The effects of total ankle replacement on ankle joint mechanics during walking

Evidence for symmetrically reduced foot mechanics and energetics in patients after trimalleolar fracture repair: A cross-sectional study

BACKGROUND

Trimalleolar fractures osteosynthesis is associated with a suboptimal outcome. It is hypothesized that patients with trimalleolar fractures face different ankle joint kinetics at mid- and long-term causing compensations at the distal foot joints.

RESEARCH QUESTION

Do patients with a history of a trimalleolar fracture demonstrate different foot joint mechanics and energetics (1) between their affected side and their matched controls? (2) between their unaffected side and their matched controls? (3) between their affected side and their unaffected side?

METHODS

Fifteen patients who sustained a trimalleolar fracture and underwent osteosynthesis for both the lateral, medial and posterior malleolus were compared to a asymptomatic control group which was matched for sex, age and walking speed. Three-dimensional gait analysis was used to quantify kinetic parameters in the Ankle, Chopart, Lisfranc and first metatarsophalangeal joint through a multi-segment kinetic foot model. Statistical analysis was performed using a Univariate Analysis of Covariance and/or a paired t-test.

RESULTS

The peak internal ankle moment was significantly lower in patients when compared to the control group (p < 0.001). Mean peak power generation and total positive work were significantly lower for the Chopart joint when comparing the patients to the control group (p < 0.001). These results were observed for both the affected and unaffected side of the patients compared to the control group, showing symmetrical changes in the patient group.

SIGNIFICANCE

Despite adequate radiographic quality of reduction and the fact that all patients were treated according to a fixed postoperative protocol, this study indicates that patients with a history of a trimalleolar fracture demonstrate reduced foot joint kinetics. It is hypothesized that these findings originate from extrinsic and intrinsic foot muscle strength, stiffness and pain. Future research is needed to validate this hypothesis.

Comparison of Ma-Griffith combined with a minimally invasive small incision to a modified suture technique for the treatment of acute achilles tendon ruptures

Background

The Achilles tendon is the strongest tendon in the human body, although it is also prone to injury and rupture. Currently, the best treatment method for acute Achilles tendon rupture remains controversial. The aim of this study was to compare the efficacy of the Ma-Griffith method combined with a minimally invasive small incision (M-G/MISI) with the modified suture technique (MST).

Methods

We conducted a retrospective review of the medical records of all patients who underwent treatment for acute Achilles tendon rupture between January 2012 and January 2020 at our hospital. Demographic characteristics, operative details, and postoperative complications were recorded, and data were statistically analyzed to compare the treatment efficacy of the two operative methods.

Results

A total of 67 patients were enrolled in the study, 34 of whom underwent M-G/MISI treatment, and 33 of whom underwent MST treatment. The intraoperative blood loss in the M-G/MISI group (16.47 ± 13.23 ml) was significantly lower than that in the MST group (34.55 ± 13.01 ml), and the difference was statistically significant (P ˂0.001). The incision in the M-G/MISI group (3.79 ± 1.81 cm) was significantly shorter than that in the MST group (5.79 ± 1.00 cm), and the difference was statistically significant (P˂0.001). The Achilles tendon rupture score and the American Orthopedic Foot and Ankle Society (AOFAS) score were higher than those of the MST group at the sixth month after the operation (P˂0.001). Postoperatively, there was 1 case of traumatic Achilles tendon rupture in the M-G/MISI group and 1 case each of infection and deep vein thrombosis in the modified suture group.

Conclusions

Compared with the MST group, the M-G/MISI group had better Achilles tendon and ankle function scores at 6 months postoperatively, and less bleeding and shorter incisions. M-G/MISI is less invasive than MST.

In Silico Finite Element Analysis of the Foot Ankle Complex Biomechanics: A Literature Review

Computational approaches, especially finite element analysis (FEA), have been rapidly growing in both academia and industry during the last few decades. FEA serves as a powerful and efficient approach for simulating real-life experiments, including industrial product development, machine design, and biomedical research, particularly in biomechanics and biomaterials. Accordingly, FEA has been a "go-to" high biofidelic software tool to simulate and quantify the biomechanics of the foot-ankle complex, as well as to predict the risk of foot and ankle injuries, which are one of the most common musculoskeletal injuries among physically active individuals. This paper provides a review of the in silico FEA of the foot-ankle complex. First, a brief history of computational modeling methods and finite element (FE) simulations for foot-ankle models is introduced. Second, a general approach to build an FE foot and ankle model is presented, including a detailed procedure to accurately construct, calibrate, verify, and validate an FE model in its appropriate simulation environment. Third, current applications, as well as future improvements of the foot and ankle FE models, especially in the biomedical field, are discussed. Finally, a conclusion is made on the efficiency and development of FEA as a computational approach in investigating the biomechanics of the foot-ankle complex. Overall, this review integrates insightful information for biomedical engineers, medical professionals, and researchers to conduct more accurate research on the foot-ankle FE models in the future.

Exercise and Osteoarthritis

Osteoarthritis (OA) is a degenerative disease of the articular cartilage with subchondral bone lesions. Osteoarthritis etiologies are mainly related to age, obesity, strain, trauma, joint congenital anomalies, joint deformities, and other factors. Osteoarthritis seriously affects the quality of life; however, there is no effective way to cure osteoarthritis. Aerobic exercise refers to a dynamic rhythmic exercise involving the large muscle groups of the body with aerobic metabolism. More and more evidence shows that exercise has become a useful tool for the treatment of osteoarthritis. This chapter will discuss the role of exercise in the prevention and treatment of osteoarthritis.

Age-related changes in proprioception of the ankle complex across the lifespan

BACKGROUND

Ankle complex proprioceptive ability, needed in active human movement, may change from childhood to elderly adulthood; however, its development across all life stages has remained unexamined. The aim of the present study was to investigate the across-the-lifespan trend for proprioceptive ability of the ankle complex during active ankle inversion movement.

METHODS

The right ankles of 118 healthy right-handed participants in 6 groups were assessed: children (6-8 years old), adolescents (13-15 years old), young adults (18-25 years old), middle-aged adults (35-50 years old), old adults (60-74 years old), and very old adults (75-90 years old). While the participants were standing, their ankle complex proprioception was measured using the Active Movement Extent Discrimination Apparatus.

RESULTS

There was no significant interaction between the effects of age group and gender on ankle proprioceptive acuity (F (5, 106) = 0.593, p = 0.705, η² _p = 0.027). Simple main effects analysis showed that there was a significant main effect for age group (F (5, 106) = 22.521, p < 0.001, η ² _p = 0.515) but no significant main effect for gender (F (1,106) =  2.283, p = 0.134, η ² _p = 0.021) between the female (0.723 ± 0.092, mean ± SD) and the male (0.712 ± 0.083) participants. The age-group factor was associated with a significant linear downward trend in scores (F (1, 106) = 10.584, p = 0.002, η ² _p = 0.091) and a strong quadratic trend component (F (1,106) = 100.701, p < 0.001, η ² _p = 0.480), producing an asymmetric inverted-U function.

CONCLUSION

The test method of the Active Movement Extent Discrimination Apparatus is sensitive to age differences in ankle complex proprioception. For proprioception of the ankle complex, young adults had significantly better scores than children, adolescents, old adults, and very old adults. The middle-aged group had levels of ankle proprioceptive acuity similar to those of the young adults. The scores for males and females were not significantly different. Examination of the range of the scores in each age group highlights the possible level that ankle complex movement proprioceptive rehabilitation can reach, especially for those 75-90 years of age.

Quantifying clinical misinterpretations associated to one-segment kinetic foot modelling in both a healthy and patient population

BACKGROUND

Rigid foot modelling approaches are still widely used to assess ankle joint kinetics in clinical biomechanical research. Yet, studies on healthy subjects using multi-segment kinetic foot models indicated that one-segment kinetic foot models tend to overestimate ankle joint kinetic data. Our aim was to compare ankle joint kinetics computed with a one-segment versus a multi-segment kinetic foot model in both asymptomatic and pathological gait. We also assessed whether differences between models can lead to different interpretations in clinical decision-making.

METHODS

A two-factor repeated measure analysis of variance was performed to investigate differences in ankle joint kinetics, with the first factor being group effect (control vs. patients) and second factor being foot model effect (one-segment vs. multi-segment). Minimal detectable change was calculated to assess the clinical relevance of the observed differences in ankle joint kinetics.

FINDINGS

Ankle joint peak kinematic, angular velocity and kinetic variables were all significantly overestimated (P < 0.05) when computed with the one-segment kinetic foot model. Kinetic differences in peak plantarflexion angular velocity and peak power generation were higher than their MDC-values.

INTERPRETATION

Ankle joint kinetics are significantly overestimated when computed with a rigid foot modelling approach in both asymptomatic and pathological gait. This overestimation leads to clinical misinterpretations as MDC-values were less than the observed overestimation. In future studies, it is of clinical relevance to assess ankle joint kinetics with a multi-segment foot modelling approach.