Bone Mineralization Changes in the Subchondral Bone of the Medial Gutter in Chronic Lateral Ankle Instability

2020 ◽  
Vol 41 (11) ◽  
pp. 1419-1426
Author(s):  
Tomoyuki Nakasa ◽  
Yasunari Ikuta ◽  
Yuki Ota ◽  
Munekazu Kanemitsu ◽  
Junichi Sumii ◽  
...  
Keyword(s):  
Subchondral Bone ◽  
Ankle Instability ◽  
Bone Mineralization ◽  
Hounsfield Unit ◽  
Control Group ◽  
Anterior Talofibular Ligament ◽  
Bone Change ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Subchondral Bone Change

Background: Chronic ankle instability (CAI) induces osteoarthritis (OA) by inflicting abnormal stresses on the medial gutter. It is important to detect early OA change and to explore factors likely to induce the OA. The purpose of this study was to evaluate subchondral bone change in the medial gutter of CAI using computed tomography (CT) scans. Methods: Thirty-five ankles with CAI (CAI group) and 35 ankles without CAI (control group) were included. The region of interest (ROI) in the subchondral bone of the medial gutter on CT axial images was set on the tibia and talus. The Hounsfield unit (HU) in ROIs was measured and corrected by the HU of the fibula in the same slice. HU ratios were compared between the CAI and control groups. In the CAI group, the relationship between the HU ratio and the talar tilt angle (TTA), OA change, and the anterior talofibular ligament (ATFL) remnant quality were analyzed. Results: The mean HU ratio in the CAI group was significantly higher than that in the control. In the CAI group, HU ratios in ≥10 degrees of TTA were significantly higher than those in <10 degrees. But there was no significant difference in the HU ratios with or without OA change in the medial gutter. A good-quality ATFL remnant showed a low HU ratio compared with that with poor quality. Conclusion: CAI patients exhibited subchondral bone change in the medial gutter, which suggests that the elimination of instability may help to prevent or decrease the development and/or progression of osteoarthritis. Level of Evidence: Level III, comparative series.

Quantitative Analysis of Deltoid Ligament Degradation in Patients With Chronic Ankle Instability Using Computed Tomographic Images

2021 ◽  
pp. 107110072199707
Author(s):  
Yasunari Ikuta ◽  
Tomoyuki Nakasa ◽  
Junichi Sumii ◽  
Akinori Nekomoto ◽  
Nobuo Adachi
Keyword(s):  
Ankle Instability ◽  
Ct Images ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Deltoid Ligament ◽  
Anterior Talofibular Ligament ◽  
Mri Findings ◽  
Calcaneofibular Ligament ◽  
Level Of Evidence ◽  
Strong Negative Correlation

Background: Rotational ankle instability (RAI) is associated with the faster onset of severe ankle osteoarthritis via dysfunction of the anterior talofibular ligament, calcaneofibular ligament, and deltoid ligament. No specific clinical examination is available for RAI, and diagnostic imaging has limitations in evaluating ligament degradation. This study investigated the deltoid ligament degeneration using Hounsfield unit (HU) values on computed tomography (CT) images. Methods: Patients were enrolled in this retrospective analysis if they had undergone magnetic resonance imaging (MRI) and CT scans of the ankle. The chronic ankle instability (CAI) group comprised 20 ankles with CAI (9 men, 11 women; mean age, 28.7 years) and the control group comprised 28 ankles (16 men, 12 women, mean age, 41.3 years). The average HU values of the deep posterior tibiotalar ligament (dPTL) that constitutes the deltoid ligament were measured on coronal CT images, and MRI results were used as a reference. All patients were subdivided based on the MRI findings of dPTL injury such as fascicular disruption, irregularity, and the loss of striation. Results: A strong negative correlation was identified between age and HU values for all patients (Spearman ρ = −0.63; P < .001). The mean HU values of the dPTL for participants aged <60 years were 81.0 HU for the control group (21 ankles) and 69.5 HU for the CAI group ( P = .0075). No significant differences in the HU values were observed for the dPTL among the MRI subgroups. Conclusion: In addition to the conventional imaging examination such as stress radiographs and MRI, HU measurements of CT images could be useful for quantitatively and noninvasively evaluating degenerative changes in the deltoid ligament for CAI patients to assist the diagnosis of RAI. Level of Evidence: Level III. case-control study.

Additional Inferior Extensor Retinaculum Augmentation After All-Inside Arthroscopic Anterior Talofibular Ligament Repair for Chronic Ankle Instability Is Not Necessary

2021 ◽  
pp. 036354652110080
Author(s):  
Sung Hyun Lee ◽  
Hyung Gyu Cho ◽  
Je Heon Yang
Keyword(s):  
Clinical Outcomes ◽  
Ankle Instability ◽  
Surgical Techniques ◽  
Chronic Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Extensor Retinaculum ◽  
Level Of Evidence ◽  
Group A ◽  
The Mean ◽  
Inferior Extensor Retinaculum

Background: Although several arthroscopic surgical techniques for the treatment of chronic ankle instability (CAI) have been introduced recently, the effect of inferior extensor retinaculum (IER) augmentation remains unclear. Purpose: To compare the clinical outcomes after arthroscopic anterior talofibular ligament (ATFL) repair according to whether additional IER augmentation was performed or not. Study Design: Cohort study; Level of evidence, 3. Methods: We performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair surgery for CAI between 2016 and 2018. The mean age of the patients was 35.2 years (range, 19-51 years), and the mean follow-up period was 32.6 months (range, 24-48 months). Patients were divided into 2 groups according to the surgical technique used for CAI: arthroscopic ATFL repair (group A; n = 37) and arthroscopic ATFL repair with additional IER augmentation (group R; n = 45). The pain visual analog scale, American Orthopaedic Foot & Ankle Society score, Foot and Ankle Outcome Score, and the Karlsson Ankle Function Score were measured as subjective outcomes, and posturographic analysis was performed using a Tetrax device as an objective outcome. Radiologic outcome evaluations were performed preoperatively and at 2 years postoperatively using stress radiographs and axial view magnetic resonance imaging (MRI). Results: Out of 101 patients, 19 (18.5%) were excluded per the exclusion criteria, and 82 were evaluated. We identified 6 retears (7.3%) based on postoperative MRI evaluation. All patients who had ATFL retear on MRI (8.1% [3/37] in group A and 6.7% [3/45] in group R) demonstrated recurrent CAI with functional discomfort and anterior displacement >3 mm as compared with the intact contralateral ankle. All clinical scores and posturography results were improved after surgery in both groups ( P < .001). However, there were no significant differences in the clinical results and radiologic findings between the groups. Conclusion: The clinical and radiologic outcomes of patients with CAI improved after all-inside arthroscopic ATFL repair. However, additional IER augmentation after arthroscopic ATFL repair did not guarantee better clinical outcomes.

Diet-related changes in mechanical properties of rat vertebrae

1992 ◽  
Vol 262 (2) ◽  
pp. R318-R321 ◽  
Author(s):  
G. J. Salem ◽  
R. F. Zernicke ◽  
R. J. Barnard
Keyword(s):  
Mechanical Properties ◽  
Vertebral Body ◽  
Calcium Metabolism ◽  
Bone Mineralization ◽  
Maximum Load ◽  
Control Group ◽  
Buffer Solution ◽  
Cross Sectional ◽  
Lumbar Vertebral Body ◽  
Significant Difference

High fat and sucrose (HFS) diets may induce glucose intolerance, alter calcium metabolism, and lead to deficits in bone mineralization, development, and mechanical properties. To determine the mechanical and structural consequences of a HFS diet on rapidly growing vertebrae, female Sprague-Dawley rats (8 wk) were assigned randomly (2:1) either to a control group (n = 20) fed a low-fat complex-carbohydrate diet or an experimental group (n = 10) fed a HFS diet for 10-12 wk. The sixth lumbar vertebral body (L6) was isolated from the pedicles, morphological measures were taken, and compression was tested at a fast strain rate, while immersed in a warmed (37 degrees C) isotonic physiological buffer solution. No significant difference in body mass existed between HFS and control groups; nevertheless, HFS L6 cross-sectional areas, lengths, and volumes were significantly smaller than controls. The HFS L6 also had significantly lower mechanical properties, including initial maximum load, energy at initial maximum load, and strain energy density at initial maximum load. Diets high in sucrose and fat content have been associated with changes in calcium metabolism, and the results of the current study suggest that in immature vertebrae, a HFS diet may adversely affect vertebral body mechanical integrity and strength.

scholarly journals Treatment of Severe Ulnar Instability of the MCP Joint Improves Function in LRTI Arthroplasty for Osteoarthritis of the Thumb CMC Joint

2019 ◽  
Vol 09 (02) ◽  
pp. 105-115
Author(s):  
Johanna Wirth ◽  
Eva-Maria Baur
Keyword(s):  
Patient Satisfaction ◽  
Strength Function ◽  
Ulnar Collateral Ligament ◽  
Metacarpophalangeal Joint ◽  
Metacarpal Bone ◽  
Control Group ◽  
Level Of Evidence ◽  
Pinch Grip ◽  
Significant Difference ◽  
Retrospective Comparative Study

Abstract Background Comorbidity in the metacarpophalangeal joint (MCPj) of the thumb, i.e., hyperextension or ulnar collateral instability, could affect the outcome of arthroplasty in the thumb carpometacarpal joint (CMCj). Objective In a retrospective study, we evaluated the effect of arthrodesis of the MCPj for thumbs with unstable MCPj and simultaneous ligament reconstruction tendon interposition (LRTI) arthroplasty for the CMCj in terms of strength, function, and patient satisfaction. Patients and Methods A total of 69 thumbs treated with a LRTI arthroplasty of the CMCj were included. In 14 of those cases, an arthrodesis of the MCPj was performed as well. In 12 thumbs, both procedures were done simultaneously; in one case MCPj arthrodesis followed LRTI arthroplasty, whereas one patient already had MCPj arthrodesis at time of LRTI arthroplasty. Those 14 thumbs were compared with the control group of 55 thumbs who had only undergone LRTI. At a mean follow-up of 4 to 5 years (mean 54 [10–124] months) postoperative assessments included range of motion (ROM) of the CMC, MCP, and interphalangeal (IP) joint of the thumb, as well as any instability of the MCPj. Pinch and grip strength were examined, also the visual analogue scale (VAS), patient satisfaction, QuickDASH, PRWE-Thumb, and the Kapandji's Opposition Score. Radiologically, proximalization of the first metacarpal bone was measured. Student's t-test was used to determine significance, p < 0.05 was considered significant. Results Additional arthrodesis of the MCPj provided no significant difference of function in thumbs that only had a hyperextension-instability. However, in thumbs with marked ulnar instability, stronger pinch-grip was obtained with arthrodesis, compared with only LRTI. Conclusion In patients with advanced painful thumb CMCj osteoarthritis, we recommend (simultaneous) arthrodesis of the MCPj, to allow a stable thumb grip if there is additional marked ulnar collateral ligament instability. Level of Evidence This is a Level III, retrospective comparative study.

Open Broström-Gould Repair vs Arthroscopic Anatomical Repair of the Anterior Talofibular Ligament for Chronic Lateral Ankle Instability

2019 ◽  
Vol 41 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Gang Zeng ◽  
Xumin Hu ◽  
Wenzhou Liu ◽  
Xuemei Qiu ◽  
Tao Yang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Open Surgery ◽  
Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Significant Difference ◽  
Surgical Cost ◽  
Surgery Duration

Background: The comparative studies on open vs arthroscopic anterior talofibular ligament (ATFL) repair are limited. This study aimed to compare the early therapeutic efficacy and cost between the traditional open Broström-Gould repair and all-arthroscopic anatomical repair of the ATFL for chronic lateral ankle instability. Methods: A total of 27 of patients with chronic lateral ankle instability undergoing repair of the ATFL between January 2013 and June 2015 were retrospectively included with a traditional open surgery (n = 10) group and arthroscopy (n = 17) group. The surgery duration, surgical cost, postoperative complications, and the preoperative/postoperative American Orthopaedic Foot & Ankle Society Score (AOFAS) and Karlsson-Peterson score were compared between groups. Results: Compared to the arthroscopy group, the open surgery group had significantly shorter surgery duration and lower surgical cost. However, there was no significant difference in hospitalization duration between groups. At 3 years after operation, the AOFAS and Karlsson scores were significantly improved in both groups. Nevertheless, there was no significant difference in the AOFAS and Karlsson scores between groups at both preoperative and postoperative assessment. No significant difference was found in the incidence of postoperative complications between the 2 groups. Conclusion: These results suggest that open Broström-Gould repair and all-arthroscopic anatomical repair of the ATFL have comparable therapeutic efficacy for chronic lateral ankle instability. The arthroscopic surgery had a smaller incision, while the open Broström-Gould had a shorter surgery duration and lower cost. Level of Evidence: Level III, comparative study.

Lower Signal Intensity of the Anterior Talofibular Ligament is Associated with a Higher Rate of Return to Sport After ATFL Repair for Chronic Lateral Ankle Instability

2019 ◽  
Vol 47 (10) ◽  
pp. 2380-2385 ◽  
Author(s):  
Hong Li ◽  
Yinghui Hua ◽  
Sijia Feng ◽  
Hongyun Li ◽  
Shiyi Chen
Keyword(s):  
Signal Intensity ◽  
Functional Outcomes ◽  
Ankle Instability ◽  
Return To Sport ◽  
Rate Of Return ◽  
Anterior Talofibular Ligament ◽  
Aofas Score ◽  
Significant Difference ◽  
The Mean

Background: The treatment strategy for anterior talofibular ligament (ATFL) injury is usually determined by the ATFL remnant condition during surgery. Preoperative magnetic resonance imaging (MRI)–based signal intensity of the ATFL remnant, represented by the signal/noise ratio (SNR) value, can reveal the ATFL remnant condition. Thus far, there is a lack of evidence regarding the relationship between the ATFL remnant condition and functional outcomes. Purpose/Hypothesis: The purpose was to quantitatively evaluate whether the MRI-based ATFL ligament SNR value is related to functional outcomes after ATFL repair for ankles with chronic lateral ankle instability. The hypothesis was that a lower preoperative SNR is related to a better clinical outcome, particularly a higher rate of return to sport. Study Design: Cohort study; Level of evidence, 3. Methods: First, a preliminary study was performed to measure the ATFL SNR in preoperative MRI, the results of which suggested that a preoperative SNR >10.4 was indicative of a poor ATFL condition. Then, a cohort study was retrospectively performed with consecutive patients who underwent open repair of ATFL injuries between January 2009 and August 2014. Accordingly, the patients were divided into 2 groups: high SNR (HSNR; ≥10.4) and low SNR (LSNR; <10.4). Functional outcomes based on the American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), and Tegner Activity Scale were then compared between the HSNR group and the LSNR group. Results: Ultimately, 70 patients were available for the final follow-up: 37 in the HSNR group and 33 in the LSNR group. No significant difference was detected between the HSNR group and the LSNR group in terms of the AOFAS score, KAFS, or Tegner Activity Scale ( P > .05 for all) preoperatively. At the final follow-up, the mean ± SD AOFAS score in the LSNR group (92 ± 6) was higher than that in the HSNR group (87 ± 12), although no significant difference was detected postoperatively ( P = .16). The mean KAFS in the LSNR group (94 ± 7) was significantly higher than that in the HSNR group (88 ± 11) postoperatively ( P = .03). At follow-up, the mean Tegner score in the LSNR group (6; range, 3-7) was significantly higher than that in the HSNR group (5; range, 1-8) postoperatively ( P = .03). Patients in the LSNR group had a significantly higher percentage of sports participation than those in the HSNR group (91% vs 65%, P = .02) postoperatively. Conclusion: A lower signal intensity in the ATFL ligament based on preoperative MRI is associated with a better clinical outcome, particularly a higher rate of return to sport.

Fair evidence consistently supports open surgical treatment for chronic ankle instability: a systematic review

2019 ◽  
Vol 4 (5) ◽  
pp. 254-269
Author(s):  
Chad Alexander Purcell ◽  
James Calder ◽  
Kentaro Matsui ◽  
Pontus Andersson ◽  
Jón Karlsson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Systematic Evaluation ◽  
Anatomical Reconstruction ◽  
Lateral Ligament ◽  
Anterior Talofibular Ligament ◽  
Reconstruction Technique ◽  
Operative Techniques ◽  
Level Of Evidence

ImportancePatients with chronic ankle instability (CAI) who have failed non-operative treatments are most commonly treated with open ankle repair or reconstruction of the anterior talofibular ligament and/or calcaneofibular ligament. Over 50 operative techniques have been described for the treatment of CAI. However, there is no current systematic evaluation of currently used open operative techniques for the treatment of CAI.Aim/ObjectiveThe primary objective of this study is to provide evidence-based treatment recommendations for CAI in adults based on a comprehensive systematic review of the literature.Evidence reviewThe literature review of PubMed, EMBASE, Cochrane and Web of Science databases was completed on 22 February 2017. Search terms included two concepts: lateral ligament of the ankle (patients) and open reconstructive or repair procedures (intervention). All published clinical studies with English translation were included. Biomechanical, cadaveric, review articles, minimally invasive procedures and arthroscopic procedures were excluded. Open operative procedures from included articles were classified as anatomical or non-anatomical and repair or reconstructive. Articles were then assigned a level of evidence (I-V) to denote quality of the research methods. Articles were reviewed collectively to provide a grade of recommendation (A-C or I) in support for or against the operative intervention in treatment of CAI.FindingsSeventy one of 1635 identified articles were included for review. There is fair evidence (Grade B) in support of anatomical repair, anatomical reconstruction and non-anatomical reconstruction procedures. There was insufficient evidence available to grade internal brace and non-anatomical repair procedures.Conclusions and relevanceAlthough only fair-quality evidence exists in support of open operative treatment of CAI, this systematic review helps reassure clinicians of their current practices. The literature reaffirms support for open anatomical repair and anatomical reconstruction technique for CAI.Level of evidenceLevel II, systematic review.

Measurement of Glenohumeral Internal Rotation in Asymptomatic Tennis Players and Swimmers

2009 ◽  
Vol 37 (5) ◽  
pp. 1017-1023 ◽  
Author(s):  
Renato Rangel Torres ◽  
João Luiz Ellera Gomes
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Control Group ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Tennis Players ◽  
Glenohumeral Internal Rotation Deficit ◽  
Significant Difference ◽  
Overhead Sports ◽  
The Difference

Background Glenohumeral internal rotation deficit, often diagnosed in players of overhead sports, has been associated with the development of secondary shoulder lesions. Hypothesis Asymptomatic players of different overhead sports will exhibit variable degrees of glenohumeral internal rotation deficit. Study Design Cross-sectional study; Level of evidence, 3. Methods Fifty-four asymptomatic male volunteers (108 shoulders) divided into 3 groups (tennis players, swimmers, control group) underwent measurements of glenohumeral internal and external rotation using clinical examination with scapular stabilization. Measurements of dominant and nondominant shoulders were compared within and between groups. Glenohumeral internal rotation deficit (GIRD) was defined as the difference in internal rotation between the nondominant and dominant shoulders. Results In tennis players, mean GIRD was 23.9° ± 8.4° (P < .001); in swimmers, 12° ± 6.8° (P < .001); and in the control group, 4.9° ± 7.4° (P = .035). Dominant shoulders showed significant difference between all groups, and the difference in internal rotation of the dominant shoulder between the group of tennis players in comparison with the control group (27.6°, P < .001) was greater than the difference in internal rotation of the dominant shoulder found in the group of swimmers compared with the control group (17.9°, P < .001). Between tennis players and swimmers, the difference in internal rotation of the dominant shoulder was 9.7° (P = .002). Conclusion Dominant limbs showed less glenohumeral internal rotation than the nondominant limbs in all groups, with the deficit in the group of tennis players about twice the deficit found for swimmers. Mean difference between limbs in the control group was less than 5°, which is within normal parameters according to most studies. There were statistically significant differences between all groups when dominant shoulders were compared with each other, differences that were not compensated by external rotation gain. Tennis players had the least range of motion, followed by swimmers.

Randomized phase II study of TJ-54 (Yokukansan) for postoperative delirium in gastrointestinal malignancy patients.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 115-115
Author(s):  
Mariko Kamiya ◽  
Toru Aoyama ◽  
Nobuhiro Sugano ◽  
Tsutomu Sato ◽  
Naoto Yamamoto ◽  
...  
Keyword(s):  
Postoperative Delirium ◽  
Postoperative Mortality ◽  
Signs And Symptoms ◽  
Perioperative Period ◽  
Phase Iii ◽  
Control Group ◽  
Level Of Evidence ◽  
Gastrointestinal Malignancy ◽  
Mortality And Morbidity ◽  
Significant Difference

115 Background: Delirium is one of the common postoperative complications. When postoperative delirium occurred, the patient management becomes much more difficult, leading to functional recovery delay, and is also associated with postoperative mortality and morbidity. Although many attempts to prevent and treat delirium have been developed, a higher level of evidence is needed. In the present study, we evaluated the efficacy and safety of TJ-54 (Yokukansan; one of the traditional Japanese medicines, Kampo) for the prevention and/or treatment of postoperative delirium in a randomized phase III trial for the patients receiving surgery for gastrointestinal malignancy. Methods: Patients 70 years of age or older, who were received surgery for gastrointestinal malignancy were eligible in this study. The 167 eligible patients were randomly assigned on a 1:1 ratio to receive TJ-54 or control during their perioperative care (between day 7 before surgery and day 4 after surgery). The signs and symptoms of delirium were assessed with using Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV by the investigator during perioperative period. Results: We analyzed 167 eligible gastrointestinal malignancy patients (TJ-54; 83, control; 84). There were no disparities between the two PPS randomized groups. The incidence of delirium was 7.2% (6 patients) in the TJ-54 group and 10.7% (9 patients) in the control group with no significant difference (p=0.431), also no significant difference was observed in duration of delirium between the two groups (p=0.477). The ratio of patients who needed some kind of the medication which including treatment of delirium were significantly less in the TJ-54 group than in the control group (p=0.037). Conclusions: In this study, TJ-54 did not demonstrate the contribution to prevention of occurring delirium in the patients receiving surgery for gastrointestinal malignancy. However, TJ-54 might be effective in reducing the medication for treating delirium after surgery for gastrointestinal malignancy. Clinical trial information: 000005423.

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