Peroneus Longus Research Articles

Comparison of effects of Mulligan taping and Kinesio taping on ankle neuromuscular control in response to a sudden inversion perturbation in individuals with chronic ankle instability

ObjectivesThis study was aimed to compare the effects of Mulligan taping (MT) with Kinesio taping (KT) and the un-taped ankle on neuromuscular control during a sudden inversion perturbation in individuals with chronic ankle instability (CAI). DesignRandomized, single blind cross-over. SettingBiomechanics lab. Participants16 individuals with chronic ankle instability. Main outcome measuresThe outcome measures were the onset time and magnitude of short (SLR) and medium latency response (MLR) for peroneus brevis (PB), peroneus longus (PL), tibialis anterior (TA), and soleus (SOL) muscles and the TA/P and SOL/TA antagonist co-activation. ResultsIn the groups of KT and MT, the onset time was significantly decreased at post-taping compared to pre-taping, such that for the onset time of PB MLR, the groups of KT and MT had an earlier onset time than the un-taped group. For the magnitude of TA SLR and PB MLR, groups exhibited different behaviors. In the KT group, the magnitude was significantly increased post-taping, however, in the MT group, it was decreased. Regarding the TA/P and SOL/TA co-activation, the groups of KT and MT showed significant changes post-taping. ConclusionThis study suggests that KT and MT significantly affect neuromuscular control in response to a sudden perturbation in individuals with CAI, although the behavior of KT and MT appears to be somewhat different from each other.

Letter to the Editor on: P.K. Megremis, O.P. Megremis, Peroneus longus tendon transfer; prospective study of treatment outcome of recurrent fixed clubfoot deformities in children after failed surgical treatment [Fuß & Sprunggelenk 20 (2022) 250–259

Letter to the Editor on: P.K. Megremis, O.P. Megremis, Peroneus longus tendon transfer; prospective study of treatment outcome of recurrent fixed clubfoot deformities in children after failed surgical treatment [Fuß & Sprunggelenk 20 (2022) 250–259

Evaluation of ankle joint protection effect of parachute ankle brace on paratrooper landing

Objective: To study the protective effect of parachute ankle brace on ankle joint during simulated parachuting landing. Methods: In August 2021, 30 male paratroopers were selected as the test subjects by simple random sampling method. They jumped from the 1.5 m and 2.0 m height platforms respectively with and without parachute ankle brace, and landed on the sandy ground in a semi-squat parachute landing position. The experiment was divided into 1.5 m experimental group and control group and 2.0 m experimental group and control group. Angle sensor and surface electromyograph were used to measure and analyze the coronal tilt range of the ankle joint and the percentage of maximal voluntary contraction (MVE%) of the muscles around the ankle joint, respectively, to evaluate the protective effect of the parachute ankle brace. Results: At the same height, the tilt range of coronal plane of ankle in experimental group was significantly reduced compared with control group, and the difference was statistically significant (P<0.05). Under the same protection state, the tilt range of the coronal plane of the ankle in the 1.5 m group was significantly reduced compared with that in the 2.0 m group, and the difference was statistically significant (P<0.05). The coronal plane inclination range of the ankle in 2 m experimental group was significantly lower than that in 1.5 m control group, and the difference was statistically significant (P<0.05). Compared with 1.5 m control group, MVE% of right tibialis anterior muscle and bilateral lateral gastrocnemius decreased in 1.5 m experimental group, while MVE% of bilateral peroneus longus increased, with statistical significance (P<0.05). Compared with 2.0 m control group, the MVE% of bilateral tibialis anterior muscle and right lateral gastrocnemius decreased in 2.0 m experimental group, while the MVE% of bilateral peroneus longus increased, with statistical significance (P<0.05). The MVE% of bilateral tibialis anterior muscle, bilateral lateral gastrocnemius muscle and right peroneus longus muscle in 1.5 m experimental group decreased compared with 2.0 m experimental group, and the differences were statistically significant (P<0.05). Compared with 2.0 m control group, the MVE% of bilateral tibialis anterior muscle, right lateral gastrocnemius muscle and right peroneus longus muscle in 1.5 m control group decreased, and the differences were statistically significant (P<0.05) . Conclusion: Wearing parachute ankle brace can effectively limit the coronal plane inclination range of ankle joint, improve the stability of ankle joint and reduce the load on the muscles around ankle joint by landing. Reducing the height of the jumping platform can reduce the coronal plane incline range of the ankle and the muscle load around the ankle during landing.

Difference in the recruitment of intrinsic foot muscles in the elderly under static and dynamic postural conditions.

The effect of foot, especially intrinsic muscles, on postural control and its related mechanisms remain unclear due to the complex structure. Therefore, this study aims to investigate the activation of intrinsic foot muscles in the elderly under static and dynamic postural tasks. Twenty-one elderly participants were included to perform different postural tests (sensory organization test (SOT), motor control test (MCT), limit of stability test (LOS), and unilateral stance test) by a NeuroCom Balance Manager System. The participants were instructed to maintain postural stability under conditions with combined different sensory inputs (vision, vestibular, and proprioception) in SOT as well as conditions with translation disturbance in MCT, and to perform an active weight-shifting tasks in LOS. During these tasks, muscle activation were simultaneously acquired from intrinsic foot muscles (abductor halluces (AbH) and flexor digitorum brevis (FDB)) and ankle muscles (anterior tibialis, medial head of gastrocnemius, lateral head of gastrocnemius, and peroneus longus). The root-mean-square amplitude of these muscles in postural tasks was calculated and normalized with the EMG activity in unilateral stance task. The activation of intrinsic foot muscles significantly differed among different SOT tasks (p<0.001). Post-hoc tests showed that compared with that under normal condition 1 without sensory interference, EMGs increased significantly under sensory disturbance (conditions 2-6). By contrast, compared with that under the single-sensory disturbed conditions (conditions 2-4; 2 for disturbed vision, 3 for disturbed vestibular sensation, 4 for disturbed proprioception), activation was significantly greater under the dual-sensory disturbed postural tasks (conditions 5 and 6; 5 for disturbed vision and proprioception, 6 for disturbed vestibular sensation and proprioception). In MCT, EMGs of foot muscles increased significantly under different translation speeds (p<0.001). In LOS, moderate and significant correlations were found between muscle activations and postural stability parameters (AbH, r = 0. 355-0.636, p<0.05; FDB, r = 0.336-0.622, p<0.05). Intrinsic foot muscles play a complementary role to regulate postural stability when disturbances occur. In addition, the recruitment magnitude of intrinsic foot muscles is positively correlated with the limit of stability, indicating their contribution to increasing the limits of stability in the elderly.

Complications of peroneus longus tendon harvesting: a retrospective review of 82 cases.

Peroneus longus tendon (PLT) has become a reliable autologous graft option for various ligament reconstructions. But there are potential risks and complications associated with its use as a graft. This retrospective study aimed to examine the complications and donor site morbidity following PLT harvesting. A retrospective review was performed on an institutional digital patient database, and all patients who underwent ligament reconstruction using PLT autograft were identified. Intraoperative, early, and late complications were reviewed using digital patient notes and patients underwent a complete physical examination during their final follow-up. Ankle function was assessed using the AOFAS score, and manual ankle muscle testing was performed on both sides. Sural nerve iatrogenic injury was evaluated with a dermatomal light touch examination. Cosmetic satisfaction due to incision scar and footwear complaints were also assessed. 82 patients (74 male, eight female) with a mean age of 31.9 ± 10.4years (range, 16-66) were included in the final analysis. The mean follow-up time was 46.6 ± 30.3months (range, 6-109). The mean AOFAS score for the donor side was 98.7 ± 3.3 (range, 87-100), and the contralateral side score was 100, with manual muscle testing graded as 5 in all movements and similar to the contralateral side. Fifteen patients (18.3%) had hypoesthesia over the dorsolateral aspect of the foot distal to the incision scar, two patients (2.4%) had hyperalgesia over the distal incision scar, and one patient (1.2%) had mild ankle instability. There were two cases (2.4%) of compartment syndrome, both of which were treated with fasciotomy and had complete regression of symptoms after 5 days. One patient (1.2%) had a transient peroneal nerve injury and foot drop that resolved in the sixth month. The results of this retrospective study suggest that harvesting the PLT is associated with a high rate of complications and donor site morbidity. The most common complication was hypoesthesia around the lateral side of the foot, although the ankle functions were not affected significantly. Two cases of compartment syndrome and one transient peroneal nerve injury were observed. Care should be taken while harvesting PLT autograft, and it should be kept in mind that peroneal nerve injury might occur. Level IV, retrospective case series.

The use of nonnormalized surface EMG and feature inputs for LSTM-based powered ankle prosthesis control algorithm development.

Advancements in instrumentation support improved powered ankle prostheses hardware development. However, control algorithms have limitations regarding number and type of sensors utilized and achieving autonomous adaptation, which is key to a natural ambulation. Surface electromyogram (sEMG) sensors are promising. With a minimized number of sEMG inputs an economic control algorithm can be developed, whereas limiting the use of lower leg muscles will provide a practical algorithm for both ankle disarticulation and transtibial amputation. To determine appropriate sensor combinations, a systematic assessment of the predictive success of variations of multiple sEMG inputs in estimating ankle position and moment has to conducted. More importantly, tackling the use of nonnormalized sEMG data in such algorithm development to overcome processing complexities in real-time is essential, but lacking. We used healthy population level walking data to (1) develop sagittal ankle position and moment predicting algorithms using nonnormalized sEMG, and (2) rank all muscle combinations based on success to determine economic and practical algorithms. Eight lower extremity muscles were studied as sEMG inputs to a long-short-term memory (LSTM) neural network architecture: tibialis anterior (TA), soleus (SO), medial gastrocnemius (MG), peroneus longus (PL), rectus femoris (RF), vastus medialis (VM), biceps femoris (BF) and gluteus maximus (GMax). Five features extracted from nonnormalized sEMG amplitudes were used: integrated EMG (IEMG), mean absolute value (MAV), Willison amplitude (WAMP), root mean square (RMS) and waveform length (WL). Muscle and feature combination variations were ranked using Pearson's correlation coefficient (r > 0.90 indicates successful correlations), the root-mean-square error and one-dimensional statistical parametric mapping between the original data and LSTM response. The results showed that IEMG+WL yields the best feature combination performance. The best performing variation was MG + RF + VM (rposition = 0.9099 and rmoment = 0.9707) whereas, PL (rposition = 0.9001, rmoment = 0.9703) and GMax+VM (rposition = 0.9010, rmoment = 0.9718) were distinguished as the economic and practical variations, respectively. The study established for the first time the use of nonnormalized sEMG in control algorithm development for level walking.

The Agonist-Antagonist Myoneural Interface in a Transtibial Amputation.

The agonist-antagonist myoneural interface (AMI) technique at the time of transtibial amputation involves the use of agonist-antagonist muscle pairs to restore natural contraction-stretch relationships and to improve proprioceptive feedback when utilizing a prosthetic limb1. Utilizing the standard incision for a long posterior myofasciocutaneous flap, the lateral and medial aspects of the limb are dissected, identifying and preserving the superficial peroneal and saphenous nerve, respectively. The tendons of the tibialis anterior and peroneus longus are transected distally to allow adequate length for the AMI constructs. After ligation of the anterior tibial vessels, the deep peroneal nerve is identified and tagged to create a regenerative peripheral nerve interface (RPNI). The tibia and fibula are cut approximately 15 cm from the medial joint line, facilitating dissection of the deep posterior compartment and ligation of the peroneal and posterior tibial vessels. The tendons of the lateral gastrocnemius and tibialis posterior are transected distally, and the amputation is completed. The extensor retinaculum is harvested from the residual limb along with multiple 2 × 3-cm free muscle grafts, which will be used for the RPNI constructs. The retinaculum is secured to the tibia with suture anchors, and AMI pairs of the lateral gastrocnemius and tibialis anterior as well as the tibialis posterior and peroneus longus are constructed. Separate RPNIs of the major lower-extremity nerves are performed, and the wound is closed in a standard layered fashion. An isometric myodesis of the gastrocnemius without coaptation of agonist-antagonist muscle pairs can be performed at the time of transtibial amputation. The AMI technique restores natural agonist-antagonist relationships at the time of transtibial amputation to increase proprioceptive feedback and improve prosthetic control. These outcomes contrast with those of a traditional isometric myodesis, which prevents proprioceptive communication from the residual limb musculature to the central nervous system. Additionally, the AMI technique allows for concentric and eccentric muscular contractions, which may contribute to the maintenance of limb volume and aid with prosthetic fitting, as opposed to the typical limb atrophy observed following standard transtibial amputation1,2. With the development and availability of more advanced prostheses, the AMI technique offers more precise control and increases the functionality of these innovative devices. Early clinical outcomes of the AMI technique at the time of transtibial amputation have been promising. In a case series of the first 3 patients who underwent the procedure, complications were minor and consisted of 2 episodes of cellulitis and 1 case of delayed wound healing1. Muscle activation measured through electromyography demonstrated an improved ability to limit unintended muscular co-contraction with attempted movement of the phantom limb, as compared with patients who underwent a standard transtibial amputation1. Additionally, residual limb volume was maintained postoperatively without the need for substantial prosthetic modifications. The tendons of the tibialis anterior, peroneus longus, tibialis posterior, and lateral gastrocnemius should be transected as distal as possible to allow adequate length for creation of the AMI constructs.Approximately 2 × 3-cm free muscle grafts are harvested from the amputated extremity for RPNI3.Smooth tendon-gliding through the synovial tunnels should be confirmed before closure. If necessary, muscle debulking can improve gliding and decrease the size of the residual limb.Harvesting the extensor retinaculum for synovial tunnels has been our preferred method, although we acknowledge that other grafts options such as the tarsal tunnel are available1. RPNI = regenerative peripheral nerve interfaceAMI = agonist-antagonist myoneural interfaceEMG = electromyographic.

The Effect of Eight Weeks of Kyokushin Karate Training on leg Muscle Activity and Medial Longitudinal arch Height of Adolescent Girls With Foot Pronation

Purpose: The purpose of this study was to investigate the effects of specialized Kyokushin karate exercises on the activity of leg muscles and the height of the medial longitudinal arch in adolescent girls with foot pronation. Methods: This study recruited twenty-four adolescent girls with foot pronation who voluntarily agreed to participate and were randomly assigned to either a training group (n=12) or control group (n=12). The training program consisted of eight weeks of specialized Kyokushin karate exercises. The fibularis longus, tibialis anterior, and lateral gastrocnemius muscles activity was measured during single-leg landing using surface electromyography. The medial longitudinal arch height was measured using the navicular drop test. All statistical analyses, including independent and paired t-tests, were conducted using SPSS software, version 26 at a significance level of 0.05. Results: The results showed that following eight weeks of specialized Kyokushin karate exercises, there was a significant increase in the activity levels of the tibialis anterior (P=0.005) and lateral gastrocnemius (P=0.04) muscles in the training group compared to the control group. However, there was no significant change in the activity of the fibularis longus muscle in the training group compared to the control group (P&gt;0.05). Within the training group, there was a significant increase in the activity of all three measured muscles (fibularis longus, P=0.009; tibialis anterior, P=0.008; and lateral gastrocnemius, P=0.008) from post-test to pre-test (P&lt;0.05). Additionally, the study found that the amount of navicular drop in the training group was significantly reduced compared to the control group (P=0.04) after eight weeks of training Conclusion: This study demonstrated that eight weeks of specialized Kyokushin karate exercises resulted in a significant increase in the activity levels of the tibialis anterior and lateral gastrocnemius muscles in adolescent girls with foot pronation. These exercises also improved the height of the medial longitudinal arch, indicating a potential solution for correcting flat feet. Therefore, we recommend Kyokushin karate exercises to improve muscle activity and arch height in adolescent girls with foot pronation.

Effect of Taping on Feedforward Activity of the Non-dominant Leg Muscles in Elite Volleyball Players With Chronic Ankle Instability During A Single-leg Jump-landing Task

Background and Aims Although volleyball is a contact sport, there are a high number of injuries in volleyball during training or competitions. Since many jumps are performed during training, it is not surprising that a high number of injuries are caused by jumping and landing. The present study aims to investigate the effect of taping on the feedforward activity of non-dominant leg muscles during single-leg jump-landing in professional volleyball players with chronic ankle instability. Methods In this study, participants were 13 volleyball players with chronic ankle instability who were selected by a purposive sampling method. Electromyographic activity of peroneus longus, anterior tibialis, gastrocnemius, vastus lateralis, gluteus medius, and rectus femoris muscles of the non-dominant leg during a single-leg jump-landing task following a spike shot before and after taping was evaluated. Root mean square was used to calculate muscle activity before and after taping. The data were analyzed using paired t-test. The significance level was set at 0.05. Results The findings showed the significant effect of taping only on maximum feedforward activity (P=0.02) and average feedforward activity (P=0.03) of the peroneus longus muscle. The effect was not statistically significant for other muscles (P&gt;0.05). Conclusion It seems that taping is not useful for improving the feedforward activity of muscles in volleyball players with chronic ankle instability during single-leg jump-landing. Hence, other exercises or methods are recommended for these players during recovery or training.

Republication of "Peroneus Brevis Tenodesis: Side-to-Side or Weave?"

Inversion ankle injuries are extremely common, sometimes causing injury to the peroneus brevis tendon. If more than 50% of the tendon is injured, it oftentimes requires tenodesis to the adjacent peroneus longus tendon. Both Pulvertaft (PT) and side-to-side (SS) techniques have been used for joining the 2 tendons. The purpose of this study was to compare the strength and stiffness of these 2 techniques. Five matched pairs of cadaver ankle specimens were randomized to receive either an SS or PT tenodesis of the peroneus brevis to longus tendons. Following the tenodesis, the specimens were tested for failure load, displacement, energy absorbed at failure, and peak load. Stiffness was also calculated. Paired t tests were performed to detect differences between the 2 conditions. There were no statistically significant differences between the SS and PT tenodesis for any of the metrics measured. For stiffness, the techniques were very similar (SS = 10.14 [4.35], PT = 12.85 [1.72]). There is no difference in failure load, displacement, energy absorbed at failure, peak load or stiffness between the PT and SS techniques for peroneal tenodesis. Level V, cadaver study.

Comparative study of the functional outcome of semitendinosus graft versus peroneus longus graft in arthroscopic reconstruction surgeries of anterior cruciate ligament

Background: ACL disruption is the commonest ligamentous knee injury among active adults, invariably leading to changes in knee kinematics which are most likely to result in secondary degenerative changes and long-term functional impairment. Thus, due to the ACL's crucial role as the primary restraint against anterior tibial translation, its reconstruction using varying graft options are being extensively studied for better functional outcome. Methods: In this prospective study, we analysed 30 patients having ACL tear (clinically and radiographically) and treated with arthroscopic reconstruction of ACL. Among these, 15 cases were operated using semitendinosus graft and 15 cases by using peroneus longus tendon graft. The study was conducted in a tertiary care hospital from January 2021 to June 2022 with minimum follow up of 6 months and maximum follow up of 15 months. Results: Mean Lysholm score (post op) in Group ST was 90.6±3.18 and in Group PLT was 92.2±2.65. The Lysholm Score and IKDC grading between the two groups was comparable and showed no significant difference. Post-Op laxity assessed using the Lachman’s grading showed normal findings in 70% patients, and of the remaining 30% (9 patients), 5 patients from ST group and 4 patients from PLT group showed 1+ laxity at follow up examination. Conclusions: Arthroscopy assisted ACL reconstruction with peroneus longus tendon autograft provides a steady knee, reduces postoperative donor site morbidity and enables early rehabilitation, similar to the traditional semitendinosus tendon autograft.

Anatomical and Biomechanical Characteristics of Peroneus Longus Tendon: Applications in Knee Cruciate Ligament Reconstruction Surgery.

The peroneus longus tendon is used in many orthopedic surgeries to regenerate the external ligaments of the knee. This study aims to evaluate some anatomical, biomechanical, and load-bearing properties of the peroneus longus tendon for use in cruciate ligament reconstruction. The study design is a cross-sectional description. The study subjects were 20 samples of the peroneus longus tendon from fresh carcasses. The leg is still intact, not crushed, is well preserved, and it has never been used in research. The average length of the peroneus longus tendon was 29.25 ± 2.1 cm, and the average distance from the peroneus longus tendon to the deep peroneal nerve was 71.1 ± 8.63 mm. The peroneus longus tendon did not have an accessory ligament, the maximum tension of the peroneus longus tendon was 1170.4 ± 203 N, and the maximum length at break was 14.29 ± 3.88 mm. Removing the peroneus longus tendon will not affect the surrounding anatomical components. The maximum breaking force and the diameter of the peroneus longus tendon are similar to other graft materials, such as the hamstring tendon and patellar tendon.

Unexpected inversion perturbation during a single-leg landing in patients with chronic ankle instability

ABSTRACT It remains unclear how unexpected perturbations during single-leg landings affect lower extremity kinematics and muscle activations in patients with chronic ankle instability (CAI). The purpose of this study was to identify the differences in lower extremity movement patterns among CAI subjects, copers, and healthy controls. Sixty-six people including 22 CAI subjects, 22 copers, and 22 healthy controls volunteered to participate in the study. Lower extremity joint kinematics and EMG activations from 200-ms pre to 200-ms post the initial contact during unexpected tilted landings were measured. Functional data analysis was used to evaluate between-group differences for outcome measures. Relative to copers and healthy controls, CAI subjects showed more inversion from 40-ms to 200-ms after initial contact. Relative to healthy controls, CAI subjects and copers showed more dorsiflexion. Relative to healthy controls, CAI subjects and copers showed more muscle activation in tibialis anterior and peroneus longus, respectively. In conclusion, CAI subjects demonstrated greater inversion angles and muscle activation before initial contact compared to LAS copers and healthy controls. This suggests that CAI subjects and copers prepare for their landing with protective movements, but the prepared movements shown by CAI subjects may be insufficient to reduce risk of recurrent injury.

Acute Effects of Selective Strength Exercise on the Peroneus Longus and Brevis

The peroneus muscles are muscles that mainly act in ankle eversion and can be divided into PL and PB, which have different but important roles in foot and ankle functions. Therefore, PL and PB dysfunction can lead to foot and ankle issues, making. selective strength exercise necessary. This study aimed to identify the effect of two different exercise techniques on PL and PB morphologies. Two interventions were performed on separate days: the PL intervention, in which a Thera-Band® was placed on the ball of the foot and pushed out from the contact point, and the PB intervention, in which the Thera-Band® was pulled from the base of the fifth metatarsal. Cross-sectional area (CSA) and thickness of the peroneus muscles at 25% (showing the PL morphology) and 75% (showing the PB morphology) proximal to the line connecting the fibular head and lateral malleolus, as well as ankle strength was measured before and immediately after the interventions and at 10, 20, and 30 min later. A repeated-measures two-way analysis of variance was conducted to identify differences in the effects of the interventions on the PL and PB. Main and interaction effects on CSA, thickness, and ankle strength, with a significant increase in CSA and thickness in the proximal 25% in the PL intervention and the distal 75% in the PB intervention immediately after implementation, were observed (p &lt; 0.05). The transient increase in muscle volume due to edema immediately after exercise indicates the acute effect of exercise. The CSA and thickness of the proximal 25% in the PL intervention and the distal 75% in the PB intervention increased immediately after the intervention, indicating that these interventions can be used to selectively exercise the PL and PB.

Peroneal muscle response to single-leg drop-jump and unexpected leg-drop in young and middle-aged adults before and after one session of neuromuscular training

BackgroundChanges in neuromuscular ability in middle age (MA) may lead to deterioration of postural control. The aim of this study was to investigate the anticipatory response of the peroneus longus muscle (PL) to landing after a single-leg drop-jump (SLDJ), and its postural response after an unexpected leg-drop in MA and young adults. A second aim was to investigate the influence of neuromuscular training on PL postural responses in both age groups.MethodsTwenty-six healthy MA (55.3 ± 4 years) and 26 healthy young adults (26.3 ± 3.6 years) participated in the study. Assessments were performed before (T0) and after (T1) PL EMG biofeedback (BF) neuromuscular training. Subjects performed SLDJ, and PL EMG activity in preparation for landing (% of flight time) was calculated. To measure PL time to activation onset and time to peak activation in response to an unexpected leg-drop, subjects stood on a customized trapdoor device that produced a sudden 30° ankle inversion.ResultsBefore training, the MA group showed significantly shorter PL activity in preparation for landing compared to the young adults (25.0% vs. 30.0%, p = 0.016), while after training there was no difference between the groups (28.0% vs. 29.0%, p = 0.387). There were no differences between groups in peroneal activity after the unexpected leg-drop before and after training.ConclusionsOur results suggest that automatic anticipatory peroneal postural responses are decreased at MA, whereas reflexive postural responses appear to be intact in this age group. A short PL EMG-BF neuromuscular training may have an immediate positive effect on PL muscle activity at MA. This should encourage the development of specific interventions to ensure better postural control in this group.Trial registrationClinicalTrials.gov NCT05006547.

Comparison of Peroneus Longus Tendon Autograft and Hamstring Tendon Autograft for Anterior Cruciate Ligament Reconstruction: A Systematic Review

Purpose: The aim of this study is to compare the outcomes between peroneus longus tendon autograft versus hamstring tendon autograft for anterior cruciate ligament reconstruction such as International Knee Documentation Committee (IKDC), Lysholm score, Modified cincinnati score, Tegner activity scale, and donor site morbidity. Methods: This systematic review uses Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Multiple databases were searched for studies that compared functional outcomes of ACL reconstruction with peroneus longus tendon autograft versus hamstring tendon autografts with a minimum 1 year follow-up. Result: We analyzed 5 studies that included direct comparison of the peroneus longus tendon (106 patients) versus the hamstring tendon (137 patients). There was no significant difference comparison of the outcome such as Modified Cincinnati, Tegner scale activity, and Lysholm score. On IKDC score, 1 study reported there was a significant difference between peroneus longus tendon autograft 87.4 (67.8- 100) versus hamstring tendon autograft 78.2 (35.6-95.6) with p=0. Two studies reported donor site morbidity mostly occurred in hamstring tendon autograft (11.4 ± 3.6) were higher than peroneus longus tendon (2.5 ± 0.5) (P=0.002). The knee flexion of donor site morbidity in the peroneus longus tendon group (41.97 ± 1.98) is higher than the hamstring tendon group (40.65 ± 1.74) (P=0.02). Conclusion: This study concluded there was no significant difference of comparison between the peroneus longus group and the hamstring group after ACL reconstruction but the IKDC score after a reconstruction could be affected by gender and graft size. Donor site morbidity most occurred in hamstring group than peroneus longus group after ACL reconstruction

WORK OF MUSCLES RESPONSIBLE FOR THE FUNCTIONING OF THE FOOT IN CONDITIONS OF KNEE JOINT CONTRACTURE

Prolonged walking with knee joint contracture causes changes in the functioning of the muscles of the lower leg and foot. Objective. To study the functioning of the foot and leg muscles in the conditions of knee joint contracture using a human walking model. Methods. The gait analysis was performed in the OpenSim 4.0 program. The modeling was based on the gait2394 model. The following muscles were studied: m. peroneus brevis, m. peroneus longus, m. peroneus tertius, m. tibialis posterior, m. tibialis anterium, m. flexor digitorum longus, m. flexor hallucis longus, m. extensor digitorum longus, m. extensor hallucis longus. Results. Restriction of joint mobility leads to a redistribution of muscle strength. In conditions of 15° knee joint flexion contracture, support on the toes causes significant overstrain of the muscles responsible for the functioning of the lower leg, foot and toes. In particular, the m. peroneus brevis and m. peroneus longus are quite long, their function is impaired, but the required increase in strength is from 10 to 400 %, while the m. peroneus tertius (short), for foot flexion in some phases of the step, its strength increased threefold. Among the muscles of the lower leg, the greatest increase in isometric strength was required for the m. tibialis anterior compared to the m. tibialis posterior, which works mainly for foot extension. For the muscles responsible for flexion/extension of the toes in conditions of knee joint contracture, a significant, sometimes 3–5 times, increase in strength was necessary to perform the required function. Conclusions. Knee joint contracture leads to a change in the biomechanics of the entire lower extremity, namely, to an increase in changes in the functioning of the muscles responsible for the functioning of the foot, which work under such conditions with a constant increase in tension. Given the impact of knee joint contracture on the functioning of the muscles of the lower extremity, it is possible to predict the course of thepathological process, determine which muscle groups are most affected and which muscle group needs to be corrected before and after surgery.

Optimal fibular tunnel direction for anterior talofibular ligament reconstruction: 45 degrees outperforms 30 and 60 degrees.

There is currently no consensus on the optimal drilling direction of the fibular bone tunnel for anterior talofibular ligament (ATFL) reconstruction, and few studies have investigated the potential injury to the peroneus longus and brevis tendons and the possibility of fibular fractures during the drilling process. The aim of this study was to assess the potential risk of drilling the tunnel from different directions and determine the most appropriate tunnel direction. The hypothesis was that drilling the tunnel in the 45-degree direction would be the safest and most suitable for the fibular tunnel. Forty-eight fibular tunnels were drilled on fresh ankle specimens using a K-wire guide and a 5.0mm hollow drill. Three tunnel orientations were created, parallel to the sagittal plane of the long axis of the fibula and angled 30°, 45°, and 60° to the coronal plane. The length of the fibular tunnel and the distances from the outlet of the K-wire to the peroneus longus and brevis tendons were measured. The occurrence of a fibula fracture was also observed. The lengths of the bone tunnels in the three groups were 32.9 ± 6.1mm (30°), 27.2 ± 4.4mm (45°) and 23.6 ± 4.0mm (60°). The length of the tunnel drilled at 30° was the longest when compared with that of the tunnels drilled at 45° and 60° (all p values < 0.05). The distances from the outlet of the K-wire to the peroneus longus tendon were 3.0 ± 3.8mm (30°), 3.8 ± 3.2mm (45°) and 5.3 ± 1.8mm (60°), and the distances to the peroneus brevis tendon were 4.2 ± 4.0mm (30°), 6.1 ± 3.8mm (45°), 7.9 ± 3.5mm (60°). In terms of protecting the peroneus longus and brevis tendons, drilling in the 60° direction was better than drilling in the 30° and 45° directions (all p values < 0.05). The risk of injury to the peroneal longus and brevis tendons was 62.5% (30°), 31.3% (45°), and 0% (60°). Although no fibular fractures were observed in any of the three directions, drilling the bone tunnel in the 60° direction disrupted the lateral cortex of the fibula. This study shows that drilling the tunnel in the 45° direction is less likely to cause injury to the peroneus longus and brevis tendons, while ensuring that the tunnel has a sufficient length and avoiding fracturing the distal fibula. Drilling a fibular bone tunnel in a 45° direction is safer and recommended for ATFL reconstruction.

Demographic Status of Patients with ACL Injury in Tertiary Hospital Bangladesh

Background: One of the strong bands of tissue that help connect your thigh bone (femur) to your shinbone (tibia) can be torn or sprained, and this is known as an anterior cruciate ligament (ACL) injury (tibia). Objective: To assess the demographic status of patients with ACL injury in tertiary hospital Bangladesh. Methods: This prospective observational study was carried out at National Institute of Traumatology and Orthoapedic Rehabilitation, Dhaka from January 2019 to December 2020. A total case of 30 in group 1 (Hamstring tendon) and 30 in group 2 (Peroneus longus tendon) is included in the study according to inclusion and exclusion criteria. Results: Mean age was 25.45 ± 0.93 years with male pre-dominance (96.67%). In both groups male patients were mostly common, group-1, 93.33% and group-2, 100%. Right knees were affected more (58%) in comparison to left knees (42%). The cause of injury which was mostly sports-related injuries (78.33%) and the injury was more common among students (43.33%). Conclusion: From our study we can say that, young age people and male patients were mostly affected. In addition to that, right knee was mostly injured and sports-related injuries were common among students.

Differences in Center of Pressure Displacement and Lower Limb Muscle Activity During Relevé Descending Phase Comparing Flat Shoes and Pointe Shoes.

In classical ballet, dancers may wear flat shoes and pointe shoes. To consider the kinematic changes between flat shoes and pointe shoes to prevent injuries, it is essential to focus on the fundamental ballet movement of standing on pointe. This study aimed to clarify the differences in the center of pressure (COP) displacement and lower limb muscle activity during the descending phase of a relevé when wearing pointe shoes versus flat shoes. Ten amateur ballet dancers volunteered for this study and performed a reléve wearing flat shoes and pointe shoes. We measured the COP displacement by using a footplate and electromyographies of the tibialis anterior, soleus, lateral gastrocnemius, and peroneus longus muscles during the relevé descending phase. These data were compared using a paired t-test or Wilcoxon signed-rank sum test. The COP significantly shifted to the lateral side when dancers were wearing pointe shoes compared to wearing flat shoes (p<0.05). The muscle activity of the tibialis anterior and soleus muscles was significantly higher by 5.7% and 5.3%, respectively, when ballet dancers were wearing pointe shoes compared to flat shoes (p<0.05). However, there were no differences in both lateral gastrocnemius and peroneus longus. Greater muscle activities in the tibialis anterior and soleus muscles when wearing pointe shoes than when wearing flat shoes were associated with a larger lateral displacement of the COP. To control the COP displacement during the descending phase of a relevé, the muscle activity of the peroneus longus, which is antagonist of tibialis anterior muscle, and soleus muscles should be increased.