scholarly journals MRI Analysis for Clarification of Mechanism of Ankle Osteoarthritis: When the Talar Tilt Exceeds 15 Degrees, the BME Pattern of the Ankle Are Changes

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0030
Author(s):  
Hiroyuki Mitsui ◽  
Takaaki Hirano ◽  
Yui Akiyama ◽  
Wataru Endo ◽  
Tomoko Karube ◽  
...  
Keyword(s):  
Tilt Angle ◽  
Subtalar Joint ◽  
Pathological Condition ◽  
Incidence Rates ◽  
Outer Side ◽  
Ankle Osteoarthritis ◽  
Poor Prognostic Factor ◽  
Exact Test ◽  
Talar Tilt ◽  
Group 5

Category: Ankle Arthritis Introduction/Purpose: In recent years, total ankle arthroplasty (TAA) has been widely performed for severe ankle osteoarthritis (OA). However, TAA is not always successful in cases of advanced varus; in fact, some researchers have stated caution regarding its indication. Previously, to elucidate the pathological condition of ankle OA using MRI, we investigated that confirmed the existence of an association among the Takakura–Tanaka classification, foot and ankle alignment, and bone marrow edema (BME). In this study, we focused on the talar tilt angle and compared the cases of terminal ankle OA as per Takakura– Tanaka classification (stage 3b and 4) wherein this angle exceeded 15° with those wherein it did not exceed in terms of the mode of BME onset. Methods: Of 616 cases of ankle OA diagnosed in our hospital between May 2009 and January 2018, we examined the MRI images of 52 feet of 50 patients diagnosed with severe ankle OA. The talar tilt angle with the ankle under load was measured using frontal X-ray, following which the presence/absence of BME was determined by dividing the talus, subtalar, and Chopart’s joints into 22 regions (areas 1–11 and 1’–11’). In statistical analysis, we first obtained the total number of BME incidences for each case. Then, after dividing this disease group into severe varus (SV; talar tilt angle = 15° or more) and mild varus (MV; talar tilt angle < 15°) groups, we compared t-test scores for the respective BME incidence rates. Furthermore, we used Fisher’s exact test to examine differences in terms of BME incidence rates between the two groups for each subdivided region. Results: No significant differences were found between the two groups in terms of BME incidence rates for each case. However, the rates in each area were significantly lower in the SV group than in the MV group for area 2 (SV group, 14%; MV group, 57%) and area 4 (SV group, 7%; MV group, 39%), i.e. the SV groups corresponding to the outer surface of the trochlea talar. Conversely, in the subtalar joint, the rates were significantly higher in the SV group than in the MV group for area 10 (SV group, 36%; MV group, 11%) and area 10’ (SV group, 29%; MV group, 5%), i.e. the medial surface of the calcaneus. Conclusion: In cases of severe ankle OA wherein the talar tilt angle exceeds 15°, the load exerted on the outer side of the talus decreases in the talar joint, whereas a greater load is exerted on the medial subtalar joint located at the innermost side in the subtalar joint. Differences in terms of the mode of BME incidence in the subtalar joint, which is not replaced with normal TAA, may be a poor prognostic factor for postoperative TAA.

scholarly journals Lateral talocalcaneal ligament substitution for calcaneofibular ligament difficient chronic ankle lateral instability

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Chen Jiao
Keyword(s):  
Tilt Angle ◽  
Subtalar Joint ◽  
Ankle Instability ◽  
Stress Test ◽  
Lateral Ligament ◽  
Lateral Instability ◽  
Calcaneofibular Ligament ◽  
Anterior Translation ◽  
Negative Results ◽  
Talar Tilt

Category: Ankle, Hindfoot, Sports, Trauma Introduction/Purpose: Introduction: Treatment of chronic ankle lateral instability associated with defective calcaneofibular ligament via tendon reconstruction or artificial grafts has several disadvantages. The method of substitution with lateral talocalcaneal ligament has never been reported. Purpose: To investigate the role of lateral talocalcaneal ligament substitution for the treatment of chronic ankle lateral instability associated with defective calcaneofibular ligament. Methods: Repair of ankle lateral ligament was performed on 32 patients with chronic ankle instability. The mean age was 26.4±8.7 years. The calcaneofibular ligament was absent in all the patients and was confirmed surgically. The calcaneofibular ligament was repaired via transfer of talar insertion of the lateral talocalcaneal ligament. Patients were followed up for an average of 22.3±4.0 months. AOFAS, Mazur and Tegner scores, objective examinations (anterior drawer test and varus stress test) and re-injury were assessed before and after the operation. The anterior translation distance of the talus and the talar tilt angle were also measured. Results: In all the patients, postoperative AOFAS, Mazur and Tegner scores were significantly improved. Postoperative evaluation (drawer test and lateral stress test) yielded negative results. The anterior translation distance was reduced from 4.9±1.0 mm to 2.0±0.8 mm. The talar tilt angle was reduced from 12.7º±2.5º to 5.0º±1.4º. The average satisfaction score was 7.4. No subjective instability or re-injury, subtalar joint (tarsal sinus) pain or/and instability occurred. Conclusion: Lateral talocalcaneal ligament substitution was effective against chronic ankle lateral instability associated with the absence of calcaneofibular ligament, without any significant effect on subtalar joint clinically.

scholarly journals Subtalar Joint Alignment in Ankle Osteoarthritis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Nicola Krähenbühl ◽  
Lukas Zwicky ◽  
Manja Deforth ◽  
Beat Hintermann ◽  
Markus Knupp
Keyword(s):  
Ankle Joint ◽  
Subtalar Joint ◽  
Ct Scans ◽  
Control Group ◽  
Talar Dome ◽  
Ankle Arthritis ◽  
Ankle Osteoarthritis ◽  
Talar Tilt ◽  
Joint Inclination ◽  
Weightbearing Ct

Category: Ankle Arthritis, Hindfoot Introduction/Purpose: The influence of the subtalar joint on the evolution of ankle joint osteoarthritis is still a matter of debate. Although subtalar joint compensation of deformities above the ankle joint was proposed until mid-stage of ankle osteoarthritis, the evidence of this assumption is weak. In this study, we investigated the subtalar joint alignment in different stages of ankle joint osteoarthritis using weightbearing CT scans. The influence of the tibio-talar tilt and presence of subtalar joint osteoarthritis was additionally assessed. We hypothesized, that the subtalar joint compensates for deformities above the ankle joint in early- to mid-stage of ankle osteoarthritis. We also hypothesized, that subtalar joint compensation increases with a pronounced tibio-talar tilt and decreases with the presence of subtalar joint osteoarthritis. Methods: We included patients with ankle joint osteoarthritis treated in our institution from January 2013 to April 2016. A control group of 28 patients was additionally assessed. Varus and valgus ankles were subdivided according to the modified Takakura classification, the tilt of the talus in the ankle mortise and stage of subtalar joint osteoarthritis. The type of ankle osteoarthritis was diagnosed on a plain weightbearing anterior to posterior radiograph of the ankle. The medial distal tibial angle (TAS) and the angle between the tibial shaft and the surface of the talar dome (TTS) were measured. The subtalar joint alignment was assessed using weightbearing CT scans. Two angles were assessed: The subtalar inclination angle (SIA) was measured to investigate the subtalar compensation. For assessment of the morphology of the talus, the inftal-subtal angle (ISA) was determined. Results: This analysis showed significant differences of the subtalar inclination between varus feet and the controls (SIA, P=.001). Regarding the talar morphology, significant differences were found between varus/ valgus feet and the controls (ISA, P=.001 and .036, respectively). No significant differences of the subtalar joint inclination and talar morphology could be identified comparing different stages of ankle joint osteoarthritis inside the varus or valgus group. No relationship between the tilt of the talus in the ankle joint mortise and the subtalar joint inclination or talar morphology was identified. Neither presence nor absence of subtalar joint osteoarthritis influenced the subtalar joint inclination and talar morphology. Conclusion: Varus ankles compensate in the subtalar joint for deformities above the ankle joint. Compensation had no influence on the stage of ankle osteoarthritis, extent of the tibio-talar tilt and stage of subtalar joint osteoarthritis. Consequently, the progression of ankle joint osteoarthritis is more depended on the supramalleolar alignment and integrity of the periarticular structures (i.e. ligaments and tendons) than on the osseous alignment of the subtalar joint.

scholarly journals Supramalleolar osteotomy combined with lateral ligament reconstruction and talofibular immobilization for varus ankle osteoarthritis with excessive talar tilt angle

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Wenqing Qu ◽  
Dajiang Xin ◽  
Shengjie Dong ◽  
Wenliang Li ◽  
Yanping Zheng
Keyword(s):  
Tilt Angle ◽  
Ligament Reconstruction ◽  
Weight Bearing ◽  
Lateral Ligament ◽  
Ankle Osteoarthritis ◽  
Supramalleolar Osteotomy ◽  
Talar Tilt ◽  
Ankle Function ◽  
Varus Ankle Osteoarthritis

Abstract Background Although supramalleolar osteotomy is the main joint-preserving method for the treatment of varus ankle osteoarthritis, it tends to be ineffective when ankle osteoarthritis presents in combination with an excessive talar tilt angle. The purpose of this study was to present a new surgical technique, supramalleolar osteotomy combined with lateral ligament reconstruction and talofibular immobilization, for the treatment of varus ankle osteoarthritis with an excessive talus tilt angle and to evaluate the clinical and radiological results. Methods From January 2013 to October 2016, a total of 17 patients with 17 cases of varus ankle arthritis with excessive talar tilt angles (larger than 7.3°) underwent surgical treatment using our new technique. The American Orthopaedic Foot and Ankle Society (AOFAS) clinical ankle-hindfoot scale and a visual analogue scale (VAS) were used to evaluate ankle function and pain before surgery and at the last follow-up. The medial distal tibial angle (MDTA), anterior distal tibial angle (ADTA), talar tilt angle (TTA), and hindfoot moment arm values (HMAVs) were evaluated on weight-bearing radiographs acquired preoperatively and at the last follow-up. Results The AOFAS score improved significantly from 45.8 ± 2.1 before surgery to 84.8 ± 1.8 after surgery (p < 0.001), and the VAS score decreased from 4.9 ± 0.4 to 1.1 ± 0.2 (p < 0.001). The MDTA, TTA, and HMAV changed from 80.9° ± 0.4° to 90.1° ± 0.4°, 11.7° ± 0.6° to 1.4° ± 0.3°, and 12.6 mm ± 0.8 mm to 4.2 mm ± 0.6 mm, respectively (each p < 0.001). The ADTA showed no obvious change (p = 0.370). The staging of 11 cases (65%) improved. Intramuscular vein thrombosis of the lower limbs occurred in 1 patient 1 week after surgery, and superficial infection occurred in 1 patient. Conclusions Supramalleolar osteotomy combined with lateral ligament reconstruction and talofibular immobilization can correct the load of the weight-bearing ankle and effectively improve the ankle function. As the talar tilt angle can be significantly improved after surgery, this technique can be used for the treatment of varus ankle osteoarthritis with an excessive TTA.

scholarly journals Demographic Predictors of Concomitant Osteochondral Lesion of the Talus in Patients With Chronic Lateral Ankle Instability

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110133
Author(s):  
Yong Sang Kim ◽  
Tae Yong Kim ◽  
Yong Gon Koh
Keyword(s):  
Tilt Angle ◽  
Ankle Instability ◽  
Osteochondral Lesion ◽  
Case Series ◽  
Level Of Evidence ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Female Patients ◽  
Lateral Ankle Instability ◽  
Talar Tilt

Background: Osteochondral lesion of the talus (OLT) is commonly found as a concomitant pathologic lesion in a large proportion of patients with chronic lateral ankle instability (CLAI). This study investigated which characteristics in a patient with CLAI increase the risk for OLT. Methods: Three hundred sixty-four patients who underwent a modified Broström operation for their CLAI were reviewed retrospectively. The characteristics of each patient and variables associated with OLTs were investigated. Statistical analyses were performed to determine the effect of each potential predictor on the incidence of OLT, and to evaluate the associations between the patient characteristics and variables associated with OLTs. Results: Patients with OLTs were more frequently female (female vs male: 63.1% vs 43.9%, P = .003). In addition, the lesion sizes were larger in female patients (female vs male: 113.9 ± 24.9 mm2 vs 100.7 ± 18.0 mm2, P = .002), and medial lesions were more common in female patients (female vs male; 93.3% vs 81.8%, P = .036). The lesion sizes were larger in patients with a wider talar tilt angle ( P < .001), and patients with a medial OLT showed a wider talar tilt angle (12.0 ± 2.0 degrees vs 10.3 ± 2.2 degrees, P = .002). Conclusion: In this CLAI patient cohort, we found female patients to be at greater risk for OLTs than male patients. Furthermore, CLAI female patients with concomitant OLT had on average a larger lesion size, more frequent OLT medial position, and were associated with wider talar tilt angles, suggesting that females had more intrinsic ankle instability than males. Level of Evidence: Level IV, retrospective case series.

403 CONTROL OF OVULATION IN SOWS IN THE TROPICAL ENVIRONMENT USING HUMAN CHORIONIC GONADOTROPHIN IN COMPARISON WITH GONADOTROPIN-RELEASING HORMONE ANALOG

2010 ◽  
Vol 22 (1) ◽  
pp. 358
Author(s):  
K. Buranaamnuay ◽  
K. Wongkaweewit ◽  
R. Raksasub ◽  
P. Prommachart ◽  
P. Tummaruk ◽  
...  
Keyword(s):  
Hormonal Treatment ◽  
Control Group ◽  
Gnrh Analog ◽  
Exact Test ◽  
Group 4 ◽  
Hormone Analog ◽  
The Mean ◽  
Group 5 ◽  
Minimum Daily Temperature ◽  
Mean Time

The reproductive performance of sows is influenced by numerous factors, including environment. The time of ovulation in response to hormonal treatment might vary depending on climate. Because control of ovulation in pigs using hormonal treatments has not been studied in the tropical climate, the effect of hCG or GnRH analog (buserelin) on the time of ovulation in weaned sows was investigated. Thirty-three multiparous Landrace (L; n = 14) and Yorkshire (Y; n = 19) sows housed in the mating and gestation unit on a commercial swine farm in Thailand were used. The average of maximum and minimum daily temperature and daily humidity during experiment was 35°C and 25°C and 31%, respectively. Estrus detection by back pressure test and presence of a mature boar was performed every 6 h. Only sows with weaning to estrus interval (WOI) of ≤7 days were studied. Estrous sows were randomly allocated to 3 groups: a control group (4 Y and 6 L), which was given no treatment; a group (5 Y and 5 L) given 750 IU of hCG i.m. at the beginning of estrus (hCG group); and a group (5 Y and 8 L) given 10 μg of GnRH analog i.m. at the beginning of estrus (GnRH group). The mean time of ovulation was monitored by transrectal ultrasonography every 6 h from the onset of estrus. Interval from onset of estrus to mean time of ovulation (EOI) was analyzed using general linear model procedures of SAS (version 9.0; SAS Institute, Cary, NC, USA). Least squares means and standard deviations of EOI were compared using ANOVA. The proportion of sows ovulating within 45 h after onset of estrus was compared using Fisher’s exact test. Differences with P < 0.05 were considered significant. All of the sows in the control and hCG groups ovulated within 5 days after onset of estrus, but 3 out of 13 (23%) sows in the GnRH group developed cystic follicles; these 3 sows were excluded from the analyses. Overall, WOI was 3.8 ± 0.9 days and did not differ among the groups (P ± 0.05). The breed of sow had no effect on the EOI (P ± 0.05). Although the EOI did not differ among the control (43.0 ± 19.2 h), hCG (40.2 ± 5.5 h), and GnRH (37.5 ± 10.3 h) groups (P ± 0.05), variation was less (P = 0.001) after administration of hCG or GnRH. In addition, the proportions of sows that ovulated within 45 h after onset of estrus in the hCG (9/10 sows) and GnRH (8/10 sows) groups tended to be higher than in the control group (5/10 sows; P = 0.10). In conclusion, results indicate that both hCG and GnRH are efficacious in inducing ovulation at a predictable time in weaned, spontaneously estrous sows. The occurrence of follicular cysts in GnRH-treated sows requires further investigation.

scholarly journals Supramalleolar osteotomy with medial distraction arthroplasty for ankle osteoarthritis with talar tilt

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Hong-Mou Zhao ◽  
Xiao-Dong Wen ◽  
Yan Zhang ◽  
Jing-Qi Liang ◽  
Pei-Long Liu ◽  
...  
Keyword(s):  
Ankle Osteoarthritis ◽  
Distraction Arthroplasty ◽  
Supramalleolar Osteotomy ◽  
Talar Tilt

scholarly journals CutL: an alternative to Kulldorff’s scan statistics for cluster detection with a specified cut-off level

2017 ◽  
Author(s):  
Barbara Więckowska ◽  
Justyna Marcinkowska
Keyword(s):  
Monte Carlo ◽  
Incidence Rate ◽  
Sensitivity And Specificity ◽  
Multiple Comparisons ◽  
Incidence Rates ◽  
Cluster Detection ◽  
Scan Statistics ◽  
Reference Level ◽  
Statistical Software ◽  
Exact Test

When searching for epidemiological clusters, an important tool can be to carry out one’s own research with the incidence rate from the literature as the reference level. Values exceeding this level may indicate the presence of a cluster in that location. This paper presents a method of searching for clusters that have significantly higher incidence rates than those specified by the investigator. The proposed method uses the classic binomial exact test for one proportion and an algorithm that joins areas with potential clusters while reducing the number of multiple comparisons needed. The sensitivity and specificity are preserved by this new method, while avoiding the Monte Carlo approach and still delivering results comparable to the commonly used Kulldorff’s scan statistics and other similar methods of localising clusters. A strong contributing factor afforded by the statistical software that makes this possible is that it allows analysis and presentation of the results cartographically.

Decreased Incidence of Osteonecrosis of the Jaw (ONJ) in Patients with Multiple Myeloma (MM) Treated with Zoledronic Acid (ZA) after Application of Preventive Measures.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3609-3609 ◽  
Author(s):  
Meletios Athanasios Dimopoulos ◽  
Efstathios Kastritis ◽  
Christina Bamia ◽  
Ioannis Melakopoulos ◽  
Dimitra Gika ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Preventive Measures ◽  
Score Test ◽  
Osteonecrosis Of The Jaw ◽  
Incidence Rates ◽  
Exact Test ◽  
Analysis Group ◽  
Dental Procedures ◽  
Group A ◽  
Group B

Abstract Background. Bisphosphonates are widely used in the treatment of MM. ONJ can occur during treatment with bisphosphonates. We have shown that use of ZA and longer exposure are associated with higher frequency of ONJ in a series of patients with both MM and solid tumors. Dental problems or interventions are precipitating factors of ONJ. For this reason, since 2003, we have implemented assessment (and management if necessary) of all patients who are candidates for ZA or who are on treatment with ZA and have dental problems by specialists with particular experience on ONJ. In addition, we recommend improved oral hygiene and we avoid dental procedures during treatment with ZA. We have investigated whether the occurrence of ONJ decreased after the implementation of these measures. Patients and Methods. According to the policy of our center, all patients with MM who demonstrate lytic lesions or osteopenia receive ZA 4 mg i.v. every 4 weeks indefinitely. In our current analysis we included patients who received only ZA wheras patients who initially received pamidronate and were later switched to ZA were excluded. Patients were stratified into two groups depending on the date of initiation of treatment in relation to the start of implementation of the preventive measures (Group A: 26/8/1998–31/12/2002, Group B: 1/1/2003–1/12/2006). Occurrence of ONJ was studied as row percentages as well as incidence rate rates (IR: number of cases of osteonecrosis /person-months). The proportions of patients with ONJ between the two groups were compared with the Fisher’s exact test whereas the respective incidence rates were compared with the score test. The 95% confidence interval of the incidence rate ratio was also estimated. Results. One hundred twenty-eight patients with MM were included in the analysis (Group A: 35, Group B: 93; M/F: 66/62). Overall there were 10 cases of ONJ (8%): 8 cases in Group A (23%) and 2 cases in Group B (2%) (p&lt;0.001). The IR was 0.560/100 person-month for Group A and 0.118/100 person-month for Group B. The IRR was Group A/Group B: 4.76 (p=0.029, 95% CI: 1.01–22.40). Median time of exposure among patients with ONJ was 31 months for Group A and 8 months for Group B (p=0.044). Conclusions. The implementation of detailed assessment by experienced specialists of patients with MM and dental problems and the avoidance of dental procedures during treatment with ZA results in a significant 5-fold reduction of ONJ. Our data provide a basis for a safer use of ZA in MM.

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