that physiological tremor, which occurs between 8 and 12 Hz, is a consequence of stretch reflex servo properties seems to be at odds with the observations of resonance in the compliance and of self-generated clonus both occurring in the 5-8 Hz region.

Adult↗
PubMed1999

[Anatomic reconstruction of the lateral ligaments of the ankle using a plantaris tendon graft in the treatment of chronic ankle joint instability].

The purpose of this work was to present our technique of anatomic reconstruction of the lateral ankle ligaments using a free plantaris tendon graft. Between 1988 and 1997, 52 ankles (48 patients) were treated for chronic ankle instability resisting to a training program of minimally 3 months. The average age was 28.6 years (16 to 46 years) at the time of surgery. There were 30 ankles in men and 22 ankles in females. 4 patients were treated on both ankles. 50 ankles were available for a follow-up investigation after a mean of 3.5 years (1 to 10 years). Based on the AOFAS-Hindfoot-Scale an average score of 97.9 points (90 to 100 points) was found. The functional result was found to be excellent in 39 ankles (78 %), good in 9 ankles (18 %), fair in 2 ankles (4 %), and poor in 0 ankle (0 %). Dorsi-/plantarflexion was not restricted in any ankle. Supination was slightly restricted in 2 ankles, but not increased in any ankle. High patient's satisfaction with respect to the achieved stability was found in all but one ankle. No deterioration with time was observed in any case. The overall good and excellent results with this method may be explained by the strictly anatomic reconstruction that did not alter the kinematics nor the mechanics of the ankle joint complex. In addition the peroneal tendons were not weakened. We feel that this procedure is a better alternative to other more complex ligament reconstructions, especially tenodesis operations by using the peroneal tendon.

Adolescent↗
PubMed2001

Long-term outcome of anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint: a multicenter study.

The long-term clinical outcome after anatomical reconstruction and tenodesis in the treatment of chronic anterolateral ankle instability was assessed in a retrospective multicentre study. The first group (AR) consisted of 25 patients (mean age at operation 22 yrs +/- 5.7) who underwent anatomical reconstruction and the second group (TE) of 29 patients (mean age 23 yrs +/- 6.6) who underwent tenodesis. For both groups, the mean follow-up period was 12.3 yrs (AR +/- 2.5 yrs, TE +/- 2.7 yrs). At physical examination, there were significantly more patients in the TE group (n=18) with a positive anterior drawer sign as compared with the AR group (n=7) (p=0.02). Medially located degenerative changes in the ankle joint as seen on standard radiographs were seen more often in the TE group (n=7) than in the AR group (n=1) (p=0.03). The mean talar tilt, 4.7 degrees in the AR group vs 6.9 degrees in the TE group, (p=0.02) and anterior talar translation, 2.9 mm in the AR group vs 4.3 mm in the TE group, (p=0.04) were significantly higher in the TE group at radiographic stress examination. According to the rating system developed by Good et al. (1975), significantly fewer patients in the TE group (n=8) had an excellent result as compared with the AR group (n=15) (p=0.03) and more patients in the TE group (n=9) had a fair or poor result (p=0.04) as compared with the AR group (n=2). We conclude that a tenodesis procedure does not restore the normal anatomy of the lateral ankle ligaments. When compared with anatomical reconstruction, a tenodesis leads to inferior results in terms of functional and mechanical stability, as well as overall satisfaction at long-term follow-up.

Adult↗
PubMedDate not supplied

Intra-articular osteochondroma of the ankle joint.

Intra-articular osteochondroma is a rare entity that appears as a single giant osteocartilaginous loose body in a joint cavity. The few reported cases of intra-articular osteochondroma have occurred in the knee joint. We report the case of a large osteochondral loose body in the ankle joint of a 10-year old girl and discuss the origin of the osteochondral tumor.

Ankle Joint↗
PubMed1993

[Standardized ultrasound diagnosis of instability after dislocation of the upper ankle joint].

The anterior drawer was evaluated sonographically under standard conditions (150 N load, 7.5 MHz linear scanner) in 95 patients with severe ankle sprain. A simple geometric construct of subsidiary lines set up with the help of a goniometer on the videoprints (enlargement 1.5 X) enabled a standardized interpretation of the anterior drawer (pathologic > or = 3 mm). Thus, the definition of poorly reproducible reference points for sonographic measurements became avoidable. In 60 patients a rupture of the lateral ankle ligaments was diagnosed, in 35 patients the findings were recorded as severe ankle sprains without ligament rupture. Compared with the radiological anterior drawer and talar tilt, the dynamic sonographic measurement of the anterior drawer showed the better values from the aspects of sensitivity, specificity and accuracy (> or = 0.93). In our own practice sonographic measurement of anterior drawer has replaced stress radiograms in diagnosis of ankle joint instabilities after severe ankle sprains.

Adolescent↗
PubMed1997

NOVEL Award 1996: 2nd prize Tenodeses do not fully restore ankle joint loading characteristics: a biomechanical in vitro investigation in the hind foot.

OBJECTIVE: In order to understand the biomechanical consequences of ligament injuries and surgical reconstruction procedures, their effects on intra-articular loading in the ankle joint complex and Chopart joint line and on the plantar pressure patterns were investigated in vitro. METHODS: Twelve fresh-frozen lower leg specimens were freed of soft tissue down to the malleoli and prepared for accessing the talocrural, subtalar, talonavicular and calcaneocuboid joints. The specimens were fixed in a loading simulator and axially loaded with 600 N in six experimental conditions: intact; after cutting the anterior talofibular ligament; after additionally cutting the calcaneofibular ligament; after performing three common types of tenodeses, the Evans, Watson-Jones and Chrisman-Snook procedures. The intra-articular loading characteristics were determined with pressure sensitive film. Plantar loading patterns were measured with a capacitive EMED pressure distribution platform. RESULTS: Average intra-articular pressures were increased and were related either to decreased contact areas or to increased contact forces found in all joints after ligament resections and tenodeses. Plantar loading was increased under the medial aspect of the foot and decreased under the midfoot region. CONCLUSIONS: The results indicate that ankle ligament injuries, as well as surgical reconstructions by tenodeses, affect joint loading characteristics and may exacerbate joint degeneration. RELEVANCE: Excessive laxity of the ankle joint is considered a pre-arthrotic condition and is treated with various surgical procedures. Some of these procedures that utilize the tendon of the peroneus brevis have been shown to change joint kinematics. The aim was to evaluate joint loading characteristics and the potential danger of developing arthritis as a consequence of various tenodeses techniques. For this purpose, in vitro investigations are needed to directly determine intra-articular pressure measurements.

Journal Article↗
PubMed2000

[Low-field MRI of the ankle joint: initial experience in children and adolescents using an open 0.2 T MR-system].

PURPOSE: To evaluate the feasibility and diagnostic confidence of MRI with an open low field System (Magnetom open, Siemens, Germany) in children with predominantly traumatic disorders. MATERIAL AND METHODS: Conventional X-rays and MRI examinations have been evaluated in 55 children. MRI was performed at an open 0.2 T MR-unit. The study protocol comprised coronal STIR-sequence, an angulated T2 weighted TSE-sequence and T1 weighted SE-sequence. RESULTS: MRI showed ligamental rupture in 33/50 (60%) cases. Injuries of the ATFL were most frequent (27/33); osseous ligamental tears occurred in approx. 50% of all cases. Fractures of the distal tibia and fibula were diagnosed in 28/55 children. 15/28 cases showed an involvement of the epiphysis. We found occult fractures in 11/28 children. Fractures, diagnosed by conventional x-rays, were excluded in 6 cases. Therapy changed in 35/55 patients on the basis of MRI-findings. CONCLUSION: Low-field MRI of the ankle joint in children and adolescents is able to show numerous pathological conditions. We recommend low-field MRI of the ankle in children with persistent or unclear pain of the ankle joint and inconspicuous conventional x-ray.

Adolescent↗
PubMed2002

Knee and ankle joint stiffness in sprint running.

INTRODUCTION: Stiffness has often been considered as a regulated property of the neuromuscular system. The purpose of this study was to examine the ankle and knee joint stiffness regulation during sprint running. METHODS: Ten male sprinters ran at the constant relative speeds of 70, 80, 90, and 100% over a force platform, and ground reaction forces, kinematic, and EMG parameters were collected. RESULTS: The results indicated that with increasing running speed the average joint stiffness (change in joint moment divided by change in joint angle) was constant (7 N x m x deg(-1)) in the ankle joint and increased from 17 to 24 N x m x deg(-1) (P < 0.01) in the knee joint. CONCLUSION: The observed constant ankle joint stiffness may depend on (constant) tendon stiffness because of its dominating role in triceps surae muscle-tendon unit. Thus, we conclude that in sprint running the spring-like behavior of the leg might be adjusted by changing the stiffness of the knee joint. However, in complicated motor task, such as sprint running, ankle and knee joint stiffness might be controlled by the individual mechanical and neural properties.

Adult↗
PubMed1984

Atypical pronation-eversion ankle joint fractures.

Two cases of pronation-eversion fractures, grade four, are described which were sustained during sports activities. However, in both cases the medial structures of the joint were intact. The trauma mechanism is obscure but may be explained by considering the ankle joint and the subtalar joints as a torsion transmitter as suggested by Inman (1976).

Adult↗
PubMed1999

Risk of degenerative ankle joint disease in volleyball players: study of former elite athletes.

To estimate the influence of long-term, high-intensity volleyball playing on premature osteoarthritis (OA) of the ankle joint, we examined a group of 22 former elite volleyball-players age (34 +/- 6 yrs.) who had played for at least 3 years in the highest volleyball league in Switzerland, and 19 normal healthy untrained controls (35 +/- 6 yrs.). Volleyball-athletes had played during an average of 5.5 (+/- 2) h/wk for 8.5 (+/- 3) yrs. Twenty of the 22 players had suffered from at least one ankle sprain (average: 3.5), 10 had had ruptures of the lateral ligaments (8 of them operated). Four players had severe mechanical instability, 5 a talar varus tilt in the stress X-ray of more than 8 degrees. Subchondral sclerosis and osteophytes were more prevalent in volleyballers than in controls (p < 0.001), while the difference in joint space was not significant. No severe grades of OA could be observed in these former elite volleyball players. Yet, a radiologic score of degenerative ankle disease was elevated in 19/22 of them, but only in 2/19 controls (p<0.001). In multiple regression analysis among athletes, the anterior drawer sign and a feeling of instability were the only significant and independent predictors of an increased radiological index (p = 0.003 and p = 0.02, respectively) from an initial set of 9 variables covering career length and intensity as volleyball player, clinical signs of ankle instability and age. Even if in the present study, athletes had clearly more radiologic findings than controls--such as spur formation and subchondral sclerosis--long-term, high-intensity volleyball playing alone could not be confirmed as an independent risk factor for OA of the ankle joint however, a combination of chronic lateral ankle instability with intensive volleyball playing could marginally increase the risk of ankle OA.

Adult↗
PubMed1997

A kinematic study of ankle joint instability due to rupture of the lateral ligaments.

Kinematic analysis of patients who have ruptured the ligaments of the ankle joint was performed to evaluate the function of those ligaments. Ten patients with ruptured lateral collateral ligaments and 10 normal volunteers were examined. Patients' ages ranged from 17 to 29, averaging 20.9 years old. We performed kinematic evaluation by a three-dimensional optical analytic technique using surface markers. According to our results, the ankles with lateral ligament injury abnormally pronated and rotated externally at the time of heel strike and abnormally supinated and rotated internally during the acceleration phase.

Adolescent↗
PubMed1990

[A new computer-controlled device for stress images of the upper ankle joint].

A new apparatus has been developed for stress roentgenograms of the ankle joint to demonstrate rupture of the fibular collateral ligaments possible. The disadvantages of well-known techniques, such as manual application of stress and the use of holding devices are eliminated. The inversion stress is applied by a foot support driven by an electric motor. A microcomputer controls the force of inversion in dependence on reactive muscle splinting; i.e. the apparatus simulates the application of the inversion force by a physician acting according to feeling. In contrast to the radiography technique with manual holding, the patient is not able to press the foot against the inversion force if a pain-reflexive muscle contraction occurs. Other holding devices generate the inversion force with a threaded shank or traction weight; with the new device the patient's discomfort lasts only 2 s. In the last 5 years the new holding device has shown its reliability in about 1500 examinations.

Ankle Injuries↗
PubMed1997

[Primary closed, stabilization of type C 3 pilon fractures with external fixator without bridging the ankle joint].

The necessity for a short operative procedure that does not cause additional stress to the soft tissue overlying pylon fractures and at the same time enables the surgeon to reconstruct the distal articular surface of tibia and fibula, which includes achieving the correct length, led us to develop a new procedure in the acute treatment of such fractures. Therefore our operative procedure starts with indirect reduction and stabilization of the fibula by means of intramedullary Kirschner wires. For a precise analysis of the main fracture fragments of the distal tibia, we continue with reduction of the articular surface by means of ligamentotaxis and stabilization with angular external fixator without bridging the ankle joint. Special positioning of the external fixator allows an almost completely percutaneous procedure under X-ray control, and furthermore, control of the alignment of the articular surface of the tibia. At the same time, additional surgical measures, such as spongious bone transfer, grafting of skin flaps or secondary correction of the axis, are possible. In three cases of type C2 pilon fracture reported, healing was achieved within 12 weeks without complications. The range of motion of the ankle joint was preserved by physiotherapy under epidural anesthesia for a period of 5 days postoperatively.

Adult↗
PubMed1986

Position dependence of ankle joint dynamics--II. Active mechanics.

System identification techniques were used to examine the position dependence of active ankle joint mechanics. Subjects were required to maintain tonic contractions in either the tibialis anterior (TA) or triceps surae (TS) muscles while the ankle was stochastically displaced about different mean angular positions. The dynamic relation between ankle position and torque was determined for each mean position/tonic torque combination; a non-linear minimization technique was used to estimate the three parameters (inertial, viscous and elastic) of a second-order, underdamped system. Whereas the inertial parameter remained essentially invariant across all test conditions, the viscous and elastic (K) parameters became larger as the level of tonic activity increased and as the joint was rotated toward the extremes of the range of motion. The relation between K and torque was linear at all ankle angles. The slope of this relation remained constant at all mean positions during plantarflexor contractions; during dorsiflexor contractions the slope increased as the ankle was rotated from maximum plantarflexion to maximum dorsiflexion. These findings are discussed in terms of: the physiological correlates of ankle mean position, the relative significance of passive and active joint mechanics and contrasts in joint behaviour during active dorsiflexor and plantarflexor contractions.

Adult↗
PubMed1991

The causes of subsequent arthrodesis of the ankle joint.

Between 1917 and 1984, we performed 217 arthrodesis of the ankle joint. Posttraumatic states were the cause of the osteoarthritis in 153 cases, whereas 118 of these cases were malleolar fractures. The accident X-rays were analyzed, and the fractures were classified in accordance with the classification of Weber (11). Our own system was used for the radiological classification of the degree of arthritis. The extent of malunion after the initial care was assessed. We found type-C malleolar fractures most frequently, the most striking malunion being the shortening of the fibula. In all fractures requiring subsequent arthrodesis, osteoarthritis of degree III-IV was present. In most cases the malleolar fractures treated surgically showed a shortening of the fibula and must be considered failures of initial care. The classification into types according to Weber also seems to provide prognostic information about the subsequent need for arthrodesis. Here it can be observed that C-fractures and compression fractures more often require arthrodeses.

Ankle Injuries↗
PubMed2003

Measurement device for ankle joint kinematic and dynamic characterisation.

The paper describes a measurement device for obtaining the kinematic characterisation and isometric loading of ankle joints under different working conditions. Non-invasive, in vivo experiments can be conducted with this experimental apparatus, the potential of which could be usefully exploited in basic biomedical research, prosthesis design, clinical applications, sports medicine and rehabilitation. The device determines the 3D movement of the foot with respect to the shank and evaluates the torques and moments around the three articular axes in relation to any desired angular position of the ankle complex. When integrated with superficial electromyographic techniques and electrical stimulation, it allows the assessment of the functionality of the lower leg in both mechanical and myo-electrical terms. The paper reports the main mechanical and electronic features of the device (high linearity; maximum moment ranges +/- 300 Nm for flexion-extension, +/- 35 Nm for both pronation-supination and internal-external rotation; angular ranges: +/- 100 degrees of dorsi-plantar flexion, +/- 50 degrees of internal-external rotation and prono-supination; linear ranges: +/- 25 mm along each axis). Results from a healthy volunteer, under voluntary or stimulated conditions, helped in testing its operatability, reliability, robustness, repeatability and effectiveness. Preliminary simplified protocols have been also applied to 20 healthy volunteers, and the main results were 80.8 +/- 11.9 degrees of internalexternal rotation, 46.2 +/- 9.1 degrees of prono-supination and 74.6 +/- 13.1 degrees of flexion-extension. Torques and moments were normalised with respect to a body mass index of 30. The maximum plantar flexion moment (57.5 + 21.3 Nm) was measured with the foot at 150 of dorsal flexion; the maximum dorsal flexion moment (50.2 + 20.3 Nm) was measured with the foot at 150 of plantar flexion.

Ankle Joint↗
PubMed1995

Nonlinear behavior of muscle reflexes at the human ankle joint.

1. Pulse inputs (similar to tendon jerks) were applied to the human ankle joint with the use of a hydraulic actuator. Inputs of only 1-2 degrees could elicit large responses (> 20% of maximum voluntary contraction). The magnitude of the response depended nonlinearly on a number of factors: the amplitude, direction, and duration of the pulse; the angle of the ankle; and the level of voluntary activation of the ankle muscles. 2. Pulses that flexed or extended the ankle could both produce reflex torques in the same direction (extensor torque). Although an extension of the ankle did not itself produce a response, it could affect the response to a subsequent flexion for up to 1 s. 3. The influence of random perturbations on the stretch reflex at the ankle was assessed. Responses to pulse displacements alone and to pulses superimposed on random perturbations were compared at the same level of voluntary activity. Reflex responses decreased in a graded manner with increasing amplitude or bandwidth of the random perturbations. 4. These results demonstrate that stretch reflexes can generate substantial torques, but in a highly nonlinear manner. In particular, passive joint movements markedly alter stretch reflex gain, and these changes must be considered in interpreting the functional significance of reflex actions.

Ankle↗