scholarly journals Migratory Loose Bodies from the Ankle Joint into the Flexor Hallucis Longus Tendon Sheath

EMJ Radiology ◽  
2021 ◽  
Author(s):  
Jenn Shiunn Wong ◽  
PNM Tyrrell ◽  
B Tins ◽  
T Woo ◽  
N Winn ◽  
...  

Objective: Loose bodies resulting from any form of osteochondral insult can migrate out of their intra-articular position to adjacent compartments. This retrospective study aims to illustrate the phenomenon of loose bodies migration from the ankle joint into the flexor hallucis longus (FHL) tendon sheath. Materials and Methods: Cases of loose bodies in the FHL tendon sheath were identified from the authors' radiological database by way of keyword interrogation, covering the modalities of CT, MRI, and ultrasound over a period of 11 years. The imaging features of the loose bodies were recorded, together with the presence of ankle instability and osteoarthritis. Patient demographics and relevant history, including trauma and surgery, were collected. Results: Thirty-four cases including 33 patients, with a total of 125 loose bodies in the FHL tendon sheath, were identified. There were 58 loose bodies (46.4%) in Zone 1 of the FHL tendon sheath, 65 loose bodies (52%) in Zone 2, and 2 loose bodies (1.6%) in Zone 3. All patients had features of ankle osteoarthritis on imaging, 14 of which had imaging features of ankle instability, and 19 patients had previous ankle trauma. Conclusion: Osteochondral loose bodies originating from the ankle joint can migrate into the FHL tendon sheath. It is important to recognise this phenomenon as a distinct entity, different from primary tenosynovial chondromatosis of the FHL tendon sheath, which may have a different surgical management and clinical outcome. Detection of FHL tendon sheath loose bodies should also prompt closer examination for articular disease in the ankle joint.

2021 ◽  
pp. 028418512110210
Author(s):  
Yeon Gyu Choi ◽  
Hee Jin Park ◽  
Ji Na Kim ◽  
Myung Sub Kim ◽  
Se Jin Park ◽  
...  

Background The evaluation of correlations among joint effusion, ligament injuries, tenosynovitis and osteochondral lesion of talus (OLT) in the ankle joint is important for developing a treatment plan and predicting prognosis. Purpose To evaluate correlations among tibiotalar (anterior) and talocalcaneal (posterior) joint effusion, tenosynovitis of major flexor tendons, ligaments, and OLT in a group of patients with ankle trauma. Material and Methods This retrospective study included 101 patients with ankle trauma who underwent magnetic resonance imaging. Two radiologists assessed the presence and amount of effusion in the tibiotalar and talocalcaneal joints from grade 0 to 2, according to the amount of capsular distension. Concomitant structural injuries were assessed in the tibialis posterior (TP), flexor digitorum longus, flexor hallucis longus, and peroneus tendons, and the anterior talofibular ligament, calcaneofibular ligament, anteroinferior tibiofibular ligament, posteroinferior tibiofibular ligament, and OLT. Results The proportion of anterior and posterior joint effusion according to grade was 67.3% for anterior joint effusion grade 0, 22.8% for grade 1, and 9.9% for grade 2; for posterior joint effusion, grade 0 was 74.2%, grade 1 was 22.8%, and grade 2 was 3.0%. We found statistically significant correlations between posterior joint effusion and tenosynovitis of TP ( P < 0.05) and between posterior joint effusion and OLT ( P < 0.05). Conclusion Posterior joint effusion is correlated with TP injury and OLT; however, tendon injuries have no correlation with other structural injuries of the ankle joint in a general population with ankle trauma.


2020 ◽  
Vol 41 (8) ◽  
pp. 978-983
Author(s):  
Shu Zhang ◽  
Amiethab Aiyer ◽  
Chao Sun ◽  
Zhi Wang ◽  
Dasheng Lin ◽  
...  

Background: Intractable hallucal ganglion cysts (HGCs) are often a symptomatic and recurrent condition. Its connection with the ankle joint is not well understood. Our aim was to evaluate the relationship between tenosynovitis of the flexor hallucis longus (FHL) tendon at the level of the ankle with formation of an HGC. In addition, we sought to analyze the outcomes of cyst excision combined with ankle capsulorrhaphy. Methods: Nineteen patients with HGC who underwent surgical intervention were included between June 2016 and June 2019. Eight had known recurrences. Ankle arthrography and cyst excision were performed on all patients. Clinical evaluations included the American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and evaluation of postoperative complications. The mean follow-up period was 16.5 ± 8.6 months. Results: Thirteen of the 19 HGCs (68.4%) had a connection with the FHL tendon sheath. Combined with ankle capsulorrhaphy, there was no recurrence after cyst excision. The VAS score decreased from 2.1 ± 1.5 to 0.4 ± 0.8, and AOFAS score significantly improved from 84.3 ± 8.7 to 97.4 ± 5.2 at final follow-up ( P < .001). Conclusions: Most of these patients had a connection between the HGC and ankle joint. Ankle arthrography appeared to be useful for diagnosis, and cyst excision combined with ankle capsulorrhaphy was an effective treatment without cyst recurrence. Level of Evidence: Level IV, case series.


2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Patrick Fuerst ◽  
Albert Gollhofer ◽  
Markus Wenning ◽  
Dominic Gehring

Abstract Background The application of ankle braces is an effective method for the prevention of recurrent ankle sprains. It has been proposed that the reduction of injury rates is based on the mechanical stiffness of the brace and on beneficial effects on proprioception and neuromuscular activation. Yet, how the neuromuscular system responds to the application of various types of ankle braces during highly dynamic injury-relevant movements is not well understood. Enhanced stability of the ankle joint seems especially important for people with chronic ankle instability. We therefore aimed to analyse the effects of a soft and a semi-rigid ankle brace on the execution of highly dynamic 180° turning movements in participants with and without chronic ankle instability. Methods Fifteen participants with functional ankle instability, 15 participants with functional and mechanical ankle instability and 15 healthy controls performed 180° turning movements in reaction to light signals in a cross-sectional descriptive laboratory study. Ankle joint kinematics and kinetics as well as neuromuscular activation of muscles surrounding the ankle joint were determined. Two-way repeated measures analyses of variance and post-hoc t-tests were calculated. Results Maximum ankle inversion angles and velocities were significantly reduced with the semi-rigid brace in comparison to the conditions without a brace and with the soft brace (p ≤ 0.006, d ≥ 0.303). Effect sizes of these reductions were larger in participants with chronic ankle instability than in healthy controls. Furthermore, peroneal activation levels decreased significantly with the semi-rigid brace in the 100 ms before and after ground contact. No statistically significant brace by group effects were found. Conclusions Based on these findings, we argue that people with ankle instability in particular seem to benefit from a semi-rigid ankle brace, which allows them to keep ankle inversion angles in a range that is comparable to values of healthy people. Lower ankle inversion angles and velocities with a semi-rigid brace may explain reduced injury incidences with brace application. The lack of effect of the soft brace indicates that the primary mechanism behind the reduction of inversion angles and velocities is the mechanical resistance of the brace in the frontal plane.


2019 ◽  
Author(s):  
Xingchen Li ◽  
Kai Rong ◽  
Yang Xu ◽  
Yuan Zhu ◽  
Xiangyang Xu

Abstract Background: It is challenging for the clinical management of malunited ankle fracture. The aim of this study is to evaluate the clinical outcome of realignment surgery for anterior translation of talus after malunited ankle fracture and to analyze its. Methods: A total of 11 patients with anterior translation of talus after malunited ankle fractures underwent corrective osteotomy in our institute were retrospectively reviewed. All patients were evaluated with radiological parameters and clinical functional scores. There were 4 patients with Weber type A fracture, 4 patients with Pilon type B fracture and 3 patients with Weber type C fracture. 8/11 patients had impaction on the anterior distal tibial plafond, intra-articular distal tibial osteotomy was performed in these patients, additional bony correction and soft tissue surgery were also performed to achieve congruent ankle joint. Results: The mean age at surgery was 32.8 ± 10.8 (range,16-48) years. The mean follow-up time was 50.5 ± 23.6 (range, 16-80) months. The mean AOFAS-AH score increased from 28.2 ± 19.1preoperatively to 72.5 ± 8.1 points postoperatively(p<0.05), the mean lateral talar station(LTS) improved from 9.2 ± 3.7 preoperatively to 1.5 ± 1.4 mm postoperatively(p<0.05). 10/11 patients had improvement or no worsening ankle osteoarthritis on sagittal plane, while 1 patient had advanced ankle osteoarthritis. Conclusion: A congruent ankle joint in sagittal plane could be achieved by corrective osteotomies with additional soft tissue procedures. The realignment surgery was a valuable treatment option for the salvage of anterior translation of talus after malunited ankle fracture.


Author(s):  
Hayri Ogul ◽  
Bahar Cankaya ◽  
Mecit Kantarci

Loose bodies (LBs) are intraarticular free bodies that result from various pathological processes and cause synovial inflammation. Timely and complete identification of LBs is important for appropriate treatment and prevention of possible complications such as osteoarthritis. LBs in the ankle joint can reach all the compartments that are adjacent to the joint via physiological or pathological connections. The presence, localisation, and number of LBs in the ankle joint and adjacent synovial compartments can be optimally evaluated using high-resolution magnetic resonance arthrography (MRA) and computed tomography arthrography (CTA). On this review article, we aimed to determine the LB location and distribution using high-resolution MRA and CTA of the ankle joint, and to demonstrate that it may be used as a complementary examination to guide interventional arthroscopy in difficult-to-reach areas during treatment. Advances in knowledge Loose bodies (LBs) are intraarticular free bodies and may cause synovial inflammation. Accurate and complete determination of the number and location of LBs before surgery are very important for effective treatment. The location, number and distribution of LBs in the ankle joint may be determined successfully by high-resolution magnetic resonance arthrography (MRA) and computed tomography arthrography (CTA). For this purpose, MRA and CTA may increase the diagnostic and therapeutic success of the arthroscopy.


Big Data ◽  
2016 ◽  
pp. 1519-1542
Author(s):  
Issam El Naqa

More than half of cancer patients receive ionizing radiation as part of their treatment and it is the main modality at advanced stages of disease. Treatment outcomes in radiotherapy are determined by complex interactions between cancer genetics, treatment regimens, and patient-related variables. A typical radiotherapy treatment scenario can generate a large pool of data, “Big data,” that is comprised of patient demographics, dosimetry, imaging features, and biological markers. Radiotherapy data constitutes a unique interface between physical and biological data interactions. In this chapter, the authors review recent advances and discuss current challenges to interrogate big data in radiotherapy using top-bottom and bottom-top approaches. They describe the specific nature of big data in radiotherapy and discuss issues related to bioinformatics tools for data aggregation, sharing, and confidentiality. The authors also highlight the potential opportunities in this field for big data research from bioinformaticians as well as clinical decision-makers' perspectives.


Author(s):  
G Marta ◽  
C Quental ◽  
J Folgado ◽  
F Guerra-Pinto

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.


1996 ◽  
Vol 75 (5) ◽  
pp. 2050-2070 ◽  
Author(s):  
S. J. Bonasera ◽  
T. R. Nichols

1. The stretch-evoked reflex organization of muscles whose major action is to abduct [peroneus brevis (PB); peroneus longus (PL)] and adduct [tibialis posterior (TP); flexor digitorum longus (FDL); flexor hallucis longus (FHL)] the ankle, and their interactions with the hindlimb extensors gastrocnemius (G) and soleus (S), were studied in 27 unanesthetized decerebrate cats. Ramp-hold-release stretches of physiological amplitudes were applied to muscle tendons detached from their bony insertion, and muscle force output was measured in response to these perturbations. Flexion and crossed-extension reflexes were used to modulate baseline force. 2. PB and TP shared strong, length-dependent, short-latency inhibitory reflexes prominent when the muscles were either actively generating force or quiescent. The mechanical characteristics of this reflex suggest Ia reciprocal inhibition as the underlying mechanism. Just as reciprocal inhibition between S and tibialis anterior stiffens the ankle joint against sagittal perturbations, we propose that reciprocal inhibition between PB and TP stiffens the ankle joint against nonsagittal perturbations. 3. In all preparations (n = 7) and under all conditions examined, PB and PL shared well-demonstrated mutual excitation. The reflex responses were asymmetric (favoring excitation of PL), length dependent, and occurred simultaneously with the stretch reflex at a latency of 16-18 ms. Mutual monosynaptic projections previously described between these two muscles explain all of the above findings. Our data further demonstrate that, under certain conditions, the ensemble activity of this reflex interaction has a powerful effect on the mechanical behavior of the muscle. 4. The heterogenic reflex organization of the ankle adductors was as follows: FDL evoked a modest excitation on TP, whereas FHL evoked weak inhibition. Latency of the excitation from FDL onto TP (24 ms) was greater than expected if the reflex were mediated by heteronymous Ia afferents. In all preparations examined (n = 3), TP contributed no significant reflexes onto either FDL or FHL. 5. Mutual, asymmetric inhibition characterized interactions between PB and the plantarflexors S and G. Most remarkable was a novel, long-latency (72-74 ms) reflex inhibition evoked on both S and G by stretch of PB. When this inhibition occurred, it dramatically decreased the S (or G) stretch response. Longer PB lengths evoked greater inhibition of isometric S; regression analysis indicated that the model best predicting this inhibition contained muscle force and stiffness terms. No long-latency reflexes were noted from either G or S onto PB. The mechanism underlying long-latency inhibition is presently unknown; however, features of this interaction suggest interneurons receive either group II or group III afferent input. 6. G and TP shared short latency, mutually inhibitory, asymmetric reflexes favoring inhibition of TP. No long-latency interactions were noted, nor were there any mechanically significant interactions between S and TP. 7. Reflex interactions across the abduction/adduction axis thus favored inhibition of plantarflexion and adduction torques while emphasizing abduction torques: PB/S (or PB/G) interactions were mutual, asymmetric, and favored inhibition of G and S; TP/G interactions were mutual, asymmetric, and favored inhibition of TP; TP/PB interactions were approximately balanced. The overall mechanical outcome of these inhibitory interactions may partly underlie the global corrective strategy seen in intact cats subjected to linear perturbations. 8. No significant reflex interactions were demonstrated between PL and TP, G, or S, nor were any long-latency reflexes noted. Thus, whereas reflex interactions between the stereotypically activated PB and other stereotypically activated muscles (including TP, G, and S) were strong and well-demonstrated, interactions between the variably activated PL and these same muscles were far weaker.


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