Isokinetic muscle strength characteristics of lower limb joints in long jumpers / Características da força muscular isocinética das articulações dos membros inferiores dos saltadores de salto em distância / Características de la fuerza muscular isocinética de las articulaciones de los miembros inferiores en saltadores de longitud

ABSTRACT Introduction: Joint strength of the lower limbs plays a decisive role in the competitive ability of long jumpers. Special strength training based on science and targeted at the strength of the lower limb joints is an essential topic for long jumpers. Objective: To analyze isokinetic muscle strength characteristics of lower limb joints in long jumpers. Methods: Voluntary jumpers were submitted to isokinetic concentric contraction tests of the lower limbs and hip joints. We also analyzed the effect of strength training on lower limb joint injury. Results: The knee muscles of the athletes have reduced eccentric contractility. The ankle of the athlete has the most vulnerable joint to injuries in the sport. Conclusion: The explosive force and eccentric contractility of long jumpers' lower limb extensor muscles have the most significant impact on joint thrust and extension speed. Athletes need muscle strength training to develop isokinetic muscle strength. This can effectively prevent injury to lower extremity joint movements. The research findings of this paper can provide a specific theoretical basis for formulating scientific training for long jumpers. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: A força conjunta dos membros inferiores desempenha um papel decisivo na capacidade competitiva nos saltadores de salto em distância. O treinamento de força especial baseado na ciência e direcionado para a força das articulações dos membros inferiores é um tópico essencial para os saltadores. Objetivo: Analisar as características de força muscular isocinética das articulações dos membros inferiores em saltadores de salto em distância. Métodos: Saltadores voluntários foram submetidos à testes de contração concêntrica isocinética dos membros inferiores e articulação do quadril. Efetuou-se também a análise do efeito do treinamento de força na lesão das articulações dos membros inferiores. Resultados: Os músculos dos joelhos dos atletas têm uma contratilidade excêntrica reduzida. O tornozelo dos atletas possui a articulação mais vulnerável a lesões no esporte. Conclusão: A força de explosão e a capacidade de contração excêntrica dos músculos extensores dos membros inferiores dos saltadores de salto longo têm o impacto mais significativo no empuxo das articulações e na velocidade de extensão. Os atletas precisam de treinamento de força muscular para desenvolver a força muscular isocinética. Isto pode efetivamente evitar lesões nos movimentos das extremidades inferiores das articulações. Os resultados da pesquisa deste trabalho podem fornecer uma base teórica específica para a formulação do treinamento científico para os saltadores de salto longo. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: La fuerza articular de los miembros inferiores desempeña un papel decisivo en la capacidad competitiva de los saltadores de longitud. El entrenamiento de fuerza especial basado en la ciencia y dirigido a la fuerza de las articulaciones de los miembros inferiores es un tema esencial para los saltadores. Objetivo: Analizar las características de la fuerza muscular isocinética de las articulaciones de los miembros inferiores en saltadores de longitud. Métodos: Los saltadores voluntarios fueron sometidos a pruebas de contracción concéntrica isocinética de los miembros inferiores y de las articulaciones de la cadera. También se realizó un análisis del efecto del entrenamiento de fuerza en las lesiones de las articulaciones de los miembros inferiores. Resultados: Los músculos de la rodilla de los atletas tienen una contractilidad excéntrica reducida. El tobillo de los atletas tiene la articulación más vulnerable a las lesiones en el deporte. Conclusión: La fuerza de explosión y la contractilidad excéntrica de los músculos extensores de las extremidades inferiores de los saltadores de longitud tienen el impacto más significativo en el empuje articular y la velocidad de extensión. Los atletas necesitan entrenar la fuerza muscular para desarrollar la fuerza muscular isocinética. Esto puede prevenir eficazmente las lesiones en los movimientos de las articulaciones de las extremidades inferiores. Los resultados de la investigación de este trabajo pueden proporcionar una base teórica específica para la formulación del entrenamiento científico de los saltadores de longitud. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Optimization method for ankle strength training during exercise / Método de otimização no treino de força do tornozelo durante o exercício / Método para optimizar el entrenamiento de la fuerza del tobillo durante el ejercicio

ABSTRACT Introduction Good ankle joint strength is a precondition for high-quality exercise and is an important factor in preventing joint injuries. Objective Explore the method of optimizing ankle strength training during exercise. Methods 40 volunteers were selected and randomly divided into an experimental group and a control group. The 20 athletes in the experimental group were trained three times a week for six weeks using a control variable method, while the control group performed only professional daily physical training. Pre-training and post-training methods were used to collect and investigate the data regarding the effect of strength training on the ankle joint and its impact on skill and strength tests submitted to the athletes. Results Ankle strength training can improve ankle muscle strength and athletes' ability to run and jump (P > 0.05). Conclusion Ankle joint strength training may improve athletes' baseline sporting ability, improve ankle joint muscle strength, reduce the likelihood of joint injuries, and contribute to improved outcomes of various abilities, meriting further study and replication. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução A boa força articular do tornozelo é uma pré-condição para exercícios físicos de alta qualidade além de ser um fator importante na prevenção de lesões articulares. Objetivo Explorar o método de otimização do treino de força do tornozelo durante o exercício físico. Métodos 40 voluntários foram selecionados e aleatoriamente divididos em grupo experimental e grupo de controle. Os 20 atletas do grupo experimental foram treinados três vezes por semana durante 6 semanas usando um método de variáveis de controle enquanto o grupo controle efetuou apenas o treinamento físico diário profissional. Foram utilizados métodos pré-treino e pós-treino para coleta e investigação dos dados quanto ao efeito do treinamento de força sob a articulação do tornozelo e seu impacto em testes de habilidade e força submetidos aos atletas. Resultados O treinamento de força do tornozelo pode melhorar a força muscular do tornozelo e melhorar a capacidade dos atletas de correr e saltar (P > 0,05). Conclusão O treino de força articular do tornozelo pode melhorar a capacidade esportiva basal dos atletas, melhorar a força muscular da articulação do tornozelo, reduzir a probabilidade de lesões articulares e contribuir na melhoria dos resultados de várias habilidades, merecendo maiores estudos e replicação. Nível de evidência II; Estudos terapêuticos - investigação dos desfechos do tratamento.

RESUMEN Introducción Una buena resistencia de la articulación del tobillo es una condición previa para la realización de ejercicio físico de alta calidad y un factor importante en la prevención de lesiones articulares. Objetivo Explorar el método para optimizar el entrenamiento de la fuerza del tobillo durante el ejercicio. Métodos Se seleccionaron 40 voluntarios y se dividieron aleatoriamente en grupo experimental y grupo de control. Los 20 atletas del grupo experimental se entrenaron tres veces a la semana durante 6 semanas con un método variable de control, mientras que el grupo de control sólo realizó un entrenamiento físico profesional diario. Se utilizaron métodos de pre-entrenamiento y post-entrenamiento para recoger e investigar los datos relativos al efecto del entrenamiento de fuerza bajo la articulación del tobillo y su impacto en las pruebas de habilidad y fuerza a las que se sometieron los atletas. Resultados El entrenamiento de la fuerza del tobillo puede mejorar la fuerza muscular del tobillo y mejorar la capacidad de los atletas para correr y saltar (P > 0,05). Conclusión El entrenamiento de la fuerza de la articulación del tobillo puede mejorar la capacidad deportiva de base de los atletas, mejorar la fuerza muscular de la articulación del tobillo, reducir la probabilidad de lesiones articulares y contribuir a mejorar los resultados de varias habilidades, mereciendo más estudios y réplicas. Nivel de evidencia II; Estudios terapêuticos - investigación de los resultados del tratamiento.

Functional training on ankle sprain rehabilitation in soccer players / Treinamento funcional sobre a reabilitação da entorse de tornozelo nos jogadores de futebol / Entrenamiento funcional en la rehabilitación del esguince de tobillo en los jugadores de fútbol

ABSTRACT Introduction An ankle sprain is a common soccer injury. Functional training is used to rehabilitate muscle strength with undiscovered benefits on soccer players' recovery. Objective Explore the functional training effects on ankle injury recovery in soccer players. Methods 29 amateur soccer players were randomly assigned to control (n=15) and experimental (n=14) groups with no statistical difference in age or sex (P>0.05). The experimental group used functional rehabilitation training, while the control group was treated with traditional rehabilitation methods. Both groups practiced 30 to 40 minutes of rehabilitation, three times a week, for two months. Mathematical statistics were used to analyze the effects of different injury rehabilitation on the two groups, estimating the ankle joint continuous motion angle by the tibialis anterior muscle electromyogram responses. Results The ankle instability assessment questionnaires were statistically different between the two groups of patients after rehabilitation training (P<0.05). There was a statistical difference in the agility test after the intervention. The ankle capacity score and agility test score were better in the experimental group (P<0.05). Conclusion Functional rehabilitation training can improve ankle performance after a sprain. This training can also help athletes avoid future sprains and is recommended as preventive training. Evidence Level II; Therapeutic Studies - Investigating the result.

RESUMO Introdução Entorse no tornozelo é uma lesão comum no futebol. O treinamento funcional é utilizado na reabilitação da força muscular com benefícios ainda explorados sobre a recuperação dos jogadores de futebol. Objetivo Explorar os efeitos do treinamento funcional na recuperação das lesões no tornozelo em jogadores de futebol. Métodos 29 jogadores de futebol amador foram aleatoriamente distribuídos em grupo controle (n=15) e experimental (n=14) sem diferença estatística de idade ou sexo (P>0,05). O grupo experimental utilizou treinamento de reabilitação funcional enquanto o grupo controle foi tratado com os métodos tradicionais de reabilitação. Ambos os grupos praticaram 30 a 40 minutos de reabilitação, três vezes por semana, durante dois meses. Estatísticas matemáticas foram utilizadas para analisar os efeitos da reabilitação de lesões diferentes nos dois grupos por estimativa do ângulo de movimento contínuo na articulação do tornozelo com as respostas do eletromiograma do músculo tibial anterior. Resultados Os questionários de avaliação da instabilidade do tornozelo entre os dois grupos de pacientes após o treinamento de reabilitação foram estatisticamente diferentes (P<0,05). Houve diferença estatística no teste de agilidade após a intervenção. A pontuação na capacidade do tornozelo e o escore no teste de agilidade foram melhores no grupo experimental (P<0,05). Conclusão O treinamento de reabilitação funcional pode melhorar o desempenho do tornozelo após a entorse. Este treinamento também pode ajudar os atletas a evitarem futuros entorses, sendo recomendado como treino preventivo. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción El esguince de tobillo es una lesión común en el fútbol. El entrenamiento funcional se utiliza en la rehabilitación de la fuerza muscular con beneficios aún explorados en la recuperación de los jugadores de fútbol. Objetivo Explorar los efectos del entrenamiento funcional en la recuperación de lesiones de tobillo en jugadores de fútbol. Métodos 29 jugadores de fútbol amateur fueron distribuidos aleatoriamente en los grupos de control (n=15) y experimental (n=14) sin diferencias estadísticas en cuanto a edad o sexo (P>0,05). El grupo experimental utilizó un entrenamiento de rehabilitación funcional mientras que el grupo de control fue tratado con métodos de rehabilitación tradicionales. Ambos grupos practicaron entre 30 y 40 minutos de rehabilitación, tres veces por semana, durante dos meses. Se utilizó la estadística matemática para analizar los efectos de las diferentes rehabilitaciones de lesiones en los dos grupos mediante la estimación del ángulo de movimiento continuo en la articulación del tobillo con las respuestas del electromiograma del músculo tibial anterior. Resultados Los cuestionarios de evaluación de la inestabilidad del tobillo entre los dos grupos de pacientes después del entrenamiento de rehabilitación fueron estadísticamente diferentes (P<0,05). Hubo una diferencia estadística en la prueba de agilidad después de la intervención. La puntuación de la capacidad del tobillo y la puntuación de la prueba de agilidad fueron mejores en el grupo experimental (P<0,05). Conclusión El entrenamiento de rehabilitación funcional puede mejorar el rendimiento del tobillo tras un esguince. Este entrenamiento también puede ayudar a los atletas a evitar futuros esguinces y se recomienda como entrenamiento preventivo. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

Outcomes of a Modified Arthroscopic-assisted Reconstruction Technique for Lateral Ankle Instability / Resultados de uma técnica modificada de reconstrução assistida por artroscopia para instabilidade lateral do tornozelo

Abstract Objective The present study assesses the results of a minimally invasive surgical technique for acute and chronic ankle instability management. Methods The present case series study retrospectively evaluated 40 patients undergoing arthroscopic-assisted percutaneous ankle ligament reconstruction from 2013 to 2019. Results The present study included 17 males and 23 females with an average age of 38.3 years old. Postintervention follow-up using American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores identified improvement of > 30 points in function and pain control. The most frequently occurring associated injuries were osteochondral (35%). No patient required reintervention or had infection during follow-up. Conclusion The technique in the present study is easy and achieves satisfactory results for function and pain control. Level of Evidence IV.

Resumo Objetivo O presente estudo avalia os resultados de uma técnica cirúrgica minimamente invasiva para o manejo da instabilidade aguda e crônica do tornozelo. Métodos O presente estudo de uma série de casos avaliou retrospectivamente 40 pacientes submetidos à reconstrução percutânea assistida por artroscopia do ligamento do tornozelo entre 2013 e 2019. Resultados O estudo incluiu 17 homens e 23 mulheres com idade média de 38,3 anos. O acompanhamento pós-intervenção utilizou a pontuação American Orthopaedic Foot and Ankle Society (AOFAS, na sigla em inglês). As pontuações do tornozelo-retropé identificaram melhora > 30 pontos na função e no controle da dor. As lesões associadas mais frequentes foram as osteocondrais (35%). Nenhum paciente precisou de reintervenção ou teve infecção durante o acompanhamento. Conclusão A técnica do presente estudo é fácil e consegue resultados satisfatórios para a função e o controle da dor. Nível de Evidência IV.

Treatment of Distal Tibiofibular Syndesmosis Injury Associated with Ankle Fractures with Suture Button / Tratamento da lesão da sindesmose tibiofibular distal associada às fraturas do tornozelo com suture button

Abstract Objective To evaluate the results obtained from the surgical treatment of malleolar ankle fractures associated with distal tibiofibular syndesmosis (DTFS) injury submitted to conventional surgical procedure for fracture fixation and DTFS fixation by suture button (SB). Methods Forty-nine patients were retrospectively evaluated, with a mean age of 45 years old and a mean follow-up of 34.1 months. Clinical and functional evaluation was based on the visual analogue scale (VAS) and on the American Foot and Ankle Society Score (AOFAS) for ankle and hindfoot, return to routine activities, and return to sport. Results The postoperative mean AOFAS and VAS were, respectively, 97.06 (confidence interval [CI 95%: 95.31-98.81] and 0.16 [CI 95% 0,04 - 0,29]. All patients returned to previous daily activities, and only 12 showed some residual symptom. There was no postoperative instability in any patient. Forty-six patients returned to sports activities and, of these, only 1 did not return to the level prior to the injury. Only two patients presented SB-related alterations. There was no report of dissatisfaction. Conclusion In malleolar fractures of the ankle with DTFS injury, the fixation of syndesmosis with SB demonstrated excellent postoperative results. Level of Evidence IV, retrospective case series.

Resumo Objetivo Avaliar os resultados obtidos do tratamento cirúrgico das fraturas maleolares do tornozelo associadas a lesão da sindesmose tibiofibular distal (STFD) submetidas a procedimento cirúrgico convencional de fixação da fratura e fixação da STFD pelo suture button (SB). Métodos Avaliou-se retrospectivamente 49 pacientes com uma média de idade de 45 anos e seguimento médio de 34,1 meses. A avaliação clínica e funcional foi baseada na escala visual analógica (EVA) e na escala American Foot and Ankle Society Score (AOFAS, na sigla em inglês) para tornozelo e retropé, retorno às atividades da rotina e retorno ao esporte. Resultados As médias pós-operatórias das escalas AOFAS e EVA foram, respectivamente, 97,06 (índice de confiança [IC 95%: 95,31 - 98,81] e 0,16 [IC 95% 0,04 - 0,29]. Todos os pacientes retornaram às atividades prévias do cotidiano, sendo que apenas 12 apresentaram algum sintoma residual. Não se verificou instabilidade pós-operatória em nenhum paciente. Ao todo, 46 pacientes retornaram às atividades desportivas e, destes, apenas 1 não retornou ao nível prévio à lesão. Apenas dois pacientes apresentaram alterações relacionadas ao SB. Não houve relato de insatisfação. Conclusão Em fraturas maleolares do tornozelo com lesão da STFD, a fixação da sindesmose com o SB demonstrou excelentes resultados pós-operatórios. Nível de Evidência IV, série de casos retrospectiva.

Characteristics and prevention of sports injuries in taekwondo training / Características e prevenção de lesões esportivas no treinamento de taekwondo / Características y prevención de lesiones deportivas en el entrenamiento de tae kwon do

ABSTRACT Introduction: With the extensive and in-depth development of Taekwondo in China, more and more people participate in Taekwondo training. Due to the lack of experience of some coaches and the misunderstanding of scientific sports training by young athletes, injuries occur from time to time. This has a bad effect on Taekwond itself, and it can also damage the health of athletes. Objective: This article discusses joint injuries in Taekwondo and analyzes the characteristics of Taekwondo sports injuries and preventive methods. Methods: This article uses a questionnaire applied to young athletes to gain an understanding of the sports injuries situation. Results: The most common injury sites were feet and joints. The nature of the injuries is mostly soft tissue injury, ligament laceration, and muscle strain. The most serious injuries are kidney and perineal damage. Conclusion: Improving the level of training, strengthening medical supervision, and paying attention to the timely treatment of acute injuries are important ways to reduce the occurrence of trauma. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: Com o desenvolvimento extenso e profundo do Taekwondo na China, cada vez mais pessoas participam do treinamento nesse esporte. Com a falta de experiência de alguns treinadores e a compreensão errônea de jovens atietas quanto ao treinamento esportivo científico, de vez em quando ocorrem lesões. Isso tem efeito negativo sobre o próprio Taekwondo e também pode prejudicar a saúde dos atletas Objetivo: Este artigo discute lesões articulares no Taekwondo e analisa as características das lesões do esporte, bem como os métodos de prevenção. Métodos: Este artigo aplicou um questionário a jovens atletas para obter uma compreensão da situação das lesões esportivas. Resultados: Os locais de lesão mais comuns foram pés e articulações. A natureza das lesões é principalmente nos tecidos moles, laceração de ligamento e tensão muscular. As lesões mais graves são danos renais e perineais. Conclusões: Melhorar o nível de treinamento, fortalecer a supervisão médica e prestar atenção ao tratamento oportuno de lesões agudas são maneiras importantes de reduzir a ocorrência de traumas. Nível de Evidência II; Estudos terapêuticos - Investigação dos resultados do tratamento.

RESUMEN Introducción: Con el amplio y profundo desarrollo del Tae Kwon Do en China, cada vez más personas participan en el entrenamiento de este deporte. Debido a la falta de experiencia de algunos entrenadores y a la comprensión errónea de jóvenes atletas sobre el entrenamiento deportivo científico, ocasionalmente se producen lesiones. Esto tiene un efecto negativo en el propio Tae Kwon Do y también puede perjudicar la salud de los atletas. Objetivo: Este artículo trata de las lesiones articulares en el Tae Kwon Do y analiza las características de las lesiones en este deporte, así como los métodos de prevención. Métodos: En este artículo se aplicó un cuestionario a jóvenes atletas para conocer la situación de las lesiones deportivas. Resultados: Los lugares más comunes de las lesiones fueron los pies y las articulaciones. La naturaleza de las lesiones es principalmente en los tejidos blandos, rotura de ligamentos y tensión muscular. Las lesiones más graves son los daños renales y perineales. Conclusiones: Mejorar el nivel de entrenamiento, reforzar la supervisión médica y prestar atención al tratamiento oportuno de las lesiones agudas son formas importantes de reducir la incidencia de traumatismos. Nivel de Evidencia II; Estudios terapéuticos - Investigatión de los resultados del tratamiento.

Effect of football on rehabilitation of ankle injury patients / Efeito do futebol na reabilitação de pacientes com lesão no tornozelo / Efecto del fútbol en la rehabilitación de pacientes con lesiones de tobillo

ABSTRACT Introduction: Brief introduction: Ankle tendon and ligament sports injuries are common in football players. Objective: To continue to improve special strength training related to the characteristics of football after rehabilitation of injured ankle tendons and ligaments. Methods: Two master football sportsmen were rehabilitated by multi-point equal-length, short-arc and long-arc equal-speed training combined with balance ability exercises. Results: There were two long muscle L be maintain muscle tone plantar flexors force four times of 96 n/m, n/m 121, 140 n/m, 145 n/m than back flexors force of 63 n/m, 52 n/m, 60 n/m, 74 n/m tall. Plantar flexor fatigue was 57%, 30%, 29%, 12%, 28%, 18%, 20%, 21%. Conclusions: With the passing of time, the relative peak moment value of the right ankle plantar flexor muscle group of the two patients kept rising, the dorsiflexor muscle was basically flat, and the work fatigue index decreased step by step, indicating that the right ankle muscle strength level was significantly improved, the anti-fatigue ability was improved, and the rehabilitation treatment had a good effect. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: Introdução breve: Lesões esportivas nos tendões e ligamentos do tornozelo são comuns em jogadores de futebol. Objetivo: Atingir melhora no treinamento de força especial relacionado com as lesões características do futebol depois de reabilitação de tendões e ligamentos do tornozelo. Métodos: Dois futebolistas de primeira linha foram reabilitados por treinamento multipontos de comprimento igual, arco curto e arco longo em velocidade igual, combinado com exercícios de habilidade de equilíbrio. Resultados: Havia dois músculos longos L para manter o tônus muscular, força dos flexores plantares antes e depois de quatro vezes de 96 n/m, 121 n/m, 140 n/m, 145 n/m e força dos flexores dorsais de 63 n/m, 52 n/m, 60 n/m, 74 n/m de altura. A fadiga do flexor plantar foi de 57%, 30%, 29%, 12%, 28%, 18%, 20%, 21%. Conclusões: Com o passar do tempo, o valor do momento de pico relativo do grupo de músculos flexores plantares do tornozelo direito dos dois pacientes continuou aumentando; o músculo flexor do dorso estava basicamente plano e o índice de fadiga no trabalho diminuiu gradativamente, indicando que o nível de força muscular do tornozelo direito melhorou significativamente, assim como a capacidade antifadiga e, portanto, que o tratamento de reabilitação teve efeito positivo. Nível de Evidência II; Estudos terapêuticos - Investigação dos resultados do tratamento.

RESUMEN Introducción: Breve introducción: Las lesiones deportivas en los tendones y ligamentos del tobillo son comunes en los jugadores de fútbol. Objetivo: Lograr una mejora en el entrenamiento de fuerza especial relacionado con las lesiones características del fútbol tras la rehabilitación de los tendones y ligamentos del tobillo. Métodos: Dos jugadores de fútbol de alto nivel fueron rehabilitados mediante un entrenamiento multipunto de igual longitud, arco corto y arco largo a igual velocidad, combinado con ejercicios de habilidad de equilibrio. Resultados: Hubo dos músculos L largos para mantener el tono muscular, fuerza de los flexores plantares antes y después de cuatro veces de 96 n/m, 121 n/m, 140 n/m, 145 n/m y fuerza de los flexor dorsales de 63 n/m, 52 n/m, 60 n/m, 74 n/m de altura. La fatiga de los flexores plantares fue del 57%, 30%, 29%, 12%, 28%, 18%, 20%, 21%. Conclusiones: Con el paso del tiempo, el valor del momento máximo relativo del grupo de músculos flexores plantares del tobillo derecho de los dos pacientes continuó aumentando; el músculo flexor dorsal estaba básicamente plano y el índice de fatiga de trabajo disminuyó gradualmente, lo que indica que el nivel de fuerza muscular del tobillo derecho mejoró significativamente, al igual que la capacidad antifatiga, y, por tanto, que el tratamiento de rehabilitación tuvo un efecto positivo. Nivel de Evidencia II; Estudios terapéuticos - Investigación de los resultados del tratamiento.

Correlation between the range of motion of the tibiotarsal joint and blood circulation in the lower limbs in diabetic individuals

SUMMARY OBJECTIVE: The aim of this study was to evaluate the relationship between the range of motion and lower-limb hemodynamic indices in the tibiotarsal joint of individuals with diabetic neuropathy. METHODS: Twenty volunteers of both sexes, with a mean age of 61.45±7.05 years, were diagnosed with type 2 diabetes mellitus and diabetic peripheral neuropathy. Arterial blood flow was assessed using Doppler ultrasound, and the variables such as average velocity, pulsatility index, and resistivity index were also evaluated. A range of dorsiflexion and plantar flexion joint movements were assessed using digital goniometry before and after exercise. Data distribution was assessed using the Shapiro-Wilk test, followed by Pearson's correlation for normal data and Spearman's correlation for non-normal data, in order to verify the association between variables. RESULTS: A moderate correlation was found between dorsiflexion and pulse rate on two occasions before (rs=0.497) and after initial evaluation (rs=0.511). A low correlation was found between plantar flexion and mean velocity (rs=-0.357), pulsatility index (rs=0.439), and resistivity index (rs=0.328); dorsiflexion and mean velocity (rs=0.374), pulse rate (rs=0.332), and resistance index (rs=0.327) before evaluation, and peak (rs=0.346) was observed after the evaluation of blood circulation. CONCLUSION: There is a correlation between the range of motion of the tibiotarsal joint and the blood circulation of diabetics, ranging from moderate to poor for the different variables evaluated.

Arthroscopic foot and ankle surgery: brazilian surgeon profile / Cirurgia artroscópica do pé e tornozelo: perfil do cirurgião brasileiro

ABSTRACT Objective: To study the profile of the practice of arthroscopy among ankle and foot surgeons in Brazil and its evolution in recent years. Methods: Observational, cross-sectional study, using a survey sent to all members of the Associação Brasileira de Medicina e Cirurgia do Tornozelo e Pé (ABTPé) in 2017 and 2019. Results: In total, 75 surgeons participated in 2017 and 82 in 2019 and most had over 10 years of experience. Of these, 56 participants in 2017 (75%) and 68 in 2019 (82%) used arthroscopy. The number of specialists with no to five years of experience (p = 0.027) and who learned the technique during fellowship (p = 0.007) increased. The use of the 4.0 mm optics and 30° optics (p = 0.040) increased whereas the routine use of traction (p = 0.049) and radiofrequency (p = 0.002) decreased. The main pathology treated with anterior ankle arthroscopy was bone injury. The most frequent complication was neuropraxia. Conclusion: Most of the foot and ankle surgeons who use arthroscopy have more than 10 years of experience, performed anterior access, and are concentrated in the Southeast region of the country. The number of younger surgeons who learned the technique during fellowship increased. Level of Evidence III, Cross-Sectional Comparative Study.

RESUMO Objetivo: Mostrar o perfil da prática da artroscopia entre cirurgiões de tornozelo e pé no Brasil e sua evolução nos últimos anos. Métodos: Estudo observacional, transversal, realizado por meio de questionário eletrônico enviado para todos os membros da Associação Brasileira de Medicina e Cirurgia do Tornozelo e Pé (ABTPé) em 2017 e 2019. Resultados: Obtivemos 75 respondentes em 2017 e 82 em 2019; a maioria tinha mais de 10 anos de experiência. Dos respondentes, 56 realizavam artroscopia em 2017 (75%) e 68 em 2019 (82%). Foi observado aumento no número de especialistas com até 5 anos de experiência (p = 0,027) e que aprenderam a técnica durante o estágio de especialização (p = 0,007). Houve aumento no uso da ótica de 4,0 mm e 30° de angulação (p = 0,040), e diminuição do uso rotineiro de tração (p = 0,049) e de radiofrequência (p = 0,002). A principal patologia tratada com artroscopia anterior do tornozelo foi o impacto ósseo, e a complicação mais frequente foi a neuropraxia. Conclusão: A maioria dos cirurgiões de pé e tornozelo que utiliza artroscopia tem mais de 10 anos de experiência, usa o acesso anterior e concentra-se na região Sudeste do país. Foi observado aumento no número de cirurgiões mais novos e que aprenderam a técnica durante o estágio de especialização. Nível de Evidência III, Estudo Transversal Comparativo.

Preliminary application of mixed reality technique in surgery for complex pilon fractures / 中华创伤骨科杂志

Objective:To explore application of the mixed reality (MR) technique in the surgery for complex pilon fractures.Methods:A retrospective analysis was conducted of the 22 patients with pilon fracture of Rüedi-Allg?wer type Ⅲ who had been treated at the Department of Orthopedics, Nanjing Tongren Hospital from May 2018 to October 2020. They were divided into 2 groups according to their treatment procedures. In the MR group of 9 cases, there were 8 males and one female, with an age of (39.2 ± 15.1) years. In addition to calcaneal traction plus open reduction and internal fixation, the MR technique was used to assist doctor-patient communication, preoperative planning, surgical guidance and rehabilitation exercises. In the control group of 13 male cases with an age of (33.7 ± 9.6) years, only conventional calcaneal traction plus open reduction and internal fixation were carried out. The communication efficiency, operation time, intraoperative blood loss, fluoroscopy frequency, fracture reduction, post-operative complications and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score at one year postoperatively were recorded and compared between the 2 groups.Results:There was no significant difference in the general data between the MR group and the control group, showing they were comparable ( P > 0.05). The questionnaire score of patients' surgical awareness [(77.8 ± 19.2) points] in the MR group was significantly higher than that in the control group [(50.0 ± 30.6) points] ( P = 0.017). The fluoroscopy frequency [(7.3 ± 2.6) times] in the MR group was significantly lower than that in the control group [(9.5 ± 2.3) times] ( P = 0.043). No significant differences were observed between the 2 groups in either the operation time [(98.3 ± 14.4) min versus (110.4 ± 20.4) min] or the intraoperative blood loss [(118.9 ± 36.5) mL versus (128.8 ± 35.2) mL] ( P = 0.142, P = 0.527). In the MR group, 8 cases achieved anatomical reduction and one case good reduction; in the control group, 4 cases achieved anatomical reduction, 8 cases good reduction and one case poor reduction. The anatomical reduction in the MR group was significantly better than that in the control group ( P = 0.011). There were one case of delayed wound healing, one case of nonunion, and one case of traumatic osteoarthritis in the MR group while there were 2 cases of delayed wound healing, one case of superficial soft tissue infection, one case of nonunion, and 2 cases of traumatic osteoarthritis in the control group. The average AOFSA ankle-hindfoot score at one year postoperatively in the MR group [(83.8 ± 9.0) points] was significantly higher than that in the control group [(73.3 ± 11.8) points] ( P = 0.035). However, there was no significant difference between the MR group and the control group in the good to excellent rate by the AOFSA ankle-hindfoot score at one year postoperatively (6 excellent cases, one good case, and 2 fair cases in the former versus 6 excellent cases, 2 good cases, 4 fair cases, and one poor case in the latter) ( P = 0.648). Conclusions:In the surgery for complex pilon fractures, MR technique can increase the efficiency of doctor-patient communication, reduce intraoperative fluoroscopy frequency, and improve reduction quality and ankle function, but fails to significantly reduce operation time and intraoperative blood loss.

Research progress in the stability evaluation and treatment of ankle fracture / 中华创伤杂志

Ankle fracture is caused by direct or indirect violence to the integrity and continuity of the distal tibia and/or fibula, often associated with ligament and other soft tissue injuries. However, ankle fracture can be easily overlooked during diagnosis and treatment due to hidden injuries or lack of experience, often resulting in poor prognosis. The existing classifications are sometimes difficult to provide guidances for clinical decision making, so the classification of ankle fracture based on stability criteria comes into being. Improper management of unstable ankle fracture can lead to serious complications such as loss of function and traumatic arthritis, requiring individualized treatment based on the specific injury. The authors review the concept, anatomy and imageological evaluation of ankle fracture stability as well as its treatment based on stability classification, so as to provide new ideas for the stability evaluation and treatment of ankle fracture.

Research progress in the diagnosis, treatment and rehabilitation of peroneal tendon spondylolisthesis / 中华创伤杂志

Peroneal tendon plays an important role in maintaining the alignment of the hindfoot and stabilizing the arch of the foot. It is also the main tendon against ankle varus injuries, and is of great significance in maintaining lateral ankle stability. As an infrequent disease, peroneal tendon spondylolisthesis can be easily misdiagnosed in clinical diagnosis and treatment which results in pain and instability of the lateral ankle and weakness in eversion of the affected foot. Improper diagnosis or treatment can affect patient quality of life. Peroneal tendon spondylolisthesis is mainly treated by non-surgical and surgical treatments, among which surgical treatments mainly include superior peroneal retinaculum repair, superior peroneal retinaculum augmentation, peroneal bone block procedure, peroneal groove deepening technique, and peroneal rearrangement. Surgical indications for different surgical treatments remain controversial. Moreover, there are no rehabilitation guidelines for peroneal tendon spondylolisthesis at home or abroad, and postoperative rehabilitation is generally based on the experience of clinicians. On the basis of related literature, the authors review the research progress in treating peroneal tendon spondylolisthesis from aspects of anatomical characteristics, injury mechanism, diagnosis, treatment and rehabilitation, so as to provide a reference for accurate and effective diagnosis, treatment and rehabilitation of peroneal tendon spondylolisthesis.

Progress in imaging evaluation and clinical relevance of ankle osteoarthritis / 国际外科学杂志

Ankle osteoarthritis is a degenerative change caused by the destruction of articular cartilage, and it is not difficult to obtain a preliminary clinical diagnosis. However, imaging evaluation is always needed to evaluate the alignment of lower limbs, potential deformity and prognosis. Therefore, it is particularly important to select the right imaging examination to determine the range of joint inflammation, the degree of deformity and the stage of the disease. This paper discusses the imaging examination and clinical correlation of ankle osteoarthritis at home and abroad, in order to summarize the latest clinical experience for the diagnosis and evaluation of ankle osteoarthritis.

Reconstruction of anterior talofibular ligament and calcaneofibular ligament with autologous peroneus brevis tendon in the treatment of chronic lateral ankle instability / 中国骨伤

OBJECTIVE@#To explore the clinical efficacy of reconstruction the anterior talofibular ligament and calcaneofibular ligament with autologous peroneus brevis tendon for the treatment of chronic lateral ankle instability.@*METHODS@#The clinical data of 42 patients with chronic lateral ankle instability treated by anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament with autologous peroneus brevis tendon from July 2016 to July 2019 was retrospectively analyzed. Including 30 males and 12 females, age ranged from 25 to 46 years old with an average of (37.6±12.4) years. There were 15 cases of left foot and 27 cases of right foot, the time from injury to operation was 3 to 12 months with a mean of (7.4±2.8) months. And 14 patients had tenderness in lateral collateral ligament area, 28 patients complained of multiple ankle sprains while walking on the flat ground. At 12 months after operation, the talar tilt angle and visual analogue scale(VAS)were observed, ankle joint varus stress and anterior drawer test were performed to check the mechanical stability of the ankle joint, American Orhopaedic Foot and Ankle Society(AOFAS) was used to score the ankle and hindfoot functions and evaluate the curative effect.@*RESULTS@#Forty patients were followed up for 12 to 48 months with an average of (28.3±10.0) months, 2 cases were lost. The VAS decreased from(4.50±0.93) scores before surgery to (1.10±0.30) scores at 12 months after surgery;the talar tilt angle was reduced from (12.26±1.13)° before operation to (4.60±0.45)° at 12 months after operation;the AOFAS score increased from (65.10±7.50)scores before surgery to (84.40±3.95) scores at 12 months after surgery;all the differences were statically significant(P<0.05). According to the AOFAS score, 27 cases got excellent results, 7 good, 5 fair, and 1 poor. One patient had the symptoms of sural nerve injury after operation, and the symptoms were relieved after oral Mecobalamin for 3 months. The remaining patients had no complications such as nerve injury, infection, and skin necrosis. There was no instability of ankle joint, and both ankle varus stress test and drawer test were negative.@*CONCLUSION@#Autologous peroneal brevis tendon with double bone channel pass through the tendon (modified Chrisman-Snook operation) can anatomically reconstruct the anterior talofibular ligament and the calcaneofibular ligament, restore the stability of the patient's ankle joint, reduce postoperative complications, and restore ankle joint function well.

The influence of subtalar axis orientation on the foot posture of older adults in a closed kinetic chain / A influência da orientação do eixo subtalar na postura do pé de idosos em cadeia cinética fechada

Objectives: This study compared the influence of subtalar axis position on foot behavior in a closed kinetic chain in older and younger adults. Methods: The sample included 50 older adults and a control group of 50 younger adults. The variables were initially analyzed for both feet together, and were later analyzed separately, comparing each foot (right and left) between groups. Range of motion was assessed by validated goniometric procedures: the position of subtalar axis was evaluated by the palpation technique, while the Foot Posture Index was used to assess behavior in a closed kinetic chain. Student's t-test / Mann-Whitney test compared the main variables according to sample distribution, while Student's t-test / Wilcoxon test was used for paired samples. A standardized Haberman residuals test was also used to determine the connection between the position of subtalar joint axis and the Foot Posture Index. Results: Data from the right and left feet were similar for all variables. The older group had reduced mobility in the ankle and first metatarsophalangeal joint (5.42º [SD (Standard Deviation), 4.49] and 76.12º [SD, 19.24], respectively) with statistically significant values, (p <0.001), as measured by the Mann-Whitney test for the ankle joint and the t-Sutdent test for the first metatarsophalangeal joint, while the younger group had normal values (11.46º [SD, 6.49] and 97.17º [SD, 13.65], respectively)(p < 0.001). The difference in subtalar axis position was not significant (p = 0.788), with more internal deviations in both groups. There was a significant difference in Foot Posture Index (p = 0.006, by applying the chi-square test), with the normal position more prevalent in the older group and the prone position more prevalent in the younger group. Conclusions: Regarding internal deviations in the subtalar joint axis, the older group had a higher frequency of feet in the normal position, while the younger group had a higher frequency of feet in the prone position which, in this case, agrees with the rotational balance theory. For the normal axis position, a higher frequency of normal position was found in both groups. Regarding external deviations of the subtalar joint axis, neither group followed the pattern expected in rotational balance theory. The most consistent connection in the older group was between external axis position and supine foot position, whereas in the younger group it was between normal axis position and normal foot position.

Objetivos: Este estudo comparou a influência da posição do eixo subtalar no comportamento do pé em cadeia cinética fechada em idosos e adultos jovens. Metodologia: O grupo amostral incluiu 50 idosos e o grupo controle, 50 adultos jovens. As variáveis foram estudadas inicialmente para ambos os pés e comparadas entre os grupos, sendo posteriormente analisadas separadamente, comparando-se cada pé (direito e esquerdo) entre os grupos. A amplitude de movimento articular foi avaliada por procedimentos goniométricos validados; a posição do eixo subtalar foi avaliada pela técnica de palpação; o Foot Posture Index foi utilizado para avaliar o comportamento do pé em uma cadeia cinética fechada. O teste t de Student/teste de Mann-Whitney comparou as principais variáveis de acordo com a distribuição amostral, enquanto o teste t de Student/teste de Wilcoxon foi utilizado para amostras emparelhadas. O teste de resíduais ajustados de Haberman padronizado foi usado para a relação entre a posição do eixo da subtalar e o Foot Posture Index. Resultados: Os dados dos pés direito e esquerdo foram semelhantes para todas as variáveis. O grupo mais velho apresentou mobilidade reduzida no tornozelo e na primeira articulação metatarsofalângica (5,42 [desvio padrão ­ DP, 4,49] e 76,12 [DP, 19,24] graus, respectivamente), enquanto o grupo mais jovem apresentou valores normais (11,46 [DP, 6,49] e 97,17 [DP, 13,65], respetivamente) com valores estatisticamente significativos, (p <0,001), aferidos pelo teste de Mann-Whitney para a articulação do tornozelo e pelo teste t-Sutdent para a primeira articulação metatarsofalângica. A diferença na posição do eixo subtalar não foi significativa (p = 0,788, pela aplicação do teste de Qui-quadrado), com mais desvios internos em ambos os grupos. O Foot Posture Index diferiu significativamente entre os grupos (p = 0,006 pela aplicação do teste de Qui-quadrado), sendo a postura normal mais prevalente no grupo mais velho e a postura pronada mais prevalente no grupo mais jovem. Conclusões: Em relação aos desvios internos do eixo da articulação subtalar, o grupo mais velho apresentou maior frequência de pés na postura normal, enquanto o mais jovem apresentou maior frequência de pés pronados, o que, neste caso, corrobora a teoria do equilíbrio rotacional. Na posição normal do eixo, foi encontrada maior frequência de pés com postura normal em ambos os grupos. Em relação aos desvios externos do eixo da articulação subtalar, nenhum dos grupos seguiu o padrão esperado na teoria do equilíbrio rotacional. A relação mais consistente no grupo mais velho foi entre a posição do eixo externo e a posutra supinada do pé, enquanto no grupo mais jovem se deu entre a posição normal do eixo e a postura normal do pé

Clinical effect of peroneal fracture line in the treatment of posterior Pilon fracture / 中华骨科杂志

Objective:To investigate the clinical effect of peroneal fracture line in the treatment of posterior Pilon fracture.Methods:The data of 26 patients treated with fibular fracture line from January 2017 to July 2019 were analyzed retrospectively, including 11 males and 15 females; the age ranged from 28 to 69 years, with an average of 42.2 years. There were 10 cases of falling injury, 9 cases of falling injury and 7 cases of traffic injury; all of them were fresh closed fibular fractures;According to Yu Guangrong's classification, there were 11 cases of type I, 8 cases of type II and 7 cases of type III; AGH was divided into 10 cases of type I, 5 cases of type IIa, 2 cases of type IIb, 5 cases of type IIIa and 4 cases of type IIIb. All cases were treated by opening the fibular fracture line through the posterolateral approach, the quality of fracture reduction was evaluated by Burwell Charnley radiological evaluation standard after operation; At the last follow-up, ankle function was evaluated by American Association of Foot and Ankle surgery (AOFAS) ankle and hindfoot scores.Results:All 26 patients were followed up for 12-23 months, with an average of 14.9 months; Bone healing was achieved in all fractures. The healing time was 3-6 months, with an average of 4.0 months. The quality of fracture reduction was evaluated according to the Burwell Charnley radiology evaluation standard after operation, including anatomical reduction in 23 cases and acceptable reduction in 3 cases. The anatomical reduction rate was 88% (23/26). At the last follow-up, AOFAS ankle and hindfoot scores ranged from 80 to 100, with an average of 89.9 points, of which 17 cases were excellent and 9 cases were good, and the excellent and good rate was 100%. At the last follow-up, no patient had complications such as reduction loss, skin necrosis, infection, internal fixation loosening or ankle stiffness.Conclusion:After the treatment of Pilon fractures via peroneal fracture line, the distal tibial articular surface and posterior ankle fracture gap can be fully exposed, which can be repositioned and fixed under direct vision, with high anatomical repositioning rate and good and safe clinical results.

Endoscopic resection of symptomatic talocalcaneal coalition in adolescents using a posterior approach / 中华创伤骨科杂志

Objective:To evaluate the outcomes of endoscopic resection of symptomatic talocalcaneal coalitions in adolescents using a posterior approach.Methods:A retrospective case-series study was performed to analyze the data of 15 adolescent patients (16 feet) with symptomatic talocalcaneal coalitions (TCC) who had been treated by posterior arthroscopy from February 2017 to December 2020 at Department of Orthopaedics, Xuzhou Central Hospital. There were 11 boys and 4 girls with an average of 14.3 years (from 11 to 17 years). The left side was affected in 9 and the right side in 5 patients, and both sides were involved in one. Ten patients had a history of ankle sprain. The clinical outcomes were evaluated by visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and 36-item short form health survey (SF-36) postoperatively.Results:The 15 patients were followed up for a mean time of 19.9 months (from 12 to 36 months). At the final follow-up, the VAS significantly decreased from preoperative 6 (6, 7) points to 1 (1, 3) point, the AOFAS ankle-hindfoot score significantly increased from preoperative (54.1±10.4) points to (90.0±16.6) points, and the SF-36 score significantly improved from preoperative (55.5±12.7) points to (88.7±6.5) points ( P<0.05). Follow-ups found such complications as infection, TCC recurrence or osteoarthritis in none of the patients. Conclusion:Endoscopic TCC resection using a posterior approach is an effective surgery for symptomatic TCC in adolescents, showing advantages of limited invasion, fast recovery, a low rate of postoperative complications and precise resection.

The clinical feature and treatment strategy of the transsyndesmotic ankle fracture dislocation / 中华骨科杂志

Objective:To explore the clinical features and treatment strategies of the transsyndesmotic ankle fracture dislocation.Methods:Data of 26 patients of transsyndesmotic ankle fracture dislocation who were treated in our hospital from December 2013 to November 2020 were retrospectively analyzed. There were 16 men and 10 women with an average age of 49.54±12.81 years (range, 26-68 years). Open injuries in 17 cases, of which the Gustilo-Anderson II type in 6 cases, IIIA type in 11 cases, closed injuries in 9 cases. According to the AO/OTA fracture classification, 44B type in 4 cases, 44C type in 22 cases. According to the Lauge-Hansen classification, there were 16 cases of pronation-abduction, 10 cases of pronation-external rotation, including 4 cases of Maisonneuve fractures, and of the 4 cases of Maisonneuve fractures, there were 3 cases of double Maisonneuve fracture. The talar dislocation was anterior, neutral, and posterior within the distal tibiofibular joint in 10 cases, 7 cases, and 9 cases. Fibular fractures in 26 cases, medial malleolar fractures in 24 cases, deltoid ligament rupture in 2 cases, posterior malleolar fractures in 13 cases, and anterior malleolar fractures in 8 cases. All closed injuries were closed reduction and plaster fixation and all open injuries were emergently debridement and reduced under the tibial plafond in the emergency department. Surgical treatment was taken until the soft tissue conditions to be allowed. The reduction quality was assessed by postoperative radiography according to the criteria proposed by Burwell-Charnley. The function of the ankle joint was assessed by the ankle-hindfoot rating system of the American Orthopaedic Foot and Ankle Society (AOFAS), and the posttraumatic arthritis and objectively quantified was assessed using the Kellgren-Lawrence grading scale.Results:There were 4 cases were unreduced due to the tibial posterior tendon to flip through the ankle joint and dislocate anterior to the tibia through the interosseous membrane. Stabilization of fibular fractures were achieved with plate in 25 cases. There were 24 cases of medial malleolar fractures, and the fixation were achieved with cannulated screws in 23 cases and with K-wire fixation in 1 case. There were 12 cases of posterior malleolar fractures treated with open reduction and internal fixation including cannulated screws in 9 cases and antiglide plates in 3 cases. There were 7 cases of anterior malleolar fractures treated with open reduction and internal fixation including suture anchors in 1 case and cannulated screws in 6 cases. Stabilization of syndesmosis was achieved with syndesmotic screws in 14 cases and with TightRope in 2 cases. All patients were followed up for 20.23±9.70 months (range, 12-60 months). According to the Burwell-Charnley criteria of reduction quality, anatomic reduction was obtained in 22 cases, and satisfactory reduction was gained in 4 cases. All fractures healed in 16.31±3.64 weeks (range, 10-24 weeks). Functional examination of the ankle joint (angle measurement method): dorsiflexion average angle 10.38°±6.66°, plantarflexion average angle 34.04°±7.20°. At latest follow up, the AOFAS score was 83.30±13.94 (range, 24-100). Ten (38%) of 26 patients had radiographic evidence of posttraumatic ankle arthritis. According to the Kellgren-Lawrence grading scale criteria, there were grade I in 5 cases, II in 2 cases, III in 2 cases, and IV in 1 case. 2 cases of wound dishence were recovered through changing dressing and 2 cases of skin necrosis were recovered by skin graft and flap transposition respectively. There were no significant complications such as infection, nonunion, or implant failure.Conclusion:The transsyndesmotic ankle fracture dislocation, represents an exceptional pattern of high-energy fractures with significant syndesmotic disruption, and potential soft tissue compromise. Careful attention to radiographic findings can identify unique fracture characteristics relative to operative decision-making. Tibialis posterior tendon dislocation, a rare complication in the transsyndesmotic ankle fracture dislocation injuries, can impede anatomical reduction of the ankle mortise. The open reduction and internal fixation may be an optimal approach to treat transsyndesmotic ankle fracture dislocation injuries. However, the rate of posttraumatic arthritis is relatively high.

Arthrodesis reconstruction of distal tibia by 3D-printed porous prosthesis after malignant tumor resection / 中华骨科杂志

Objective:To evaluate the safety and short-term clinical postoperative functional outcomes of a novel 3D-printed porous prosthesis of the distal tibia for the bone defect after tumorectomy.Methods:From December 2017 to December 2019, a total of eight patients diagnosed with malignant bone tumor of the distal tibia were enrolled in this study. All cases received standard preoperative chemotherapy, after which osteosarcoma resection was performed and ankle arthrodesis was reconstructed using a 3D-printed prosthesis developed by our medical center. The contact surface between the distal part of the prosthesis and the talus is a 3D-printed porous surface, which is conducive to ankle fusion. The length of the prosthesis is adjusted by the conical mounting part of the modular prosthesis. The proximal part of the prosthesis can be fixed either biologically or with bone cement. At postoperative follow-up, the function of the fused ankle was assessed by radiographs and the monthly Musculoskeletal Tumor Society (MSTS) score.Results:Of the 8 patients, 5 were male and 3 were female, aged 8-29 years (mean 16.1±7.4 years), including 7 osteoblastic osteosarcomas and 1 telangiectatic osteosarcoma. Among the procedures, the mean length of osteotomy was 16 cm (11-20 cm). The method of fixation of the proximal part of the prosthesis included one case with 3D-printing of trabecular metal bone, one case with autogenous fibular graft, and six cases with bone cement. All patients were followed up for 7-39 months (mean 15.6±10.5 months). The distal prosthesis and talus were completely fused in all cases. The mean fusion duration was 4.3±0.7 months. The mean MSTS score was 84.2%±3.0% (mean 80%-90%). No tumor recurrence, wound complications, or prosthesis loosening were observed during the follow-up period.Conclusion:The novel 3D-printed distal tibial prosthesis is a safe and effective technique for reconstruction of a massive bone defect after tumorectomy of a malignant bone tumor, with high fusion rate, few complications, and satisfactory postoperative function.

Chaput tuberosity osteotomy and lateral malleolus sagittal osteotomy in treatment of talus osteochondral lesions with autologous osteochondral transplantation / 中华创伤骨科杂志

Objective:To evaluate the clinical outcomes of Chaput tuberosity osteotomy and lateral malleolus sagittal osteotomy in the treatment of talus osteochondral lesions with autologous osteochondral transplantation (AOT).Methods:From January 2017 to December 2019, Chaput tuberosity osteotomy and lateral malleolus sagittal osteotomy were performed in the AOT treatment of 11 patients with talus osteochondral lesions. They were 9 men 2 women, with a mean age of 32. 6 years (range, from 22 to 45 years). Their lesions were all Hepple type V. Their American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), International Knee Documentation Committee Knee Evaluation Form (IKDC) score, and imaging data were measured pre- and post-operatively for assessment of clinical outcomes.Results:All the patients were followed up for 13 to 24 months (average, 15.6 months). Their AOFAS (94.3±2.9) and VAS (1.2±0.4) scores at the final follow-up were significantly improved compared with the pre-operative values (49.5±6.6 and 5.7±1.2) ( P<0.05). There was no significant difference between their pre- and post-operative IKDC scores for the ipsilateral knee joint ( P>0.05). The imaging showed that the talus cystic change disappeared and the grafted bone was fully fused with the talus with no abnormal change in the joint space. Conclusion:In the AOT treatment of talus osteochondral lesions, Chaput tuberosity osteotomy and lateral malleolus sagittal osteotomy can obviously relieve ankle pain and improve ankle function.