Cavovarus With a Twist: Midfoot Coronal and Axial Plane Rotational Deformity in Charcot-Marie-Tooth Disease

Background: The cavovarus deformity of Charcot-Marie-Tooth (CMT) disease is often characterized by a paradoxical relationship of hindfoot varus and forefoot valgus. The configuration of the midfoot, which links these deformities, is poorly understood. Accurate assessment of 3-dimensional alignment under physiologic loadbearing conditions is possible using weightbearing computed tomography (WBCT). This is the first study to examine the rotational deformity in the midfoot of CMT patients and, thus, provide key insights to successful correction of CMT cavovarus foot. Methods: A total of 27 WBCT scans from 21 CMT patients were compared to control WBCTs from 20 healthy unmatched adults. CMT patients with a history of bony surgery, severe degenerative joint disease, or open physes in the foot were excluded. Scans were analyzed using 3-dimensional software. Anatomic alignment of the tarsal bones was calculated relative to the anterior-posterior axis of the tibial plafond in the axial plane, and weightbearing surface in the coronal plane. Results: Maximal rotational deformity in CMT patients occurred at the transverse tarsal joints, averaging 61 degrees of external rotation (supination), compared to 34 degrees among controls ( P < .01). The talonavicular joint was also the site of peak adduction deformity in the midfoot, with an average talonavicular coverage angle measuring 12 degrees compared with −11 degrees in controls ( P < .01). Conclusion: This 3-dimensional WBCT analysis is the first to isolate and quantify the multiplanar rotational deformity in the midfoot of CMT patients. Compared with healthy unmatched control cases, CMT patients demonstrated increased axial plane adduction and coronal plane rotation at the talonavicular (TN) joint. These findings support performing soft tissue release at the TN joint to abduct and derotate the midfoot as a first step for targeted deformity correction. Level of Evidence: Level III, retrospective case-control study.

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Anterior cruciate ligament femoral-tunnel drilling through an anteromedial portal: 3-dimensional plane drilling angle affects tunnel length relative to notchplasty

Knee Surgery and Related Research ◽

10.1186/s43019-021-00092-5 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Dong-Kyu Moon ◽

Ho-Seung Jo ◽

Dong-Yeong Lee ◽

Dong-Geun Kang ◽

Hee-Chan Won ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Sagittal Plane ◽

Femoral Tunnel ◽

Cruciate Ligament ◽

Standard Technique ◽

Axial Plane ◽

Coronal Plane ◽

Tunnel Length ◽

3 Dimensional ◽

Anterior Cruciate

Abstract Background Notchplasty is a surgical technique often performed during anterior cruciate ligament reconstruction (ACLR) with widening of the intercondylar notch of the lateral distal femur to avoid graft impingement. The purpose of this study was to correlate femoral-tunnel length with 3-dimensional (3D) drilling angle through the anteromedial (AM) portal with and without notchplasty. Materials and methods Computer data were collected from an anatomical study using 16 cadaveric knees. The anterior cruciate ligament (ACL) femoral insertion was dissected and outlined for gross anatomical observation. The dissected cadaveric knees were scanned by computed tomography (CT). Three-dimensional measurements were calculated using software (Geomagic, Inc., Research Triangle Park, NC, USA) and included the center of the ACL footprint and the size of the ACL femoral footprint. The femoral-tunnel aperture centers were measured in the anatomical posterior-to-anterior and proximal-to-distal directions using Bernard’s quadrant method. The ACL tunnel was created 3-demensionally in the anatomical center of femoral foot print of ACL using software (SolidWorks®, Corp., Waltham, MA, USA). The 8-mm cylinder shaped ACL tunnel was rested upon the anatomical center of the ACL footprint and placed in three different positions: the coronal plane, the sagittal plane, and the axial plane. Finally, the effect of notchplasty on the femoral-tunnel length and center of the ACL footprint were measured. All the above-mentioned studies performed ACLR using the AM portal. Results The length of the femoral tunnels produced using the low coronal and high axial angles with 5-mm notchplasty became significantly shorter as the femoral starting position became more horizontal. The result was 30.38 ± 2.11 mm on average at 20° in the coronal plane/70° in the axial plane/45° in the sagittal plane and 31.26 ± 2.08 mm at 30° in the coronal plane/60° in the axial plane/45° in the sagittal plane, respectively, comparing the standard technique of 45° in the coronal/45° in the axial/45° in the sagittal plane of 32.98 ± 3.04 mm (P < 0.001). The tunnels made using the high coronal and low axial angles with notchplasty became longer than those made using the standard technique: 40.31 ± 3.36 mm at 60° in the coronal plane/30° in the axial plane/45° in the sagittal plane and 50.46 ± 3.13 mm at 75° in the coronal plane/15° in the axial plane/45° in the sagittal plane (P < 0.001). Conclusions Our results show that excessive notchplasty causes the femoral tunnel to be located in the non-anatomical center of the ACL footprint and reduces the femoral-tunnel length. Therefore, care should be taken to avoid excessive notchplasty when performing this operation.

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An Automated Histologic System for 3D Histomorphometry of the Mouse Knee

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53443 ◽

2011 ◽

Author(s):

Barbara J. Murienne ◽

Michael J. Girard ◽

Lise Loerup ◽

Alexandra Boussommier-Calleja ◽

Sandra J. Shefelbine ◽

...

Keyword(s):

Joint Space ◽

Bone Defects ◽

Structural Features ◽

Degenerative Joint Disease ◽

Cartilage Volume ◽

Joint Disease ◽

Point Counting ◽

Geometrical Properties ◽

3 Dimensional ◽

And Cartilage

Osteoarthritis (OA) is a degenerative joint disease that is a leading cause of adult pain and disability in Western countries1. Clinically, several structural features of the joint are important in diagnosis, prognosis and evaluation of treatment efficacy, e.g. cartilage volume, homogeneity and joint space narrowing2,3. In animal models of OA, structural features such as bone defects and cartilage changes are commonly investigated using histomorphometry, a technique that uses stereological point counting and manual tracing of regions of interest to extract 3-dimensional (3D) geometrical properties from 2D histology slides. This is time-consuming and subject to inter-observer variations, hence limiting precision 4,5. Therefore, a technique for rapidly imaging joint structures in 3D at high resolution, including articular cartilage and subchondral bone, is currently needed in pre-clinical OA research.

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COMPARATIVE STUDY OF SURGICAL CORRECTION OF CONGENITAL TALIPES EQUINO VARUS DEFORMITY WITH AND WITHOUT INTERNAL FIXATION (USING K-WIRES)

10.36106/ijar/3402369 ◽

2019 ◽

pp. 1-2

Author(s):

Archana Babu. P

Keyword(s):

Soft Tissue ◽

Internal Fixation ◽

Club Foot ◽

Varus Deformity ◽

Soft Tissue Release ◽

Congenital Deformity ◽

Tarsal Joint ◽

Tarsal Bones ◽

Congenital Talipes ◽

K Wires

Congenital Talipes Equino Varus is one of the most common congenital deformity which occurs in 1/1000 live birth worldwide. Regarding management of this clubfoot ,most orthopaedic surgeons agree that approach management of children with congenital talipes equino varus deformity of foot should begin with conservative measures i.e, manipulation and serial casting in position of correction. One or more surgical procedures are often required in patients who had incomplete correction , recurrent deformity , syndromic correction and after repeated manipulation and casts. Recurrence is a common problem following the club foot surgery one of the reason for recurrence can be redisplacement of tarsal bones .This study aims to compare prospectively the functional and cosmetic outcome of two groups of club foot-one in whom tarsal joint were fixed with k-wires after doing posteromedial soft tissue release and one in whom tarsal joint were not fixed after soft tissue release .To know the incidence of congenital talipes equino varus with respect to age and sex predilection over a period of two years which were admitted between October 2017 to October 2019, 28 idiopathic club foot in 20 children range from 4 months to 3 years were treated out of 20 cases 12 were males,8 were females.8 patients had bilateral deformity out of 12 unilateral deformities 8 were on right side and 4 were on the left side. Male and female ratio 1.5:1 and unilateral to bilateral 1.5 :1.In 12 feet turco's posteromedial soft tissue release and internal fixation of tarsal joints with k-wires was done in 16 feet only turco's posteromedial soft tissue release was done. The period of follow up ranges from 6 months to 2 years

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Degenerative Rotatory Scoliosis: Coronal Plane Lumbar Spine Deformity Correction

Spine Surgery ◽

10.1016/b978-0-443-06616-0.50060-2 ◽

2005 ◽

pp. 675-683

Author(s):

Edward C. Benzel ◽

Russ P. Nockels

Keyword(s):

Lumbar Spine ◽

Deformity Correction ◽

Coronal Plane ◽

Spine Deformity

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Postoperative excessive anterior acetabular coverage is associated with decrease in range of motion after periacetabular osteotomy

Hip International ◽

10.1177/1120700020910370 ◽

2020 ◽

pp. 112070002091037 ◽

Cited By ~ 1

Author(s):

Shinya Hayashi ◽

Shingo Hashimoto ◽

Tomoyuki Matsumoto ◽

Koji Takayama ◽

Nao Shibanuma ◽

...

Keyword(s):

Range Of Motion ◽

Clinical Outcomes ◽

Internal Rotation ◽

Hip Dysplasia ◽

External Rotation ◽

Periacetabular Osteotomy ◽

Femoral Anteversion ◽

Acetabular Coverage ◽

3 Dimensional ◽

The Relationship

Purpose: The aim of this study was to evaluate the relationship between acetabular 3-dimensional (3D) alignment reorientation and clinical range of motion (ROM) after periacetabular osteotomy (PAO). Methods: 50 patients (58 hips) with hip dysplasia participated in the study and underwent curved PAO. The pre- and postoperative 3D centre-edge (CE) angles and femoral anteversion were measured and compared with clinical outcomes, including postoperative ROM. Results: The correlation between pre- and postoperative acetabular coverage and postoperative ROM was evaluated. Postoperative abduction and internal rotation ROM were significantly associated with postoperative lateral CE angles (abduction; p < 0.001, internal rotation; p = 0.028); flexion and internal rotation ROM was significantly associated with postoperative anterior CE angles (flexion; p < 0.001, internal rotation; p = 0.028). Femoral anteversion was negatively correlated with postoperative abduction ( p = 0.017) and external rotation ( p = 0.047) ROM. Conclusion: Postoperative anterior acetabular coverage may affect internal rotation ROM more than the lateral coverage. Therefore, the direction of acetabular reorientation should be carefully determined according to 3D alignment during PAO.

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Altered Ankle Kinematics and Shank-Rear-Foot Coupling in Those with Chronic Ankle Instability

Journal of Sport Rehabilitation ◽

10.1123/jsr.18.3.375 ◽

2009 ◽

Vol 18 (3) ◽

pp. 375-388 ◽

Cited By ~ 86

Author(s):

Lindsay K. Drewes ◽

Patrick O. McKeon ◽

Gabriele Paolini ◽

Patrick Riley ◽

D. Casey Kerrigan ◽

...

Keyword(s):

Outcome Measures ◽

Ankle Instability ◽

External Rotation ◽

Chronic Ankle Instability ◽

Initial Contact ◽

3 Dimensional ◽

Joint Coupling ◽

Ankle Inversion ◽

Ankle Kinematics ◽

Phase Angles

Context:Kinematic patterns during gait have not been extensively studied in relation to chronic ankle instability (CAI).Objective:To determine whether individuals with CAI demonstrate altered ankle kinematics and shank-rear-foot coupling compared with controls during walking and jogging.Design:Case control.Setting:Motion-analysis laboratory.Participants:7 participants (3 men, 4 women) suffering from CAI (age 24.6 ± 4.2 y, height 172.6 ± 9.4 cm, mass 70.9 ± 8.1 kg) and 7 (3 men, 4 women) healthy, matched controls (age 24.7 ± 4.5 y, height 168.2 ± 5.9 cm, mass 66.5 ± 9.8 kg).Interventions:Subjects walked and jogged on a treadmill while 3-dimensional kinematics of the lower extremities were captured.Main Outcome Measures:The positions of rear-foot inversion–eversion and shank rotation were calculated throughout the gait cycle. Continuous relative-phase angles between these segments were calculated to assess coupling.Results:The CAI group demonstrated more rear-foot inversion and shank external rotation during walking and jogging. There were differences between groups in shank-rear-foot coupling during terminal swing at both speeds.Conclusions:Altered ankle kinematics and joint coupling during the terminal-swing phase of gait may predispose a population with CAI to ankle-inversion injuries. Less coordinated movement during gait may be an indication of altered neuromuscular recruitment of the musculature surrounding the ankle as the foot is being positioned for initial contact.

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Foot and Ankle Manifestations of Charcot-Marie-Tooth Disease

Foot & Ankle ◽

10.1177/107110079301400809 ◽

1993 ◽

Vol 14 (8) ◽

pp. 476-486 ◽

Cited By ~ 100

Author(s):

James R. Holmes ◽

Sigvard T. Hansen

Keyword(s):

Soft Tissue ◽

Neurological Dysfunction ◽

Careful Examination ◽

Soft Tissue Release ◽

Tibialis Posterior ◽

Foot And Ankle ◽

Tendon Transfers ◽

Charcot Marie Tooth ◽

Charcot Marie Tooth Disease ◽

Tooth Disease

The term Charcot-Marie-Tooth disease represents a spectrum of neurological dysfunction more recently described as hereditary motor-sensory neuropathies. An abnormality of myelination is thought to be responsible for the clinical manifestations. While histological findings have been well described, the exact biochemical basis for this disorder remains unknown. Over one half of patients with Charcot-Marie-Tooth disease manifest foot and ankle problems, including pain, weakness, deformity, and, rarely, paresthesias. Characteristic patterns of neuromuscular weakness have been identified. Bilateral pes cavovarus is the most common pathologic foot deformity seen. The specific components include hindfoot varus, anterior or forefoot cavus, and, often, clawtoes. The etiology of this abnormal foot posture usually results from tibialis posterior overpowering peroneus brevis coupled with peroneus longus overpowering tibialis anterior. Multiple treatment options have been described. Rationale for specific tendon transfers, soft tissue release, osteotomies, and arthrodesis is discussed. Results of surgical intervention are difficult to interpret and compare because of the wide spectrum of both neurological dysfunction and described operative procedures. In the presence of flexible deformity, early soft tissue release and tendon transfers may help prevent or delay more extensive bony procedures. The clinical results of triple arthrodesis in the Charcot-Marie-Tooth disease patient appear to deteriorate with time. Genetic transmission, progression of the neurological dysfunction, flexibility of the deformity, distribution of muscular weakness, and anticipated foot demands vary a great deal within this patient population. Treatment decisions, therefore, must be individualized and based upon a clear history, careful examination, and well-defined patient goals.

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Correlation of 3-Dimensional Shoulder Kinematics to Function in Subjects With Idiopathic Loss of Shoulder Range of Motion

Physical Therapy ◽

10.1093/ptj/85.7.636 ◽

2005 ◽

Vol 85 (7) ◽

pp. 636-647 ◽

Cited By ~ 23

Author(s):

Peter J Rundquist ◽

Paula M Ludewig

Keyword(s):

Range Of Motion ◽

Multiple Regression ◽

External Rotation ◽

Regression Equation ◽

Multiple Regression Equation ◽

3 Dimensional ◽

Shoulder Range Of Motion ◽

Shoulder Kinematics ◽

And Function ◽

Shoulder Range

AbstractBackground and Purpose. People with idiopathic loss of shoulder range of motion (ROM) have difficulty completing activities of daily living. This investigation was performed to determine the association between active glenohumeral ROM and function and to develop a multiple regression equation to explain variation in function in people with idiopathic loss of shoulder motion. Subjects and Methods. This was a comparative study of 21 subjects (18 female, 3 male), using measurements of shoulder kinematics and administration of the Shoulder Rating Questionnaire (SRQ). Electromagnetic tracking sensors monitored the 3-dimensional position of the scapula and humerus throughout active shoulder motions. Correlations were performed between the active ROMs of interest and various demographic factors and the SRQ. A multiple regression equation was generated. Results. A multiple regression equation including scapular-plane abduction, external rotation at the side, external rotation at 90 degrees of abduction, and weight explained 69% of the variation in the SRQ scores. Discussion and Conclusion. The results suggest that active ROM can be used to predict function in people with idiopathic loss of shoulder ROM.

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A Biomechanical Comparison of 2 Hip Capsular Reconstruction Techniques: Iliotibial Band Autograft Versus Achilles Tendon Allograft

The American Journal of Sports Medicine ◽

10.1177/0363546520962071 ◽

2020 ◽

Vol 48 (13) ◽

pp. 3288-3295

Author(s):

Nicholas Pasic ◽

Timothy A. Burkhart ◽

Pardis Baha ◽

Olufemi R. Ayeni ◽

Alan Getgood ◽

...

Keyword(s):

Achilles Tendon ◽

External Rotation ◽

Coronal Plane ◽

Rotational Stability ◽

Iliotibial Band ◽

Kinematic Effect ◽

Intact State ◽

Lateral Translation ◽

Motion Simulator ◽

Hip Flexion

Background: Several techniques for hip capsular reconstruction have been described to address gross instability or microinstability due to capsular deficiency. However, objective biomechanical data to support their use are lacking. Purpose: To compare the kinematic effect of 2 capsular reconstruction techniques (iliotibial band [ITB] graft and Achilles tendon graft). Kinematic effect encompassed rotational range of motion (ROM) as well as joint translation in the coronal, sagittal, and axial planes. Study Design: Controlled laboratory study. Methods: 8 paired, fresh-frozen hemi-pelvises (16 hips) were tested on a custom-designed joint motion simulator in the intact state and after capsulectomy. Pairs were randomly allocated to either ITB or Achilles reconstruction and retested. Testing was performed at 0°, 45°, and 90° of flexion. Internal-external rotation (IR-ER) torques and abduction-adduction torques of 3 N·m were applied to the femur via a load cell at each position, and rotational ROM and joint translation in the coronal, sagittal, and axial planes were recorded. Results: At 45° and 90°, there was a significant effect of the condition of the hip on the total IR-ER ( P = .004, effect size [ES] = 0.305; and P < .001, ES = 0.497; respectively). At 45°, mean ± SD total rotation was significantly greater for the capsulectomy (59.7°± 15.9°) state compared with intact (53.3°± 13.2°; P = .007). At 90°, reconstruction significantly decreased total rotation to 49.0°± 18.9° compared with a mean total rotation of 52.8°± 18.7° after capsulectomy ( P = .02). No difference was seen in the total abduction-adduction of the hip between conditions. Comparisons of the 2 different reconstruction techniques showed no significant differences in total IR-ER or abduction-adduction ROM or joint translation in the coronal, sagittal, or axial planes. For translation, at both 0° and 45° there was a statistically significant effect of the condition on the medial-lateral translation ( P = .033; ES = 0.204). Reconstruction, independent of technique, was successful in significantly decreasing ( P = .030; P = .014) the mean medial-lateral translation at 0° and 45° of hip flexion from 5.2 ± 3.8 mm and 5.6 ± 4.0 mm to 2.8 ± 1.9 mm and 3.9 ± 3.2 mm, respectively. Conclusion: The integrity of the native hip capsule played a significant role in rotational stability, where capsulectomy significantly increased rotational ROM. Both ITB and Achilles reconstruction techniques restored normal rotational ROM of the hip at 90° of flexion as well as coronal plane stability at 0° and 45° of hip flexion. No differences were seen between ITB and Achilles reconstruction techniques. Clinical Relevance: Both capsular reconstruction techniques provide comparable joint kinematics, restoring rotation and translation to normal values with the exception of rotational ROM at 45°, which remained significantly greater than the intact state. The most significant results were the rotational stability at 90° of hip flexion and coronal plane stability at 0° and 45° of hip flexion, which were significantly improved compared with the capsulectomy state.

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