Ankle Research Articles

Iliac Periosteal Bone Autografting vs Talus Non-Weight-Bearing Surgery in Hepple V Talus Osteochondral Injuries: Comparative Analysis of Perioperative Outcomes.

BACKGROUND Hepple stage V osteochondral injuries of the talus include subchondral cyst formation, secondary degenerative change, and secondary osteoarthritis. This retrospective study aimed to compare perioperative outcomes from iliac periosteal bone autografting and talus non-weight-bearing surgery in 162 patients with Hepple V osteochondral injuries of the talus. MATERIAL AND METHODS According to the inclusion criteria, 162 eligible patients were selected for analysis and divided into an iliac periosteal bone autograft group (n=82) and a talus non-weight-bearing group (n=80) according to the surgical methods. General data and data on perioperative conditions, complications, intraoperative fluoroscopy times, preoperative and postoperative visual analog scale (VAS) for pain, ankle-hindfoot scoring system (AOFAS Ankle-Hindfoot Scale), and plantar flexion and extension range of motion were collected to assess ankle joint function and were compared between groups. RESULTS The comparison of perioperative results between the 2 groups showed that the incision length (P=0.000), operation time (P=0.000), and length of hospital stay (P=0.000) in the iliac periosteal bone autograft group were longer than those in the talus non-weight-bearing group. The intraoperative blood loss in the anterior group was greater than that in non-weight-bearing group (P=0.000). Regarding complications, there were more cases of donor site paresthesia (P=0.014) and postoperative pain aggravation in the iliac periosteal bone autograft group than in the non-weight-bearing group. CONCLUSIONS In patients with Hepple V osteochondral injury of the talus, the incision length, operation time, and length of hospital stay in the talus non-weight-bearing group were shorter, there was less intraoperative blood loss, and there were fewer postoperative complications. In the short term, bone transplantation in the talus non-weight-bearing group was more "minimally invasive" and the postoperative recovery was better than in the iliac periosteal bone allograft group.

Chromone components of Saposhnikovia divaricate attenuate rheumatoid arthritis development by inhibiting the inflammatory response

Ethnopharmacological relevanceSaposhnikovia divaricata (Turcz.) Schisck., a traditional Chinese medicine (TCM), has historically been utilized in the clinical treatment of RA. It was initially documented in the 'Shennong Ben Cao Jing' as a superior quality, with the text stating: 'The herb is widely renowned for its efficacy in alleviating whole-body discomfort, bone pain, malaise, and promoting long-lasting vitality. Chromones (CHR) were identified as the primary active components in Saposhnikovia divaricata. However, the specific molecular mechanisms by which CHR impacts RA remain incompletely understood. Aim of the studyTo explore the therapeutic efficacy of CHR, a class of compound derived from Saposhnikovia divaricata, in alleviating arthropathy and immune hyperactivity in a collagen-induced arthritis (CIA) mouse model. Material and methodsSurface plasmon resonance (SPR) molecular fishing and UHPLC-QTOF/MS technology were used to identify CHR in Saposhnikovia divaricata as an active ingredient for treating RA. A CIA mouse model was used to verify the anti-RA effect of CHR in vivo. The anti-RA efficacy of CHR in vivo was evaluated by body weight change, joint swelling, arthritis index, immune organ index, ankle joint disease, and immunoglobulin G (IgG) content. The mechanism of improving RA was further analyzed by a protein chip assay and verified by Western blotting. ResultsCHR treatment reduced swelling, arthritis index, and IgG, IgG1, IgG2a, and IgG2b levels in CIA mice. Protein microarray indicated that CHR mitigated CIA-induced joint inflammation by inhibiting immune cell activation, reducing the expression of inflammatory factors and chemokines, potentially by modulating the rheumatoid arthritis pathway involving tumor necrosis factor-α (TNF-α), interleukin-17 (IL-17), and chemokines. This hypothesis was supported by the upregulation of bone morphogenetic proteins 3 (BMP3) and phospho-Smad2 (p-Smad2) proteins, coupled with the downregulation of interleukin-6 (IL-6), interleukin-1β (IL-1β), TNF-α, and IL-17A proteins in the joints of CHR-treated mice. ConclusionCHR shows promise as a potential therapeutic agent for RA, exerting its effects through anti-inflammatory mechanisms.

Vascularized medial femoral condyle bone graft for the management of an acute talar neck fracture: A case report

Background Management of talar neck fractures can be challenging due to the high rate of non- or malunion, avascular necrosis and post-traumatic arthritis, which has been attributed to the disruption of the bone’s tenuous blood supply during fracture displacement. Osseous medial femoral condyle (MFC) flaps are increasingly being used in the reconstruction of small bony defects due to recalcitrant non-union and avascular necrosis in the upper and lower limbs. We report a rare case of an MFC flap used in the reconstruction of an acute talar neck fracture. Case Presentation A 38-year-old male presented with multiple injuries following a motor vehicle accident, including an open comminuted talar neck and lateral process fracture, with dislocation of the subtalar and talocrural joints (Hawkins III). Initial exploration and debridement demonstrated a significant defect in the dorsal portion of the talar neck. Temporary stabilisation was achieved with Kirschner wires and the defect was packed with bone cement. Two weeks later, a MFC flap was harvested from the ipsilateral knee and tailored to fit the talar defect. Fixation was achieved with cannulated compression screws. At six weeks post-operative, all wounds had healed, a radiograph demonstrated a positive Hawkins sign and computed tomography showed incorporation of the flap. The patient had no donor site morbidity, and commenced weight bearing at 3 months postoperatively. Conclusion This is the first report demonstrating the viability of MFC flap reconstruction for the management of bony defects in acute talar neck fractures.

Ilizarov fixator as salvage procedure after frustrating arthrodesis using intramedullary nailing - is there a chance of consolidation?

Arthrodesis of the tibiotalar and subtalar joints is a salvage procedure that has been used successfully for years. Treatment options include internal procedures and external procedures. Retrograde intramedullary nailing is considered a safe procedure with a high degree of stability and comfort. Nevertheless, there are cases in which this internal arthrodesis fails and another procedure must be considered. Ilizarov fixator treatment could be a solution for those patients in whom intramedullary nailing has failed. Even if it means another surgical revision - is it possible to finally achieve consolidation with this method? In this single-center, retrospective study all documents of patients who underwent tibiotalar and subtalar joints fusion using the Ilizarov external fixator at our institution from 2003 to 2023 as secondary treatment after frustrated first arthrodesis using an intramedullary nail were reviewed. Nineteen patients (17 men and 2 women), with an average age of 55.7 (standard deviation (SD) 8.7, range 34-75) years were included. On average, 1.7 (SD 1.3, range 1-6) arthrodesis attempt were performed before final Ilizarov fixator arthrodesis. The average time spent in the Ilizarov fixator was 19 (SD 4, range 14-29) weeks. In seven cases (36.8%), both the tibiotalar and subtalar joints received bony consolidation in the end. If patients have undergone fusion of the tibiotalar and subtalar joints with a retrograde nail and this fails, it is difficult to achieve complete consolidation in the further course. A further attempt at arthrodesis using an Ilizarov fixator is possible, but the overall results are also poor. This procedure must therefore be seen as a last resort before amputation.

Effects of Parallax and Distortion in Total Ankle Arthroplasty.

Surgeons rely on intraoperative fluoroscopy to assist in placement of implant components during total ankle arthroplasty (TAA). Parallax alters the direction of an object when viewed from two different points, resulting in image distortion. The purpose of this study was to evaluate parallax/distortion in intraoperative fluoroscopic images during TAA. A retrospective review of all TAAs performed by two surgeons (R.W.M. and B.S.) from August 2019 to April 2023 were reviewed. Intraoperative fluoroscopic anteroposterior (AP) ankle views were evaluated for any obvious parallax image distortion. Cases with obvious parallax distortion were included for angular evaluation of AP intraoperative fluoroscopic and first postoperative plain films. The tibia was marked at 2-centimeter intervals to create zones from the proximal stem of the implant. The anatomical axis of the tibia (AAT) was drawn at the mid-diaphysis. The anatomic lateral distal tibial angle (aLDTA) and anatomic axis deviation (AAD) were measured for each zone. A total of 22 TAAs were performed during the study period. Four cases were excluded due to inadequate imaging, leaving a total of 18 TAAs for review. We found 6 of 18 (33.3%) cases had obvious parallax distortion. We found the average aLDTA was 90.9° (84°-101°). At the most proximal tibial zone, the average aLDTA was 94° (91°-101°). We found the average AAD was 4.7 (0.5-17.2) mm. The AAD ranged from 0.5 to 17.2 mm lateral to 0.8 to 8.2 mm medial. Postoperative plain film radiographs displayed a normal aLDTA and an AAT centered within the ankle joint. Parallax can distort the appearance of the tibia on fluoroscopic images. Deviation from the normal aLDTA and anatomical axis should be anticipated. Surgeons should be aware of the potential impact of parallax and ways to mitigate these effects.

Influence of whole-body vibration and drop jump on the range of motion in the ankle joint and running parameters-Arandomized crossover study.

Warm-up (WU) is a commonly practiced technique aimed at preparing athletes for physical activity. Although coaches and athletes consider WU essential, there is still an ongoing debate about its effectiveness. This might be due to the fact that WU procedures often rely on experiences rather than scientific research. During WU, athletes may pursue intermediate goals such as ensuring proper ranges of motion in joints, which seem crucial particularly for runners' ankle joints. Hence, the aim of this study was to evaluate influence of whole-body vibration (WBV), drop jump (DJ), and a combination of both (WBV+DJ) in terms of ankle dorsiflexion and running parameters among recreational runners. Sixteen runners performed as a WU: five sets of 30s calf raises without WBV (CTRL), five sets of 30s calf raises during WBV, five sets of six DJ, five sets of 30s calf raises during WBV followed by 6 DJ. Range of motion (ROM) of the ankle joint was measured in a prone position using an inclinometer for the soleus and gastrocnemius muscles, separately. Measurements were conducted before and after WU, and after a 3000m run. There was no interaction for time and WU for left (p=0.926) and right (p=0.738) soleus muscle as well as for left (p=0.748) and right (p=0.197) gastrocnemius muscles. No difference (p=0.914) for the running time was found. WBV, drop jumps, or a combination of both did not affect ankle dorsiflexion and running time.

Pelvic and Lower Limb Kinematics in Individuals With Chronic Low Back Pain During Sit-to-Stand Function: A Cross-Sectional Study

ObjectivesThe aim of this study was to investigate the 3-dimensional movement kinematics of pelvic and lower limb joints in CLBP subjects, compared to healthy individuals, utilizing a functional data analysis (FDA) approach. MethodsIn this study, a 7-camera Qualisys motion capture system was employed to record the kinematics of the pelvic, hip, knee, and ankle joints in 20 patients with low back pain (LBP) and 20 control subjects on both sides during the sit-to-stand motion. An FDA statistical approach was utilized to compare the data collected over time between the 2 groups. The STS task was divided into two distinct phases: the prelift off phase (pre-Lo) and the postlift off phase (post-Lo). ResultsDuring the “pre-Lo phase” of the STS motion, our statistical analysis revealed that the only significant difference between the two groups was a decreased medial rotation (P = .00) in the hip joint position of LBP patients on their dominant side, in comparison to healthy subjects. As for the “post-Lo phase,” the LBP group exhibited a more anterior pelvic tilt position (P = .00) and increased pelvic counterclockwise rotation (P = .03) in the sagittal and transverse planes when compared to the control group. Regarding hip joints, the LBP group demonstrated a more flexed position (indicative of reduced extension) on both the dominant (P = .00) and nondominant (P = .00) sides, coupled with diminished abduction (P = .04) and internal rotation (P = .03) of the hip on the dominant side. In relation to the knee and ankle joints, the results indicated a more adducted knee position (P = .00) and decreased ankle joint flexion (P = .02) on the dominant side in CLBP subjects when compared to the healthy group during the STS motion. ConclusionOur findings indicate that patients with CLBP exhibited distinct kinematic patterns in the pelvic and lower limb joints during the STS motion. These kinematic alterations primarily manifest in the joints of the dominant limb, with most of the differences observed during the second phase (postlift off phase) of the motion. It appears that these changes in pelvic and lower limb joint kinematics should be taken into account when planning future rehabilitation programs for CLBP patients engaged in this task.

The influence of talus size and shape on in vivo talocrural hopping kinematics.

Talus morphology (shape and size) plays a pivotal role in talocrural joint function. Despite its importance, the relationship between talus morphology, particularly the talar dome, and dynamic, in vivo talocrural function is poorly understood. Understanding these form-function relationships in a healthy cohort is essential for advancing patient-specific treatments aimed at restoring function. Nine participants (five females) hopped on one leg while biplanar videoradiography and ground reaction forces were simultaneously collected. Three-dimensional bone models were created from computed tomography scans. Helical axes of motion were calculated for the talus relative to the tibia (rotation axes), and a cylinder was fitted through the talar dome (morphological axis). Bland-Altman plots and spatial angles were used to examine the level of agreement between the rotation and morphological axes. A shape model of 36 (15 females) participants was established, and a cylinder fit was morphed through the range of ±3 standard deviations. The rotation and morphological axes largely agree regarding their orientation and location during hopping. The morphological axes were consistently oriented more anteriorly during landing than the rotation axes. Some shape components affect talar dome orientation and curvature independent of size. This suggests that besides bone size, the shape of the talar dome might influence the movement pattern during locomotion. Our findings may further inform talocrural joint arthroplasty design.

An open-source framework for the generation of OpenSim models with personalised knee joint geometries for the estimation of articular contact mechanics

Musculoskeletal modelling pipelines typically use generic models scaled to individual’s anthropometry. The ability to represent variations in bone or joint geometry and alignment is highly limited. This may have a large effect, particularly when modelling contact between articular surfaces such as for the knee where articular contact mechanics are used to determine joint kinematics and the resulting cartilage contact pressures and locations. Here we describe a developed open-source framework for the personalisation of such models and compare dynamic simulation outputs. The framework involves three main steps: (1) positions personalised geometries from magnetic resonance imaging and replaces generic bone and contact geometries. (2) Repositions muscle and ligament attachments and via points and optimisation of wrapping surfaces to ensure physiological lengthening behaviour. Finally, (3) muscle and ligament properties are calibrated to ensure physiological behaviour. Following model creation, dynamic simulations from a single participant and gait trial were compared. Small changes in knee adduction/abduction and rotation angles were observed between models. Joint moment differences however were present in not only the knee but also hip and ankle joints. These differences resulted in changes in both the magnitude and location of knee joint contact pressure. The framework developed is automated and requires only minimal user interaction and is built using open-source software packages which can be freely downloaded and installed. The adoption of such personalised modelling approaches facilitates patient specific modelling and may provide more detailed information regarding disease progression, patient stratification and facilitate personalised rehabilitation and treatment planning.

Human foot force informs balance control strategies when standing on a narrow beam.

Despite the abundance of studies on the control of standing balance, insights about the roles of biomechanics and neural control have been limited. Previous work introduced an analysis combining the direction and orientation of foot-ground forces. The "intersection point" of the lines of actions of these forces exhibited a consistent pattern across healthy, young subjects when computed for different frequency components of the center of pressure signal. To investigate the control strategy of quiet stance, we applied this intersection point analysis to experimental data of 15 healthy, young subjects balancing in tandem stance on a narrow beam and on the ground. Data from the sagittal and frontal planes were analyzed separately. The task was modeled as a double-inverted pendulum controlled by an optimal controller with torque-actuated ankle and hip joints and additive white noise. To test our prediction that the controller that minimized overall joint effort would yield the best fit across the tested conditions and planes of analyses, experimental results were compared with simulation outcomes. The controller that minimized overall effort produced the best fit in both balance conditions and planes of analyses. For some conditions, the relative penalty on the hip and ankle joints varied in a way relevant to the balance condition or to the plane of analysis. These results suggest that unimpaired quiet balance in a challenging environment can be best described by a controller that maintains minimal effort through the adjustment of relative ankle and hip joint torques. NEW & NOTEWORTHY This study explored balance control in humans during a challenging task using the novel intersection point analysis, based on foot-ground force direction and point of application. Experimental data of subjects standing on a narrow beam in tandem stance were compared with modeling results of a double-inverted pendulum. The analysis showed that individuals minimized effort by adjusting ankle and hip torques, shedding light on the interplay of biomechanics and neural control in maintaining balance.

Impact of whole-body vibration training on ankle joint proprioception and balance in stroke patients: a prospective cohort study

BackgroundAlthough whole-body vibration (WBV) training is acknowledged for its benefits in enhancing motor functions across several neurological disorders, its precise influence on ankle joint proprioception and balance in stroke patients is still not well understood. This research seeks to assess the impact of WBV training on ankle joint proprioception and balance in stroke patients, thereby filling this important research void.MethodsIn this prospective cohort study, thirty-five stroke patients were randomly assigned to either the WBV group (n = 17) or a control group (n = 18) using a random number table method. The control group received daily general rehabilitation for four weeks, while the WBV group received an additional 30 min of WBV training each day with the Trunsan S110 Vibration Training System. Blinded outcome assessments were conducted at baseline and post-treatment, utilizing the Berg balance scale (BBS), Functional reach test (FRT), Romberg test length (RTL) and area (RTA), and completion rates of ankle joint dorsiflexion-plantar flexion (DP) and inversion-eversion (IE) tests. Follow-up assessments were performed after four weeks of intervention, focusing on RTL, RTA, DP, and IE as primary outcomes.ResultsAnalysis of intra-group changes from baseline to post-treatment revealed significant improvements across the BBS, FRT, RTL, RTA, and DP and IE assessments (p < 0.001). Notably, the WBV group showed significant enhancements compared to the control group in DP and IE (p < 0.001 and p < 0.05, respectively), with mean values increasing from 13.556 to 16.765 (23.7%) and from 5.944 to 8.118 (36.6%), respectively. However, WBV did not provide additional benefits over the control treatment for balance recovery parameters such as BBS, FRT, RTL, and RTA (p > 0.05).ConclusionsThis study demonstrates that WBV therapy is equally effective as conventional methods in enhancing proprioception and balance in stroke patients, but it does not provide additional benefits for balance recovery. WBV significantly improves proprioceptive functions, particularly in DP and IE parameters. However, it does not surpass traditional rehabilitation methods in terms of balance recovery. These findings indicate that WBV should be incorporated into stroke rehabilitation primarily to enhance proprioception rather than to optimize balance recovery.Trial registrationThis study was retrospectively registered in the ISRCTN Registry on 29/07/2024 (https://www.isrctn.com/, ISRCTN64602845).

Utilizing artificial intelligence for the detection of hemarthrosis in hemophilia using point-of-care ultrasonography

BackgroundRecurrent hemarthrosis and resultant hemophilic arthropathy are significant causes of morbidity in persons with hemophilia despite the marked evolution of hemophilia care. Prevention, timely diagnosis, and treatment of bleeding episodes are key. However, a physical examination or a patient’s assessment of musculoskeletal pain may not accurately identify a joint bleed. This difficulty is compounded as hemophilic arthropathy progresses. ObjectivesOur system aims to utilize artificial intelligence and ultrasonography (US; point-of-care and handheld) to enable providers, and ultimately patients, to detect joint bleeds at the bedside and at home. We aimed to develop and assess the reliability of artificial intelligence algorithms in detecting and segmenting synovial recess distension (SRD; an indicator of disease activity) on US images of adult and pediatric knee, elbow, and ankle joints. MethodsA total of 12,145 joint exams, comprising 61,501 US images from 7 international healthcare centers, were collected. The dataset included healthy participants and adult and pediatric persons with hemophilia, with and without SRD. Images were manually labeled by 2 experts and used to train binary convolutional neural network classifiers and segmentation models. Metrics to evaluate performance included accuracy, sensitivity, specificity, and area under the curve. ResultsThe algorithms exhibited high performance across all joints and all cohorts. Specifically, the knee model showed an accuracy of 97%, sensitivity of 96%, specificity of 97%, and an area under the curve of 0.97 in SRD. High Dice coefficients (80%-85%) were achieved in segmentation tasks across all joints. ConclusionThis technology could assist with the early detection and management of hemarthrosis in hemophilia.

Analysis of the interplay between proximal lower limb and foot joint structures as a mechanical predictor of neuropathic ulceration

BackgroundDiabetes-related foot ulcers are a leading cause of morbidity and mortality globally, in which the most significant contributing factor is peripheral neuropathy. The purpose of this research was to evaluate the influence of diabetic peripheral neuropathy and ulceration on lower limb and foot joint kinematics during gait. Research questionAre there any significant alterations lower limb and foot joint kinematics during gait in the presence of active and history of diabetic neuropathic ulceration? MethodsA prospective, cross-sectional study was conducted, recruiting eighty adult participants who were equally divided into four groups, namely, the diabetes (DM), diabetic peripheral neuropathy (DPN), active diabetic neuropathic ulceration (DNU) and history of diabetic neuropathic ulceration (DHNU) groups. Three-dimensional gait analysis was performed, and participants were instructed to walk barefoot over a 10-m walkway at self-selected speed. The acquired pelvic, hip, knee, ankle and foot joint segmental kinematic data was compared between individuals with and without active neuropathic ulceration. ResultsMean scores between the four independent groups was performed using the Kruskal-Wallis test. Participants within the DNU and DHNU groups demonstrated significantly reduced knee flexion, ankle dorsiflexion and first metatarsal dorsiflexion kinematics with resultant increased anterior pelvic tilt, hip flexion and midtarsal kinematics (all values p<0.01) when compared to participants within the DM and DPN groups. SignificanceThrough the integration of a more individualised, biomechanical approach, the findings in this study may provide improved preventative and management strategies of ulceration amongst the diabetic population.

Effect of External Work Magnitude on Mechanical Efficiency of Sledge Jumping.

The mechanical efficiency of human locomotion has been studied extensively. The mechanical efficiency of the whole body occasionally exceeds muscle efficiency during bouncing type gaits. It is thought to occur due to elasticity and stiffness of the tendinomuscular system and neuromuscular functions, especially stretch reflexes. In addition, the lower limb joint kinetics affect mechanical efficiency. We investigated the impact of varying external work on mechanical efficiency and lower limb kinetics during repeated sledge jumping. Fifteen male runners performed sledge jumping for 4minutes at 3 different sledge inclinations. Lower limb kinematics, ground reaction forces, and expired gases were analyzed. Mechanical efficiency did not differ according to sledge inclination. Mechanical efficiency correlated positively with the positive mechanical work of the knee and hip joints and the negative contribution of the hip joints. Conversely, it correlated negatively with both the positive and negative contributions of the ankle joint. This may be attributable to the greater workload in this study versus previous studies. To achieve greater external work, producing more mechanical energy at the proximal joint and transferring it to the distal joint could be an effective strategy for improving mechanical efficiency because of the greater force-generating capability of distal joint muscles.

Joint reaction and simulated muscle forces during squatting and walking in persons with hemophilia

BackgroundPersons with hemophilia experience joint bleeding that can lead to debilitating arthropathy, most commonly seen in ankles, knees, and elbows. Arthropathy can hinder participation in daily and athletic activities. We explored how hemophilic arthropathy impacts movement patterns in walking and bilateral squatting tasks in persons with hemophilia compared to healthy controls. MethodsPersons with hemophilia and healthy controls completed walking and squatting tasks while kinematic and kinetic motion capture data were collected. The Hemophilia Joint Health Score exam was performed to measure hemophiliac arthropathy. OpenSim was used to model muscle and joint reaction forces and calculate moments and angles. Peak values were compared using Cohen's d to estimate effect sizes of hemophilia on movement parameters. FindingsNine persons with hemophilia and eight age-matched controls were analyzed. Temporal-spatial metrics were similar between hemophilia and control groups in both tasks. In walking, persons with hemophilia had higher peak ankle dorsiflexion angles, vertical ground reaction force weight acceptance peaks, and hip extension and flexion moments compared to controls. In squatting, persons with hemophilia had lower knee extension moments, ankle joint reaction force, and knee extensor forces, but had higher hip extension moments. InterpretationTemporal-spatial metric similarity between hemophilia and controls suggests that kinetic and kinematic analyses are needed to identify movement pattern differences. These data identify potential compensatory strategies at the hip that may be used by persons with hemophilia to mitigate impact on the knee and ankle. Future work will confirm these data in a larger sample size and be used to develop physical therapy strategies.

Age and initial position affect movement biomechanics in sit to walk Transitions: Lower limb muscle Activity and joint moments

Facilitating forward movement while maintaining dynamic stability during transitions like sit-to-walk (STW) requires coordination from many muscles. Age-related muscle, sensory, and neural decline can introduce compensatory biomechanics when completing STW, such as adjusting initial foot position or rising with arm support. Many previous STW studies restrict arm movement and prescribe symmetric foot positions, therefore the purpose of this study was to quantify lower limb muscle excitations and joint moments in STW transitions from four initial foot positions [symmetric, posterior offset, wide, narrow] and two arm placements [hands on knees, arms folded] in 15 younger and 15 older adults. Peak knee and ankle joint extension moments, as well as peak electromyography of five bilateral lower-limb muscles were analyzed. In all conditions, older adults had larger knee extension moments, whereas younger adults had larger ankle plantarflexion moments. Older adults generated larger peak excitation from the knee extensor muscles during rising compared to younger adults, consistent with the higher knee extension moments. Older adults had greater peak dorsiflexor and plantarflexor muscle excitation while rising compared to younger adults. Posterior offset and wide foot positions required the largest peak ankle plantarflexion and knee extension moments and plantarflexor muscle excitation. Arm-supported rising decreased peak knee extensor muscle excitation. In addition, there were interaction effects between age and initial foot position/arm placement for multiple quantities, indicating that the effects of foot and arm placement vary with age. These results inform assessments of movement performance and guidelines for rising given individual lower limb capability.

Atypical Presentation of Congenital Insensitivity to Pain With Anhidrosis Leading to Diagnostic Odyssey.

Congenital insensitivity to pain with anhidrosis (CIPA) (OMIM 256800) is a rare autosomal-recessive condition, also known as hereditary sensory and autonomic neuropathy type IV (HSAN-IV). The most commonly reported features include anhidrosis, intellectual disability, self-mutilation, febrile episodes, impaired temperature perception, recurrent infections and/or autonomic nervous system impairment. Major joint destruction and joint deformity known as Charcot (neuropathic) joints are also seen in CIPA patients attributed to insensitivity to joint pain. We present a case of a 46-year-old female affected with CIPA with a known NTRK1 variant and previously unidentified variant. Minigene reporter constructs were generated encompassing the exon 8 to exon 13 of the NTRK1 gene using the reference sequence and one harboring c.1483 + 5G > A variant identified in our proband. Minigene constructs were transfected into HEK293T cells, and the transcript was analysed for splicing to evaluate the effect of this variant in splicing. The patient (46-year-old female) exhibited right ankle joint deformity around 5 years of age. Patient also experienced lumbar compression and knee damage in adulthood. She had undergone a significant number of evaluations without clear diagnosis. Her presentation lacked many of the common clinical presentations of CIPA, and therefore, the focus of her evaluation was directed towards her unexplained joint deformities. Exome sequencing revealed a known pathogenic variant in NTRK1 (c.851-33T > A:p.? [Intron 7]) and a novel NTRK1 variant (c.1483 + 5G > A:p.? [Intron 11]), which was later re-classified as likely pathogenic. The patient was started on a biologic disease-modifying anti-rheumatic medication (bDMARD) due to a possible inflammatory etiology of her joint deformity. Molecular diagnosis allowed for modification of her treatment and surveillance strategies. Our minigene splicing assay demonstrated that the presence of the c.1483 + 5G > A variant has a negative effect on splicing, supporting the pathogenicity of this novel variant.

Columbianadin ameliorates rheumatoid arthritis by attenuating synoviocyte hyperplasia through targeted vimentin to inhibit the VAV2/Rac-1 signaling pathway

IntroductionRheumatoid arthritis (RA) is an autoimmune disease pathologically characterized by synovial inflammation. The abnormal activation of synoviocytes seems to accompany the progression of RA. The role and exact molecular mechanism in RA of columbianadin (CBN) which is a natural coumarin is still unclear. ObjectivesThe present research aimed to investigate the effect of vimentin on the abnormal growth characteristics of RA synoviocytes and the targeted regulatory role of CBN. MethodsCell migration and invasion were detected using the wound healing and transwell method. Mechanistically, the direct molecular targets of CBN were screened and identified by activity-based protein profiling. The expression of relevant proteins and mRNA in cells and mouse synovium was detected by western blotting and qRT-PCR. Changes in the degree of paw swelling and body weight of mice were recorded. H&E staining, toluidine blue staining, and micro-CT were used to visualize the degree of pathological damage in the ankle joints of mice. Small interfering RNA and plasmid overexpression of vimentin were used to observe their effects on MH7A cell proliferation, migration, apoptosis, and downstream molecular signaling. ResultsThe TNF-α-induced proliferation and migration of MH7A cells could be significantly repressed by CBN (25,50 μM), and the expression of apoptosis and autophagy-associated proteins could be modulated. Furthermore, CBN could directly bind to vimentin and inhibit its expression and function in synoviocytes, thereby ameliorating foot and paw swelling and joint damage in CIA mice. Silencing and overexpression of vimentin might be involved in developing RA synovial hyperplasia and invasive cartilage by activating VAV2 phosphorylation-mediated expression of Rac-1, which affects abnormal growth characteristics, such as synoviocyte invasion and migration. ConclusionCBN-targeted vimentin restrains the overactivation of RA synoviocytes thereby delaying the pathological process in CIA mice, which provides valuable targets and insights for understanding the pathological mechanisms of RA synovial hyperplasia.

Relationship Between Posterior Tibial Artery Blood Flow And Lower Leg Flexibility Among Collegiate Runners

Purpose: Understanding relationships between blood flow and muscle inflexibility in the lower leg can support improved healthcare competency. Sports medicine practitioners might use the reference ranges and knowledge of relationships among these variables to support effective health screenings among their competitive runners. These variables have been linked in other areas of the body where inflexibility in the pectoralis minor and scalene muscles have been associated with diminished blood flow to the upper limb. No studies, however, have examined the relationship between vascular and mobility characteristics in the lower legs of runners. Therefore, the purpose of this study was to examine the relationship between blood flow in the posterior tibial artery and ankle range of motion (ROM) among competitive runners. Methods: Blood flow in the posterior tibial artery and ankle ROM were measured bilaterally on twenty-five, asymptomatic collegiate track athletes (15 males, 10 females, age = 20.0±1.2 years, height = 171.5±10.2 cm, mass = 66.7±13.7 kg) using diagnostic ultrasound and standard goniometry, respectively. Pearson correlation analysis was used to analyze the relationship between blood flow in the posterior tibial artery and ROM of the ankle joint. Results: Findings revealed no significant relationship between blood flow in the dominant leg’s posterior tibial artery and dorsiflexion (r=.14, P=.52, CI95% = -0.27 – 0.51) or plantarflexion (r=-.32, P=.12, CI95% = -0.63 – 0.09) and no significant relationship between blood flow in the non-dominant leg’s posterior tibial artery and dorsiflexion (r=-.02, P=.93; CI95% = -0.41 – 0.38) or plantarflexion (r=-.02, P=.92; CI95% = -0.41 – 0.38). Conclusion: While muscle inflexibility is associated with compromised blood flow in other body regions, findings of this study demonstrated no relationship between the variables within the lower legs of a sample of competitive runners. Sports medicine practitioners should consider these findings in their efforts to predict, prevent, and manage potential vascular and musculoskeletal adaptations among clients/patients who are competitive runners.

Prognosis of Nonconcurrent Bilateral Achilles Tendon Rupture Is Worse Than Unilateral Achilles Tendon Rupture: Patient-Reported Outcomes at Minimum 2-Year Follow-up.

Approximately 5%-7% of patients who have had Achilles tendon rupture (ATR) suffer from contralateral ATR. However, no studies have evaluated the clinical outcomes of contralateral ATR in patients with an existing ATR. Therefore, in this study, we aimed to investigate patient-reported ankle function and activity levels in patients with nonconcurrent bilateral ATR. We retrospectively reviewed the data of 222 patients with an acute ATR who presented at our 2 institutions between 2005 and 2017. All patients had a minimum 2-year follow-up period, with no other major injuries to the ankle joint. Of these patients, 17 patients had nonconcurrent bilateral ATR. Patient-reported outcomes were assessed by telephone interview, using the Achilles tendon Total Rupture Score (ATRS), the ankle activity score, and a patient satisfaction questionnaire. Telephonic interviews were conducted by 2 authors, using a prepared script to minimize bias owing to individual interviewers. The mean age of the patients was 45.1 ± 9.8 years, and 89% were men. Patients with nonconcurrent bilateral ATR had significantly lower values in terms of ATRS, ankle activity score, and satisfaction with current activity level, compared to patients who had unilateral ATR (p < 0.001, p = 0.027, and p = 0.012, respectively). Patients with nonconcurrent bilateral ATR had poorer ankle function, activity levels, and satisfaction than those with unilateral ATR in terms of patient-reported outcome measures with an intermediate-term result and a 2-year minimum follow-up period. These results emphasize the importance of the impact of contralateral injury on the prognosis of patients with ATR and the need for efforts to prevent contralateral rupture.