Chronic deltoid ligament insufficiency repair with Internal Brace™ augmentation.

BACKGROUND: Patients with chronic deltoid ligament insufficiency (CDLI) present a challenging situation. Although numerous procedures have been described, optimal treatment is still a matter of debate. While the treatment armamentarium ranges from simple ligament repair to complex reconstructions with or without realignment osteotomies, direct repair augmented with an Internal Brace™ device appears to be an attractive intermediate option. We investigated functional outcomes and complications in patients with CDLI operated on using Internal Brace™ augmentation. METHODS: A prospective study was conducted. Patients were included if they presented medial ankle pain and/or giving way, exhibited asymmetric flexible hindfoot valgus, failed conservative treatment, and had a positive MRI evaluated by an independent radiologist. Patients with stage IV flatfoot deformity, neuropathy and/or inflammatory arthritis were excluded. CDLI was confirmed intraoperatively with the arthroscopic drive-through sign. Patients were evaluated preoperatively and postoperatively using FAAM, SF-36 and grade of satisfaction. Paired t-tests were used to assess FAAM and SF-36 scores variation. RESULTS: Thirteen patients met inclusion criteria. No patient was lost to follow-up, with a mean follow-up time of 13.5 months (range 6-21). Preoperative FAAM and SF-36 scores improved from 58.7 to 75.3 and from 60.2 to 84.4 postoperatively, respectively (p<.01). Two implant failures were observed, with no apparent compromise of construct stability. No patient was re-operated. CONCLUSIONS: Our results suggest that deltoid ligament repair with Internal Brace™ augmentation in patients with CDLI is a reliable option with good functional outcomes and high satisfaction grade in short term follow-up. LEVEL OF EVIDENCE: Level IV.

Desgaste protésico en sujetos con reemplazo articular total de tobillo HINTEGRA de origen postraumático en fase funcional / Prosthetic wear in subjects with HINTEGRA total ankle joint replacement secondary to trauma in functional phase

Objetivo: El objetivo de nuestra investigación fue describir en fase funcional, la restauración del comportamiento de las fuerzas articulares de tobillo y sus factores mecánicos durante la marcha en sujetos con reemplazo articular total de tobillo con prótesis HINTEGRA unilateral de origen postraumático. Material y métodos: Dieciséis sujetos de sexo masculino, 8 con prótesis HINTEGRA unilateral de origen postraumático y 8 sujetos sin prótesis HINTEGRA, se sometieron a un análisis de marcha. El comportamiento de las fuerzas articulares de tobillo y sus factores mecánicos fueron obtenidos. Se empleó un análisis de correlación cruzada junto a la prueba U Mann-Whitney no pareada (alfa = 0,05). Resultados: Existió significación estadística con un menor coeficiente de correlación cruzada en la fuerza articular anteroposterior, mediolateral y ambiente articular de cizalla; menor segundo peak compresivo, peak posterior, primer peak anterior, segundo peak anterior, tiempo de segundo peak vertical, peak de momento plantiflexor, y mayor tiempo de primer peak vertical en sujetos con prótesis HINTEGRA. Conclusiones: Los resultados indican que sujetos con prótesis HINTEGRA de origen postraumático presentan alteración del comportamiento de las fuerzas articulares de tobillo durante fase functional, generando una ineficiente función amortiguadora y de propulsión, creando un ambiente patomecánico de cizalla predisponente de un mayor desgaste de la interface en fase funcional

Objective: The objective of our research was to describe the recovery behavior of the ankle joint forces and their mechanical factors during gait in subjects with total ankle replacement with unilateral HINTEGRA prosthesis secondary to trauma during the functional phase. Material and methods: Sixteen male subjects, 8 with unilateral HINTEGRA prosthesis secondary to trauma and 8 subjects without HINTEGRA prosthesis underwent gait analysis. The ankle joint forces behavior and its mechanical factors during gait were obtained. A cross correlation analysis was used with a non-paired Mann-Whitney U test (alfa = 0.05). Results: There was statistical significance with a smaller cross-correlation coefficient in the anteroposterior, mediolateral joint forces and in shear force environment; lesser second compressive peak, posterior peak, first anterior peak, second anterior peak, time of the second vertical peak, plantar flexion moment peak; and a higher first vertical peak time in subjects with HINTEGRA prosthesis. Conclusions: These results suggest that subjects with HINTEGRA prosthesis secondary to trauma have impaired behavior of the ankle joint forces during the functional phase, creating an inefficient damping and propulsion function, this creating a pathomechanic shear environment that predisposes to higher wear of the interface in the functional phase