Joint Stability Research Articles

What Do We Know About Ligaments?

Ligaments have been extensively studied in anatomy and are traditionally defined as structures that connect bones and contribute to joint stability. However, a universally accepted definition of "ligament" remains elusive. Many structures classified as ligaments do not connect bones, such as the ligamentum arteriosum, raising questions about the criteria used for their designation. Moreover, distinguishing ligaments from tendons presents a significant challenge because of their shared histological characteristics and the lack of a clear, standardized definition of "ligament". Historically, ligaments have been named primarily on the basis of their gross anatomical appearance rather than well-defined structural or functional criteria. Ambiguities in nomenclature such as the interchangeable use of "patellar ligament" and "patellar tendon" further complicate classification. Additionally, dissection bias can lead to the artificial identification of ligaments because traditional dissection techniques can isolate tissue layers in a manner that creates the illusion of distinct ligament structures. Given these limitations, gross anatomical dissection alone is insufficient to confirm the presence of a ligament, necessitating histological validation based on a fundamental definition. Establishing a precise classification system that differentiates traditional bone-to-bone ligaments from other connective structures is imperative. Close collaboration between anatomists and surgeons is essential for refining anatomical definitions because inaccurate classifications can have direct implications for clinical practice, particularly in ligament reconstruction. A research-driven, standardized definition of ligaments can enhance anatomical education and improve surgical precision.

Rehabilitation and Physical Activity in Ehlers-Danlos Syndrome: A Review of Interventions and Outcomes

Purpose of Research: This study aims to explore the impact of physical activity on the quality of life of individuals with Ehlers-Danlos Syndrome (EDS), a group of disorders affecting connective tissues. The focus is on understanding how tailored exercise programs can improve symptoms and overall well-being across different EDS subtypes. Research Materials and Methods: A PubMed review identified studies on Ehlers-Danlos syndrome, quality of life, and exercise. Relevant peer-reviewed research from the last 20 years was included, screened, and synthesized. Basic Results: The findings indicate that physical activity plays a crucial role in improving the quality of life for individuals with EDS. Tailored exercise programs, including proprioceptive and stabilization exercises, have been shown to reduce pain and enhance functional capacity. Additionally, interdisciplinary approaches combining physical therapy with cognitive-behavioral strategies can mitigate psychological factors such as anxiety and depression, which are prevalent among EDS patients. Studies highlight the importance of adapting exercises to individual needs to avoid exacerbating symptoms like joint instability and chronic pain. Conclusions: In conclusion, physical activity is a vital component of EDS management, offering benefits in pain reduction, improved joint function, and enhanced quality of life. However, further research is necessary to determine the optimal exercise strategies for different EDS subtypes and to address the limitations of current studies, which often suffer from small sample sizes and heterogeneity in interventions. Developing personalized treatment plans that integrate physical therapy with psychological support can significantly improve patient outcomes and should be a priority in future studies. Additionally, there is a need to explore the effectiveness of interventions in pediatric and adolescent populations with EDS.

Complex Post-Traumatic Reconstruction of the Lower Limb: A Case Report on Managing Soft Tissue Defects and Deltoid Ligament Damage Using an ALT Flap With Fascia Lata Extension and Fascia Lata Graft

AIM: High-energy ankle traumas often lead to extensive soft tissue loss and ligament damage, making reconstruction both challenging and crucial for restoring stability and function. This study evaluated the effectiveness of using a free anterolateral thigh (ALT) flap with a fascia lata extension for addressing complex soft tissue defects and repairing the deltoid ligament in complex post-traumatic ankle injuries. CASE PRESENTATION: A 38-year-old man was examined at the Plastic Surgery Unit three months after a motorcycle crash for reconstruction of a soft tissue defect and deltoid ligament repair. Clinical examination revealed a 3 × 5 cm soft tissue defect with bone exposure and ankle instability. Reconstruction was planned and performed using a free ALT flap with an extension of the fascia lata and a fascia lata graft for deltoid ligament repair. No complications of the flap and no clinical signs of local infection were observed. During the follow-up period of 12 months, the ankle stability and the gait were improved with a reduction in pain. RESULTS: No complications related to the flap or clinical signs of infection were observed postoperatively. During the 12-month follow-up period, the patient exhibited improved ankle stability, reduced pain, and enhanced gait. At the one-year follow-up, the patient achieved a satisfactory functional outcome with an American Orthopedic Foot and Ankle Society (AOFAS) score of 79 points. The reconstructed tissue demonstrated adequate coverage, and the deltoid ligament repair provided joint stability. While flap bulkiness necessitated minor debulking surgery, the aesthetic and functional outcomes were satisfactory, with the patient expressing high satisfaction at 15 months post-surgery. CONCLUSIONS: The ALT flap combined with fascia lata graft is a viable option for soft tissue loss and deltoid ligament injury in clinical cases. While the ALT flap offers numerous advantages, including ease of harvest, pedicle length, and versatility, its bulkiness may necessitate revision surgery. However, despite this drawback, the combination of ALT flap and fascia lata demonstrated positive outcomes in our patient, highlighting its effectiveness in providing adequate tissue coverage and repairing the deltoid ligament.

A Self-Tension Screw for Meniscal Root Repair: Biomechanical Properties and Design Considerations for Optimal Outcomes.

The meniscus is a collagenous and elastic tissue that plays a crucial role in preventing wear and tear within the knee joint. Meniscus root tears are a common knee pathology that can significantly impact joint function. One of the prevalent surgical techniques for repairing meniscus root tears is the transtibial pull-out method, favored by many orthopedic surgeons. It is essential to consider that displacement of the meniscus root and inadequate stabilization during the rehabilitation period are likely contributing factors to the failure of meniscus root repair outcomes. Understanding these challenges is vital for improving surgical techniques and postoperative care to enhance patient recovery and joint stability. Meniscal root tears pose a significant challenge in orthopedics, disrupting the delicate mechanics of the knee. This study introduces a novel self-tension screw designed for meniscal root repair, addressing the limitations associated with traditional screws. 14 Bovine cadaveric specimens were employed to conduct biomechanical evaluations and compare the new self-tension screw with a conventional washer screw system used in these surgeries. From cyclic loading tests, comparable displacement trends are observed 3.092 ± 0.258mm in Self-tension screw group and 2.629 ± 0.727mm in Washer screw. load-to-failure assessments demonstrated superior tolerance in the washer screw by 391.34 ± 60.203N that is significantly better than the self-tension screw group with a load tolerance of 136.58 ± 25.48N. Stiffness analyses indicated greater structural stability in the washer screw (22.77 ± 4.234) over self-tension screw (15.2 ± 4.89). The innovative self-tension mechanism of the screw, generating tension during bone channel engagement, suggests a potential breakthrough in addressing manual tensioning challenges.

Black holes in hand anatomy: exploring research areas in hand surgery.

Black holes in hand anatomy: exploring research areas in hand surgery.

Changes in Motor Unit Activity of Co-activated Muscles During Dynamic Force Field Adaptation.

Muscle co-contraction plays a critical role in motor adaptation by minimizing movement errors and enhancing joint stability in novel dynamic environments. However, the underlying changes in motor unit (MU) activity within co-activated muscles during adaptation remain largely unexplored. To investigate this, we employed advanced electromyography sensor arrays and signal processing to examine MU activation in the triceps brachii (agonist) and biceps brachii (antagonist) during a reaching task under force-field perturbation. Our results revealed a gradual reduction in movement errors and an increase in velocity with adaptation, accompanied by a decrease in muscle co-contraction from early to late adaptation phases. This reduction was primarily driven by increased triceps activity, while biceps activity remained unchanged throughout the adaptation process. At the MU level, recruitment, amplitude, and firing rate increased in both muscles during adaptation compared to baseline (without force-field perturbation). However, from early to late adaptation phases, triceps MU amplitude continued to increase, while its firing rate stabilized, suggesting a shift in force generation strategy. In contrast, biceps MU activity remained stable throughout the adaptation. These findings indicate that the reduction in co-contraction during motor adaptation is likely mediated by a shift in motor unit control strategy within the agonist muscle. The increased reliance on MU amplitude modulation rather than firing rate in later adaptation may represent a mechanism for optimizing force production while maintaining movement accuracy and joint stability in dynamic environments.

Comparison of gluteus maximus muscle activity according to three different foot heights from the ground during bridge exercise.

Background: Gluteus maximus (GM) and biceps femoris (BF) have important roles in the stability and mobility of the hip joint during various functional activities including bridge exercises. In addition, the different heights of the foot during bridge exercise can contribute to the other muscle activities of the lower extremities. Objective: This study aims to investigate the muscle activities of GM, BF, and multifidus (MF) during bridge exercises based on three different foot heights in healthy individuals. Methods: Fifteen healthy subjects were participated. An electromyography device was used to measure muscle activities of GM, MF, and BF. The participants were asked to perform bridge exercises with their feet at three different heights (0 cm, 5 cm, and 10 cm) from the ground in a random order. Results: The muscle activity of GM was significantly different among three conditions (the foot heights 0 cm, 5 cm, and 10 cm) (adjusted p-value [Padj] < 0.01). The GM muscle showed higher activity with a foot height of 10 cm compared to 0 cm and 5 cm (Padj < 0.01). Both MF muscles showed higher activity with a foot height of 10 cm compared to 0 cm (Padj < 0.01). BF muscle showed lower activity with a foot height of 10 cm compared to 0 cm (Padj < 0.01). The ratio of GM/BF muscle activity was higher during the bridge exercise with a foot height of 10 cm than with 0 cm and 5 cm (Padj < 0.01). Conclusion: Bridge exercise at 30° of hip abduction with a foot height of 10 cm can be recommended to selectively facilitate GM and MF muscle activity and improve the muscle activity ratio of the GM/BF.

No Short-Term Effects of Acromioclavicular Joint Augmentation in Acute Acromioclavicular Joint Stabilization Surgery: A Randomized Controlled Clinical Trial on 70 Patients.

Background: Optimal treatment for high-grade acromioclavicular (AC) joint dislocations is still not unanimous. Improving horizontal AC stability has been emphasized in recent years. Biomechanical studies and computer simulations have demonstrated that adequate horizontal stability could be restored with an additional AC fixation. We aim to prospectively investigate if AC augmentation leads to better clinical and radiological results. Methods: A total of 70 patients with a mean (± SD) age of 42 ± 11 years with acute AC joint dislocation Rockwood type IIIb and V were prospectively randomized into two equal groups. All patients underwent arthroscopically assisted stabilization using a double coracoclavicular (CC) suspensory system. Group N (No-augmentation group) had no additional fixation across the AC joint, while group T (tape-augmentation group) had additional fixation with tape. Patients were evaluated at 3, 6, and 12 months postoperatively. Primary clinical outcome measures included the Constant-Murley score and the Specific AC Score (SACS). Secondary outcome measures included the Subjective Shoulder Value (SSV), the Simple Shoulder Test (SST), the Disabilities of the Arm, Shoulder, and Hand (DASH) outcome measure, and the AC Joint Instability (ACJI) Score. Horizontal stability was radiologically measured with overlapping length (OL) and overlapping area (OA). Vertical alignment was measured with the CC distance. All radiological measurements were compared to the uninjured side and expressed in percentages as relative values. Results: There were no significant differences found between groups regarding the Constant score (p = 0.664), SACS (p = 0.518), or any other outcome measure at the one-year follow-up. Pain level (p = 0.635) and strength (p = 0.217) at the one-year mark also showed no significant differences. Clinical drawer testing for residual horizontal instability was non-significant (p = 0.061), but showed a tendency for a more stable AC joint in group T. The CC distance was smaller in group T at 6 and 12 months (p = 0.047 and p = 0.046, respectively). A two-way mixed factorial ANOVA test showed significantly lower CC differences for group T (p = 0.032); however, the gradual increase in CC distance was similar for both groups over time (p = 0.869). No significant differences were found in OL (p = 0.619) or OA (p = 0.236). Conclusions: The results of our study show that both CC stabilization with the double suspensory system alone and with additional AC fixation are effective surgical treatment options for acute AC joint dislocations, without any important clinical differences. CC distance similarly increased over one year in both groups but was better retained in the AC-augmented group, which showed a tendency toward a more stable fixation.

Management Fisioterapi untuk Penangganan Cedera Olahraga Sprain Ankle : Case Report

Ankle sprain is a tearing or rupture injury that occurs in the ligaments, especially the lateral part, which triggers joint instability, causing pain, disrupting functional activities and reducing the athlete's ability. The purpose of this study was to determine the management and effectiveness of physiotherapy interventions carried out in cases of ankle sprains. the study used a case report with single subject research, observing a patient, Mr. S, aged 27 years who complained of pain and swelling in the ankle due to a sports injury. The study was conducted in December 2024. Physiotherapy was carried out every 3 days, 3 times with ultrasound intervention, ice compresses, TENS and exercise therapy in the form of ankle theraband, calf raise, toe curl with towel, and marble pick-up. Results: This study showed periodic improvements in T0 to T3 as seen from several aspects such as pain evaluated using NRS, increased ROM measured using a goniometer, decreased edema evaluated with the midline, and improved functional ability evaluated with FAAM. Treatment of ankle sprain with ultrasound modality, ice compress, TENS and exercise therapy in the form of ankle theraband, calf raise, toe curl with towel, and marble pick-up can reduce pain, increase LGS, reduce swelling, and improve functional activities in ankle sprain patients.

Peri-operative protein or amino acid supplementation for total joint arthroplasty: a systematic review and meta-analysis

PurposeOsteoarthritis (OA) affects weight-bearing joints, such as hips and knees, and its prevalence is rising due to factors like obesity and aging. Muscle atrophy, exacerbated by aging and surgery, increases the risk of joint instability and falls. Orthopedic surgeons explore dietary interventions to counteract these effects, with protein supplementation (PS) showing promise. This systematic review and meta-analysis assessed the effectiveness of PS in arthroplasty patients, comparing findings with sports medicine and sarcopenia literature.MethodsFollowing PRISMA guidelines, we searched PubMed, Web of Science, Scopus, and Embase (February 2025) for protein and amino acid supplementation studies in total knee or hip arthroplasty (TKA and THA) patients. The quality assessment used the Cochrane risk of bias and the Newcastle–Ottawa Scale. Meta-analysis calculated effect sizes for muscle atrophy and strength outcomes.ResultsNineteen studies (903 patients) evaluated oral or intravenous protein/amino acid supplementation over a mean follow-up of 55.2 days. Essential amino acids (EAA) significantly reduced muscle atrophy in quadriceps femoris muscle mass (SMD: 0.69; 95% CI: 0.44 to 0.95) and hamstring muscle mass (SMD: 1.04; 95% CI: 0.52 to 1.55). However, effects on intramuscular adipose tissue (IMAT) and muscle thickness (MT) were inconsistent. Muscle strength outcomes varied, with no significant effect on quadriceps muscle strength (QMS) or handgrip strength (HGS). Intravenous amino acid infusion improved muscle protein synthesis and reduced perioperative blood loss.ConclusionsProtein and amino acid supplementation can reduce muscle atrophy in hip or knee arthroplasty patients. While effects on muscle strength and function are mixed, intravenous supplementation offers benefits. Further standardized research is needed to confirm these findings.Trial registrationPROSPERO registration code (CRD42024555899).

Biomechanical effects of different rotator cuff tear conditions and mediolateral offset in lateralized reverse total shoulder arthroplasty (Coralis Reverse Shoulder System).

Biomechanical effects of different rotator cuff tear conditions and mediolateral offset in lateralized reverse total shoulder arthroplasty (Coralis Reverse Shoulder System).

Proximal tibiofibular joint instability: Outcomes following reconstruction with biceps femoris and iliotibial band autografts with suture tape augmentation.

Proximal tibiofibular joint instability: Outcomes following reconstruction with biceps femoris and iliotibial band autografts with suture tape augmentation.

Combined endoscopic endonasal and trans-oral approach for excision of lower clival chordoma and stabilization.

Combined endoscopic endonasal and trans-oral approach for excision of lower clival chordoma and stabilization.

Imaging Review of Knee Ligament Reconstructions Other than the Anterior Cruciate Ligament.

Assessment of knee ligament reconstructions other than the anterior cruciate ligament is challenging due to limited data and continuously developing techniques. Imaging is vital to assessment, demonstrating expected postoperative findings, allowing detection of complications, and enabling differentiation of techniques from one another-information that is critical if revision is being contemplated. Stress radiography is useful for evaluating joint stability in the setting of ligament insufficiency. The three-dimensional and multiplanar reconstruction capabilities of CT are highly useful in multiligament reconstruction, allowing unhindered evaluation of the many intersecting bone tunnels. Susceptibility artifacts in MRI can be remedied by use of metal artifact reduction sequences. Each technique, graft, and choice of specific ligaments to reconstruct must be decided on a case-to-case basis. Anatomic reconstruction reproduces the native ligament's anatomy but is more technically complex. Nonanatomic reconstruction is easier to perform but potentially provides less stability. As for graft selection, an autograft weakens another knee stabilizer, but an allograft is more expensive and less readily available. The decision to perform a single-ligament versus combined-ligament reconstruction ultimately rests on the degree of instability and the desire to return to sport. In contrast to single-ligament reconstruction, combined-ligament procedures are at higher risk of postoperative stiffness, arthrofibrosis, and tunnel convergence. Renewed attention to repair along with improvements in patient selection and rehabilitation protocols may change the future of operative treatment of ligament injury, and along with it, radiologic appraisal and reporting. ©RSNA, 2025 Supplemental material is available for this article.

Little Known Ligaments Responsible for Stabilisation of Craniovertebral Joints

Craniovertebral joints are the joints formed between the atlas, axis and os occipitale and stabilisation of these joints is important in terms of topographic anatomy. Therefore, knowing the detailed anatomy and function of the ligaments in this region provides important information for clinicians in the surgery of patients with a lesion related to this region. When the literature is reviewed, in addition to the basic ligaments of the craniovertebral joints in “Terminologia Anatomica” and basic anatomy textbooks, there are different ligament definitions and related studies such as “The suboccipital ligament”, “ The accessory atlantoaxial ligament”, “The anterior atlantodental ligament”, “Gerber’s Ligament”, “Superficial anterior atlantooccipital ligament”, “Lateral oblique atlantooccipital ligament”, “Lateral atlantooccipital ligament”, “Transverse occipital ligament” and “Barkow’s Ligament”. For this review, the ‘Pubmed’ database was searched as craniovertebral joint and craniovertebral junction ligaments. Each ligament not included in ‘Terminologia Anatomica’, ‘Pubmed’, ‘Web of Science’, and ‘ScienceDirect’ databases were searched separately. All articles related to ligaments other than the essential ligaments were included in the review. We think that our literature review on the detailed anatomy and function of these ligaments described in the literature will be a guide for clinicians and related future studies. Keywords: Accessory atlantoaxial ligament, Gerber’s Ligament, anterior atlantodental ligament, Barkow’s Ligament, transverse occipital ligament.

The Effect of Progressive Muscle Relaxation on Low Back Pain And Anxiety in Primiparas

Pregnancy changes that result in looseness and instability of joints in the third trimester of pregnancy often cause lower back pain in mothers. This certainly disturbs the mother's discomfort and causes anxiety. Progressive muscle relaxation is a combination of deep breathing and progressive muscle relaxation techniques by stretching and relaxing the muscles systematically. The purpose of this study was to analyze the effect of progressive muscle relaxation on lower back pain and anxiety in primigravida pregnancies. This study used all experiments with a pretest-posttest controlled group design for primigravida pregnant women with a gestational age of 28-36 weeks at the Misriah Galang Clinic as many as 28 respondents. The sampling technique used was simple random sampling. There were two groups in this study, namely the intervention group with progressive muscle relaxation and the control group. The research instruments used were VAS (Visual Analog Scale), Hamilton Anxiety Rating Scale (HARS) and questionnaires. Data analysis used was the dependent t-test and independent t-test to measure pain intensity and the Wilcoxon test with Mann Whitney to measure anxiety. There was a difference in the intensity of pain and anxiety before and after the progressive muscle relaxation intervention with a value of p = 0.001 and 0.004. The percentage of pain reduction after the intervention was 45.71%. There was a difference in the average pain and anxiety after the intervention between the control and intervention groups with a value of p = 0.000; p = 0.002. Progressive muscle relaxation has been proven effective in reducing the intensity of lower back pain and anxiety. Obstetric practitioners can apply this method to pregnant women who experience lower back pain and anxiety. The progressive muscle relaxation method can be used as material in Complementary Therapy in Pregnancy to develop obstetric science.

Ligament Cell Biology: Effect of Mechanical Loading.

Ligaments are biomechanically specialized connective tissues that maintain joint stability and guide motion under complex loading conditions. At the cellular and molecular levels, ligament homeostasis is governed by fibroblast-like cells (ligamentocytes) embedded in an intricately organized ECM composed predominantly of type I collagen, with contributions from type III collagen, elastin, proteoglycans, and glycoproteins. These cells continuously sense and respond to mechanical stimuli-tension, compression, and shear-through mechanotransduction pathways involving integrins, focal adhesions, cytoskeletal remodeling, and mechanosensitive ion channels. Downstream signaling cascades, including MAPKs and PI3K/AKT, integrate biomechanical cues with growth factor and cytokine signaling to fine-tune gene expression, collagen fibrillogenesis, and ECM turnover. Distinct from tendons, ligaments must adapt to multidirectional loads, resulting in unique ECM compositions and cellular phenotypes. Appropriate mechanical loading maintains collagen alignment, promotes ECM integrity, and stabilizes the ligament cell phenotype. By contrast, insufficient or excessive load alters the molecular balance, triggering catabolic processes, inflammation, and disorganized ECM assembly. This delicate equilibrium also underlies the ligamentization observed in ACL graft remodeling, where controlled mechanical environments and molecular interventions accelerate the acquisition of ligamentous properties. Emerging insights into transcriptional and epigenetic regulation, growth factor-mediated cues, and cytokine-driven responses offer avenues to engineer ligament-like tissues and optimize recovery strategies. By leveraging molecular knowledge of cell-matrix interactions, growth factor profiles, and genetic/epigenetic modulators, clinicians and researchers can design tailored loading protocols, biomimetic scaffolds, and regenerative therapies. These approaches aim to restore ligament functionality, enhance graft integration, and prevent degenerative changes, ultimately improving patient outcomes in ligament injury repair and reconstruction.

Ligament Cell Biology: Effect of Mechanical Loading.

Ligaments are biomechanically specialized connective tissues that maintain joint stability and guide motion under complex loading conditions. At the cellular and molecular levels, ligament homeostasis is governed by fibroblast-like cells (ligamentocytes) embedded in an intricately organized ECM composed predominantly of type I collagen, with contributions from type III collagen, elastin, proteoglycans, and glycoproteins. These cells continuously sense and respond to mechanical stimuli-tension, compression, and shear-through mechanotransduction pathways involving integrins, focal adhesions, cytoskeletal remodeling, and mechanosensitive ion channels. Downstream signaling cascades, including MAPKs and PI3K/AKT, integrate biomechanical cues with growth factor and cytokine signaling to fine-tune gene expression, collagen fibrillogenesis, and ECM turnover. Distinct from tendons, ligaments must adapt to multidirectional loads, resulting in unique ECM compositions and cellular phenotypes. Appropriate mechanical loading maintains collagen alignment, promotes ECM integrity, and stabilizes the ligament cell phenotype. By contrast, insufficient or excessive load alters the molecular balance, triggering catabolic processes, inflammation, and disorganized ECM assembly. This delicate equilibrium also underlies the ligamentization observed in ACL graft remodeling, where controlled mechanical environments and molecular interventions accelerate the acquisition of ligamentous properties. Emerging insights into transcriptional and epigenetic regulation, growth factor-mediated cues, and cytokine-driven responses offer avenues to engineer ligament-like tissues and optimize recovery strategies. By leveraging molecular knowledge of cell-matrix interactions, growth factor profiles, and genetic/epigenetic modulators, clinicians and researchers can design tailored loading protocols, biomimetic scaffolds, and regenerative therapies. These approaches aim to restore ligament functionality, enhance graft integration, and prevent degenerative changes, ultimately improving patient outcomes in ligament injury repair and reconstruction.

Automated radiography assessment of ankle joint instability using deep learning

This study developed and evaluated a deep learning (DL)-based system for automatically measuring talar tilt and anterior talar translation on weight-bearing ankle radiographs, which are key parameters in diagnosing ankle joint instability. The system was trained and tested using a dataset comprising of 1,452 anteroposterior radiographs (mean age ± standard deviation [SD]: 43.70 ± 22.60 years; age range: 6–87 years; males: 733, females: 719) and 2,984 lateral radiographs (mean age ± SD: 44.37 ± 22.72 years; age range: 6–92 years; male: 1,533, female: 1,451) from a total of 4,000 patients, provided by the National Information Society Agency. Patients who underwent joint fusion, bone grafting, or joint replacement were excluded. Statistical analyses, including correlation coefficient analysis and Bland-Altman plots, were conducted to assess the agreement and consistency between the DL-calculated and clinician-assessed measurements. The system demonstrated high accuracy, with strong correlations for talar tilt (Pearson correlation coefficient [r] = 0.798 (p < .001); intraclass correlation coefficient [ICC] = 0.797 [95% CI 0.74, 0.82]; concordance correlation coefficient [CCC] = 0.796 [95% CI 0.69, 0.85]; mean absolute error [MAE] = 1.088° [95% CI 0.06°, 1.14°]; mean square error [MSE] = 1.780° [95% CI 1.69°, 2.73°]; root mean square error [RMSE] = 1.374° [95% CI 1.31°, 1.44°]; 95% limit of agreement [LoA], 2.0° to − 2.3°) and anterior talar translation (r = .862 (p < .001); ICC = 0.861 [95% CI 0.84, 0.89]; CCC = 0.861 [95% CI 0.86, 0.89]; MAE = 0.468 mm [95% CI 0.42 mm, 0.51 mm]; MSE = 0.551 mm [95% CI 0.49 mm, 0.61 mm]; RMSE = 0.742 mm [95% CI 0.69 mm, 0.79 mm]; 95% LoA, 1.5 mm to − 1.3 mm). These results demonstrate the system’s capability to provide objective and reproducible measurements, supporting clinical interpretation of ankle instability in routine radiographic practice.

Correction of Deformity and Improvement of Functional Outcomes in Neglected Tibial Fracture with Post-Traumatic Osteoarthritis Through Long Stem Total Knee Arthroplasty: A Case Report

Background: Tibial plateau fractures, which account for 1% of all fractures, can lead to significant complications such as post-traumatic osteoarthritis (PTOA). This case report describes the management of a neglected tibial plateau fracture leading to PTOA treated with total knee arthroplasty (TKA). Case report: A 55-year-old male presented with severe pain and impaired mobility in the right knee, seven months post a fall that resulted in a tibial plateau fracture. The patient had not sought medical treatment initially due to fear of surgery. Physical examination and imaging confirmed a malunion fracture with associated PTOA. The patient underwent right total knee replacement (TKR) with a long stem prosthesis. Postoperative care included antibiotic prophylaxis, anticoagulation, and early rehabilitation. Discussion: Neglected tibial plateau fractures can lead to malunion and PTOA due to altered biomechanics and joint incongruency. Surgical intervention aims to restore joint stability and alignment, crucial for functional recovery. This patient's postoperative outcomes demonstrated significant improvement in pain, mobility, and knee function, highlighting the efficacy of TKA in managing advanced PTOA secondary to neglected fractures. Conclusion: This case illustrates that TKA can effectively correct deformity and enhance functional outcomes in patients with neglected tibial plateau fractures complicated by PTOA. Early diagnosis and appropriate surgical intervention are critical in preventing long-term joint dysfunction. Keywords: neglected fracture dislocation, hinged external fixator, interposition arthroplasty, early mobilization, case report