Football injuries of the ankle: A review of injury mechanisms, diagnosis and management.

Football is the most popular sport worldwide and is associated with a high injury rate, most of which are the result of trauma from player contact. Ankle injuries are among the most commonly diagnosed injuries in the game. The result is reduced physical activity and endurance levels, lost game time, and considerable medical cost. Sports medicine professionals must employ the correct diagnostic tools and effective treatments and rehabilitation protocols to minimize the impact of these injuries on the player. This review examines the diagnosis, treatment, and postoperative rehabilitation for common football injuries of the ankle based on the clinical evidence provided in the current literature.

Anterolateral tibial osteotomy for accessing osteochondral lesions of the talus in autologous osteochondral transplantation: functional and t2 MRI analysis.

BACKGROUND: Autologous osteochondral transplantation (AOT) is a primary treatment strategy for large or cystic osteochondral lesions of the talus (OLT) or a secondary replacement strategy after failed bone marrow stimulation. The technique requires perpendicular access to the talar dome, which is often difficult to obtain for posterior or lateral lesions. Traditional methods to access these areas have required disruption of the syndesmotic complex with concern over osteotomy reduction, malalignment, and ligament disruption. An alternate to these traditional methods of access is an anterolateral tibial osteotomy. The purpose of this study was to report functional and magnetic resonance imaging (MRI) outcomes in a series of patients that underwent AOT for treatment of an OLT via an anterolateral tibial osteotomy. METHODS: Records of patients that underwent an anterolateral tibial osteotomy for AOT were retrospectively reviewed. Pre- and postoperative Foot and Ankle Outcome Scores (FAOS) and demographic data were recorded. Magnetic resonance observation of cartilage repair tissue (MOCART) was used to assess morphologic state of tibial cartilage at the repair site of the osteotomy. Quantitative T2 mapping MRI was analyzed in the superficial and deep cartilage layers of the repair site of the osteotomy and in adjacent normal cartilage to serve as control tissue. Seventeen patients with a mean age of 36.9 (range, 17-76) years underwent anterolateral tibial osteotomy with a mean follow-up of 64 (range, 29 to 108) months. MOCART data were available in 9 of 17 patients, and quantitative T2 mapping was available in 6 patients. RESULTS: FAOS significantly improved from an average 39.2 (range, 14 to 66) out of 100 points preoperatively to 81.2 (range, 19 to 98) postoperatively (P < .01). The average MOCART score was 73.9 out of 100 points (range, 40 to 100). Quantitative T2 analysis demonstrated relaxation times that were not significantly different from the normal native cartilage in both the deep half and superficial half of interface repair tissue (P > .05). CONCLUSION: This study demonstrated that the anterolateral tibial osteotomy was a reasonable alternative for accessing centrolateral or posterolateral OLT for AOT with limited morbidity associated with the osteotomy. The evidence demonstrated adequate osteotomy and cartilaginous healing with improvement in functional outcome scores at medium-term follow-up. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Dark-field hyperspectral X-ray imaging.

In recent times, there has been a drive to develop non-destructive X-ray imaging techniques that provide chemical or physical insight. To date, these methods have generally been limited; either requiring raster scanning of pencil beams, using narrow bandwidth radiation and/or limited to small samples. We have developed a novel full-field radiographic imaging technique that enables the entire physio-chemical state of an object to be imaged in a single snapshot. The method is sensitive to emitted and scattered radiation, using a spectral imaging detector and polychromatic hard X-radiation, making it particularly useful for studying large dense samples for materials science and engineering applications. The method and its extension to three-dimensional imaging is validated with a series of test objects and demonstrated to directly image the crystallographic preferred orientation and formed precipitates across an aluminium alloy friction stir weld section.

Non-invasive imaging of the crystalline structure within a human tooth.

The internal crystalline structure of a human molar tooth has been non-destructively imaged in cross-section using X-ray diffraction computed tomography. Diffraction signals from high-energy X-rays which have large attenuation lengths for hard biomaterials have been collected in a transmission geometry. Coupling this with a computed tomography data acquisition and mathematically reconstructing their spatial origins, diffraction patterns from every voxel within the tooth can be obtained. Using this method we have observed the spatial variations of some key material parameters including nanocrystallite size, organic content, lattice parameters, crystallographic preferred orientation and degree of orientation. We have also made a link between the spatial variations of the unit cell lattice parameters and the chemical make-up of the tooth. In addition, we have determined how the onset of tooth decay occurs through clear amorphization of the hydroxyapatite crystal, and we have been able to map the extent of decay within the tooth. The described method has strong prospects for non-destructive probing of mineralized biomaterials.

A laboratory system for element specific hyperspectral X-ray imaging.

X-ray tomography is a ubiquitous tool used, for example, in medical diagnosis, explosives detection or to check structural integrity of complex engineered components. Conventional tomographic images are formed by measuring many transmitted X-rays and later mathematically reconstructing the object, however the structural and chemical information carried by scattered X-rays of different wavelengths is not utilised in any way. We show how a very simple; laboratory-based; high energy X-ray system can capture these scattered X-rays to deliver 3D images with structural or chemical information in each voxel. This type of imaging can be used to separate and identify chemical species in bulk objects with no special sample preparation. We demonstrate the capability of hyperspectral imaging by examining an electronic device where we can clearly distinguish the atomic composition of the circuit board components in both fluorescence and transmission geometries. We are not only able to obtain attenuation contrast but also to image chemical variations in the object, potentially opening up a very wide range of applications from security to medical diagnostics.

A new approach to synchrotron energy-dispersive X-ray diffraction computed tomography.

A new data collection strategy for performing synchrotron energy-dispersive X-ray diffraction computed tomography has been devised. This method is analogous to angle-dispersive X-ray diffraction whose diffraction signal originates from a line formed by intersection of the incident X-ray beam and the sample. Energy resolution is preserved by using a collimator which defines a small sampling voxel. This voxel is translated in a series of parallel straight lines covering the whole sample and the operation is repeated at different rotation angles, thus generating one diffraction pattern per translation and rotation step. The method has been tested by imaging a specially designed phantom object, devised to be a demanding validator for X-ray diffraction imaging. The relative strengths and weaknesses of the method have been analysed with respect to the classic angle-dispersive technique. The reconstruction accuracy of the method is good, although an absorption correction is required for lower energy diffraction because of the large path lengths involved. The spatial resolution is only limited to the width of the scanning beam owing to the novel collection strategy. The current temporal resolution is poor, with a scan taking several hours. The method is best suited to studying large objects (e.g. for engineering and materials science applications) because it does not suffer from diffraction peak broadening effects irrespective of the sample size, in contrast to the angle-dispersive case.

A rotational scarf osteotomy decreases troughing when treating hallux valgus.

BACKGROUND: The traditional scarf osteotomy has been associated with complication rates between 1.1% and 45%. We have modified the traditional technique with a rotational osteotomy to reduce these complications. QUESTIONS/PURPOSES: We determined whether a modified rotational scarf osteotomy improves functional outcome scores, allows correction of a wide degree of an intermetatarsal (IM) angle deformity, has a low incidence of troughing, and maintains normal ROM postoperatively in the treatment of symptomatic hallux valgus (HV). PATIENTS AND METHODS: We retrospectively reviewed 140 patients: 38 men and 102 women with a mean age of 54 years (range, 35-66 years) who underwent surgery for HV and had a minimum followup of 24 months (mean, 41 months; range, 24-68 months). All patients had preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) forefoot and Short Form (SF)-36 V2 outcome scores recorded. RESULTS: The mean AOFAS score improved from 52 points preoperatively to 92 points (range, 71-96 points) at followup. The mean SF-36 V2 score improved from 69 points preoperatively to 94 points (range, 67-98 points) at followup. The IM angle improved from a preoperative mean of 18° (range, 9°-23°) to a mean of 8° (range, 6°-12°). Eleven patients experienced a complication. CONCLUSIONS: The modified rotational scarf osteotomy has a low complication rate (9%) and apparently reduces the risk of troughing. This procedure can reduce a high degree of IM angle deformity while restoring function to the forefoot. LEVEL OF EVIDENCE: Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

Ankle instability in sports.

Ankle stability is integral to normal motion and to minimizing the risk of ankle sprain during participation in sport activities. The ability of the dynamic and static stabilizers of the ankle joint to maintain their structural integrity is a major component of the normal gait cycle. In sports, this quality assumes even greater importance given the range of movement and stresses imposed on the ankle during various sporting disciplines. In the general population, the incidence of ankle sprain is very high. In several studies, injuries to the lateral ankle ligaments have been shown to be the most common sports-related injuries, accounting for approximately 25% of all sports-related injuries. Furthermore, up to 80% of all ankle sprains involve the lateral ligament complex. Other studies have estimated their incidence as approximately 5000 injuries per day in the United Kingdom and 23 000 in the United States. Aggressive treatment of the sprained ankle is essential to maintain foot and ankle mobility and prevent prolonged disability and subsequent overuse injuries among athletes, both professional and "weekend warriors" alike.

Effects of experience on the coordination of internally and externally timed soccer kicks.

The authors investigated differences in the soccer kick between 8 experienced and 10 less experienced participants in 2 different task conditions (kicking a stationary ball or a moving ball at a target). The experienced participants were more accurate than their less experienced counterparts, whereas there were no differences in maximum foot velocity between groups or between conditions. When compared with their performance in the stationary condition, participants kicked the moving ball with a smaller range of movement at the knee of the kicking leg, maintaining a proximodistal coordination pattern. Because of their significantly shorter knee-flexion phase, the participants in the experienced group displayed a significantly shorter time between initiation of the forward swing of the kick and ball contact than that of those in the less experienced group. The rapid knee flexion may have been a strategy of exploiting passive dynamics to increase accuracy rather than velocity. Members of both groups showed a proximodistal initiation sequence in the kicking leg, which suggests that players can acquire that coordination pattern with relatively little structured practice and that further practice leads to improvement possibly through the increased exploitation of passive dynamics.

Mouse genomic representational oligonucleotide microarray analysis: detection of copy number variations in normal and tumor specimens.

Genomic amplifications and deletions, the consequence of somatic variation, are a hallmark of human cancer. Such variation has also been observed between "normal" individuals, as well as in individuals with congenital disorders. Thus, copy number measurement is likely to be an important tool for the analysis of genetic variation, genetic disease, and cancer. We developed representational oligonucleotide microarray analysis, a high-resolution comparative genomic hybridization methodology, with this aim in mind, and reported its use in the study of humans. Here we report the development of a representational oligonucleotide microarray analysis microarray for the genomic analysis of the mouse, an important model system for many genetic diseases and cancer. This microarray was designed based on the sequence assembly MM3, and contains approximately 84,000 probes randomly distributed throughout the mouse genome. We demonstrate the use of this array to identify copy number changes in mouse cancers, as well to determine copy number variation between inbred strains of mice. Because restriction endonuclease digestion of genomic DNA is an integral component of our method, differences due to polymorphisms at the restriction enzyme cleavage sites are also observed between strains, and these can be useful to follow the inheritance of loci between crosses of different strains.