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At least 721 records · Page 40Linked to original sources
PubMed1994

[MRI monitoring of reconstruction of ligaments of the upper ankle joint after injury].

The therapy of fibular ligament ruptures is still a controversial subject. Reports on healing processes following operative or conservative treatment have been verified hitherto by means of clinical examinations and stress tests. The MRT, as a highly sensitive non-invasive method, allows exact documentation of the ligament structures in the ankle joints. This technique was used in a randomized clinical trial over a 6-month period. The 29 patients (ages 17-51 years) had recent ligament rupture [admission criteria: clinical signs of trauma, talar tilt in anteroposterior stress radiographs (15 kp) > or = 10 degrees, talar shift > or = 10 mm] were examined with regard to ligament healing during functional therapy with AIRCAST pneumatic leg braces. Within the first week an MRT was done for verification of ligament injury. Treatment was conservative and functional: lower leg cast for 2 weeks and subsequent mobilization with protection provided by an AIRCAST brace. Follow-up examination was 3 months after injury, taking the form of clinical examination, a-p-radiographs with stress tests, and MRT. In all patients both clinical and radiological examination confirmed that ligament structures had healed, as was also verified by MRT.

Adolescent↗
PubMed2005

The effect of estradiol and progesterone on knee and ankle joint laxity.

BACKGROUND: Female athletes suffer a higher incidence of anterior cruciate ligament injuries compared to their male counterparts, and they appear to be at increased risk for these injuries when they have increased anterior-posterior knee laxity and at specific phases of the menstrual cycle. Although the mechanism by which these factors combine to increase injury risk is unclear, studies suggest that cyclic variations in joint laxity produced by hormone fluctuation during the menstrual cycle predispose an athlete to increased risk of ligamentous injury. Little is known about whether joint laxity varies cyclically during the menstrual cycle and if so, whether it is modulated by cyclic variations of estradiol (E2) and progesterone (P4). HYPOTHESIS: Increased serum estradiol (E2) and progesterone (P4) levels are associated with increased ankle and knee joint laxity. STUDY DESIGN: Cohort study. Level of evidence, 2. METHODS: Ankle laxity, anterior-posterior knee laxity, and serum concentrations of estradiol (E2) and progesterone (P4) were measured during the menstrual cycle in women and at corresponding time intervals in men (controls). Ankle laxity was measured from stress radiographs and included anterior talar translation relative to the tibia and talar tilt relative to the tibia; anterior-posterior knee laxity was measured with the KT-1000 arthrometer. RESULTS: Women had greater knee and ankle laxity values compared to men. There was, however, no change in knee and ankle laxity over the normal menstrual cycle in women and no change over time in men. There was no relationship between estradiol and progesterone fluctuation and ankle and knee joint laxity. CONCLUSIONS: Knee and ankle joint laxities are greater for women compared to men; however, the cyclic estradiol and progesterone fluctuations that occur during the menstrual cycle do not produce cyclic fluctuations of joint laxity. Studies using joint laxity to identify a subject at risk for ligamentous injury need only consider making measurements at a specific point in time, such as during a preseason screening evaluation.

Adult↗
PubMed1993

[Resection arthrodesis of the proximal ankle joint in Ewing's sarcoma. Maintenance of leg length using distraction osteogenesis].

The technique of segmental transport of the tibia according to Ilzarov is a well-known procedure in pediatric orthopedics, but in the treatment of bone tumors it has not yet been established. The method is also applicable for filling a large gap after tumor resection in the distal tibia. A case history is presented in which Ewing's sarcoma localized in the distal tibia was removed surgically after multiagent chemotherapy. The ankle joint was successfully fused after bone transport of the tibia 5 cm distal to the talus.

Adult↗
PubMedDate not supplied

Comparative study of therapies for fibular ligament rupture of the lateral ankle joint in competitive basketball players.

This retrospective study compares the results of different therapies for fibular ligament rupture in a homogenous group of professional athletes. The endpoint "competitive sports" was an outcome consideration. Subjects were examined by means of a standardized questionnaire and a structured interview. One hundred and seventy-nine of the questionnaires were completed and returned for evaluation. All of the basketball players with severe ankle sprain (supination trauma with swelling, pain, and inability to bear stress) were included. Those players with fractures of the foot, pronation trauma, or additional distal fibula or tibia fractures were excluded from this study. Of the 179 basketball players 160 (89%) had suffered severe ankle sprain. The treatment was divided into three groups: primary surgery (N = 35), plaster cast (N = 39), and functional treatment (N = 89). While simple ligament injuries (Grade I and II) were mostly treated functionally, complex ligament injuries (Grade III) were usually operated on. A total of 119 (74%) of the players reported no further pain. For pain reduction surgical and functional treatments showed advantages over plaster treatment. In the surgical group 63% of the players judged their regained stability to be equivalent to that of their healthy leg. Only 50% of the players in the plaster and functional groups believed their ankle joints to have regained the same stability as before their injuries. Despite the achievement of good results through surgery, there were clear differences in the players' assessments of their performance in competitive sports. Most subjects (92%) did not have any problems in everyday life regardless of which kind of therapy had been chosen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Differential matrix degradation and turnover in early cartilage lesions of human knee and ankle joints.

OBJECTIVE: To determine whether there are differences in matrix turnover within early cartilage lesions of the ankle (talocrural) joint compared with the knee (tibiofemoral) joint that may help explain differences in the prevalence of osteoarthritis in these 2 joints. METHODS: Cartilage removed from lesions of the tali and femoral condyles was analyzed for type IIB collagen messenger RNA, C-terminal type II procollagen propeptide (CPII), the collagenase cleavage neoepitope (Col2-3/4C(short)), and the denaturation epitope (Col2-3/4m). The content of collagen, glycosaminoglycan, and epitope 846 of aggrecan was quantitated. RESULTS: In ankle lesions, there was an up-regulation of markers of synthesis (CPII [P = 0.07]; epitope 846 [P < or = 0.0001]), but these were down-regulated in the knee (CPII [P = 0.1]; epitope 846 [P = 0.004]). In lesions of the knee, but not the ankle, there was an up-regulation of collagen degradation markers (P = 0.008). On a molar basis, there was 24 times more cleavage epitope than denaturation epitope in knee lesions compared with ankle lesions. CONCLUSION: The up-regulation of matrix turnover that is seen in early cartilage lesions of the ankle would appear to represent an attempt to repair the damaged matrix. The increase in collagen synthesis and aggrecan turnover seen in ankle lesions is absent from knee lesions. Instead, there is an increase in type II collagen cleavage. Together with the differences in collagen denaturation, these changes point to an emphasis on matrix assembly during early lesion development in the ankle and to degradation in the knee, resulting in fundamental differences in matrix turnover in these lesions.

Adult↗
PubMed2001

Intra-articular load distribution in the human ankle joint during motion.

The rational treatment of injuries to the ankle is predicated on an understanding of biomechanics of the ankle. While several investigators have reported on three-dimensional dynamic kinematics of the ankle and on the static distribution of pressure within the ankle, it has not been possible to measure intra-articular forces reliably under dynamic conditions. The assumption that the distribution of forces under dynamic conditions is well represented by statically determined forces has not been validated, leaving in question the applicability to dynamic conditions of data obtained under static conditions. This study characterizes an electro-mechanical thin-membrane force transducer with potential for intra-articular use. The sensor was found to yield a reproducible linear response to loads experienced in the ankle, and was insensitive to both a moist environment and shearing forces. On the basis of these results, these force-transducers were placed in axially loaded cadaveric ankles that were either statically or dynamically cycled through a physiologic range of motion. In each of six specimens, sensors were secured to the medial and lateral malleolar articular surfaces, and to articular surfaces of the medial and lateral tibial plafond. Both medial and lateral malleolar-talar forces increased with dorsiflexion. Moving from plantarflexion to dorsiflexion caused an increase in lateral tibio-talar load accompanied by a decrease in the medial tibio-talar loading. There was no significant hysteresis in force-distribution with respect to the direction of sagittal motion. There was no difference between the forces measured under static or dynamic conditions. This study validates the use of static loading methodologies in future studies of force-distribution. Our data in intact ankles closely corresponded to data on forces under dynamic conditions. Dorsiflexion caused an increase in both medially and laterally directed forces towards the malleoli. This is the first demonstration of such forces, which are responsible for the external rotation and lateral translation of the distal fibula that occurs in dorsiflexion of the ankle.

Ankle Injuries↗
PubMedDate not supplied

Treatment of chronic, two-plane instability of the ankle joint: syndesmoplasty versus periosteal flap versus tenodesis.

Repair of chronic ankle instability is recommended by a step-to-step approach. Anatomic repair with ligamentoplasty or periosteal flap will result in complete range of motion of the foot, but with less stability (7.1 degrees talar tilt). The more unphysiologic tenodesis procedure should be done in long-standing cases and gross instability, with the risk of loss of motion (10 degrees supination in one third of the cases), but with the advantage of best mechanical stability (3.5 degrees talar tilt).

Adolescent↗
PubMedDate not supplied

Cylindrical total ankle joint replacement: surgical and biomechanical rationale.

Incongruent designs of total ankle arthroplasty are all unsatisfactory owing to inherently poor wear, deformation resistance, and poor stability. Several congruent designs are capable of providing good function. It is concluded that a cylindrical surface with a horizontal axis located at the center of curvature of the lateral border of the talar dome seems most desirable where adequate subtalar motion is present and a spherical type seems most desirable where such motion is not present. The "New Jersey" cylindrical total ankle arthroplasty using a cylindrical surface uses an ultrahigh molecular weight polyethylene talar component and a mortised cobalt-chromium alloy tibial component both stabilized with methylmethacrylate bone cement and dual fixation fins.

Ankle Joint↗
PubMed1992

[Pressure behavior in muscle compartments of the foot in defined stress, metatarsal and ankle joint fractures].

In addition to the importance of compartment syndrome in the lower leg, a growing interest is being shown in the muscle compartments of the foot region. The standard pressure rates in the muscle compartments of the foot comprise up to 4 kPa for men and up to 2.5 kPa for women. During graded exercise (n = 9) on the treadmill the pressure increased in line with the strain and declined again rapidly when the exercise stopped without showing any significant differences in pressure between the muscle compartments studied. In metatarsal and ankle joint fractures post-traumatic pressures were found which were as high as or higher than after 20 minutes on the treadmill and would make the development of a compartment syndrome possible. This points to the necessity of measuring the pressure in the muscle compartments of the patient's foot when there is a clinical suspicion of a compartment syndrome.

Adolescent↗
PubMed1989

[Surgical treatment of chronic upper ankle joint instability in childhood].

The Department of Traumatology of the Hanover Medical School treated 347 patients having chronic instability or second stage rupture of the fibular ligament system, by surgery, during 1971 through 1986. Children were represented by one-seventh of the total number of patients only (13%; n = 44); however, in children the preoperative and intraoperative findings are different from normal findings and must be treated surgically in a special way. Whereas in adults old osseous/osteochondral ligament tears are apt to be rare (16% of the cases), they can be seen in children in almost every second case (18 of 44). Surgical approach requires a step-by-step procedure to achieve maximum stability and minimum functional loss. First Choice: Direct reconstruction of the ligament in case of ligaments which are present but have not healed correctly from a biomechanical point of view (e.g. pseudoarthroticosseous ligament tear) or in case of second-stage rupture (n = 20). Second Choice: Double periosteal flap plasty in case of necessary replacement of only one ligament (n = 13). Third Choice: Tenodesis of m. peroneus brevis using only half of the tendon chip while sparing the epiphysis if the condition persists for many years, or if ligaments cannot be reconstructed or replaced intraoperatively or if there is a combined instability of the ankle joint and the talo-calcaneonavicular joint (n = 11). In almost 90% of the cases very good to good results were obtained after five years, assessed according to a 100-point schema.

Adolescent↗