ABSTRACT: The purpose of the present study was to document the patient self-reported improvements in quality of life, function, and overall impairment scores, as well as the improvement in the clinically derived outcome scores, following a Scandinavian Total Ankle Replacement (STAR) arthroplasty performed for the treatment of end-stage ankle arthritis.
All patients who underwent a Scandinavian Total Ankle Replacement arthroplasty from July 1998 through February 2008 were prospectively followed and retrospectively reviewed. All surgical procedures were performed by a single surgeon. Preoperatively and at subsequent follow-up visits, patients were assessed with (1) a visual analog scale (VAS) score for pain, (2) the Short Form-36 (SF-36) quality-of-life scale, (3) the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale and subscales, (4) the Buechel-Pappas pain and function scores, and (5) the ankle range of motion. Additional measures that were recorded included (1) concomitant surgical procedures during the initial ankle replacement, (2) revision surgery during the follow-up period, and (3) any additional surgical procedures. Revision was defined as failure of either the tibial or the talar metallic component that required removal of a metallic implant for any reason.
Eighty-two consecutive patients were evaluated. The duration of follow-up ranged from twenty-four to 108 months (mean, sixty-one months; median, sixty months). During the follow-up period, three patients died and six patients moved out of the region. The latter six patients were followed by another surgeon group, and their data were included. Eight patients were lost to follow-up after twelve months. There were significant improvements in all outcome categories between the preoperative and postoperative evaluations. The most compelling finding of the present study involved the marked improvement in terms of the self-reported measures of impairments, quality of life, pain, and function.
Total ankle arthroplasty with the Scandinavian Total Ankle Replacement prosthesis was associated with significant improvements in terms of pain, function, and quality of life after intermediate to long-term follow-up.
The Journal of Bone and Joint Surgery 01/2012; 94(1):43-8. · 3.27 Impact Factor
ABSTRACT: Damage to the anterior talofibular ligament (ATFL) and cacaneofibular ligament (CFL) during an ankle sprain may be linked to the development of osteoarthritis. Although altered tibiotalar kinematics have been demonstrated, the effects of lateral ankle instability (LAI) on in vivo cartilage strains have not been described. We hypothesized that peak cartilage strains increase, and the location is shifted in patients with ATFL injuries. We used 3-D MRI models and biplanar fluoroscopy to evaluate in vivo cartilage contact strains in seven patients with unilateral LAI. Subjects had chronic unilateral ATFL injury or combined ATFL and CFL injury, and were evaluated with increasing load while stepping onto a force plate. Peak cartilage strain and the location of the peak strain were measured using the contralateral normal ankle as a control. Ankles with LAI demonstrated significantly increased peak strain when compared with ATFL-intact controls. For example, at 100% body weight, peak strain was 29+/-8% on the injured side compared to 21+/-5% on the intact side. The position of peak strain on the injured ankle also showed significant anterior translation and medial translation. At 100% body weight, the location of peak strain in the injured ankle translated anteriorly by 15.5+/-7.1mm and medially by 12.9+/-4.3mm relative to the intact ankle. These changes correspond to the region of clinically observed osteoarthritis. Chronic LAI, therefore, may contribute to the development of tibiotalar cartilage degeneration due to altered cartilage strains.
Journal of biomechanics 09/2010; 43(13):2561-6. · 2.66 Impact Factor
ABSTRACT: Previous studies have suggested that injury to the anterior talofibular ligament (ATFL) may be linked to altered kinematics and the development of osteoarthritis of the ankle joint. However, the effects of ATFL injury on the in vivo kinematics of the ankle joint are unclear.
Based on the orientation of the ATFL fibers, ATFL deficiency leads to increased anterior translation and increased internal rotation of the talus relative to the tibia.
Descriptive laboratory study.
The ankles of 9 patients with unilateral ATFL injuries were compared as they stepped onto a level surface. Kinematic measurements were made as a function of increasing load. With use of magnetic resonance imaging and orthogonal fluoroscopy, the in vivo kinematics of the tibiotalar joint were measured in the ATFL-deficient and intact ankles of the same individuals.
A statistically significant increase in internal rotation, anterior translation, and superior translation of the talus was measured in ATFL-deficient ankles, as compared with the intact contralateral controls. For example, at 100% body weight, ATFL-deficient ankles demonstrated an increase of 0.9 +/- 0.5 mm in anterior translation (P = .008), an increase of 5.7 degrees +/- 3.6 degrees in internal rotation (P = .008), and a slight increase of 0.2 +/- 0.2 mm in the superior translation (P = .02) relative to the intact contralateral ankles.
Deficiency of the ATFL increases anterior translation, internal rotation, and superior translation of the talus.
Altered kinematics may contribute to the degenerative changes observed with chronic lateral ankle instability. These findings might help to explain the degenerative changes frequently observed on the medial talus in patients with chronic ATFL insufficiency and so provide a baseline for improving ankle ligament reconstructions aimed at restoring normal joint motion.
The American journal of sports medicine 08/2009; 37(11):2241-8. · 3.61 Impact Factor