Left Ankle Research Articles

Penilaian Spatial dan Temporal Gaya Berjalan dalam Satah Hadapan menggunakan MediaPipe Pose

Gait analysis is a vital field in biomechanics, focusing on studying human walking patterns and movement. Traditional methods relied on visual observation, lacking accuracy and objectivity. Instrumented gait analysis improved measurements using specialized equipment like motion capture systems and wearable sensors, but had limitations due to cost, and markers or sensors interfering with natural movement. The field underwent a significant transformation with the advent of markerless pose estimation-based gait analysis, which harnessed computer vision methodologies to monitor human movement without the requirement for specialized equipment, delivering a cost-effective and easily accessible analysis in real-world environments. However, it still faces challenges, including limitations in the sagittal plane and reliance on computationally demanding models like OpenPose. This study introduced a novel frontal plane gait analysis approach using the lightweight MediaPipe Pose model and a single camera setup. The objective is to evaluate the feasibility, and accuracy of MediaPipe Pose by comparing it to the established 3D Vicon motion capture system. The proposed approach tracked body keypoints during gait, detected gait events based on ankle depth changes and vertical difference between left and right ankles, and calculated gait parameters. The findings demonstrated that MediaPipe Pose-based gait analysis showed promise for accurately analyzing gait parameters in the frontal plane with low mean absolute error (0.00–0.30). Combining this method with satellite technology enhances e-health by facilitating teleconsultations, remote diagnostics, and extending healthcare services to disaster-stricken or remote areas.

Cardiovascular Risk Assessment in Women with Psoriasis

Objectives: Psoriasis is a chronic inflammatory skin disease. The exact cause of psoriasis is unclear; nevertheless, it is thought to be complex including several key components such as genetic predisposition, triggers from the environment, skin barrier disruption, and immunological dysfunction. About 85–90% of all psoriatic patients present with plaque type of psoriasis. The systemic nature of psoriasis makes an independent risk factor for cardiac disease. The main objective is to find the association between lipid profile, arterial stiffness, and psoriasis among female patients. Materials and Methods: Female patients with psoriasis in the age group of 20–50 years were selected. The duration of the study was 1 year. For lipid profile, after 12 h of fasting, 5 mL of blood was taken and analyzed by kit method using Transasia RX 1000. Low-density lipoprotein (LDL) cholesterol concentrations were estimated using the Friedewald formula. Arterial stiffness was measured using an oscillometric noninvasive arteriography. Right brachial ankle pulse wave velocity (RbaPWV), left brachial ankle pulse wave velocity (LbaPWV), and carotid femoral pulse wave velocity were measured in cm/s. Results: In the present study, 28% of the females were <38 years and 44% of females were in the range of 39–46 years. The mean value of cholesterol was (263.66 ± 47.74), Triglyceride (188.38 ± 27.56), high-density lipoprotein (HDL) (50.06 ± 18.05) LDL (171.60 ± 33.98), and very LDL (89.74 ± 13.361) mg/dL, respectively. Significant correlation was found between LbaPWV and Psoriasis (0.03), HDL and psoriasis (0.04), and psoriasis and RbaPWV (0.01). Conclusion: We conclude that psoriasis patients have hyperlipidemia, which will increase arterial stiffness and may lead to cardiovascular disorders (CVDs). Variables such as lipid profiles and arterial stiffness may be used as screening tools for the early detection of CVDs.

A Novel Method for Identifying Frailty and Quantifying Muscle Strength Using the Six-Minute Walking Test.

The six-minute walking test (6MWT) is an essential test for evaluating exercise tolerance in many respiratory and cardiovascular diseases. Frailty and sarcopenia can cause rapid aging of the cardiovascular system in elderly people. Early detection and evaluation of frailty and sarcopenia are crucial for determining the treatment method. We aimed to develop a wearable measuring system for the 6MWT and propose a method for identifying frailty and quantifying walking muscle strength (WMS). In this study, 60 elderly participants were asked to wear accelerometers behind their left and right ankles during the 6MWT. The gait data were collected by a computer or smartphone. We proposed a method for analyzing walking performance using the stride length (SL) and step cadence (SC) instead of gait speed directly. Four regions (Range I-IV) were divided by cutoff values of SC = 2.0 [step/s] and SL = 0.6 [m/step] for a quick view of the frail state. There were 62.5% of frail individuals distributed in Range III and 72.4% of non-frail individuals in Range I. A concept of a WMS score was proposed for estimating WMS quantitatively. We found that 62.5% of frail individuals were scored as WMS1 and 41.4% of the non-frail elderly as WMS4. The average walking distances corresponding to WMS1-4 were 207 m, 370 m, 432 m, and 462 m, respectively. The WMS score may be a useful tool for quantitatively estimating sarcopenia or frailty due to reduced cardiopulmonary function.

The Utility of Musculoskeletal Ultrasound in Diagnosing Uncommon Talocrural Synovitis in an Amateur Weightlifting Athlete

The use of musculoskeletal ultrasound to assess sports-related injuries has been increasing worldwide. This case report focuses on an unusual form of synovitis of the talocrural joint in a 33-year-old male amateur weightlifter who presented to our sports medicine clinic with acute non-traumatic left ankle pain lasting for 2 days. He reported a recent change in his squatting technique and had no significant medical history other than a recent viral upper respiratory illness. Weight-bearing ankle X-rays were inconclusive, however, ultrasound evaluation revealed effusion in the talocrural joint upon assessment of the ankle’s anterior joint capsule. Additionally, the ultrasound examination helped rule out other common soft tissue ankle pathologies that can affect athletes. The athlete's symptoms resolved by day 5 with conservative measures, including weight bearing as tolerated, nonsteroidal anti-inflammatory drugs, and lymphatic drainage techniques. This report demonstrates the utility of musculoskeletal ultrasound in diagnosing an uncommon cause of ankle pain in athletes.

A quantitative analysis of fidgeting in ADHD and its relation to performance and sustained attention on a cognitive task.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder where hyperactivity often manifests as fidgeting, a non-goal-directed motoric action. Many studies demonstrate fidgeting varies under different conditions as a self-regulating mechanism for attention and alertness during cognitively demanding tasks. Fidgeting has also been associated with reaction time variability. However, a lack of standard variables to define and quantify fidgeting can lead to discrepancies in data and interpretability issues across studies. Furthermore, little is known about fidgeting in adults with ADHD compared to youth. This study aims to design a framework to quantify meaningful fidgeting variables and to apply them to test the relation between fidgeting and performance on a cognitive task, the Flanker, in adults with ADHD. Our study included 70 adult participants diagnosed with ADHD, aged 18-50 years (30.5 ± 7.2 years). Screening included a structured clinical interview, childhood, current self and current observer ratings of ADHD symptoms. Actigraphy devices were attached to the left wrist and right ankle during completion of a cognitive control, attention task (the Flanker). Laboratory testing was subsequently completed on a single day. The relation between task performance, reaction time variability and fidgeting was examined. Our analysis revealed increased fidgeting during correct trials as defined by our new variables, consistent with previous observations. Furthermore, differences in fidgeting were observed between early and later trials while the percentage of correct trials were not significantly different. This suggests a relation between the role of fidgeting and sustaining attention. Participants with low reaction time variability, that is, those with more consistent reaction times, fidgeted more during later trials. This observation supports the theory that fidgeting aids arousal and improves sustained attention. Finally, a correlation analysis using ADHD-symptom rating scales validated the relevance of the fidget variables in relation to ADHD symptom severity. These findings suggest fidgeting may be a compensatory mechanism that aids in sustained attention for those with ADHD, although alternative explanations exist. Our study suggests that fidgeting may aid in sustained attention during the attention-demanding, cognitive control processes for adults with ADHD, with more fidgeting observed during correct trials and among participants with lower reaction time variability. Furthermore, the newly defined fidget variables were validated through a significant correlation with ADHD rating scales. By sharing our implementation of fidget variables, we hope to standardize and encourage further quantitative research into the role of fidgeting in ADHD.

Influence of Six-Week Plyometric and Strength Training on the Performance of Female Sprinters of the Islamia University of Bahawalpur

This is a comparative analysis of the female sprinter of the plyometric and strength training groups. Thirty participants (21.17±1.94 years) were selected from the Islamia University of Bahawalpur and divided into two groups. The selected variables were height and weight, skinfolds, girths, lengths, breadths, 30-meter dash, flexibility, agility, 600-meter running, sit-ups, standing long jump, push-ups, and 100-meter sprinter races. Two video cameras for videography with Kinovea software for kinematic analysis. Repeated measures ANOVA revealed that six-week strength and plyometric training significantly affected calf skinfold, Ilic-crest skinfold, arm relax and flex girth, hand grip strength, flexibility, left ankle angle at starting position, knee angle at starting position, 30-meter dash, and agility, and 100-meter performance. It was concluded that strength and plyometric training significantly reduces body fat, improving physical fitness. On the other hand, six weeks of plyometric training more significantly improves sprinting performance than strength training.

The effects of ankle mulligan mobilisation in children with cerebral palsy: A randomized single blind control study.

To assess the impact of range of motion changes before and after Mulligan mobilisation with ankle movement interventions on the daily lives of children with diplegic cerebral palsy. The single blind randomised controlled study was conducted from July 30, 2022, to January 10, 2023, at 3 rehabilitation centres in Hebron, Palestine, after approval from the ethics review committee of Eastern Mediterranean University, Northern Cyprus, and comprised children with cerebral palsy, who were randomised into intervention group IG and control group CG. All the subjects received regular physiotherapy sessions, overseen by their parents, while those in group IG received mobilisation with ankle movement treatment 3 times per week for 4 weeks. Post-intervention assessment of ankle range of motion, balance, functional performance and quality of life was done using a goniometer, the timed up and go test, 88-item gross motor function measure, 6-minute walk test and the cerebral palsy quality of life questionnaire. Data was analysed using SPSS 24. Of the 64 patients, 40(63%) were girls, and 24(37%) were boys. The overall age range was aged 4-12 years. There were 32(50%) patients in each of the two groups. Mobilisation with movement had a significant effect on active and passive range of motion for the left and right ankles (p<0.05) as well as on balance, gross motor function and quality of life (p>0.05). However, mobilisation with movement had no significant effect on the the distance covered during the 6-minute walk test (p>0.05). Mobilisation with movement had a significant impact on active and passive ankle range of motion, balance and quality of life in diplegic children with cerebral palsy, but it had no impact on gait function. The study was registered at the United States National Institutes of Health (ClinicalTrials.gov) with registration number NCT05500924.

Analgesic Effect of SKI306X on Chronic Postischemic Pain and Spinal Nerve Ligation-Induced Neuropathic Pain in Mice.

Neuropathic pain (NP) results from lesions or diseases affecting the peripheral or central somatosensory system. However, there are currently no drugs that are particularly effective in treating this condition. SKI306X is a blend of purified extracts of three oriental herbs (Clematis mandshurica, Trichosanthes kirilowii, and Prunella vulgaris) commonly used to treat osteoarthritis for their chondroprotective effects. Chronic postischemic pain (CPIP) and spinal nerve ligation (SNL) models were created by binding the upper left ankle of mice with an O-ring for 3 h and ligating the L5 spinal nerve, respectively. Mice with allodynia were injected intraperitoneally with 0.9% normal saline (NS group) or different doses (25, 50, or 100 mg/kg) of SKI306X (SKI groups). We assessed allodynia using von Frey filaments before injection and 30, 60, 90, 120, 180, and 240 min and 24 h after injection to confirm the antiallodynic effect of SKI306X. We also measured glial fibrillary acidic protein (GFAP) levels in the spinal cord and dorsal root ganglia to confirm the change of SKI306X administration. Both models exhibited significant mechanical allodynia. The intraperitoneal injection of SKI306X significantly increased the paw withdrawal threshold in a dose-dependent manner, as the paw withdrawal threshold was significantly increased after SKI306X administration compared with at baseline or after NS administration. GFAP levels in the SKI group decreased significantly (p < 0.05). Intraperitoneal administration of SKI306X dose-dependently attenuated mechanical allodynia and decreased GFAP levels, suggesting that GFAP is involved in the antiallodynic effect of SKI306X in mice with CPIP and SNL-induced NP.

Disseminated septic arthritis caused by Ureaplasma urealyticum in an immunocompromised patient with hypogammaglobulinemia after rituximab therapy

Abstract Purpose Ureaplasma urealyticum is a rare pathogen associated with septic arthritis that predominantly affects patients with hypogammaglobulinemia. Bacterial identification of fastidious organisms is challenging because they are undetectable by routine culture testing. To the best of our knowledge, this is the first report of septic arthritis induced by U. urealyticum infection in Japan. Case description We describe the case of a 23-year-old Japanese female with secondary hypogammaglobulinemia (serum immunoglobulin level &lt; 500 mg/dL), identified 8 years after treatment with rituximab. The patient presented with persistent fever and polyarthritis that were unresponsive to ceftriaxone and prednisolone. Contrast-enhanced computed tomography and gallium-67 scintigraphy revealed effusion and inflammation in the left sternoclavicular, hip, wrist, knee, and ankle joints. Although Gram staining and bacterial culture of the drainage fluid from the left hip joint were negative, the condition exhibited characteristics of purulent bacterial infection. The patient underwent empirical treatment with doxycycline, and her symptoms promptly resolved. Subsequent 16S ribosomal RNA (rRNA) gene sequencing of the joint fluid confirmed the presence of U. urealyticum, leading to the diagnosis of septic arthritis. Combination therapy with doxycycline and azithromycin yielded a favorable recovery from the inflammatory status and severe arthritic pain. Conclusion This case highlights U. urealyticum as a potential causative agent of disseminated septic arthritis, particularly in patients with hypogammaglobulinaemia. The 16S rRNA gene analysis proved beneficial for identifying pathogens in culture-negative specimens, such as synovial fluid, in suspected bacterial infections.

Recognition of TaeKwonDo kicking techniques based on accelerometer sensors

TaeKwonDo (TKD) is a worldwide sport in both competitive among athletes and physical exercise among the public scenarios. Measuring TKD kicks have been studied a lot in a laboratory setting but rarely in a free-living situation. Machine learning algorithm combined with accelerometer data was used to study some martial art styles, e.g., Chinese KungFu but little in TKD. The purpose of this study was to discover a method to recognize different kicking techniques in TKD. A total of 20 participants (35 % male) were recruited to perform front kick, roundhouse kick, side kick and back kick 6 times on each side with three accelerometers wore on waist, right ankle and left ankle. SVM and decision tree were used to analyze data and classify kicking movements. The usage of different combination of accelerometers were also compared. The result showed that using accelerometers on waist and both ankles, on waist and only right ankle, on only waist and combined with SVM model could have at least 0.96 accuracy of classification, while decision tree had the accuracies around 0.8. It was concluded that using SVM model on only waist data is the optimal choice because of the high accuracy and less accelerometers used.

A Novel Diabetic Arthritic Model in Rats Induced by Streptozotocin, High-Fat Diet, and Complete Freund's Adjuvant.

Ankle arthrodesis is one of the treatments of choice, particularly in late-stage and unstable diabetic Charcot arthropathy. Unfortunately, poor healing capacity might play a role in the high nonunion rate (10-40%). The advancement in regenerative medicine opens a new horizon for enhancing fusion after ankle arthrodesis in patients with poor healing capacity. However, a suitable small animal model is warranted to study the effectivity of these regenerative medicine approaches. Streptozotocin (STZ)-induced diabetes models and adjuvant-induced arthritis models with complete Freund's adjuvant are two established models. However, no study has combined those two models to make a diabetic arthritic model that more closely resembles the condition in Charcot arthropathy. Twenty male Sprague-Dawley rats were assigned into five groups, consisting of one control group, and four diabetic groups which were induced by STZ injection and a high-fat diet. Among these diabetic rats, two groups received complete Freund's adjuvant (CFA) injections to the left ankle of the hind limb. The control group, one of the diabetic-only groups, and one of the arthritic-diabetic-induced groups were euthanized at 4 weeks after STZ induction, and the remainder were euthanized 6 weeks after STZ induction. Clinical, radiological, and histological examinations were then compared in all five groups. Diabetic status was successfully achieved in the model, which was maintained until the completion of the study. The CFA-induced ankles were significantly larger than the contralateral ankles in all groups (p<0.05). Histopathological evaluation confirmed arthritic changes in the CFA-induced group with less variability after 4 weeks of arthritis induction. This rat model of arthritic diabetic mimics the progressive and chronic nature of Charcot arthropathy in humans. This model can be further use to study treatments that might enhance the fusion rate in ankle arthrodesis in healing-defective patients such as those with diabetes. 5.

Case Report: Halting terminal osseous overgrowth post tibia amputation in children: a report of three cases

Terminal osseous overgrowth is a common complication after trans-diaphyseal amputation in children, leading to pain, soft tissue problems, and recurrent surgical procedures. We report three different cases with post-amputation issues of osseous overgrowth, ulceration, and deformity over the amputation site. The first case involves a 9-year-old boy with a right leg congenital amputation secondary to amniotic band syndrome. The right below-knee stump later experienced recurrent episodes of osseous overgrowth, leading to ulceration. After the prominent tibia was resected and capped with the ipsilateral proximal fibula, a positive outcome was achieved with no more recurrent overgrowth over the right leg stump. The second case involves a 9-year-old girl born with an amniotic constriction band over both legs. Her left leg remained functional after a circumferential Z-plasty, but the right leg was a congenital below-knee amputation. Multiple refashioning surgeries were performed on the right leg due to osseous overgrowth but the patient continued to experience recurrent overgrowth causing pain and difficulty fitting into a prosthesis. We performed osteocartilaginous transfer of the proximal part of the ipsilateral fibula to the right tibial end, successfully preventing the overgrowth of the tibia without any complications. The third case involves an 11-year-old boy with a history of meningococcal septicemia who underwent a right below-knee amputation and left ankle disarticulation due to complications of septic emboli. He experienced a prominent right distal tibia stump, which later developed into valgus deformity as a result of the previous insult to the proximal tibial growth plate. We performed a corrective osteotomy over the proximal right tibia and capped the entire tibia with the ipsilateral fibula as an intramedullary splint for the osteotomy site. Post-operatively, we achieved satisfactory deformity correction and successfully halted the recurrent overgrowth over the right tibia stump. The method of ipsilateral fibula capping is safe and effective in managing the osseous overgrowth complications in trans-diaphyseal amputations among children. Therefore, it is a reasonable option during primary below-knee amputations in children compared to multiple refashioning surgeries.

#2864 IgA dominant post-infectious glomerulonephritis secondary to the infected left ankle joint in a non-diabetic patient, a case report

Abstract Introduction Post-infectious glomerulonephritis (PIGN) is an immune complex glomerulonephritis that commonly affects children and young adults following beta haemolytic Streptococcal throat or skin infections. Kidney biopsy is characterised by Segmental or global endocapillary hypercellularity, and crescents may be present. In immunofluorescence, post-infectious glomerulonephritis typically shows IgG and C3 deposition. A rare type of PIGN is IgA-dominant post-infection glomerulonephritis. It commonly occurs in the setting of active infection. It usually presents in patients &amp;gt; 60 years old with diabetes mellitus, alcohol consumption, and Staphylococcal infections. It can present with RPGN, AKI, and nephrotic syndrome. Hypocomplementemia can be present, and immunofluorescence is characterised by IgA dominance with C3 co-dominance and no IgG. Despite the strong association with Staph aureus, however, it has been reported with other types of infections. The main line of treatment is antibiotic eradication of the infection. Steroids can be used based on the severity of the lesion and the presence of crescents. Its prognosis is worse than that of the traditional PIGN. In this case, we report a case of IgA-dominant post-infectious glomerulonephritis secondary to left ankle osteomyelitis with Staph aureus infection. Case Presentation A 65-year-old lady had open reduction and internal fixation of a left trimalleolar ankle fracture in June 2023 at a district general hospital. Unfortunately, the post-operative course was complicated by wound infection. The wound swab showed Heavy growth of Staphylococcus aureus. This was followed by Acute Kidney Injury (AKI) stage 3; therefore, she was transferred from her hospital to our renal ward. On admission to the ward, her creatinine was 388 μmol/L(baseline creatinine was 73 μmol/L one month before admission), urine dipstick was positive for blood and protein, and urine protein creatinine ratio was 480 mg/mmol. She had only a medical background of bronchial asthma for which she was only on Inhalers (Beta Agonist) as a regular medication. CT scan of the left ankle revealed appearances consistent with osteomyelitis of both the lateral and medial malleoli. This finding was discussed with microbiology and orthopaedic teams, and the patient was started on intravenous antibiotics (Vancomycin followed by doxycycline). A kidney biopsy was done. Mesangial electron-dense deposits were identified. Immunohistochemistry revealed IgA dominant, predominantly mesangial positivity, with associated C3. The picture was consistent with IgA acute glomerulonephritis associated with S. aureus, which is a post-infectious Glomerulonephritis with dominant IgA staining (rather than conventional IgA nephropathy). With proper intravenous hydration and antibiotics, her inflammatory markers started to improve, and her renal chemistry followed the inflammatory markers, and her last creatinine improved to 146 μmol/L, eGFR 31 ml/min and UPCR was 40 mg/mmol. Discussion IgA-dominant post-infectious glomerulonephritis is now a distinct form of PIGN, which usually presents with acute kidney injury, haematuria, and proteinuria and is typically related to Staph aureus infection. In contrast to typical IgA nephropathy, there is no role for steroid or immunosuppression in the treatment of IgA-dominant post-infectious glomerulonephritis, and the treatment is mainly dependent on the treatment of infection.

#2387 Case study of a patient with gouty nephropathy treated with immunosorbent therapy

Abstract Background and Aims Gouty nephropathy is a kidney disease caused by chronic hyperuricemia, in which uric acid crystals are deposited in the kidneys leading to tubular and glomerular damage, which in turn affects kidney function. Patient female, 68 years old, 7 years ago, no obvious cause of the first toe joint of the right foot, the right ankle joint redness, swelling and pain, the local skin temperature increases, serious limitation of activities, had checked the high uric acid (specific unknown), diagnosed as “gout”, simple treatment after the symptoms are relieved, but did not have systematic treatment, and gradually appeared in the left foot, the first toe joint, the left ankle joint, double knee joint redness, swelling and pain, oral pain medication treatment, pain disappears after still no systematic treatment. After that, redness, swelling and pain appeared gradually in the first toe joint of the left foot, left ankle joint and both knee joints, and the pain disappeared without systematic treatment after taking pain-relieving medicines. He was admitted to our hospital as an outpatient with the diagnosis of “gout”. Method Immunosorbent therapy was given once/day on days 1-3, along with Jinshuibao and urotoxin clearing granules. Immunosorbent therapy was given again three times on the 8th-10th day of admission. Results Before admission, uric acid: 899.3 µmol/L; creatinine: 586.1 µmol/L, both seriously out of the normal range. 3 days later, uric acid: 770.4 µmol/L, creatinine: 468.7 µmol/L. At the time of discharge, serum uric acid: 298.5 µmol/L and creatinine: 182.6 µmol/L were detected and restored to the normal range. Conclusion The case demonstrated the presence of gout with arthritic symptoms, vascular damage, anemia, and hepatic and renal impairment. The patient's gout progressively worsened due to prolonged absence of systemic treatment. After admission, the levels of uric acid and creatinine were effectively controlled and restored by immunosorbent therapy. This indicates that immunosorbent therapy plays a positive role in removing uric acid from the body and improving renal function. Meanwhile, the management and control of gout was further strengthened by combining the comprehensive treatment with Jinshuibao and uremic acid granules.

Chronic Nonbacterial Osteomyelitis, Hidradenitis Suppurativa, and SAPHO Syndrome

Introduction: Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome may represent one side of a spectrum of disease that also includes chronic nonbacterial osteomyelitis. Case: A 23-year-old male with bone pain in the anterior chest, shoulder, clavicles, left elbow, and left ankle presented to rheumatology clinic after multiple evaluations for infectious osteomyelitis. Imaging and deep bone biopsies of affected areas were consistent with chronic osteomyelitis, with labs notable for elevated erythrocyte sedimentation rate, C-reactive protein, and positivity for HLA-B27. A full skin exam was consistent with hidradenitis suppurativa, and he was started on infliximab and methotrexate with improvement in both his osteoarticular and skin symptoms. Conclusions: Patients presenting with features of follicular occlusion or neutrophilic dermatoses in conjunction with bone pain should be evaluated for SAPHO/CNO. In patients with SAPHO/CNO with vertebral involvement, bisphosphonates in addition to anti-inflammatory medications (such as methotrexate and TNF-inhibitors) can be effective.

Maisonneuve fracture treated with short leg cast: A case report with 41-month follow-up.

Maisonneuve fracture is a specific type of severe ankle injury. To our current knowledge, once a Maisonneuve fracture is diagnosed, the surgery is always recommended for fear of sequelae from inaccurate joint reconstruction. However, in this case, we treated a Maisonneuve fracture with a short leg cast, and the 41-month follow-up showed a favorable outcome with no post-traumatic osteoarthritis, chronic pain, and instability. Therefore, this case provides evidence for the feasibility of conservative treatment of Maisonneuve fracture. A female patient in her early twenties sprained her left ankle while running, suffering regional pain, swelling, and limited mobility. We diagnosed a Maisonneuve fracture with superior fibular fracture and Volkmann tuberosity fracture, a slight separation of inferior tibiofibular syndesmosis (ITS). The patient rejected our surgical recommendations in favor of nonsurgical treatment, in addition to refusing immobilization of the knee. Consequently, we had to treat her with a short leg cast for 8 weeks and asked her to return for regular follow-up visits. At the final follow-up, the radiography showed complete healing of proximal fibula fracture. The patient reported no discernible subjective differences between her bilateral ankles. The range of motion of the left ankle was measured at 22° of dorsiflexion and 40° of plantarflexion. Functional assessments using Olerud-Molander ankle scale and American Orthopedic Foot and Ankle Society Ankle-Hindfoot scale both scored 100 points. Additionally, the radiographic assessment classified arthritis as stage 0 according to Morrey-Wiedeman classification. To avoid missing and misdiagnosing, the physical examination should always extend to 2 neighboring joints. Secondly, if a Maisonneuve fracture is suspected, further computed tomography scans, radiography, and magnetic resonance imaging can help to determine the stability of the ITS and the integrity of the lateral collateral ligaments before making therapeutic decisions. Finally, considering the lateral collateral ligaments may remain intact, we recommend stabilizing ITS by repairing the medial ligaments, which can be conducted arthroscopically and be more minimally invasive, providing an elastic fixation that aligns better with the biomechanics of the ITS which is characterized as a micro-mobile rather than fully fixed joint.

ALL-COMPONENT REVISION FOR FAILED TOTAL ANKLE ARTHROPLASTY: EARLY RESULTS AND COMPLICATIONS

AimSurgical options for management of a failed ankle arthroplasty are currently limited; typically conversion to fusion is recommended with only a few patients being considered for revision replacement surgery. This paper presents our experience of revision ankle replacements in a cohort of patients with failed primary replacements.MethodA total of 18 revision TAR in 17 patients were performed in patients with aseptic loosening. The technique was performed by a single surgeon (CSK) over a 4 year period between July 2014 and August 2018 using the Inbone total ankle replacement system. Patient demographics and clinical outcomes were collected retrospectively using - MOXFQ, EQ5D, VAS pain score and patient satisfaction questionnaires.Results12 right and 6 left ankle replacements were revised in 17 patients (11 male/ 6 female). The mean age at revision was 69.1 years (range 56–81 years) with a mean BMI of 31. The mean surgical time was 171 minutes with 22% of cases requiring bone grafting. 6 patients had early wound complications, all superficial and settled with dressings. There were no deep infections, 2 patients had further surgery for exploration for possible nerve injuries. At a mean follow up of 20.6 months, 4 patients had mild/moderate ongoing pain with the majority of patients being satisfied with the outcome of their surgery.ConclusionThis study represents one of the largest group of patients reported to have undergone revision total ankle arthroplasty. Our experience shows that this results in acceptable level of complications and provides satisfactory function in most patients. We feel revision TAR is a viable option in patients with failed primary arthroplasty who wish to continue to maintain mobility at the ankle joint.

Manual acupuncture ameliorates inflammatory pain by upregulating adenosine A3 receptor in complete Freund’s adjuvant-induced arthritis rats

BackgroundAdenosine A3 receptor (A3R) exerts analgesic, anti-inflammatory, and anti-nociceptive effects. In this study, we determined the analgesic mechanism of manual acupuncture (MA) in rats with complete Freund's adjuvant (CFA)-induced arthritis and explored whether MA ameliorates inflammation in these rats by upregulating A3R. MethodsSixty Sprague Dawley (SD) rats were randomly divided into the following groups: Control, CFA, CFA + MA, CFA + sham MA, CFA + MA + DMSO, CFA + MA + IB-MECA, and CFA + MA + Reversine groups. The arthritis rat model was induced by injecting CFA into the left ankle joints. Thereafter, the rats were subjected to MA (ST36 acupoint) for 3 days. The clinical indicators paw withdrawal latency (PWL), paw withdrawal threshold (PWT), and open field test (OFT) were used to determine the analgesic effect of MA. In addition, to explore the effect of A3R on inflammation after subjecting arthritis rats to MA, IB-MECA (A3R agonist) and Reversine (A3R antagonist) were injected into ST36 before MA. ResultsMA ameliorated the pathological symptoms of CFA-induced arthritis, including the pain indicators PWL and PWT, number of rearing, total ambulatory distance, and activity trajectory. Furthermore, after MA, the mRNA and protein expression of A3R was upregulated in CFA-induced arthritis rats. In contrast, the protein levels of TNF-α, IL-1β, Rap1, and p-p65 were downregulated after MA. Interestingly, the A3R agonist and antagonist further downregulated and upregulated inflammatory cytokine expression, respectively, after MA. Furthermore, the A3R antagonist increased the degree of ankle swelling after MA. ConclusionMA can alleviate inflammatory pain by inhibiting the NF-κB signaling pathway via upregulating A3R expression of the superficial fascia of the ST36 acupoint site in CFA-induced arthritis rats.

Ultrasonographic Evaluation of the Ankle Joint in Relation to Rheumatoid Factor Status and Disease Activity in Patients with Rheumatoid Arthritis

Abstract Background: Rheumatoid arthritis (RA) is a form of inflammatory disease whose clinical pattern is largely dependent on the presence of both anti-citrullinated protein antibodies and rheumatoid factor (RF). Although this is still debatable, seronegative RA seems to be a somewhat less serious condition. The present study aimed to evaluate ankle joint ultrasound in relation to RF status and disease activity in RA patients. Methods: A cross-sectional study involving RA patients from a single center was conducted. Laboratory test evaluations and clinical activity assessments were carried out. The ankle joint was examined using musculoskeletal ultrasound (US). Results: The study included 100 patients with established RA in total. Eighty-two patients tested positive for RF with a mean age of 42.3, whereas only 18 tested negative with a mean age of 39.6. Patients who tested positive for RF had a longer duration of illness (9.39 ± 5.39 vs. 4.56 ± 3.24). There were no differences in clinical activity scores between the seropositive and seronegative groups. The pathological US findings of any ankle joint showed no differences between the seropositive and seronegative groups. Patients with US findings of tibialis posterior tenosynovitis in the left ankle and synovitis and erosion in the right ankle, particularly in the tibiotalar and talonavicular joints, had significantly high Disease Activity Score 28-Erythrocyte sedimentation rate-scores. The increased disease activity was accompanied by significant erosions on both ankles. Conclusion: In terms of disease activity, there is no clinically significant difference between seropositive and seronegative RA patients. Sonographic ankle joint abnormalities do not appear to be associated with the patients’ RF status. High RA disease activity, on the other hand, is associated with synovitis and erosions, particularly in the talonavicular and tibiotalar joints, as well as tibialis posterior tenosynovitis.

Evaluation of the Psychometric Properties of the Musculoskeletal Health Questionnaire (MSK-HQ) in a Population of Professional Basketball Players: A Cross-Sectional Study.

Background and Objective: Musculoskeletal disorders affect a large portion of the population worldwide. The musculoskeletal health questionnaire is a helpful tool for assessing the health state of patients with these disorders. The primary goal of this study is to evaluate the psychometric properties of the MSK_HQ-IT in a population of professional basketball players. The secondary aim is to assess the prevalence of musculoskeletal disorders. Material and Methods: The study was performed from September to October 2022. The questionnaire was completed using an online or paper form, to which personal data were collected. Data were collected by submitting a translated version of the musculoskeletal health questionnaire directly to professional athletes. Results: A total of 63 basketball players were recruited. Regarding functional limitations, the body parts mentioned by the sample were the left ankle (23.8%) and the right ankle (17.5%), followed by the lumbar column and right hip (15.9%). Regarding pain, the data are more homogeneous, with a distribution in line with functional limitations. A peak of pain was perceived in the left foot, with a mean score of 4. Cronbach's alpha showed a value of 0.85. Conclusions: The musculoskeletal health questionnaire shows promising results in evaluating the health state of a population of professional athletes. Further studies are needed to enlarge the sample and possibly open it to more categories of professional sports.