[Diagnosis and therapy of injuries to the ankle-joint ligaments].
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Ankle Injuries↗
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Strength training in old age: adaptation of antagonist muscles at the ankle joint.
The purpose of this study was to determine whether strength training could reduce the deficit in plantarflexion (PF) maximal voluntary contraction (MVC) torque observed in previous studies in older subjects relative to young adults. Accordingly, the effects of a 6-month strength training program on the muscle and neural properties of the major muscle groups around the ankle were examined. PF and dorsiflexion (DF) isometric MVC torques were measured and surface electromyographic activity of the triceps surae and tibialis anterior muscles was recorded. The strength training program was very effective in improving strength in PF (+24.5%), and it thus reduced the DF-to-PF MVC torque ratio; in addition, it also induced gains in DF (+7.6%). Thus, there must be an improvement in ankle joint stability. In PF, gains were due particularly to a modification of the agonist neural drive; in DF, the gains appeared to be the consequence of a reduction in antagonist coactivation. Our findings indicate that the investigation of one muscle group should always be accompanied by examination of its antagonist muscle group.
Adaptation, Physiological↗
[ON THE SURGICAL TREATMENT OF OLD LACERATION OF THE LIGAMENTS OF THE ANKLE JOINT].
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Adolescent↗
[Diagnosis and therapy of lateral ligament rupture of the upper ankle joint].
Symptoms, diagnosis and therapy of the ligaments at the malleolus lateralis are demonstrated. It is only the x-ray examination in fixed talar drawer position that enables exclusion of an instability with certainty. Hence, we may infer that every distorsion of the articulation must be x-rayed in talar drawer position to make sure that no rupture of the ligaments is omitted. Posttraumatic weak ankle due to neglected rupture of the fibular collateral ligaments can be avoided by suturing the rupture and fixation by plaster. Indications for surgery are: 1. considerable instability of the ankle joint compared with the healthy side, 2. a suspected covering of one periosteum or ligament as an interposition. 3. a suspected lesion of the cartilage or "flake fracture".
Adolescent↗
Kinematic and dynamic analysis of the ankle joint in children with cerebral palsy.
The assessment of walking in children affected by cerebral palsy (CP) is currently based principally on qualitative assessment criteria. Gait analysis, meanwhile, evaluates quantitatively kinematic and dynamic aspects of locomotion. The main aim of this study was to examine (using an optoelectronic system and a force platform) kinematic and dynamic aspects of the ankle joint in hemiplegic and in diplegic children (9 and 11 subjects respectively) and in 10 normal control subjects. Our results reveal, in spastic subjects, "equinus" placement of the foot in the initial contact phase, a lack of dorsiflexion (negative DF peak) in the stance phase and a reduction in push-off capacity (capacity to move the leg forward) in the swing phase. The results furnished by this study represent a useful contribution to the assessment of the walking ability of children affected by CP and to the evaluation of the indications and advantages of the rehabilitative intervention chosen.
Ankle Joint↗
[Arthroscopic treatment of anterior synovitis of the upper ankle joint in the athlete].
UNLABELLED: In a retrospective study we analyzed the results of arthroscopic treatment of anterior synovitis of the ankle in 35 athletes. 5 athletes suffered additionally from anterior osteophytes and 3 presented with an anterolateral plica. Average age was 25 years (SD: 8.3) and follow-up interval was 32.4 months (SD: 19.4). 8 patients suffered from additional hyperlaxity of the ankle joint. At time of follow-up the patients were examined clinically as well as radiologically. The results were scored according to an ankle score containing the criteria pain, function, athletic activity, walking aids, range of motion, and swelling. During surgery a partial synovectomy was performed as well as removal of anterior osteophytes or anterolateral plica if necessary. The overall score increased non-significantly from 66.2 preoperatively to 78.7 postoperatively (p > 0.05). Comparing the different criteria the score parameter pain significantly increased after arthroscopy. All other parameters (function, athletic activity, walking aids, range of motion, swelling) showed only slight changes in this patient group. Athletes with hypermobile joint showed worse results compared to the others. Even after surgery we documented severe restriction in athletic activity. Only 9 patients performed their activities on their previous level, 19 reduced their activity level and 7 discontinued their athletic activity. In 6 cases we found iatrogenic temporary neurologic damage. CLINICAL RELEVANCE: Due to the uncertain clinical outcome and the documented high risk of neurovascular complications, patient selection for arthroscopic partial synovectomy in the athletic population should be performed extremely carefully. Prior to surgery, all other conservative options including changes of running shows as well as modifications in exercise program and athletic activity should be considered.
Adolescent↗
Surgical treatment of fracture-dislocations of the ankle joint with biodegradable implants: a prospective randomized study.
In a randomized study 43 patients with fracture-dislocations of the ankle joint were treated by open reduction and fixation with either steel or biodegradable implants. Results in both groups were favorable and the biodegradable material appears to be useful for some fracture-dislocations to obviate the need for a second operation.
Adolescent↗
[Novel functional studies of the stabilizing behavior of ankle joint ortheses].
For functional treatment of acute ankle sprain after surgical or nonsurgical management various special shoes and braces are in use. For a comparison under functional conditions we applied controlled inversion movements of 20 and 30 degrees to 13 subjects. The reduction of angular displacement was measured for the following orthosis: Aircast, Adimed Stabil 2, Adipromed Stabil Super, Mikros Ankle Brace, MHH-Splint Caligamed, Puschbrace and Tape. For evaluation of the neuromuscular activation surface EMGs of selected leg muscles were analyzed. A significant reduction of the induced inversion displacement was observed in all devices, although a complete inhibition of this movement was not possible. EMG activation was comparable to physiological conditions and is not correlated to the displacement characteristics. It is concluded that functional evaluation must take into consideration both the optimal reduction of the inversion and the high functional innervation.
Ankle Injuries↗
The reliability of isokinetic testing of the ankle joint and a heel-raise test for endurance.
The aim of the present study was to investigate the reliability of different methods used for isokinetic testing of calf muscle strength and endurance. The detailed evaluation of test-retest reliability serves the purpose of establishing reliable research tools when evaluating patients who have sustained an Achilles tendon rupture. The test-retest reliability of isokinetic measurements at the ankle for eccentric and concentric muscle action was calculated in ten healthy male volunteers using intra-class correlation (ICC) and coefficient of variation (CV). Three different positions were compared at the angular velocities of 30 degrees /s and 180 degrees /s for right and left ankles. The ICC for plantar flexion was 0.37-0.95, whilst it was 0.00-0.96 for dorsiflexion. The corresponding CVs were 4.0-19.9 and 2.4-19.8 respectively. The test-retest reliability of standardised heel-raises, Achilles tendon width, calf circumference and ankle range of motion revealed ICC values of 0.71-0.98 and CVs of 0.67-19.1. The test-retest interval was 5 to 7 days. We conclude that all three positions studied for the isokinetic evaluation of calf muscle function are equally reliable concerning plantar flexion at the ankle joint. The same level of reliability was also found in the evaluation of the standing heel-raise test and the isokinetic dorsiflexion test, except for dorsiflexion in the supine position. The reliability of the investigated methods was only fair despite the use of a detailed and standardised test protocol.
Achilles Tendon↗
Articulated external fixation of pilon fractures: the effects on ankle joint kinematics.
The effect of the Orthofix articulated ankle external fixator on ankle and subtalar joint kinematics and fracture fragment motion was investigated in fresh cadaver specimens using biplanar radiographic analysis. The kinematic testing was performed for the normal ankle (i.e., no fixation) and for three alternate fixator hinge orientations. The fixator applications simulated a horizontal ankle axis (the current clinically preferred orientation), an axis coincident with a previously defined approximate ankle axis, and an axis located using a mechanical axis finder. The horizontal fixator application significantly disturbed normal ankle kinematics. Aligning the fixator hinge with an approximate ankle axis caused significant distortion of motion about only two of six possible rotational axes. Aligning the fixator hinge with the (specimen-specific) ankle axis determined by the axis finder most closely matched the motion of the normal ankle. For pilon fractures simulated by a transverse osteotomy, there appeared to be no physiologically significant fracture fragment motions, regardless of fracture stability or fixator orientation.
Ankle Injuries↗
Randomized controlled study of ultrasound therapy in the management of acute lateral ligament sprains of the ankle joint.
OBJECTIVE: To determine the efficacy of a fixed dose of ultrasound energy to treat acute lateral ligament sprains of the ankle joint. STUDY DESIGN: Double-blind randomised controlled trial. SETTING: Accident and Emergency department of University Teaching Hospital. SUBJECTS: Patients presenting at Accident and Emergency with ankle injuries. INTERVENTION: Ultrasound or placebo, and Tubigrip. OUTCOME MEASURES: Pain measured with visual analogue scales, swelling using a tape measure, range of movement using a fluid-filled goniometer, and weight bearing using two scales simultaneously. RESULTS: Patients in both groups improved symptomatically. There were no statistically significant differences between groups in any outcome measure. Within groups, statistically significant differences were detected in pain perceived, and range of movement (dorsiflexion). CONCLUSION: At the dose and duration used, ultrasound therapy is no better than placebo in the management of lateral ligament injuries.
Ankle Injuries↗
Imaging articular cartilage defects in the ankle joint with 3D fat-suppressed echo planar imaging: comparison with conventional 3D fat-suppressed gradient echo imaging.
PURPOSE: To shorten the examination time for articular cartilage imaging, using a recently developed three-dimensional (3D) multishot echo planar imaging (EPI) sequence with fat saturated (FS), compared to a conventional 3D fat-saturated spoiled gradient echo sequence (3D FS GRE). MATERIAL AND METHODS: There were 32 consecutive patients with ankle joint disorders who underwent magnetic resonance imaging (MRI) in a 1.0-T unit. Hyaline cartilage was imaged with a 3D FS EPI sequence and a 3D FS GRE sequence. Image assessment criteria included lesion conspicuity, contrast between different types of normal tissue, and image artifacts. In addition, contrast-to-noise ratios (CNRs) of cartilage vs. joint fluid and bone marrow were measured. RESULTS: The 3D FS EPI sequence provided a high CNR between cartilage and subchondral bone, similar to that of the 3D FS GRE sequence. The CNR between cartilage and effusion was significantly lower on the 3D EPI sequence due to the higher signal intensity of fluid. Both sequences were equal in lesion detection ability. The image quality of the 3D FS GRE sequence was slightly higher than that of the 3D FS EPI, but the difference was not statistically significant. CONCLUSION: We conclude that the 3D FS EPI sequence is comparable to the 3D FS GRE sequence in the detection of cartilage lesions, with the additional advantage of reduction in scan time by a factor of 4.
Adolescent↗
The detached osteochondral fragment as a source of cells for autologous chondrocyte implantation (ACI) in the ankle joint.
OBJECTIVE: Autologous chondrocyte implantation (ACI) has been successfully used for the treatment of osteochondral lesions of the talus. One of the main problems of this surgical strategy is related to the harvesting of the cartilage slice from a healthy knee. The aim of this study was to examine the capacity of chondrocytes harvested from a detached osteochondral fragment to proliferate and to serve as a source of viable cells for ACI in the repair of ankle cartilage defects. METHODS: Detached osteochondral fragments harvested from the ankle joint of 20 patients with osteochondral lesions of the talus served as the source of human articular cartilage specimens. All of the osteochondral lesions were chronic and of traumatic origin. In all cases, the fragments were utilized to evaluate the viability and proliferation of the cells, the histological appearance of the cartilage tissue and the expression of specific cartilage markers by real-time polymerase chain reaction (PCR). In the 16 patients scheduled for ACI, the expanded chondrocytes were used for chondrocyte implantation. In the other 4 patients, with lesion size <1.5cm(2), microfractures were created during the initial arthroscopic step. As a control group, 7 patients with comparable osteochondral lesions underwent the same surgery, but received chondrocytes harvested from the ipsilateral knee. RESULTS: According to the American Orthopaedic Foot and Ankle Scoring (AOFAS) system, patients in the experimental group had a preoperative score of 54.2+/-16 points and a postoperative one of 89+/-9.6 points after a minimum follow-up time of 12 months (P<0.0005). The control group of patients had a preoperative score of 54.6+/-11.7 points and a postoperative one of 90.2+/-9.7 points at a minimum follow-up time of 12 months (P<0.0005). The clinical results of the two groups did not differ significantly from each other. Chondrocytes isolated from the detached fragments were highly viable, phenotypically stable, proliferated in culture and redifferentiated when grown within the three-dimensional scaffold used for ACI. The morphological and molecular characteristics of the cartilage samples obtained from the detached osteochondral fragments were similar to those of healthy hyaline articular cartilage. CONCLUSIONS: The good results achieved with this strategy indicate that cells derived from the lesioned area may be useful in the treatment of osteochondral defects of the talus.
Adult↗
[Benign tenosynovial giant cell tumor in the region of the upper ankle joint. A rare differential diagnosis of a soft tissue tumor of the foot].
The giant cell synovioma is a benign neoplasia classically located in the fingers. It mostly rises from tendon sheaths, sometimes from the synovia. Other locations than the fingers are rare. Making a differential diagnosis to lipomas, gangliomas or even malignant soft tissue tumors can be very difficult especially in rare locations. We report the case of a 21 years old man suffering from a giant cell synovioma in the area of the right ankle joint. The clinical, radiological and patho-morphological findings are documented. The tumor was excised totally, other foci were not found. The problems of making the right diagnosis are described.
Adult↗
Radiographic examination of the large tendons of the knee and ankle joints.
The authors present some interesting cases to illustrate the diagnostic potential of soft tissue radiography on the knee and ankle joints. Radiographs using the special soft tissue technique provide significant diagnostic assistance to estimate the morphologic alterations and give an objective basis for determining the disability of the patient.
Achilles Tendon↗
[Surgical management of fresh injuries of the outer ligament of the upper ankle joint in local anesthesia].
Fresh, isolated external ligament ruptures in adults have been surgically treated almost without exception under local anaesthesia for more than a year now at the Department of Surgery of the Rhenish-Westphalian Technical University (RWTH) at Aachen. No complications due to anaesthesia developed in these 119 patients; all of them expressed great satisfaction at this mode of surgical approach. What is more: this method is less costly and requires less personnel than surgery under peridural anaesthesia or intratracheal (intubation) anaesthesia. Hence, in the authors' opinion, isolated fresh ruptures of the outer ligaments of the ankle joint should be operated on more often under local anaesthesia than is actually being done at present.
Adolescent↗
[Late results following ankle joint osteosyntheses].
Follow-up checks were performed on 106 patients, between four and 16 years after osteosynthesis on the upper ankle joint. Good to very good results by Weber's criteria were recorded from 57.5 per cent. That percentage had been much higher in other comparable studies. The high percentage of poor results from the authors' patients was attributed to malreduction, incorrect osteosynthesis, and delay of surgical treatment in many cases. The prognosis was found to be clearly deteriorated by distal tibial edge fractures. Long-time results can best be favourably influenced by high-accurate reduction and osteosynthesis and high rates of primary operations.
Adult↗
Computer-assisted ankle joint arthroplasty using bio-engineered autografts.
Bio-engineered cartilage has made substantial progress over the last years. Preciously few cases, however, are known where patients were actually able to benefit from these developments. In orthopaedic surgery, there are two major obstacles between in-vitro cartilage engineering and its clinical application: successful integration of an autologuous graft into a joint and the high cost of individually manufactured implants. Computer Assisted Surgery techniques can potentially address both issues at once by simplifying the therapy, allowing pre-fabrication of bone grafts according to a shape model, individual operation planning based on CT images and providing optimal accuracy during the intervention. A pilot study was conducted for the ankle joint, comprising a simplified rotational symmetric bone surface model, a dedicated planning software and a complete cycle of treatment on one cadaveric human foot. The outcome was analysed using CT and MRI images; the post-operative CT was further segmented and registered with the implant shape to prove the feasibility of computer assisted arthroplasty using bio-engineered autografts.
Ankle Joint↗