Kinetic and kinematic evaluation of the ankle joint after achilles tendon reconstruction with free semitendinosus tendon graft: preliminary results.

Chronic rupture of the Achilles tendon (AT) is a surgical challenge and has effects on the gait. The purpose of this study was to evaluate the kinetic and kinematic parameters of the ankle joint in patients with AT rupture operated using a free semitendinosus tendon graft. Thirteen patients were analyzed 6 and 12 months after surgery in a force platform, while the movements were recorded by six infrared cameras. The kinematic variables analyzed included speed, cadence, step length, percentage of stance phase, and range of movement (ROM) of the ankle joint in the sagittal and frontal planes. Kinetic data were obtained by joint movement in different phases of the gait cycle. Functional assessment was performed using the American Orthopaedic Foot and Ankle Society (AOFAS) score. The patients showed a significant increase (P = 0.0215) in AOFAS from 68.5 (±18.7) to 85.2 (±18.0). Speed, cadence, and length of step of the four groups (1A, 1B, 2A, 2B) were lower than the control group (group 3), and the percentage in stance phase was higher for the nonoperated foot 6-month group (1B) compared to the control group (group 3). For the kinematic data, the ROM of the ankle in stance phase increased from 6 to 12 months showing an effect of time between four groups (1A, 1B, 2A, 2B). During swing phase, the ankle ROM was lower in the operated side (effect of side, P = 0.0255) and groups 1A and 2A demonstrated statistical differences when compared with the control group (group 3) (P = 0.0240 and P = 0.0414, respectively). ROM of inversion and eversion presented effect of time among the same groups (P = 0.0059) cited before. There were no differences in kinetic data between groups. This study showed close proximity between the control group and the operated group. Furthermore, improvement was shown when comparing the 6 and 12 months postsurgery periods. The surgical procedure is therefore helpful for the patient and few changes were present in gait and ankle biomechanics.

Anatomical and functional study of the medial collateral ligament complex of the elbow.

OBJECTIVE: To carry out an anatomical study of the medial collateral ligament, an important elbow stabilizer in different degrees of elbow flexion-extension. METHODS: Forty elbows were dissected in order to analyze the functional behavior of the anterior, posterior and transverse ligament bands during valgus stress maneuvers of the elbow in different degrees of flexion and extension. Two groups were determined; in the group GPA the posterior band of the ligament was sectioned initially, then the articular capsule and finally the anterior band; in group GAP this order was reversed. RESULTS: Instability was observed in GPA only in the third stage, when there was a greater mean elbow's opening during the flexion (between 50° and 70°); in GAP, the instability was present since the first stage; the degrees of flexion with greater instability were the same as in group GPA. CONCLUSION: The anterior band of the medial collateral ligament of the elbow is the most important stabilizer of the elbow valgus instability, and its principal action occurs between 50° and 70° of elbow flexion. Level of Evidence III, Diagnostic Studies - Investigating a diagnostic test.

Vascular density of the posterior tibial tendon: a cadaver study.

BACKGROUND: Degenerative pathology of the posterior tibial tendon, a common cause of foot and ankle dysfunction, frequently affects women over 40 years of age. Its etiology is still controversial. The literature reports decreased vascularization coinciding with the most common site of the lesion, near the medial malleolus. METHODS: Forty pairs of PTT obtained from human cadavers were transversally cut into six levels, from the musculotendon transition to its insertion point. In each segment, a histologic cut was made and stained with Masson's trichrome allowing viewing of the vascular structure of the tendon under a light microscope. By using an integrating eyepiece on the microscope, vascular density was calculated. This verified any variation of the vascular concentration in the normal tendon, a possible cause of its degeneration. RESULTS: When the results were compared by side, sex, and age, no statistically significant difference was observed. When the levels were compared, no area of decreased vascularization was seen in the midportion of the tendons, the most common site of degeneration of the posterior tibial tendon. CONCLUSION: These results indicate that an area of decreased vascularity is not a factor in degeneration of the posterior tibial tendon at the medial malleolus.

Pedobarometric evaluation of the normal adult male foot.

Static and dynamic pedobarometric evaluations were performed on the feet of 100 normal adult white men aged from 20 to 49 years old (mean = 29.9 +/- 6.9), using version 3.848 of the F-SCAN system. All evaluations were performed using new pressure sensor insoles with standardized conditions. Maximum vertical forces and plantar peak pressure measurements were taken during 7.88 seconds each of walking in a straight line at subject's own pace and standing. Feet were separated based on their side and lower limb dominance. The means of three consecutive and three alternate tests provided quantitative data. Maximum static and vertical dynamic forces were found to be greater on the dominant side and were significantly correlated with body weight. There were significant differences between dominant and non-dominant sides in static plantar peak pressure evaluations at the forefoot and midfoot, and in the dynamic evaluations at the midfoot. There was a significant correlation between dynamic plantar peak pressures at the midfoot and body weight.