Bilateral lower extremity gait and function after unilateral total ankle arthroplasty: a case report.

BACKGROUND: End-stage ankle osteoarthritis is one of the leading causes of chronic disability in North America. The main purpose of this case report was to describe the functional recovery of a person following total ankle arthroplasty (TAA) surgery using the INFINITY™ system for end stage osteoarthritis of the left ankle. CASE DESCRIPTION: We report a case of a 55-year-old male who had attempted conservative management for end stage ankle osteoarthritis in his left ankle but ultimately elected to undergo TAA using The INFINITY™ Total Ankle System. He not only had significant left ankle pain limiting his daily function, but also had developed severe right knee pain. We performed gait analysis both before and 6 months after his TAA surgery to examine the sagittal and frontal-plane motions of bilateral ankle, knee, and hip joints during gait. OUTCOMES: At 6 months post-surgery, the patient demonstrated a 44-point improvement in his Foot and Ankle Outcome questionnaire scores as well as an increase in both left knee and left ankle motion in the sagittal and frontal planes. Kinematic deviations in the left ankle, hip, and knee joints during gait also reduced post-surgery. Despite improvement in his left ankle and overall function, the participant's right knee pain and altered kinematics of the right limb during gait worsened after surgery. DISCUSSION: Interventions, either before or after ankle surgery, should consider bilateral lower extremities simultaneously in order to optimize patient care and minimize future secondary complications for individuals with unilateral ankle osteoarthritis.

Increased knee flexion and varus moments during gait with high-heeled shoes: A systematic review and meta-analysis.

BACKGROUND: High-heeled shoes have been thought to alter lower extremity joint mechanics during gait, however its effects on the knee remain unclear. RESEARCH QUESTION: This systematic review and meta-analysis aimed to determine the effects of high-heeled shoes on the sagittal- and frontal-plane knee kinetics/kinematics during gait. METHODS: 1449 studies from 6 databases were screened for the following criteria: 1) healthy adult females, 2) knee joint kinematics/kinetics reported for the early stance phase during gait under varying shoe heel heights (including barefoot). Excluded studies included those mixing different shoe styles in addition to altering the heel heights. A total of 14 studies (203 subjects) met the selection criteria, resulting in 51 and 21 Cohen's d effect sizes (ESs) comparing the differences in knee sagittal- (flexion) and frontal-plane (varus) moment/angle, respectively, between shoes with higher heels and shoes with lower heels/barefoot. RESULTS: Meta-analyses yielded a significant medium-to-large effect of higher heels compared to lower heels on increasing knee flexion moment (overall ES = 0.83; P < 0.01), flexion angle (overall ES=0.46; P < 0.01), and varus moment (overall ES=0.52; P < 0.01) during the early stance phase of gait. The results of meta-regressions used to explore factors explaining the heterogeneity among study ESs revealed that a greater ES in the knee flexion moment was associated with an elevated heel height of the high-heeled shoes (P = 0.02) and greater body mass of the individuals (P = 0.012). A greater ES in the knee varus moment during high-heeled gait was associated with a greater body height (P = 0.003) and mass (P = 0.006). SIGNIFICANCE: Given the association between increased knee flexion/varus moments and risk of developing knee osteoarthritis (OA), women who wear high-heel shoes frequently and for a long period may be more susceptible to knee OA. Preventive treatments, such as lower extremity muscle strengthening, may help improve shock absorption to decrease knee loading in high-heel users.

Acromion morphology and prevalence of rotator cuff tear: A systematic review and meta-analysis.

The causes of degenerative rotator cuff (RTC) tears are unclear but certain acromion morphology may contribute. This study's objective was to determine using a systematic review and meta-analysis the association of acromion type and acromial index with the prevalence of RTC tears. Six databases were searched electronically. Seventeen relevant studies between 1993 and 2017 were included in the meta-analyses determining the association of RTC tears with acromion type (n = 11) or acromial index (n = 10). Effect sizes were calculated as an odds ratio (OR) for the studies reporting acromion type and as raw mean difference (RMD) for the studies reporting acromial index. Meta-analysis was performed using a random-effects model. There was a significant small-to-medium effect found in the meta-analysis for acromion type (overall OR = 2.82, P = 0.000003), indicating an almost three times greater odds for a RTC tear in individuals with a type-III acromion as compared with those with a type-I or -II. A significant effect was also found for acromial index (RMD = 0.071, P < 0.0000001), indicating that a larger acromial index is associated with a greater likelihood of a RTC tear. Because of substantial heterogeneity in RMD for acromial index (Q-df = 92, P < 0.00001; I2 = 89%), subgroup analyses and meta-regressions were performed. Interestingly, the continent where the study was conducted (i.e., Europe vs. Asia) was the only moderator variable that could explain some of the acromial index heterogeneity. Overall, the findings from our analyses indicate that individuals with either a type-III acromion and/or a larger acromial index have a greater likelihood for non-traumatic RTC tears. Clin. Anat. 32:122-130, 2019. © 2018 Wiley Periodicals, Inc.

Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis.

BACKGROUND: There is debate as to whether the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is beneficial after acute skeletal muscle injury. Some studies have suggested that NSAID use may be detrimental to injured muscle. PURPOSE: To determine whether NSAID use affects recovery from skeletal muscle injury as assessed by strength loss, soreness, and/or blood creatine kinase level. STUDY DESIGN: Systematic review and meta-analysis. METHODS: An extensive systematic review was completed searching 16 databases (eg, PubMed, Cochrane Library, EMBASE). Inclusion criteria were (1) acute injury to skeletal muscle, (2) use of a control condition, (3) certainty of the NSAID dose administered, and (4) use of 1 or more of the 3 desired outcome measures. A total of 5343 study reports were screened, of which 41 studies were deemed suitable for inclusion. The standardized mean difference was used as the effect size (ES) and was calculated such that a positive ES indicated NSAID efficacy. Meta-analyses were run using a random-effects model. RESULTS: For all studies, time points after injury, and injury markers combined, NSAID use was found to elicit a small to medium, significant decrease in the markers of injury (overall ES = +0.34; P = .0001). Because heterogeneity in study ES was apparent (ie, Q- df = 52.4, P = .000005; I2 = 57%), subgroup meta-analyses and meta-regressions were run in an attempt to explain the heterogeneity. In human studies, study ESs were higher when lower body muscles were injured ( P = .045). In animal studies, study ESs were lower with longer NSAID administration durations ( P = .023) and at longer follow-up times after injury ( P = .010). CONCLUSION: Overall, our analysis supports NSAID use for reducing strength loss, soreness, and blood creatine kinase level after an acute muscle injury, at least for humans and in the short term. Additional research is required to determine why NSAID use appears to be more effective when lower-body muscles in humans are injured. It would also be important to determine why NSAID use appears detrimental at later times after injury in animals but not humans.