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1.
Bone Joint J ; 102-B(2): 205-211, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009424

RESUMO

AIMS: To evaluate the donor site morbidity and tendon morphology after harvesting whole length, full-thickness peroneus longus tendon (PLT) proximal to the lateral malleolus for ligament reconstructions or tendon transfer. METHODS: A total of 21 eligible patients (mean age 34.0 years (standard deviation (SD) 11.2); mean follow-up period 31.8 months (SD 7.7), and 12 healthy controls (mean age, 26.8 years (SD 5.9) were included. For patients, clinical evaluation of the donor ankle was performed preoperatively and postoperatively. Square hop test, ankle strength assessment, and MRI of distal calf were assessed bilaterally in the final follow-up. The morphological symmetry of peroneal tendons bilaterally was evaluated by MRI in healthy controls. RESULTS: Among the patients, the mean pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and Karlsson-Peterson score were 98.7 (SD 2.5; p = 0.480) and 98.5 (SD 2.4; p = 0.480), and 98.3 (SD 2.4; p = 0.162) and 97.9 (SD 2.5; p = 0.162), respectively. There was no significant difference between square hop test bilaterally (p = 0.109) and plantar flexion peak force bilaterally (p = 0.371). The harvested limb had significantly less eversion peak force compared to the contralateral limb (p < 0.001). Evidence of probable tendon regeneration was observed in all the patients by MRI and the total bilateral peroneal tendon index (mean ratio of harvested side cross-sectional area of peroneal tendon compared with the contralateral side) was 82.9% (SD 17.4). In 12 healthy controls, peroneal tendons (mean 99.4% (SD 4.3) were found to be morphologically symmetrical between the two sides. CONCLUSION: The current study showed satisfactory clinical foot and ankle outcomes after full-thickness PLT harvesting and indicated the regenerative potential of PLT after its removal. Level of Evidence: Level IV, therapeutic retrospective case series. Cite this article: Bone Joint J 2020;102-B(2):205-211.


Assuntos
Articulação do Tornozelo/fisiopatologia , Tornozelo/fisiopatologia , Pé/fisiopatologia , Ligamentos Articulares/fisiopatologia , Tendões/transplante , Sítio Doador de Transplante/fisiopatologia , Adulto , Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/diagnóstico por imagem , Feminino , Pé/diagnóstico por imagem , Humanos , Ligamentos Articulares/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos , Recuperação de Função Fisiológica , Regeneração , Estudos Retrospectivos , Transferência Tendinosa , Tendões/diagnóstico por imagem , Tendões/fisiologia , Coleta de Tecidos e Órgãos/métodos , Coleta de Tecidos e Órgãos/reabilitação , Sítio Doador de Transplante/diagnóstico por imagem , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
2.
J Pediatr Orthop ; 40(1): 29-35, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31815859

RESUMO

BACKGROUND: The prevention and treatment of relapsed clubfoot remained challenging tasks. There were controversies as to treatment options and management, such as complete subtalar release, application of an Ilizarov external frame, or repeated Ponseti method; and different options were available in different treatment centers. This study was designed to evaluate the clinical outcome of relapsed clubfeet treated by repeated Ponseti method in comparison with the cases without relapse in term of gait analysis and to clarify the clinical efficacy of repeated Ponseti method in treating the relapsed clubfeet. METHODS: Thirty-seven patients (53 feet) were retrospectively identified from our database according to the inclusion and exclusion criteria. Among the 37 patients, 17 cases (25 relapsed clubfeet) were assigned to group I, whereas 20 cases (28 clubfeet without relapse) were assigned to group II. Clinical examination, gait analysis, and kinematic gait deviation criteria from Texas Scottish Rite Hospital for Children were used for evaluation. RESULTS: There was statistically significant difference in the parameters of foot length, stride length, and single limb support time (%gait cycle) between the 2 groups (P<0.05). No statistically significant difference was found in the kinematic parameters of total hip, knee, and ankle excursion, peak knee and ankle flexion and extension, and internal foot progression (P>0.05). There was no statistically significant difference in peak hip, knee, and ankle flexion moment, peak knee valgus moment, and peak ankle power (P>0.05). No statistically significant difference was found in equinus and calcaneus gait, increased ankle dorsiflexion, foot drop, and internal foot progression angle (P>0.05). CONCLUSIONS: Repeated Ponseti method for relapsed clubfeet can yield good or excellent clinical results. We recommend repeated Ponseti method as the treatment choice for relapsed clubfeet in the early stage. LEVEL OF EVIDENCE: Level III-retrospective comparative study.


Assuntos
Articulação do Tornozelo/fisiopatologia , Pé Torto Equinovaro/fisiopatologia , Pé Torto Equinovaro/terapia , Pé/fisiopatologia , Articulação do Joelho/fisiopatologia , Fenômenos Biomecânicos , Moldes Cirúrgicos , Feminino , Análise da Marcha , Articulação do Quadril/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Manipulação Ortopédica , Amplitude de Movimento Articular , Recidiva , Retratamento , Estudos Retrospectivos , Resultado do Tratamento
3.
Gait Posture ; 75: 8-13, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31586753

RESUMO

BACKGROUND: Children with Generalized Joint Hypermobility (GJH) have been reported to have poorer proprioception than children with normal mobility. However, they were usually tested under unloaded conditions and in an age-group in which pain starts to play a role. RESEARCH QUESTION: In contrast, some young children with GJH perform well in motor tasks, suggesting they may have good proprioceptive abilities if assessed more ecologically. METHODS: Children with GJH (Beighton score of  ≥ 5; mean age 8.34 years) were compared to children with a Beighton score of 4 or less. A proprioception test was performed using wedges of different heights to evaluate the ability to judge heel height. A pair of wedges of various heights, was placed under the children's feet at random and they were required to report the higher leg while standing RESULTS: Independent t-test showed that children with GJH performed better (p < 0.01) than controls, suggesting better proprioceptive abilities when assessed under loaded conditions SIGNIFICANCE: Children with GJH do not have inferior proprioception when tested under loaded conditions. The least one can say is that one should be careful in postulating that measuring passive position sense in one particular joint is necessarily the best estimation of proprioception. Body position during standing can be estimated on the basis of knowledge of joint positions (of the ankle in particular in the present test) but also of other information (loading of foot mechanoreceptors for example). In conclusion, the new test may be more suited to evaluate proprioception than the conventional tests, which rely on passive joint position estimation during sitting.


Assuntos
Articulação do Tornozelo/fisiopatologia , Calcanhar/anatomia & histologia , Instabilidade Articular/fisiopatologia , Propriocepção/fisiologia , Artrometria Articular , Criança , Feminino , Humanos , Masculino , Amplitude de Movimento Articular/fisiologia
4.
Clin Podiatr Med Surg ; 37(1): 61-69, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735270

RESUMO

The current understanding is that gastrocnemius equinus is caused by a pathologic tightening of the muscle leading to decreased ankle joint dorsiflexion. However, an alternative hypothesis is that it is a normal limitation of available muscle length. Passive muscular insufficiency of the gastrocnemius muscle acts on a pathologic foot, which is poorly prepared to accept the forces from the gastrocnemius-soleus complex. In this manner, a normal gastrocnemius muscle exerts abnormal forces across the foot. This alternative hypothesis leads to a different interpretation of the current research literature and a potential new area of biomechanical research.


Assuntos
Articulação do Tornozelo/fisiopatologia , Pé Equino/etiologia , Músculo Esquelético/fisiopatologia , Pé Equino/fisiopatologia , Humanos
5.
J Sports Sci Med ; 18(4): 653-662, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31827349

RESUMO

This study analyzed landing strategies used by athletes with chronic ankle instability (CAI) and copers compared to uninjured controls. Thirty participants were asked to perform a single-leg forward jump followed by a single-leg landing. Compared to uninjured controls, those with CAI athletes had significantly greater hip flexion and ankle eversion angles at initial landing, suggesting preference for using hip movements and extra ankle eversion angles to avoid ankle inversion when landing. CAI athletes were also found to have significantly decreased peroneus longus activation and higher ankle inversion velocity were both found during descending phase. And these were potential contributors to cause ankle inversion injury as there were likely many others. Based on these findings, CAI athletes may need to utilize more multi-joint or multi-muscle strategies during landing to maintain stability and prevent re-injury.


Assuntos
Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Extremidade Inferior/fisiologia , Exercício Pliométrico , Traumatismos do Tornozelo/prevenção & controle , Fenômenos Biomecânicos , Eletromiografia , Feminino , Quadril/fisiologia , Humanos , Instabilidade Articular/etiologia , Masculino , Movimento/fisiologia , Músculo Esquelético/fisiologia , Recidiva , Entorses e Distensões/fisiopatologia , Adulto Jovem
6.
J Bone Joint Surg Am ; 101(18): e93, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31567808

RESUMO

BACKGROUND: Malaligned ankle arthroplasty components have been associated with increased postoperative pain and reduced ankle range of motion. With this study, we aimed to quantify how anterior and posterior malalignment of the talar component affects foot bone kinematics and plantar pressures in a dynamic, cadaveric gait simulation. METHODS: Ten cadaveric foot specimens received a modified ankle prosthesis. Proper alignment was defined as the prosthesis being neutral to a plantigrade foot, where varus/valgus and internal/external rotation were determined using the tibial alignment guide from the prosthesis manufacturer. Axially loaded lateral radiographs were made to measure the tibiotalar ratio (TTR) preoperatively and postoperatively. Specimens were prepared for gait simulation and mounted into the robotic gait simulator. Foot bone kinematics and plantar pressures were measured for each alignment condition. RESULTS: Posterior malalignment of the talar component decreased mean sagittal-plane range of motion (p ≤ 0.0005) in the tibiotalar joint (by up to 3.9°) and in the first metatarsophalangeal joint (by up to 7.7°) and increased sagittal-plane range of motion (p ≤ 0.0005) in the calcaneocuboid joint (by up to 2.0°). Posterior malalignment increased mean transverse-plane range of motion (p ≤ 0.0005 and p = 0.012) in the tibiotalar joint (by up to 2.3°) and in the calcaneocuboid joint (by 2.3°). Posterior malalignment decreased mean peak plantar pressures (p = 0.001 and p = 0.013) under the hallux and the first metatarsal (by up to 82.1 and 110.1 kPa, respectively) and increased (p = 0.012 and p = 0.0006) peak plantar pressures under the third metatarsal and the hindfoot (by 23.0 and 47.8 kPa, respectively). Anterior malalignment decreased (p = 0.0006) mean hindfoot peak plantar pressure (by 127.7 kPa). Anterior and posterior malalignments shifted center of pressure laterally during early and late stance. The TTR weakly to moderately correlated with range-of-motion changes in the tibiotalar, calcaneocuboid, and first metatarsophalangeal joints (r ≤ 0.39) and weakly correlated with plantar pressure changes under the hindfoot, the first metatarsal, and the hallux (r ≤ 0.15). CONCLUSIONS: Anterior and posterior malalignments of the talar component altered foot bone kinematics and plantar pressures. Mild malalignments produced fewer significant differences than moderate and extreme malalignments. A greater number of significant differences were found for posterior malalignments than for anterior. The TTR weakly to moderately correlated with changes in range of motion and plantar pressures. CLINICAL RELEVANCE: The observed changes in range of motion and plantar pressures may explain why malaligned ankle arthroplasties are associated with unfavorable clinical outcomes and poor prosthesis longevity. Posterior malalignments may produce worse clinical outcomes than anterior malalignments.


Assuntos
Articulação do Tornozelo/fisiopatologia , Artroplastia de Substituição do Tornozelo/efeitos adversos , Mau Alinhamento Ósseo/fisiopatologia , Pé/fisiopatologia , Marcha/fisiologia , Complicações Pós-Operatórias/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Artroplastia de Substituição do Tornozelo/instrumentação , Fenômenos Biomecânicos , Mau Alinhamento Ósseo/etiologia , Feminino , Humanos , Prótese Articular , Masculino , Pressão
7.
BMC Musculoskelet Disord ; 20(1): 453, 2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31627717

RESUMO

BACKGROUND: The topic that whether the injured deltoid ligament should be repaired when associated with ankle joint fractures is still discussed. The objective of this study was to compare the clinical effect of open reduction and internal fixation (ORIF) with deltoid ligament repair (DLR) or transarticular external fixation (TEF) in treating supination-external rotation type IV (SER IV) ankle fractures. METHODS: Between January 2012 and December 2015, 43 patients were diagnosed as SER IV ankle fractures, 20 underwent ORIF and transarticular external fixation (TEF) without DLR (group 1), 23 were treated with ORIF and DLR (group 2). The pre- and post-operative radiographic examination were performed, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the visual analog scale (VAS), the Medical Outcomes Short Form 36-item questionnaire score (SF-36), and the ankle range of motion (ROM) were used for functional evaluation. RESULTS: In both groups, the three scores improved significantly after surgery, but there was no significant difference between the two groups. At 6 weeks after surgery, patients in group 2 had better ankle ROM than group 1 (29.35 ± 2.033 vs. 40.35 ± 3.550, P <  0.001), but there was no difference at 12 months postoperatively. No cases of bone nonunion or post-traumatic arthritic changes were seen during the follow-up. Patients in group 1 required a shorter time to achieve fracture union than patients in group 2. CONCLUSIONS: ORIF with TIF is an optional strategy to manage SER IV ankle fractures as it achieves comparable functional results to ORIF with DLR. It also allows patients to start relatively earlier weight-bearing and may promote fracture union.


Assuntos
Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/fisiopatologia , Músculo Deltoide/cirurgia , Fixação de Fratura/métodos , Ligamentos Articulares/cirurgia , Adolescente , Adulto , Fraturas do Tornozelo/fisiopatologia , Músculo Deltoide/lesões , Músculo Deltoide/fisiopatologia , Feminino , Seguimentos , Humanos , Ligamentos Articulares/lesões , Ligamentos Articulares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Estudos Retrospectivos , Rotação , Supinação , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
Medicine (Baltimore) ; 98(39): e17317, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574862

RESUMO

INTRODUCTION: Stroke is the principal cause of impairment in the motor function and gait of adults. One of the resources used in rehabilitation to optimize gait is a prescription of ankle-foot orthosis (AFO), and the most prescribed AFOs are Fixed AFO and Articulated AFO; however, it is not known which of these options is more effective for these individuals. The aim of this study is to evaluate the impact of different types of ankle-foot orthosis functional mobility and dynamic balance in stroke patients. METHODS: Prospective randomized controlled clinical trial with 2 parallel groups will be conducted, and the aim is to recruit 50 patients with stroke diagnosis within 1 year, who indicated that they use both types of orthotics, who had a previous Rankin score less than or equal to 3, and who obtained AFO orthosis through the Hospital Clinics at the Botucatu Medical School (HCBMS) São Paulo, Brazil. After a specific evaluation by a physiotherapist, the patient will receive 1 of the AFO types via randomization. After 30 days, the patient will be reevaluated. The primary outcomes will be balance and mobility, which will be evaluated by the Time Up Go Test (TUG) and Tinetti's Scale of Mobility and Balance (TSMB). The secondary outcomes will be quality of life and the levels of anxiety and depression, which will be evaluated with the European (5D) Quality of Life Scale (Euroqol) and Hospital Anxiety and Depression Scale (HADS). Group allocation will be not concealed because the blinding of participants and of therapists that provide intervention is not possible, and all analyses will be based on an intention-to-treat principle. This study was approved by the Human Research Ethics Committee of the São Paulo State University UNESP, number 2.367.953. The results will be published in relevant journal. DISCUSSION: The results of this study will contribute to clinical practice by identifying the type of AFO orthosis that is more suitable for this condition, helping to standardize prescription of these orthoses by professionals, and guiding future research studies on this subject, which is still incompletely defined in the literature. TRIAL REGISTRATION: RBR-6SF2VV (March 5, 2018).


Assuntos
Tornozelo/fisiopatologia , Órtoses do Pé/normas , Transtornos Neurológicos da Marcha , Qualidade de Vida , Reabilitação do Acidente Vascular Cerebral , Adulto , Articulação do Tornozelo/fisiopatologia , Fenômenos Biomecânicos , Desenho de Equipamento , Feminino , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/terapia , Humanos , Masculino , Equilíbrio Postural , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/instrumentação , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/psicologia
9.
Bone Joint J ; 101-B(10): 1256-1262, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564155

RESUMO

AIMS: Postoperative rehabilitation regimens following ankle arthrodesis vary considerably. A systematic review was conducted to determine the evidence for weightbearing recommendations following ankle arthrodesis, and to compare outcomes between different regimens. PATIENTS AND METHODS: MEDLINE, Web of Science, Embase, and Scopus databases were searched for studies reporting outcomes following ankle arthrodesis, in which standardized postoperative rehabilitation regimens were employed. Eligible studies were grouped according to duration of postoperative nonweightbearing: zero to one weeks (group A), two to three weeks (group B), four to five weeks (group C), or six weeks or more (group D). Outcome data were pooled and compared between groups. Outcomes analyzed included union rates, time to union, clinical scores, and complication rates. RESULTS: A total of 60 studies (2426 ankles) were included. Mean union rates for groups A to D were 93.2%, 95.5%, 93.0%, and 93.0%, respectively. Mean time to union was 10.4 weeks, 14.5 weeks, 12.4 weeks, and 14.4 weeks for groups A to D, respectively. Mean complication rates were 22.3%, 23.0%, 27.1%, and 28.7% for groups A to D, respectively. Reporting of outcome scores was insufficient to conduct meaningful analysis. CONCLUSION: Outcomes following ankle arthrodesis appear to be similar regardless of the duration of postoperative nonweightbearing, although the existing literature is insufficient to make definitive conclusions. Cite this article: Bone Joint J 2019;101-B:1256-1262.


Assuntos
Articulação do Tornozelo/cirurgia , Artrodese/métodos , Medição da Dor , Cuidados Pós-Operatórios/métodos , Suporte de Carga/fisiologia , Fatores Etários , Idoso , Articulação do Tornozelo/fisiopatologia , Artrodese/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Medição de Risco , Fatores Sexuais
10.
Gait Posture ; 74: 218-222, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31561120

RESUMO

BACKGROUND: Many people with multiple sclerosis (pwMS) experience walking impairments often including foot drop, evident as either reduced dorsiflexion at initial contact and/or at the swing phase of the gait cycle. To measure even subtle differences in ankle kinematics, 3D gait analysis is considered a 'gold' standard. However, the psychometric properties of ankle kinematics in the MS population have not yet been examined. OBJECTIVE: The aim of the study was to examine test-retest relative and absolute reliability of sagittal ankle kinematics and spatiotemporal parameters in two groups of pwMS with different levels of walking impairment. METHODS: Two groups of pwMS underwent 3D gait analysis on two occasions 7-14 days apart. Group A consisted of 21 (14 female) people with Expanded Disability Status Scale (EDSS) 1-3.5 and group B consisted of 28 participants (14 female) with EDSS 4-6. The Intraclass Correlation Coefficient (ICC2,2), standard error of measurement (SEM) and minimal detectable change (MDC95%) were calculated for peak dorsiflexion (DF) in swing, ankle angle at initial contact (IC), gait profile score (GPS), walking speed, cadence and step length. RESULTS: Both groups presented 'excellent' ICC values (>0.75) for DF in swing, IC and step length of most and least affected limbs, walking speed and cadence, with GPS for both limbs exhibiting 'fair' to 'good' ICCs (0.489-0.698). The MDC95% values for all ankle kinematic parameters in group A were lower (1.9°-4.2°) than those in group B (2.2°-7.7°). CONCLUSION: The present results suggest that ankle kinematic and spatiotemporal parameters derived from 3D gait analysis are reliable outcome measures to be used in the MS population. Further, this study provides indices of reliability that can be applied to both clinical decision making and in the design of studies aimed at treating foot drop in people with MS.


Assuntos
Articulação do Tornozelo/fisiopatologia , Transtornos Neurológicos da Marcha/fisiopatologia , Marcha/fisiologia , Esclerose Múltipla/fisiopatologia , Caminhada , Adulto , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
11.
Gait Posture ; 74: 169-175, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31525655

RESUMO

BACKGROUND: Individuals with CAI have demonstrated a more inverted foot position during walking when compared to a healthy control group. Copers are individuals who have had an ankle sprain but learn to cope and return to pre-injury levels of function and may be a better comparison group than healthy controls because they have had the same initial injury. RESEARCH QUESTION: A controlled laboratory study was performed to simultaneously analyze differences in lower extremity walking gait kinematics, kinetics, and surface electromyography (EMG) between individuals with CAI and copers at a preferred walking speed (PWS), 120% preferred walking speed (120WS), and standardized walking speed (SWS) of 1.34 m/s. METHODS: Thirty-six (18 coper, 18 CAI) physically active individuals participated. Three-dimensional kinematics and kinetics at the ankle, knee, and hip and EMG amplitude for fibularis longus, tibialis anterior, medial gastrocnemius, and gluteus medius muscles were analyzed. Ten consecutive strides from each speed were analyzed using statistical parametric mapping (SPM). A 2 × 3 group by speed ANOVA and post-hoc t-tests were used to compare differences between the coper and CAI groups. RESULTS: The CAI group had more ankle inversion at IC (PWS: MD = 4.2°, d = 1.08; 120WS: MD = 5.0°, d = 1.28; SWS: MD = 6.6°, d = 1.37) and greater peak inversion throughout swing at all three walking speeds (PWS: MD = 4.2°, d = 0.89; 120WS: MD = 4.4°, d = 0.91; SWS: MD = 6.2°, d = 1.21). The CAI group had greater peak hip adduction during swing (PWS: MD = 4.5°, d = 0.96; 120WS: MD = 4.1°, d = 1.04; SWS: MD = 3.6°, d = 0.98). SIGNIFICANCE: The CAI group demonstrated greater ankle inversion at IC and during the swing phase and greater peak hip adduction during the swing phase compared to the copers. As the speed increased, ankle inversion in the CAI group also increased which could be linked to greater risk of recurrent sprains. Therefore, modeling gait training programs after the coper mechanics may be advantageous.


Assuntos
Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Marcha/fisiologia , Instabilidade Articular/fisiopatologia , Velocidade de Caminhada/fisiologia , Adulto , Análise de Variância , Fenômenos Biomecânicos , Estudos de Casos e Controles , Eletromiografia/efeitos adversos , Feminino , Humanos , Masculino , Músculo Esquelético/fisiologia , Adulto Jovem
12.
Phys Ther Sport ; 40: 137-142, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31542637

RESUMO

OBJECTIVES: To quantify differences in generic and psychological patient-reported outcomes (PROs) between those with CAI and uninjured controls. To determine associations between generic and psychological PROs, in those with CAI, to regional PROs and injury history characteristics. DESIGN: Cross-sectional, descriptive. SETTING: Sport Medicine Research Laboratory. PARTICIPANTS: Included 45 individuals with CAI and 45 uninjured controls. CAI was defined based on the recommendations of the International Ankle Consortium. MAIN OUTCOME MEASURES: Two regional PROs (e.g. Foot and Ankle Ability Measure), and several generic and psychological PROs (e.g. SF-36, select PROMIS short forms, Fear Avoidance Beliefs Questionnaire). RESULTS: Those with CAI had worse scores, relative to controls, in PROs related to regional function, generic physical function, pain, ability to participate in social roles and activities, and injury related fear. The number of giving way episodes, CAI severity, and regional PROs associated with generic physical function scales as well as a pain scale. CONCLUSIONS: Select generic physical function and psychological scales can detect differences between those with and without CAI. Specific injury history characteristics and regional PROs associate with generic and psychological PROs.


Assuntos
Traumatismos do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/psicologia , Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/psicologia , Adulto , Doença Crônica , Estudos Transversais , Medo , Humanos , Medidas de Resultados Relatados pelo Paciente , Inquéritos e Questionários , Adulto Jovem
13.
J Electromyogr Kinesiol ; 49: 102353, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31473451

RESUMO

Children with cerebral palsy (CP) present increased passive ankle joint stiffness, measured as the slope of the torque-angle curve relationship. However, large discrepancies in results exist among studies, likely because of various methodologies used. The purpose of this study was to determine the influence of different calculation methods on the outcomes and their inter-session reliability in children with unilateral CP (UCP). Thirteen children (mean age: 9.8 years) with spastic UCP underwent passive ankle mobilization at 2°/s on both legs using a dynamometer, on two occasions separated by one week. Passive ankle joint stiffness was calculated as the slope of the torque-angle curve using linear regression on three different relative ranges of torque (i.e. 30%-100%, 20-80% and 50-90% of maximal torque for method 1, 2 and 3, respectively) for both the paretic and non-paretic legs. Inter-session reliability was significantly lower on paretic leg (mean CV = 13.8%, ICC = 0.62) when compared to non-paretic leg (mean CV = 6%, ICC = 0.85), and method 3 presented lower reliability outcomes (mean CV = 11.7%, ICC = 0.75) than methods 1 (mean CV = 7.5%, ICC = 0.78) and 2 (mean CV = 6.6%, ICC = 0.79). Paretic values (0.24 Nm/°) were not different from the non-paretic leg (0.25 Nm/°), although significantly higher when considering the same angular sector (0.18 Nm/°). Passive ankle joint stiffness measurement can be reliably performed in children with UCP using method 1 and 2 while method 3 should be avoided. The non-paretic leg may be used for comparison with the paretic leg when taking into account differences in maximal dorsiflexion angle between legs. ClinicalTrials.gov Identifier: NCT02960932.


Assuntos
Articulação do Tornozelo/fisiopatologia , Paralisia Cerebral/fisiopatologia , Miografia/métodos , Amplitude de Movimento Articular , Criança , Feminino , Lateralidade Funcional , Humanos , Masculino , Contração Muscular , Força Muscular , Músculo Esquelético/fisiopatologia , Miografia/normas , Reprodutibilidade dos Testes , Torque
14.
Phys Ther Sport ; 40: 91-98, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31505432

RESUMO

OBJECTIVE: Chronic ankle instability (CAI) is reported after ankle sprain. Our aim was to assess differences in mechanical pain sensitivity of lower extremity nerve trunks and physical performance between amateur soccer players with and without CAI. DESIGN: A cross-sectional case-control study. SETTING: Amateur soccer teams. PARTICIPANTS: Fifty-five male soccer players, 28 with and 27 without CAI participated. MAIN OUTCOME MEASURES: The perceived instability was assessed with the Cumberland Ankle Instability Tool (CAIT). Pressure pain thresholds (PPTs) on the common peroneal and tibialis nerve trunks, vertical jump, lateral step-down test and joint position sense of the knee were assessed by a blinded assessor. RESULTS: Soccer players with CAI showed lower PPTs over the common peroneal nerve than those without CAI (between-groups mean difference: 1.0 ±â€¯0.8 kg/cm2, P < 0.001). No differences for PPT over the tibialis posterior (P = 0.078) or any physical performance outcome (knee joint positioning sense [P = 0.798], lateral step-down test [P = 0.580] and vertical jump variables [all, P > 0.310]) were found. PPT over the common peroneal nerve exhibited a significant moderate correlation with the CAIT score (r = 0.528, P < 0.001). CONCLUSION: Amateur soccer players with CAI have higher pressure pain sensitivity over the common peroneal nerve but exhibit similar physical performance to amateur soccer players without CAI.


Assuntos
Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Limiar da Dor , Nervo Fibular/fisiopatologia , Desempenho Físico Funcional , Futebol , Adulto , Traumatismos do Tornozelo/complicações , Atletas , Estudos de Casos e Controles , Estudos Transversais , Teste de Esforço , Humanos , Articulação do Joelho , Masculino , Adulto Jovem
15.
Gait Posture ; 73: 262-268, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31382233

RESUMO

BACKGROUND: Previous studies showed functional ankle instability (FAI) patients have morphological ligamentous abnormality, despite having no apparent joint laxity. RESEARCH QUESTION: Whether tibiotalar and subtalar joints hypermobility exists in FAI patients during stance phase of walking, remains controversial. METHODS: Ten unilateral FAI patients, ten unilateral lateral ankle sprain (LAS) copers and ten healthy controls were included. A dual fluoroscopy imaging system was utilized to capture the fluoroscopic images of tibiotalar and subtalar joint during the stance phase of walking. Kinematic data from six degrees of freedom were calculated utilizing a solid modeling software. The range of motion and joint excursions about six degrees of freedom were compared among the three groups. The correlations between range of motion and Cumberland Ankle Instability Tool (CAIT) scores were assessed utilizing the Spearman's correlation coefficient (r). RESULTS: During the stance phase, the FAI patients and LAS copers showed larger tibiotalar anterior/posterior translation than the healthy controls (FAI patients, p = .013; LAS copers, p = .002). The FAI patients also showed significantly larger lateral/medial translation (p = .035) and inversion/eversion rotation (p = .003) of subtalar joints than healthy controls. By contrast, the subtalar joints of the LAS copers were not different from those of the healthy controls in the lateral/medial translation (p = .459) and inversion/eversion rotation (p = .091). CAIT scores were negatively correlated with range of motion. SIGNIFICANCE: During the stance phase of walking, FAI patients showed significantly larger hypermobility of subtalar joints than healthy controls, contrary to the LAS copers. These findings justify the utilization of dual fluoroscopy imaging system to detect joint hypermobility in FAI patients. Treatment for FAI patients may require stabilization of the subtalar joint.


Assuntos
Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Articulação Talocalcânea/fisiopatologia , Adulto , Traumatismos do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/diagnóstico por imagem , Fenômenos Biomecânicos , Estudos de Casos e Controles , Feminino , Fluoroscopia/métodos , Análise da Marcha , Humanos , Instabilidade Articular/diagnóstico por imagem , Masculino , Amplitude de Movimento Articular , Rotação , Articulação Talocalcânea/diagnóstico por imagem , Adulto Jovem
16.
Int J Surg ; 70: 53-59, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31430548

RESUMO

OBJECTIVE: Aim of this study was to establish three-dimensional finite element model of the posterolateral-oblique type of posterior malleolus fracture with different sagittal angle and to explore the effect of sagittal angle on ankle joint stability. METHODS: CT data of ankle were collected from a normal male volunteer.Established finite element model of the normal ankle and verified its reliability. Five posterior malleolus fracture models with different sagittal angles were established. Finite element analysis(FEA)was carried out to simulate the conditions of vertical loading in neutral position with a total weight of 600 N.Recorded the data and did statistical analyses. RESULTS: (1) The contact area was 483.55 mm2 and the maximum contact stress was 3.793 MPa in the model of the normal ankle joint. (2) There was a positive correlation between the sagittal angle(SA)and the contact area(CA)(r = 0.925,P < 0.05). Regression equation was CA = 316.755 + 1.749* SA. The correlation between the sagittal angle and the maximum contact stress(MCS)was negative (r = -0.988,P < 0.01). Regression equation was MCS = 5.214-0.018*SA. There was a negative correlation between the sagittal angle of fracture and relative displacement(RD)(r = -0.950,P < 0.05). Regression equation was RD = 1.388-0.009*SA. CONCLUSION: The greater the sagittal angle of fracture was, The more stable the ankle joint was. The sagittal angle of fracture could be used as a relative index to reflect ankle stability for posterior malleolus fracture.


Assuntos
Fraturas do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Análise de Elementos Finitos , Instabilidade Articular/fisiopatologia , Adulto , Estudos de Coortes , Fixação Interna de Fraturas/métodos , Humanos , Masculino
17.
J Knee Surg ; 32(10): 1033-1038, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31434142

RESUMO

Mechanically aligned total knee arthroplasty (MATKA) aims to make alignment of the hip, knee, and ankle straight unexceptionally. However, emerging evidence suggests that unexceptional straightening the mechanical axis of the lower limb may lead to clinical and radiological problems of the ankle joint. By contrast, kinematically aligned total knee arthroplasty (KATKA) strives to restore the articular surface of the prearthritic knee. In this study, we examined results from KATKA and MATKA to determine which surgery restores the ankle joint orientation closer to the native ankle joint in bipedal stance and hypothesized that KATKA, rather than MATKA, would be more effective. Data from long-leg standing radiographs of 60 healthy adults (control group, n = 120 knees), patients who underwent MATKA (n = 90 knees), and patients who underwent KATKA (n = 90 knees) were retrospectively reviewed. The hip-knee-ankle angle, orientation of the tibial plafond and the talar dome relative to the ground (G-plafond and G-talus, respectively), and orientation of the plafond relative to the mechanical axis of the limb (M-plafond and M-talus, respectively) were measured and analyzed for comparison. Results show that bipedal stance alignment in patients who underwent KATKA (G-plafond: -0.65 ± 3.03 and G-talus: -1.72 ± 4.02) were not significantly different to native ankle joint alignment indicated by the control group. Compared with the native ankle joint measured in the control group (G-plafond: -0.76 ± 2.69 and G-talus: -1.30 ± 3.25), the tibial plafond and talar dome significantly tilted laterally relative to the ground in ankle joints after MATKA (G-plafond: -2.32 ± 3.30 and G-talus: -2.97 ± 3.98, p = 0.001 and p = 0.004, respectively). Thus, postoperative ankle joint line orientation after KATKA was horizontal to the floor and closer to that of native ankle joints than those after MATKA. The level of evidence is Level III.


Assuntos
Articulação do Tornozelo/diagnóstico por imagem , Artroplastia do Joelho/métodos , Mau Alinhamento Ósseo/prevenção & controle , Articulação do Joelho/cirurgia , Extremidade Inferior/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Adulto , Idoso , Articulação do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Artroplastia do Joelho/efeitos adversos , Fenômenos Biomecânicos , Mau Alinhamento Ósseo/diagnóstico por imagem , Mau Alinhamento Ósseo/etiologia , Mau Alinhamento Ósseo/cirurgia , Feminino , Genu Varum/diagnóstico por imagem , Genu Varum/etiologia , Genu Varum/fisiopatologia , Genu Varum/cirurgia , Humanos , Articulação do Joelho/fisiopatologia , Prótese do Joelho , Extremidade Inferior/fisiopatologia , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Posição Ortostática , Adulto Jovem
18.
Orthop Surg ; 11(4): 671-678, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31456322

RESUMO

OBJECTIVE: To compare the clinical and radiological outcome between the modified Broström repair with augmentation using suture tape (MBA) and the modified Broström repair (MB) for patients with chronic lateral ankle instability. METHODS: A retrospective study was performed in Ningbo No. 6 Hospital. The study included 53 patients who underwent surgical treatment from March 2014 to July 2016 and were followed for 2 years. A total of 25 patients underwent modified Broström repair with augmentation using suture tape, and 28 patients were treated with modified Broström repair. Patients were evaluated using the American Orthopedic Foot and Ankle Scale (AOFAS) hindfoot scale, the Foot and Ankle Ability Measure (FAAM) score, range of motion (ROM), and the visual analogue scale (VAS). The talar tilt angle (TTA) and anterior talar translation (ATT) were used to evaluate the mechanical stability. All radiological outcomes were measured by two orthopaedic surgeons, with the measurements repeated 3 days later. RESULTS: The mean age of the patients was 26.6 ± 17.8 years in the MBA group and 28.1 ± 19.4 years in the MB group, and no statistical difference in preoperative data was found between two groups. There were significant differences before and after the operation within the groups. Both groups achieved satisfactory outcomes, and significant improvements (VAS, FAAM, AOFAS, TTA, and ATT) were observed between the 1-year follow-up and final follow-up (P < 0.05). The MBA group showed significant improvement in the FAAM Sport (87.1 ± 5.4 vs 78.2 ± 12.0, P = 0.001) and total scores (93.1 ± 2.3 vs 90.5 ± 5.1, P = 0.027) at the final follow-up compared with the MB group, and for the other outcomes, there were no significant differences between the two groups. CONCLUSION: The modified Broström repair with augmentation using suture tap for chronic lateral ankle instability achieves a better outcome; however, further research is necessary.


Assuntos
Articulação do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Procedimentos Ortopédicos/instrumentação , Fita Cirúrgica , Adolescente , Adulto , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Avaliação da Deficiência , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/fisiopatologia , Pessoa de Meia-Idade , Medição da Dor , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Adulto Jovem
19.
Med Sci Monit ; 25: 5920-5928, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31393860

RESUMO

BACKGROUND The effect of foot orthoses in terms of kinematics and kinetics during walking could be affected on different geometrical designs. Therefore, the purpose of this study was to compare the biomechanical and clinical effects of 3 different insoles on rearfoot motion (RFM) and ankle joint moment parameters. MATERIAL AND METHODS Twenty eight university students with flexible flatfoot were recruited for this study, and each participant was asked to wear 3 different insoles: normal insole without arch support function, type A insole with only arch support function, and type B insole with both arch support and cushion pads for shock absorbing functions. Three-dimensional motion analysis was performed to compute the ranges and peak orientation angles of RFM and ankle joint moment parameters. RESULTS The type A and type B insoles exhibited significantly smaller peak everted position and evertor moment than the normal insole. Also, the type A insole showed significantly smaller range of rearfoot motion in the longitudinal axis and the length of MA (moment arm) in the mediolateral axis than the normal insole. CONCLUSIONS The use of the type A insole using arch support function was induced to promote a cautious gait pattern associated with a relatively lower potential risk compared to the normal insole. The type A and type B insoles could be important to positively reduce the possibility of injury. Also, the smaller length of MA in the type A insole might have a contribution to the decrease of ankle joint evertor moment.


Assuntos
Pé Chato/terapia , Caminhada/fisiologia , Articulação do Tornozelo/fisiopatologia , Fenômenos Biomecânicos/fisiologia , Feminino , Pé Chato/fisiopatologia , , Órtoses do Pé , Marcha , Humanos , Cinética , Articulação do Joelho/fisiopatologia , Masculino , Movimento (Física) , Movimento/fisiologia , Sapatos , Adulto Jovem
20.
J Bone Joint Surg Am ; 101(16): 1485-1494, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31436657

RESUMO

BACKGROUND: Newer designs and techniques of total ankle arthroplasty (TAA) have challenged the assumption of ankle arthrodesis (AA) as the primary treatment for end-stage ankle arthritis. The objective of this study was to compare physical and mental function, ankle-specific function, pain intensity, and rates of revision surgery and minor complications between these 2 procedures and to explore heterogeneous treatment effects due to age, body mass index (BMI), patient sex, comorbidities, and employment on patients treated by 1 of these 2 methods. METHODS: This was a multisite prospective cohort study comparing outcomes of surgical treatment of ankle arthritis. Subjects who presented after nonoperative management had failed received either TAA or AA using standard-of-treatment care and rehabilitation. Outcomes included the Foot and Ankle Ability Measure (FAAM), Short Form-36 (SF-36) Physical and Mental Component Summary (PCS and MCS) scores, pain, ankle-related adverse events, and treatment success. RESULTS: Five hundred and seventeen participants underwent surgery and completed a baseline assessment. At 24 months, the mean improvement in FAAM activities of daily living (ADL) and SF-36 PCS scores was significantly greater in the TAA group than in the AA group, with a difference between groups of 9 points (95% confidence interval [CI] = 3, 15) and 4 points (95% CI = 1, 7), respectively. The crude incidence risks of revision surgery and complications were greater in the AA group; however, these differences were no longer significant after adjusting for age, sex, BMI, and Functional Comorbidity Index (FCI). The treatment success rate was greater after TAA than after AA for those with an FCI of 4 (80% versus 62%) and not fully employed (81% versus 58%) but similar for those with an FCI score of 2 (81% versus 77%) and full-time employment (79% versus 78%). CONCLUSIONS: At 2-year follow-up, both AA and TAA were effective. Improvement in several patient-reported outcomes was greater after TAA than after AA, without a significant difference in the rates of revision surgery and complications. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Articulação do Tornozelo/cirurgia , Artrodese/métodos , Artroplastia de Substituição do Tornozelo/métodos , Osteoartrite/cirurgia , Medidas de Resultados Relatados pelo Paciente , Segurança do Paciente , Idoso , Articulação do Tornozelo/fisiopatologia , Artrodese/efeitos adversos , Artroplastia de Substituição do Tornozelo/efeitos adversos , Distribuição de Qui-Quadrado , Estudos de Coortes , Feminino , Seguimentos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Reoperação/métodos , Resultado do Tratamento
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