Ankle Tendon Research Articles

The Use of Supramalleolar Osteotomies in Posttraumatic Deformity and Arthritis of the Ankle.

Osteoarthritis of the ankle is a debilitating musculoskeletal disease that affects approximately 1% of adults worldwide. The most common etiology of ankle osteoarthritis is trauma. In general, patients with ankle osteoarthritis are 12 to 15 years younger than patients with hip or knee osteoarthritis. More than 50% of all patients with ankle osteoarthritis exhibit a substantial concomitant hindfoot deformity on the supramalleolar and/or inframalleolar level. Different treatment options for ankle osteoarthritis, including joint-preserving and non-joint-preserving surgical procedures, have been described in the current literature. Supramalleolar osteotomy is a joint-preserving option that can be considered in patients who have asymmetric ankle osteoarthritis, a partially preserved ankle joint, and a concomitant supramalleolar deformity. The primary goal of the supramalleolar osteotomy is to realign the hindfoot and, specifically, the spatial relationship between the talus and the tibia in order to restore normal ankle biomechanics and normalize load distribution within the ankle joint. Different surgical techniques of supramalleolar osteotomy that are based on the underlying deformity, e.g., varus versus valgus, are described. The major steps of the procedure, which are demonstrated in this video article, include (1) exposure of the distal end of the tibia, (2) determination of the osteotomy site, (3) performance of the supramalleolar osteotomy, (4) mobilization of the osteotomized distal end of the tibia, (5) internal fixation of the osteotomy site, (6) additional balancing, and (7) step-by-step wound closure. In some instances, additional procedures are required to balance the ankle joint, e.g., inframalleolar osteotomies, arthrodeses, ligament reconstructions, and tendon transfers. The postoperative rehabilitation requires non-weight-bearing activity for 6 to 8 weeks postoperatively. Intraoperative, perioperative, and postoperative complications can occur and are discussed in this article.

Ankle Evaluation in Active Rheumatoid Arthritis by Ultrasound: A Cross-Sectional Study

Ankle joint evaluation is underestimated in many clinical and sonographic scores used for evaluation and follow-up of rheumatoid arthritis (RA) patients. Agreement on examination parameters is poor among sonographic scores that include the ankle joint. More effort is needed to detect the value of ankle joint examination in RA and assessment of ultrasonographic signs according to frequency, disease duration and activity. The objective of this study was to use ultrasound (US) to detect ankle involvement in active RA and to compare findings with disease duration, disease activity and assessment of ankle bone erosion. A total of 63 RA patients with active disease and 20 controls were included in the study. The tibiotalar and talonavicular joints were examined by US for synovitis and/or effusion in gray-scale and power Doppler modes. The anterior, lateral and posterior ankle tendons were examined for tenosynovitis and tendinosis. Mean age was 35.1 ± 8.3 y, mean disease duration was 22.7 ± 9.6 mo and the mean 28-joint Disease Activity Score–erythrocyte sedimentation rate was 3.05 ± 0.66. Ankle involvement was seen in 28 patients (44.4%). The most frequent pathologies detected were tenosynovitis (30.2%), followed by synovitis (18.3%), erosion (8.7%) and tendinosis (4%). The earliest sonographic signs were tenosynovitis, followed by synovitis, erosion and tendinosis. The right ankle exhibited greater involvement than the left ankle, which was significant with respect to erosions (p = 0.009). The most common tendon affected by tenosynovitis was the tibialis anterior (22.2%), followed by the tibialis posterior (20.6%). Tenosynovitis, especially of the tibialis anterior and posterior, tibiotalar synovitis and erosions should be considered in future US ankle scores for the assessment of RA.

Construction of spontaneous-tendon-rupture of rheumatoid arthritis of rabbit model

Objective To investigate the feasibility of constructing a rabbit model of spontaneous rupture of tendon in rheumatoid arthritis. Methods Twenty New Zealand rabbits were divided into three groups by random grouping. In group A (control group), saline was injected in the construction of the animal model of rheumatoid arthritis. In group B (animal model group), antigen induced arthritis (AIA) method was used to construct the animal model. In group C, is model animal in tendon by tendinitis, injection of type I collagen construct muscle tendinitis animal model. Compared with the A group B group animal in general and joint inflammatory changes before and after the measurement of serum interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α) content, determine the animal model of rheumatoid arthritis is constructed successfully. The use of neuromuscular electrical stimulation passive ankle joint construction of experimental animal, animal model of spontaneous rupture of tendon, and killed all the animal after comparison of B group and C group, the animal model of ankle joint hyperplasia and tendon rupture, fracture, parallel histological observation. Results With the increasing of immuning, group B animals loss of appetite, slow increase of body weight, hair color is yellow, sparse activity decreased; in the intra-articular injection of ovalbumin after severe joint swelling, group B ankle diameter (1.7±0.3) cm, temperature (38.1±0.4) ℃, was significantly different (P=0.003), the content of IL-1 in serum of B group (168.4±21.5) ng/L, TNF-α content (408.4±47.5) ng/L, was significantly higher than that of group A (P=0.000). The establishment of rheumatoid arthritis model was successfully confirmed by anatomical observation, pathological section and histological observation. After muscle electrical stimulation, B group animals gradually appeared toe to toe dysfunction at 5 to 17 d. Anatomical observation of flexor digitorum tendon confirmed the spontaneous exercise of tendon, and the animal model was successfully constructed. Conclusion Using the electrical stimulation can construct the rabbit model of spontaneous-tendon- rupture of rheumatoid arthritis. Key words: Rheumatoid arthritis; Model, animal; Spontaneous rupture of tendons; Rabbits

MRI evaluation of ligaments and tendons of foot arch in talar dome osteochondral lesions.

Background There are no publications in literature describing an association between disorders of the ligaments and tendons supporting the foot arch and osteochondral lesions of the talus (OCLT). We believe there may be a correlation between the damage of these structures. Purpose To investigate the pathologies of main ligaments and tendons that support the foot arch in sprained ankles, by reviewing magnetic resonance imaging (MRI) studies and comparing the results in two groups of patients, with and without OCLT. Material and Methods MR images from 316 patients examined in the orthopedic clinic for ankle sprain were evaluated for pathologic findings of the plantar fascia, short and long plantar ligaments, spring ligament, sinus tarsi, and ankle tendons supporting the foot arch. Findings were compared between two groups of patients: 158 patients with OCLT and 158 patients without OCLT. Results Plantar fascia, short plantar ligament, and spring ligament abnormalities were seen in 50 (31.6%), 28 (17.7%), and 60 (38%) patients with OCLT, and in nine (5.6%), three (1.9%), and 18 (11.4%) patients without OCLT, respectively ( P < 0.05). Sinus tarsi and tendon abnormalities were seen in 11 (6.7%) and nine (5.7%) patients with OCLT, and in eight (5%) and eight (5%) patients without OCLT, respectively ( P > 0.05). Two or more associated abnormalities were present in 50 (31.6%) patients with OCLT and in 11 (6.7%) without OCLT ( P < 0.05). Conclusion Plantar fascia, short plantar ligament, and spring ligament abnormalities were commonly seen in patients with OCLT on MRI, while sinus tarsi and tendon abnormalities were not. Concomitant pathologies have an increased incidence in patients with OCLT.

Ultrasound-guided steroid tendon sheath injections in juvenile idiopathic arthritis: a 10-year single-center retrospective study

BackgroundThe aims of this study were to: (a) Identify tendon sheaths most commonly treated with steroid injections in a pediatric patient population with Juvenile Idiopathic Arthritis (JIA); (b) Describe technical aspects of the procedure; (c) Characterize sonographic appearance of tenosynovitis in JIA; (d) Assess agreement between clinical request and sites injected.MethodsThis was a 10 year single-center retrospective study (May 2006-April 2016) of patients with JIA referred by Rheumatology for ultrasound-guided tendon sheath injections. Patient demographics, clinical referral information, sonographic appearance of the tendon sheaths and technical aspects of the procedure were analyzed.ResultsThere were 308 procedures of 244 patients (75% female, mean age 9.6 years) who underwent a total of 926 tendon sheath injections. Ankle tendons were most commonly injected (84.9%), specifically the tendon sheaths of tibialis posterior (22.3%), peroneus longus (20%) and brevis (19.7%). The majority of treated sites (91.9%) showed peritendinous fluid and sheath thickening on ultrasound. There were 2 minor intra-procedure complications without sequelae. A good agreement between clinical request and sites injected was observed.ConclusionsUltrasound-guided tendon sheath injections with steroids are used frequently to treat patients with JIA. It is a safe intervention with a high technical success rate. The ankle region, specifically the medial compartment, is the site most commonly injected in this group of patients. The most common sonographic finding is peritendinous fluid and sheath thickening. These findings might assist clinicians and radiologists to characterize and more effectively manage tenosynovitis in patients with JIA.

Incidence and Association of CT Findings of Ankle Tendon Injuries in Patients Presenting With Ankle and Hindfoot Fractures.

Tendon injuries are a commonly encountered finding in ankle CT examinations performed for fractures. This study was designed to identify the incidence and associations of tendon injuries in ankle CT examinations performed for fractures. A retrospective review was performed of 410 patients who underwent ankle CT during a 6-year period. Tendon injuries were common, seen in 25% of all ankle CT examinations. Tendon subluxation-dislocation accounted for most of the tendon injuries (77 of 196 total injuries). Pilon fractures carried 2.2 times increased risk of tibialis posterior tendon injury (p = 0.0094). Calcaneus fractures carried 11.86 times increased risk of peroneus brevis tendon and 10.71 times increased risk of peroneus longus tendon injury (p < 0.0001). Calcaneus fractures also carried 5.21 times increased risk of flexor hallucis longus tendon injury (p = 0.0024). Talus fracture was associated with injury to all flexor compartment tendons. Talus fractures carried 3.43 times increased risk of tibialis posterior tendon injury (p < 0.0001), 4.51 times increased risk of flexor digitorum longus tendon injury (p = 0.0005), and 6.97 times increased risk of flexor hallucis longus tendon injury (p < 0.0001). Calcaneal fractures are prone to peroneal tendon injury, and talus fractures are prone to flexor tendon injury. In patients with pilon fractures, it is important to look for tibialis posterior tendon injury, specifically for entrapment. Overall, the most common type of injury is tendon malalignment, so it is imperative to know the normal tendon paths and associated bony landmarks to identify tendon injury.

MRI appearance of injured ligaments and/or tendons of the ankle in different positions: study protocol for a single-center, diagnostic clinical trial

Background: The ankle joint is capable of flexion and extension, including plantar flexion and dorsiflexion, which enables it to act as a lever and a support, and to transmit movement. Ankle joint function is seriously threatened by ankle injury, which is often accompanied by fracture and ligament injury. Previously, diagnosis of ankle injury mainly relied on clinical signs and radiographic examination. However, radiographic examination is insufficient for ankle injury diagnosis, as it cannot clearly diagnose damage to the surrounding ligaments, tendons and other soft tissues. Multisequence and multiplanar MRI is currently the optimal noninvasive method for high-resolution determination of soft tissue deformations, but little has been reported on the diagnostic accuracy of MRI for ankle ligament and tendon injury. Here, we describe our protocol to evaluate the diagnostic value of MRI for ligament and tendon injury of the ankle in its normal position, and during complete plantar flexion and dorsiflexion. Methods/Design: This is a single-center, prospective, diagnostic trial that will be completed at the First Affiliated Hospital of Hebei Medical University, China. Sixty cases have been recruited, including 30 normal ankle joint cases and 30 cases of ankle ligament and tendon injury. All cases underwent MRI with the ankle joint in normal position, complete plantar flexion and complete dorsiflexion, and the multiposition MRI results were compared. The primary outcome measure is the sensitivity of MRI to detect ligament and tendon injury of the ankle during complete plantar flexion. The secondary outcomes include the specificity, positive and negative predictive values, and positive and negative likelihood ratios of MRI for diagnosis of ligament and tendon injury of the ankle in the complete plantar position as well as the rate of correct diagnosis; specificity and sensitivity, positive and negative predictive values, and positive and negative likelihood ratios in normal ankle position or in the complete dorsiflexion position as well as the rate of correct diagnosis; morphology of the ankle on multiposition MRI. Discussion: This study aims to determine the rate of correct diagnosis of ankle ligament and tendon injury using MRI, to clarify the diagnostic value of MRI for ankle ligament and tendon injury, and provide a quantitative MRI diagnostic standard for developing a reasonable surgical strategy. Trial registration: ClinicalTrials.gov identifier: NCT03049423. Ethics: The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Hebei Medical University in China (approval No. 2015076), and performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Informed consent: Written informed consent was obtained from all participants prior to the trial.

POSTERIOR TIBIAL ARTERY FLAPS FOR LEG AND ANKLE RECONSTRUCTION

Defects of the leg, ankle, and Achilles tendon regions still represent a tricky issue in lower limb surgery. Among the several reconstructive possibilities, local propeller perforator flaps have gained popularity in the last decades. The posterior tibial artery perforator flap is one of the most versatile flaps for reconstruction in these regions. Objectives: To explore the feasibility and therapeutic effect of the posterior tibial artery perforator flaps for coverage of defects around the ankle, heel and lower third of leg Methods: From June 2013 to March 2016 a total number of 15 cases of soft tissue defect on the leg, achilles tendon and ankle area in 13 patients managed by posterior tibial artery perforator flap inShebinElkom Teaching Hospital, SohagUniversity hospital and Menofia University Hospital Follow up was done for at least 6 months with good results. Results: A total number of 15 cases of soft tissue defect on the leg, achilles tendon and ankle area in 13 patients managed by posterior tibial artery perforator flap. All flaps healed well with good functional results and acceptable donor site morbidity Conclusions It was concluded that the distally based pedicled posterior tibial artery perforator flap was a reliable, easy, less time consuming, and versatile procedure for covering the defects around the ankle, heel, and lower third a leg. KEYWORDS: Lower limb reconstruction; achilis and calcaneal regions; Adipofascial flaps; posterior tibial perforators

Application of improved external use of Kujiu ointment in the nursing of injured tendens in the ankle

Objective To improve the operation method of external application of Kujiu ointment, which can enhance satisfaction and comfort level of patients, as well as improving the nursing quality. Methods Totally 112 cases of injured tendons in the ankle were chosen and divided into two groups randomly by retrospective study. Each group included 56 cases. Patients in the control group (July 2013-June 2014) were treated by conventional methods of operation, and the ointment was fixed to the wound surface with gauze and bandage. Patients in the treatment group (July 2014-June 2015) were treated with the improved medical plaster application which was fixed to the wound surface. Satisfaction degree of traditional Chinese medicine (TCM) nursing, comfort degree , retention time, condition of leakage ointment were compared between two groups. Results After the improvement of TCM operation methods, the patient satisfaction, comfort degree of patients in the treatment group were significantly higher than the control group (P<0.01). The leakage rate of ointment in the treatment group was significantly lower than the control group (P<0.01). Conclusions The improved external application of Kujiu ointment can increase patient satisfaction and comfort level, and make more patients accept this treatment, and it also can improve the quality of nursing. It is worthy of further promotion in the clinical practice. Key words: External application of Kujiu ointment; Improved method; Injured tendons in the ankle; Nursing quality evaluation

Adjacent Joint Kinematics after Ankle Arthrodesis in Cadaveric Gait Simulation

Category: Ankle Arthritis Introduction/Purpose: Ankle arthrodesis is an effective treatment for decreasing pain in patients with end-stage ankle arthritis. However, all patients with an ankle arthrodesis will eventually develop adjacent joint arthritis. The etiology of adjacent joint arthritis after ankle arthrodesis is not fully understood due to the difficulty of investigating these joints in vivo. Cadaveric simulation provides a unique capability of studying intrinsic foot and ankle joint mechanics. The objective of this study was to establish the effect of ankle arthrodesis on adjacent joint kinematics using cadaveric gait simulation. We hypothesized that adjacent joint motion of the hindfoot would increase after ankle arthrodesis. Methods: Four mid-tibia cadaveric specimens were potted and secured to a static mounting fixture about a six-degree of freedom robotic platform.(Figure 1A) The nine extrinsic ankle tendons were isolated and connected to linear actuators instrumented with load cells in series. During simulations, a force plate was moved relative to the stationary specimen through an inverse tibial kinematic path. Three-dimensional ankle and hindfoot kinematics were captured using a motion capture system. After ankle arthrodesis, kinematics were recorded using the same muscle force and kinematic inputs as the intact condition to determine how the hindfoot would behave when simulating normal gait. To assess the effect of ankle arthrodesis during simulated walking on adjacent joint kinematics, pre- and post-arthrodesis kinematics of the subtalar and talonavicular joint were directly compared along the stance phase and differences were assessed using two-tailed, paired Student’s t-tests with an alpha value set at p = 0.05. Results: Subtalar and talonavicular joint plantarflexion was greater during the early phase of stance in the ankle arthrodesis condition.(Figure 1B and 1C). Talonavicular joint motion also demonstrated greater dorsiflexion during late stance following ankle arthrodesis (Figure 1C). Ankle arthrodesis had no detectable effect on axial or coronal plane motion in adjacent joints of the hindfoot. Conclusion: This study reveals that sagittal plane motion in the hindfoot is increased following ankle arthrodesis. These results provide further insight into how motion is redistributed to adjacent joints after arthrodesis during gait. Such compensatory motions may be related to changes in contact mechanics in adjacent joints which can lead to degenerative changes.

Ankle and Hindfoot Kinematics After Total Ankle Arthroplasty in Cadaveric Gait Simulation

Category: Ankle Arthritis. Introduction/Purpose: Total ankle arthroplasty (TAA) is an effective treatment option for end-stage ankle arthritis. However, with reports on long-term survivorship of current implant designs still anticipated in the literature, current research has focused on assessing prosthetic function and predicting potential failure mechanisms. Cadaveric gait simulation is a valuable tool for investigating the effects of surgical techniques on foot and ankle biomechanics. The objective of this study was to assess the effect of TAA on ankle and hindfoot kinematics using cadaveric gait simulation. We hypothesized that joint motion would be altered by the change in the articular constraint associated with joint replacement. Methods: Three mid-tibia cadaveric specimens were secured to a static mounting fixture about a six-degree of freedom robotic platform. A force plate was moved relative to the stationary specimen through an inverse tibial kinematic path calculated from in vivo data. Target tendon force profiles were applied to the nine extrinsic ankle tendons by linear actuators instrumented with load cells. (Figure 1A). Ankle and hindfoot kinematics were measured from reflective markers attached to bones via surgical pins. TAA was performed using the Salto Talaris prosthesis (Bloomington, MN). After replacing the ankle joint, foot and ankle kinematics were directly measured using the same kinematic inputs and muscle force as the intact condition. To assess the effect of TAA on joint kinematics, pre- and post-TAA motions were directly compared throughout the stance phase, and differences were assessed using two-tailed, paired Student’s t-tests with an alpha value set at p = 0.05. Results: Analyses revealed that ankle joint transverse plane motion was affected by TAA, with significantly greater talar internal rotation during the middle portion of stance after joint replacement (Figure 1B). In contrast, no differences were present in ankle joint sagittal and coronal plane motion between the intact and TAA condition. Dorsiflexion was greater in the subtalar joint after TAA during early stance. Similarly, there was greater dorsiflexion in the talonavicular joint during mid-stance in the TAA condition compared to the intact condition. There were no differences observed in the coronal or axial plane in either the subtalar or talonavicular joint after TAA. Conclusion: This study revealed that the talus underwent greater internal rotation during the weight acceptance portion of gait after TAA. The ankle joint however behaved similarly with respect to sagittal and coronal plane motion throughout stance after TAA. Compensatory motion however was noted in the subtalar and talonavicular joints, with greater dorsiflexion present in both joints during stance after TAA. This abstract represents an early subset of an ongoing study; smaller yet clinically important differences may still be present, and may be detected as more specimens are completed.

Image-Guided Intervention of the Postoperative Foot and Ankle After Ligament and Tendon Repair.

This review article describes the potential range of image-guided interventional procedures performed following foot and ankle ligament and/or tendon repair. Diagnosis of the cause of recurrent or persistent pain/symptoms in this postoperative group is challenging and requires a coordinated clinical and radiologic assessment. This directs appropriate treatment including image-guided intervention that may be used both as a diagnostic tool and a therapeutic option. There is a paucity of high-quality studies on the role of image-guided intervention in the foot and ankle after ligament/tendon repair. Many of the procedures used in this group are extrapolated from other areas of the body or the preoperative scenario. We review the role of imaging to identify the cause of postsurgical symptoms and to direct appropriate image-guided intervention. The available injectables and their roles are discussed. Specific surgical procedures are described including lateral ligament repair, Achilles repair, posterior tibialis tendon surgery, and peroneal tendon surgery.

Incidence of tendon entrapment and dislocation with calcaneus and pilon fractures on CT examination.

To examine the association between tibial pilon and calcaneal fracture classification and tendon entrapment or dislocation. After institutional review board approval, we retrospectively reviewed consecutive CT scans with calcaneal or pilon fractures from 5years at a level 1 trauma center. We categorized calcaneal fractures according to the Sanders classification, and pilon fractures according to the Ruedi and Allgower and the Arbeitsgemeinschaft für Osteosynthesefragen-Orthopaedic Trauma Association (AO-OTA) classifications. Ankle tendons were assessed for dislocation or entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. A total of 312 fractures (91 pilon only, 193 calcaneal only, and 14 ankles with ipsilateral pilon and calcaneal fractures) were identified in 273 patients. Twenty-two pilon, 42 calcaneal, and nine combination fractures were associated with 99 occurrences of tendon entrapment or superior peroneal retinacular injury. Such findings were associated with multiple fractures (p = 0.002). Multifragmentary pilon fractures were associated with posterior tibial and flexor digitorum longus tendon entrapment (p < 0.0001 and p = 0.0003 for Ruedi/Allgower and AO-OTA, respectively), and multifragmentary Sanders type 3 or 4 calcaneal fractures were associated with superior peroneal retinacular injury (p = 0.0473) compared to simple fracture patterns. Thirty-nine percent of tendon entrapments or retinacular injuries were prospectively identified, 85% by musculoskeletal radiologists (p < 0.0001). Approximately 25% of calcaneal and pilon fractures were retrospectively identified to contain posteromedial tendon entrapment or superior peroneal retinacular injury. Radiologists should meticulously search for such injuries, particularly when analyzing multifragmentary and multiple fractures.

An Osteochondral Lesion of the Distal Tibia and Fibula in Patients With an Osteochondral Lesion of the Talus on MRI: Prevalence, Location, and Concomitant Ligament and Tendon Injuries.

The purpose of this study was to evaluate the prevalence and common location of a coexisting osteochondral lesion of the distal tibia and fibula and of associated abnormalities of the ankle ligaments and tendons on MRI in patients with an osteochondral lesion of the talus (OLT). A search of a database of MRI studies performed between July 2003 and January 2014 yielded MRI examinations of 297 feet with OLTs. Two readers reviewed the MRI examinations independently for the presence of an osteochondral lesion of the distal tibia and fibula and for concomitant ligament and tendon injuries. If an osteochondral lesion of the distal tibia and fibula was present, the reviewers also recorded the location (zones 1-10) and stage. Interobserver and intraobserver reliabilities were assessed using kappa statistics. The associations between a coexisting osteochondral lesion of the distal tibia and fibula and an OLT or a concomitant ankle injury were evaluated using the chi-square test. Readers A and B identified 61 (20.5%) and 47 (15.8%) coexisting osteochondral lesions of the distal tibia and fibula, respectively, with good interobserver (κ = 0.73) and excellent intraobserver (κ = 0.97) reliabilities. The most common location of a coexisting osteochondral lesion of the distal tibia and fibula was zone 4 (29.5%) by reader A and zone 2 (21.3%) by reader B. Stage I and stage IIA were common (> 85%). The frequency of osteochondral lesions of the distal tibia and fibula was not significantly different according to the location or stage of OLT. Abnormalities in the tibialis posterior tendon and in the anterior and posterior talofibular, calcaneofibular, and deltoid ligaments were significantly more common in patients with a coexisting osteochondral lesion of the distal tibia and fibula than in those with an isolated OLT (p < 0.05). A coexisting osteochondral lesion of the distal tibia and fibula is not rare on MRI in patients with an OLT and is related to a higher frequency of concomitant ankle ligament and tendon injuries.

Atypical, polyarticular lipoma arborescens in a child

Lipoma arborescens is a rare, tumor-like lesion commonly involving synovial joints and less commonly bursae and synovial tendon sheaths. We report a case of a 12-year-old boy with symmetric involvement of the bicipitoradial bursae, synovial sheaths of extensor compartments of both hands and medial ankles. The diagnosis of polyarticular lipoma arborescens was proposed on magnetic resonance (MR) imaging and this diagnosis was histologically proven after biopsy of the bursae and later by open surgery of the synovial sheath of the right ankle tendons. Literature search was performed and twelve cases with polyarticular involvement were analyzed. Lipoma arborescens commonly involves suprapatellar recess of the knee and very rarely other joints or bursae. Histological analysis revealed an accompanying non-necrotizing granulomatous synovial inflammation. Polyarticular lipoma arborescens is a rare entity and symmetrical involvement of the joints other than the knees is exceedingly rare. MR imaging plays a significant role in the diagnostic protocol, and the characteristic fatty signal on MR imaging is highly suggestive of lipoma arborescens.

Role of ultrasonography in assessment of tendons around ankle joint

Introduction Ankle injury is a common condition secondary to trauma; ultrasonography plays a big role in the assessment of a variety of musculoskeletal disorders. These improvements along with economic factors and availability have resulted in renewed interest in using ultrasound (US) as a diagnostic tool. As such, the efficacy of US has been compared with other modalities, in particular MRI, as a cost effective imaging alternative. Context US is a rapid, accurate, and cheap diagnosing tool. Aims The aim of this study was to show the efficacy of US as a cost effective diagnostic imaging alternative. Settings and design Selected individuals of ankle or foot injuries by clinical examination, with no exclusion criteria. Performing real time ankle US bilaterally for each patient. Participants and methods They will be divided into two groups: first control group which demonstrates 25 asymptomatic ankle ligaments and tendons. Second group includes 25 patients suffering from unilateral or bilateral ankle as sequelae of trauma. All patients will be subjected to history taking and real-time high-resolution ultrasonography. The procedures followed were in accordance with the ethical standards and approval by Benha University. Statistical analysis used Parametric analysis of our results using Excel program. Results Forty pathological entities were diagnosed by both utilized imaging modalities in 25 cases. The study included 11 cases with tendon pathology that were interpreted into 13 pathological entities by all imaging modalities. However, US missed two cases: (a) a case of partial tear of Achilles tendon; (b) a case of flexor hallucis longus tenosynovitis. US could detect all of the ligamentous lesions identified in three cases, which were interpreted as tear by MRI, likely due to US anisotropy effect. Conclusion Ankle US is a rapid, accurate, and cost effective imaging modality.

Hemispheric specificity for proprioception: Postural control of standing following right or left hemisphere damage during ankle tendon vibration

Right brain damage (RBD) following stroke often causes significant postural instability. In standing (without vision), patients with RBD are more unstable than those with left brain damage (LBD). We hypothesised that this postural instability would relate to the cortical integration of proprioceptive afferents. The aim of this study was to use tendon vibration to investigate whether these changes were specific to the paretic or non-paretic limbs.14 LBD, 12 RBD patients and 20 healthy subjects were included. Displacement of the Centre of Pressure (CoP) was recorded during quiet standing, then during 3 vibration conditions (80Hz – 20s): paretic limb, non-paretic limb (left and right limbs for control subjects) and bilateral. Vibration was applied separately to the peroneal and Achilles tendons. Mean antero-posterior position of the CoP, variability and velocity were calculated before (4s), during and after (24s) vibration.For all parameters, the strongest perturbation was during Achilles vibrations. The Achilles non-paretic condition induced a larger backward displacement than the Achilles paretic condition. This condition caused specific behaviour on the velocity: the LBD group was perturbed at the onset of the vibrations, but gradually recovered their stability; the RBD group was significantly perturbed thereafter. After bilateral Achilles vibration, RBD patients required the most time to restore initial posture.The reduction in use of information from the paretic limb may be a central strategy to deal with risk-of-fall situations such as during Achilles vibration. The postural behaviour is profoundly altered by lesions of the right hemisphere when proprioception is perturbed.

Improvement of large-joint ultrasonographic synovitis is delayed in patients with newly diagnosed rheumatoid arthritis: results of a 12-month clinical and ultrasonographic follow-up study of a local cohort.

We analyzed the longitudinal changes in gray-scale ultrasonography (GSUS) and power Doppler ultrasonography (PDUS) parameters and correlated them with clinical, functional, and radiologic outcomes in patients with newly diagnosed rheumatoid arthritis (RA). GSUS and PDUS examinations, 44-joint disease activity score (DAS44) calculations, measurements of erythrocyte sedimentation rate, and C-reactive protein levels were performed in 68 RA patients at baseline and after 1, 3, 6, 9, and 12 months. Metacarpophalangeal joints, wrist, elbow, knee, ankle, metatarsophalangeal joints, and wrist and ankle tendons were examined by GSUS and PDUS. The laboratory and clinical findings began to decrease significantly at 1 month (P < 0.05). Improvement of the ultrasonography (US) variables began at 3 months. After 6 months, all of the joint synovitis scores, except those of the knee, elbow, and ankle joints, showed a statistically significant reduction compared to baseline scores (P < 0.001). DAS44 scores were lower in the very early RA group at 12 months compared to those whose symptom duration was greater than 3 months of RA (respectively, 1.53 ± 0.34; 1.80 ± 0.38; z = -2501, P = 0.012). The total modified Sharp scores at 12 months correlated with total PDUS synovitis scores at 12 months (r = 0.354, P = 0.003). Regression of US synovitis at large joints such as the knee, elbow, and ankle tended to be delayed compared to that at small joints. PD synovitis that is persistent despite disease-modifying anti-rheumatic drug therapy may cause radiographic bone erosions.

Elastic properties of Thiel-embalmed human ankle tendon and ligament.

Thiel embalming is recommended as an alternative to formalin-based embalming because it preserves tissue elasticity, color, and flexibility in the long term, with low infection and toxicity risk. The degree to which Thiel embalming preserves elasticity has so far been assessed mainly by subjective scoring, with little quantitative verification. The aim of this study is to quantify the effect of Thiel embalming on the elastic properties of human ankle tendons and ligament. Biomechanical tensile tests were carried out on six Thiel-embalmed samples each of the peroneus longus, peroneus brevis, and calcaneal tendons, and the calcaneofibular ligament, with strain rates of 0.25%s(-1), 2%s(-1), and 8%s(-1). The stress-strain relationship was calculated from the force-extension response with cross-sectional area and gauge length. Young's modulus was determined from the stress-strain curve. The results showed that the tendon and ligament elasticity were lower after Thiel embalming than the literature values for fresh nonembalmed tendons and ligament. The biomechanical tensile test showed that the measured elasticity of Thiel-embalmed tendons and ligaments increased with the strain rate. The Thiel embalming method is useful for preserving human ankle tendons and ligaments for anatomy and surgery teaching and research, but users need to be aware of its softening effects. The method retains the mechanical strain rate effect on tendons and ligament.

Use of the semitendinosus tendon for foot and ankle tendon reconstructions

ObjectiveTo demonstrate the results obtained from foot and ankle tendon reconstructions using the tendon of the semitendinosus muscle. The clinical results, the patient's degree of satisfaction and complications in the graft donor and recipient areas were evaluated. MethodsThis was a retrospective study in which the medical files of 38 patients who underwent this surgical procedure between 2006 and 2010 were surveyed. The functional results from this technique, the complications in the donor and recipient areas and the patients’ degree of satisfaction were evaluated. ResultsThree patients presented complications in the recipient area (skin necrosis); one patient showed complications in the donor area (pain and insensitivity); and all patients had satisfactory functional results, with complete range of motion. ConclusionThe semitendinosus muscle is a good option for treatments for foot and ankle tendon injuries.