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Obionu K, Palm H, Astrup Y, Lange NB, Krogsgaard MR. A clinical guide to the medial ligaments of the ankle: Anatomy, function, diagnosis of injuries and treatment of instability-a narrative review. Foot Ankle Surg 2024; 30:85-91. [PMID: 37926624 DOI: 10.1016/j.fas.2023.10.010] [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: 10/11/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The aim was to provide an update on anatomy and function of the medial ankle ligaments, diagnosis of their injuries and treatment of medial ankle instability. METHODS Literature search on PubMed. RESULTS Injuries to the deltoid ligament are not uncommon in relation to malleolar fractures and ankle sprains. Chronic instability may lead to ankle osteoarthritis. However, there is no consensus on diagnostic criteria (clinically, by imaging and by arthroscopy), on indications for non-operative and operative treatment, and on standards for repair and reconstruction of the ligament complex. There is no current evidence to support acute repair of deltoid ligament injury. Reports on the effect of isolated deltoid ligament reconstruction are very sparse. CONCLUSION There is a need for a focused effort to establish evidence for all aspects of deltoid ligament injury.
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Affiliation(s)
- Kenneth Obionu
- Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Henrik Palm
- Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Yvette Astrup
- Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Naja Bjørslev Lange
- Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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Rougereau G, Marty-Diloy T, Vigan M, Donadieu K, Hardy A, Vialle R, Langlais T. A Preliminary Study to Assess the Relevance of Shear-Wave Elastography in Characterizing Biomechanical Changes in the Deltoid Ligament Complex in Relation to Ankle Position. Foot Ankle Int 2022; 43:840-849. [PMID: 35373593 DOI: 10.1177/10711007221079829] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was (1) to evaluate the biomechanical properties of the different bundles of the deltoid ligament in various ankle positions in a cohort of healthy adult volunteers; (2) describe the impact of demographic and hindfoot morphology characteristics on their stiffness; (3) to assess the reliability and reproducibility of these measurements. METHODS Deltoid ligament complex of both ankles were assessed by shear-wave elastography (SWE) in 20 healthy patients resting on hinge support. The propagation shear-wave speed (SWS) in ligaments was measured, which is related to the tissue's elastic modulus. The following ligaments were analyzed in a neutral position and then in varus, valgus, dorsal, and plantar flexions: tibionavicular ligament (TNL), tibiocalcaneal ligament (TCL), the superficial posterior tibiotalar ligament (SPTL), the anterior tibiotalar ligament (ATTL), and the deep posterior tibiotalar ligament (DPTTL). RESULTS The mean SWS increased between neutral and 20 degrees valgus position for TCL (4.08 ± 0.78 m/s vs 5.56 ± 0.62 m/s, respectively; P < .0001) and for DPTTL (2.58 ± 0.52 m/s vs 3.59 ± 0.87 m/s, respectively; P < .0001). The mean SWS increased between neutral and 30 degrees plantarflexion for ATTL (2.11 ± 0.44 m/s vs 3.1 ± 0.5 m/s, respectively; P < .0001) and TNL (2.96 ± 0.66 m/s vs 4.99 ± 0.69 m/s, respectively; P < .0001). The mean SWS increased between neutral and 20 degrees dorsal flexion for SPTL (4.2 ± 1 m/s vs 5.45 ± 0.65 m/s, respectively; P < .0001).Women had less DPTTL SWS than men in the neutral position (2.37 ± 0.35 m/s vs 2.71 ± 0.49 m/s, respectively; P = .007). Other demographics had no impact on the SWS value of other ligaments. All inter- and intraobserver agreements were good to excellent. CONCLUSION This study presents a reliable and reproducible SWE measurement protocol to describe the physiological function of all bundles of the medial collateral ligament in healthy adults. CLINICAL RELEVANCE This examination technique can be available to orthopaedic surgeons, allowing reliable and reproducible monitoring of the SWS of the various ligaments constituting the medial collateral plane. The biomechanical values described in this study may give insight into in what position medial ankle ligament reconstruction should be tensioned.
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Affiliation(s)
- Grégoire Rougereau
- Department of Pediatric Orthopedic surgery, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
- Department of Adult Orthopedic surgery, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
| | - Thibault Marty-Diloy
- Department of Pediatric Orthopedic surgery, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Marie Vigan
- Department of Pediatric Orthopedic surgery, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
- Unité de Recherche Clinique Hôpitaux Universitaires Paris Ile-de-France Ouest, APHP, Boulogne-Billancourt, France
| | - Kalinka Donadieu
- Department of Pediatric Orthopedic surgery, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Alexandre Hardy
- Clinique du sport, Department of Orthopedic surgery, Paris, France
| | - Raphaël Vialle
- Department of Pediatric Orthopedic surgery, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
- Department for Innovative Therapies in Musculoskeletal Disease, The MAMUTH Hospital, Sorbonne University, Paris
| | - Tristan Langlais
- Department of Pediatric Orthopedic surgery, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
- Department of Pediatric Orthopedic surgery, Children's hospital, Purpan, Toulouse University, Toulouse, France
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Lühmann P, Kremer T, Siemers F, Rein S. Comparative histomorphological analysis of elbow ligaments and capsule. Clin Anat 2022; 35:1070-1084. [DOI: 10.1002/ca.23913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/23/2022] [Accepted: 05/06/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Paul Lühmann
- Department of Plastic and Hand Surgery with Burn Unit Hospital Sankt Georg Leipzig Germany
| | - Thomas Kremer
- Department of Plastic and Hand Surgery with Burn Unit Hospital Sankt Georg Leipzig Germany
| | - Frank Siemers
- Department of Plastic and Hand Surgery with Burn Unit Trauma Center Bergmannstrost Halle Germany
- Martin‐Luther‐University Halle‐Wittenberg Halle Germany
| | - Susanne Rein
- Department of Plastic and Hand Surgery with Burn Unit Hospital Sankt Georg Leipzig Germany
- Martin‐Luther‐University Halle‐Wittenberg Halle Germany
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Alteration of Ligamento-Muscular Reflex Patterns After Cutaneous and Periarticular Desensitization of the Basal Thumb Joint: An Electromyographic Study. J Hand Surg Am 2022:S0363-5023(22)00025-9. [PMID: 35241318 DOI: 10.1016/j.jhsa.2022.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/16/2021] [Accepted: 01/11/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Stimulation of the dorsoradial ligament (DRL) of the first carpometacarpal joint (CMC-1) has shown a ligamento-muscular reflex pathway between the DRL and CMC-1 stabilizing muscles in healthy volunteers. However, it remains unclear how this ligamento-muscular reflex pattern is altered after anesthetizing sensory skin receptors and administering a further periarticular block around the CMC-1 joint, which may influence the dynamic aspects of joint stability. METHODS Ligamento-muscular reflexes were obtained from the extensor pollicis longus, abductor pollicis longus, abductor pollicis brevis, and the first dorsal interosseous muscles in 10 healthy participants after establishing superficial anesthesia of the skin around the CMC-1. The DRL was stimulated with a fine wire electrode while EMG activities were recorded during isometric tip, key, and palmar pinch. The measurements were repeated after an additional periarticular CMC-1 block using 5 ml of 1% lidocaine. Average EMG values were analyzed to compare the prestimulus and poststimulus activity. RESULTS Statistically significant changes in poststimulus EMG activity were observed in all 4 muscles and all 3 tested thumb positions. A markedly reduced activity in all 4 muscles was observed in the palmar position, followed by the tip and key pinch positions. Almost no reactions were observed in the first 20 ms poststimulus for all muscles in all positions. CONCLUSIONS Superficial skin anesthesia and an additional periarticular CMC-1 block anesthesia resulted in a reduced ligamento-muscular reflex pattern in all 4 muscles. CLINICAL RELEVANCE Ligamento-muscular reflexes play an important role in dynamic CMC-1 joint stability. The elimination of early reactions, those considered joint-protective reflexes, is a potential risk factor for developing osteoarthritis or injury because it results in an inability to adequately protect and stabilize the joint in sudden movements.
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Gwiazda M, Bhardwaj SK, Kijeńska-Gawrońska E, Swieszkowski W, Sivasankaran U, Kaushik A. Impedimetric and Plasmonic Sensing of Collagen I Using a Half-Antibody-Supported, Au-Modified, Self-Assembled Monolayer System. BIOSENSORS-BASEL 2021; 11:bios11070227. [PMID: 34356698 PMCID: PMC8301786 DOI: 10.3390/bios11070227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022]
Abstract
This research presents an electrochemical immunosensor for collagen I detection using a self-assembled monolayer (SAM) of gold nanoparticles (AuNPs) and covalently immobilized half-reduced monoclonal antibody as a receptor; this allowed for the validation of the collagen I concentration through two different independent methods: electrochemically by Electrochemical Impedance Spectroscopy (EIS), and optically by Surface Plasmon Resonance (SPR). The high unique advantage of the proposed sensor is based on the performance of the stable covalent immobilization of the AuNPs and enzymatically reduced half-IgG collagen I antibodies, which ensured their appropriate orientation onto the sensor's surface, good stability, and sensitivity properties. The detection of collagen type I was performed in a concentration range from 1 to 5 pg/mL. Moreover, SPR was utilized to confirm the immobilization of the monoclonal half-antibodies and sensing of collagen I versus time. Furthermore, EIS experiments revealed a limit of detection (LOD) of 0.38 pg/mL. The selectivity of the performed immunosensor was confirmed by negligible responses for BSA. The performed approach of the immunosensor is a novel, innovative attempt that enables the detection of collagen I with very high sensitivity in the range of pg/mL, which is significantly lower than the commonly used enzyme-linked immunosorbent assay (ELISA).
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Affiliation(s)
- Marcin Gwiazda
- Faculty of Materials Science and Engineering, Warsaw University of Technology, 141 Woloska Str., 02-507 Warsaw, Poland; (M.G.); (E.K.-G.); (W.S.)
- Department of Chemistry, The University of Manchester, Manchester M13 9PL, UK
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Tuwima 10, 10-748 Olsztyn, Poland;
| | - Sheetal K. Bhardwaj
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Tuwima 10, 10-748 Olsztyn, Poland;
- Van’t Hoff Institute for Molecular Sciences, University of Amsterdam Science Park 904, 1098 XH Amsterdam, The Netherlands
- Correspondence: or (S.K.B.); or (A.K.)
| | - Ewa Kijeńska-Gawrońska
- Faculty of Materials Science and Engineering, Warsaw University of Technology, 141 Woloska Str., 02-507 Warsaw, Poland; (M.G.); (E.K.-G.); (W.S.)
- Centre for Advanced Materials and Technologies CEZAMAT, Poleczki 19, 02-822 Warsaw, Poland
| | - Wojciech Swieszkowski
- Faculty of Materials Science and Engineering, Warsaw University of Technology, 141 Woloska Str., 02-507 Warsaw, Poland; (M.G.); (E.K.-G.); (W.S.)
| | - Unni Sivasankaran
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Tuwima 10, 10-748 Olsztyn, Poland;
| | - Ajeet Kaushik
- NanoBioTech Laboratory, Department of Natural Sciences, Florida Polytechnic University, Lakeland, FL 33805, USA
- Correspondence: or (S.K.B.); or (A.K.)
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Gan QF, Foo CN, Leong PP, Cheong SK. Incorporating regenerative medicine into rehabilitation programmes: a potential treatment for ankle sprain. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2019.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ankle sprain has a great effect on morbidity and complications of chronic diseases. Experts have come to a consensus where ankle sprain can be managed by rest, ice, compression and elevation, non-steroidal anti-inflammatory drugs, immobilisation, functional support such as the use of an ankle brace, exercise, surgery and other therapies that include physiotherapy modalities and acupuncture. However, the time required for healing is still relatively long in addition to post-operative complications. Because of the challenges and setbacks faced by interventions to manage ankle sprains and in view of the recent trend and development in the field of regenerative medicine, this article discusses future treatments focusing on a personalised and holistic approach for ankle sprain management. This narrative review provides a novel idea for incorporating regenerative medicine into conventional therapy as an intervention for ankle sprain based on theoretical concepts and available evidence on regenerative medicine involving ligament injuries.
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Affiliation(s)
- Quan Fu Gan
- Pre-clinical Department, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - Chai Nien Foo
- Population Medicine Department, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - Pooi Pooi Leong
- Pre-clinical Department, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - Soon Keng Cheong
- Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Selangor, Malaysia
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Structural topography of the interosseous membrane of the human forearm. Ann Anat 2020; 231:151547. [PMID: 32512201 DOI: 10.1016/j.aanat.2020.151547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/05/2020] [Accepted: 05/20/2020] [Indexed: 11/23/2022]
Abstract
The aim of this study was to evaluate the morphology of the six different parts of the interosseous membrane (IOM) in 11 human cadaver forearms, including the distal oblique bundle (DOB), the distal accessory band (DAB), the central band (CB), the proximal accessory band (PAB), the dorsal oblique accessory cord (DOAC), and the proximal oblique cord (POC). Hematoxylin-eosin and Elastica van Gieson stained slices were used to investigate the tissue morphology. The DOB and DOAC were absent in one IOM and the POB in two IOMs, respectively. The CB and DAB were longer than all other structures except for each other. The DOAC was longer than the DOB. The DAB, CB, and PAB, were broader than the DOB, DOAC, and POC. No significant differences were observed regarding structure thickness. All structures were found to consist of densely packed parallel collagen fiber arrangement. The DOB and POC had a higher amount of elastic fibers in the fascicular collagen tissue than the other structures. Elastic fibers were more often equally distributed throughout the structures than condensed epifascicular or at the insertion into bone. The tight parallel collagen composition within the different structures reflects the central stabilizing role of the IOM in the forearm. The higher amount of elastic fibers within the DOB and POC can be attributed to their location close to the distal and proximal radioulnar joints, respectively. Here elastic fibers allow adaption to forearm rotation, whereas the structures of the central part of IOM have less elasticity reflecting the predominant stabilizing function.
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Hardy MA, Connors JC, Zulauf EE, Coyer MA. Acute Deltoid Ligament Repair in Ankle Fractures: Five-year Follow-up. Clin Podiatr Med Surg 2020; 37:295-304. [PMID: 32146985 DOI: 10.1016/j.cpm.2019.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Direct repair of deep deltoid ruptures after traumatic ankle fracture is not commonly performed. Previous studies overlook the contributions of the medial deltoid to overall ankle stability and long-term patient satisfaction. Historically, deep deltoid injuries have been addressed indirectly through syndesmotic ligament repair. This technique fails to restore, however, the anatomic function of the primary medial stabilizing structure. The oversight of direct deltoid repair may be one contributing factor to the less than optimal outcomes after ankle fractures with syndesmotic injuries. This article reports a positive response with direct deep deltoid repair, at average 5-year follow-up, with 93% positive return to normal function.
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Affiliation(s)
- Mark A Hardy
- Division of Surgery and Biomechanics, Kent State University College of Podiatric Medicine, 6000 Rockside Woods Boulevard, Independence, OH 44131, USA
| | - James C Connors
- Division of Surgery and Biomechanics, Kent State University College of Podiatric Medicine, 6000 Rockside Woods Boulevard, Independence, OH 44131, USA.
| | - Emily E Zulauf
- Grant Medical Center, 323 East Town Street, First Floor, Suite 100, Columbus, OH 43215, USA
| | - Michael A Coyer
- Private Practice, Orange County Foot and Ankle Surgeon, 16405 Sand Canyon Avenue, Suite 270, Irvine, CA 92618, USA
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Abdeen R, Comfort P, Starbuck C, Nester C. Ultrasound Characteristics of Foot and Ankle Structures in Healthy, Coper, and Chronically Unstable Ankles. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:917-926. [PMID: 30208221 DOI: 10.1002/jum.14770] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/01/2018] [Accepted: 07/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Ankle sprains constitute approximately 85% of all ankle injuries, and up to 70% of people experience residual symptoms. While the injury to ligaments is well understood, the potential role of other foot and ankle structures has not been explored. The objective was to characterize and compare selected ankle structures in participants with and without a history of lateral ankle sprain. METHODS A total of 71 participants were divided into 31 healthy, 20 coper, and 20 chronic ankle instability groups. Ultrasound images of the anterior talofibular and calcaneofibular ligaments, fibularis tendons and muscles, tibialis posterior, and Achilles tendon were obtained. Thickness, length, and cross-sectional areas were measured and compared among groups. RESULTS When under tension, the anterior talofibular ligament (ATFL) was longer in copers and chronic ankle instability groups compared to healthy participants (P < .001 and P = .001, respectively). The chronic ankle instability group had the thickest ATFL and calcaneofibular ligament among the 3 groups (p < 0.001). No significant differences (P > .05) in tendons and muscles were observed among the 3 groups. CONCLUSIONS The ultrasound protocol proved reliable and was used to evaluate the length, thickness, and cross-sectional areas of selected ankle structures. The length of the ATFL and the thickness of the ATFL and calcaneofibular ligament were longer and thicker in injured groups compared to healthy.
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Affiliation(s)
- Rawan Abdeen
- School of Health Sciences, University of Salford, Salford, UK
| | - Paul Comfort
- School of Health Sciences, University of Salford, Salford, UK
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Amaha K, Nimura A, Yamaguchi R, Kampan N, Tasaki A, Yamaguchi K, Kato R, Akita K. Anatomic study of the medial side of the ankle base on the joint capsule: an alternative description of the deltoid and spring ligament. J Exp Orthop 2019; 6:2. [PMID: 30689117 PMCID: PMC6890913 DOI: 10.1186/s40634-019-0171-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 01/17/2019] [Indexed: 01/14/2023] Open
Abstract
Background Adult acquired flatfoot deformity (AAFD) is caused by impaired medial ligamentous structures and posterior tibialis tendon dysfunction (PTTD). Although degeneration and trauma could separately cause AAFD, how these factors interact in the pathomechanism of AAFD is unclear. The joint capsule in the medial ankle is considered an important structure, providing passive stability by limiting joint movement. Previous reports on the joint capsule suggest its involvement in pathological changes of the ankle, but because of the high priority placed on the ligaments, few reports address the ankle joint from the joint capsule standpoint. The current study aimed to anatomically examine the medial ankle joint, focusing on the deltoid and spring ligaments in perspective of the joint capsule. Methods We conducted a descriptive anatomical study of 19 embalmed cadavers (mean 82.7 years, range 58 to 99). We included 22 embalmed cadaveric ankles. We detached the joint capsule in 16 ankles from the anterior to posteromedial joint, analyzed the capsular attachments of the ankle and adjacent joints, and measured the widths of the bony attachments. We histologically analyzed the joint capsule using Masson’s trichrome staining in 6 ankles. Results The capsule could be separated as a continuous sheet, including 3 different tissues. The anterior capsule was composed of fatty tissue. Between the medial malleolus and talus, the capsule was strongly connected and was composed of fibrous tissue, normally referred to as the deep deltoid ligament. The tibial attachment formed a steric groove, and the talar side of the attachment formed an elliptical depressed area. On the medial part of the subtalar and talonavicular joints, the capsule covered the joints as cartilaginous tissue, normally referred to as the superomedial ligament of the spring ligament. The outer side of the cartilaginous and fibrous tissue formed the sheath floor of the posterior tibialis tendon. Histological analysis revealed three different tissue types. Conclusions The capsules of the ankle, subtalar, and talonavicular joints could be detached as a continuous sheet. The deltoid and the superomedial ligament of the spring ligaments could be interpreted as a part of the continuous capsule, which had different histological features. Level of evidence Descriptive Laboratory Study.
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Affiliation(s)
- Kentaro Amaha
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Orthopaedic Surgery, St. Luke's International Medical center, Tokyo, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Reiko Yamaguchi
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Natnicha Kampan
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Tasaki
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Orthopaedic Surgery, St. Luke's International Medical center, Tokyo, Japan
| | - Kumiko Yamaguchi
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryuichi Kato
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,JA Kyosai Research Institute, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Yamaguchi R, Nimura A, Amaha K, Yamaguchi K, Segawa Y, Okawa A, Akita K. Anatomy of the Tarsal Canal and Sinus in Relation to the Subtalar Joint Capsule. Foot Ankle Int 2018; 39:1360-1369. [PMID: 30052059 DOI: 10.1177/1071100718788038] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anatomical knowledge of the tarsal canal and sinus is still unclear owing to the complexity of the ligamentous structures within them, particularly the relationship with the capsules of the subtalar joints. The aim of this study was to examine the anatomical relationship between the fibrous tissues of the tarsal canal and sinus and the articular capsules of the subtalar joint. METHODS We conducted a descriptive anatomical study of 21 embalmed cadaveric ankles. For a macroscopic overview of the subtalar joint, we removed the talus in 18 ankles and separated the fibrous tissues from the surrounding connective tissues to analyze the layered relationship between the inferior extensor retinaculum (IER) and the subtalar joint capsule. Additionally, we histologically analyzed the tarsal canal and the medial and lateral sides of the tarsal sinus using Masson's trichrome staining in 3 ankles. RESULTS The medial and intermediate roots of the IER and interosseous talocalcaneal ligament (ITCL) were located in the same layer and were connected to each other, between the capsules of the posterior talocalcaneal and talocalcaneonavicular joints. The intermediate root of the IER and the cervical ligament (CL) had adjacent attachments on the tarsal sinus, and synovial tissues originating from the joint capsules filled the remaining area in the tarsal canal and sinus. CONCLUSION We determined that the tarsal canal and sinus tarsi contained 3 layered structures: the anterior capsule of the posterior talocalcaneal joint, including the anterior capsule ligament; the layer of ITCL and IER; and the posterior capsule of the talocalcaneonavicular joint, including the CL. CLINICAL RELEVANCE The results of this study may help with the understanding of the pathomechanism of subtalar instability and sinus tarsi syndrome, resulting in better treatment.
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Affiliation(s)
- Reiko Yamaguchi
- 1 Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,2 Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akimoto Nimura
- 3 Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kentaro Amaha
- 2 Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kumiko Yamaguchi
- 2 Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuko Segawa
- 1 Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- 1 Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiichi Akita
- 2 Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Bleakley CM, Taylor JB, Dischiavi SL, Doherty C, Delahunt E. Rehabilitation Exercises Reduce Reinjury Post Ankle Sprain, But the Content and Parameters of an Optimal Exercise Program Have Yet to Be Established: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2018; 100:1367-1375. [PMID: 30612980 DOI: 10.1016/j.apmr.2018.10.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 08/03/2018] [Accepted: 10/11/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To determine if exercise-based rehabilitation reduces reinjury following acute ankle sprain. Our secondary objective was to assess if rehabilitation efficacy varies according to exercise content and training volume. DATA SOURCES The following electronic databases were searched: EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials, and Physiotherapy Evidence Database (PEDro). STUDY SELECTION Randomized controlled trials investigating the effect of exercise-based rehabilitation programs on reinjury and patient-reported outcomes (perceived instability, function, pain) in people with an acute ankle sprain. No restrictions were made on the exercise type, duration, or frequency. Exercise-based programs could have been administered in isolation or as an adjunct to usual care. Comparisons were made to usual care consisting of 1 or all components of PRICE (protection, rest, ice, compression, elevation). DATA EXTRACTION Effect sizes with 95% CIs were calculated in the form of mean differences for continuous outcomes and odds ratios (ORs) for dichotomous outcomes. Pooled effects were calculated for reinjury prevalence with meta-analysis undertaken using RevMan software. DATA SYNTHESIS Seven trials (n=1417) were included (median PEDro score, 8/10). Pooled data found trends toward a reduction in reinjury in favor of the exercise-based rehabilitation compared with usual care at 3-6 months (OR, 0.87; 95% CI, 0.48-1.58) with significant reductions reported at 7-12 months (OR, 0.53; 95% CI, 0.38-0.73). Sensitivity analysis based on pooled reinjury data from 2 high quality studies (n=629) also found effects in favor of exercise-based rehabilitation at 12 months (OR, 0.60; 95% CI, 0.49-0.89). Training volume differed substantially across rehabilitation programs with total rehabilitation time ranging from 3.5-21 hours. The majority of rehabilitation programs focused primarily on postural balance or strength training. CONCLUSIONS Exercise-based rehabilitation reduces the risk of reinjury following acute ankle sprain when compared with usual care alone. There is no consensus on optimal exercise content and training volume in this field. Future research must explicitly report all details of administered exercise-based rehabilitation programs.
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Affiliation(s)
- Chris M Bleakley
- Congdon School of Health Sciences, High Point University, High Point, NC.
| | - Jeffrey B Taylor
- Congdon School of Health Sciences, High Point University, High Point, NC
| | - Steven L Dischiavi
- Congdon School of Health Sciences, High Point University, High Point, NC
| | - Cailbhe Doherty
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Eamonn Delahunt
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
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Semisch M, Hagert E, Garcia-Elias M, Lluch A, Rein S. Re: Nakamura T. Commentary on Histological assessment of the triangular fibrocartilage complex. J Hand Surg Eur. 2016, 41: 534-5. J Hand Surg Eur Vol 2017; 42:101-103. [PMID: 30178706 DOI: 10.1177/1753193416672353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M Semisch
- 1 Department of Orthopaedic and Trauma Surgery, University Hospital 'Carl Gustav Carus', Dresden, Germany
| | - E Hagert
- 2 Department of Clinical Science and Education, Karolinska Institutet, and Hand & Foot Surgery Center, Stockholm, Sweden
| | - M Garcia-Elias
- 3 Hand and Upper Extremity Surgery, Institut Kaplan, Barcelona, Spain.,4 Departamento de Anatomía, Universidad de Barcelona, Barcelona, Spain
| | - A Lluch
- 3 Hand and Upper Extremity Surgery, Institut Kaplan, Barcelona, Spain.,4 Departamento de Anatomía, Universidad de Barcelona, Barcelona, Spain
| | - S Rein
- 1 Department of Orthopaedic and Trauma Surgery, University Hospital 'Carl Gustav Carus', Dresden, Germany.,5 Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost, Halle (Saale), Germany
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14
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De Dea M, L Loizou C, Allen GM, Wilson DJ, Athanasou N, Uchihara Y, Cooke P, Cosker T. Talonavicular ligament: prevalence of injury in ankle sprains, histological analysis and hypothesis of its biomechanical function. Br J Radiol 2016; 90:20160816. [PMID: 27993094 DOI: 10.1259/bjr.20160816] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the prevalence of injury of the talonavicular ligament (TNL) in ankle sprains, its anatomy and the stability of the talonavicular joint (TNJ) before and after dividing the TNL in a cadaver. METHODS During a prospective study of 100 patients to assess the outcome of ankle injuries, we noted high incidence of TNL injuries; we will discuss here the TNL findings. Each patient had undergone ultrasound and cone beam CT examination of the ankle. Six TNLs were dissected off fresh-frozen cadaveric feet for histological analysis. In further six cadaveric feet, the stability of the TNJ was assessed by mechanical stress before and after division of the TNL; movement at the joint was assessed by measuring the distance between the talus and navicular bone [talonavicular distance (TD)] using ultrasound. The TD was measured on ten randomly selected ultrasound images by three independent observers and repeated twice by a single observer to determine the inter- and intraobserver reliability. RESULTS 21% of the patients had an injury to the TNL. Histological examination demonstrated a dense connective tissue composed of bundles of collagen in parallel arrangement along the ligament length. The interobserver and intraobserver reliability of the TD showed almost perfect agreement. Displacement at the TNJ after stress with the TNL intact measured 0.18 ± 0.08 cm and 0.29 ± 0.07 cm (p < 0.005) when divided. CONCLUSION The TNL is surprisingly commonly injured in ankle sprains. Its anatomy and histology suggest a role in tensile force transmission during the windlass mechanism in gait. Advances in knowledge: Injury to the TNL is common and has not been described. Its anatomy suggests resistance to tensile forces and its injury allows excessive movement at the TNJ.
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Affiliation(s)
- Miriam De Dea
- 1 Department of Radiology, St Lukes Radiology, Oxford, UK
| | - Constantinos L Loizou
- 2 Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - David J Wilson
- 1 Department of Radiology, St Lukes Radiology, Oxford, UK
| | - Nick Athanasou
- 3 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Oxford University, Oxford, UK
| | - Yoshinobu Uchihara
- 3 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Oxford University, Oxford, UK
| | - Paul Cooke
- 2 Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Thomas Cosker
- 4 Department of Physiology, Anatomy and Genetics, Oxford University, Oxford, UK
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15
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Investigation of biomechanical response of Hoffa's fat pad and comparative characterization. J Mech Behav Biomed Mater 2016; 67:1-9. [PMID: 27936429 DOI: 10.1016/j.jmbbm.2016.11.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/21/2016] [Accepted: 11/30/2016] [Indexed: 11/23/2022]
Abstract
The infrapatellar adipose body (Hoffa's fat pad, IFP) is situated between the patellar tendon, the femoral condyle and the tibial plateau. The IFP consists of lobules of white adipose tissue delimited by thin connective septa. The actual structural functionality of the IFP is debated and should pertain to a cushioning role in the knee joint, providing to distribute and to damp mechanical stresses during articular activity. The present study is aimed to analyze the correlation between histological configuration and mechanical properties of the IFP, compared to other adipose tissues, partially differentiated by composition and conformation. Histological and ultrastructural methods were exploited to analyze the microscopic anatomies of IFP, knee (KSF) and abdominal (ASF) subcutaneous fat tissues. Numerical micro-models of the different tissues were developed by using histo-morphometric data, as the size of adipose lobules, the thickness of the septa and their composition. Numerical analyses made it possible to evaluate the mechanical functionality of the different fat tissues considering the characteristic loading conditions, as compressive and shear actions. The results pointed out the actual mechanical relevance of IFP and KSF, while ASF exhibited different mechanical properties. Furthermore, the contribution of connective septa and adipose lobules to compressive and shear mechanical behavior was elucidated. This preliminary investigation represents the basis for biomechanical interpretation and the definition of more refined model to be developed on the acquisition of additional histological and morphometric data.
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16
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Semisch M, Hagert E, Garcia-Elias M, Lluch A, Rein S. Histological assessment of the triangular fibrocartilage complex. J Hand Surg Eur Vol 2016; 41:527-33. [PMID: 26685153 DOI: 10.1177/1753193415618391] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 10/26/2015] [Indexed: 02/03/2023]
Abstract
The morphological structure of the seven components of triangular fibrocartilage complexes of 11 cadaver wrists of elderly people was assessed microscopically, after staining with Hematoxylin-Eosin and Elastica van Gieson. The articular disc consisted of tight interlaced fibrocartilage without blood vessels except in its ulnar part. Volar and dorsal radioulnar ligaments showed densely parallel collagen bundles. The subsheath of the extensor carpi ulnaris muscle, the ulnotriquetral and ulnolunate ligament showed mainly mixed tight and loose parallel tissue. The ulnolunate ligament contained tighter parallel collagen bundles and clearly less elastic fibres than the ulnotriquetral ligament. The ulnocarpal meniscoid had an irregular morphological composition and loose connective tissue predominated. The structure of the articular disc indicates a buffering function. The tight structure of radioulnar and ulnolunate ligaments reflects a central stabilizing role, whereas the ulnotriquetral ligament and ulnocarpal meniscoid have less stabilizing functions.
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Affiliation(s)
- M Semisch
- Department of Orthopaedic and Trauma Surgery, UniversityHospital 'Carl Gustav Carus', Dresden, Germany
| | - E Hagert
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - M Garcia-Elias
- Institut Kaplan, Hand and Upper Extremity Surgery, Barcelona, Spain Departamento de Anatomía, Universidad de Barcelona, Spain
| | - A Lluch
- Institut Kaplan, Hand and Upper Extremity Surgery, Barcelona, Spain Departamento de Anatomía, Universidad de Barcelona, Spain
| | - S Rein
- Department of Orthopaedic and Trauma Surgery, UniversityHospital 'Carl Gustav Carus', Dresden, Germany Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost, Halle (Saale), Germany
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17
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Prinold JAI, Mazzà C, Di Marco R, Hannah I, Malattia C, Magni-Manzoni S, Petrarca M, Ronchetti AB, Tanturri de Horatio L, van Dijkhuizen EHP, Wesarg S, Viceconti M. A Patient-Specific Foot Model for the Estimate of Ankle Joint Forces in Patients with Juvenile Idiopathic Arthritis. Ann Biomed Eng 2015; 44:247-57. [PMID: 26374518 PMCID: PMC4690839 DOI: 10.1007/s10439-015-1451-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 09/04/2015] [Indexed: 11/11/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is the leading cause of childhood disability from a musculoskeletal disorder. It generally affects large joints such as the knee and the ankle, often causing structural damage. Different factors contribute to the damage onset, including altered joint loading and other mechanical factors, associated with pain and inflammation. The prediction of patients’ joint loading can hence be a valuable tool in understanding the disease mechanisms involved in structural damage progression. A number of lower-limb musculoskeletal models have been proposed to analyse the hip and knee joints, but juvenile models of the foot are still lacking. This paper presents a modelling pipeline that allows the creation of juvenile patient-specific models starting from lower limb kinematics and foot and ankle MRI data. This pipeline has been applied to data from three children with JIA and the importance of patient-specific parameters and modelling assumptions has been tested in a sensitivity analysis focused on the variation of the joint reaction forces. This analysis highlighted the criticality of patient-specific definition of the ankle joint axes and location of the Achilles tendon insertions. Patient-specific detection of the Tibialis Anterior, Tibialis Posterior, and Peroneus Longus origins and insertions were also shown to be important.
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Affiliation(s)
- Joe A I Prinold
- Department of Mechanical Engineering, University of Sheffield, Pam Liversidge Building, Sheffield, S13JD, UK.,INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - Claudia Mazzà
- Department of Mechanical Engineering, University of Sheffield, Pam Liversidge Building, Sheffield, S13JD, UK. .,INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, UK.
| | - Roberto Di Marco
- Department of Mechanical Engineering, University of Sheffield, Pam Liversidge Building, Sheffield, S13JD, UK.,Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, Rome, Italy
| | - Iain Hannah
- Department of Mechanical Engineering, University of Sheffield, Pam Liversidge Building, Sheffield, S13JD, UK.,INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - Clara Malattia
- Pediatria II - Reumatologia, Istituto Giannina Gaslini, Genoa, Italy
| | - Silvia Magni-Manzoni
- Pediatric Rheumatology Unit, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Units, IRCCS Ospedale Pediatrico Bambino Gesù, Passoscuro, Rome, Italy
| | - Anna B Ronchetti
- UOC Medicina Fisica e Riabilitazione, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - E H Pieter van Dijkhuizen
- Pediatria II - Reumatologia, Istituto Giannina Gaslini, Genoa, Italy.,Paediatric immunology, University Medical Centre Utrecht Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Stefan Wesarg
- Visual Healthcare Technologies, Fraunhofer IGD, Darmstadt, Germany
| | - Marco Viceconti
- Department of Mechanical Engineering, University of Sheffield, Pam Liversidge Building, Sheffield, S13JD, UK.,INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, UK
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