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Background: Previous studies have examined the effect of concomitant triceps surae lengthening on ankle dorsiflexion motion at the time of total ankle arthroplasty (TAA). As plantarflexor muscle-tendon structures are important for producing positive ankle work during the propulsive phase of gait, caution should be exercised when lengthening triceps surae, as it may decrease plantarflexion strength. In order to develop an understanding of the work of the anatomical structures crossing the ankle during propulsion, joint work must be measured. The aim of this explorative study was to assess the effect of concomitant triceps surae lengthening with TAA on the resultant ankle joint work. Methods: Thirty-three patients were recruited to the study and divided into 3 groups of 11. The first group underwent both triceps surae lengthening (Strayer and TendoAchilles) and TAA (Achilles group), the second group underwent only TAA (Non-Achilles group), and the third group underwent only TAA, but had a greater radiographic prosthesis range of motion (Control group) compared to the first 2 groups. The 3 groups were matched in terms of demographic variables and walking speed. All patients underwent a 3D gait analysis 1 year after surgery to measure intersegmental joint work using a 4-segmented kinetic foot model. An analysis of variance (ANOVA) or Kruskal-Wallis test was used to compare the 3 groups. Results: The ANOVA showed significant differences between the 3 groups. Post hoc analyses suggested that (1) the Achilles group had less positive work at the ankle joint than the Non-Achilles and Control groups; (2) the Achilles group produced less positive work performed by all foot and ankle joints than the Control group; and (3) the Achilles and Non-Achilles groups absorbed less energy across all foot and ankle joints during the stance phase than the Control group. Conclusion: Concomitant triceps surae lengthening in TAA may reduce the positive work at the ankle joint. Level of Evidence: Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR] more...

Background: The success of total ankle replacement (TAR) must be based on restoring reasonable mechanical balance with anatomical structures that can produce mechanical joint work through elastic (eg, tendons, fascia) or viscoelastic (eg, heel pad) mechanisms, or by active muscle contractions. Yet, quantifying the work distribution across the affected joint and the neighboring foot joints after TAR is lacking. Therefore, the objective of this study was to investigate if there is a change in the joint work distribution across the Ankle, Chopart, Lisfranc and Metatarsophalangeal joints during level walking before and after patients undergo TAR. Methods: Fifteen patients with end-stage ankle osteoarthritis scheduled for primary TAR for pain relief were recruited and peer-matched with a sample of 15 control subjects. All patients underwent a 3D gait analysis before and after surgery, during which a kinetic multisegment foot model was used to quantify intersegmental joint work. Results: The contribution of the Ankle joint (P =.007) to the total foot and ankle positive work increased significantly after TAR. In contrast, a significant decrease in the contribution to the total foot and ankle joint positive work (P <.001) were found at the Chopart joint after TAR. The foot joints combined produced a significant increase in a net mechanical work from +0.01 J/kg before surgery to +0.05 J/kg after TAR (P =.006). Conclusion: The findings of this study corroborate the theoretical rationale that TAR reduces significantly the compensatory strategy in the Chopart joint in patients with end-stage ankle osteoarthritis after TAR. However, the findings also showed that the contribution of the ankle joint of patients after TAR to the total foot and ankle joint positive work remained impaired compared to the control group. [ABSTRACT FROM AUTHOR] more...

Study Objective: To validate the use of an innovative navigation method for sacrospinous fixation in surgery-like conditions as a new teaching tool and surgical method.Design: old>Two-month experimental prospective pilot study between July and August 2021.Setting: Biomechanics laboratory academic research.Patients: A total of 29 participants took part in the study: 9 gynecological surgeons and 20 participants with no medical background.Interventions: All participants used the 2 mocks-up.Measurements and Main Results: The experiment was composed of 2 training phases dedicated to improving the hand-eye coordination and suture skills on a training mock-up and of a suturing phase on a pelvic mock-up designed to recreate the surgery-like conditions of a sacrospinous fixation. The surgeons provided qualitative feedback on the bio-accuracy of the mock-ups and evaluated the ease of use of the navigation software. Nonsurgeons were included to assess the progression of the suture performance between 2 experiments performed 1 week apart (session 1 and 2). The main objective for participants was to reach a virtual target and to stitch sacrospinous ligaments. For session 1, an overall comfort score of 7.2 of 10 was attributed to the tool; 14 (42%) surgeon suture attempts and 63 (65%) nonsurgeon suture attempts were accurate (i.e., below the 5-mm threshold). Twenty-two (67%) surgeon suture attempts and 28 (34%) nonsurgeon suture attempts were fast (i.e., in the first 2 quantiles of the duration dataset). An improvement in the nonsurgeon performance was observed between the 2 sessions in terms of duration (session 1: 46 ± 20 s; session 2: 37 ± 18 s; p = .047) and distance (session 1: 3.8 ± 1.3 mm; session 2: 3.2 ± 1.4 mm; p = 10-5) for the last suturing exercise.Conclusion: This new motion capture-based navigation method for sacrospinous fixation tested under surgery-like conditions seemed to be accurate and effective. The next step will be to design a pelvis model more adapted to the constraints of a sacrospinous fixation and to validate the benefits of this method compared with current techniques. [ABSTRACT FROM AUTHOR] more...