scholarly journals Stability of the ankle joint in anatomical or non-anatomical anterior talofibular ligament repair

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0044
Author(s):  
Hiroaki Shoji ◽  
Atsushi Teramoto ◽  
Yuzuru Sakakibara ◽  
Tomoaki Kamiya ◽  
Kota Watanabe ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Ankle Joint ◽  
Repeated Measures ◽  
Attachment Site ◽  
P Value ◽  
Anterior Talofibular Ligament ◽  
Anterior Translation ◽  
Significant Difference ◽  
Intact Condition ◽  
The Stability

Category: Ankle Introduction/Purpose: Chronic ankle instability (CAI) often needs surgical treatment if conservative treatment is ineffective. Recently, arthroscopic surgeries have become widely used to treat CAI. Although it is crucial to accurately ascertain the anterior talofibular ligament (ATFL) attachment site under arthroscopy, previous study showed that it might not be feasible to thoroughly observe the ATFL attachment site, and repair or reconstruction position were often unintentionally carried out proximal to the ATFL attachment site at the fibula as a result. Currently, there are few reports about stability of the ankle joint by different repair position of ATFL. The aim of this study was to evaluate the stability of the ankle joint by different repair position of ATFL. Methods: Six fresh-frozen human cadaveric ankles with the mean age of 83.5 ± 7.3 years were used. The ankles were tested using a six-degrees of freedom robotic system. The following ankle states were evaluated: intact, ATFL transection, ATFL anatomical repair, and ATFL non-anatomical repair. ATFL was transected at fibular attachment. Anatomical repair was performed at the center of original ATFL attachment of the fibula. Non-anatomical repair was set 8mm proximal from anatomical ATFL attachment of the fibula. At each state, laxity of anterior translation under 60 N load, inversion under 1.7 Nm load, and internal rotation under 1.7 Nm load were evaluated. Each test was performed at 30 degrees plantarflexion (PF), 15 degrees PF, 0 degree, and 15 degrees dorsiflexion (DF). The one-way repeated measures analysis of variance (ANOVA) with post hoc pairwise comparisons with Dunnett’s test was adopted. A P value of 0.05 was chosen as the level of significance. Results: Anterior translation under 60 N load was significantly increased in transection condition at 30 degrees PF compared with the intact condition (P=0.005). Anatomical repair and Non-anatomical repair did not show significant differences. Inversion under 1.7 Nm load was significantly increased in transection condition at 30 and 15 degrees PF compared with the intact condition (P=0.004, =0.049). Anatomical repair and Non-anatomical repair did not show significant differences. Internal rotation under 1.7 Nm load was significantly increased in transection condition at 30, 15 degrees PF and 0 degree compared with the intact condition (P<0.001, <0.001, and <0.001). Although anatomical repair did not show significant differences, non-anatomical repair showed significant increase at 30 and 15 degrees compared with the intact condition (P=0.006, =0.026). (Fig. 1). Conclusion: Anatomical repair did not show significant difference in all three loads with the intact condition. In non-anatomical repair, anterior translation and inversion did not show significant difference, but internal rotation significantly increased at 30 and 15 degrees PF compared with the intact condition. Compared with anatomical repair, non-anatomical repair might become more vertical ligament running because its attachment site of the fibula was more proximal. This difference might affect stability of the ankle joint. Anatomical repair of the ATFL might be essential to obtain the stability of the ankle joint like the intact condition.

Kinematics and Laxity of the Ankle Joint in Anatomic and Nonanatomic Anterior Talofibular Ligament Repair: A Biomechanical Cadaveric Study

2019 ◽  
Vol 47 (3) ◽  
pp. 667-673 ◽  
Author(s):  
Hiroaki Shoji ◽  
Atsushi Teramoto ◽  
Yuzuru Sakakibara ◽  
Tomoaki Kamiya ◽  
Kota Watanabe ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Ankle Joint ◽  
Degrees Of Freedom ◽  
External Rotation ◽  
Arthroscopic Surgery ◽  
Attachment Site ◽  
Anterior Talofibular Ligament ◽  
Loading Test ◽  
Intact State ◽  
Anatomic Repair

Background: Although it is crucial to accurately identify the anterior talofibular ligament (ATFL) attachment site, it may not be feasible to fully observe the ATFL attachment site during arthroscopic surgery. As a result, the repair position might often be an unintentionally nonanatomic ATFL attachment site. Hypothesis: Anatomic ATFL repair restores kinematics and laxity to the ankle joint, while nonanatomic ATFL repair does not. Study Design: Controlled laboratory study. Methods: Seven normal fresh-frozen human cadaveric ankles were used. The ankles were tested with a 6 degrees of freedom robotic system. The following ankle states were evaluated: intact, ATFL injured, ATFL anatomic repair, and ATFL nonanatomic repair. The ATFL nonanatomic repair position was set 8 mm proximal from the center of the ATFL attachment site of the fibula. For each state, a passive plantarflexion (PF)–dorsiflexion (DF) kinematics test and a multidirectional loading test (anterior forces, inversion moment, and internal rotation moment) were performed. Results: The kinematics and laxity of the anatomic repair were not significantly different from those of the intact state. In nonanatomic repair, the inversion-eversion angle showed significant inversion (3.0°-3.4°) from 5° to 15° of DF, and the internal rotation–external rotation angle showed significant internal rotation (2.0°) at neutral PF-DF versus the intact state. In addition, internal rotation laxity was significantly increased (5.5°-5.8°) relative to the intact state in the nonanatomic repair at 30° and 15° of PF. There were no significant differences in anterior-posterior translation between the repairs. Conclusion: Although the anatomic ATFL repair state did not show significant differences in kinematics and laxity relative to the intact state, the nonanatomic ATFL repair state demonstrated significant inversion and internal rotation kinematics and internal rotation laxity when compared with the intact state. Clinical Relevance: Nonanatomic repair alters kinematics and laxity from the intact condition.

scholarly journals A preliminary study exploring the change in ankle joint laxity and general joint laxity during the menstrual cycle in cis women

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Tomomi Yamazaki ◽  
Sae Maruyama ◽  
Yuki Sato ◽  
Yukako Suzuki ◽  
Sohei Shimizu ◽  
...  
Keyword(s):  
Menstrual Cycle ◽  
Ankle Joint ◽  
Length Change ◽  
Joint Laxity ◽  
Anterior Talofibular Ligament ◽  
Menstrual Phase ◽  
Anterior Drawer ◽  
Linear Distance ◽  
Significant Difference ◽  
Early Follicular Phase

Abstract Background The purpose of the present study was to examine the relationship between ankle joint laxity and general joint laxity (GJL) in relation to the menstrual cycle, which was divided into four phases based on basal body temperature and ovulation, assessed using an ovulation kit. Methods Participants were 14 female college students (21–22 years) with normal menstrual cycles (cis gender). Anterior drawer stress to a magnitude of 120 N was applied for all participants. Anterior talofibular ligament (ATFL) length was measured as the linear distance (mm) between its points of attachment on the lateral malleolus and talus using ultrasonography. Data on ATFL length from each subject were used to calculate each subject’s normalized length change with anterior drawer stress (AD%). The University of Tokyo method was used for evaluation of GJL. AD% and GJL were measured once in each menstrual phase. Results There was no statistically significant difference between AD% in each phase. GJL score was significantly higher in the ovulation and luteal phases compared with the early follicular phase. AD% and GJL showed a positive correlation with each other in the ovulation phase. Conclusions Although it is unclear whether estrogen receptors are present in the ATFL, the present study suggests that women with high GJL scores might be more sensitive to the effects of estrogen, resulting in ATFL length change in the ovulation phase.

Contact patterns in the ankle joint after lateral ligamentous injury during internal rotation: A computational study

2020 ◽  
Vol 235 (1) ◽  
pp. 82-88
Author(s):  
G Marta ◽  
C Quental ◽  
J Folgado ◽  
F Guerra-Pinto
Keyword(s):  
Finite Element ◽  
Contact Mechanics ◽  
Internal Rotation ◽  
Ankle Joint ◽  
Ankle Instability ◽  
Computational Study ◽  
Rotational Instability ◽  
Anterior Talofibular Ligament ◽  
Maximum Contact ◽  
Contact Pressures

Lateral ankle instability, resulting from the inability of ankle ligaments to heal after injury, is believed to cause a change in the articular contact mechanics that may promote cartilage degeneration. Considering that lateral ligaments’ insufficiency has been related to rotational instability of the talus, and that few studies have addressed the contact mechanics under this condition, the aim of this work was to evaluate if a purely rotational ankle instability could cause non-physiological changes in contact pressures in the ankle joint cartilages using the finite element method. A finite element model of a healthy ankle joint, including bones, cartilages and nine ligaments, was developed. Pure internal talus rotations of 3.67°, 9.6° and 13.43°, measured experimentally for three ligamentous configurations, were applied. The ligamentous configurations consisted in a healthy condition, an injured condition in which the anterior talofibular ligament was cut, and an injured condition in which the anterior talofibular and calcaneofibular ligaments were cut. For all simulations, the contact areas and maximum contact pressures were evaluated for each cartilage. The results showed not only an increase of the maximum contact pressures in the ankle cartilages, but also novel contact regions at the anteromedial and posterolateral sections of the talar cartilage with increasing internal rotation. The anteromedial and posterolateral contact regions observed due to pathological internal rotations of the talus are a computational evidence that supports the link between a pure rotational instability and the pattern of pathological cartilaginous load seen in patients with long-term lateral chronic ankle instability.

scholarly journals Analysis of the Effect of Musical Stimulation on Cortical Auditory Evoked Potentials

2018 ◽  
Vol 23 (01) ◽  
pp. 031-035
Author(s):  
Daiane Lima ◽  
Simone Regaçone ◽  
Anna Oliveira ◽  
Yara Alcântara ◽  
Eduardo Chagas ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Auditory System ◽  
Repeated Measures ◽  
Auditory Evoked Potentials ◽  
P Value ◽  
Mixed Analysis ◽  
Sphericity Test ◽  
Significant Difference ◽  
Healthy Female ◽  
Cortical Auditory Evoked Potentials

Introduction Cortical auditory evoked potentials (CAEPs) are bioelectric responses that occur from acoustic stimulations, and they assess the functionality of the central auditory system. Objective The objective of the present study was to analyze the effect of musical stimulation on CAEPs. Methods The sample consisted of 42 healthy female subjects, aged between 18 and 24 years, divided into two groups – G1: without musical stimulation prior to the CAEP examination; and G2: with stimulation prior to the examination. In both groups, as a pre-collection procedure, the complete basic audiological evaluation was performed. For the musical stimulation performed in G2, we used an MP4 player programmed to play Pachelbel's “Canon in D Major” for five minutes prior to the CAEP examination. To analyze the effect on the groups, the ear side and the ide–group interaction , a mixed analysis of variance (ANOVA) of repeated measures was performed. Box M test and Mauchly sphericity test were also performed. Results Test differences were considered statistically significant when the p-value was < 0.05 (5%). Thus, it was possible to observe that there was a statistically significant difference of the P2 component characterized by the decrease in the amplitude of response in the left ear in G2 when comparing the responses of CAEP with and without prior musical stimulation. Conclusion The result of the present study enabled us to conclude that there was a change in the response of CAEPs with musical stimulation.

Strain in the Lateral Ligaments of the Ankle

Foot & Ankle ◽  
1988 ◽  
Vol 9 (2) ◽  
pp. 59-63 ◽  
Author(s):  
P. Renstrom ◽  
M. Wertz ◽  
S. Incavo ◽  
M. Pope ◽  
H.C. Ostgaard ◽  
...  
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Anterior Talofibular Ligament ◽  
Neutral Position ◽  
Calcaneofibular Ligament ◽  
Ankle Ligaments ◽  
Significant Difference ◽  
Ligament Strain ◽  
Pronation External Rotation ◽  
Relaxing Effect

Strain was measured in the normal anterior talofibular ligament (ATF) and the calcaneofibular ligament (CF) using Hall effect strain transducers in five cadaveric ankles. These measurements were made in both ligaments with the ankle in neutral position and with the foot moving from 10° dorsiflexion to 40° plantarflexion in an apparatus that permits physiologic motion. The ankle ligaments were then tested with the foot placed in six different positions that combined supination, pronation, external rotation, and internal rotation. In the neutral position, through a range of motion of 10° dorsiflexion to 40° plantarflexion, the anterior talofibular ligament underwent an increasing strain of 3.3%. No significant strain increase was found with internal rotation. The only significant difference from the strains at the neutral position was in external rotation, which decreased strain 1.9%. In all positions, increased strain occurred with increased plantarflexion. The calcaneofibular ligament was essentially isometric in the neutral position throughout the flexion arc. The calcaneofibular ligament strain was significantly increased by supination and external rotation. However, with increasing plantarflexion in these positions, the strain in the calcaneofibular ligament decreased. Therefore, plantarflexion has a relaxing effect on the calcaneofibular ligament. Thus, the anterior talofibular and calcaneofibular ligaments are synergistic, such that when one ligament is relaxed, the other is strained and vice versa.

scholarly journals How Relevant Is the Place Where First-Year College Students Live in Relation to the Increase in Body Mass Index?

Healthcare ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1638
Author(s):  
Antonio Viñuela ◽  
Juan José Criado-Álvarez ◽  
Javier Aceituno-Gómez ◽  
Carlos Durantez-Fernández ◽  
José Luis Martín-Conty ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Nursing Students ◽  
Body Mass ◽  
Repeated Measures ◽  
Eating Habits ◽  
The Body ◽  
P Value ◽  
First Year ◽  
Significant Difference ◽  
The Mean

(1) Objective: This study analyzes the evolution of the body mass index (BMI) throughout the academic year associated with changes in the lifestyle associated with the place where students live during the course, lifestyle design, and health strategies for the university community. (2) Methods: A total of 93 first-year nursing students participated in this study. Data were collected throughout the course by administering self-reported questionnaires about eating habits and lifestyles, weight, and height to calculate their BMI and place of residence throughout the course. Data were analyzed using statistical analysis (Mann–Whitney, chi-square, Student’s t-test, repeated-measures analysis of variance, and least significant difference tests). (3) Results: We found that the mean BMI increases significantly throughout the course among all students regardless of sex, age, eating habits, or where they live during the course. At the beginning of the course, the mean BMI was 22.10 ± 3.64. The mean difference between the beginning of the course and the middle has a value of p-value < 0.015 and between the middle of the course and the end a p-value < 0.009. The group that increased the most is found among students who continue to live in the family nucleus rather than those who live alone or in residence. Students significantly changed their eating and health habits, especially those who live alone or in residence. (4) Conclusions: There is an increase in BMI among students. It is necessary to carry out seminars or talks that can help students understand the importance of good eating practices and healthy habits to maintain their weight and, therefore, their health, in the short, medium, and long term and acquire a good quality of life.

scholarly journals Effects of posterior capsule stretch on adhesive capsulitis.

2019 ◽  
Vol 26 (08) ◽  
pp. 1272-1277
Author(s):  
Madiha Maryam ◽  
Muhammad Kashif ◽  
Abdul Ghafoor Sajjad ◽  
Razia Rizwan ◽  
Sehrish Ali ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Manual Therapy ◽  
Functional Disability ◽  
Adhesive Capsulitis ◽  
Mean Value ◽  
Control Group ◽  
P Value ◽  
Significant Difference ◽  
Group A ◽  
Group B

To compare the effect of posterior capsular stretch on pain, ROM and functional disability in Adhesive Capsulitis. Study Design: Experimental, Randomized Control Trail. Setting: Department of Physiotherapy, Capital Development Authority Hospital Islamabad. Period: October 2015 to March 2016. Materials and Methods: Forty female patients having aged between 40 to 70 years with freezing and frozen stage of adhesive capsulitis were screened out. Adhesive capsulitis secondary to cervical Spondylosis, osteoporosis, direct trauma and any inflammation were excluded from the study. Subjects were randomly placed into two groups lottery method, the experimental group having 19 subjects received posterior capsular stretch along with conventional manual therapy and electrotherapy  whereas the control group had 21 subjects and they were given manual therapy and electrotherapy alone. The Numeric Pain Rating Scale, Shoulder Pain and Disability Index, and Range of Motion of shoulder joint were used as outcome measures. All the patients were assessed at baseline before intervention and at the completion of 6 weeks of treatment. Data was analyzed using SPSS version 20. Results: Abduction, Internal Rotation and disability show significant result. The abduction mean value of Group A was 115.00±22.023and of the Group B was 81.74±20.653 with p value was P<05. The internal rotation mean value of Group A was 70.71±12.776 and for the Group B was 60.32±8.699 and having p value P<05. The SPADI mean value of Group A was 51.76±22.043 and for the Group B was 24.24±7.287 having p value P<05. The NPRS and external rotation showed non-significant difference. Conclusion: It is concluded that posterior capsular stretch along with mobilization is more effective in treating ROM and functional disability.

Effect of a Flexor Digitorum Superficialis Hemitenodesis on Reducing Volar Plate Strains for Swan Neck Deformities

Hand ◽  
2021 ◽  
pp. 155894472110408
Author(s):  
Mohammad M. Haddara ◽  
Assaf Kadar ◽  
Louis M. Ferreira ◽  
Nina Suh
Keyword(s):  
Repeated Measures ◽  
Statistical Significance ◽  
Volar Plate ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Common Procedure ◽  
Motion Simulator ◽  
Significant Difference ◽  
Intact Condition ◽  
Flexor Digitorum

Background Flexor digitorum superficialis (FDS) hemitenodesis is a common procedure to treat swan neck deformity (SND). We hypothesize that this surgical technique is a biomechanically effective way to reduce strain in the volar plate at the proximal interphalangeal joint (PIPJ). Methods Fifteen digits from 5 cadaveric specimens were tested using a novel in vitro active finger motion simulator under 4 finger conditions: intact, SND, FDS hemitenodesis, and FDS hemitenodesis with distal interphalangeal (DIP) joint fusion. Tensile loads in FDS and flexor digitorum profundus (FDP) and joint ranges of motion were measured by electromagnetic tracking. In addition, strain gauges were inserted under the volar plate to measure strain during PIPJ hyperextension. Results were analyzed using 1-way repeated-measures analysis of variance tests. Results The SND condition increased volar plate strain by 176% ± 25% ( P < .001) compared with the intact condition. The FDS hemitenodesis repair relieved more than 50% of the SND strain, restoring it to within no statistical difference from intact. The DIP fusion further reduced strain with no further statistical significance. At full flexion, FDS and FDP tendon loads diverged as a function of the test condition ( P < .001). With the FDS hemitenodesis, the FDP load increased by 2.1 ± 1.5 N from the SND condition ( P < .001), whereas the FDS load decreased by 1.3 ± 1.3 N ( P = .012). Conclusion The FDS hemitenodesis repair restored strains to within 3.0 milli-strain of the intact condition with no significant difference. Application of DIP fusion did not further protect the PIPJ from increased hyperextension and further exacerbated the imbalance of flexor tendon loads.

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

2014 ◽  
Vol 7 (6) ◽  
pp. 471-477 ◽  
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

scholarly journals The Effect of Capsulectomy on Hip Joint Biomechanics

2017 ◽  
Vol 5 (10) ◽  
pp. 232596711773343 ◽  
Author(s):  
Neil K. Bakshi ◽  
Jen L. Bayer ◽  
Erin M.R. Bigelow ◽  
Omar F. Jameel ◽  
Jon K. Sekiya
Keyword(s):  
Hip Joint ◽  
Repeated Measures ◽  
Arthroscopic Surgery ◽  
Compressive Force ◽  
Neutral Position ◽  
Anterior Translation ◽  
Bonferroni Adjustment ◽  
Hip Stability ◽  
Labral Tears ◽  
Significant Difference

Background: Capsulectomy is performed during hip arthroscopic surgery in young adult patients with hip pain to improve intraoperative visualization. The stability of the hip joint after anterior capsulectomy is relatively unknown. Purpose: To evaluate anterior hip stability in capsular sectioned states with a labral injury to test whether the load required for anterior translation would decrease with greater capsular injuries. Study Design: Controlled laboratory study. Methods: Sixteen hips from 8 of 10 human cadaveric pelvises (mean age, 54.25 years) were prepared/mounted onto a custom-built fixture and tested in 5 states: intact capsule, intact labrum (all intact); sutured capsule, intact labrum (sutured intact); sutured capsule, 1-cm partial labrectomy (sutured labrectomy); partial capsulectomy, 1-cm partial labrectomy (partial capsulectomy); and total capsulectomy, 1-cm partial labrectomy (total capsulectomy). Each hip was tested in a neutral position with a 20-N compressive force. The load at 12 mm of anterior translation was recorded for each state after 2 preconditioning trials. Results: A repeated-measures analysis of variance with Bonferroni adjustment showed no difference between the all-intact versus sutured-intact states and demonstrated no significant difference between the sutured-intact and sutured-labrectomy states. There were significant differences between the sutured-labrectomy and partial capsulectomy ( P = .01), sutured-labrectomy and total capsulectomy ( P < .001), and partial capsulectomy and total capsulectomy ( P = .04) states. Conclusion: The findings demonstrate that the capsule/labrum plays an important role in anterior hip stability and that the iliofemoral ligament is crucial for preventing anterior translation in labral-injured states. In addition, the ischiofemoral and pubofemoral ligaments provide resistance to anterior translation in iliofemoral- and labral-deficient states. Intraoperative capsulectomy should be avoided in patients with large, irreparable labral tears to prevent postoperative anterior hip instability. Clinical Relevance: This study quantifies the roles of the capsulolabral structures in anterior hip stability and demonstrates the importance of maintaining/repairing them during hip arthroscopic surgery.

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