ABSTRACT
Objective:To measure and compare the geometric rotation axis of the talocrucial joint at different poses during the normal gait.Methods:The kinematic data of 15 healthy volunteers, 8 females, 7 males; age, 26.2±5.4 y (range 19-39 y); height, 170.4±6.9 cm (range 160-183 cm); mass, 65.6±14.0 kg (range 52-100 kg). They were collected using the dual-fluoroscopy technique, and the spatial position of the tibia and talus was determined using the 3D-2D registration method. The medial and lateral side of the trochlear of each talus was fitted by two spheres and the geometric rotation axis of the tibiotalar joint was defined as the line connecting the origins of two spheres. Compared the position and orientation of the axis for different poses during the gait and also compared the difference of the radius of the medial and lateral spheres fitting the trochlear of each talus.Results:The radii of the medial spheres fitting the trochlear of each talus 19.52±1.47 mm,were significantly less than that of the lateral spheres 20.62±1.49 ( t=7.081, P<0.05). The averaged anterior-posterior distance between the geometric rotation point of the tibiotalar joint were 1.54±1.84, 1.71±1.69, 1.70±1.57, 1.72±1.62, 1.80±1.75, 1.96±1.86 mm, respectively, while the averaged medial-lateral distance were 0.06±1.84, -0.03±1.83, 0.08±1.83, 0.10±1.73, 0.10±1.47, 0.09±1.46 mm, respectively, and the averaged superior-inferiordistance were -21.92±1.46, -22.10±1.32, -22.10±1.50, -22.06±1.64, -21.93±1.62, -21.98±1.50 mm, respectively. The averaged angle between the geometric rotation axis of the tibiotalar joint and coronal plane were 3.31°±2.48°, 3.10°±2.67°, 3.64°±2.71°, 3.96°±3.19°, 4.28°±2.82°, 4.16°±3.11°, respectively, while the averaged angle between that and sagittal plane were 84.11°± 2.42°, 83.77°±3.19°, 83.77°±3.45°, 83.81°±3.69°, 83.99°±2.97°, 84.23°±3.01°, respectively, and the averaged angle between that and transverse plane were 4.40°±2.93°, 4.54°±3.74°, 3.97°±3.34°, 3.73°±2.49°, 3.78°±2.76°, 4.48°±2.49°, respectively. The position and orientation of the geometrical rotation axis of the tibiotalar joint at different poses during the gait showed no significant difference ( P>0.05). The rotation axis orientated from laterally and inferiorly to medially and superiorly with an averaged inclination angle from the horizontal plane of 3.74° and an averaged deviation angle from the coronal plane of 4.15°. Conclusion:The geometric rotation axis of the tibiotalar joint was fixed during the gait, therefore fitting the talar trochlea with the two-sphere model with a small radius of the medial sphere and a large radius of the lateral sphere may better mimic the kinematics of tibiotalar joint.
ABSTRACT
Objective:To compare the operative treatment and non-operative treatment of the re-ruptured Achilles tendon with rupture end distance within 1 cm.Methods:We retrospectively analyzed 14 cases with Achilles tendon postoperative re-rupture in our hospital from May 2012 to March 2019. All 14 cases showed distance of rupture end less than 1cm during imaging in a passive plantarflexion position. Among the 14 cases with re-rupture, 8 were in the operative treatment group (7 males and 1 female, mean age 36.3±6.4 years, duration from initial rupture to re-rupture 3 to 213 weeks, height 174.9±8.7 cm, weight 75.5±13.9 kg, body mass index 24.5±2.7 kg/m 2, distance of re-ruptured ends 4.9±2.5 mm) and 6 were in the non-operative treatment group (5 males and 1 female, mean age 40.0±9.0 years, duration from initial rupture to re-rupture 4 to 60 weeks, height 173.8±3.5 cm, weight 77.5±7.4 kg, body mass index 25.7±2.5 kg/m 2, distance of re-ruptured ends 5.7±2.1 mm). The Achilles tendon rupture score (ATRS), visual analogue scale (VAS), and foot and ankle ability measure (FAAM) were used to evaluate the result at the patients' last follow-up. Results:All the 14 cases were followed for 8.7 to 92.2 months, with mean follow-up of 39.6 months. Ultrasound or MRI was performed at 6 months postoperatively or at last follow-up to ensure the Achilles tendons' healing. The average ATRS score, VAS score, FAAM-ADL score, and FAAM-Sports score of the operative treatment group were 85.4±13.5, 0 (0, 1.0) , 86.9±8.3, and 76.3±15.4, respectively. While those of the non-operative treatment group were 82.8±5.7, 0.5 (0, 1.3) , 88.1±8.3, and 77.2±15.0, respectively. The average VAS score, FAAM-ADL score, and FAAM-Sports score of the operative treatment group and those of the non-operative treatment group was not significantly different. The ATRS scores of 7 patients of the operative treatment group were between 81 and 96. The satisfaction rate of operative treatment group was 87.5% (7/8). The ATRS scores of 5 patients of the non-operative treatment group were between 81 and 91. The satisfactory rate of non-operative treatment group was 83.3% (5/6). All Achilles tendon re-rupture cases had no complications such as a third time Achilles tendon rupture or wound infection after treatment.Conclusion:For the re-ruptured Achilles tendon with rupture end distance within 1 cm, non-operative treatment achieved similar curative effect compared to operative treatment through extended duration of immobilization and non-weightbearing.