Infrared assessment of knee instability in ACL deficient patients.

PURPOSE: Previous clinical studies have shown that anterior cruciate ligament (ACL) ruptures require reconstructive surgery. The main goal of this study is an objective test definition for unstable knee diagnosis based on real measurements by using infrared cameras and adequate software. METHODS: In the study of gait analysis 35 males with deficient ACL's participated. Pathological parameters for anterior posterior translation (APT) and internal external rotation (IER) and their values of kinematic data were obtained from a gait analysis 3D system. Movement curves were obtained by recording the position of fluorescent markers over time. A machine learning algorithm was developed in order to support decisions on the severity of the ACL injury and its corresponding deficiency. The algorithm was based on logistic regression. RESULTS: The value of APT, designated as exponentiation of the Ó¨ coefficient (Exp (Ó¨)) of APT, showed that the likelihood of ACL-deficient knee occurrence due to higher values of APT is 1.1758 (95 % CI) times more frequent than that of the patients with lower values of APT. The value of IER, designated as Exp (Ó¨) of IER, showed that the patients with higher values of IER present 2.2516 (95 % CI) times higher values of ACL-deficient knee frequency than those with lower values. CONCLUSION: This study showed that the creation of ordered pairs of pathological parameters gives a wider picture of ACL deficiency and that such an algorithm may improve both examination and treatment of patients.

Clubfoot in children.

Clubfoot, or talipes equinovarus, is a deformity consisting of equinus, varus, and adductus foot deformity. The true etiology of congenital clubfoot is unknown; several theories have been proposed. The pathology of the individual bones contributes to the clubfoot deformity and soft tissue contractures around the ankle and talocalcaneonavicular joint maintains the deformity and involve muscles, tendons, tendon sheaths, ligaments and joint capsules. Various treatment regimens have been proposed, including the use of corrective splinting, taping, and casting. Surgery in clubfoot is indicated for deformities that do not respond to conservative treatment by serial manipulation and casting. Surgery in the treatment of clubfoot must be tailored to the age of the child and to the deformity to be corrected. The main goals of treatment is the painless, functional and anatomical normal foot without need for custom made footwear, and those can be achieved after detailed, indivudial approach with great experience in pediatric orthopedics.

Flatfoot in children.

Foot arches are defined by the position of bones and stabilized by active and passive soft tissue structures. The most significant foot arches are longitudinal, medial and lateral. During lifetime they develop and change, while the most significant disorder represents the flatfoot. During the first two years of life, the flatfoot in full weight bearing position is considered a normal physiological condition, while in later age it represents a deformity requiring additional diagnostics and treatment. The flexible flatfoot is caused by ligamentous laxity, it is mostly pain-free and is treated symptomatically (prescription of adequate shoes and kinesitherapy). The rigid foot is most often caused by bone changes (tarsal coalition, vertical congenital talus) occurring idiopathically or within neuromuscular pathological conditions, with mostly present pain problems. In such cases treatment is also initiated by non-surgical methods, however, some type of surgical treatment is most frequently necessary to be used.

Hallux valgus.

Hallux valgus is a complex deformity of the forefoot. Beside the lateral deviation of the first metatarsophalangeal joint angle exceeding 15-20 degrees and intermetatarsalvarus exceeding 8-9 degrees, it is also characterized by extensive changes of the soft tissue arch, sesamoid mechanism and metatarsocuneiform joint. It occurs almost exclusively in humans wearing shoes. Although in some measure it can be treated non-operatively, by corrective separators and inserts, operative treatment is predominant. There are numerous operative procedures aimed at the correction of the deformity and inducing normal biomechanics of the forefoot. There are seven conceptually different procedures starting from simple bunionectomy, through various soft tissue procedures, metatarsal and phalangeal osteotomies, to resection arthroplasty and metatarsophalangeal arthrodesis. All have clear indications, and none of them has advantages over the others. In accordance with the etiopathogenesis of the disease prevention is easy; wearing comfortable shoes.