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1.
Medicine (Baltimore) ; 100(10): e24998, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725876

RESUMO

BACKGROUND: Ankle fusion is the primary treatment for advanced ankle arthritis. With the advancement of arthroscopy technology, ankle arthroscopy fusion has shown many advantages over traditional surgery. However, there are few related studies globally, and evidence-based medicine is needed to verify the reliability and feasibility of ankle arthroscopy fusion. OBJECTIVE: To compare the clinical efficacy and safety of arthroscopic ankle arthrodesis and open ankle arthrodesis. METHODS: We searched the databases of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure [CNKI], Wanfang Database, and VIP Database for published prospective or retrospective controlled studies of arthroscopic-assisted ankle fusion in the treatment of advanced ankle arthritis. The dates were limited from the construction of the library to June 30, 2019. Literature was included based on the principles and methods of evidence-based medicine. Literature retrieval, data extraction, and quality assessment were performed by 2 independent reviewers using the Cochrane 5.1 risk bias assessment tool. The methodological bias of the literature was evaluated, and a meta-analysis was using by RevMan 5.3 software. RESULTS: A total of 18 studies and 1102 patients were included in the study, including 551 in the arthroscopic surgery group and 551 in the open surgery group. Arthroscopy-assisted surgery for advanced ankle arthritis was more effective than open surgery in terms of fusion rate (odd ratio[OR] = 3.32, 95% confidence interval[CI]:2.16, 5.10), fusion time (mean difference[MD] = -2.31, 95% CI:-4.63, -2.21), intraoperative blood loss (MD = -43.37, 95%CI: -48.49, -38.25), hospital stay (MD = -1.80, 95%CI: -2.28, -1.33), and visual analog scale score (MD = -1.75, 95%CI: -2.04, -1.46). In addition, rate of complications (OR = 0.33, 95%CI: 0.21, 0.52) was superior to open ankle fusion (P < .00001). CONCLUSION: Arthroscopic ankle arthrodesis has more advantages than open ankle arthrodesis in improving the fusion rate and reducing complications, which is worthy of clinical application. PROSPERO REGISTRATION NUMBER: CRD42020195727.


Assuntos
Articulação do Tornozelo/cirurgia , Artrodese/métodos , Artroscopia/métodos , Osteoartrite/cirurgia , Complicações Pós-Operatórias/epidemiologia , Articulação do Tornozelo/fisiopatologia , Artrodese/efeitos adversos , Artroscopia/efeitos adversos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Estudos de Viabilidade , Humanos , Tempo de Internação/estatística & dados numéricos , Osteoartrite/diagnóstico , Osteoartrite/fisiopatologia , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Resultado do Tratamento
2.
Bone Joint J ; 103-B(2): 286-293, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33390020

RESUMO

AIMS: No randomized comparative study has compared the extensile lateral approach (ELA) and sinus tarsi approach (STA) for Sanders type 2 calcaneal fractures. This randomized comparative study was conducted to confirm whether the STA was prone to fewer wound complications than the ELA. METHODS: Between August 2013 and August 2018, 64 patients with Sanders type 2 calcaneus fractures were randomly assigned to receive surgical treatment by the ELA (32 patients) and STA (32 patients). The primary outcome was development of wound complications. The secondary outcomes were postoperative complications, pain scored of a visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, 36-item Short Form health survey, operative duration, subtalar joint range of motion (ROM), Böhler's angle and calcaneal width, and posterior facet reduction. RESULTS: Although four patients (12.5%) in the ELA groups and none in the STA group experienced complications, the difference was not statistically significant (p = 0.113). VAS and AOFAS score were significantly better in the STA group than in the ELA group at six months (p = 0.017 and p = 0.021), but not at 12 months (p = 0.096 and p = 0.200) after surgery. The operation time was significantly shorter in the STA group than in the ELA group (p < 0.001). The subtalar joint ROM was significantly better in the STA group (p = 0.015). Assessment of the amount of postoperative reduction compared with the uninjured limb showed significant restoration of calcaneal width in the ELA group compared with that in the STA group (p < 0.001). CONCLUSION: The ELA group showed higher frequency of wound complications than the STA group for Sanders type 2 calcaneal fractures even though this was not statistically significant. Cite this article: Bone Joint J 2021;103-B(2):286-293.


Assuntos
Fraturas do Tornozelo/cirurgia , Calcâneo/lesões , Fixação Interna de Fraturas/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Fraturas do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Calcâneo/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Amplitude de Movimento Articular , Resultado do Tratamento
3.
Phys Ther Sport ; 48: 26-34, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33352395

RESUMO

OBJECTIVES: The purpose of this study was to identify prospectively the anatomical and functional intrinsic risk factors for lateral ankle sprain (LAS) in adolescent athletes participating in team sports. DESIGN: A prospective cohort study. SETTING: University research laboratory. PARTICIPANTS: A total of 152 adolescent male athletes (age: 14.45 ± 2.96 years; height: 165.63 ± 15.33 cm; weight: 55.60 ± 16.56 kg; body mass index: 19.97 ± 3.58 kg/m2) participated in this study. MAIN OUTCOME MEASURES: The participants were assessed during the preseason for previous ankle sprain history, navicular drop, tibia vara, Q angle, tibia torsion, knee recurvatum, and ankle ROM. LASs were prospectively recorded and diagnosed for two consecutive seasons (20 months). RESULTS: Previous ankle sprain history (odds ratio [OR] = 60.911, p < 0.001), increased navicular drop (OR = 1.767, p < 0.001), and knee recurvatum (OR = 1.881, p = 0.002) were positively associated with the incidence of LAS. The receiver operating characteristic (ROC) analyses revealed the predictive potentials of previous ankle sprain history (the area under the ROC [AUROC] = 0.706, p < 0.001), navicular drop (AUROC = 0.906, p < 0.001), and knee recurvatum (AUROC = 0.724, p < 0.001). CONCLUSION: Athletes with previous ankle sprain history, knee recurvatum, and especially navicular drop may have a greater risk of LAS injury. The data from this study can help therapists and trainers to identify people with a higher risk of LAS.


Assuntos
Traumatismos do Tornozelo/epidemiologia , Atletas , Entorses e Distensões/epidemiologia , Adolescente , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Criança , Estudos de Coortes , Humanos , Incidência , Articulação do Joelho/fisiopatologia , Masculino , Estudos Prospectivos , Amplitude de Movimento Articular , Fatores de Risco , Entorses e Distensões/fisiopatologia , Tíbia/fisiopatologia
4.
J Vis Exp ; (163)2020 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-33016940

RESUMO

Computerized dynamic posturography (CDP) is an objective technique for the evaluation of postural stability under static and dynamic conditions and perturbation. CDP is based on the inverted pendulum model that traces the interrelationship between the center of pressure and the center of gravity. CDP can be used to analyze the proportions of vision, proprioception, and vestibular sensation to maintain postural stability. The following characters define chronic ankle instability (CAI): persistent ankle pain, swelling, the feeling of "giving way," and self-reported disability. Postural stability and fibular muscle activation level in individuals with CAI decreased due to lateral ankle ligament complex injuries. Few studies have used CDP to explore the postural stability of individuals with CAI. Studies that investigate postural stability and related muscle activation by using synchronized CDP with surface electromyography are lacking. This CDP protocol includes a sensory organization test (SOT), a motor control test (MCT), and an adaption test (ADT), as well as tests that measure unilateral stance (US) and limit of stability (LOS). The surface electromyography system is synchronized with CDP to collect data on lower limb muscle activation during measurement. This protocol presents a novel approach for evaluating the coordination of the visual, somatosensory, and vestibular systems and related muscle activation to maintain postural stability. Moreover, it provides new insights into the neuromuscular control of individuals with CAI when coping with real complex environments.


Assuntos
Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Extremidade Inferior/fisiopatologia , Músculos/fisiopatologia , Equilíbrio Postural/fisiologia , Adulto , Doença Crônica , Eletromiografia , Feminino , Humanos , Masculino , Propriocepção/fisiologia
5.
Foot Ankle Spec ; 13(5): 372-377, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32924584

RESUMO

BACKGROUND: Patients with talar avascular necrosis (AVN) have limited treatment options to manage their symptoms. Historically, surgical options have been limited and can leave patients with little ankle motion and have high failure rates. The use of custom 3D printed total talar replacements (TTRs) has arisen as a treatment option for these patients, possibly allowing better preservation of hindfoot motion. We hypothesized that patients undergoing TTR will demonstrate a statistically significant improvement in Foot and Ankle Outcome Score (FAOS) at 1 year after surgery. METHODS: We retrospectively reviewed 15 patients who underwent a TTR over a 2-year period. Patient outcomes were reviewed, including age, sex, comorbidities, etiology of talar pathology, number and type of prior surgeries, radiographic alignment, FAOS and Visual Analog Scale (VAS) score, and range of motion. Data analysis was performed with Student t-tests and multivariate regression. RESULTS: FAOSs and VAS scores showed statistically significant improvements postoperatively as compared with preoperative scores. There was a statistically significant decrease in VAS pain scores from 7.0 preoperatively to 3.6 (P < .001). Average follow-up was 12.8 months. With the number of patients available, there was no statistically significant change in radiographic alignment parameters postoperatively as compared with preoperatively (P values ranged from .225 to .617). CONCLUSION: Our hypothesis that these patients show statistically significant improvements in FAOSs at 1 year was confirmed. TTR represents an exciting treatment option for patients with talar AVN, though longer-term follow-up is needed.Level of Evidence: Level IV: Case series.


Assuntos
Articulação do Tornozelo/cirurgia , Artroplastia de Substituição do Tornozelo/métodos , Osteonecrose/cirurgia , Impressão Tridimensional , Tálus/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Articulação do Tornozelo/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteonecrose/fisiopatologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Tálus/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
6.
Artigo em Inglês | MEDLINE | ID: mdl-32664535

RESUMO

Manipulative therapies and exercises are commonly used for the management of chronic ankle instability (CAI), but there is no evidence regarding the efficacy of high-velocity low-amplitude manipulation (HVLA) in addition to ankle therapeutic exercise to improve CAI in adolescent baseball players (ABP). To compare the effects of HVLA plus ankle therapeutic exercise and ankle therapeutic exercise alone on ankle status, pain intensity, pain pressure threshold (PPT), range of motion (ROM) of the ankle joint, and balance ability in ABP with CAI, a single-blinded randomized controlled trial was conducted. A total of 31 ABP with CAI were randomly allocated to the intervention (n = 16) or control (n = 15) groups. The intervention group received HVLA plus resistance exercise twice a week for 4 weeks, while the control group received resistance exercise alone. Ankle status, pain intensity, PPT, ROM, and balance ability were assessed before and after the intervention. The American Orthopedic Foot and Ankle Society scores showed significant group and time interactions (total, p = 0.002; pain, p < 0.001; alignment, p = 0.001). There were significant group and time interactions in pain intensity (resting pain, p = 0.008; movement pain, p < 0.001). For ROM, there were significant group and time interactions on dorsiflexion (p = 0.006) and eversion (p = 0.026). The unipedal stance of the balance ability showed significant group and time interactions in path length (p = 0.006) and velocity (p = 0.006). Adding HVLA to resistance exercises may be synergistically effective in improving the ankle status, pain intensity, ROM, and balance ability in ABP with CAI.


Assuntos
Articulação do Tornozelo/fisiopatologia , Beisebol , Instabilidade Articular/reabilitação , Manipulações Musculoesqueléticas/métodos , Modalidades de Fisioterapia/estatística & dados numéricos , Equilíbrio Postural/fisiologia , Amplitude de Movimento Articular/fisiologia , Adolescente , Doença Crônica , Feminino , Humanos , Instabilidade Articular/fisiopatologia , Masculino , Avaliação de Resultados em Cuidados de Saúde/métodos
7.
J Am Acad Orthop Surg ; 28(14): e595-e603, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32692095

RESUMO

Weight-bearing CT (WBCT) scans of the foot and ankle have improved the understanding of deformities that are not easily identified on radiographs and are increasingly being used by orthopaedic surgeons for diagnostic and preoperative planning purposes. In contrast to standard CT scans, WBCT scans better demonstrate the true orientation of the bones and joints during loading. They have been especially useful in investigating the alignment of complex pathologies such as adult-acquired flatfoot deformity in which patients have been found to have a more valgus subtalar joint alignment than in a normal cohort and high rates of subfibular impingement. Studies using WBCT scans have also provided new insight into more common lower extremity conditions such as hallux valgus, ankle fractures, and lateral ankle instability. WBCT scans have allowed researchers to investigate pronation of the first metatarsal in patients with hallux valgus compared with normal feet, and patients with lateral ankle instability have been found to have more heel varus than healthy control subjects. Understanding the application of WBCT scans to clinical practice is becoming more important as surgeons strive for improved outcomes in the treatment of complicated foot and ankle disorders.


Assuntos
Tornozelo/diagnóstico por imagem , Tornozelo/fisiopatologia , Pé Chato/diagnóstico por imagem , Pé Chato/fisiopatologia , Pé/diagnóstico por imagem , Pé/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Suporte de Carga , Tornozelo/cirurgia , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/fisiopatologia , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Pé Chato/cirurgia , Pé/cirurgia , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/fisiopatologia , Hallux Valgus/cirurgia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Planejamento de Assistência ao Paciente
8.
J Stroke Cerebrovasc Dis ; 29(8): 104933, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689617

RESUMO

BACKGROUND AND PURPOSE: Stroke patients have limited ranges of motion and gait disturbances due to neurological deficits and connective tissue changes. We assessed the effects of joint mobilization and active stretching on ankle joint range of motion and gait in stroke patients. METHODS: In total, 45 stroke patients were evenly divided into three groups: joint mobilization, active stretching, and combination (joint mobilization and active stretching) groups. Patients in each group received the corresponding interventions in a non-simultaneous manner for 6 weeks in total (3 days per week, 15 min per day). The range of motion of the ankle joint was measured using a goniometer, and spatiotemporal gait variables were measured using G-walk. All measurements were taken immediately before and after the 6-week intervention. RESULTS: The joint mobilization group exhibited significantly increased range of motion for ankle joint after the intervention (p < 0.05), while the spatiotemporal gait variables were unchanged. In the active stretching group, both the range of motion of the ankle joint in the supine position and the spatiotemporal gait variables (cadence, speed, stride length) were significantly increased (p < 0.05). In the combination group, both the range of motion of the ankle joint and spatiotemporal gait variables (cadence, speed, stride length) were significantly increased (p < 0.05). CONCLUSION: Combination therapy of joint mobilization and active stretching improves the range of motion of the ankle joint and spatiotemporal gait variables in stroke patients, suggesting that ankle rehabilitation of stroke patients should include limited joint structure and muscles shortness.


Assuntos
Articulação do Tornozelo/fisiopatologia , Marcha , Exercícios de Alongamento Muscular , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Idoso , Fenômenos Biomecânicos , Feminino , Análise da Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , República da Coreia , Análise Espaço-Temporal , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
9.
Phys Ther ; 100(10): 1816-1824, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32691064

RESUMO

OBJECTIVE: Direct strength training (DST) is effective in managing unilateral weakness in people with multiple sclerosis (MS). Its feasibility, however, is considerably reduced if one limb is too compromised to train. In this case, contralateral strength training (CST) of the unaffected side to induce a strength transfer to the untrained homologous muscles can help to establish a strength baseline in the weaker limb, eventually allowing direct training. Limited effects for CST, however, have been reported on patient functioning. We tested the effects on dynamometric, electromyographic, and functional outcomes of a sequential combination of CST and DST of the ankle dorsiflexors in a case of MS-related foot-drop. METHODS: A 56-year-old man diagnosed with relapsing-remitting MS exhibited severe weakness of the right dorsiflexors impairing functional dorsiflexion. The intervention consisted of a 6-week CST of the unaffected dorsiflexors followed by 2 consecutive 6-week DST cycles targeting the weaker dorsiflexors. RESULTS: At baseline, the participant could not dorsiflex his right ankle but could do so after CST. Maximal strength of the affected dorsiflexors increased by 80% following CST, by 31.1% following DST-1, and by a further 44.6% after DST-2. Neuromuscular recruitment was found progressively increased, with the largest changes occurring after DST-1. Improvements in mobility and walking speed were also detected, although plantar flexors' spasticity on the Modified Ashworth Scale increased from 1+ to 2. CONCLUSION: In this case, the sequential combination of CST and DST proved a feasible approach to manage severe unilateral weakness in a patient who was not able, at least initially, to dorsiflex his weaker ankle. In this perspective, CST may prime a minimum gain in strength necessary to allow subsequent direct training.


Assuntos
Articulação do Tornozelo/fisiopatologia , Esclerose Múltipla Recidivante-Remitente/complicações , Força Muscular/fisiologia , Debilidade Muscular/reabilitação , Treinamento de Resistência/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Debilidade Muscular/etiologia , Amplitude de Movimento Articular
10.
Acta Orthop Traumatol Turc ; 54(3): 300-304, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32544066

RESUMO

OBJECTIVE: This study aimed to develop the Turkish version of Identification of Functional Ankle Instability (TV_IdFAI) scale and evaluate its validity and reliability. METHODS: A total of 100 participants (54 men and 46 women; 50 volleyball players and 50 sedentary individuals) between 18 and 38 years of age were included this study. The construct validity, reference validity, sensitivity, specificity, and test-retest reliability of TV_IdFAI were evaluated. For the test-retest reliability, the scale was applied to all participants again in 10-14 days. A correlation between the scale scores and test-retest results was examined with intraclass correlation coefficient. To evaluate the construct validity, a factor analysis method was used. For reference validity, a sports physician evaluated all participants and the clinical diagnoses were compared with total score of the scale. Sensitivity and specificity were calculated to evaluate the classification success of the scale with specified cutoff. RESULTS: TV_IdFAI scale was grouped under two separate factors. It was determined that the variance for factor 1, factor 2 and for scale was 46.68%, 15.70%, and 62.38%, respectively. There was a statistically significant relationship 0.74 (95% CI 0.64-0.84; p<0.001) between the physician's diagnosis and TV_IdFAI in terms of reference validity. The sensitivity and specificity of TV_IdFAI was 0.61 and 0.80, respectively. The reliability of TV_IdFAI was 0.94 (95% CI 0.92-0.96; p<0.001). CONCLUSION: This study shows that TV_IdFAI is a simple, easy to apply, reliable, and valid scale to define functional ankle instability in Turkish population. LEVEL OF EVIDENCE: Level II, Diagnostic study.


Assuntos
Articulação do Tornozelo/fisiopatologia , Instabilidade Articular , Adulto , Comparação Transcultural , Feminino , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/fisiopatologia , Masculino , Desempenho Físico Funcional , Reprodutibilidade dos Testes , Inquéritos e Questionários/normas , Traduções , Turquia
11.
Artigo em Inglês | MEDLINE | ID: mdl-32526916

RESUMO

Stroke patients often have muscles spasticity, difficulty with posture control, and tend to fall. This study investigated the use of kinesiology tape for patients with spasticity of ankle muscles after stroke. This study had a randomized, repeated measures design, and evaluated the immediate effect of kinesiology tape on the center of pressure (COP) excursion when applied to the calf and tibialis anterior muscles in stroke survivors. We determined that the taping attachment direction affects the COP movement. Twenty subjects were randomly assigned to the tibialis anterior taping condition, calf taping condition, or nontaping condition. Condition excursion was assessed. The measured variables included the paretic side area, nonparetic side area, forward area, and backward area of COP. All evaluations were conducted immediately after taping. COP excursion for chronic stroke survivors improved after tibialis anterior and calf taping (p < 0.05). Calf taping conditions increased significantly in the forward area (p < 0.05), and tibialis anterior taping conditions increased significantly in the backward area (p < 0.05). Kinesiology tape immediately increased the forward and backward COP excursion for patients with stroke.


Assuntos
Articulação do Tornozelo , Fita Atlética , Acidente Vascular Cerebral , Idoso , Tornozelo , Articulação do Tornozelo/fisiopatologia , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/terapia , Acidente Vascular Cerebral/complicações
12.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 64(3): 199-205, mayo-jun. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-196341

RESUMO

OBJETIVO: El tumor de células gigantes tenosinovial (TCGT) es una entidad localmente agresiva, que afecta a pacientes jóvenes (en torno a la 4.ª década de vida) y puede producir destrucción articular. Presenta 2 variedades, nodular y difusa, similares histológica y genéticamente, pero con diferente pronóstico. El objetivo de este estudio es identificar los factores predisponentes para el desarrollo de artrosis precoz y de recidiva local en estos pacientes. MATERIAL Y MÉTODOS: Hemos realizado un estudio retrospectivo de 35 pacientes con diagnóstico anatomopatológico de TCGT en nuestra institución desde 1991 hasta 2017. Se recogieron variables demográficas, características del tumor primario y de su evolución para identificar posibles factores de riesgo. El tiempo medio de seguimiento fue 8.5 años (rango: 1,1-19,8). RESULTADOS: La variante difusa presenta más riesgo de artrosis que la nodular (p = 0,01), y mayor tasa de recidiva local (p = 0,015). La artrosis fue más frecuente en la cadera y el tobillo (p = 0,03) que en la rodilla. Hemos observado una diferencia de 16 meses en la duración de los síntomas previos al diagnóstico entre los que desarrollaron artrosis y los que no (p = 0,05). CONCLUSIONES: La variante difusa es más agresiva que la nodular, y se asocia con mayor riesgo de artrosis y de recidiva local. La cadera y el tobillo presentan mayor riesgo de artrosis que otras articulaciones. El tiempo de evolución de los síntomas antes del diagnóstico y del tratamiento adecuado, puede influir de forma negativa en el desarrollo de artrosis


OBJECTIVE: Tenosynovial giant cell tumour (TGCT) is locally aggressive entity affecting young people (around 4th decade of life) and can cause joint destruction. It could be nodular or diffuse. These two varieties are histological and genetically similar, but present a different prognosis. The aim of this study is to identify risk factors for local recurrence and predisposing factors for the development of early osteoarthritis in patients with TGCT. MATERIAL AND METHODS: We conducted a retrospective study of 35 patients with an anatomopathological diagnosis of TGCT in our Institution from 1991 to 2017. The mean follow-up was 8.2 years. Demographic variables, characteristics of the primary tumor and its evolution were collected to assess the risk factors for local recurrence and early osteoarthritis. RESULTS: The diffuse type was identified as a risk factor for the development of osteoarthritis (p = 0.01) and for local recurrence (p = 0.015). Osteoarthritis was more frequent in the hip and ankle than in the knee (p = 0.03). A difference of 16 months in the duration of symptoms prior to diagnosis between those who developed osteoarthritis and those who did not was observed (p = 0.05). CONCLUSIONS: The diffuse type is more aggressive than the nodular type; it is associated with a higher risk of osteoarthritis and local recurrence. The hip and ankle present a higher risk of osteoarthritis than other joints. The time of evolution of the symptoms before diagnosis and adequate treatment, negatively influences the development of osteoarthritis


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Tumor de Células Gigantes de Bainha Tendinosa/complicações , Recidiva Local de Neoplasia , Osteoartrite/etiologia , Estudos Retrospectivos , Fatores de Risco , Osteoartrite do Quadril/etiologia , Articulação do Tornozelo/diagnóstico por imagem , Osteoartrite/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Tumor de Células Gigantes de Bainha Tendinosa/diagnóstico por imagem , Tumor de Células Gigantes de Bainha Tendinosa/cirurgia , Recidiva Local de Neoplasia/diagnóstico por imagem
13.
Rev Assoc Med Bras (1992) ; 66(2): 216-221, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32428158

RESUMO

OBJECTIVE: In diabetics, foot deformities are risk factors that increase the risk of amputation as a result of developing ulcers. However, knowledge of the influence of plantar stiffness is still limited. The main objective was to describe connections between the degree of stiffness of the ankle, atypical amputation, and the Foot Posture Index (FPI). METHODS: 62 diabetic patients, 58 with type 2 and 4 with type 1 (average age 63.35 years) were included. Records of foot deformities were included; A range of motion test of the ankle joint was used to determine the degree of stiffness. An exploratory analysis of the association of foot position and the degree of rigidity was performed. RESULTS: The dorsal flexion range of the ankle was 9.6 ± 5.1 0, 13.8 ± 5.9 0 and 17.2 ± 6.5 0 and 20.5 ± 6.8 0 to 45, 67, 89 and 111 N respectively in the amputated feet., And 14 patients (22.58%) had a high level of pronation of IPF with an average value of 3.7 ± 2.629, CI (3.032.-4.367) in amputated feet compared to non-amputees. We use the device "Iowa ankle range of motion" (IAROM) to determine the differences in ankle stiffness. Proper IPF was associated with the presence of amputation and an increase in stiffness. CONCLUSIONS: There was an increase in the degree of limitation of movement of the ankle, as a greater force was applied. Comparing FPI between the groups, there was a higher frequency of prone feet in the group of amputees.


Assuntos
Amputação , Articulação do Tornozelo/fisiopatologia , Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Idoso , Antropometria , Estudos Transversais , Feminino , Pé/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Postura/fisiologia , Valores de Referência , Estatísticas não Paramétricas
14.
Phys Ther Sport ; 44: 24-32, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32388016

RESUMO

OBJECTIVES: To examine sports and physical education (PE) injury rates in youth females during a school year and to investigate if an association exists between injury and phase of the menstrual cycle. DESIGN: Prospective cohort. SETTING: An online questionnaire was used to record training and competition exposure and self-reported injuries for 30-weeks. PARTICIPANTS: 103 PE students (12-15 years) from a girls' secondary school. MAIN OUTCOME MEASURES: Injury rates and prevalence of acute, gradual onset/overuse and substantial injuries. RESULTS: On average, girls trained 3.4 h/week and competed 1 h/week. During the study, 74 participants reported 595 injuries. The average weekly prevalence of all injuries was 20.7% (95% CI: 20.0-21.3), of which 8.6% (95% CI: 8.3-9.0) were acute injuries and 12.0% (95% CI: 11.4-12.6) were gradual onset/overuse injuries. The overall rate of sport and PE injuries was 10.4 injuries/1000 h of exposure. The most common acute injury involved the ankle (35%) while the most common gradual onset/overuse injury involved the knee (51%). There was no significant association between the stage of the menstrual cycle and the likelihood of injury (P = 0.18). CONCLUSION: The high number of injuries in this population of girls suggests preventative measures, particularly targeting the lower extremity, are needed.


Assuntos
Traumatismos do Tornozelo/epidemiologia , Articulação do Tornozelo/fisiopatologia , Traumatismos em Atletas/epidemiologia , Transtornos Traumáticos Cumulativos/epidemiologia , Estudantes , Adolescente , Feminino , Humanos , Incidência , Nova Zelândia/epidemiologia , Prevalência , Estudos Prospectivos , Instituições Acadêmicas/estatística & dados numéricos , Inquéritos e Questionários
15.
Medicine (Baltimore) ; 99(17): e19775, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332619

RESUMO

Patients with chronic ankle instability (CAI) have postural-control deficits during center-of-pressure excursions than do healthy individuals. While an external analysis of center-of-pressure excursions in CAI has been performed, a quantitative analysis of center-of-gravity movements, to detect the balance deficits associated with CAI, has yet to be performed. Therefore, the aim of the study is to quantify the balance deficits in patients with unilateral CAI.Forty-four patients with unilateral CAI (24 men; age, 31.7 ±â€Š5.5 years) and 26 uninjured volunteers (12 men; age, 28.6 ±â€Š5.9 years) underwent Neurocom Balance Manager assessments of dynamic and static balance responses in limits of stability, unilateral stance, and forward lunge tests.In the limits of stability test, there were no significant group differences in the forward direction; however, reaction times were longer in the CAI group than in the control group in the backward (P = .037, effect size [ES] = 0.49) and rightward directions (P = .032, ES  = 0.47). Furthermore, the CAI group showed more excursions in the rightward (P = .046, ES = 0.50) and leftward directions (P = .002, ES = 0.80), and less directional control in the leftward direction (P = .036, ES = 0.59). In the unilateral stance test, the center of gravity sway velocity was faster in the CAI group than in the control group, whether eyes were opened or closed (P < .05). There were no significant group differences in forward lunge-test outcomes.Patients with CAI have poor static and dynamic balance performance compared to that in healthy counterparts. Thus, balance retraining should be an essential component of rehabilitation programs for patients with CAI.


Assuntos
Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/classificação , Equilíbrio Postural/fisiologia , Adulto , Articulação do Tornozelo/anormalidades , China , Feminino , Humanos , Instabilidade Articular/fisiopatologia , Masculino , Entorses e Distensões/classificação , Entorses e Distensões/complicações , Entorses e Distensões/fisiopatologia , Estatísticas não Paramétricas
16.
Phys Ther Sport ; 44: 1-7, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32325415

RESUMO

OBJECTIVE: The purpose of this study was to determine if WBV performed concurrently with static stretching was more effective than static stretching alone to increase dorsiflexion ROM (DFROM) in individuals with chronic ankle instability (CAI). DESIGN: Controlled laboratory study. PARTICIPANTS: Thirty-nine participants with CAI (history of ankle sprain, a feeling of "giving way" during activity, and a qualifying Foot and Ankle Ability Measure Ankle score) were divided into 3 groups (normative (N), static stretch (SS), and static stretch with vibration (SV)). Participants stretched the triceps surae 4 days/wk for 3 wks. Vibration was imposed at 34 Hz and 1.8 mm. MAIN OUTCOME MEASURES: DFROM was assessed in a straight and bent-leg position. RESULTS: No differences were detected at any time in the N or SS group, however SS did exhibit large effect sizes with 95% confidence intervals (CI) that did not cross zero from baseline to 3 weeks for both measures. The SV group demonstrated increased DFROM from baseline for both time points and a large effect size with 95% CI that did not cross zero from post tx-1 to post tx-2. CONCLUSIONS: Static stretching with WBV increases DFROM in participants with CAI more effectively than static stretching alone.


Assuntos
Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/reabilitação , Músculo Esquelético/fisiopatologia , Modalidades de Fisioterapia , Amplitude de Movimento Articular/fisiologia , Adulto , Doença Crônica , Feminino , Humanos , Instabilidade Articular/fisiopatologia , Masculino , Vibração , Adulto Jovem
17.
PLoS One ; 15(4): e0232064, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32330162

RESUMO

Clinical gait analysis is widely used in clinical routine to assess the function of patients with motor disorders. The proper assessment of the patient's function relies greatly on the repeatability between the measurements. Marker misplacement has been reported as the largest source of variability between measurements and its impact on kinematics is not fully understood. Thus, the purpose of this study was: 1) to evaluate the impact of the misplacement of the lateral femoral epicondyle marker on lower limb kinematics, and 2) evaluate if such impact can be predicted. The kinematic data of 10 children with cerebral palsy and 10 aged-match typical developing children were included. The lateral femoral epicondyle marker was virtually misplaced around its measured position at different magnitudes and directions. The outcome to represent the impact of each marker misplacement on the lower limb was the root mean square deviations between the resultant kinematics from each simulated misplacement and the originally calculated kinematics. Correlation and regression equations were estimated between the root mean square deviation and the magnitude of the misplacement expressed in percentage of leg length. Results indicated that the lower-limb kinematics is highly sensitive to the lateral femoral epicondyle marker misplacement in the anterior-posterior direction. The joint angles most impacted by the anterior-posterior misplacement were the hip internal-external rotation (5.3° per 10 mm), the ankle internal-external rotation (4.4° per 10 mm) and the knee flexion-extension (4.2° per 10 mm). Finally, it was observed that the lower the leg length, the higher the impact of misplacement on kinematics. This impact was predicted by regression equations using the magnitude of misplacement expressed in percentage of leg length. An error below 5° on all joints requires a marker placement repeatability under 1.2% of the leg length. In conclusion, the placement of the lateral femoral epicondyle marker in the antero-posterior direction plays a crucial role on the reliability of gait measurements with the Conventional Gait Model.


Assuntos
Fenômenos Biomecânicos/fisiologia , Análise da Marcha/métodos , Joelho/fisiopatologia , Adolescente , Algoritmos , Articulação do Tornozelo/fisiopatologia , Paralisia Cerebral/fisiopatologia , Criança , Feminino , Fêmur/fisiopatologia , Marcha/fisiologia , Articulação do Quadril/fisiopatologia , Humanos , Articulação do Joelho/fisiopatologia , Extremidade Inferior/fisiopatologia , Masculino , Amplitude de Movimento Articular/fisiologia , Reprodutibilidade dos Testes
18.
Phys Ther Sport ; 43: 127-133, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32146433

RESUMO

OBJECTIVES: To compare ankle, knee and hip isometric peak torque between young and middle-aged adults with CAI, copers and un-injured controls. DESIGN: Cross-sectional. SETTING: Research Laboratory. PARTICIPANTS: One hundred fifty-six young and middle-aged adults with or without CAI volunteered. MAIN OUTCOME MEASURES: A handheld dynamometer measured isometric dorsiflexion, plantarflexion, knee extension, hip extension and hip abduction peak force during a 5 s trial. Average peak torque was calculated and normalized to body mass. RESULTS: A significant Age by Injury interaction for dorsiflexion suggest middle-aged un-injured controls (p < 0.001) and copers (p < 0.001) had lower isometric peak torque compared to their young adult counterparts, but there were no differences between young and middle-aged adults with CAI (p > 0.05). Significant Injury main effects suggest the CAI group had decreased plantarflexion (p = 0.004) and hip extension (p = 0.010) strength compared to un-injured controls, but not copers (p > 0.05). Significant Age main effects for all primary outcome measures were observed, indicating peak torque decreased with age (p < 0.05). CONCLUSIONS: Regardless of age, isometric ankle and hip peak torque was lower in participants with CAI compared to un-injured controls, but not copers. These findings provide further evidence towards the impact of CAI in both young and middle-aged adults.


Assuntos
Adaptação Psicológica , Articulação do Tornozelo/fisiopatologia , Articulação do Quadril/fisiopatologia , Contração Isométrica/fisiologia , Instabilidade Articular/fisiopatologia , Adolescente , Adulto , Idoso , Doença Crônica , Estudos Transversais , Feminino , Humanos , Instabilidade Articular/psicologia , Masculino , Pessoa de Meia-Idade , Dinamômetro de Força Muscular , Adulto Jovem
19.
Phys Ther Sport ; 43: 84-88, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32135450

RESUMO

OBJECTIVE: To examine the factor structure and validity of the Quick-FAAM in individuals with chronic ankle instability (CAI) and those classified as ankle sprain copers (ASC). DESIGN: Cross-sectional. SETTING: Laboratory. PARTICIPANTS: Adult participants were included in both groups based on previously established criteria. MAIN OUTCOME MEASURE(S): The 12-item Quick-FAAM is scored on a 5-point Likert scale were scores are converted to a percentage (0-100%), and greater scores indicate greater function. The Cumberland Ankle Instability Tool (CAIT) is a 9-item scale used to assess impairments in individuals with a history of ankle sprain. Scores range from 0 to 30, and greater scores indicate greater impairment levels. Confirmatory factory analyses, internal consistency, and concurrent validity were determined. Known-groups validity and differences in scores between groups were examined. Alpha was set at p < 0.05. RESULTS: The instruments were strongly correlated (r = 0.76, p < 0.001), the Quick-FAAM internal consistency remained high (α = 0.94) and the single factor was confirmed. The cutoff score differentiating between the groups was 94.79%. CONCLUSIONS: The Quick-FAAM is a valid, shortened version of the FAAM. It also has the ability to discriminate between individuals with CAI and those classified as ASC. The Quick-FAAM should be considered for future use with individuals who have ankle sprain history.


Assuntos
Adaptação Psicológica , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Medidas de Resultados Relatados pelo Paciente , Adolescente , Adulto , Traumatismos do Tornozelo/reabilitação , Doença Crônica , Estudos Transversais , Feminino , Humanos , Instabilidade Articular/reabilitação , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
J Orthop Surg (Hong Kong) ; 28(1): 2309499020905054, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32189573

RESUMO

PURPOSE: Osteochondral lesions of the talus are lesions that are seen particularly in the young age group and are often related to sports injuries and trauma. These lesions, which show late symptoms radiologically, can be determined in the early stages with magnetic resonance imaging. The aim of this study was to present a new osteotomy technique to reduce the complications of mosaicplasty surgery to a minimum and provide an early return to work. METHODS: A total of 11 patients who had cartilage lesions due to osteochondritis dissecans in the medial aspect of the talus underwent mosaicplasty after a triplanar osteotomy. The dimensions of the lesion and the depth of the triplanar osteotomy were determined preoperatively. Coronal, sagittal and transverse cuts were made at the depth defined arthroscopically. Following the osteotomy, an osteochondral graft taken from the ipsilateral knee was placed in the prepared area. Osteotomy side was fixed with one or two cannulated screws following mosaicplasty. RESULTS: With this technique, weight-bearing can be immediate in cases with no need for osteotomy in the joint surface. In cases including the joint surface, partial weight-bearing is permitted after 4 weeks and can be increased as tolerated. In the 11 cases treated with this technique, full weight-bearing was achieved at mean 5 weeks (range, 5-8 weeks). No shift (upward displacement of osteotomized fragment) or non-union was seen in any patient. CONCLUSION: With the triplanar osteotomy technique described here, potential shift complications can be reduced to a minimum. As only the lesion region is targeted, the osteochondral surface formed by the fracture is much less. STUDY DESIGN: Case Series; Level of Evidence, 4.


Assuntos
Articulação do Tornozelo/cirurgia , Artroscopia/métodos , Cartilagem Articular/transplante , Osteocondrite Dissecante/cirurgia , Osteotomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Osteocondrite Dissecante/diagnóstico , Transplante Autólogo , Suporte de Carga , Adulto Jovem
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