Intermalleolar Distance Research Articles

Genu valgum deformity – correction by a wedgeless implantless femoral “V” osteotomy

Coronal malalignment of the knee joint is very common in developing countries especially because of nutritional rickets. Significant valgus deformity needs to be treated surgically to improve appearance, gait and function of the patient. The purpose of this prospective study was to evaluate the results of supracondylar "V" osteotomy as a surgical technique for correction of the valgus knee deformity. This study was conducted in a tertiary level teaching hospital and 30 cases were included in the study. For all the patients deformity was assessed using ana- tomical tibiofemoral angle, mechanical axis deviation and intermalleolar distance preoperatively and post- operatively. The average age of our patients was 13.7 years and the average follow up was3.29 years (1.39-14.22 yrs). Clinically the average value of intermalleolar distance preoperatively was 16cm and 3.2 cm postperatively. Average pre-operative tibiofemoral angle was 23° and the average postoperative angle was 6 0 which was found to be statistically significant using the Paired t test (p<0.005). The average value of preoperative mechanical axis deviation was 3.1 cm which decreased to an average value of 1.1 cm postoperatively. The results with this technique have been encouraging. The advantages of this technique are low morbidity, good stability allowing early ambulation, ability to adjust alignment postoperatively by casting and no need for internal fixation. Few studies have been conducted on osteotomies that do not require internal fixation and are inherently stable. This technique has the advantage of practically no occurrence of any infection or a second surgery to remove hardware in children and adolescents. Since no specialized instrumentation, image intensifier and implants are required, it is cost effective and can be used in any primary care or district level surgical setup in a developing country like ours.

Ginocchio valgo punto per punto: quello che deve sapere il pediatra

Knee valgus is one of the most frequent paediatric orthopaedic problems based on the evaluation by the paediatricians. Most cases are physiological variants that resolve spontaneously with growth, however pathological cases require surgical treatment. Therefore, the paediatrician must know how to distinguish between the two entities from the beginning, sending the child to the specialist when necessary, thus respecting the correct timing for treatment. The most frequent condition is idiopathic knee valgus, which occurs when the physiological variant persists after the age of 8 without spontaneous resolution. Children who always need specialist evaluation are those who on physical examination show a tibiofemoral angle greater than 15° with an intermalleolar distance of about 10 cm that persists beyond 10 years of age. The gold standard treatment in these children is growth-guided hemiepiphysiodesis, namely a simple and minimally invasive procedure that reshapes the altered angle of the knees through the application of the 8-plate. The correction is based on the presence of residual growth of the physical cartilages, therefore it should not be performed too late, but not before 10 years of age.

Holistic Approach in the Management of Skeletal Deformity in a Case of Homocystinuria

Introduction:Homocystinuria has a wide range of clinical presentations ranging from near normal intelligence and appearance with just lens dislocation and minimal skeletal deformities to severe mental retardation with gross skeletal deformities. In this background, we describe one such case with skeletal deformity managed comprehensively.Case Report:A 17-year-old boy presented with complaints of deformity of the left lower limb since childhood more evident for the past 5 years along with a history of blurring of vision. On examination the pubis-heal length > crown-pubis length along with genu valgum of left lower-limb with 16 cm intermalleolar distance. He also had a superolateral subluxation of the lens in both eyes. Valgus angle was 16° on the left leg compared to 6° on the right. The diagnosis of homocystinuria was confirmed by biochemical investigations. The left side genu valgum was addressed with medial closing wedge osteotomy and fixed with distal femur locking compression plating. Lens subluxation was treated with posterior chamber intra-ocular lens surgery. He was also given medical treatment and on regular monitoring of his homocysteine levels. The patient had good functional outcome at 2-year follow-up.Conclusion:Homocystinuria is a rare disease that needs early identification and effective management to avoid complications. Skeletal complications are common and include genu valgum, pes cavus, chest wall deformities, and skeletal deformities such as kyphosis and scoliosis. Skeletal deformities can be avoided when identified early and associated osteoporosis which is managed effectively. A holistic approach is needed in the management of such patients with inter-departmental coordination to bring quality to the life of patients with homocystinuria.

The efficacy of manual soft-tissue mobilization in ankylosing spondylitis: A randomized controlled study.

The aim of this randomized controlled study was to investigate the effect of soft-tissue mobilization in patients with ankylosing spondylitis (AS). Twenty-one patients (mean age 44.57±10.40years) were randomly divided into two groups. There were 13 patients (11 females, 2 males, age 43.69±9.94years) in the intervention group and 8 patients (5 females, 3 males, age 46.00±11.67years) in the control group. In the intervention group, soft-tissue mobilization therapy and 20 spinal mobility exercises were applied. The control group received only 20 spinal mobility exercises. The Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), and Bath AS Metrology Index (BASMI) were used for assessment of disease activity, functional level, and mobility, respectively. Nottingham Health Profile (NHP) for quality of life and Roland Morris Disability Questionnaire (RMDQ) were used to determine disability levels. We found significant differences between pretreatment and post-treatment scores of BASDAI (P=0.049); BASFI (P=0.009; lateral lumbar flexion (P=0.005), maximal intermalleolar distance (P=0.001) and total score (P=0.001) of BASMI; pain subtest (P=0.036) and total score (P=0.036) of NHP; and RMDQ score (P=0.004) in the intervention group. However, in the control group the BASMI score (P=0.049) was observed to worsen significantly. Delta values were compared and differences in BASFI (P=0.039), and in lateral lumbar flexion (P=0.027), maximal intermalleolar distance (P=0.045) and total score (P=0.001) of BASMI were significant in favor of intervention group. Only tragus-to-wall distance (P=0.039) of BASMI was observed to worsen significantly in the control group. We recommend the use of soft-tissue mobilization in addition to the exercises to treat AS patients.

A Novel Technique of Stabilization of Supracondylar Femoral Dome Osteotomy with Proximal Humeral Locking Plate for Surgical Management of Genu Valgum Deformity

Background: Genu valgum is a common deformity in the developing world. When the patient presents after a second growth spurt, corrective surgery remains the only treatment option. Different types of osteotomies and fixation methods have been described in the literature, but the choice of the method remains debatable. We evaluated the outcome of the proximal humeral locking plate used for stabilization of supracondylar femoral dome osteotomy (DO). Methods: In this prospective study, we performed 39 osteotomies for genu valgum deformity on 24 patients who satisfied inclusion criteria (15 bilateral and 9 unilateral) between May 2015 and May 2017. The mean age was 13 years (11–20), 16 were male and 8 were female patients. All patients underwent supracondylar femoral DO and stabilization with the proximal humeral locking plate. Informed consent was obtained from all patients. All patients were evaluated preoperatively and postoperatively by using the Bostman knee score, intermalleolar distance (IMD), tibiofemoral angle (TFA), and lateral distal-femoral angle (LDFA). Patients with a minimum follow-up of 2 years were included in the study. Results: The preoperative LDFA was 73.4 ± 2.1 which improved to 87.2 ± 0.6 postoperatively while clinical and radiological TFA improved from 19.7 ± 21 and 21.4 ± 2.1 to 7.3 ± 0.8 and 8.6 ± 0.8, respectively. The mean Bostman score improved significantly. Two patients (2 limbs) had a good score (20–27), while the rest had an excellent score (28–30). IMD, TFA, and LDFA also improved statistically significantly (P &lt; 0.001). All the patients were satisfied with the cosmetic correction. There were no implant failures, re-operations, and any loss of correction. Conclusion: This novel technique of stabilizing supracondylar femoral DO with the proximal humeral locking plate is cost-effective and has encouraging early results.

Genu varum and football participation: Does football participation affect lower extremity alignment in adolescents?

BackgroundGenu varum is one of the most common anatomical variations of knee alignment which is considered a risk factor for anterior knee pain and anterior cruciate ligament injury among football players. Considering that millions of children participate in high-level football training, the purpose of this study was to determine the genu varum development in adolescent football players and non-athlete peers. The hypothesis of this study was that genu varum incidence was higher in adolescent football players compared with non-athletic peers. MethodsThe design was a cross-sectional study. Two-hundred and thirty-seven male football players (FG) and aged-matched and anthropometrically similar non-athletes (CG) were recruited into the study. The quadriceps angle and intercondylar–intermalleolar distance were measured to evaluate the leg alignment. The distance between the medial edges of the condyles and malleoli was measured in millimeters using a digital caliper while angle measurements were performed using a photographic technique in a standing position. To analyze the variables, comparison, correlation and regression statistical tests were performed. ResultsThe intercondylar–intermalleolar distance and quadriceps angle values were significantly higher in FG than CG in all ages. In FG, a very strong correlation was found between number of training years and the intercondylar–intermalleolar distance. The prevalence of genu varum was markedly higher in FG than CG (~37% vs. 2%, respectively) based on intercondylar–intermalleolar distance. ConclusionThis study determined that the prevalence of genu varum and abnormal quadriceps angles in adolescent football players is significantly higher compared with their non-athletic peers.

Relationship between frontal knee position and the degree of thoracic kyphosis and lumbar lordosis among 10-12-year-old children with normal body weight.

IntroductionIncorrect positioning of the body in space increases the tension of the myofascial tissue and overloads the skeleton. It is important to look for factors that affect the deterioration of body posture that could be eliminated. Understanding the interrelationship between the positioning of individual body segments should be the key knowledge for those involved in the prevention and correction of faulty body posture. The study aimed to determine the relationship between the degree of physiological curvatures of the spine and the incidence of incorrect knee position.Materials and methodsThe study involved 685 children aged 10–12. Body height, weight and BMI were measured and calculated. The degree of thoracic kyphosis and lumbar lordosis was assessed using the Zebris Pointer ultrasound system. Valgus and varus knees were diagnosed in an upright position based on the intermalleolar distance with knees together, and intercondylar distance with the feet placed together. The statistical analysis uses descriptive statistics, the Mann-Whitney U test (comparison of girls and boys), the Kruskal-Wallis test, the Tukey's post hoc test (comparison of variables in participants with correct, varus and valgus knees) and Spearman's rank correlation coefficient (the relationship between the position of the spine and knees).ResultsThe examined girls were heavier than the boys and had higher BMI. Spine deformities and incorrect knee position are common among 10-12-year-old children. The girls and boys differed significantly in the spine shape in the sagittal plane and the intermalleolar distance. Round lumbar lordosis is more characteristic for girls, and for boys, round thoracic kyphosis. For both genders, valgus knees occur more often than varus knees and coexist with decreased thoracic kyphosis. The rounder the thoracic kyphosis, the greater distance between the knees and the smaller distance between ankles.ConclusionsThe frontal knee position significantly correlated with the depth of thoracic kyphosis.

Changes in knee joint line orientation after high tibial osteotomy are the result of adaptation of the lower limb to the new alignment

BackgroundChanges in knee joint line orientation (KJLO) resulting in excessive joint line obliquity are a well-known consequence of high tibial osteotomy (HTO) procedures and could lead to degenerative changes. The precise effect of the correction on final KJLO changes is poorly understood. The goal of this study was to identify radiographical parameters that could help to explain the size of KJLO changes after HTO surgery. MethodsA total 117 HTO patients were radiographically examined preoperatively and three months postoperatively. Radiographic parameters were KJLO, medial proximal tibial angle (MPTA), hip–knee angle (HKA), mechanical lateral distal femoral angle (mLDFA), lateral distal tibial angle (LDTA), knee joint line congruence angle (KJLCA), ankle joint line congruence angle (AJLCA) and ankle joint line orientation (AJLO). Four new radiographic parameters were introduced to describe knee and foot position on long-leg X-ray: malleolar distance to midline (MDTM), intermalleolar distance (IMD), condylar distance to midline (CDTM) and intercondylar distance (ICD). Correlations of these parameters and changes in KJLO were assessed. ResultsStrong correlations are found between KJLO changes and MDTM (r = 0.709), IMD (r = 0.691), CDTM (r = 0.711) and ICDM (r = 0.702), in contrast to weak correlations between changes in KJLO and MPTA (r = −0.342). These results suggest an important impact of foot and knee position changes on the final alteration of KJLO after HTO. ConclusionsThe final change of KJLO after HTO is the effect of adaptation of the lower limb, which is driven by the (maximum) alterations of foot and knee position rather than the size of correction of the procedure.

The Profile and Development of the Lower Limb in Setswana-Speaking Children between the Ages of 2 and 9 Years.

Profile data on normal lower limb development and specifically tibiofemoral angle development in black, Setswana-speaking South African children are lacking. This study aimed to provide profiles on the development of the tibiofemoral angle, hip anteversion angle and tibial torsion angles in two- to nine-year-old children. Measurements of the tibiofemoral angle, intercondylar distances or intermalleolar distances, quadriceps-angle, hip anteversion- and tibial torsion angle were clinically obtained from 691 healthy two- to nine-year-old children. Two-year-old children presented with closest to genu varum at −3.4° (±3.4°). At three years, a peak of −5.7° (±2.3°) genu valgum was seen, which plateaued at −4.5° (±2.1°) at age nine years. Intermalleolar distance results support tibiofemoral angle observations. Small quadricep-angles were observed in the two-year-old group, (−3.81° ± 3.77°), which increased to a mean peak of −9.2° (±4.4°) in nine-year-olds. From the age of four years old, children presented with neutral tibial torsion angles, whilst two- and three-year-olds presented with internal tibial torsion angles. Anteversion angles were the greatest in three-year-olds at 77.6° ± 13.8° and decreased to a mean angle of 70.8° ± 6.9° in nine-year-olds. The tibiofemoral angle developed similarly to those tested in European, Asian and Nigerian children, but anteversion- and internal tibial torsion angles were greater in the Setswana population than angles reported in European children. Our findings indicate that lower limb development differs in different environments and traditions of back-carrying may influence the development, which requires further investigation.

Outcome of Dome Osteotomy With Plate Osteosynthesis for Genu Valgum in Late Adolescents and Young Adults.

AimTo evaluate the degree of correction and outcomes after correction of genu valgum deformity using dome osteotomy with plate osteosynthesis in late adolescents and young adults.MethodsA total of 27 knees in 21 patients underwent correction using dome osteotomy fixed with 3.5-mm low-profile proximal humeral locking system (PHILOS) plate. The functional, clinical, and radiological assessments were performed preoperatively and at six months postoperatively. Functional assessment was performed using the Bostman score, while clinical and radiological assessments were performed by measuring intermalleolar distance, tibiofemoral angle, mechanical lateral distal femoral angle, and mechanical axis deviation. All values were compared preoperatively and postoperatively using the paired t-test and Wilcoxon’s test.ResultsThe comparison between preoperative and postoperative data was statistically significant (P<0.0001). Twenty patients had an excellent knee score, and one patient had a good score. None had an unsatisfactory score.ConclusionsDome osteotomy fixed with well-contoured, 3.5-mm low-profile PHILOS plate allows deformity correction at the CORA (center of rotation of angulation) of the knee and permits early knee mobilization without significant procedure or implant-related complications with excellent outcomes.

Predictive role of ankle MRI for tendon graft choice and surgical reconstruction.

Tendon transfers have become a common surgical procedure around the ankle. In this study, we sought to evaluate the existence of a correlation between specific anthropometric parameters and the size of some ankle tendons measured on MRI, in particular those mostly used as graft in ankle surgery. We recorded gender, height, weight, and body mass index (BMI) of 113 patients (57 females; mean age: 42 ± 18) who underwent ankle MRI. MRI measurements performed by a radiologist were: axial shortest diameter of Achilles (AT), posterior tibialis (PTT), flexor digitorum longus (FDLT), flexor hallucis longus (FHLT), peroneus longus (PLT), and anterior tibialis (ATT) tendons, intermalleolar distance (ID) and talus width (TW). Mann-Whitney U test and Pearson's correlation coefficient were used. After applying the Bonferroni correction for multiple comparisons, statistical significance was set at p < 0.002. The mean patient height, weight and BMI were 169 ± 9.8cm (range: 140-193), 72.4 ± 16.4kg (range: 44-142), and 25 ± 5.7 (range: 16-50), respectively. The mean ankle measurements were: AT = 5.3 ± 1.4mm, PTT = 3.3 ± 0.6mm, FDLT = 2.6 ± 0.4mm, FHLT = 2.7 ± 0.4mm, PLT = 2.9 ± 0.5mm, ATT = 3±0.6mm, ID = 62.9 ± 4.5mm, and TW = 28.8 ± 2.5mm. A statistical difference between male and female patients was observed regarding ID (z = -6.955, p < .001), TW (z = -6.692, p < .001), AT (z = -3.587, p < .001), PTT (z = -3.783, p < .001), and FDLT (z = -3.744, p < .001). Both PTT and FDLT showed a significant correlation with ID (p < .001) and TW (p < .001). ATT size was significantly correlated with weight, ID and TW (all with p < 0.001). PLT and AT showed a significant correlation only with ID and weight (p ≤ .001), respectively. Our data might help orthopaedists in preoperative planning to identify the best graft for ankle surgical procedures including tendon transfers.

Angular deformities of lower limb in children: Correction for whom, when and how?

Angular deformities are common presentations in childhood and adolescent age group. It is important to differentiate a true deformity from a physiological deformity, this requires measurement of the intercondylar and intermalleolar distance. Once a true deformity is diagnosed, the apex of the deformity requires to be established. Lower limb frontal plane deformities are evaluated with a true AP standing radiographs of the entire lower limb from hip to ankle. Mechanical or anatomical axis calculation gives the apex (CORA) as well as the magnitude of deformity. Frontal plane deformities require surgical intervention. In younger children, growth modulation surgery allows correction of the deformity with minimal morbidity and without the need for osteotomy. Older children, adolescents and adults require corrective osteotomy. The corrective osteotomy can be closed wedge, open wedge, or a dome osteotomy. The osteotomy may be stabilized with internal fixation with plate and screws or an intramedullary implant as is dictated by the level of osteotomy and the local bony anatomy. External fixators allow gradual and precise correction of the deformity.

Clinical measurement of angular profile of the knee and correlation with intermalleolar distance in children in Enugu metropolis.

Angular deformities of the lower limbs are commonly encountered deformities in pediatric orthopedic clinics. The values of the tibiofemoral angle undergoes changes as the child grows and these changes are self-limiting. The aim of the study is to establish the normal variation of knee angles of children between 2 and 12 years of age in Enugu metropolis and to establish any correlation between the knee angles and the intermalleolar distances (IMDs). This study was done on 630 school children in Enugu metropolis between the age groups of 2 and 12 years. Multistage sampling was used in the study. The tibiofemoral angles and intermalleolar/intercondylar distances were measured. The maximum tibiofemoral angle from this study was 7.6° ± 2.4° and the age corresponding to this value was 4 years. Only 23 subjects (3.5%) had varus knee angle. The values of the mean tibiofemoral angle and IMDs plateaued from 8 to 12 years. There was a significant positive correlation between average knee angle and IMD (r = 0.785, P < 0.001). The physiological changes in the knee angle (tibiofemoral) follow a similar pattern as established in the literature and there was positive correlation between IMD and the tibiofemoral angle.

Morphometry of talus - for an anatomically compatible prosthesis

Introduction: The talus is the tallest bone in the foot and also one of the bones that makes up the ankle joint. The treatment options available for Talar pathology are limited with unsatisfactory results affecting the quality of life. However, very little is reported in the literature about the morphology of the talus. A better understanding of ankle anatomy is essential for better design of ankle prosthesis, especially when aiming to restore the Normal Anatomy of the Ankle joint. Aim: This study was aimed at measuring various dimensions of Talus on Radiographs and its measurements can act as baseline data and help in designing better anatomically and functionally effective prosthesis. Materials and Methods: The present study was conducted on patients between the age group of 25 years to 50 years who were scheduled for anteroposterior and lateral plain ankle radiographs because of clinical hindfoot symptoms. All patients without radiological pathologies, fully able to load the foot were included in the study. In a sample size of 96 m easurements such as length, breadth, height and intermalleolar distance were noted down for 2 years in the Department of Radiology, K.M.C. Mangalore. Results: As observed in the study the right Tali exhibited greater measurements than the Left. Conclusions: An anatomical compatible prosthesis can be developed due to the baseline data available and keeping in mind that right Talus exhibited higher measurements than left, hence prosthetic design would vary for each side. Keywords: Talus, Prosthesis, Morphometry.

Assessing the Ankle Joint Line Level Before and After Total Ankle Arthroplasty With the "Joint Line Height Ratio".

Background:Restoring the joint line is an important principle in total knee arthroplasty. However, the effect of joint line level on patient outcomes after total ankle arthroplasty (TAA) remains unclear, as there is no established method for measuring ankle joint level in TAA. The objective of this study was to develop a reliable radiographic ankle joint line measurement method and to compare ankle joint line level measured pre-TAA, post-TAA, and in nonarthritic ankles.Methods:A total of 112 radiographic sets were analyzed. Each set included weightbearing anteroposterior radiographs of the operative ankle taken preoperatively, 1-year postoperatively, and of the contralateral ankle. Measurements of vertical intermalleolar distance (VIMD) and vertical joint line distance (VJLD) at pre-TAA, post-TAA, and of the contralateral ankle were recorded by 2 authors on 2 separate occasions. The ratio of VJLD to VIMD was defined as the joint line height ratio (JLHR). Reliability of measurements and correlation between VIMD and VJLD were assessed. Pre-TAA, nonarthritic contralateral ankle, and post-TAA JLHR were compared and considered significantly different if P <.05.Results:The inter- and intrarater reliability of radiographic measurements was excellent (r > 0.9). There were strong positive correlations of VIMD and VJLD, r = 0.809 (pre-TAA)/0.756 (post-TAA), P < .001. Mean (SD) pre-TAA, nonarthritic contralateral ankle, and post-TAA JLHRs were 1.54 (0.31), 1.39 (0.26), and 1.62 (0.49), respectively. Pre- and post-TAA JLHRs were significantly higher compared to the nonarthritic contralateral ankle (P < .05). JHLR was not significantly different between pre- and post-TAA (P = .15).Conclusion:The JLHR was reliable and could be a clinically applicable method for assessing ankle joint line level in patients undergoing TAA. End-stage ankle arthritis demonstrated elevated joint line level compared with nonarthritic ankles, and the joint line level post-TAA remained elevated compared with nonarthritic ankles. Further studies are needed to understand the effect of joint line elevation on clinical outcomes after TAA.Level of Evidence:Level III, retrospective comparative study.

The “Joint Line Height Ratio” Assessing the Ankle Joint Line Level Before and After Total Ankle Replacement

Category:Ankle ArthritisIntroduction/Purpose:n important principle of joint replacement is to restore the joint line to its native level. Previous studies have demonstrated a correlation between clinical outcomes and our ability to restore the joint in total knee arthroplasty. To date, there has been no study to assess restoration of joint height in total ankle replacement (TAR). In addition, there is no accepted method for assess joint line height in patients who undergo TAR. The objective of this study is to develop a reliable radiographic ankle joint line level measurement. Additionally, the measure will be used to evaluate and compare ankle joint line levels seen on pre-TAR, post-TAR, and non-arthritic contralateral ankle radiographs.Methods:One hundred and twelve primary TAR patients with weightbearing preoperative (pre-TAR) and 1-year postoperative (post-TAR) anteroposterior (AP) ankle radiographs were retrospectively reviewed. Patients with bilateral disease, concomitant malleolar osteotomy, and component subsidence were excluded. Two raters measured the vertical intermalleolar distance (VIMD, Figure 1) and the vertical joint line distance (VJLD, Figure 1) for all radiographs (pre-TAR, post-TAR, and contralateral normal ankle) on two separate occasions. The measurement ”joint line height ratio” was calculated as the ratio of the VJLD to the VIMD (Figure 1). Reliability was assessed using intraclass correlation coefficients (ICCs). Pearson correlation test was used to assess the level of correlation between the VJLD and the VIMD. The comparisons of pre-TAR, non-arthritic contralateral ankle, and post- TAR “joint line height ratio” were performed using paired t-tests and considered significantly different if p < 0.05.Results:Inter/intra-rater reliabilities of all measurements were excellent (r>0.9). Pearson correlation test demonstrated strong positive correlations of VIMD and VJLD with r 0.809 for pre-TAR and r 0.756 for post-TAR, p<0.001. Mean(SD) VIMDs for pre- TAR, non-arthritis contralateral ankle, and post-TAR were 17.91(4.79), 18.96(4.67) and 17.37(4.76) mm. Mean(SD) VJLDs for pre- TAR, non-arthritis contralateral ankle, and post-TAR were 26.49(4.64), 25.47(4.12) and 26.70(5.31) mm. Additionally, mean(SD) ”joint line height ratio” for pre-TAR, non-arthritic contralateral, and post-TAR ankle radiographs were 1.54(0.31), 1.39(0.26) and 1.62(0.49). The “joint line height ratio” of pre- and post-TAR was significantly higher compared to non-arthritic contralateral ankle (p 0.0001 and < 0.0001), respectively. No significant difference in ”joint line height ratio” was found between pre- and post-TAR(p = 0.15).Conclusion:The “joint line height ratio” was a reliable tool for assessing the ankle joint line pre and post-TAR. End-stage ankle arthritis leads to an elevated joint line compared to non-arthritic ankle. The joint line level after TAR was preserved to that measured before TAR, but not restored compared to the non-arthritic contralateral ankle. When performing TAR, joint line level restoration should be evaluated compared to the contralateral non-arthritic ankle radiograph. The amount of tibial cut should be minimized as much as possible to prevent further bone loss and ankle joint line elevation.

Assessing mechanical ankle instability via functional 3D stress-MRI – A pilot study

BackgroundQuantitative measurement of the mechanical deficit in chronic ankle instability (CAI) is difficult. Therefore, the distinction between functional (FAI) and mechanical ankle instability (MAI) as well as the evaluation of surgical techniques is difficult. This pilot study uses a novel method of functional 3-dimensional stress ankle-MRI to test its applicability for assessing mechanical ankle instability. MethodsWe used a custom-built ankle arthrometer that allows a stepless positioning of the foot and an axial in situ loading with up to 500 N combined with a 3-dimensional MRI protocol. We assessed four parameters (3D cartilage contact area (CCA) fibulotalar, tibiotalar horizontal and vertical and intermalleolar distance) under six different conditions (neutral-null, plantarflexion-supination and dorsiflexion-pronation each with and without loading) in n = 10 individuals (7 suffering from MAI and 3 healthy controls). FindingsThe MAI group showed a substantially increased reduction of lateral osseous constraint compared to healthy controls when the foot was positioned in plantarflexion-supination (CCA fibulotalar 69% vs. 30% in controls). The reduction of the weight bearing surface in plantarflexion-supination was also more pronounced (CCA tibiotalar horizontal −49% in MAI vs. −28% in controls). InterpretationThis novel technique is valuable for assessing mechanical ankle instability in the target population and has a potential clinical benefit for assessing the mechanical deficit of individual patients. Further studies are needed to provide evidence for a possible prognostic value of this novel technique.

Development of an Automatic Instrument for Efficient Measuring the Joint’s Range of Motion

A range of motion (ROM) has been measured using several indices to judge the progress of ankylosing spondylitis (AS). However, measuring and calculating the ROM is time-consuming & labor-intensive and it would be even difficult to measure accurately. Thus, an automated measurement system (AMS) is proposed & developed to measure the ROM more easily without any restraint sensor, and to recognize changes in the ROM more constantly with the same standard of measurement. The measurement items are neck cervical rotation, cervical lateral flexion, finger-to-floor distance, intermalleolar distance, and lumbar side flexion. Data from 30 healthy subjects were collected by the AMS and their motions were recorded simultaneously by installed webcams to acquire gold-standard data compared with the measurement value of the AMS. The accuracy was determined by calculating the standard error of estimation (SEE) and a possibility of replacement of measurement obtained by a physician using a protractor & ruler has been assessed by pattern recognition of Bland-Airman plots. These statistical results exhibit a significant degree of agreement with the novel AMS. The total measurement time for the 5 items using the proposed AMS was less than 5 min, which is faster than manual measurement. However, the measurement was conducted against only healthy subjects; therefore additional tests with AS patients will be required for utilization in clinical practice.

Épiphysiodèse distale fémorale par vis + suture versus plaque en 8 dans le genu valgum de l’enfant

IntroductionThere are different techniques for gradual correction of angular deformities in lower limbs. The use of screws and non-absorbable filament have been described as an effective alternative for transitory hemiepiphysiodesis in pediatric population. HypothesisIn pediatric population with genu valgum there are no differences in outcome between hemiepiphysiodesis, using screws and non-absorbable filament (SNAF) versus 8-plate. MethodsRetrospective evaluation, 44 knees in 22 patients younger than 15 years, with idiopathic genu valgum, were operated on. One group (20 knees) was operated on with 8-plate technique and another group (24 knees) was operated on with SNAF technique. Initial and final intermalleolar distance (IMD) and mechanical lateral distal femoral angle (mLDFA) were compared, registering complications for each group. Mann–Whitney test was used for statistics, with significance value<0.05. ResultsAll patients achieved the expected mechanical axis correction. IMD and mLDFA significatively improved. There were no significant differences in magnitude and speed of correction when comparing the two techniques. Only one SNAF patient had a minor perioperative complication. DiscussionThis report compares postoperative results between SNAF and 8-plate technique for correction of angular deformities in lower limbs. In this series of patients, significant clinical and radiological changes were observed between the initial and final values using both techniques, with no significant differences between them. Our group proposes the SNAF technique as an efficient, simple and cost-effective alternative to the traditional 8-plate technique, for the treatment of idiopathic genu valgum in children. Level of evidenceIII, Retrospective comparative study.

Distal femoral hemiepiphysiodesis with screws and suture versus 8-plate for the treatment of genu valgum in children

IntroductionThere are different techniques for gradual correction of angular deformities in lower limbs. The use of screws and non-absorbable filament have been described as an effective alternative for transitory hemiepiphysiodesis in pediatric population. HypothesisIn pediatric population with genu valgum there are no differences in outcome between hemiepiphysiodesis, using screws and non-absorbable filament (SNAF) versus 8-plate. MethodsRetrospective evaluation, 44 knees in 22 patients younger than 15 years, with idiopathic genu valgum, were operated on. One group (20 knees) was operated on with 8-plate technique and another group (24 knees) was operated on with SNAF technique. Initial and final intermalleolar distance (IMD) and mechanical lateral distal femoral angle (mLDFA) were compared, registering complications for each group. Mann-Whitney test was used for statistics, with significance value <0.05. ResultsAll patients achieved the expected mechanical axis correction. IMD and mLDFA significatively improved. There were no significant differences in magnitude and speed of correction when comparing the two techniques. Only one SNAF patient had a minor perioperative complication. DiscussionThis report compares postoperative results between SNAF and 8-plate technique for correction of angular deformities in lower limbs. In this series of patients, significant clinical and radiological changes were observed between the initial and final values using both techniques, with no significant differences between them. Our group proposes the SNAF technique as an efficient, simple and cost-effective alternative to the traditional 8-plate technique, for the treatment of idiopathic genu valgum in children. Level of evidenceIII, retrospective comparative study.