scholarly journals Percutaneous Osteoplasty for the Treatment of a Painful Osteochondral Lesion of the Talus: A Case Report and Literature Review

2012 ◽  
Vol 5;15 (5;9) ◽  
pp. E743-E748
Author(s):  
Kyung-Hoon Kim
Keyword(s):  
Bone Cement ◽  
Ankle Joint ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Osteochondral Lesion ◽  
The Body ◽  
Pain Clinic ◽  
Fluoroscopic Guidance ◽  
Ankle Pain ◽  
Computed Tomography Images

An osteochondral lesion of the talus (OLT) is a lesion involving the talar articular cartilage and its subchondral bone. OLT is a known cause of chronic ankle pain after ankle sprains in the active population. The lesion causes deep ankle pain associated with weight-bearing, impaired function, limited range of motion, stiffness, catching, locking, and swelling. There are 2 common patterns of OLTs. Anterolateral talar dome lesions result from inversion and dorsiflexion injuries of the ankle at the area impacting against the fibula. Posteromedial lesions result from inversion, plantar flexion, and external rotation injuries of the ankle at the area impacting against the tibial ceiling of the ankle joint. Early diagnosis of an OLT is particularly important because the tibiotalar joint is exposed to more compressive load per unit area than any other joint in the body. Failure of diagnosis can lead to the evolution of a small, stable lesion into a larger lesion or an unstable fragment, which can result in chronic pain, joint instability, and premature osteoarthritis. A 43-year-old man, with a history of ankle sprain one year previously, visited our pain clinic for continuous right ankle pain after walking or standing for more than 30 minutes. There was a focal tenderness on the posteromedial area of the right talus. Imaging studies revealed a posteromedial OLT classified as having a geode form according to the FOG (fractures, osteonecroses, geodes) radiological classification and categorized as a stage 2a lesion on magnetic resonance imaging. The patient was scheduled for aspiration and osteoplasty with hydroxyapatite under arthroscopic and fluoroscopic guidance. A 26-gauge needle was inserted to infiltrate local anesthetics into the skin over the cyst and ankle joint. An arthroscope was placed into the joint to approach the OLT. The arthroscopic view showed that there was no connection between the OLT and the cyst of the talus body. A 13-gauge bone biopsy needle was inserted into the cyst, and aspiration was performed. Aspirated fluid from the cyst was originally white and clear; however, it changed to a blood-tinged, reddish color due to mixing with the incisional blood. After aspiration, contrast medium was injected, and the shape of the spread was observed. Bone cement comprising hydroxyapatite was injected to fill the bone defect of the cyst. A 1.5 mL volume of cement was injected into the talus under vigilant fluoroscopic and arthroscopic monitoring to prevent its dissemination into the joint. There was no cement leakage into the vessels or articular space. Postoperative fluoroscopy and computed tomography images showed bone cement filling of the defect. In the present case, arthroscopic and fluoroscopic guidance was used for aspiration of an OLT and for performing percutaneous osteoplasty with hydroxyapatite for one defect; this treatment decreased pain upon weight bearing and enabled a return to work without any restrictions one week after the procedure. The purpose of this report was to highlight the presence of OLT in chronic ankle pain and to review its management strategies. Key words: Ankle, bone fracture, cartilage fracture, calcium polyacrylate-hydroxyapatite cement, cementoplasty, endoscopy, osteochondritis dissecans, pain, sprain, talus.

Diagnosis and treatment of anterior ankle impingement: state of the art

2020 ◽  
Vol 5 (5) ◽  
pp. 295-303
Author(s):  
Pedro Diniz ◽  
Duarte André Sousa ◽  
Jorge Pablo Batista ◽  
Nasef Abdelatif ◽  
Helder Pereira
Keyword(s):  
Soft Tissue ◽  
Conservative Treatment ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Osteochondral Lesion ◽  
Osteochondral Lesions ◽  
X Rays ◽  
Ankle Pain ◽  
Ankle Impingement ◽  
Anterior Ankle Impingement

The aim of this paper is to discuss anterior ankle impingement (AAI) regarding diagnosis, interventions, techniques and future perspectives. AAI is a pain syndrome due to soft tissue or bony impingement. Impingement caused by soft tissues is frequently found in the anterolateral compartment of the ankle, whereas impingement caused by bony spurs is generally located in the anteromedial compartment. Typical complaints are chronic ankle pain, limited dorsiflexion and swelling. The most important feature is recognisable tenderness on palpation, which helps distinguish this condition from an osteochondral lesion, which is characterised with deep ankle pain. Although the diagnosis is mainly based on clinical assessment, imaging is helpful for differential diagnosis and preoperative planning. Standard X-rays, using anteroposterior, lateral and an anteromedial oblique view for detecting bony spurs, are sufficient to make the diagnosis. CT can be used to accurately assess the extent and size of a bony spur. MRI is useful to evaluate soft tissue lesions and exclude concomitant pathology, like osteochondral lesions or stress fractures. Conservative treatment is the first-line treatment. In cases where conservative treatment has been unsuccessful, surgery may be indicated. Arthroscopic debridement is considered the gold standard to treat AAI. Rehabilitation protocol includes full weight-bearing and exercises to stimulate active dorsiflexion-plantar flexion and avoid stiffness.

scholarly journals Effects of Unweighting on Gait Kinematics During Walking on a Lower-Body Positive-Pressure Treadmill in Patients with Hip Osteoarthritis

2021 ◽  
Author(s):  
Yoshiaki Kataoka ◽  
Tomohiro Shimizu ◽  
Ryo Takeda ◽  
Shigeru Tadano ◽  
Yuki Saito ◽  
...  
Keyword(s):  
Rating Scale ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Hip Osteoarthritis ◽  
The Body ◽  
Lower Limbs ◽  
Positive Pressure ◽  
Control Group ◽  
Lower Body ◽  
Gait Kinematics

Abstract Background: Hip osteoarthritis (OA) is a musculoskeletal condition that makes walking difficult due to pain induced by weight-bearing activities. Treadmills that support the body weight (BW) reduce the load on the lower limbs, and those equipped with a lower-body positive-pressure (LBPP) device, developed as a new method for unweighting, significantly reduce pain in patients with knee OA. However, the effects of unweighting on gait kinematics remain unclear in patients with hip OA. Therefore, we investigated the effects of unweighting on kinematics in patients with hip OA during walking on a treadmill equipped with an LBPP device. Methods: A total of 15 women with hip OA and 15 age-matched female controls wore a three-dimensional (3-D) motion analysis system and walked at a self-selected speed on the LBPP treadmill. Data regarding self-reported hip pain using a numeric rating scale (NRS) in which the scores 0 and 10 represented no pain and the worst pain, respectively, under three different BW conditions (100%, 75%, and 50%) were collected. Moreover, 3-D peak joint angles during gait under each condition were calculated and compared. Results: In the hip OA group, the NRS pain scores at 50% and 75% BW conditions significantly decreased compared with that at 100% BW condition (50%, P=0.002; 75%, P=0.026), and the peak hip extension angle decreased compared with that in the healthy controls (P=0.044). In both groups, unweighting significantly decreased the peak hip (P<0.001) and knee (P<0.001) flexion angles and increased the peak ankle plantar flexion angle (P<0.001) during walking. Conclusions: Unweighting by the LBPP treadmill decreased pain in the hip OA group but did not drastically alter the gait kinematics compared with that in the control group. Therefore, regarding the use of the LBPP treadmill for patients with hip OA, clinicians should consider the benefits of pain reduction rather than the kinematic changes.

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

Single Hemicerclage for Lateral Type B Malleolar Fracture - A Novel, Minimal and Reliable Osteosynthesis

Swiss Surgery ◽  
2003 ◽  
Vol 9 (6) ◽  
pp. 283-288
Author(s):  
Maurer ◽  
Stamenic ◽  
Stouthandel ◽  
Ackermann ◽  
Gonzenbach
Keyword(s):  
Ankle Joint ◽  
Weight Bearing ◽  
Fracture Type ◽  
Type B ◽  
Malleolar Fracture ◽  
Metallic Wire ◽  
Long Term Outcome ◽  
X Ray ◽  
Upper Ankle Joint ◽  
Upper Ankle

Aim of study: To investigate the short- and long-term outcome of patients with isolated lateral malleolar fracture type B treated with a single hemicerclage out of metallic wire or PDS cord. Methods: Over an 8-year period 97 patients were treated with a single hemicerclage for lateral malleolar fracture type B and 89 were amenable to a follow-up after mean 39 months, including interview, clinical examination and X-ray controls. Results: The median operation time was 35 minutes (range 15-85 min). X-ray controls within the first two postoperative days revealed an anatomical restoration of the upper ankle joint in all but one patient. The complication rate was 8%: hematoma (2 patients), wound infection (2), Sudeck's dystrophy (2) and deep vein thrombosis (1). Full weight-bearing was tolerated at median 6.0 weeks (range 2-26 weeks). No secondary displacement, delayed union or consecutive arthrosis of the upper ankle joint was observed. All but one patient had restored symmetric joint mobility. Ninety-seven percent of patients were satisfied or very satisfied with the outcome. Following bone healing, hemicerclage removal was necessary in 19% of osteosyntheses with metallic wire and in none with PDS cord. Conclusion: The single hemicerclage is a novel, simple and reliable osteosynthesis technique for isolated lateral type B malleolar fractures and may be considered as an alternative to the osteosynthesis procedures currently in use.

scholarly journals ORTHOPEDIC INJURIES IN ADOLESCENT GYMNASTS: A SYSTEMATIC REVIEW

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0011
Author(s):  
Katie Kim ◽  
Michael Saper
Keyword(s):  
Lower Extremity ◽  
Upper Extremity ◽  
Weight Bearing ◽  
The Body ◽  
Adolescent And Young Adult ◽  
Body Region ◽  
Lower Extremity Injuries ◽  
Common Location ◽  
Orthopedic Injuries ◽  
Extremity Injuries

Background: Gymnastics exposes the body to many different types of stressors ranging from repetitive motion, high impact loading, extreme weight bearing, and hyperextension. These stressors predispose the spine and upper and lower extremities to injury. In fact, among female sports, gymnastics has the highest rate of injury each year. Purpose: The purpose of this study was to systematically review the literature on location and types of orthopedic injuries in adolescent (≤20 years) gymnasts. Methods: The Pubmed, Medline, EMBASE, EBSCO (CINAHL) and Web of Science databases were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify all studies reporting orthopedic injuries in adolescent and young adult gymnasts. All aspects of injuries were extracted and analyzed including location, type and rates of orthopedic injuries. Results: Screening yielded 22 eligible studies with a total of 427,225 patients. Twenty of 22 studies reported upper extremity injuries of which four specifically focused on wrist injuries. Eight studies reported lower extremity injuries. Nine studies reported back/spinal injuries. Seven studies investigated each body location of injury; one study reported the upper extremity as the most common location for injury and six studies reported the lower extremity as the most common location for injury. Of those seven studies, five (23%) reported sprains and strains as the most common injury. One study reported fractures as the most common injury. Conclusion: There is considerable variation in reported injury location. Some studies focused specifically on the spine/back or wrist. The type of gymnastics each patient participated in was also different, contributing to which area of the body was more heavily stressed, or lacking. Current literature lacks data to fully provide evidence regarding which body region is more frequently injured and the type of injury sustained.

Preparation of bioactive and antibacterial PMMA-based bone cement by modification with quaternary ammonium and alkoxysilane

2021 ◽  
pp. 088532822110044
Author(s):  
Haiyang Wang ◽  
Toshinari Maeda ◽  
Toshiki Miyazaki
Keyword(s):  
Antibacterial Activity ◽  
Methyl Methacrylate ◽  
Bone Cement ◽  
Setting Time ◽  
Antibacterial Properties ◽  
The Body ◽  
Apatite Formation ◽  
Gram Positive ◽  
E Coli ◽  
Gram Positive Bacteria

Bone cement based on poly(methyl methacrylate) (PMMA) powder and methyl methacrylate (MMA) liquid is a very popular biomaterial used for the fixation of artificial joints. However, there is a risk of this cement loosening from bone because of a lack of bone-bonding bioactivity. Apatite formation in the body environment is a prerequisite for cement bioactivity. Additionally, suppression of infection during implantation is required for bone cements to be successfully introduced into the human body. In this study, we modified PMMA cement with γ-methacryloxypropyltrimetoxysilane and calcium acetate to introduce bioactive properties and 2-( tert-butylamino)ethyl methacrylate (TBAEMA) to provide antibacterial properties. The long-term antibacterial activity is attributed to the copolymerization of TBAEMA and MMA. As the TBAEMA content increased, the setting time increased and the compressive strength decreased. After soaking in simulated body fluid, an apatite layer was detected within 7 days, irrespective of the TBAEMA content. The cement showed better antibacterial activity against Gram-negative E. Coli than Gram-positive bacteria; however, of the Gram-positive bacteria investigated, B. subtilis was more susceptible than S. aureus.

scholarly journals Is postoperative non-weight-bearing necessary? INWN Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ramy Khojaly ◽  
Ruairí Mac Niocaill ◽  
Muhammad Shahab ◽  
Matthew Nagle ◽  
Colm Taylor ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Multicentre Trial ◽  
Short Form ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Fracture Patterns ◽  
Randomised Controlled

Abstract Background Postoperative management regimes vary following open reduction and internal fixation (ORIF) of unstable ankle fractures. There is an evolving understanding that extended periods of immobilisation and weight-bearing limitation may lead to poorer clinical outcomes. Traditional non-weight-bearing cast immobilisation may prevent loss of fixation, and this practice continues in many centres. The purpose of this trial is to investigate the safety and efficacy of immediate weight-bearing (IWB) and range of motion (ROM) exercise regimes following ORIF of unstable ankle fractures with a particular focus on functional outcomes and complication rates. Methods A pragmatic randomised controlled multicentre trial, comparing IWB in a walking boot and ROM within 24 h versus non-weight-bearing (NWB) and immobilisation in a cast for 6 weeks, following ORIF of all types of unstable adult ankle fractures (lateral malleolar, bimalleolar, trimalleolar with or without syndesmotic injury) is proposed. All patients presenting to three trauma units will be included. The exclusion criteria will be skeletal immaturity and tibial plafond fractures. The three institutional review boards have granted ethical approval. The primary outcome measure will be the functional Olerud-Molander Ankle Score (OMAS). Secondary outcomes include wound infection (deep and superficial), displacement of osteosynthesis, the full arc of ankle motion (plantar flexion and dorsal flection), RAND-36 Item Short Form Survey (SF-36) scoring, time to return to work and postoperative hospital length of stay. The trial will be reported in accordance with the CONSORT statement for reporting a pragmatic trial, and this protocol will follow the SPIRIT guidance. Discussion Traditional management of operatively treated ankle fractures includes an extended period of non-weight-bearing. There is emerging evidence that earlier weight-bearing may have equivocal outcomes and favourable patient satisfaction but higher wound-related complications. These studies often preclude more complicated fracture patterns or patient-related factors. To our knowledge, immediate weight-bearing (IWB) following ORIF of all types of unstable ankle fractures has not been investigated in a controlled prospective manner in recent decades. This pragmatic randomised-controlled multicentre trial will investigate immediate weight-bearing following ORIF of all ankle fracture patterns in the usual care condition. It is hoped that these results will contribute to the modern management of ankle fractures. Trial registration ISRCTN Registry ISRCTN76410775. Retrospectively registered on 30 June 2019.

Role of ultrasonography in assessment of painful ankle

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Amin Nassef ◽  
Shaimaa El Metwaly El Diasty ◽  
Marina Sameh Lamei
Keyword(s):  
Ankle Joint ◽  
Joint Pain ◽  
Pathological Condition ◽  
Ankle Injuries ◽  
Ankle Pain ◽  
Cross Sectional ◽  
Screening Study ◽  
Underlying Causes ◽  
Post Traumatic

Abstract Background Ankle disorders are a relatively common pathological condition, and ankle injuries account for approximately 14% of sports-related orthopedic emergency visits. Various imaging modalities can be used to make a diagnosis in cases of ankle pain; however, ultrasound (US) has several benefits for the evaluation of ankle pain, especially in the tendons, ligaments, and nerves of the ankle. Aim of the work to assess the role of high resolution US as a valuable tool in the depiction of causes of ankle joint pain. Patient & methods our study is a cross sectional descriptive screening study including 25 patients with ankle joint pain (acute or chronic), post traumatic or not with no age or sex predilection. Results The study included 15 (60%) males and 10 (40%) females. Their age ranged from 10 to 60 years with a mean age of 33.84±13.31years. Chronic ankle pain was the most common presenting symptom in 15 patients (60%) whereas 10 (40%) patients presented with acute ankle pain after trauma. The posterior ankle compartment was the most common affected compartment (24%) of cases. About 7 cases (28%) were presented by ankle swelling with or without pain. Conclusion In conclusion, MSK US is useful in detecting the underlying causes of ankle pain and still it has the potential to offer more valuable data if it is well mastered by the sonographers.

Muscle regeneration during hindlimb unloading results in a reduction in muscle size after reloading

2001 ◽  
Vol 91 (1) ◽  
pp. 183-190 ◽  
Author(s):  
P. E. Mozdziak ◽  
P. M. Pulvermacher ◽  
E. Schultz
Keyword(s):  
Mitotic Activity ◽  
Satellite Cell ◽  
Soleus Muscle ◽  
Weight Bearing ◽  
Weight Ratio ◽  
The Body ◽  
Hindlimb Unloading ◽  
Muscle Size ◽  
Unit Size ◽  
Muscle Weight

The hindlimb-unloading model was used to study the ability of muscle injured in a weightless environment to recover after reloading. Satellite cell mitotic activity and DNA unit size were determined in injured and intact soleus muscles from hindlimb-unloaded and age-matched weight-bearing rats at the conclusion of 28 days of hindlimb unloading, 2 wk after reloading, and 9 wk after reloading. The body weights of hindlimb-unloaded rats were significantly ( P < 0.05) less than those of weight-bearing rats at the conclusion of hindlimb unloading, but they were the same ( P > 0.05) as those of weight-bearing rats 2 and 9 wk after reloading. The soleus muscle weight, soleus muscle weight-to-body weight ratio, myofiber diameter, number of nuclei per millimeter, and DNA unit size were significantly ( P< 0.05) smaller for the injured soleus muscles from hindlimb-unloaded rats than for the soleus muscles from weight-bearing rats at each recovery time. Satellite cell mitotic activity was significantly ( P < 0.05) higher in the injured soleus muscles from hindlimb-unloaded rats than from weight-bearing rats 2 wk after reloading, but it was the same ( P > 0.05) as in the injured soleus muscles from weight-bearing rats 9 wk after reloading. The injured soleus muscles from hindlimb-unloaded rats failed to achieve weight-bearing muscle size 9 wk after reloading, because incomplete compensation for the decrease in myonuclear accretion and DNA unit size expansion occurred during the unloading period.

scholarly journals A Custom-Made Lower Limb Dynamometer for Assessing Ankle Joint Torque in Humans: Calibration and Measurement Procedures

Sensors ◽  
2021 ◽  
Vol 22 (1) ◽  
pp. 135
Author(s):  
Iulia Iovanca Drăgoi ◽  
Florina Georgeta Popescu ◽  
Teodor Petrița ◽  
Romulus Fabian Tatu ◽  
Cosmina Ioana Bondor ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Plantar Flexion ◽  
Calibration Procedure ◽  
Measurement Procedure ◽  
Joint Torque ◽  
Ankle Torque ◽  
Offset Voltage ◽  
Interclass Correlation ◽  
Custom Made ◽  
Measurement Protocol

Custom-made dynamometry was shown to objectively analyze human muscle strength around the ankle joint with accuracy, easy portability and low costs. This paper describes the full method of calibration and measurement setup and the measurement procedure when capturing ankle torque for establishing reliability of a portable custom-built electronic dynamometer. After considering the load cell offset voltage, the pivotal position was determined, and calibration with loads followed. Linear regression was used for calculating the proportionality constant between torque and measured voltage. Digital means were used for data collection and processing. Four healthy consenting participants were enrolled in the study. Three consecutive maximum voluntary isometric contractions of five seconds each were registered for both feet during plantar flexion/dorsiflexion, and ankle torque was then calculated for three ankle inclinations. A calibration procedure resulted, comprising determination of the pivotal axis and pedal constant. Using the obtained data, a measurement procedure was proposed. Obtained contraction time graphs led to easier filtering of the results. When calculating the interclass correlation, the portable apparatus demonstrated to be reliable when measuring ankle torque. When a custom-made dynamometer was used for capturing ankle torque, accuracy of the method was assured by a rigorous calibration and measurement protocol elaboration.

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