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Gorbachova T, Saad SS, Pruna R, Melenevsky YV. Patterns of ankle injury in soccer: MRI clues to traumatic mechanism. Skeletal Radiol 2025; 54:683-693. [PMID: 38157033 DOI: 10.1007/s00256-023-04547-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/10/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024]
Abstract
Understanding the traumatic mechanisms of ankle injuries in soccer is crucial for an accurate and complete MRI diagnosis. Many ankle injuries share universal mechanisms seen in other athletic activities, but certain patterns are found to be more specific and relatively unique to soccer. Ankle impingement syndromes encountered in soccer encompass a spectrum of disorders that include anterior and posterior impingement categories, with anterior impingement representing pathology relatively specific to soccer. Lateral ligamentous sprains are one of the most common injuries; however, there is a higher rate of injuries to the medial structures in soccer as compared to other sports. Ankle fractures are uncommon in soccer while bone contusions and chondral and osteochondral injuries frequently accompany ligamentous sprains. Tendon abnormalities in soccer most commonly result from overuse injuries and typically affect peroneal tendons, posterior and anterior tibialis tendons, and Achilles tendon. Acute Achilles tendon ruptures occur in both recreational players and elite soccer athletes. Tibialis anterior friction syndrome may mimic tibial stress fractures. Long-term sequelae of acute traumatic and chronic overuse ankle injuries in professional soccer players manifest as ankle osteoarthritis that is more prevalent compared to not only the general population, but also to former elite athletes from other sports. This article examines the most common and specific injuries in soccer in order of their frequency.
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Affiliation(s)
- Tetyana Gorbachova
- Department of Radiology, Jefferson Einstein, 5501 Old York Road, Levy building, Philadelphia, PA, 19141, USA.
| | - Sherif S Saad
- Department of Musculoskeletal Radiology, Atlantic Medical Imaging, Galloway, NJ, USA
| | - Ricard Pruna
- FC Barcelona Medical Department, Barcelona, Spain
| | - Yulia V Melenevsky
- Department of Radiology, University of Alabama at Birmingham, UAB Medical Center, Birmingham, AL, USA
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Fabião L, Macedo-Campos V, Ferreira de Castro R, Frada T, Silva LM, Esteves N, Pereira BS. Isolated syndesmotic injury: treatment with suture button system-retrospective cohort study. Porto Biomed J 2025; 10:e287. [PMID: 40115419 PMCID: PMC11922477 DOI: 10.1097/j.pbj.0000000000000287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Revised: 02/22/2025] [Accepted: 02/25/2025] [Indexed: 03/23/2025] Open
Abstract
Background Ankle injuries, often involving the syndesmotic complex, are common and may lead to acute instability. The syndesmosis, comprising several key ligaments, provides critical support for ankle function. This study assesses the efficacy and safety of the suture button system for isolated syndesmotic injuries, a treatment method that is gaining popularity over traditional transsyndesmotic screws. Methods A retrospective review was conducted on patients treated surgically with the suture button system for isolated syndesmotic injuries from January 2018 to December 2023. Key outcomes measured included time to full weight-bearing, returning of daily activities, and complications. The study also compared these outcomes with historical data from screw fixation methods. Results Thirty-two patients (20 men, 12 women; mean age 41.66 ± 16.57 years [range 16-72 years]) were analyzed over an average follow-up of 9.94 ± 5.49 months (range 3-28 months). Patients achieved full weight-bearing at 1.23 ± 0.31 months postoperatively, resumed daily activities with restrictions at 3 ± 1.09 months, and without restrictions at 6.67 ± 2.55 months. No major complications were reported; minor complications included implant removal due to irritation in two patients (6.25%) and minor wound issues in one patient (3.13%). Conclusion The suture button system demonstrated good outcomes in allowing physiological motion, low malreduction rates, and minimizing reoperation needs. The present results indicate a promising safety profile and functional recovery, despite limitations such as small sample size and lack of patient-reported outcome measures.
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Affiliation(s)
- Luís Fabião
- Unidade Local de Saúde de Barcelos/Esposende, Barcelos, Portugal
| | | | | | - Tiago Frada
- Unidade Local de Saúde de Barcelos/Esposende, Barcelos, Portugal
- Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal
- Hospital Lusíadas Braga, Braga, Portugal
| | - Luís Miguel Silva
- Unidade Local de Saúde de Barcelos/Esposende, Barcelos, Portugal
- Hospital Lusíadas Braga, Braga, Portugal
| | - Nuno Esteves
- Unidade Local de Saúde de Barcelos/Esposende, Barcelos, Portugal
- Hospital CUF Trindade, Porto, Portugal
| | - Bruno S Pereira
- Unidade Local de Saúde de Barcelos/Esposende, Barcelos, Portugal
- Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal
- Hospital Lusíadas Braga, Braga, Portugal
- 3B's Research Group-Biomaterials, Biodegradables & Biomimetics, University of Minho, Braga, Portugal
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Kuhn AW, Coughlin MJ, McGonegle SJ, Herzog MM, Weir N, Meade Spratley E, O’Cain CM, Anderson RB. Distal Tibiofibular Syndesmosis Injuries in the National Football League (NFL): A Spectrum of Pathology That Correlates With Time to Return to Full Participation. Sports Health 2025; 17:404-411. [PMID: 38804171 PMCID: PMC11569699 DOI: 10.1177/19417381241253223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Studies routinely evaluate high ankle sprains in isolation, but recent data suggest that these injuries are often associated with concomitant pathology, potentially influencing return to full participation. HYPOTHESIS In National Football League (NFL) players, isolated high ankle sprains are rare and syndesmosis injuries with concomitant pathology will result in increased time to return to full participation. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS Distal tibiofibular syndesmosis injuries sustained by NFL players between 2017 and 2019 were identified through NFL Injury Surveillance Database queries and verified with video analysis. Each injury underwent a comprehensive magnetic resonance imaging (MRI) review. Regression modeling was utilized to explore the influence of numerous imaging findings on time to return to full participation. RESULTS There were 83 external rotation ankle injuries involving the syndesmosis. Isolated distal tibiofibular syndesmosis injuries were rare (n = 11; 13%) and more often associated with other ligamentous injury (deltoid ligament and lateral ligamentous complex) and/or fractures. Regression modeling resulted in clustering of 3 injury pattern groups for time to return to full participation across numerous imaging findings: syndesmosis injury-fracture combinations (250 days [interquartile range [IQR,] 142-266 days]), syndesmosis injury with complete deep deltoid tear or acute diastasis (175 days [IQR, 20-248 days]), and all other syndesmosis injuries (27 days [IQR, 18-46 days]). CONCLUSION In NFL athletes with external rotation ankle injuries, isolated distal tibiofibular syndesmosis injuries were rare and more often associated with concomitant pathology. Time to return to full participation was affected by an associated fracture and complete deep deltoid ligament tear or diastasis but no other relevant MRI variables such as lateral ligament complex involvement or the presence of osteochondral lesions or bone contusions.
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Affiliation(s)
- Andrew W. Kuhn
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, California
- Gem State Radiology, Boise, Idaho
- IQVIA, Durham, North Carolina
- Green Bay Packers, Green Bay, Wisconsin
- Biocore LLC, Charlottesville, Virginia
- Biocore LLC, Charlottesville, Virginia
- Green Bay Packers, Green Bay, Wisconsin, Bellin Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin, and OrthoCarolina, Charlotte, North Carolina
| | - Michael J. Coughlin
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, California
- Gem State Radiology, Boise, Idaho
- IQVIA, Durham, North Carolina
- Green Bay Packers, Green Bay, Wisconsin
- Biocore LLC, Charlottesville, Virginia
- Biocore LLC, Charlottesville, Virginia
- Green Bay Packers, Green Bay, Wisconsin, Bellin Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin, and OrthoCarolina, Charlotte, North Carolina
| | - Shane J. McGonegle
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, California
- Gem State Radiology, Boise, Idaho
- IQVIA, Durham, North Carolina
- Green Bay Packers, Green Bay, Wisconsin
- Biocore LLC, Charlottesville, Virginia
- Biocore LLC, Charlottesville, Virginia
- Green Bay Packers, Green Bay, Wisconsin, Bellin Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin, and OrthoCarolina, Charlotte, North Carolina
| | - Mackenzie M. Herzog
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, California
- Gem State Radiology, Boise, Idaho
- IQVIA, Durham, North Carolina
- Green Bay Packers, Green Bay, Wisconsin
- Biocore LLC, Charlottesville, Virginia
- Biocore LLC, Charlottesville, Virginia
- Green Bay Packers, Green Bay, Wisconsin, Bellin Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin, and OrthoCarolina, Charlotte, North Carolina
| | - Nate Weir
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, California
- Gem State Radiology, Boise, Idaho
- IQVIA, Durham, North Carolina
- Green Bay Packers, Green Bay, Wisconsin
- Biocore LLC, Charlottesville, Virginia
- Biocore LLC, Charlottesville, Virginia
- Green Bay Packers, Green Bay, Wisconsin, Bellin Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin, and OrthoCarolina, Charlotte, North Carolina
| | - E. Meade Spratley
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, California
- Gem State Radiology, Boise, Idaho
- IQVIA, Durham, North Carolina
- Green Bay Packers, Green Bay, Wisconsin
- Biocore LLC, Charlottesville, Virginia
- Biocore LLC, Charlottesville, Virginia
- Green Bay Packers, Green Bay, Wisconsin, Bellin Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin, and OrthoCarolina, Charlotte, North Carolina
| | - Cody M. O’Cain
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, California
- Gem State Radiology, Boise, Idaho
- IQVIA, Durham, North Carolina
- Green Bay Packers, Green Bay, Wisconsin
- Biocore LLC, Charlottesville, Virginia
- Biocore LLC, Charlottesville, Virginia
- Green Bay Packers, Green Bay, Wisconsin, Bellin Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin, and OrthoCarolina, Charlotte, North Carolina
| | - Robert B. Anderson
- Robert B. Anderson, MD, OrthoCarolina, 2001 Vail Avenue - Suite 200B, Charlotte, NC 28207 ()
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Pietrobelli A, Marchi D, Noerwidi S, Alamsyah N, Sutikna T, Kivell TL, Skinner MM, Tocheri MW. A new distal fibular fragment of Homo floresiensis and the first quantitative comparative analysis of proximal and distal fibular morphology in this species. J Anat 2025. [PMID: 39966695 DOI: 10.1111/joa.14194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 10/23/2024] [Accepted: 11/22/2024] [Indexed: 02/20/2025] Open
Abstract
The hindlimb skeleton of the holotype (LB1) of Homo floresiensis is relatively complete and includes both fibulae, which despite being well preserved have yet to be subject to a quantitative comparative analysis with other hominids. A new distal fragment of a fibula has also been recovered from the H. floresiensis-bearing sediments at Liang Bua (Flores, Indonesia). In this study, we used 3D geometric morphometrics (3DGM) to quantify detailed aspects of the external shape and articular facet morphology of the proximal and distal ends of these H. floresiensis fibulae. The comparative sample included fibulae from 57 extant great apes (Pongo, Gorilla, and Pan), 41 recent and fossil Homo sapiens, five Australopithecus afarensis, and five Neandertals. Shape variation was analyzed using principal component analysis of Procrustes coordinates, and mean differences among taxa were tested using a Procrustes ANOVA with a randomization procedure. Size comparisons were made using centroid size and tested via correlations with principal component scores. Results demonstrate that H. floresiensis fibulae possess the absolute smallest mean linear dimensions and mean centroid sizes among our comparative sample. The proximal and distal fibular ends of H. floresiensis exhibit four key features adapted for obligate bipedalism while also displaying a suite of plesiomorphic traits shared with extant great apes and A. afarensis that, compared with that of H. sapiens and Neandertals, suggest a more versatile ankle joint with a greater range of motion and enhanced load-bearing capabilities of the fibula. Our results are consistent with other aspects of the H. floresiensis lower limb, such as long feet relative to the femur and a long forefoot relative to the hindfoot, that together suggest an australopith-like locomotor repertoire that included both obligate bipedalism and climbing.
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Affiliation(s)
- Annalisa Pietrobelli
- Department of Human Origins, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | | | - Sofwan Noerwidi
- Pusat Riset Arkeometri, Badan Riset dan Inovasi Nasional, Jakarta, Indonesia
| | - Nico Alamsyah
- Pusat Riset Arkeometri, Badan Riset dan Inovasi Nasional, Jakarta, Indonesia
| | - Thomas Sutikna
- Pusat Riset Arkeometri, Badan Riset dan Inovasi Nasional, Jakarta, Indonesia
- Centre for Archaeological Science, School of Earth and Environmental Sciences, University of Wollongong, Wollongong, Sydney, Australia
- Australian Research Council Centre of Excellence for Australian Biodiversity and Heritage, University of Wollongong, Wollongong, Sydney, Australia
| | - Tracy L Kivell
- Department of Human Origins, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Matthew M Skinner
- Department of Human Origins, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Matthew W Tocheri
- Australian Research Council Centre of Excellence for Australian Biodiversity and Heritage, University of Wollongong, Wollongong, Sydney, Australia
- Department of Anthropology, Lakehead University, Thunder Bay, Ontario, Canada
- Human Origins Program, Department of Anthropology, National Museum of Natural History, Smithsonian Institution, Washington, DC, USA
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Bartoníček J, Naňka O. The tibiofibular mortise - anatomical controversies and their clinical importance: a historical and pictorial essay. INTERNATIONAL ORTHOPAEDICS 2025; 49:515-524. [PMID: 39747470 DOI: 10.1007/s00264-024-06403-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Accepted: 12/26/2024] [Indexed: 01/04/2025]
Abstract
INTRODUCTION During 280 years of studies of the anatomy of the distal tibiofibular articulation, there have arisen many unclear issues regarding the description of individual structures and their terminology. These historical inaccuracies were subsequently reflected in the clinical practice. MATERIALS AND METHODS A literature search of original publications and historical sources was performed. RESULTS The distal tibiofibular articulation is a synovial joint, rather than a syndesmosis, as it is an integral part of the ankle joint. The interosseous tibiofibular ligament (ITFL), described for the first time by a French anatomist Bichat in 1801, is the strongest ligament of the tibiofibular mortise. Unfortunately, this clinically important ligament is not recognized by the current international anatomical nomenclature. The terms anterior inferior (AITFL) and posterior inferior tibiofibular ligaments (PITFL) are historical remnants "reimported" from the American/British literature and should not be used, because the analogous superior ligaments do not exist. The intermalleolar ligament, first described by Weitbrecht in 1742, is a variable, but constant, structure reinforcing the posterior capsule of the ankle joint. The term inferior transverse ligament (IFT) denoting in the English literature the inferior part of the posterior tibiofibular ligament was originally used for the intermalleolar ligament. The IFT ligament is a part of the posterior tibiofibular ligament and there is no reason to stress its importance. CONCLUSION The chaos in the anatomy, terminology and depiction of the articulation of the distal tibia and fibula, unparalleled in any other joint of the human body, is the result of historical development. A certain negative role was, in this respect, played also by Basiliensia Nomina Anatomica (1895), that eradicated ITFL and called the distal tibiofibular joint a syndesmosis.
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Affiliation(s)
- Jan Bartoníček
- Department of Orthopedics, First Faculty of Medicine, Charles University and the Central Military Hospital, U Vojenské nemocnice 1200, Prague 6, Prague, Czech Republic
- Institute of Anatomy, First Faculty of Medicine, Charles University, U Nemocnice 3, Prague 2, Prague, Czech Republic
| | - Ondřej Naňka
- Institute of Anatomy, First Faculty of Medicine, Charles University, U Nemocnice 3, Prague 2, Prague, Czech Republic.
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Akram R, Duarte Silva F, de Silva LNM, Gupta A, Basha A, Chhabra A. Three-Dimensional MRI of Foot and Ankle: Current Perspectives and Advantages Over 2D MRI. Semin Roentgenol 2024; 59:447-466. [PMID: 39490039 DOI: 10.1053/j.ro.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/03/2024] [Accepted: 06/03/2024] [Indexed: 11/05/2024]
Affiliation(s)
- Rubeel Akram
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | | | | | - Anuj Gupta
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Adil Basha
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
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Datta S, Bandyopadhyay B, Tahir M, Bose G, Khadilkar S. A Comprehensive Review of Recent Trends in Posterior Malleolus Fracture Management. Cureus 2024; 16:e72081. [PMID: 39575057 PMCID: PMC11580813 DOI: 10.7759/cureus.72081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2024] [Indexed: 11/24/2024] Open
Abstract
Posterior malleolus fractures (PMFs) are challenging injuries around the ankle that can lead to poor clinical outcomes as they can compromise ankle stability. Although there has been an evolution in the principles of management of PMFs, their optimal treatment remains controversial. This review article aims to provide an in-depth account of the management of PMF, thereby providing a better understanding of these complex cases hence resulting in improving patient outcomes.
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Affiliation(s)
- Sunandan Datta
- Trauma and Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Margate, GBR
| | | | - Muhammad Tahir
- Trauma and Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Margate, GBR
| | - Gourab Bose
- Trauma and Orthopaedics, North West Anglia NHS Foundation Trust, Peterborough, GBR
| | - Siddharth Khadilkar
- Trauma and Orthopaedics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR
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Wanezaki Y, Kurokawa H, Ueno Y, Tablante A, Mei N, Yinghao L, Taniguchi A, Suzuki A, Takakubo Y, Takagi M, Tanaka Y. Medial opening low tibial osteotomy shifts the load laterally not only at the ankle joint but also at the knee joint. J Exp Orthop 2024; 11:e70029. [PMID: 39697994 PMCID: PMC11652783 DOI: 10.1002/jeo2.70029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 07/19/2024] [Accepted: 07/25/2024] [Indexed: 12/20/2024] Open
Abstract
Purpose The purpose of this study was to determine the effects of medial opening low tibial osteotomy (LTO) on lower limb alignment, including the knee joint, 1 year after low tibial osteotomy. Methods This study included 20 legs of 20 patients (mean age, 66.8 ± 5.4 years) who underwent LTO for medial ankle osteoarthritis and evaluated the changes in the hip-knee-ankle angle (HKA), percentage hip-to-ankle line (%HA), percentage hip-to-calcaneal line (%HC), medial proximal tibial angle (MPTA), knee joint line convergence angle (K-JLCA), tibio-calcaneal angle (TCA), tibial anterior surface angle (TAS), tibio-plafond inclination (TPI), talar inclination (TI), ankle joint line convergence angle (A-JLCA), mechanical ankle joint axis point (MAJAP) on radiographs and the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale before and 1 year after low tibial osteotomy. Results The mean preoperative/postoperative measured values showed the following: HKA (degrees) of 1.0 ± 3.7/-0.8 ± 3.7; %HC of 38.8 ± 10.0/53.8 ± 16.1; MPTA (degrees) of 85.6 ± 2.4/87.6 ± 2.1; and A-JLCA (degrees) of 4.2 ± 2.9/1.1 ± 2.3 respectively. Including other measurements, a significant increase in the %HA, %HC, MPTA, TCA, TAS, MAJAP and JSSF ankle/hindfoot scale was observed postoperatively, whereas a significant decrease in the HKA, TPA, TI and A-JLCA was observed postoperatively (p < 0.05). With the numbers available, no significant differences were observed between the preoperative and postoperative values of K-JLCA (n.s.). Conclusion After LTO, the entire lower limb alignment became valgus, and the loading points of the knee and ankle joints shifted laterally. These changes must be considered when performing LTO, especially in patients with lateral knee OA. Level of Evidence Ⅳ.
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Affiliation(s)
- Yoshihiro Wanezaki
- Department of Orthopedic SurgeryNara Medical UniversityKashihara cityNaraJapan
- Department of Orthopedic SurgeryFaculty of Medicine, Yamagata UniversityYamagataJapan
| | - Hiroaki Kurokawa
- Department of Orthopedic SurgeryNara Medical UniversityKashihara cityNaraJapan
| | - Yuki Ueno
- Department of Orthopedic SurgeryNara Medical UniversityKashihara cityNaraJapan
| | - Adrian Tablante
- Department of Orthopedic SurgeryNara Medical UniversityKashihara cityNaraJapan
| | - Nan Mei
- Department of Orthopedic SurgeryNara Medical UniversityKashihara cityNaraJapan
| | - Li Yinghao
- Department of Orthopedic SurgeryNara Medical UniversityKashihara cityNaraJapan
| | - Akira Taniguchi
- Department of Orthopedic SurgeryNara Medical UniversityKashihara cityNaraJapan
| | - Akemi Suzuki
- Department of Orthopedic SurgeryFaculty of Medicine, Yamagata UniversityYamagataJapan
| | - Yuya Takakubo
- Department of Orthopedic SurgeryFaculty of Medicine, Yamagata UniversityYamagataJapan
| | - Michiaki Takagi
- Department of Orthopedic SurgeryFaculty of Medicine, Yamagata UniversityYamagataJapan
| | - Yasuhito Tanaka
- Department of Orthopedic SurgeryNara Medical UniversityKashihara cityNaraJapan
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9
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Butler JJ, Randall GW, Dalmau-Pastor M, Lin CC, Schoof L, Kennedy JG. A hypertrophic distal fascicle of the anterior tibiofibular ligament is associated with a high rate of osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 2024; 32:2452-2462. [PMID: 39033348 DOI: 10.1002/ksa.12360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 06/28/2024] [Accepted: 07/02/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE The purpose of this retrospective review was to determine the prevalence of osteochondral lesions (OCLs) of the lateral talar dome in patients with anterior ankle impingement with an associated hypertrophic distal fascicle of the anterior tibio-fibular ligament. METHODS Retrospective chart review identified 40 patients who underwent anterior ankle arthroscopy for the management of anterior ankle impingement. Clinical outcomes assessed included pre- and postoperative foot and ankle outcome score (FAOS), visual analogue scale (VAS), complications, failures, secondary surgical procedures, return-to-work data and return-to-sport data. RESULTS Thirty-two patients with a mean follow-up time of 29.3 ± 10.4 months were included. The hypertrophic distal fascicle of the anterior tibio-fibular ligament was hypertrophic in 29 patients (90.6%), with a mean thickness of 2.5 ± 0.4 mm on MRI. There were 22 OCLs of the lateral talar dome (75.9%) with an associated hypertrophic distal fascicle of the anterior tibio-fibular ligament visualized during arthroscopy. The international cartilage repair society gradings of the lesions included 3 (13.6%) grade I lesions, 15 (68.1%) grade II lesions, 3 (13.6%) grade III lesions, and 1 (4.6%) grade IV lesion. There was a statistically significant improvement in mean FAOS and VAS scores from preoperative to postoperative (p < 0.001). No cases of syndesmotic instability were observed following resection of hypertrophic distal fascicle of the anterior tibio-fibular ligament. CONCLUSION This retrospective case series demonstrated that a hypertrophic distal fascicle of the anterior tibio-fibular ligament was associated with an OCL of the lateral talar dome identified during arthroscopic evaluation. In addition, preoperative MRI demonstrated poor sensitivity for the detection of these OCLs. Heightened awareness is warranted for potential lateral talar dome OCLs in patients presenting with anterolateral ankle impingement with a hypertrophic ATiFLdf identified on preoperative MRI in the absence of an associated OCLs. LEVEL OF EVIDENCE Level IV, Retrospective case series.
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Affiliation(s)
- James J Butler
- Department of Orthopaedic Surgery, Foot and Ankle Division, NYU Langone Health, New York City, New York, USA
| | - Grace W Randall
- Department of Orthopaedic Surgery, Foot and Ankle Division, NYU Langone Health, New York City, New York, USA
| | - Miki Dalmau-Pastor
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
| | - Charles C Lin
- Department of Orthopaedic Surgery, Foot and Ankle Division, NYU Langone Health, New York City, New York, USA
| | - Lauren Schoof
- Department of Orthopaedic Surgery, Foot and Ankle Division, NYU Langone Health, New York City, New York, USA
| | - John G Kennedy
- Department of Orthopaedic Surgery, Foot and Ankle Division, NYU Langone Health, New York City, New York, USA
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10
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Kilic Safak N. Fibular notch morphometry and its clinical importance on dry bones. PLoS One 2024; 19:e0307387. [PMID: 39137194 PMCID: PMC11321577 DOI: 10.1371/journal.pone.0307387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 06/28/2024] [Indexed: 08/15/2024] Open
Abstract
The aim of the present study was to determine the morphometric characteristics of the fibular notch (FN). This study was carried out with 76 dry adult tibial bone specimens (right 38, left 38) with unknown age and sex collected from the Department of Anatomy, Cukurova University, Adana. The mean width of the FN was 23.04 ± 2.02 mm; the mean depth of the FN 3.63 ± 0.83 mm; the mean height of the FN was 41.76 ± 4.01 mm. The mean anterior facet length and posterior facet length was found to be 10.44 ± 1.94 mm and 13.93 ±1.63 mm, respectively. The mean value of the angle between the anterior and posterior facets was found to be 140.56° ± 11.72. The mean value of the angle between the anterior surface of the tibia and the intertubercular line was 75.5° ± 5.47. No statistically significant differences were detected between the right and left sides for all measurements. It is considered that knowing the morphometric and anatomical characteristics of the fibular notch in detail will help radiologists evaluate the talocrural region. It is also considered that these data will guide surgeons and help determine the appropriate size for ankle reconstruction operations.
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Affiliation(s)
- Nazire Kilic Safak
- Department of Anatomy, Cukurova University Faculty of Medicine, Adana, Turkey
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11
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Spindler FT, Böcker W, Polzer H, Baumbach SF. A 3-Ligament Syndesmotic Injury Is at Higher Risk for Malreduction Than a 2-Ligament Injury: A CT-Based Analysis. Foot Ankle Int 2024; 45:812-821. [PMID: 38817051 PMCID: PMC11344963 DOI: 10.1177/10711007241238227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND Syndesmotic malreduction is common and has been associated to an impaired outcome. Various risk factors for DTFJ malreduction have been postulated. The aims of this study were to assess the DTFJ malreduction rate based on (1) the severity of the syndesmotic injury, (2) the anatomy of the tibial incisura, and (3) the fixation device used in patients treated with suture-button systems. METHODS This retrospective, radiographic study included all adult patients who were treated for an acute, unilateral, and unstable syndesmotic injury with a suture-button system and postoperative bilateral CT imaging. Included were isolated syndesmotic injuries and fracture cases. The number of syndesmotic ligaments injured, that is, 2-ligament (AiTFL+IOL) and 3-ligament (AiTFL+IOL+PiTFL), was rated for each patient. The quality of DTFJ reduction, as well as the anatomy of the tibial incisura, was rated based on the postoperative, bilateral CT images and the intraoperative DTFJ reduction was recalculated based on the drilling-tunnel deviation. The possible influence on the DTFJ malreduction rate was assessed. RESULTS A total of 147 patients were included, and 94 and 53 patients had a 2- and 3-ligament syndesmotic injury, respectively. In addition, 113 patients were treated with a single-button system, 26 with a double suture-button system, and 8 with a hybrid fixation (suture-button + screw). Malreduction was significantly higher in 3-ligament compared with 2-ligament injuries, both intraoperatively (51% vs 27%; P = .003) and postoperatively (28% vs 11%; P = .006). The tibial anatomy had no significant influence on the malreduction rates. No significant differences were seen per the different fixation devices used independent of the number of ligaments injured. CONCLUSION This study did not find an influence of the incisura's anatomy on the DTFJ malreduction rate. However, we did find that 3-ligament syndesmotic injuries carried a higher risk of intra- and postoperative malreduction compared with 2-ligament injuries.
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Affiliation(s)
- Fabian Tobias Spindler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Hans Polzer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Felix Baumbach
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
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12
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Shevate I, Salunkhe R, Pervez F, Pawar P. A Prospective Study on Fixation of Syndesmotic Ankle Injury: Tight Rope Versus Screw Fixation. Cureus 2024; 16:e67172. [PMID: 39295653 PMCID: PMC11409161 DOI: 10.7759/cureus.67172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Accepted: 08/18/2024] [Indexed: 09/21/2024] Open
Abstract
Background Syndesmotic injury can result in significant instability and long-term complications if not treated correctly. Traditional management has involved transyndesmotic screw fixation, but a newer technique, the tight rope system, has been developed to mitigate some of the issues related to screw fixation, such as hardware discomfort and the necessity for hardware removal. Methods In this randomized, prospective study, 32 patients with ankle injuries requiring syndesmotic fixation were equally divided into two groups: one receiving the tight rope system (n=16) and the other undergoing screw fixation (n=16). The patients were monitored for six months following surgery. The study measured outcomes such as time to weight-bearing, range of motion, pain levels, functional outcomes using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, and complication rates. Results Both groups had comparable demographic and injury profiles. The tight rope group achieved weight-bearing significantly earlier (6.19 ± 0.9 weeks vs. 7.13 ± 0.95 weeks, p=0.008) and had better functional outcomes at six months (87.5% excellent AOFAS scores vs. 37.5%, p=0.003) compared to the screw fixation group. The range of motion and pain scores were similar between the groups. Different complications were observed: screw breakage was more common in the screw fixation group, while the tight rope group experienced more laxity. Overall complication rates were similar. Conclusion Both techniques were effective in reducing pain and maintaining range of motion. However, the tight rope system allowed for earlier weight-bearing and better functional outcomes at six months. These results indicate that the tight rope system may provide certain advantages in treating syndesmotic injuries, although the choice of technique should be tailored to the specific injury and patient factors.
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Affiliation(s)
- Ishan Shevate
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pune, IND
| | - Rahul Salunkhe
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pune, IND
| | - Faiz Pervez
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pune, IND
| | - Prashant Pawar
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pune, IND
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Kobayashi Y, Tsukamoto S, Kurokawa H, Nitta Y, Honoki K, Kido A, Ueno Y, Taniguchi A, Tanaka Y. En bloc resection and reconstruction using a talar prosthesis for malignant talar bone tumor: a surgical technique. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3377-3383. [PMID: 39126461 DOI: 10.1007/s00590-024-04056-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024]
Abstract
En bloc resection is required for treatment of intermediate-grade talar tumors with extraosseous extension (Enneking stage 3) and malignant talar tumors without intra-articular invasion (Enneking stages IA and IIA). After resection, reconstruction options include tibiocalcaneal fusion, frozen autograft, and talar prosthesis; however, a talar prosthesis is preferable because it preserves ankle range of motion, does not cause leg length discrepancy, and is associated with good long-term outcomes. To the best of our knowledge, en bloc resection and reconstruction of a malignant talar tumor has not been previously reported in detail. We report a detailed surgical technique for en bloc resection of a malignant talar bone tumor using combined anterior and lateral approaches followed by reconstruction using a talar prosthesis.
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Affiliation(s)
- Yusuke Kobayashi
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-City, Nara, 634-8521, Japan
| | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-City, Nara, 634-8521, Japan.
| | - Hiroaki Kurokawa
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-City, Nara, 634-8521, Japan
| | - Yuji Nitta
- Department of Diagnostic Pathology, Nara Medical University, 840, Shijo-cho, Kashihara-City, Nara, 634-8521, Japan
| | - Kanya Honoki
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-City, Nara, 634-8521, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, 840, Shijo-cho, Kashihara-City, Nara, 634-8521, Japan
| | - Yuki Ueno
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-City, Nara, 634-8521, Japan
| | - Akira Taniguchi
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-City, Nara, 634-8521, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-City, Nara, 634-8521, Japan
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14
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Ong SSL, Kwek EBK. Functional Syndesmotic Widening: A Case Report and Literature Review. Cureus 2024; 16:e63531. [PMID: 39086783 PMCID: PMC11288764 DOI: 10.7759/cureus.63531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 08/02/2024] Open
Abstract
Injury to the distal tibiofibular syndesmosis can be a diagnostic challenge in the absence of advanced imaging. We report a case of a 21-year-old male patient who sustained an ankle injury and demonstrated radiological evidence of syndesmosis widening on plain radiographs. He underwent endobutton fixation which resulted in anterior subluxation of the talus and difficulty in ankle dorsiflexion. This is the first case report in the literature of a functional syndesmotic widening and the subsequent sequelae when subjected to a stabilisation procedure. The previously reported risk factors were inconsistent with our patient's demographics of a young, previously obese adult. We postulate that his childhood morbid obesity likely contributed to the functional widening of his ankle syndesmosis.
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Affiliation(s)
- Samuel Sing Li Ong
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore, SGP
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15
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Voight ML, Norman C, Wilk KE, Lucas M, Wolfe C. Management of High Ankle Sprains Utilizing the Tightrope Surgical Procedure - A Novel Approach for a Rapid Return to Play. Int J Sports Phys Ther 2024; 19:513-521. [PMID: 38707856 PMCID: PMC11065778 DOI: 10.26603/001c.116862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
The distal tibiofibular joint is described as a syndesmosis. The syndesmosis is important to the structural integrity of the ankle joint by maintaining the proximity of the tibia, fibula, and talus. Syndesmotic or high ankle sprains, involving the syndesmotic ligaments, pose a significant rehabilitative challenge due to their intricate anatomy, prolonged recovery periods following injury, and high susceptibility to persistent disability. Traditional management strategies have often been conservative, marked by lengthy periods of immobilization and a gradual return to activity. Severe syndesmotic injuries with diastasis have been treated surgically with screw fixation which may require a second intervention to remove the hardware and carries an inherent risk of breaking the screw during rehabilitation. Another fixation technique, the Tightrope™, has gained popularity in treating ankle syndesmosis injuries. The TightRope™ involves inserting Fiberwire® through the tibia and fibula, which allows for stabilization of the ankle mortise and normal range of motion. The accelerated rehabilitation protocol promotes early weight-bearing and has been shown to expedite the return to sport. This emerging strategy has shown promise in reducing recovery time as it is now possible to return to sport in less than 2 months after a tightrope repair and accelerated rehabilitation, compared with 3-6 months post screw fixation. This clinical commentary delves into this novel approach, highlighting the procedure, rehabilitation protocols, and the implications for physical therapy practice. Level of Evidence V.
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16
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Luo Y, Guo L, Huang X, Wu D, Zhao X, Wang S. Effects of added trunk load on the in vivo kinematics of talocrural and subtalar joints during landing. Gait Posture 2024; 110:122-128. [PMID: 38569401 DOI: 10.1016/j.gaitpost.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/17/2023] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Landing from heights is a common movement for active-duty military personnel during training. And the additional load they carry while performing these tasks can affect the kinetics and ankle kinematic of the landing. Traditional motion capture techniques are limited in accurately capturing the in vivo kinematics of the talus. This study aims to investigate the effect of additional trunk load on the kinematics of the talocrural and subtalar joints during landing, using a dual fluoroscopic imaging system (DFIS). METHODS Fourteen healthy male participants were recruited. Magnetic resonance imaging was performed on the right ankle of each participant to create three-dimensional (3D) models of the talus, tibia, and calcaneus. High-speed DFIS was used to capture the images of participants performing single-leg landing jumps from a height of 40 cm. A weighted vest was used to apply additional load, with a weight of 16 kg. Fluoroscopic images were acquired with or without additional loading condition. Kinematic data were obtained by importing the DFIS data and the 3D models in virtual environment software for 2D-3D registration. The kinematics and kinetics were compared between with or without additional loading conditions. RESULTS During added trunk loading condition, the medial-lateral translation range of motion (ROM) at the talocrural joint significantly increased (p < 0.05). The subtalar joint showed more extension at 44-56 ms (p < 0.05) after contact. The subtalar joint was more eversion at 40-48 ms (p < 0.05) after contact under the added trunk load condition. The peak vertical ground reaction force (vGRF) significantly increased (p < 0.05). CONCLUSIONS With the added trunk load, there is a significant increase in peak vGRF during landing. The medial-lateral translation ROM of the talocrural joint increases. And the kinematics of the subtalar joint are affected. The observed biomechanical changes may be associated with the high incidence of stress fractures in training with added load.
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Affiliation(s)
- Ye Luo
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Luqi Guo
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Xiaofan Huang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Danni Wu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Xuan Zhao
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Shaobai Wang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China; Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China.
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17
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Brumbaugh AD, Casagranda BU. Postoperative Return to Play and the Role of Imaging. Semin Musculoskelet Radiol 2024; 28:165-179. [PMID: 38484769 DOI: 10.1055/s-0043-1778024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Return to play (RTP) following surgery is a complex subject at the interface of social and internal pressures experienced by the athlete, psychological readiness, and intrinsic healing of the surgically repaired structures. Although functional testing, time from surgery, clinical examination, and scoring metrics can help clarify an athlete's readiness to return to sport, imaging can allow for a more direct assessment of the structures in question. Because imaging is often included in the diagnostic work-up of pain following surgery, the radiologist must be familiar with the expected postsurgical imaging appearance, as well as the associated complications. We briefly review such findings following anterior cruciate ligament reconstruction, Achilles tendon repair, syndesmotic fixation, and ulnar collateral ligament reconstruction in the context of the athlete, highlighting issues related to RTP.
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Affiliation(s)
- Aaron D Brumbaugh
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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18
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Gomaa AR, Mason L. Chronic syndesmotic instability - Current evidence on management. J Clin Orthop Trauma 2024; 50:102382. [PMID: 38435397 PMCID: PMC10904910 DOI: 10.1016/j.jcot.2024.102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/21/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
This review article discusses the current evidence on the management of chronic syndesmotic instability. Conservative treatment has a limited role, and surgical intervention is most commonly reported as the mainstay of treatment, however the literature consists of small case series and descriptions of operative techniques, and thus the evidence base for any treatment is weak. Surgical options include arthroscopic debridement alone, static fixation with cortical screws, dynamic fixation with suture-button devices, and ligamentous repair or augmentation.
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Affiliation(s)
- Abdul-Rahman Gomaa
- Human Anatomy and Resource Centre, University of Liverpool, Liverpool, UK
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Lyndon Mason
- Human Anatomy and Resource Centre, University of Liverpool, Liverpool, UK
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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19
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Ahmed A, Mishra P, Patra B, Ravi PK. Lateral Ankle Ligaments: An Insight Into Their Functional Anatomy, Variations, and Surgical Importance. Cureus 2024; 16:e53826. [PMID: 38465086 PMCID: PMC10924277 DOI: 10.7759/cureus.53826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Ankle sprains are prevalent injuries leading to functional impairment. The lateral ankle ligament complex (LLC), comprising the anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), and calcaneofibular ligament (CFL), is weak and prone to injury. The morphometric data of these ligaments are essential for orthopedic practices, including techniques like direct repair or ATFL reconstruction with autograft/allograft, which are limited in the literature. The present study aims to document the anatomy and morphometry of the LLC. METHODS Fifteen adult Indian-origin embalmed cadavers were selected for the study. Ankles with antemortem or postmortem injuries or previous surgical interventions were excluded from the study. After precise dissection of the ankle's anterior and lateral aspects as per Cunningham's dissection manual, ligaments were exposed. Length and width were measured using a digital vernier caliper. Morphological attributes such as shape, orientation, and inter-fiber angles were documented. RESULTS The most common shape in ATFL was a single band (53.33%). Inner ATFL fibers merged with the ankle joint capsule in 73.33%. ATFL mean length and width were 14 ± 2.4 mm and 7.6 ± 2.0 mm. The angle between the fibula's long axis and ATFL fibers was 107 ± 22°, and the angle between tibiotalar joint lines and parallel ATFL fibers was 30 ± 9.5°. A single band of CFL was predominant (73.33%). The mean length and width of CFL were 18.4 ± 3.9 mm and 5.2 ± 1.3 mm; the angle between the anterior fibula border's long axes and parallel CFL line was 131°. PTFL length was 20.9 ± 3.3 mm and width was 6.2 ± 1.4 mm. The mean length and width of the anterior inferior talofibular ligament (AiTFL) were 11.7 ± 2.6 mm and 9.5 ± 1.6 mm, and of the posterior inferior talofibular ligament (PiTFL) were 12.8 ± 2.1 mm and 10.4 ± 2 mm. CONCLUSION Comprehensive knowledge of these ligaments' anatomy and relationships is vital for clinical examination and ultrasonography. Understanding LLC details aids radiologists and orthopedic surgeons in graft selection, sizing, and precise anatomical structure placement during surgical reconstruction.
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Affiliation(s)
- Akhalaq Ahmed
- Anatomy, Jawaharlal Nehru Medical College, Aligarh, IND
| | - Pravash Mishra
- Anatomy, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Bishnu Patra
- Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Praveen Kumar Ravi
- Anatomy, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
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20
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Yüce A, Erkurt N, Yerli M, Saygılı MS, Özkan CB. Morphology of Fibular Incisura is a Deciding Factor Between Posterior Malleolus Avulsion Fracture or Syndesmotic Ligament Injury in Ankle Fractures. J Foot Ankle Surg 2024; 63:18-21. [PMID: 37572828 DOI: 10.1053/j.jfas.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/18/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023]
Abstract
The bone anatomy of tibiofibular syndesmosis has been a topic of interest. Fibular incisura morphology has been analyzed on cadaver specimens, plain radiographs, or CT images. The aim of this study is to examine the effects of fibula incisura features and fibula morphology in ankle injuries, especially involving posterior malleolus and posteroinferior tibiofibular ligament injuries. From 2017 through 2022, A total of 59 patients with isolated lateral malleolar fracture, Mason-Malloy type 1 posterior malleolar fracture, syndesmosis injury in those without posterior malleolar fracture, supination external rotation type 3 injuries according to Lauge-Hansen classification, and preoperative bilateral ankle computed tomography images were included in the study. Fibula morphologies and syndesmosis measurements were made from preoperative computed tomography images using axial CT images from 1 cm proximal to the tibial plafond. The diagnosis of posterior malleolar fractures was made using the CT classification system of Mason and Malloy, and the diagnosis of syndesmosis injury was made with a cotton test during surgery. Age, gender, fractured side, incisura type, incisor depth, width, anterior and posterior facet lengths, incisor version (antevert-retrovert), the angle between the anterior and posterior facets, and fibula type were recorded. There was a statistically significant difference between the groups in posterior facet length and incisura width. Morphological features of fibular incisura may be the determinant of PITFL injury or PMA injury in fibular fractures caused by an external rotation mechanism.
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Affiliation(s)
- Ali Yüce
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey.
| | - Nazım Erkurt
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Mustafa Yerli
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Mehmet Selçuk Saygılı
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Can Burak Özkan
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
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21
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Nakajima H, Yamaguchi S, Kimura S, Mikami Y, Watanabe S, Toguchi K, Ito R, Sakamoto T, Sasho T, Ohtori S. Validity of the Center-Center Method for the Syndesmotic Fixation Axis Compared to the Transsyndesmotic Axis. Foot Ankle Int 2023; 44:1166-1173. [PMID: 37750413 DOI: 10.1177/10711007231198818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Placement of clamp forceps along the transsyndesmotic (TS) axis reduces the risk of iatrogenic syndesmotic malreduction during ankle fracture surgery with tibiofibular diastasis. This study aimed to measure the difference between the TS axis and the axis determined by an intraoperative fluoroscopic technique using the center-center (CC) method. We also compared the values obtained when the CC method was performed at different heights from the tibial plafond. METHODS We evaluated the computed tomography scans of 150 patients with normal syndesmosis. The CC method was simulated using digitally reconstructed radiographs. The TS and CC axes were projected onto an axial computed tomographic image linked to digitally reconstructed radiography. The angle between the two axes (interaxis angle) and the distance between the intersection of these axes and the medial tibial cortex (interaxis distance) were measured. The procedures were performed 0, 10, and 20 mm proximal to the tibial plafond, and the measurements were compared among the different heights using a 1-way repeated-measures analysis of variance. RESULTS The TS axis was found to be externally rotated to the CC axis, with an interaxis angle of 8.5 degrees (SD, 6.8 degrees). The interaxis angle increased from 1.9 degrees at a height of 0 mm to a greater angle at higher heights (P < .001). The overall interaxis distance was 7.7 (SD, 6.3) mm, increasing from 2.0 mm at a height of 0 mm to a greater distance at higher heights (P < .001). CONCLUSION The TS axis was externally rotated relative to the CC axis, and the difference between the 2 axes was greater when the CC method was performed on the higher heights from the tibial plafond. To clamp the syndesmosis along the TS axis, the CC method should be applied close to the ankle joint. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Hirofumi Nakajima
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Satoshi Yamaguchi
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
- Graduate School of Global and Transdisciplinary Studies, Chiba University, Inage-ku, Chiba-shi, Chiba, Japan
| | - Seiji Kimura
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Yukio Mikami
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Shotaro Watanabe
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Kaoru Toguchi
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Ryu Ito
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Takuya Sakamoto
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Takahisa Sasho
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Seiji Ohtori
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
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22
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Wright CT, Hanna P, Medina G, Kiers V, Kim S. Pediatric Maisonneuve and Tillaux Fractures with Lateral Ankle Dislocation: A Pediatric "Logsplitter" Injury: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00035. [PMID: 38011320 DOI: 10.2106/jbjs.cc.23.00288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
CASE A 12-year-old adolescent boy presented with a proximal fibula fracture and lateral ankle dislocation consistent with a Maisonneuve fracture (MF) associated with a transsyndesmotic ankle dislocation. The dislocation was reduced under conscious sedation in the emergency department. Postreduction imaging studies demonstrated a Tillaux fracture. The patient underwent surgical stabilization of the Tillaux fragment and of the distal tibiofibular syndesmosis. At the 26-month follow-up, the patient remained active without restrictions. CONCLUSION Operative treatment of a concurrent MF, Tillaux fracture with lateral ankle dislocation, or a pediatric "logsplitter" injury resulted in satisfactory alignment and function of the ankle joint.
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Affiliation(s)
- Connor T Wright
- Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
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Sugimoto K, Isomoto S, Ishida E, Miura K, Hyakuda Y, Ohta Y, Tanaka Y, Taniguchi A. Treatment of Intra-Articular Lesions After Posterior Inferior Tibiofibular Ligament Injury: A Case Series of Elite Rugby Players. Orthop J Sports Med 2023; 11:23259671231200934. [PMID: 37781642 PMCID: PMC10540585 DOI: 10.1177/23259671231200934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/19/2023] [Indexed: 10/03/2023] Open
Abstract
Background Surgical intervention is not typically used to treat symptoms after mild tibiofibular ligament injuries without ankle dislocation or subluxation. Purpose To describe outcomes in patients arthroscopically treated for unique intra-articular lesions after sustaining syndesmosis injury of the ankle. Study Design Case series; Level of evidence, 4. Methods A total of 11 elite male rugby players with a mean age of 21.0 years (range, 17-28 years) were referred to our hospital for prolonged posterior ankle pain after a high ankle sprain during rugby football. The patients were examined using standing view radiography, computed tomography (CT) and magnetic resonance imaging (MRI) to determine the extent of ligament damage. Posterior ankle arthroscopy was performed to examine intra-articular lesions. The patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot rating scale and sports activity score of the Self-Administered Foot Evaluation Questionnaire (SAFE-Q). Results The average reduced tibiofibular overlap on the standing mortise view was 1.2 mm (range, 0.5-2.0 mm) compared with the opposite ankles. Mason type 1 fracture was detected on CT in 6 patients, and ossification of the interosseous membrane was detected in 2 patients. A bone bruise in the posterior malleolus was observed on MRI in all but 1 patient. Intra-articular fragments located in the posterior ankle were observed and removed arthroscopically. Symptoms improved rapidly after arthroscopic treatment in all patients. All patients returned to rugby games at a median of 11 weeks postoperatively. The median AOFAS scores improved from 77 preoperatively to 100 postoperatively (P < .01), and the median SAFE-Q sports activity subscale score improved from 49.4 to 100 (P < .01). Conclusion All unique intra-articular lesions that developed in rugby football players after syndesmosis injury were able to be treated arthroscopically. Patients returned to playing rugby football without syndesmosis reduction. Posterior ankle arthroscopy was effective in patients with residual symptoms after syndesmosis injury.
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Affiliation(s)
- Kazuya Sugimoto
- Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Shinji Isomoto
- Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Eiwa Ishida
- Department of Pathology, Nara Prefecture General Medical Center, Nara, Japan
| | - Kimio Miura
- Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Yoshinobu Hyakuda
- Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Yuichi Ohta
- Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, School of Medicine, Nara Medical University, Kashihara, Japan
| | - Akira Taniguchi
- Department of Orthopaedic Surgery, School of Medicine, Nara Medical University, Kashihara, Japan
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Lenz CG, Urbanschitz L, Shepherd DW. Dynamic syndesmotic stabilisation and reinforcement of the antero-inferior tibiofibular ligament with internal brace. Foot (Edinb) 2023; 56:102026. [PMID: 37001344 DOI: 10.1016/j.foot.2023.102026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Syndesmotic injuries are associated with long recovery times and high morbidity. Systematic reviews show a trend toward better outcomes of suture buttons compared to screw fixation. The anteroinferior tibiofibular ligament (AITFL) confers the most significant component of translational and rotatory stability. Techniques have developed which reinforce the AITFL. This study aimed to assess results of syndesmotic stabilisation with dynamic stabilisation and reinforcement of the AITFL, with an early mobilisation program. MATERIALS AND METHODS Retrospective case series of 30 patients (mean age 31 years). Syndesmotic instability was confirmed with clinical examination, MRI and weightbearing-CT. Dynamic syndesmotic stabilisation with a single suture button was performed followed by the placement of an Internal Brace over the AITFL. A standardised postoperative rehabilitation protocol was established. Foot and Ankle Ability Measure (FAAM) scores were collected postoperatively. RESULTS The average follow-up was 13 months. The total FAAM score for ADL was 95 ± 4.9 % (range, 83 - 100 %) and for sport activities 87 ± 13.6 % (range, 50 - 100 %). The rating of mean postoperative function for ADL was 94 ± 5.5 % (range, 80 - 100 %) and 90 ± 13 % (range, 35 - 100 %) for sportv. The difference between acute and chronic injuries was statistically higher (p < 0.05) for daily activities and sport, but the rating of current level of sport activites as well as for daily activites did not show a significant difference (p = 0.9296 and p = 0.1615, respectively). Twenty-seven patients (90 %) rated their overall current level of function as normal or nearly normal. CONCLUSION This technique aims to directly stabilise the AITFL and the interosseous components of the syndesmosis, and allow early mobilisation and return to sport at 10 weeks. Early results show the procedure is safe, with comparable results to the literature. Acute injuries showed better results of the FAAM score than chronic injuries.
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Affiliation(s)
| | - Lukas Urbanschitz
- Department of Orthopaedic Surgery, Schulthess Klinik, Zurich, CH, Switzerland.
| | - David W Shepherd
- Western Health Victoria, Melbourne Orthopaedic Group, Victoria, Australia.
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25
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Rozis M, Zachariou D, Vavourakis M, Vasiliadis E, Vlamis J. Anterior Incisura Fibularis Corner Landmarks Can Safely Validate the Optimal Distal Tibiofibular Reduction in Malleolar Fractures-Prospective CT Study. Diagnostics (Basel) 2023; 13:2615. [PMID: 37568978 PMCID: PMC10417129 DOI: 10.3390/diagnostics13152615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Distal tibiofibular injuries are common in patients with malleolar fractures. Malreduction is frequently reported in the literature and is mainly caused by insufficient intraoperative radiological evaluation. In this direction, we performed a prospective observational study to validate the efficacy of the anatomical landmarks of the anterior incisura corner. METHODS Patients with malleolar fractures and syndesmotic instability were reduced according to specific anatomic landmarks and had a postoperative bilateral ankle CT. The quality of the reduction was compared to the healthy ankles. RESULTS None of the controlled parameters differed significantly between the operated and healthy ankles. Minor deviations were correlated to the normal incisura morphology rather than the reduction technique. CONCLUSIONS The anterior incisura anatomical landmarks can be an efficient way of reducing the distal tibiofibular joint without the need for intraoperative radiological evaluation.
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Affiliation(s)
- Meletis Rozis
- 3rd Orthopedic Department, University of Athens, KAT Hospital, 145 61 Athens, Greece; (D.Z.); (J.V.)
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26
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Huang L, Zhang X, Yang S, Qing J, Wu W, Shi H, Wang D, Zhang L. Association between the distal tibiofibular syndesmosis morphology classification and ankle osteoarthritis: a retrospective study. J Orthop Surg Res 2023; 18:566. [PMID: 37537622 PMCID: PMC10401784 DOI: 10.1186/s13018-023-03985-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/06/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Syndesmosis injury is proposed to contribute to ankle stability and osteoarthritis (OA). However, whether distal tibiofibular syndesmosis structure is closely related to ankle OA is unclear. We hypothesized that different DTS morphology classifications would affect the biomechanics properties in ankle OA. The study aimed to determine the association between the distal tibiofibular syndesmosis (DTS) morphological classification and ankle OA. METHODS This is a retrospective study examining imaging data of 147 patients (87 males and 60 females) with ankle OA. Magnetic resonance imaging was used to access the DTS morphological classification, according to measuring various parameters. Joint space narrowing and osteophytes were measured using ankle weight-bearing radiography. The classification and parameters were analyzed to determine the relationship between the syndesmosis classification and the abnormality of ankle OA. RESULTS Five morphological classifications of the DTS, including Chevron (19.6%), Widow's peak (16.2%), Flat (22.3%), Trapezoid (32.0%), and Crescent (19.6%), were shown. There were statistical differences between DTS classification and tibial angle surface angle (TAS) (P = .009) and talar tilt angle (TTA) (P = .014). The TAS (degree) of the Crescent (86.47 ± 3.21) was less than Chevron (88.75 ± 2.72) (P = .006), Widow's peak (89.26 ± 3.15) (P = .001), Flat (88.83 ± 3.62) (P = .003) and Trapezoid (88.11 ± 2.62) (P = .041), respectively. The TTA (degree) of Crescent (86.83 ± 5.30) was less than Chevron (89.28 ± 2.46) and Widow's peak (89.82 ± 3.41). The men were greater than women for TAS (P = .008) and angle (P = .003), which are consistent with osteophyte (P = .019) and the modified Kellgren-Lawrence grades (P = .041) between gender. CONCLUSIONS DTS morphological classification might affect the biomechanics properties in TAS and TTA in ankle OA. In clinical practice, surgeons should pay attention to the effects of DTS on ankle OA. LEVEL OF EVIDENCE Level III, retrospective study.
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Affiliation(s)
- Lei Huang
- School of Physical Education, Southwest Medical University, Luzhou, 646000, Sichuan Province, China
| | - XiaoHong Zhang
- School of Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Siyi Yang
- School of Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Jiwen Qing
- School of Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Wangyu Wu
- School of Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Houyin Shi
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, 182 Chun Hui Road, Luzhou, 646000, Sichuan Province, China
| | - Dingxuan Wang
- School of Physical Education, Southwest Medical University, Luzhou, 646000, Sichuan Province, China.
| | - Lei Zhang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, 182 Chun Hui Road, Luzhou, 646000, Sichuan Province, China.
- Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China.
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27
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Jain N, Murray D, Kemp S, Calder J. Republication of "High-Speed Video Analysis of Syndesmosis Injuries in Soccer-Can It Predict Injury Mechanism and Return to Play? A Pilot Study". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231195048. [PMID: 37578852 PMCID: PMC10422888 DOI: 10.1177/24730114231195048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Background Ankle syndesmosis injuries in professional soccer may lead to an unpredictable and prolonged recovery. This injury has been investigated in anatomical and radiologic studies but the precise mechanism leading to syndesmosis injury is not well understood and remains debated. The 2 goals of this study were to (1) evaluate the relationship between the mechanism of syndesmosis injury as determined by high-speed video analysis and the injured structures identified by clinical and radiologic examination and to (2) investigate the relationship between mechanism of injury and time of return to play. Methods This pilot study prospectively reviewed high-speed video analysis of 12 professional soccer players who sustained syndesmosis injuries. The mechanism of injury was compared with the clinical and MRI evaluation and the time taken to return to play. Results Higher-grade syndesmosis injuries occurred during ankle external rotation with dorsiflexion. Supination-inversion injuries with a standard lateral ankle sprain (rupture of the anterior talofibular ligament) may extend proximally, causing a lower-grade syndesmosis injury. These may present with signs of a high ankle sprain but have a quicker return to sport than those following a dorsiflexion-external rotation injury (mean 26 days vs 91 days). Conclusions Video analysis confirmed that at least 2 mechanisms may result in injury to the ankle syndesmosis. Those "simple" ankle sprains with signs of syndesmosis injury had a quicker return to play. This new finding may be used by club medical teams during their initial assessment and help predict the expected time away from soccer in players with suspected high ankle sprains. Level of Evidence Level IV, retrospective cohort study.
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Affiliation(s)
- Neil Jain
- Manchester Institute of Health & Performance, Manchester, UK
| | - David Murray
- Manchester Institute of Health & Performance, Manchester, UK
| | - Steve Kemp
- The Football Association, Burton-upon-Trent, UK
| | - James Calder
- Department of Bioengineering, Imperial College, Fortius Clinic, London, UK
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28
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Wang F, Guan Y, Bamber Z, Cao X, Qi Q, Niu W, Chen B. Preventive interventions for lateral ankle sprains: A systematic review and meta-analysis. Clin Rehabil 2023; 37:585-602. [PMID: 36630892 DOI: 10.1177/02692155221137640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the effect of preventive interventions for lateral ankle sprain in the general population. DATA SOURCES A search of PubMed, EMBASE, Cochrane CENTRAL, Medline, CINAHL, and ClinicalTrials.gov was conducted up to August 2022. REVIEW METHODS Randomized controlled trials and prospective cohort studies that evaluated any interventions for preventing lateral ankle sprain were included. Two reviewers independently conducted the search, screening, and data extraction. The methodological quality of each study was assessed using the revised Cochrane risk-of-bias tool for randomized trials or using the Cochrane Risk Of Bias In Non-Randomized Studies tool for prospective cohort studies. RESULTS Seventeen studies met the inclusion criteria. Proprioceptive training exhibited better effects on preventing future lateral ankle sprain compared with the control group (risk ratio = 0.59, p < 0.001), and a stronger preventive effect was observed in participants with a history of lateral ankle sprain in the subgroup analysis (risk ratio = 0.49, p = 0.02). Compared with no bracing, ankle bracing had no significant better effect in preventing lateral ankle sprain (risk ratio = 0.43, p = 0.05). Proprioceptive training and ankle bracing had similar preventive effects (risk ratio = 0.98, p = 0.97). Limited evidence hindered the synthesis of data on pain, swelling, costs, and time loss. CONCLUSION Proprioceptive training is recommended for preventing lateral ankle sprain, especially for people with a history of lateral ankle sprain. Bracing seems to have an ambiguous preventive effect and requires more further investigation.
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Affiliation(s)
- Fanjia Wang
- Department of Physical Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Yonghao Guan
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zoe Bamber
- Division of Orthopaedics, Trauma and Sports Medicine, Faculty of Medicine and Health Sciences, School of Medicine, 6123University of Nottingham, Nottingham, UK
| | - Xianxin Cao
- Department of Physical Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Qi Qi
- Department of Physical Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Wenxin Niu
- Department of Rehabilitation Sciences, 481875Tongji University School of Medicine, Shanghai, China
| | - Bin Chen
- Department of Physical Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
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Abstract
The distal tibiofibular syndesmosis (DTFS) is more frequently injured than previously thought. Early diagnosis and appropriate treatment is essential to avoid long term complications like chronic instability, early osteoarthritis and residual pain. Management of these injuries require a complete understanding of the anatomy of DTFS, and the role played by the ligaments stabilizing the DTFS and ankle. High index of suspicion, appreciating the areas of focal tenderness and utilizing the provocative maneuvers help in early diagnosis. In pure ligamentous injuries radiographs with stress of weight bearing help to detect subtle instability. If these images are inconclusive, then further imaging with MRI, CT scan, stress examination under anesthesia, and arthroscopic examination facilitate diagnosis. An injury to syndesmosis frequently accompanies rotational fractures and all ankle fractures need to be stressed intra-operatively under fluoroscopy after fixation of the osseous components to detect syndesmotic instability. Non-operative treatment is appropriate for stable injuries. Unstable injuries should be treated operatively. Anatomic reduction of the syndesmosis is critical, and currently both trans-syndesmotic screws and suture button fixation are commonly used for syndesmotic stabilization. Chronic syndesmotic instability (CSI) requires debridement of syndesmosis, restoration of ankle mortise with or without syndesmotic stabilization. Arthrodesis of ankle is used a last resort in the presence of significant ankle arthritis. This article reviews anatomy and biomechanics of the syndesmosis, the mechanism of pure ligamentous injury and injury associated with ankle fractures, clinical, radiological and arthroscopic diagnosis and surgical treatment.
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Affiliation(s)
- Rajeev Vohra
- Department of Foot & Ankle Surgery, Amandeep Hospital, Amritsar, India
| | - Avtar Singh
- Department of Foot & Ankle Surgery, Amandeep Hospital, Amritsar, India
| | - Babaji Thorat
- Department of Foot & Ankle Surgery, Amandeep Hospital, Amritsar, India
| | - Dharmesh Patel
- Department of Foot & Ankle Surgery, Amandeep Hospital, Amritsar, India
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30
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Hegazy MA, Khairy HM, Hegazy AA, Sebaei MAEF, Sadek SI. Talus bone: normal anatomy, anatomical variations and clinical correlations. Anat Sci Int 2023:10.1007/s12565-023-00712-y. [PMID: 37017903 DOI: 10.1007/s12565-023-00712-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/28/2023] [Indexed: 04/06/2023]
Abstract
Talus is a pivotal bone that assists in easy and correct locomotion and transfers body weight from the shin to the foot. Despite its small size, it is implicated in many clinical disorders. Familiarity with the anatomy of the talus and its anatomical variations is essential for the diagnosis of any disorder related to these variations. Furthermore, orthopedic surgeons must be fully aware by this anatomy during podiatry procedures. In this review, we attempt to present its anatomy in a simple, updated and comprehensive manner. We have also added the anatomical variations and some clinical points relevant to the unique and complex anatomy of talus. The talus has no muscle attachment. However, it does have many ligaments attached to it and others around it to keep it in place. Moreover, the bone plays a pig role in movements due to its involvement in many joints. Most of its surface is covered with articular cartilage. Therefore, its blood supply is relatively poor. This puts the talus at greater risk for poor healing as well as more complications in the event of injury than any other bone. We hope this review will make it easier for clinicians to pursue and understand the updated essential knowledge of one of the most complex bone anatomies that they need in their clinical practice.
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Affiliation(s)
| | - Hossam Mohammed Khairy
- Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Zagazig City, 44519, Egypt
| | - Abdelmonem Awad Hegazy
- Basic Medical Science Department, Faculty of Dentistry, Zarqa University, Zarqa City, 13110, Jordan.
- Human Anatomy and Embryology Department, Faculty of Medicine, Zagazig University, Zagazig City, 44519, Egypt.
| | | | - Sami Ibrahim Sadek
- Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Zagazig City, 44519, Egypt
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31
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Diagnostic Value of DECT-Based Collagen Mapping for Assessing the Distal Tibiofibular Syndesmosis in Patients with Acute Trauma. Diagnostics (Basel) 2023; 13:diagnostics13030533. [PMID: 36766638 PMCID: PMC9914815 DOI: 10.3390/diagnostics13030533] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Background: Injury to the distal tibiofibular syndesmosis (DTFS) is common in patients with trauma to the ankle, but diagnostic accuracy of conventional X-ray and CT is insufficient. A novel dual energy CT (DECT) post-processing algorithm enables color-coded mapping of collagenous structures, which can be utilized to assess the integrity of the DTFS. Methods: Patients were included in this retrospective study if they underwent third-generation dual-source DECT followed by 3T-MRI or ankle joint surgery within 14 days between January 2016 and December 2021. Three radiologists blinded to all patient data independently evaluated grayscale images and, after 8 weeks, grayscale and collagen mapping images for the presence of ligamentous injury or avulsion fractures of the DTFS. MRI and surgery provided the reference standard. Diagnostic accuracy parameters were calculated for all ratings, and a comparison of ROC curve analysis was performed to evaluate the incremental diagnostic value of color-coded images over grayscale images. Results: A total of 49 patients (median age 49 years; 32 males) were evaluated. Application of collagen mapping significantly increased sensitivity (25/30 [83%] vs. 20/30 [67%]), specificity (110/118 [93%] vs. 70/118 [60%]), positive predictive value (25/33 [76%] vs. 20/67 [30%]), negative predictive value (110/115 [96%] vs. 70/80 [88%]), and accuracy (134/147 [91%] vs. 90/147 [61%]) for the detection of injury to the DTFS (all parameters, p < 0.001). Collagen mapping achieved higher diagnostic confidence, image quality, and noise scores compared to grayscale CT (all parameters, p < 0.001). Conclusions: Collagen mapping yields substantially higher diagnostic accuracy and confidence for assessing the integrity of the distal tibiofibular syndesmosis compared to grayscale CT in patients with acute trauma. The application of this algorithm can accelerate the adequate diagnosis and treatment of DTFS injury in clinical routine.
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32
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Spindler FT, Gaube FP, Böcker W, Polzer H, Baumbach SF. Value of Intraoperative 3D Imaging on the Quality of Reduction of the Distal Tibiofibular Joint When Using a Suture-Button System. Foot Ankle Int 2023; 44:54-61. [PMID: 36537750 PMCID: PMC9834319 DOI: 10.1177/10711007221138775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The quality of reduction of the distal tibiofibular joint (DTFJ) has a major impact on the outcome. Novel suture-button systems as well as intraoperative 3D imaging can be applied to increase the quality of DTFJ reduction intraoperatively. The individual effect of either remains unknown. The aim of this study was to investigate the value of intraoperative 3D imaging on the quality of reduction of the DTFJ when using a suture-button system. METHODS Retrospective, radiographic study including adult patients who underwent surgical stabilization of the syndesmosis with a suture-button system for acute, unilateral, unstable syndesmotic injuries with postoperative bilateral CT imaging. The use of an intraoperative 3D scan was the individual surgeon's choice. Assessed was whether the intraoperative 3D imaging had an influence on the postoperative quality of DTFJ reduction and revision rates. These findings were put in perspective to the correction potential of the suture-button system. RESULTS A total of 147 patients were included; 76 of these received an intraoperative 3D imaging. Neither the rate of formal malreduction (17% vs 17%) nor the postoperative revision rate (4% vs 3%) differed significantly between patients with or without intraoperative 3D imaging. Intraoperative 3D imaging revealed a false-negative rate of 14%. The intrinsic correction potential of the suture-button system reduced the number of formally malreduced DTFJs in both groups by 51%. CONCLUSION The additional value of intraoperative 3D imaging to assess the quality of DTFJ reduction in our series did not improve syndesmotic reduction when using a flexible suture-button system. LEVEL OF EVIDENCE Level III, retrospective comparative cohort study.
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Affiliation(s)
- Fabian T. Spindler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
| | - Federico P. Gaube
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
| | - Hans Polzer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
| | - Sebastian F. Baumbach
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
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Yammine K, Jalloul M, Assi C. Distal tibiofibular syndesmosis: A meta-analysis of cadaveric studies. Morphologie 2022; 106:241-251. [PMID: 34801386 DOI: 10.1016/j.morpho.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
Though injuries to the distal tibiofibular (DTF) syndesmosis are commonly encountered in orthopedic and trauma settings, its anatomical structures have been poorly researched. The commonly overlooked DTF ligament injuries are known to cause chronic ankle pain, instability and post-traumatic osteoarthritis. Quantitative and morphological evidence synthesis has not been yet conducted. A meta-analysis was conducted to collect data from morphological studies to document more accurate details on the prevalence, size, and insertion sites of its components. The Checklist for Anatomical Reviews and Meta-Analyses (CARMA) was followed. Ten studies met the inclusion criteria with a total of 265 investigated ankles. The analysis demonstrated that the anterior and posterior tibiofibular ligaments along with the interosseous ligament were present in 100% of joints. The inferior transverse tibiofibular and the distal fascicle of the anterior tibiofibular ligament were the least prevalent with frequencies of 96% and 86.5%, respectively. The inferior transverse ligament was recorded as the longest ligament. The widest ligament was found to be the interosseous tibiofibular ligament at its fibular attachment. The thickest of the ligamentous components was the posterior tibiofibular ligament. While more cadaveric research is warranted, these results would help directing future biomechanical investigations and planning new research to further aid in diagnostic and therapeutic approaches to the injuries of the distal tibiofibular syndesmosis.
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Affiliation(s)
- K Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon; The Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, Lebanon.
| | - M Jalloul
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | - C Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, Lebanon
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Collins MS, North TJ, Sellon JL. Traumatic rupture of the midportion of the interosseous membrane: a rare cause of acute lower leg pain in two soccer players kicked in the anterior shin. Skeletal Radiol 2022; 51:2333-2339. [PMID: 35583600 DOI: 10.1007/s00256-022-04071-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/29/2022] [Accepted: 05/07/2022] [Indexed: 02/02/2023]
Abstract
The interosseous membrane (IOM) of the leg is a component of the tibiofibular syndesmosis that serves an important role in stabilization, as well as transferring forces to the fibula during weight-bearing. We present two separate cases of acute traumatic rupture of the midportion of the interosseous membrane in high school soccer players with blunt trauma to the anterior shin with MRI and ultrasound confirmation.
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Affiliation(s)
- Mark S Collins
- Department of Radiology, Musculoskeletal Division, Mayo Clinic, Rochester, MN, USA.
| | - Taylor J North
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Jacob L Sellon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.,Mayo Clinic Sports Medicine Center, Rochester, MN, USA
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35
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Peiffer M, Burssens A, De Mits S, Heintz T, Van Waeyenberge M, Buedts K, Victor J, Audenaert E. Statistical shape model-based tibiofibular assessment of syndesmotic ankle lesions using weight-bearing CT. J Orthop Res 2022; 40:2873-2884. [PMID: 35249244 DOI: 10.1002/jor.25318] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 02/03/2022] [Accepted: 03/01/2022] [Indexed: 02/04/2023]
Abstract
Forced external rotation is hypothesized as the key mechanism of syndesmotic ankle injuries, inducing a three-dimensional deviation from the normal distal tibiofibular joint (DTFJ) alignment. However, current diagnostic imaging modalities are impeded by a two-dimensional assessment, without considering ligamentous stabilizers. Therefore, our aim is threefold: (1) to construct an articulated statistical shape model of the normal DTFJ with the inclusion of ligamentous morphometry, (2) to investigate the effect of weight-bearing on the DTFJ alignment, and (3) to detect differences in predicted syndesmotic ligament length of patients with syndesmotic lesions with respect to normative data. Training data comprised non-weight-bearing CT scans from asymptomatic controls (N = 76), weight-bearing CT scans from patients with syndesmotic ankle injury (N = 13), and their weight-bearing healthy contralateral side (N = 13). Path and length of the syndesmotic ligaments were predicted using a discrete element model, wrapped around bony contours. Statistical shape model evaluation was based on accuracy, generalization, and compactness. The predicted ligament length in patients with syndesmotic lesions was compared with healthy controls. With respect to the first aim, our presented skeletal shape model described the training data with an accuracy of 0.23 ± 0.028 mm. Mean prediction accuracy of ligament insertions was 0.53 ± 0.12 mm. In accordance with the second aim, our results showed an increased tibiofibular diastasis in healthy ankles after weight-bearing. Concerning our third aim, a statistically significant difference in anterior syndesmotic ligament length was found between ankles with syndesmotic lesions and healthy controls (p = 0.017). There was a significant correlation between the presence of syndesmotic injury and the positional alignment between the distal tibia and fibula (r = 0.873, p < 0,001). Clinical Significance: Statistical shape modeling combined with patient-specific ligament wrapping techniques can facilitate the diagnostic workup of syndesmosic ankle lesions under weight-bearing conditions. In doing so, an increased anterior tibiofibular distance was detected, corresponding to an "anterior open-book injury" of the ankle syndesmosis as a result of anterior inferior tibiofibular ligament elongation/rupture.
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Affiliation(s)
- Matthias Peiffer
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Arne Burssens
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Sophie De Mits
- Department of Reumatology, Ghent University Hospital, Ghent, Belgium.,Department of Podiatry, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Thibault Heintz
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium
| | | | - Kris Buedts
- Department of Orthopaedics, ZNA Middelheim, Antwerpen, Belgium
| | - Jan Victor
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Emmanuel Audenaert
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Electromechanics, Op3Mech Research Group, University of Antwerp, Antwerp, Belgium
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36
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Spindler FT, Gaube FP, Böcker W, Polzer H, Baumbach SF. Compensation of Dynamic Fixation Systems in the Quality of Reduction of Distal Tibiofibular Joint in Acute Syndesmotic Complex Injuries: A CT-Based Analysis. Foot Ankle Int 2022; 43:1393-1401. [PMID: 35942915 PMCID: PMC9643819 DOI: 10.1177/10711007221115193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is an ongoing discussion on how to best stabilize syndesmotic injuries. Previous studies have indicated a better quality of reduction of the distal tibiofibular joint (DTFJ) for the suture button systems compared to syndesmotic screw fixation. Still, the reason for this superiority remains unclear. The aims of this retrospective study were to (1) analyze the deviation of the tibial and fibular drilling tunnels of the suture button system and (2) to compare these to the quality of reduction of the DTFJ assessed on bilateral postoperative CT images. METHODS Included were all adult patients who underwent syndesmotic stabilization for an acute injury using a suture button system, with postoperative, bilateral CT imaging over a 10-year period. A total of 147 patients were eligible. Based on individually reconstructed axial CT slices, the postoperative quality of reduction of the DTFJs was rated on bilateral CT images. Furthermore, the rotation and translation of the suture button drilling tunnels were analyzed. Based on these measurements, the intraoperative reduction of the DTFJ was recalculated and again rated. Using these values, the correction potential of suture button systems on the reduction of the DTFJ was analyzed. RESULTS (1) The drilling tunnel deviated considerably for both rotation |2.3±2.1 degrees| (range: |0.0-13.1 degrees|) and translation |0.9±0.8 mm| (range: |0-4.3 mm|). Based on the deviation of the drilling tunnels in fibula and tibia, the calculated intraoperative reduction of the DTFJ was classified as malreduced in 35.4%. (2) The DTFJ was postoperatively identified as malreduced in 17% of patients. Overall, the suture button system tended to compensate toward a more anatomical reduction both in the axial and sagittal plane. CONCLUSION A suture button system postoperatively deviates and apparently has the capacity to compensate for intraoperative malreduction. Analysis of the drilling tunnels revealed that the use of a rigid fixation system would have doubled the postoperative malreduction rate.
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Affiliation(s)
- Fabian T. Spindler
- Department of Orthopaedics and Trauma
Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU
Munich, Munich, Germany
| | - Federico P. Gaube
- Department of Orthopaedics and Trauma
Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU
Munich, Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma
Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU
Munich, Munich, Germany
| | - Hans Polzer
- Department of Orthopaedics and Trauma
Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU
Munich, Munich, Germany,Hans Polzer, MD, Department of Orthopaedics
and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University
Hospital, LMU Munich, Ziemssenstraße 5, Munich, 80336, Germany.
| | - Sebastian F. Baumbach
- Department of Orthopaedics and Trauma
Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU
Munich, Munich, Germany
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37
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Hao KA, Vander Griend RA, Nichols JA, Reb CW. Intraoperative Assessment of Reduction of the Ankle Syndesmosis. Curr Rev Musculoskelet Med 2022; 15:344-352. [PMID: 35829893 DOI: 10.1007/s12178-022-09769-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Postoperative malreduction of the ankle syndesmosis is common, poorly defined, and its assessment is controversial. In the absence of a gold standard method to evaluate the ankle syndesmosis, a variety of techniques have been described. As the knowledgebase expands, data illustrating caveats for such techniques has become available. The purpose of this review is to highlight literature-sourced technical pearls and their related caveats for the intraoperative assessment of the ankle syndesmosis. RECENT FINDINGS Although numerical criteria are commonly used to assess syndesmotic reduction, anatomical variation in the healthy population frequently exceeds proposed cutoffs. Patient-specific uninjured anatomy can be defined by comparing to the uninjured contralateral ankle; however, side-to-side variation is present for many anatomical relationships. Advanced imaging (e.g., lateral radiographs, 3-dimensional radiography) can influence intraoperative surgeon decision-making and improve syndesmosis reduction, but minute improvements in syndesmosis reduction may not outweigh increased operating time and costs. Intraoperative imaging is an adjunct, not a replacement for direct visualization or palpation when reducing the syndesmosis. Arthroscopy may benefit younger patients with high physical demands by improving identification of intra-articular pathology absent on MRI. Although anatomical reduction is important to restore pre-injury biomechanics, it is unclear whether differences in reduction quality influence patient-reported outcomes. In the absence of a gold standard, awareness of the options for intraoperative assessment of the syndesmosis and their respective accuracy and limitations reported herein could enhance surgeons' ability to intraoperatively reduce the syndesmosis with the tools currently available.
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Affiliation(s)
- Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Robert A Vander Griend
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Jennifer A Nichols
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Christopher W Reb
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, 500 University Dr., Hershey, PA, 17033, USA.
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Wu CC, Yeh WL, Lee PC, Chou YC, Hsu YH, Yu YH. Should Diastatic Syndesmosis be Stabilized in Advanced Pronation-External Rotation Ankle Injuries? A Retrospective Cohort Comparison. Orthop Surg 2022; 14:1447-1456. [PMID: 35698255 PMCID: PMC9251295 DOI: 10.1111/os.13331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/29/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE With or without screw stabilization for diastatic syndesmosis in advanced pronation-external rotation (PE) ankle injuries has not yet been well-determined. Both techniques were retrospectively compared to investigate the superiority of either of the two. METHODS A retrospective cohort study was carried out. From January 1, 2008, to December 31, 2017, 81 consecutive adult patients (average, 42 years; range, 18-78 years; 44 men and 37 women) with advanced PE ankle injuries (stage 3 or 4 PE type) were treated. After malleolar fractures were internally stabilized with screws and plates, the syndesmotic stability was rechecked by external rotation and hook tests. The necessity of cortical screw insertion to stabilize diastatic syndesmosis was decided by the individual orthopaedic surgeon. Postoperatively, a short leg splint was used for 6 weeks. The syndesmotic screw was removed based on the surgeon's policy. The removal of internal fixation for malleolar fractures was required after 1 year. The outcomes of both approaches were compared clinically, and ankle function was compared using the American Orthopaedic Foot and Ankle Society (AOFAS) score. For statistical comparison, the chi-square test was used for categorical data and the Mann-Whitney U test was used for numerical data. RESULTS Seventy-one patients (average, 40 years; range, 18-78 years; 40 men and 31 women) were followed for at least 1 year (87.7%; average, 2 years; range, 1-11 years). Group 1 (with syndesmotic stabilization) had 22 patients and Group 2 (without syndesmotic stabilization), 49 patients. The union rate in Group 1 patients was 100% (22/22), and in Group 2 patients, 91.8% (45/49; p = 0.17). One deep wound infection occurred in Group 1 patients and two in Group 2 patients. Syndesmosis re-diastasis occurred in 13.6% (3/22) of Group 1 patients and 30.6% (15/49) of Group 2 patients (p = 0.13). One syndesmotic screw broke at 6 months. Satisfactory ankle function according to the AOFAS score was noted in 86.4% (19/22) of Group 1 patients and 65.3% (32/49) of Group 2 patients (p = 0.07). CONCLUSION Insertion of syndesmotic screws to promote ligament healing after internal fixation of malleolar fractures in advanced PE ankle injuries may be reasonable.
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Affiliation(s)
- Chi-Chuan Wu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan, China
| | - Wen-Ling Yeh
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan, China
| | - Po-Cheng Lee
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan, China
| | - Ying-Chao Chou
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan, China
| | - Yung-Heng Hsu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan, China
| | - Yi-Hsun Yu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan, China
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39
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Marchi D, Rimoldi A, García‐Martínez D, Bastir M. Morphological correlates of distal fibular morphology with locomotion in great apes, humans, and Australopithecus afarensis. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 178:286-300. [PMID: 36790753 PMCID: PMC9314891 DOI: 10.1002/ajpa.24507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/15/2022] [Accepted: 02/22/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Recent studies highlighted the importance of the fibula to further our understanding of locomotor adaptations in fossil hominins. In this study, we present a three-dimensional geometric morphometric (3D-GM) investigation of the distal fibula in extant hominids and Australopithecus afarensis with the aim of pointing out morphological correlations to arboreal behavior. METHODS Three-dimensional surface meshes of the distal fibula were obtained using computer tomography for 40 extant hominid specimens and laser scanner for five A. afarensis specimens. Distal fibula morphology was quantified positioning 11 fixed landmarks, 40 curve semilandmarks, and 20 surface landmarks on each specimen. A generalized Procrustes analysis (GPA) was carried out on all landmark coordinates followed by Procrustes ANOVA. Principal component analysis (PCA) was performed on the GPA-aligned shape coordinates. Kruskal-Wallis tests and Mann-Whitney test were performed on scores along PCs. RESULTS Great apes are characterized by a shorter subcutaneous triangular surface (STS), more downward facing fibulotalar articular facets, more anteriorly facing lateral malleolus and wider/deeper malleolar fossa than humans. Within great apes, orangutans are characterized by more medially facing fibulotalar articular facets. Australopithecus afarensis shows a unique distal fibular morphology with several traits that are generally associated more to arboreality and less to bipedalism such as a short STS, a more anteriorly facing, laterally pointing malleolus and deeper and larger malleolar fossa. CONCLUSIONS The distal fibula morphology is indicative of locomotor patterns within extant hominids. The 3D-GM method presented here can be successfully used to further our understanding of arboreal adaptations in fossil hominins.
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Affiliation(s)
- Damiano Marchi
- Department of BiologyUniversity of PisaPisa
- Centre for the Exploration of the Deep Human JourneyUniversity of the WitwatersrandWits
| | | | - Daniel García‐Martínez
- Centre for the Exploration of the Deep Human JourneyUniversity of the WitwatersrandWits
- Centro Nacional de Investigación sobre la Evolución Humana (CENIEH)BurgosSpain
- Paleoanthropology GroupMuseo Nacional de Ciencias Naturales (MNCN‐CSIC)MadridSpain
| | - Markus Bastir
- Centre for the Exploration of the Deep Human JourneyUniversity of the WitwatersrandWits
- Paleoanthropology GroupMuseo Nacional de Ciencias Naturales (MNCN‐CSIC)MadridSpain
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40
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Kang L, Helms E, Broadhead M. Bilateral ankle syndesmosis injury: a rare case report. Orthop Rev (Pavia) 2022. [DOI: 10.52965/001c.35494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This report describes a case of bilateral acute ankle syndesmosis injuries in a 15-year-old male basketball player. The patient had a background of previous inversion injuries but no symptoms of chronic pain or instability. The case report illustrates the importance of clinical suspicion when evaluating acute syndesmosis injuries in conjunction with radiographic assessments in primary care. This is the first reported case of such injury in bilateral limbs.
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41
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Kang L, Helms E, Broadhead M. Bilateral ankle syndesmosis injury: a rare case report. Orthop Rev (Pavia) 2022; 14:35494. [PMID: 35769662 PMCID: PMC9235416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 05/03/2022] [Indexed: 06/15/2023] Open
Abstract
This report describes a case of bilateral acute ankle syndesmosis injuries in a 15-year-old male basketball player. The patient had a background of previous inversion injuries but no symptoms of chronic pain or instability. The case report illustrates the importance of clinical suspicion when evaluating acute syndesmosis injuries in conjunction with radiographic assessments in primary care. This is the first reported case of such injury in bilateral limbs.
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42
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Ng N, Onggo JR, Nambiar M, Maingard JT, Ng D, Gupta G, Nandurkar D, Babazadeh S, Bedi H. Which test is the best? An updated literature review of imaging modalities for acute ankle diastasis injuries. J Med Radiat Sci 2022; 69:382-393. [PMID: 35504849 PMCID: PMC9442321 DOI: 10.1002/jmrs.589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 03/02/2022] [Accepted: 04/02/2022] [Indexed: 11/17/2022] Open
Abstract
Ankle diastasis injuries, or ankle syndesmotic injuries, are common among athletes who usually experience a traumatic injury to the ankle. Long‐term complications are avoidable when these injuries are diagnosed promptly and accurately treated. Whilst ankle arthroscopy remains the gold standard diagnostic modality for ankle diastasis injuries, imaging modalities are still widely utilised due to the treatment having greater accessibility, being less invasive and the most cost effective. There are various imaging modalities used to diagnose diastasis injuries, varying in levels of specificity and sensitivity. These observation methods include; X‐ray, computed tomography (CT), magnetic resonance imaging (MRI) and ankle arthroscopy. This article uncovers common criteria and parameters to diagnose diastasis injuries through the implementation of different imaging modalities. The conclusions addressed within this article are deduced from a total of 338 articles being screened with only 43 articles being selected for the purposes of this examination. Across most articles, it was concluded that that plain X‐ray should be used in the first instance due to its wide availability, quick processing time, and low cost. CT is the next recommended investigation due to its increased sensitivity and specificity, ability to show the positional relationship of the distal tibiofibular syndesmosis, and reliability in detecting minor diastasis injuries. MRI is recommended when ankle diastasis injuries are suspected, but not diagnosed on previous imaging modalities. It has the highest sensitivity and specificity compared to X‐ray and CT.
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Affiliation(s)
- Nico Ng
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | - James Randolph Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Mithun Nambiar
- Monash Imaging, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | | | - David Ng
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | - Gaurav Gupta
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | - Dee Nandurkar
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | - Sina Babazadeh
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Harvinder Bedi
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
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43
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Peiffer M, Burssens A, Duquesne K, Last M, De Mits S, Victor J, Audenaert EA. Personalised statistical modelling of soft tissue structures in the ankle. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 218:106701. [PMID: 35259673 DOI: 10.1016/j.cmpb.2022.106701] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 01/20/2022] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Revealing the complexity behind subject-specific ankle joint mechanics requires simultaneous analysis of three-dimensional bony and soft-tissue structures. 3D musculoskeletal models have become pivotal in orthopedic treatment planning and biomechanical research. Since manual segmentation of these models is time-consuming and subject to manual errors, (semi-) automatic methods could improve the accuracy and enlarge the sample size of personalised 'in silico' biomechanical experiments and computer-assisted treatment planning. Therefore, our aim was to automatically predict ligament paths, cartilage topography and thickness in the ankle joint based on statistical shape modelling. METHODS A personalised cartilage and ligamentous prediction algorithm was established using geometric morphometrics, based on an 'in-house' generated lower limb skeletal model (N = 542), tibiotalar cartilage (N = 60) and ankle ligament segmentations (N = 10). For cartilage, a population-averaged thickness map was determined by use of partial least-squares regression. Ligaments were wrapped around bony contours based on iterative shortest path calculation. Accuracy of ligament path and cartilage thickness prediction was quantified using leave-one-out experiments. The novel personalised thickness prediction was compared with a constant cartilage thickness of 1.50 mm by use of a paired sample T-test. RESULTS Mean distance error of cartilage and ligament prediction was 0.12 mm (SD 0.04 mm) and 0.54 mm (SD 0.05 mm), respectively. No significant differences were found between the personalised thickness cartilage and segmented cartilage of the tibia (p = 0.73, CI [-1.60 .10-17, 1.13 .10-17]) and talus (p = 0.95, CI[ -1.35 .10-17, 1.28 .10-17]). For the constant thickness cartilage, a statistically significant difference was found in 89% and 92% of the tibial (p < 0.001, CI [0.51, 0.58]) and talar (p < 0.001, CI [0.33, 0.40]) cartilage area. CONCLUSIONS In this study, we described a personalised prediction algorithm of cartilage and ligaments in the ankle joint. We were able to predict cartilage and main ankle ligaments with submillimeter accuracy. The proposed method has a high potential for generating large (virtual) sample sizes in biomechanical research and mitigates technological advances in computer-assisted orthopaedic surgery.
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Affiliation(s)
- M Peiffer
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium; Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, Ghent 9000, Belgium.
| | - A Burssens
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium; Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - K Duquesne
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - M Last
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - S De Mits
- Department of Reumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium; Department of Podiatry, Artevelde University of Applied Sciences, Voetweg 66, Ghent 9000, Belgium
| | - J Victor
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium; Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - E A Audenaert
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium; Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, Ghent 9000, Belgium; Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; Department of Electromechanics, Op3Mech research group, University of Antwerp, Groenenborgerlaan 171, 2020, Antwerp, Belgium
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44
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Kurokawa H, Kosugi S, Fujinuma T, Oishi Y, Miyamoto T, Taniguchi A, Takemura H, Tanaka Y. Evaluation of Subtalar Joint’s Compensatory Function in Varus Ankle Osteoarthritis Using Globally Optimal Iterative Closest Points (Go-ICP). FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221103584. [PMID: 35782686 PMCID: PMC9247379 DOI: 10.1177/24730114221103584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: A previous study on 2-dimensional evaluation of the subtalar joint
functioning in varus ankle osteoarthritis concluded that varus deformity was
compensated for by the subtalar joint during early stages but not in the
advanced stages. Although compensatory function is expected both along the
axial and coronal planes, compensatory function in all 3 dimensions (3D)
remains unevaluated. This study evaluated the 3D-compensatory function of a
varus subtalar joint using Globally Optimal Iterative Closest Points
(Go-ICP), a 3D-shape registration algorithm, after 3D-bone shape
reconstruction using computed tomography. Methods: This study included 22 ankles: 4 stage 2 ankles, 5 stage 3a ankles, 6 stage
3b ankles, and 4 stage 4 ankles, categorized according to the
Takakura-Tanaka classification. As the control group, 3 ankles without prior
ankle injuries and disorders and 4 stage 2 ankles were included. One control
ankle was used as a reference. Relative values compared with the reference
ankle were evaluated in each group using Go-ICP. Each axis was set so that
dorsiflexion, valgus, and abduction were positive on the X axis, Y axis, and
Z axis, respectively. Results: Rotation angles of the talus (Rotation T) and calcaneus (Rotation C) on the Y
axis in the control and stage 3b were −7.6, −28, −2.1, and −13 degrees,
respectively, indicating significant differences. Value of Rotation
T-Rotation C (Rotation T-C) represents compensatory function of the subtalar
joint. In all ankles, there was a correlation between Rotation T and
Rotation T-C on the Y axis and Z axis (P < .01,
r = 0.84; P < .01, r
= −0.84, respectively). There was a correlation between
Rotation T values on the on Y and Z axes (P = .01,
r = 0.53). Conclusion: In varus ankle osteoarthritis, the talus had varus deformity with adduction.
Compensatory function in the coronal plane persisted, even in the advanced
stages; however, it was not sufficiently maintained in stage 3b.
Furthermore, compensatory function in the axial plane was relatively
sustained. Level of Evidence: Level III, retrospective comparative study.
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Affiliation(s)
| | | | | | - Yuya Oishi
- Tokyo University of Science, Noda, Chiba, Japan
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45
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Wever S, Schellinkhout S, Workman M, McCollum GA. Syndesmosis injuries in professional rugby players: associated injuries and complications can lead to an unpredictable time to return to play. J ISAKOS 2022; 7:66-71. [DOI: 10.1016/j.jisako.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/20/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
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Chan LYT, Heng HYC, Kon Kam King C. Investigating the Radiological Outcomes of Syndesmosis Injuries in Ankle Fracture Patients After Suture Button Fixation. J Foot Ankle Surg 2022; 61:350-354. [PMID: 34657805 DOI: 10.1053/j.jfas.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/08/2021] [Indexed: 02/03/2023]
Abstract
Concomitant syndesmotic injury occurs in 10% of ankle fractures. Anatomic reduction and maintenance of this reduction is critical in ensuring ankle stability and preventing long-term complications. This is a retrospective cohort study aimed at evaluating the mid-term radiological outcomes of syndesmotic injuries in ankle fracture patients after surgical fixation with suture button device. The study group included 33 patients. Plain radiographs including anteroposterior, lateral and mortise views of the affected ankle were performed preoperatively, postoperatively and at 3-month follow-up. Anteroposterior views were used to measure the amount of tibiofibular overlap and tibiofibular clear space. Paired Student's t test and linear model regression were performed. Between the immediate postoperative and 3-month follow-up period, there was a mean decrease in tibiofibular overlap of 0.841 (±2.07) mm (p = .0259). There was a mean increase in tibiofibular clear space of 0.621 (±1.46) mm (p = .0201). In addition, we found significant correlation between fracture type and change in tibiofibular clear space (p = .047). Our study showed that there is statistically significant widening of the syndesmosis after suture button fixation at 3-month follow-up as evidenced by reduced tibiofibular overlap and increase in tibiofibular clear space. However, they remain within the maximum threshold for acceptable syndesmotic widening of 1.5 mm. Further correlation between radiological outcomes and patient function is needed to determine clinical significance of these changes.
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Affiliation(s)
- Li Yi Tammy Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | | | - Charles Kon Kam King
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore
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Zeng J, Xu C, Xu G, Wang D, Zhang W, Li H, Gan X, Xiong Y, Li J, Zhang L, Tang P. The Global Status of Research in Ankle Fracture: A Bibliometric and Visualized Study. Front Surg 2022; 9:853101. [PMID: 35360430 PMCID: PMC8963901 DOI: 10.3389/fsurg.2022.853101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Ankle fractures are common lower extremity fractures that pose a significant economic and social burden. This study analyzed the ankle fracture research literature between 2000 and 2021 to clarify the current status of ankle fracture research and predict future research trends. Methods Publications related to ankle fractures published between 2000 and 2021 were retrieved from the Web of Science Core Collection. Then Bibliometric analysis and Visualized Study were performed by VOSviewer software. Results A total of 2656 publications were retrieved. The number of publications related to ankle fractures is increasing every year. The top countries and journals in terms of the total number of publications, number of citations, and H-index ranking were USA and foot and ankle int. Lorich DG had the most publications in this field. University of Amsterdam's research group had the biggest number of publications in this field. Co-occurrence analysis clustered the keywords into seven clusters: survival analysis and prognosis study, internal fixation treatment study, treatment study of combined deltoid ligament rupture, treatment study of combined inferior tibiofibular ligament injury, treatment study of posterior ankle fracture, treatment study of postoperative traumatic arthritis of ankle fracture, and treatment study of ankle injury in children. Conclusions The importance of ankle fractures is increasing year by year with the aging process, and the number of publications related to ankle fractures will not continue to increase in the future. Survival and prognosis studies, internal fixation studies, combined deltoid ligament rupture studies, and combined inferior tibiofibular ligament injury studies may become the future research hotspots in the field of ankle fractures.
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Affiliation(s)
- Jianshuang Zeng
- School of Medicine, Nankai University, Tianjin, China
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Cheng Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Gaoxiang Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Daofeng Wang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Wupeng Zhang
- School of Medicine, Nankai University, Tianjin, China
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Hua Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Xuewen Gan
- Department of Orthopedics, Kunming Medical University, Yanan Hospital, Kunming, China
| | - Ying Xiong
- Department of Orthopedics, Kunming Medical University, Yanan Hospital, Kunming, China
| | - Jiantao Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
- Jiantao Li
| | - Licheng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
- Licheng Zhang
| | - Peifu Tang
- School of Medicine, Nankai University, Tianjin, China
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
- *Correspondence: Peifu Tang
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Gadomski BC, Labus KM, Stewart HL, Bisazza KT, Nelson BB, Puttlitz CM, McGilvray KC, Regan DP, Easley JT. A Large Animal Model for Orthopedic Foot and Ankle Research. Front Vet Sci 2022; 9:816529. [PMID: 35187145 PMCID: PMC8850350 DOI: 10.3389/fvets.2022.816529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
Trauma to the soft tissues of the ankle joint distal syndesmosis often leads to syndesmotic instability, resulting in undesired movement of the talus, abnormal pressure distributions, and ultimately arthritis if deterioration progresses without treatment. Historically, syndesmotic injuries have been repaired by placing a screw across the distal syndesmosis to provide rigid fixation to facilitate ligament repair. While rigid syndesmotic screw fixation immobilizes the ligamentous injury between the tibia and fibula to promote healing, the same screws inhibit normal physiologic movement and dorsiflexion. It has been shown that intact screw removal can be beneficial for long-term patient success; however, the exact timing remains an unanswered question that necessitates further investigation, perhaps using animal models. Because of the sparsity of relevant preclinical models, the purpose of this study was to develop a new, more translatable, large animal model that can be used for the investigation of clinical foot and ankle implants. Eight (8) skeletally mature sheep underwent stabilization of the left and right distal carpal bones following transection of the dorsal and interosseous ligaments while the remaining two animals served as un-instrumented controls. Four of the surgically stabilized animals were sacrificed 6 weeks after surgery while the remaining four animals were sacrificed 10 weeks after surgery. Ligamentous healing was evaluated using radiography, histology, histomorphometry, and histopathology. Overall, animals demonstrated a high tolerance to the surgical procedure with minimal complications. Animals sacrificed at 10 weeks post-surgery had a slight trend toward mildly decreased inflammation, decreased necrotic debris, and a slight increase in the healing of the transected ligaments. The overall degree of soft tissue fibrosis/fibrous expansion, including along the dorsal periosteal surfaces/joint capsule of the carpal bones was very similar between both timepoints and often exhibited signs of healing. The findings of this study indicate that the carpometacarpal joint may serve as a viable location for the investigation of human foot and ankle orthopedic devices. Future work may include the investigation of orthopedic foot and ankle medical devices, biologic treatments, and repair techniques in a large animal model capable of providing translational results for human treatment.
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Affiliation(s)
- Benjamin C. Gadomski
- Orthopedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO, United States
- *Correspondence: Benjamin C. Gadomski
| | - Kevin M. Labus
- Orthopedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO, United States
| | - Holly L. Stewart
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Katie T. Bisazza
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Brad B. Nelson
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Christian M. Puttlitz
- Orthopedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO, United States
| | - Kirk C. McGilvray
- Orthopedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, CO, United States
| | - Daniel P. Regan
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, United States
| | - Jeremiah T. Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
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Gilbertson JA, Sweet MC, Weistroffer JK, Jastifer JR. Articular Cartilage of the Syndesmosis: Avoiding Iatrogenic Cartilage Injury During Syndesmotic Fixation. Foot Ankle Int 2022; 43:186-192. [PMID: 34493113 DOI: 10.1177/10711007211041325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal surgical management of syndesmosis injuries consists of internal fixation between the distal fibula and tibia. Much of the available data on this joint details the anatomy of the syndesmotic ligaments. Little is published evaluating the distribution of articular cartilage of the syndesmosis, which is of importance to minimize the risk of iatrogenic damage during surgical treatment. The purpose of this study is to describe the articular cartilage of the syndesmosis. METHODS Twenty cadaveric ankles were dissected to identify the cartilage of the syndesmosis. Digital images of the articular cartilage were taken and measured using calibrated digital imaging software. RESULTS On the tibial side, distinct articular cartilage extending above the plafond was identified in 19/20 (95%) specimens. The tibial cartilage extended a mean of 6 ± 3 (range, 2-13) mm above the plafond. On the fibular side, 6/20 (30%) specimens demonstrated cartilage proximal to the talar facet, which extended a mean of 24 ± 4 (range, 20-31) mm above the tip of the fibula. The superior extent of the syndesmotic recess was a mean of 10 ± 3 (range, 5-17) mm in height. In all specimens, the syndesmosis cartilage did not extend more than 13 mm proximal to the tibial plafond and the syndesmotic recess did not extend more than 17 mm proximal to the tibial plafond. CONCLUSION Syndesmosis fixation placed more than 13 mm proximal to the tibial plafond would have safely avoided the articular cartilage in all specimens and the synovial-lined syndesmotic recess in most. CLINICAL RELEVANCE This study details the articular anatomy of the distal tibiofibular joint and provides measurements that can guide implant placement during syndesmotic fixation to minimize the risk of iatrogenic cartilage damage.
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Affiliation(s)
- Jeffrey A Gilbertson
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Matthew C Sweet
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Joseph K Weistroffer
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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Zhang Q, Zhang Y, Huang J, Teo EC, Gu Y. Effect of Displacement Degree of Distal Chevron Osteotomy on Metatarsal Stress: A Finite Element Method. BIOLOGY 2022; 11:127. [PMID: 35053125 PMCID: PMC8772834 DOI: 10.3390/biology11010127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The stress of foot bone can effectively evaluate the functional damage caused by foot deformity and the results of operation. In this study, the finite element method was used to investigate the degree of displacement of distal chevron osteotomy on metatarsal stress and metatarsophalangeal joint load; Methods: Four finite element models of displacement were established by using the CT images of a patient with moderate hallux valgus (hallux valgus angle and intermetatarsal angle were 26.74° and 14.09°, respectively), and the validity of the model was verified. Each finite element model consisted of bones and various cartilage structures, ligaments, and plantar fascia, as well as encapsulated soft tissue. Except for soft tissue, the material properties of other parts were isotropic linear elastic material, and the encapsulated soft tissue was set as nonlinear hyperelastic material. The mesh was tetrahedral mesh. Link elements were used in ligament and plantar fascia. A ground reaction force with a half-body weight was applied at the bottom of the floor to simulate the ground reaction when standing. The upper surfaces of the encapsulated soft tissue, distal tibia, and distal fibula were fixed. The stress distribution of metatarsals and the stress of cartilage of the first metatarsophalangeal joint were compared and analyzed; Results: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2-4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance; Conclusions: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2-4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance. For the degree of displacement of the distal chevron osteotomy, the postoperative stability and the stress distribution of metatarsal bone should be considered. Factors such as hallux valgus angle, intermetatarsal angle, patient's age, body weight, and metatarsal width should be considered comprehensively. The factors affecting osteotomy need to be further explored. The degree of displacement of osteotomy can be evaluated by FE method before the operation, and the most suitable distance can be obtained.
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Affiliation(s)
- Qiaolin Zhang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
| | - Yan Zhang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
| | - Jialu Huang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
| | - Ee Chon Teo
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
- Faculty of Engineering, University of Szeged, 6720 Szeged, Hungary
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