Haemophilic Ankle Arthropathy Research Articles

Arthroscopic ankle fusion in haemophilic ankle arthropathy: A report of four cases and narrative literature review

Arthroscopic ankle fusion in haemophilic ankle arthropathy: A report of four cases and narrative literature review

Immersive visualization of movement in patients with hemophilic ankle arthropathy. Multicenter, single-blind, randomized clinical trial.

To evaluate the efficacy of immersive movement observation in adult patients with haemophilic ankle arthropathy. Multicentre, single-blind, randomized clinical trial. 48 patients with haemophilia. Patients were randomly allocated to 2 groups (180º immersive video-based visualization of movement and a control group with no intervention). Twenty-eight consecutive 15-min home sessions, 1 per day, of immersive visualization of ankle flexion-extension movement were carried out. Three evaluations were performed: pretreatment (T0), post-intervention (T1), and at 16 weeks' follow-up (T2). The primary variable was joint-pain intensity (visual analogue scale). The secondary variables were conditioned pain modulation (Conditioned Pain Modulation Index), pressure pain threshold (pressure algometer), range of motion (goniometry) and kinesiophobia (Tampa Scale of Kinesiophophia). There were intergroup differences in pain intensity (F = 37.14; p < 0.001), conditioned pain modulation (F = 5.40; p = 0.006), and dorsal (F = 19.17; p < 0.001) and plantar (F = 9.27; p<0.001) ankle flexion. More than 50% of experimental group patients exhibited changes exceeding the minimum detectable change in pain intensity (MDC = 0.43), and the pressure pain threshold in the extensor carpi radialis longus muscle (MDC = 1.34) and malleolus (MDC = 4.93). 180º immersive video-based visualization of movement can improve the intensity of pain, conditioned pain modulation, and ankle range of motion in patients with haemophilic ankle arthropathy.

Stability, Balance, and Physical Variables in Patients with Bilateral Hemophilic Arthropathy of the Ankle versus Their Healthy Peers: A Case-Control Study.

(1) Background: The recurrence of hemarthrosis in patients with hemophilia triggers a pathophysiological process of degenerative, progressive, and irreversible joint destruction. This hemophilic arthropathy is characterized by chronic pain, muscle atrophy, loss of mobility, and proprioceptive alterations. As the same joint undergoes repeated hemarthrosis, the function of the mechanical receptors deteriorates, causing a pathophysiological modulation and deterioration of the musculoskeletal system. The objective was to analyze the differences in stability and balance, as well as in ankle dorsal flexion, functionality, and muscle strength, between patients with bilateral hemophilic arthropathy and their healthy peers. (2) Methods: A cross-sectional descriptive case-control study was performed. Twenty-two participants were recruited: 10 adult patients with bilateral hemophilic arthropathy of the knee and ankle and 12 healthy subjects. The variables were balance (Rs Scan pressure platform), ankle dorsiflexion range of motion (Leg Motion), functionality (2-Minute Walk Test), and ankle dorsal strength (dynamometry). (3) Results: Statistically significant differences (p < 0.05) were found in the balance without visual support in the Max-Y variable (MD = 2.83; CI95%: 0.33;5.33; Effect size (d) = 0.67), ankle dorsiflexion (MD = 16.00; CI95%: 14.30; 20.0; d = 7.46), and strength of the ankle flexor muscles (MD = 128.50; CI95%: 92.50; 153.60; d = 2.76). (4) Conclusions: Ankle range of motion in dorsal flexion, functionality, and muscle strength in dorsal flexion is poorer in patients with bilateral lower limb hemophilic arthropathy than in their healthy peers. Patients with bilateral hemophilic ankle arthropathy have statistically poorer stability and balance without visual support than their healthy peers.

Arthroscopic ankle surgery in people with haemophilia.

People with haemophilia (PWH) not administered primary haematological prophylaxis since childhood, that is, those treated haematologically on demand or not treated at all, often experience the degeneration of the ankles, leading to pain and functional impairment. To analyse the outcomes and complications of arthroscopic ankle surgery performed on PWH. For this narrative review of the literature, a search was conducted in PubMed on 2, December 2023, using the keywords "haemophilia", "ankle" and "arthroscopy". Of the 29 articles identified, 15 specifically related to ankle arthroscopy in PWH were selected (inclusion criterion). The remaining articles did not meet this requirement (exclusion criterion) and were therefore eliminated. Arthroscopic procedures (arthroscopic synovectomy, debridement and arthrodesis of the ankle) are increasingly used in the surgical treatment of haemophilic ankle arthropathy. Although arthroscopic ankle surgery offers good outcomes in patients with haemophilia, the procedure is not free of complications, which range from 7.9% for arthroscopic ankle debridement to 13.1% in arthroscopic ankle synovectomy and 17.8% in arthroscopic ankle arthrodesis, respectively. The non-union rate of arthroscopic ankle arthrodesis is 7.1% (2/28). Although arthroscopic interventions in the haemophilic ankle (synovectomy, debridement, arthrodesis) offer good functional outcomes, they are associated with a non-negligible rate of complications. Arthroscopic ankle surgery in PWH is major surgery and should be treated as such.

A single‐centre experience of 29 total ankle replacement in haemophiliac patients: Therapeutic management, factor consumption and cost

AbstractIntroductionIn patients with haemophilia, repeated bleeding in large joints leads to chronic haemophilic arthropathy, a rare disease that can be managed surgically with ankle arthrodesis or with total ankle replacement (TAR). TAR has been reported to provide good surgical results in the medium/long‐term and allow preservation of joint mobility but the medical therapeutic management of the patients has not been described.AimTo describe the medical therapeutic management of TAR.MethodsAll patients with haemophilia A/B, with haemophilic ankle arthropathy, and who underwent TAR between April 2006 and October 2019 were retrospectively included. Factor consumption, perioperative and early complications, volume of blood lost, and orthopaedic data were collected.ResultsA total of 25 patients underwent 29 TAR (mean age was 44.7 years [range: 26–65]). In the 17 patients with HA without history of anti‐FVIII inhibitor, the mean ± SD consumption the day of surgery was 116 ± 16 UI/kg when clotting factors were administered by continuous infusion, 106 ± 13 UI/kg when SHL factors were administered by bolus infusion, and 75 ± 22 UI/kg when EHL factors were administered by bolus infusion. During hospitalisation, the mean factor cost was €38,073 (83.7% of the total cost of surgery). Mean blood loss was significantly lower in patients treated with tranexamic acid (164 mL, range: 40–300) than in those not (300 mL, range: 70–800; p = .01). Six patients had haematoma. The 10‐year survival free of any prosthesis removal/arthrodesis was estimated to be 92.2% (95% CI [83; 100]).ConclusionThe medical therapeutic management of TAR is complex, carried out by a multidisciplinary team but effective in avoiding the occurrence of complications.

Treatment of hemophilic arthropathy of ankle by arthrodesis with a small anterior approach:a case report

Treatment of hemophilic arthropathy of ankle by arthrodesis with a small anterior approach:a case report

Structural changes after ankle joint distraction in haemophilic arthropathy: an explorative study investigating biochemical markers and 3D joint space width.

Ankle joint distraction (AJD) is a promising treatment for patients with severe haemophilic ankle arthropathy (HAA). However, some patients showed no clinical improvement after AJD and these differences may be related to structural differences. Primarily to quantify the structural changes after AJD in patients with HAA by the use of 3D joint space width (JSW) measurements and biochemical markers and secondarily to correlate these findings with clinical pain/function. Patients with haemophilia A/B who underwent AJD were included for this study. Bone contours on MRI (performed before and 12 and 36 months after AJD) were drawn manually and percentage change in JSW was calculated. Blood/urine (before and 6, 12, 24 and 36 months after AJD) was collected for biomarker measurement (COMP, CS846, C10C, CALC2, PRO-C2, CTX-II) and combined indexes of markers were calculated. Mixed effects models were used for analyses on group level. Structural changes were compared with clinical parameters. Eight patients were evaluated. On group level, percentage changes in JSW showed a slight decrease after 12 months followed by a non-statistically significant increase in JSW after 36 months compared to baseline. Biochemical marker collagen/cartilage formation also showed an initial decrease, followed by a trend towards net formation 12, 24 and 36 months after AJD. On individual patient level, no clear correlations between structural changes and clinical parameters were observed. Cartilage restoration activity on group level in patients with HAA after AJD was in concordance with clinical improvements. Correlating structural modifications with clinical parameters in the individual patient remains difficult.

Self-Induced Myofascial Release in Patients with Hemophilic Ankle Arthropathy: A Pilot Observational Study.

Hemophilic ankle arthropathy is manifested by degenerative functional alterations (reduced muscle strength, mobility, and proprioception) and chronic pain. Myofascial release techniques are used to treat soft tissue adhesions, relieve pain, and reduce tissue sensitivity. The aim was to evaluate the safety of self-induced myofascial release in patients with hemophilic ankle arthropathy and to assess possible changes in musculoskeletal variables. We recruited 20 patients with ankle hemophilic arthropathy. Patients carried out a daily self-induced myofascial release exercise program using a foam roller over a period of 8 weeks. The primary variable was the frequency of hemarthrosis (regular telephone follow-up). Secondary variables were pain intensity (visual analog scale), range of motion (goniometry), and functional capacity of the lower limbs (six-minute walk test). Three evaluations were performed: pre-treatment (T0), post-treatment (T1), and at 8 weeks follow-up (T2). There was a lower, non-significant, association in the frequency of hemarthrosis between the experimental and follow-up periods, compared to the pre-study period (SE = 0.50; 95%CI: -1.67; 0.28). There were significant within-subject changes in intensity of pain (T0: 4.91; T1: 2.79; T2: 2.46; p &lt; 0.001), plantar flexion (T0: 125.55; T1: 131.5; T2: 130.30; p = 0.01), and functionality of the lower limbs (T0: 173.06; T1: 184.85; T2: 178.39; p = 0.009). Self-induced myofascial release is safe in patients with hemophilic ankle arthropathy. A protocol based on self-induced myofascial release can lead to changes in pain intensity, range of ankle motion in plantar flexion, and functionality in hemophilic patients.

Effectiveness of Motion Visualization Through Immersive Video in Patients With Hemophilic Arthropathy Of The Ankle

<h3>Research Objectives</h3> To investigate the efficacy of a 180° immersive motion visualization intervention in patients with hemophilic ankle arthropathy. <h3>Design</h3> Multicenter cohort study. <h3>Setting</h3> The study was conducted in three regional Hemophilia Patient Associations. <h3>Participants</h3> 15 volunteer patients with hemophilia were recruited, mean age: 42.73 (standard deviation: 12.36) years. All patients had a diagnosis of hemophilia A or B, bilateral ankle arthropathy, and were older than 18 years. Patients with central neurological or visual problems were excluded. No patient suffered adverse effects, and all completed the study and follow-up period. <h3>Interventions</h3> A home intervention was carried out for 28 consecutive days by visualizing ankle flexion-extension movement with 180° immersive video. The duration of each session was 15 minutes. The subjects used their own smartphone coupled to VR glasses, using a mobile application designed ad hoc for the study (HEMirror®). The subjects had to remain seated in a chair with their knees flexed and their feet resting on the floor only on the heel. <h3>Main Outcome Measures</h3> The primary study outcome measurements were joint health (Hemophilia Joint Health Score), range of motion (goniometry) and perceived pain intensity (Visual Analogue Scale). <h3>Results</h3> After the intervention there was improvement (p < 0.05) in joint health (Means difference [MD]: 1.20; 95% confidence interval [95%IC]: 0.89–1.50; Effect size [ES]: 0.48), range of motion (MD: 1.19; 95%IC: 0.80-1.58; ES: 0.53) and perceived pain intensity (MD: -3.27; 95%IC: -4.76- -1.77; ES: 0.20). <h3>Conclusions</h3> Immersive video motion visualization is safe in hemophilia patients. This intervention can improve joint health, perceived pain intensity and joint range in patients with hemophilic ankle arthropathy. <h3>Author(s) Disclosures</h3> The authors certify that there are no conflicts of interest with any financial organization regarding the material discussed in the manuscript.

180-degree immersive VR motion visualization in the treatment of haemophilic ankle arthropathy.

Patients with haemophilic arthropathy suffer chronic pain that affects and restricts their quality of life. Visualization of movement through immersive virtual reality is used for pain management. To evaluate the efficacy of 180-degree immersive VR motion visualization therapy in patients with haemophilic ankle arthropathy. Prospective, multicentre pilot study. Fifteen adult patients with bilateral haemophilic ankle arthropathy were recruited (mean age: 42.73±12.36 years). The intervention lasted 4weeks, with daily home sessions of 180-degree immersive motion visualization. The patients were given virtual reality glasses to use with their smartphones. From the YouTube mobile app® they accessed the recorded video with access from the He-Mirror App®. The study variables were joint state (Haemophilia Joint Health Score), pressure pain threshold (pressure algometer), muscle strength (dynamometry) and range of motion (goniometry). Three evaluations were performed: at baseline (T0), after the intervention (T1) and at the end of a 16-week follow-up period (T2). No patient developed ankle hemarthrosis during the experimental phase. In the repeated measures analysis we found statistically significant differences in joint state (F=51.38; η2 p =.63), pressure pain threshold of the lateral malleolus (F=12.34; η2 p =.29) and range of motion (F=11.7; η2 p =.28). Therapy using immersive motion visualization does not cause hemarthrosis. This intervention can improve joint condition, pressure pain threshold and range of motion in patients with ankle arthropathy. Changes greater than the MDC were reported in more than 40% of patients for the variables pressure pain threshold, anterior tibialis strength and range of motion, which were considered clinically relevant.

Ankle joint distraction is a promising alternative treatment for patients with severe haemophilic ankle arthropathy.

Haemophilic ankle arthropathy (HAA) causes major morbidity. When conservative treatment fails, major surgical interventions are indicated. An alternative treatment to maintain joint mobility and postpone these interventions is desired. To gather prospective data on clinical/structural changes after ankle joint distraction (AJD) in HAA. This study includes patients with severe HAA insufficiently responding to conservative treatment. AJD was performed during 8-10weeks by use of an external frame. Questionnaires, physical examination and radiology were used to evaluate pain, function and structural changes before and 6, 12, 24 and 36months after distraction. Mixed effect models were used for analysis. This study includes eight cases (21-53years). The fixed effects estimates of the visual analogue score (0-10) improved from 7.5 at baseline to 3.4 (p=.023) 3years after distraction. The Haemophilia Activities List (HAL, 0-100) for basic/complex lower extremities functions improved from respectively 29.6 and 31.5 to 54.3 (p=.015) and 50.7 (p=.031). Joint mobility was maintained. Magnetic resonance imaging (MRI) showed thickened cartilage and reduced bone marrow oedema and subchondral cysts. Pin tract infections (n=6) were effectively treated and no adverse bleeding events occurred. At 3-year follow-up, in none of the patients the originally indicated arthrodesis was performed. This first prospective study showed that AJD in HAA results in decreased pain, improved function and decreased arthropathy-related MRI findings in the majority of patients for prolonged time. Although the study population is small and follow-up is relatively short, AJD may be promising to postpone invalidating interventions and might be a breakthrough treatment.

Self-Myofascial Release Intervention and Mobile App in Patients With Hemophilic Ankle Arthropathy: Protocol for a Randomized Controlled Trial.

BackgroundHemophilic ankle arthropathy is manifested by degenerative functional alterations and chronic pain. Myofascial release techniques are used to treat soft tissue adhesions, relieve pain, and reduce tissue sensitivity.ObjectiveThis study aims to evaluate the safety and efficacy of a protocol using self-myofascial release with a foam roller to be applied in patients with hemophilic ankle arthropathy.MethodsPatients with ankle arthropathy (N=70) will be recruited, enrolled, and assigned to one of two groups—experimental or control—in a 1:1 allocation ratio. Patients will be recruited from 5 centers in different regions of Spain. Patient data will be collected at baseline, posttreatment, and follow-up. The primary outcome will be frequency of ankle joint bleeding (self-reported). The secondary outcomes will be ankle range of motion (measured with a digital goniometer); joint pain (measured with a visual analog scale and an algometer); joint status (measured using the Hemophilia Joint Health Score); muscle strength (measured with a dynamometer); functionality of lower limbs (measured using the 6-minute walking test); activity (self-reported); and muscle flexibility (measured using the fingertip-to-floor test). The treatment program includes 11 exercises that must be administered bilaterally. A mobile app will be developed where each patient will be able to observe the exercises to be carried out. Each session will last 15 minutes with 5 physiotherapy sessions per week for a period of 3 months. It is expected that patients with hemophilia who receive the foam roller intervention will show improvement in mobility, pain, and status of the ankle joint; muscle strength; and function in the lower extremities.ResultsThe study has been approved by the institutional review board of the University of Murcia. Patient recruitment will begin in September 2020, and the intervention period will last until June 2021. Data collection will take place between September 2020 and October 2021.ConclusionsThis protocol describes a randomized clinical trial to examine the safety and efficacy of a self-myofascial release intervention using a foam roller in patients with hemophilic ankle arthropathy.Trial RegistrationClinicalTrials.gov NCT03914287; http://clinicaltrials.gov/ct2/show/NCT03914287.International Registered Report Identifier (IRRID)PRR1-10.2196/15612

Acquired multi-segment foot kinematics in haemophilic children, adolescents and young adults with or without haemophilic ankle arthropathy.

The ankle joint remains vulnerable in children with haemophilia and is the primary joint affected. The purpose of this study was to dynamically characterize the segmental foot and ankle kinematics of male children, adolescents and young adults with or without ankle arthropathy. The barefoot multi-segment foot kinematics of 70 ankles from 35 haemophilia subjects between 6 and 20years old were captured with the Rizzoli Multi-Segment Foot Model. Joint damage of the tibiotalar and subtalar joints was scored using the IPSG-MRI score. The feet of patients with or without evidence of ankle arthropathy were compared with those of matched typically developing boys via a nonpaired comparison. The differences between the affected and nonaffected sides of patients with unilateral ankle arthropathy were assessed using a paired comparison. Subjects without arthropathy demonstrated a nonsignificant trend towards a higher frontal plane range of motion (RoM) at the midfoot upon loading response and a lower sagittal plane RoM at the midfoot during midstance. No differences were observed between the affected side group and their matched control group. The affected side of unilaterally affected subjects exhibited a nonsignificant tendency towards a higher frontal plane RoM at the ankle joint upon loading response and terminal stance compared to the healthy side. Most patients maintained physiological rocker function of the ankle and had no (mal)adaptive motion patterns in the more distal joints of the foot. Therefore, established structural lesions may remain subclinical with respect to moderate functional activities like walking.

Functionality and range of motion in patients with hemophilic ankle arthropathy treated with fascial therapy. A randomized clinical trial

BackgroundHemophilic arthropathy is characterized by loss of function and range motion. Fascial therapy mobilizes the connective tissue, intervening in the state of the injured fascial complex. ObjectivesThe aim of this study is to assess the safety and effectiveness of a fascial therapy treatment in patients with hemophilic ankle arthropathy. DesignRandomized clinical trial. MethodsSixty-five adult patients with hemophilia from 18 to 65 years of age were recruited. The intervention through fascial therapy lasted 3 consecutive weeks with a weekly session of 45 min each. The dependent variables were frequency of bleeding (selfregistration), ankle range of motion (goniometer) and lower limb functionality (6-Minute Walking Test). Three assess were made: baseline, posttreatment and after follow-up period. ANOVA of repeated measures was performed to compare both groups at the three assess time points. Bonferroni correction has been applied to control the error rate of the significance level. ResultsImprovements were found (p < 0.001) in terms of a reduced frequency of ankle hemarthrosis. Significant differences were found in the experimental group following intervention (p < 0.001), and when comparing baseline and follow-up assessments (p < 0.05) in all variables. The frequency of hemarthrosis (p = 0.04) and functionality (p = 0.01) improved in patients who received manual therapy as compared to the control group. ConclusionsFascial therapy achieves improvements in terms of frequency of hemarthrosis in patients with hemophilic ankle arthropathy. Ankle functionality improved in patients treated with manual therapy. This technique can improve ankle range of motion.

The biomechanical behaviour of ankle and foot joints during walking with shoes in patients with haemophilia.

Patients with haemophilia (PwH) often prefer shod walking over barefoot walking as footwear offers ankle joint stability and comfort during gait. Yet, the biomechanical mechanisms contributing to the latter remain poorly understood. To explore the effect of shoes on the biomechanical functioning of the ankle and foot complex in PwH with and without haemophilic ankle arthropathy and to determine the amount of ankle joint loading during shod walking. We analysed data of PwH without haemophilic ankle arthropathy (n=5) and PwH with severe haemophilic ankle arthropathy (n=17) and a control group (n=17). During 3D gait analysis, a four-segment kinetic foot model was used to calculate kinematic and kinetic parameters of the ankle, Chopart, Lisfranc and first metatarsophalangeal (MTP 1) joints during both barefoot and shod walking. We found a significantly greater ankle joint power generation during shod walking compared to barefoot walking in PwH with severe haemophilic ankle arthropathy (P<.001). Chopart joint biomechanics were significantly lowered in all three groups during shod walking compared to barefoot walking. During shod walking, the ankle joint load was significantly lowered in both PwH groups (P=.039 and P=.002), but not in the control group (P=.952). Explorations in this study uncover a tendency that shoes alter the biomechanical functioning of the ankle and foot complex in PwH and simultaneously lower the ankle joint load during walking.

Ankle arthrodesis for end-stage haemophilic ankle arthropathy using a Ilizarov method.

Only a few studies in the literature have reported on the outcome of ankle arthrodesis in haemophilia patients, and the optimal surgery technique for end-stage haemophilic ankle arthropathy remains controversial. The purpose of this study was to evaluate the results of ankle arthrodesis using the Ilizarov method in treating end-stage haemophilic ankle arthropathy. Fourteen haemophilia patients with end-stage ankle arthropathy who underwent ankle arthrodesis using the Ilizarov method from December 2013 to May 2018 were enrolled in this study. The hospital day, fusion rate, complications, and functional outcomes were recorded and analyzed. Functional outcomes were evaluated according to the pre-operative and final follow-up of the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score, visual analog scale (VAS), and Medical Outcomes Short Form 12-item questionnaire score (SF-12) . All patients achieved bony fusion as confirmed by post-operative radiographs. The average time to fusion was 12.9weeks (range, 10-17weeks). Superficial pin track infection was observed in two patients, and subtalar arthritis was found in one patient. The mean AOFAS ankle-hind foot score, VAS score, physical component summary (PCS), and mental component summary (MCS) at final follow-up were significantly improved compared with the pre-operative data. All patients were satisfied with the surgery. Ankle arthrodesis using the Ilizarov method is a minimally invasive, effective, and safe surgical method and can be a viable option for hemophilia patients with end-stage ankle arthropathy.

Clinical gait features are associated with MRI findings in patients with haemophilic ankle arthropathy.

Haemophilic ankle arthropathy due to repeated joint bleeds often leads to altered gait in adult patients with haemophilia. To investigate the association between clinical gait features and blood-induced ankle joint damage scored using MRI findings in patients with haemophilic ankle arthropathy. This observational study investigated 48 ankles of 24 patients with severe haemophilia (median age of 33years). Blood-induced ankle joint damage was scored by an experienced radiologist using the International Prophylaxis Study Group (IPSG-)MRI score which evaluates the presence or absence of effusion, synovial hypertrophy, haemosiderin, surface erosions, subchondral cysts and cartilage degeneration. Using 3D gait analysis, peak ankle joint power generation and absorption (W/kg) were measured for each ankle since these are surrogate measures for joint loading during walking. Associations between MRI findings and these two clinical gait features were calculated using Spearman's ρ correlation with an α-level correction (α=0.01) for multiple tests. We found large negative associations between ankle joint peak power generation and IPSG-MRI score (ρ=-0.631; P=<.001), IPSG-MRI osteochondral subscore (ρ=-0.701; P=<.001), severity of synovial hypertrophy (ρ=-0.507; P=<.001) and haemosiderin (ρ=-0.400; P=.005). Associations were also found for ankle joint peak power absorption and IPSG-MRI score (ρ=-0.425; P=.003) and IPSG-MRI osteochondral subscore (ρ=-0.556; P=<.001). Severe blood-induced ankle joint damage relates to a lowered tolerance towards ankle joint mechanical loading during walking in patients with haemophilia.

Pulsed Nd:YAG laser: effects on pain, postural stability, and weight-bearing pattern in children with hemophilic ankle arthropathy.

Hemophilic ankle arthropathy features joint pain, impaired postural control, and abnormal weight-bearing pattern. This study was designed to investigate the effects of pulsed Nd:YAG laser on pain, postural stability, and weight-bearing pattern in children with hemophilic ankle arthropathy. Forty children diagnosed with hemophilia type A (age, 8-16 years) were randomly allocated to either the treatment group (n = 20) who received a three-phase active therapy with pulsed Nd:YAG laser thrice/week (total energy was 1500 J) plus a physical exercise program for four consecutive weeks, or the placebo group (n = 20) who received placebo laser plus the physical exercise program. Pain, postural control (i.e., directional control [DC], endpoint excursion [EE], center-of-gravity movement velocity [CoG-MV], and maximum excursion [MXE]), and weight-bearing pattern (i.e., pressure peaks of the hindfoot [PP-HF] and forefoot [PP-FF], and the foot contact area [FCA]) were assessed pre- and post-treatment. The treatment group showed greater improvement in pain (P = .004), DC (P = .02), EE (P = .003), and CoG-MV (P = .003) compared to the placebo group. However, there was no statistically significant difference between both groups regarding the MXE (P = .15). In addition, the treatment group achieved favorable improvements in PP-HF (P = .003), PP-FF (P = .027), and FCA (P = .002) relative to the placebo group. Pulsed Nd:YAG laser is a potentially effective therapy for pain relief, postural control enhancement, and weight-bearing pattern adjustment in children with hemophilic ankle arthropathy.

Effect of manual therapy in patients with hemophilia and ankle arthropathy: a randomized clinical trial

Objective: The aim of this study was to evaluate the effects of a manual therapy using fascial therapy on joint bleeding, joint pain and joint function in patients with hemophilic ankle arthropathy. Setting: Hemophilia patient associations. Design: Randomized, controlled trial, multicenter and intention-to-treat analysis. Participants: A total of 65 patients with hemophilic ankle arthropathy. Intervention: The experimental group (n = 33) received one fascial therapy session per week for three weeks. The control group (n = 32) received no treatment. Outcome measure: The primary outcome was frequency of joint bleeding measured using self-reporting. Secondary outcomes were joint pain (under load-bearing and non-load-bearing conditions) measured using the visual analog scale; joint condition was measured using the Hemophilia Joint Health Score. Outcomes were measured at baseline, posttreatment and after five months of follow-up. Results: Improvements in the frequency joint bleeding at T0, T1 and T2 were significantly higher in the experimental group (T0: mean (SD) = 1.56 (1.30); T1: mean (SD) = 0.00 (0.00); T2: mean (SD) = 0.27 (0.57)) compared to the control group (T0: mean (SD) = 1.70 (1.78); T1: mean (SD) = 0.05 (0.21); T2: mean (SD) = 0.58 (0.85)). Mean improvement of joint state after the study period was 1.74 points (±1.66) for patients in the experimental group, while the control group exhibited a joint deterioration with 0.43 points (±0.85). Ankle joint pain under load-bearing and non-load-bearing conditions improved in the experimental group with −1.72 (±1.86) and −0.50 (±1.39) points, respectively. Conclusion: The study showed that fascial therapy is favorable for patients with hemophilic ankle arthropathy.

Commentary on the paper: "Hindfoot malalignment in adults with haemophilic ankle arthropathy: The importance of early detection and orthotic treatment": Authored by: De la Corte-Rodriguez, Rodriguez-Merchan, Alvarez-Roman, Martin-Salces, Jimenez-Yuste.

Commentary on the paper: "Hindfoot malalignment in adults with haemophilic ankle arthropathy: The importance of early detection and orthotic treatment": Authored by: De la Corte-Rodriguez, Rodriguez-Merchan, Alvarez-Roman, Martin-Salces, Jimenez-Yuste.