Altered Joint Biomechanics Research Articles

The distal fascicle of the anterior inferior tibiofibular ligament as a cause of tibiotalar impingement syndrome: a current concepts review

Impingement syndromes of the ankle involve either osseous or soft tissue impingement and can be anterior, anterolateral, or posterior. Ankle impingement syndromes are painful conditions caused by the friction of joint tissues, which are both the cause and the effect of altered joint biomechanics. The distal fascicle of the anterior inferior tibiofibular ligament (AITFL) is possible cause of anterior impingement. The objective of this article was to review the literature concerning the anatomy, pathogenesis, symptoms and treatment of the AITFL impingement and finally to formulate treatment recommendations. The AITFL starts from the distal tibia, 5 mm in average above the articular surface, and descends obliquely between the adjacent margins of the tibia and fibula, anterior to the syndesmosis to the anterior aspect of the lateral malleolus. The incidence of the accessory fascicle differs very widely in the several studies. The presence of the distal fascicle of the AITFL and also the contact with the anterolateral talus is probably a normal finding. It may become pathological, due to anatomical variations and/or anterolateral instability of the ankle resulting from an anterior talofibular ligament injury. When observed during an ankle arthroscopy, the surgeon should look for the criteria described to decide whether it is pathological and considering resection of the distal fascicle. The presence of the AITFL and the contact with the talus is a normal finding. An impingement of the AITFL can result from an anatomical variant or anteroposterior instability of the ankle. The diagnosis of ligamentous impingement in the anterior aspect of the ankle should be considered in patients who have chronic ankle pain in the anterolateral aspect of the ankle after an inversion injury and have a stable ankle, normal plain radiographs, and isolated point tenderness on the anterolateral aspect of the talar dome and in the anteroinferior tibiofibular ligament. The impingement syndrome can be treated arthroscopically.

Surgical Management of Paget's Disease of Bone

Paget's disease is a chronic nonmetabolic bone disorder that is characterized by increased bone resorption, bone formation, and remodeling. This unbalanced process may lead to osseous deformities, structural weakness, and altered joint biomechanics, all of which can make surgical reconstruction difficult. Although few patients with Paget's disease ever need surgical treatment, successful surgical management of orthopedic manifestations of the disease has improved the quality of life for these patients. Surgical options include corrective osteotomy for long bone deformity, fracture fixation, joint arthroplasty, spinal decompression, and tumor resection. Patients are at increased risk for surgical complications such as blood loss and heterotopic bone formation. Issues relating to the surgical management of patients with Paget's disease such as appropriate preoperative diagnosis, technical challenges of surgery, and strategies to improve the long-term outcome of surgical intervention are discussed.

Surgical Manifestations of Pagetʼs Disease

Paget's disease is a chronic, nonmetabolic bone disorder characterized by increased bone resorption, bone formation, and remodeling. This unbalanced process may lead to osseous deformities, structural weakness, and altered joint biomechanics, all of which can make surgical reconstruction difficult. Although few patients with Paget's disease require surgical treatment, successful surgical management of severe orthopaedic complications has improved the quality of life for these patients. Surgical options include osteotomy to correct long-bone deformity and arthroplasty to restore altered joint mechanics. Patients are at increased risk for surgical complications, such as blood loss and heterotopic bone formation. Issues relating to the surgical management of patients with Paget's disease include appropriate preoperative diagnosis, technical challenges of surgery, and strategies to improve the long-term outcome of surgical intervention.

MR imaging of ankle impingement syndromes.

551 nkle impingement syndromes are painful conditions caused by the friction of joint tissues, which is both the cause and the effect of altered joint biomechanics. The leading causes of impingement lesions are posttraumatic ankle injuries, usually ankle sprains, resulting in chronic ankle pain [1]. From anatomic and clinical viewpoints, these syndromes are classified as anterolateral, anterior, anteromedial, posteromedial, and posterior [1, 2]. Careful analyses of patient history and signs and symptoms at physical examination can suggest a specific diagnosis in most patients. MR imaging and MR arthrography are the most useful imaging methods for detecting the osseous and soft-tissue abnormalities present in these syndromes and for ruling out other potential causes of chronic ankle pain [1–3]. Treatment of all impinging lesions is the same regardless of the cause. The initial treatment is conservative, but when this fails, arthroscopic examination is indicated to identify and resect the impinging lesion [1, 2]. The purpose of this article is to describe the clinical, MR imaging, and MR arthrography features of ankle impingement syndromes.

Joint impingement syndrome: clinical features

Joint impingement is a painful syndrome caused by the friction of joint tissues, which is both the cause and the effect of altered joint biomechanics. From the anatomical and clinical viewpoints, these syndromes are classified as bone impingement, soft tissue impingement and entrapment neuropathy, depending on what joint portion impinges on the others. We considered the most important impingement syndromes of the upper and the lower limbs from the clinical viewpoint. As for the upper limb, supraspinatus impingement is a frequent cause of shoulder pain in both athletes and the normal population; the painful subacromial arch is a typical sign of the rotator cuff impingement syndrome and of outlet and non-outlet impingement as well. As for the elbow, we considered both medial and lateral impingement. The carpal tunnel syndrome is the most common peripheral entrapment neuropathy of the upper limb; it is caused by compression of the median nerve at the wrist. We considered the main causes of carpal tunnel narrowing and the relative clinical findings. As for the lower limb, we considered the iliotibial band friction syndrome, which is the most common overuse syndrome of the knee and the ankle impingement syndrome. The latter includes anterolateral impingement (with chronic anterolateral and lateral pain and ankle instability), sinus tarsi impingement, anterior impingement (with pain during foot dorsiflection and posterior impingement. The tarsal tunnel syndrome is the most important ankle entrapment neuropathy causing burn pain and paresthesias in the toes and sole of the foot.

Wrist pain in adult athletes.

As more and more adults become physically active, primary care physicians are seeing an increasing number of wrist injuries. Effective treatment is based on (1) accurate diagnosis, (2) maintenance of bone and joint-surface alignment until healing of bone, soft tissue, or both occurs, and (3) institution of an appropriate rehabilitation program. After symptoms have subsided, patients can gradually return to athletic participation. The long-term sequelae of wrist injuries are yet to be determined. If it is assumed that such injury causes a form of joint trauma, then analogies may be drawn to other types of musculoskeletal trauma, in which such factors as joint-surface and bone malalignment can lead to abnormal cartilage wear, predisposing patients to degenerative arthritis. Similarly, untreated ligament injuries may alter joint biomechanics, which can also lead to joint-surface trauma. Further clinical study should clarify the long-term effects of wrist injury.