Effect analysis of iliac bone autografting for Hepple V osteochondral lesions of the talus

Background Talar cartilage injury is a kind of disease that causes long-term and chronic pain of ankle joint. Autologous osteochondral transplantation has been viewed as an alternative choice for treating these lesions, but donor-site morbidity has limited its application. This study aimed to analyze the efficacy of iliac bone autografting for Hepple V osteochondral lesions of the talus. Methods This retrospective study included 32 patients surgically treated for Hepple V osteochondral lesions of the talus from January 2015 to January 2020. All patients underwent open surgery. Ipsilateral iliac bone grafts were taken and filled with talar cartilage injury area. The improvement of postoperative ankle pain was evaluated by Visual Analogue Scale (VAS), and the improvement of ankle function was evaluated by the American Orthopaedic Foot & Ankle Society (AOFAS). During the postoperative follow-up, X-ray examination of the front and side of the ankle joint and CT of the ankle joint were performed to evaluate the bone cartilage healing in the graft area. Results Thirty-two patients (32 ankles) (100%) returned for clinical and radiologic follow-up at an average of 28 (range 24–36) months postoperatively. At 3 months postoperatively and at the last follow-up, the AOFAS scores were (80.4 ± 3.6) and (89.2 ± 6.4), respectively, which were significantly improved compared with the preoperative score (49.7 ± 8.1), and the difference was statistically significant (P < 0.05). The VAS scores were (2.1 ± 0.9) and (1.5 ± 0.8), respectively, which were significantly better than the preoperative score (6.2 ± 1.7), and the difference was statistically significant (P < 0.05). Re-examination of the front and side of the ankle joint X-rays and CT showed that the bone healing at the osteotomy of medial malleolus and osteochondral transplantation area. All patients had no pain at the donor site. No complications occurred in 32 patients at the last follow-up. Conclusions With iliac bone autografting for Hepple V osteochondral lesions of the talus can effectively relieve ankle joint pain and significantly improved ankle function. Level of evidence Level III, Retrospective series.

Decrease of IL-1β and TNF in the Spinal Cord Mediates Analgesia Produced by Ankle Joint Mobilization in Complete Freund Adjuvant-Induced Inflammation Mice Model

ObjectiveThis study aims to investigate the effects of ankle joint mobilization (AJM) on mechanical hyperalgesia and peripheral and central inflammatory biomarkers after intraplantar (i.pl.) Complete Freund’s Adjuvant (CFA)-induced inflammation.MethodsMale Swiss mice were randomly assigned to 3 groups (n = 7): Saline/Sham, CFA/Sham, and CFA/AJM. Five AJM sessions were carried out at 6, 24, 48, 72, and 96 h after CFA injection. von Frey test was used to assess mechanical hyperalgesia. Tissues from paw skin, paw muscle and spinal cord were collected to measure pro-inflammatory (TNF, IL-1β) and anti-inflammatory cytokines (IL-4, IL-10, and TGF-β1) by ELISA. The macrophage phenotype at the inflammation site was evaluated by Western blotting assay using the Nitric Oxide Synthase 2 (NOS 2) and Arginase-1 immunocontent to identify M1 and M2 macrophages, respectively.ResultsOur results confirm a consistent analgesic effect of AJM following the second treatment session. AJM did not change cytokines levels at the inflammatory site, although it promoted a reduction in M2 macrophages. Also, there was a reduction in the levels of pro-inflammatory cytokines IL-1β and TNF in the spinal cord.ConclusionTaken together, the results confirm the anti-hyperalgesic effect of AJM and suggest a central neuroimmunomodulatory effect in a model of persistent inflammation targeting the pro-inflammatory cytokines IL-1β and TNF.

Correction of Posttraumatic Medial Growth Arrest of the Distal Tibia in Adolescents

Background Partial growth arrest of the medial part of the distal tibial physis following fractures that penetrated the epiphysis is relatively common. We present the results of treatment, based on a protocol of supramalleolar tibial and fibular osteotomy for ankle alignment correction, and contralateral epiphysiodesis of distal tibia and fibula to balance leg length discrepancy (LLD). Methods This case series study describes the results of 7 patients with a median age of 14 years (range = 10-15 years) who were operated in our institution. All were treated by closed or open reduction and internal fixation after Salter-Harris (SH) types 3 and 4 fractures of the distal tibia. All patients had a partial medial growth arrest, distal tibial varus, relative overlengthening of the distal fibula, and slight leg shortening. Treatment Protocol Contralateral distal tibial and fibular epiphysiodesis to prevent significant LLD, completion of closure of the ipsilateral epiphysis, supramalleolar osteotomy of the distal tibia and fibula, and insertion of a triangular wedge cortical allograft into the tibial osteotomy creating a normal ankle joint orientation. The osteotomy was supported by a medial anatomically contoured locking plate. The fibula was fixed with an intramedullary wire. Results All patients had uneventful healing of the osteotomy after 6 weeks. At the latest follow-up (mean 3 years, range 1.5-5 years), 6 out of 7 patients reached maturity, and the lateral distal tibial angle was within normal limits. The LLD in all patients was less than 8 mm. Conclusions Our protocol provides anatomic correction with the restoration of the ankle joint and prevents the progression of LLD. Levels of Evidence: Level IV

Total Talar Replacement with Ceramic Implant in Combination with Tibial Component of Ankle Endoprosthesis: A Case Report

Background. Surgical treatment of patients with talus posttraumatic aseptic necrosis and its consequences usually includes tibiotalocalcaneal arthrodesis with various foot joints according to additional indications. This type of surgical treatment has number of significant disadvantages: traumatic surgical technique, permanent loss of movement in functionally significant joints, high risk of non-union, high frequency of residual deformities, the need for long periods of limb immobilization. The question arises: how to overcome the existing disadvantages and improve the results of talus posttraumatic aseptic necrosis treatment? A potential solution to this problem is the total talus endoprosthetics. Clinical case. A 64-year-old patient came to the clinic complaining of pain and deformity of the right foot and ankle area. After the examination, talus posttraumatic aseptic necrosis was diagnosed. The patient underwent ankle joint arthroplasty using total talus ceramic endoprosthesis in combination with the tibial component of the ankle joint endoprosthesis, a course of rehabilitation treatment was performed. Results. The VAS and AOFAS scales indicators showed a significant improvement both in the pain decrease (from 75 mm before surgery to 10 mm after), and in the functional state according to AOFAS by 2.2 times (from 36 to 80 points 20 months after surgery). By the last follow-up the patient could take more than 8000 steps a day. Conclusion. Considering the good clinical result achieved, the ankle joint arthroplasty using total talus ceramic endoprosthesis in combination with the tibial component of the ankle joint endoprosthesis can be considered a promising method of treatment of this severe pathology.

Comparative analysis of the validity of goniometric, inclinometric, and radiographic methods to measure ankle joint dorsiflexion

Background. The search for an optimal method to assess the amplitude of ankle joint dorsiflexion remains topical for scientific discussions. The purpose of the research was to analyze the validity of goniometric and inclinometric methods for measuring the scope of ankle joint (AJ) dorsiflexion compared to radiological data. Materials and methods. The research included 25 healthy and physically active people (50 ankle joints), 18 men and 7 women with an average age of 25.8 ± 5.2 years; their mean body mass index was 25.01 ± 5.01 kg/m2. Ankle dorsiflexion measures were obtained in a weight-bearing lunge position using a double-plane goniometer and inclinometer, then compared with X-ray data. The measurement results were evaluated by descriptive statistics. Results. Mean values of AJ dorsiflexion obtained with a double-plane goniometer were 37.62 ± 5.56°; with an inclinometer — 40.61 ± 5.15°; radiological results — 23.69 ± 7.25°. Their difference was significant (p < 0.001). The mean variability index for the radiological method was 0.31 prevailing over goniometric (0.15) and inclinometric (0.13) methods (p < 0.001). X-ray ima-ging of a weight-bearing AJ at its maximum dorsiflexion raises the indicator of a talus-first metatarsal angle. Conclusions. The values of the dorsiflexion angle parameters of an AJ, measured using goniometric and inclinometric methods, significantly exceed those obtained by X-ray imaging. Higher variation index for radiological imaging demonstrates better reproducibility of inclinometry and goniometry when evaluating AJ dorsiflexion. A weight-bearing AJ radiogram at maximum extended position demonstrates an increase in a talus-first metatarsal angle compared to normal values that should be considered when interpreting the results of X-ray imaging of an AJ dorsiflexion.

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

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.