Effect of CAM boot immobilization on weightbearing stability in syndesmotic injuries

Category: Trauma Introduction/Purpose: Ankle injuries are one of the most frequent traumas of the lower limb. They typically involve the lower lateral ligaments of the ankle, but the syndesmosis is also affected in up to 18% of cases. The degree of instability of syndesmotic joint depends on which ligaments are affected. Adequate management of syndesmotic injuries is crucial to avoid long term complications. The primary goal of our study was to evaluate the effect of simulated weightbearing on syndesmotic instability resulting from isolated AiTFL injury and from combined AiTFL/IOL injuries. The secondary goal was to evaluate the effect of a controlled ankle motion walking boot on syndesmosis stability following injury. We hypothesized that the CAM boot would prevent significant instability even in two ligaments injuries. Methods: Ten cadaveric specimens were dissected to expose the syndesmosis to create progressive iatrogenic syndesmosis ruptures. Uninjured syndesmoses were compared to isolated AiTFL and combined AiTFL/IOL ruptures. The specimens were fitted in a custom-made device to allow stabilization of the leg and apply a reproducible axial load (AL) of 750 N, equivalent to the weight of a 168-pound person. For each specimen and injury pattern, CT-scan images were obtained with and without AL, and with a CAM boot under AL. Distal tibio-fibular relationship was evaluated in three planes using a previously validated measurement system developed on CT. Wilcoxon tests for paired samples and non-parametric data were done to compare the different conditions. Results: For our first objective, when comparing ankles with isolated AiTFL to combined AiTFL/IOL rupture with and without AL, the only significant difference was an increase in internal rotation between the incisura and a line drawn in the axis of the fibula. Even with minimal statistical differences, it appears that axial loading does not impact syndesmotic stability apart from a slight increase in internal rotation with a single or two-ligament injury. As for our second end point, with the CAM orthopedic boot, no significant widening of the syndesmosis happened when either one or both ligaments were sectioned, in an axial loading state. We therefore confirmed our hypothesis that even with two syndesmotic ligament injuries, axial loading in a CAM boot does not affect distal tibio-fibular anatomy. Conclusion: This study reveals that weight bearing without rotational force does not affect the stability of the syndesmosis. Incomplete syndesmotic injuries can likely be treated with nonoperative treatment in a CAM boot and weight bearing as tolerated. Further clinical studies are needed to confirm these findings.

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The Effect of “High-ankle Sprain” Taping on Ankle Syndesmosis Congruity: A Cadaveric Study

The Open Sports Sciences Journal ◽

10.2174/1875399x02013010123 ◽

2020 ◽

Vol 13 (1) ◽

pp. 123-128

Author(s):

Stéphanie Lamer ◽

Jonah Hébert-Davies ◽

Vincent Dubé ◽

Stéphane Leduc ◽

Émilie Sandman ◽

...

Keyword(s):

Ankle Sprain ◽

Weight Bearing ◽

Axial Loading ◽

Cadaveric Study ◽

P Value ◽

Level Of Evidence ◽

Parametric Data ◽

Custom Made ◽

Significant Difference ◽

High Ankle Sprain

Background: Different treatment options exist for dynamically unstable purely ligamentous syndesmotic injury, including surgery, walking boot, brace and taping. Objective: The main purpose of this study was to evaluate the effect of high-ankle sprain taping (ring taping) on syndesmotic stability in various ligament conditions when axial loading is applied. Methods: This controlled cadaveric laboratory study included ten cadaveric specimens installed in a custom-made device applying 750N of axial loading in order to simulate weight-bearing. Sectioning of syndesmotic ligaments, AiTFL and IOL, was done sequentially and CT scan images were taken with and without high-ankle sprain taping. A validated measurement system consisting of 3 lengths and 1 angle was used. Results were compared with Wilcoxon tests for paired samples and non-parametric data. Results: In every ligament condition (intact vs. cut), no statistically significant difference was observed between specimens, with or without high-ankle sprain taping and with or without axial loading. When the data from ankles with AiTFL and IOL ruptures were compared, the mean for length “b” without axial loading was 7.19 (±2.17), compared to 7.20 (±1.98) with axial loading (p-value = 0.905). With taping and the leg still in axial loading, the value was 7.17 (±2.09) (p-value = 0.721), which is not statistically significant. Conclusion: It is impossible to conclude regarding high-ankle sprain taping’s capacity to maintain syndesmosis congruity because no significant difference was observed, regardless of condition. The most important finding is that high-ankle sprain taping did not cause malreduction of the injured syndesmosis. Level of Evidence: Level V cadaveric study

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Clinical and Radiographic Outcomes of 3D Printed Total Talus Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00376 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0037

Author(s):

Daniel Scott ◽

John Steele ◽

Amanda Fletcher ◽

Selene Parekh

Keyword(s):

Avascular Necrosis ◽

Weight Bearing ◽

Treatment Options ◽

Ankle Motion ◽

Motion Data ◽

Radiographic Outcomes ◽

Significant Difference ◽

3D Printed ◽

Vas Scores

Category: Ankle, Ankle Arthritis, Hindfoot, Trauma Introduction/Purpose: Patients with talar avascular necrosis have limited treatment options to manage their symptoms. Historically, surgical options have been limited and can leave patients with little ankle motion and have high failure rates. The use of custom 3D printed total talar replacements (TTR) has arisen as a treatment option for these patients, possibly allowing for better preservation of hind-foot motion. Patients undergoing TTR will demonstrate a statistically significant improvement in FAOS scores at one year after surgery. Methods: We retrospectively reviewed 15 patients who underwent a TTR over 2 years. Patient outcomes were reviewed including age, sex, comorbidities, etiology of talar pathology, number and type of prior surgeries, pre-operative and post-operative weight bearing radiographs, as well as FAOS and VAS scores, and range of motion. Data analysis performed with student T-test and multivariate regression. Results: Results: FAOS scores showed statistically significant improvements post-operatively as compared to pre-operative scores. There was a statistically significant decrease in VAS pain scores from 7.0 pre-operatively to 3.4 post operatively. There was no significant difference in pre-operative and post-operative coronal and sagittal alignment on weight bearing radiographs. All FAOS sub-score shows statistically significant improvements, with the exception of the sports/recreation sub-scale, did show a trend towards improved outcomes (p =0.19). Average follow-up was 12.8 months. Conclusion: Our hypothesis was confirmed that these patients show statistically significant improvements in AOFS and VAS scores at 1 year. Sagittal and coronal alignment was well maintained at an average of 1 year following surgery. TTR represents an exciting treatment options for patients with talar avascular necrosis, though longer-term follow-up is needed.

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Effect of a Controlled Ankle Motion Walking Boot on Syndesmotic Instability During Weightbearing: A Cadaveric Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119864018 ◽

2019 ◽

Vol 7 (8) ◽

pp. 232596711986401 ◽

Cited By ~ 1

Author(s):

Stéphanie Lamer ◽

Jonah Hébert-Davies ◽

Vincent Dubé ◽

Stéphane Leduc ◽

Émilie Sandman ◽

...

Keyword(s):

External Rotation ◽

Axial Loading ◽

Interosseous Ligament ◽

Ankle Motion ◽

Paired Samples ◽

Tibiofibular Ligament ◽

Custom Made ◽

Anterior Inferior Tibiofibular Ligament ◽

Careful Management

Background: Syndesmotic injuries can lead to long-term complications; hence, they require careful management. Conservative treatment is adequate when 1 syndesmotic ligament is injured, but surgery is often necessary to achieve articular congruity when 3 syndesmotic ligaments are ruptured. However, there is some controversy over the best treatment for 2-ligament injuries. Purpose: To evaluate the effect of a controlled ankle motion (CAM) walking boot on syndesmotic instability following iatrogenic isolated anterior inferior tibiofibular ligament (AiTFL) injury and combined AiTFL/interosseous ligament (IOL) injuries in a cadaveric simulated weightbearing model. Study Design: Controlled laboratory study. Methods: Ten cadaveric specimens were dissected to expose the tibial plateau and syndesmosis. The specimens were fitted to a custom-made device, and a reproducible axial load of 750 N was applied. Iatrogenic rupture of the syndesmotic ligaments (AiTFL + IOL) was done sequentially. Uninjured syndesmoses, isolated AiTFL rupture, and combined AiTFL/IOL rupture were compared with and without axial loading (AL) and CAM boot. The distal tibiofibular relationship was evaluated using a previously validated computed tomography scan measurement system. Wilcoxon tests for paired samples and nonparametric data were used. Results: The only difference noted in the distal tibiofibular relationship during AL was an increase in the external rotation of the fibula when using the CAM boot. This was observed with AiTFL rupture (8.40° vs 11.17°; P = .009) and combined AiTFL/IOL rupture (8.81° vs 11.97°; P = .005). Conclusion: AL did not cause a significant displacement between the tibia and fibula, even when 2 ligaments were ruptured. However, the CAM boot produced a significant external rotation with 1 or 2 injured ligaments. Clinical Relevance: Further studies are needed to assess the capacity of the CAM walking boot to prevent malreduction when external rotation forces are applied to the ankle. Moreover, special care should be taken during the fitting of the CAM boot to avoid overinflation of the cushions.

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Percutaneous Chevron Akin (PECA) Correction of Hallux Valgus Deformity: Analysis of the Learning Curve

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00407 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0040

Author(s):

Peter W. Robinson ◽

Robbie Ray ◽

Paul M. Dearden ◽

Thomas A. Goff ◽

Michael R. Whitehouse ◽

...

Keyword(s):

Learning Curve ◽

Hallux Valgus ◽

Pearson Correlation ◽

Weight Bearing ◽

Learning Phase ◽

Plateau Phase ◽

Tourniquet Time ◽

Hallux Valgus Deformity ◽

Parametric Data ◽

Significant Difference

Category: Bunion Introduction/Purpose: Percutaneous hallux valgus correction is increasing in popularity, with good correction of deformity and improvement in outcomes. The learning curve is reported as steep, based on arbitrary analysis. Methods: We performed a prospective study of a single surgeon series on the 1st 58 feet in 53 patients undergoing PECA hallux valgus correction, following cadaveric training and surgical observation. Pre- & post-operative (6 month) hallux valgus angles (HVA) & 1-2 intermetatarsal angles (IMA) were measured on weight bearing radiographs. Tourniquet time & number of fluoroscopy images were recorded. Complications were analysed. Parametric data was described with mean+-SD & non- parametric data with median+-interquartile range. Unpaired 2-tailed t tests were used to compare continuous data. The learning curve was calculated by plotting the tourniquet time against case number using a smoothed cubic spline with straight lines fitted to the slope. This was used to define a learning phase & a plateau phase. Results: Median age was 62 (IQR 56-66). The mean HVA improved from 32°+-4.7 to 9°--+-5.9 (p<0.0001). Mean IMA improved from 16°+-3.1 to 8°+-2.3 (p<0.0001). There were 6 re-operations (ostectomy & screw removal). The learning curve inflection point was between case 38 & 39. 38 were analysed in the learning phase & the remaining 20 in the plateau phase. No significant difference between the learning and plateau phases were seen for age, pre- & post-operative HMA or IMA, difference from normal angles or return to theatre. Pearson correlation revealed that only tourniquet time (p=0.001) & number of fluoroscopy shots (p=0.019) were significantly correlated with the learning or plateau phase. Conclusion: The learning curve for the PECA hallux valgus technique is around 40 cases, reflected by tourniquet time and number of fluoroscopy shots. It does not affect radiological correction or complications, showing that if taught properly this technique is reproducible and reliable.

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Effect of a calcaneo-tibial screw on medial and lateral stability of the canine tarsocrural joint ex vivo

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-16-12-0160 ◽

2017 ◽

Vol 30 (05) ◽

pp. 331-338

Author(s):

Janis Bridges ◽

Andrew Worth ◽

Kevin Frame

Keyword(s):

Ex Vivo ◽

Screw Fixation ◽

Weight Bearing ◽

Ligament Injury ◽

Collateral Ligaments ◽

Collateral Ligament ◽

Injured Limb ◽

Significant Difference ◽

Adequate Method ◽

Intact Limb

SummaryObjective: To evaluate the use of a temporary calcaneo-tibial screw for stabilization of the tarsocrural joint in dogs with surgically treated collateral ligament injury.Methods: The degree of varus and valgus laxity of the tarsocrural joint in various states of injury and stabilization was measured in paired cadaveric limbs of Greyhound dogs. The angle of varus or valgus laxity was calculated following simulated collateral ligament injury (long collateral ligament only, long and short collateral ligaments, and bilateral long and short collateral ligaments) and stabilization with a calcaneo-tibial screw.Results: The joint was significantly more stable after placement of a calcaneo-tibial screw compared to limbs with any combination of injured collateral ligaments. There was not a significant difference between stability of the intact limb compared to the injured limb with calcaneo-tibial screw fixation.Clinical significance: Calcaneo-tibial screw fixation appears to be an adequate method of stabilizing the tarsocrural joint following collateral ligament injury, and warrants clinical evaluation as a less expensive alternative to external skeletal fixation application. It is likely that this method would need to be supplemented with a cranial half cast to prevent screw failure during weight bearing.

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The Effects of a Semi-Rigid Brace or Taping on Talocrural and Subtalar Kinematics in Chronic Ankle Instability

Foot & Ankle Specialist ◽

10.1177/1938640014543357 ◽

2014 ◽

Vol 7 (6) ◽

pp. 471-477 ◽

Cited By ~ 7

Author(s):

Takumi Kobayashi ◽

Masayuki Saka ◽

Eiichi Suzuki ◽

Naohito Yamazaki ◽

Makoto Suzukawa ◽

...

Keyword(s):

Internal Rotation ◽

Ankle Instability ◽

Plantar Flexion ◽

Weight Bearing ◽

Case Series ◽

Chronic Ankle Instability ◽

Cross Sectional ◽

Anterior Translation ◽

Computed Tomography Images ◽

Significant Difference

Background. A semi-rigid brace or taping is often used to prevent giving-ways in the joint with chronic ankle instability (CAI). However, it remains unknown whether the application of a semi-rigid brace or taping modifies abnormal kinematics in CAI joints. The objective of this study was to determine if the application of a semi-rigid brace or taping of the ankle normalizes abnormal weight-bearing kinematics in CAI joints during ankle internal rotation in plantar flexion. Methods. A total of 14 male patients with unilateral CAI (mean age 21.1 ± 2.5 years) were enrolled. Three-dimensional bone models created from the computed tomography images were matched to the fluoroscopic images to compute the 6 degrees-of-freedom talocrural, subtalar, and ankle joint complex (AJC) kinematics for the healthy and contralateral CAI joints, as well as for CAI joints with a brace or taping. Selected outcome measures were talocrural anterior translation, talocrural internal rotation, and subtalar internal rotation. Results. There was no significant difference in talocrural anterior translation and internal rotation induced by applying either a semi-rigid brace or taping ( P > .05). For subtalar internal rotation, there was a tendency toward restoration of normal kinematics in CAI joints after applying a semi-rigid brace or taping. However, the difference was not significant ( P > .05). Discussion. Application of a semi-rigid brace or taping had limited effects on the CAI joint during weight-bearing ankle internal rotation in plantar flexion. Further studies using a variety of testing conditions should be conducted in the future. Levels of Evidence: Therapeutic, Level IV: Cross-Sectional Case Series

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Naproxen versus Acetaminophen for Therapy of Soft Tissue Injuries to the Ankle in Children

Annals of Pharmacotherapy ◽

10.1345/aph.1h596 ◽

2007 ◽

Vol 41 (9) ◽

pp. 1368-1374 ◽

Cited By ~ 18

Author(s):

Victoria A Cukiernik ◽

Rod Lim ◽

David Warren ◽

Jamie A Seabrook ◽

Doreen Matsui ◽

...

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Weight Bearing ◽

Soft Tissue Injury ◽

Self Report ◽

Ankle Injuries ◽

Intermittent Therapy ◽

Double Blind ◽

Significant Difference ◽

Degree Of Disability

Background: Musculoskeletal (MSK) ankle injuries cause significant morbidity in ambulatory pediatric populations. No optimal pharmacotherapy is available. Objective: To conduct a randomized, double-blind trial to compare 2 drug therapies for soft tissue injury of the ankle. Methods: Patients (N = 77, aged 8–14 y, 61% male) with ankle injuries presenting to a regional pediatric emergency department were assigned to receive either acetaminophen (15 mg/kg 4 times a day) or naproxen (5 mg/kg 4 times a day) in a double-blind fashion on a routine basis for a 5 day period. On days 0 and 7, patients rated their degree of disability and pain on weight bearing using a 10 cm visual analog scale developed for this study. In addition, they were examined by a physician who rated pain, tenderness on palpation, and swelling using a 4 point scale. There were 3 follow-up telephone calls on days 3, 14, and 21. Adherence was evaluated by self-report and pill count. Results: Both the acetaminophen and naproxen groups had significant improvement in degree of disability and pain from day 0 to day 7. There was no statistically significant difference in outcome between the 2 groups by patient self-evaluation or physician assessment. There also was no significant difference in adverse event rates between the 2 groups, and the majority of patients in both groups felt that the medication was helpful. Conclusions: No significant difference in efficacy of pain control or improvement of disability between the naproxen and acetaminophen groups suggests no preferential advantage for naproxen over acetaminophen for MSK injuries when given on a regular basis, with concurrent supportive treatment. Possible differential benefit from intermittent therapy needs to be evaluated among children with ankle injury.

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Is Immediate Weight Bearing Safe for Lateral Malleolus Fracture after Surgery?

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00167 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0016

Author(s):

Young Rak Choi ◽

Sang-June Lee ◽

Jaehyung Lee ◽

Seung-Hwan Park

Keyword(s):

Return To Work ◽

Weight Bearing ◽

Lateral Malleolus ◽

Initiation Point ◽

Rehabilitation Protocol ◽

Ankle Motion ◽

Significant Difference ◽

Rehabilitation Protocols ◽

Motion Exercise ◽

Hospital Stays

Category: Trauma; Ankle Introduction/Purpose: Isolated lateral malleolus fracture is one of the most common fractures. However, there is controversy regarding the rehabilitation protocols used after surgery. In particular, the initiation point for the weight bearing has not been standardized. In the present study, we investigated the prognostic difference between the immediate and delayed weight bearing on isolated lateral malleolus fractures. Methods: Retrospectively, the medical records of matched 50 and 41patients in the immediate and delayed weight-bearing groups were reviewed. All patients were treated with open reduction and internal fixation using an anatomical locking compression plate. In the immediate weight-bearing group (IWB), tolerable weight bearing (i.e., that can be endured immediately after surgery with crutches) was permitted. In the delayed weight-bearing group (DWB), weight bearing was completely restricted for 4 weeks after surgery. Ankle motion exercise were permitted in both groups since postoperative day. Radiographic assessment data and the clinical outcomes were reviewed. Results: There were no significant differences noted in the radiographic assessments and complications between the two groups. Significant differences of shortening the return to work and hospital stays of IWB rehabilitation protocol were confirmed(5.7 vs. 8.0 days, 6.0 vs. 8.0 days in the IBW and DWB groups, respectively). In FAOS, there was a significant difference in the sport factor evaluated at postoperative 3 months(75.5 vs 68.5, respectively). Conclusion: There were no significant differences between the two groups in the postoperative radiological outcome and complications. And benefits of shortening the return to work and hospital stays of IWB rehabilitation protocol were confirmed. Conclusively, immediate weight bearing is recommended in patients with isolated lateral malleolus fracture, following anatomical reduction and firm fixation through surgery.

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Passive Posterior Tibial Subluxation on Routine Knee MRI as a Secondary Sign of PCL Tear

Radiology Research and Practice ◽

10.1155/2014/715439 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Andrew J. Degnan ◽

Catherine Maldjian ◽

Richard J. Adam ◽

Christopher D. Harner

Keyword(s):

Interobserver Agreement ◽

Weight Bearing ◽

Intraclass Correlation ◽

Ligament Injury ◽

Clinical Test ◽

Posterior Tibial Translation ◽

Posterior Tibial ◽

Knee Mri ◽

Significant Difference ◽

Tibial Translation

The posterior drawer test is an accurate clinical test to diagnose posterior cruciate ligament (PCL), indicating laxity of the PCL that allows posterior tibial translation. This study aimed to determine whether posterior tibial translation relative to the femur on routine MRI could serve as an additional sign of PCL tear. Routine knee MRI in eleven patients (7 males, 4 females) with arthroscopically confirmed isolated PCL tears were reviewed independently by two musculoskeletal radiologists. Measurements of tibial translation were made in the medial and lateral compartments of patients and controls (10 males, 12 females) without clinical or MRI evidence of ligament injury. Significant medial compartment posterior tibial translation was present in patients with PCL tear compared to controls (+2.93 mm versus +0.03 mm,P=0.002) with excellent interobserver agreement (intraclass correlation coefficient (ICC) = 0.94). No significant difference in lateral compartment tibial translation was observed (+0.17 mm versus −0.57 mm,P=0.366) despite excellent interobserver agreement (ICC = 0.96). Posterior tibial translation in the midmedial compartment may be a secondary sign of isolated PCL tear on routine knee MRI with passive extension without manipulation or weight bearing. Additional work in a larger cohort may better address the accuracy of this finding.

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Influence of Weight Bearing Dorsiflexion (WBDF) on Ankle Injury History Among Semi-professional Recreational Basketball Players

Advanced Journal of Graduate Research ◽

10.21467/ajgr.11.1.45-51 ◽

2021 ◽

Vol 11 (1) ◽

pp. 45-51

Author(s):

Sameera Senanayake ◽

Tharanga Premakumara ◽

Piyumika Kodagoda ◽

Harindu Jayasekara

Keyword(s):

Demographic Data ◽

Weight Bearing ◽

Ankle Injury ◽

Ankle Injuries ◽

Basketball Players ◽

Training Time ◽

Significant Difference ◽

Recreational Basketball ◽

Quasi Experimental ◽

Leg Dominance

Ankle injuries are one of the most common occurrences in the field of sports. Weight bearing dorsiflexion range can be an effecting factor in ankle injuries. Weight bearing lunge test is used to assess weight bearing dorsiflexion. By using this test as a standard testing protocol, it is possible to minimize development of further sport related ankle injuries. But this test for basketball players with ankle injuries has not been studied yet. The current study will aim to examine the weight bearing dorsiflexion of basketball players related to their gender, ankle injury history and leg dominance. A quasi-experimental design study was conducted. Thirty-four (34) participants were recruited and initially and two (2) were excluded. 18 participants were male and 14 were female basketball players in Colombo Blues and Kotelawala Defence University basketball teams. The average of age of the sample was 21.8 years. Demographic data, information about training time, injury history of the participants was obtained using an interview administered assessment form. The Weight Bearing Dorsiflexion was measured using digital inclinometer. Findings indicated that the weight bearing dorsiflexion range is smaller than that of males (p>0.05). There was a significant difference in weight bearing dorsiflexion and ankle injury history (p<0.01) among players. Significant differences were seen in influence in leg dominance to weight bearing dorsiflexion (p<0.05). This is the first study that is investigated weight bearing dorsiflexion among basketball players in Sri Lanka. No significant difference was found between gender and weight bearing dorsiflexion. A significant difference was determined between ankle injury history and weight bearing dorsiflexion. Furthermore, a significant difference was found in leg dominance and weight bearing dorsiflexion.

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