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Background Common etiologies for post-traumatic ankle osteoarthritis are ankle fractures and chronic ankle instability. As the nature of trauma is different for these two etiologies, it might be expected that the two subtypes of post-traumatic ankle osteoarthritis would display different foot mechanics during gait. Research question The objective of this exploratory cross-sectional study was to compare the foot kinematics and kinetics of patients suffering from post-fracture ankle osteoarthritis with those of patients suffering from post-sprain ankle osteoarthritis. Methods Twenty-nine subjects with end-stage post-traumatic ankle osteoarthritis and fifteen asymptomatic control subjects participated in this study. All patients suffered from post-traumatic ankle osteoarthritis secondary to ankle-related fracture (Group 1; n = 15) or to chronic ankle instability (Group 2; n = 14). A four-segment kinematic and kinetic foot model was used to calculate intrinsic foot joint kinematics and kinetics during gait. Vector field statistical analysis MANOVA was used to assess differences between groups for the entire three-component intrinsic foot joint angles and moments. Results MANOVA showed significant differences between the groups. Post-hoc analyses suggested that the differences between post-fracture ankle osteoarthritis group and controls were caused by a combination of less adducted Shank-Calcaneus position and less plantarflexion at this joint. Post-hoc analyses also suggested that both pathological groups exhibited a decreased plantarflexion moment for Shank-Calcaneus, Chopart, Lisfranc joints compared to controls. Analyses of both pathological groups versus controls for power suggested lower Shank-Calcaneus and Lisfranc power generation during pre-swing phase. Significance No significant differences were found between the two pathological groups in this exploratory study. Alterations in foot kinematics and kinetics were mainly found about the dorsi-/plantarflexion axis during the pre-swing phase of the stance phase for both pathological groups compared to controls. Observed differences were not limited to the painful ankle joint, but seem also to have affected the kinetics of the neighbouring foot joints.

Background: Kinematic and kinetic foot models showed that computing ankle joint angles, moments and power with a one-segment foot modeling approach alters kinematics and tends to overestimate ankle joint power. Nevertheless, gait studies continue to implement one-segment foot models to assess the effect of total ankle replacement. Research question: The objective of this pilot study was to investigate the effect of the foot modeling approach (one-segment versus multi-segment) on how total ankle replacement is estimated to benefit or degrade the patient's biomechanical performance. Methods: Ten subjects with post-traumatic ankle osteoarthritis scheduled for total ankle replacement and 10 asymptomatic subjects were recruited. A one-segment and a multi-segment foot model were used to calculate intrinsic foot joints kinematics and kinetics during gait. A linear mixed model was used to investigate the effect of the foot model on ankle joint kinematic and kinetic analysis and the effect of total ankle replacement. Results: Differences in range of motion due to the foot model effect were significant for all the gait subphases of interest except for midstance. Peak power generation was significantly overestimated when computed with the one-segment foot model. Ankle and shank-calcaneus joint dorsi-/plantarflexion range of motion did not increase post-operatively except during the loading response phase. A significant 'group' effect was found for stance and pre-swing phase range of motion, with total ankle replacement patients showing lower range of motion values than controls for dorsi/plantarflexion. Significance: The outcome of this study showed that the 'foot model' had a significant effect on estimates of range of motion and power generation. The findings in our study therefore emphasize the clinical interest of multi-segment foot modeling when assessing the outcome of a therapeutic intervention.

Introduction One of the reasons for revision of total ankle replacement (TAR) implants is loosening due to subchondral cysts. Reconstruction and fusion of the ankle is often the first choice for revision procedures due to the large bone defects, which are typically filled with autograft and/or allograft. Filling the defect with a trabecular metal tantalum implant is a potential alternative given the biomechanical properties of this component. Hypothesis Using tantalum as a spacer provides primary stability and contributes to fusion of the ankle joint after removal of failed TAR implants. Methods Eleven patients underwent arthrodesis an average of 6.9 years after TAR. The mean height of the bone defect was 32 mm. It was filled with a specially designed quadrangular implant (Trabecular Metal™, Zimmer/Biomet) combined with an iliac crest graft. Ten patients underwent tibio-talo-calcaneal (TTC) arthrodesis fixed with an angled retrograde nail and one patient underwent talocrural arthrodesis fixed with two plates (anterolateral and anteromedial). The clinical, functional (AOFAS and SF36 scores) and radiological (plain X-rays and CT scan) outcomes were determined. Results At a mean follow-up of 19.3 months, the mean total AOFAS score was 56 (21–78) and the mean SF36 score was 60.5 (19–84). One patient was lost to follow-up and four patients still had pain. The tantalum implant was integrated in six patients. Five patients achieved fusion of the subtalar joint and 8 achieved fusion of the talocrural joint. Three patients required surgical revision. Discussion Our hypothesis was not confirmed. The clinical outcomes after more than 1 year of follow-up are disappointing, as was the large number of nonunion cases and the lack of tantalum integration. These technical failures can be explained by insufficient construct stability and/or insufficient implant porosity. Level of Evidence IV (retrospective cohort study).

L'ostéoblastome est une tumeur osseuse bénigne rare, qui survient chez l'adulte jeune avant 30 ans avec une nette prédominance masculine. Il se localise surtout au niveau du rachis et la diaphyse des os longs. La localisation au niveau de la cheville est exceptionnelle. Nous rapportons le cas d'un ostéoblastome de la cheville gauche chez un adulte révélé par des douleurs localisées et une impotence fonctionnelle partielle. La radiographie standard faite a été jugée strictement normale et devant la persistance des plaintes une TDM a été réalisée mais qui était trompeuse évoquant une ostéochondrite. C'est l'examen anatomopathologique effectué sur pièce opératoire qui a permis de redresser le diagnostic. Les suites chez ce patient ont été simples, le résultat fonctionnel était très satisfaisant. Notre observation est particulière par l'âge de survenue au-delà de 30 ans et par la localisation inhabituelle au niveau de la cheville. Même si des formes agressives ont été rapportées dans la littérature, le pronostic de l'ostéoblastome est bon, et les récidives peuvent être évitées par un traitement chirurgical adéquat.

Nous rapportons le cas d'un sportif de 20 ans victime d'un accident de hand-ball occasionnant une luxation pure de la cheville (A). La reduction a ete pratiquee en urgence sous anesthesie generale, la radiographie et le scanner de controle apres reduction avaient objectives une bonne congruence articulaire (B, C). Une contention par une botte plâtree fut assuree pendant six semaines. L'examen de la cheville realise apres l'ablation du plâtre n'a pas retrouve une laxite de la cheville et l'IRM de la cheville realisee a la recherche d'une lesion ligamentaire avait objectivee une integrite des ligaments peri-articulaire (D). Apres un recul de neuf mois, les resultats fonctionnels etaient excellents, sans signes d'instabilite ni d'arthrose.La luxation tibio-talienne sans fracture malleolaire associee est une lesion tres rare, souvent causee par un traumatisme de haute velocite, jusqu'a l'heure actuelle, peu de cas ont ete rapportes dans la litterature.La rarete de cette lesion peut etre expliquee par la durabilite des ligaments par rapport aux malleoles et donc lors d'un traumatisme de la cheville une fracture se produise plutot qu'une luxation.

L'instabilite chronique de la cheville est l'une des evolutions possibles dans l'histoire naturelle de l'entorse aigue de cheville. Elle represente 10% a 30% des sequelles d'entorses. Le traitement chirurgical est reserve aux patients ayant une instabilite de cheville persistante apres reeducation a l'origine d'une gene invalidante. La technique de ligamentoplastie utilisant le court fibulaire selon Castaing est la plus repondue en France. La simplicite du geste et ses bons resultats nous ont incites a poursuivre cette voie. Il s'agit d´une etude retrospective a propos de 52 patients ayant beneficie d'une ligamentoplastie au court fibulaire selon Castaing entre Janvier 2000 et Decembre 2010. Le recul minimum etait d'un an. L'evaluation des patients reposait sur le score de Karlson et le "Ankle score" Molander et Olerud. Les patients sont satisfaits ou tres satisfaits de l'intervention dans 80% des cas revus. Les resultats fonctionnels de nos patients sont comparables a ceux publies dans la litterature. Le prelevement du transplant du court fibulaire ne semble pas avoir de retentissement sur la stabilite de la cheville. Les patients conservent une eversion du pied satisfaisante avec une force comparable au cote oppose. L'evolution arthrosique de la cheville ne semble pas significative apres cette chirurgie. Le point faible de notre etude est le nombre des patients perdus de vue, cela est lie a la jeunesse de la population operee et au recrutement du service d'envergure nationale. Key words : Cheville, instabilite chronique, Castaing

For young children, biomechanical joint maturation is achieved at 4 years old for the ankle, at about 6-7 years for the knee, at 6 for the hip. These differences may involve different propulsion strategies with respect to age and particularly to increase walking speed. One hundred and six children are included in the study. Mechanical work during the stance phase was computed and an involvement ratio for each joint was deduced (work of one joint divided by the sum of the works of the three joints). Whatever the age, the biomechanical strategy to increase speed is similar for the positive work: increase of the ankle involvement and decrease of the hip involvement. The negative work is mainly produced by the knee whatever age.; Chez le jeune enfant, la maturation articulaire est atteinte à des âges différents pour la cheville (4 ans), le genou (6-7 ans) et la hanche (6 ans). Ces différences peuvent entraîner différentes stratégies de propulsion, en particulier, pour augmenter la vitesse de marche. Cent six enfants sont inclus dans l'étude. Le travail mécanique au cours de la phase d'appui est calculé et le ratio d'implication de chaque articulation est déduit (travail d'une articulation divisé par la somme des travaux des trois articulations). Quel que soit l'âge, la stratégie d'augmentation de vitesse est similaire pour le travail positif : augmentation de l'implication de la cheville, diminution de celle de la hanche. Le travail négatif est principalement fourni par le genou, pour tous les âges.

Nous rapportons le cas d'une rupture post-traumatique du tendon tibial postérieur survenue lors d'une fracture bimalléolaire de la cheville. Le diagnostic a été posé lors de l'intervention chirurgicale. La réparation du tendon, non dégénératif, a été réalisée en même temps que l'ostéosynthèse. Bien que rare, cette possibilité de lésion tendineuse lors des fractures de la cheville ne doit pas êtreoubliée. Des douleurs résiduelles, un déficit de l'inversion active du pied, une modification de l'arche médiane du pied et à terme une évolution vers un pied plat valgus doivent faire évoquer rétrospectivement le diagnostic.Pan African Medical Journal 2015; 22

Une patiente âgée de 28 ans sans antécédents pathologiques et sans notion de contage tuberculeux, a été hospitalisée pour prise en charge rééducative d'une paraparésie post-spondylodiscite tuberculeuse multi-étagée découverte devant des dorsalgies de type mixte à irradiation intercostale avec fièvre, paresthésies, lourdeurs des deux membres inférieurs, fuites urinaires, le tout évoluant depuis 8 mois. La TDM et l'IRM rachidienne (A, B, C, D) ont montré: une collection épidurale en regard de D3D4D5D6, une destruction vertébrale de D4 avec recul du mur postérieur responsable d'une déformation dorsale avec compression médullaire, une atteinte D8D9D10D11D12 avec présence d'une collection intra-osseuse, une atteinte de L5 avec une petite collection vertébrale, une opacité alvéolaire de l'hémi-champs pulmonaire gauche. L'examen a trouvé un syndrome pyramidal prédominant à droite, une paraparésie et une douleur à la mobilisation de la cheville droite avec limitation articulaire. Les radiographies standards (E,F) étaient sans anomalies. Devant ce contexte, une ostéo-arthrite tuberculeuse de la cheville a été suspectée. La patiente a eu une arthrotomie montrant une hypertrophie synoviale pour laquelle elle a eu un lavage articulaire avec une synovectomie partielle. L'origine tuberculeuse a été confirmée par l'examen anatomo-pathologique. Concernant le rachis, la patiente a eu une immobilisation par un corset cervico-dorso-lombaire pendant 6 mois. L'évolution était marquée par la disparition des rachialgies, la récupération du déficit musculaire des deux membres inférieurs, la disparition des troubles vésico-sphinctériens, la disparition des douleurs et l'amélioration des amplitudes articulaires de la cheville droite.Pan African Medical Journal 2015; 21

Background The aim of this study was to compare conventional X-rays and CT-scan in detecting peri-prosthetic osteolytic lesions, a major concern after total ankle replacement (TAR). Methods We prospectively assessed 50 patients (mean age 56 years), consecutively operated on by the same senior surgeon, between 2003 and 2006 and with a mean follow-up period of 4 years (range, 2–6.2). The component used was AES ® total ankle replacement. The etiologies for total ankle arthroplasty were: posttraumatic in 50%, osteoarthritis secondary to instability in 36%. Plain radiographs were analyzed by 4 independent observers, using a 10-zone protocol (location) and 5 size categories. Results At 4-year follow-up, all patients had been CT-scan assessed with the same protocol by 2 independent observers. Plain radiographs showed dramatic progression of severe periprosthetic lyses (>10mm): from 14% to 36% of interface cysts for the tibial component respectively at 2 and 4-year follow-up and from 4% to 30% for the talar implant. The talar component was more accurately assessed by CT-scan (mean frontal and sagittal talar lesion: from 270mm 2 to 288mm 2 for CT-scan versus 133mm 2 to 174mm 2 for X-rays). For tibial cysts, axial views showed larger lesions (313mm 2 ) than frontal (194mm 2 ) or sagittal (213.5mm 2 ) views. At 4-year follow-up, 24% of patients had revision with curetage or arthrodesis, and at 7 years follow-up 38% were revised. Conclusion These results are similar to recent AES series, justifying withdrawal of this device. CT-scan was more accurate than X-rays for detecting and quantifying periprosthetic osteolysis. We recommend a yearly radiological control and CT-scan in case of lesion on X-rays.

L 'arthrodèse de la cheville est le traitement de choix dans les atteintes articulaires importantes de la cheville afin de lui restituer une indolence parfaite et une bonne stabilité. L'objectif de notre travail est d'évaluer les résultats à moyen terme de l'arthrodèse de la cheville pour arthrose post-traumatique à travers l 'étude d 'une série de dix patients. Nous avons menu une étude rétrospective étalée entre janvier 2009 et juin 2013, portant sur dix cas d 'arthrose post-traumatique de la cheville traités par arthrodèse. Selon la technique de Méary, utilisant une voie d 'abord antérolatérale de la cheville avec une fixation par deux vis. L 'âge moyen au moment du traitement est de 45 ans. La consolidation a été obtenue dans un délai moyen de 10 semaines. Au recul moyen de 30 mois, sur les dix patients 7 se sont estimés satisfaits, 2 moyennement satisfait et un patient non satisfait vu la persistance de douleurs. Le score moyen de l 'AOFAS postopératoire est de 69,6. L 'étude de notre série, nous a permis de confirmer l'intérêt l'arthrodèse dans le traitement de l'arthrose post-traumatique de la cheville en assurant à la fois indolence et stabilité.

Introduction The benefit of ankle arthroplasty compared to arthrodesis continues to be debated, but the quality of life after these two interventions has rarely been assessed. We conducted a case-control study to compare quality of life and functional and athletic ability. Hypothesis Functional results, athletic ability, and quality of life after total ankle arthroplasty (TAA) are better than after ankle arthrodesis. Material and methods Two continuous series of 59 TAAs and 46 arthrodeses (operated on between 1997 and 2009) were evaluated retrospectively using a questionnaire including the functional items of the AOFAS score, the Foot Function Index (FFI) score, the Foot Ankle Ability Measure (FAAM), and the SF-36. Results Eighty-three responses (79% of the overall series) were matched in two groups: 32 TAAs [age at the intervention, 51.4 years (range, 21–63 years); follow-up, 52.2 months (range, 30–146 months); age at revision, 55.8 years (range, 26–67 years); BMI, 27.7 (range, 21.7–36.7)] and 22 arthrodeses [age at intervention, 50.1 years (range, 24–72 years); follow-up 57.9 months (range, 12–147 months); age at revision 54.9 years (range, 31–75 years); BMI, 26.8 (range, 17.6–37)] (NS on all items between the two groups). The pain results were better after TAA, but with no statistically significant difference: AOFAS pain, (/40) 28.1 ± 8.2 vs. 24.5 ± 9.6; FFI pain, 16.6 ± 18.8 vs. 24.3 ± 21.5. The overall FFI score (/100) was better (P = 0.048) after TAA (16.2 ± 16.5 vs. 24.8 ± 18.2). The overall mean athletic level compared to the state prior to the injury was relatively low in both groups, but significantly (p = 0.007) higher in the TAA group: FAAM sports score (/100), 49.5 ± 24.4 vs. 29.8 ± 26.2. The quality-of-life scores, SF-36 physical health, mental health, and general health were not significantly different after TAA and arthrodesis: mental health score, 63.1 ± 14.7 vs. 57.8 ± 21.5; physical health score, 61.3 ± 17.8 vs. 53.7 ± 23.9, overall score, 63.2 ± 16.4 vs. 55.9 ± 23.5. Discussion Very few publications describe activities and quality of life after TAA and arthrodesis. Despite weaknesses, this comparative study demonstrates a tendency toward better functional results after TAA than after ankle arthrodesis, without the difference between the two groups being very significant. On the other hand, there was no difference in terms of quality of life. After the doubts raised by publications on severe periprosthetic osteolysis at the intermediate term with certain TAA models, these results encourage pursuit of implantation and development of TAA. Level of proof Comparative retrospective. Level III study.

Summary Objectives After more than 10 years’ experience in France, the French Foot Surgery Association ( Association francaise de chirurgie du pied [AFCP]) presents an update on mobile-bearing ankle prostheses, based on a multicenter study. Meta-analysis – Biomechanics – Assessment and indications A preliminary comparative meta-analysis of the literature studies on ankle and prosthesis biomechanics, reviews validated indications and contra-indications, and details clinical and radiological outcomes assessment protocols. Professional survey Sixty-three surgeons (95% AFCP members) answered a professional online survey, by email or regular post: 70% performed total ankle replacement (TAR), 39% of them at least two per year and 16% more than 10 per year, resulting in 317 TARs per year or 50% of the French activity and 312 arthrodeses per year or 17% of the French activity – which gave the survey considerable power. In 2004–2005, 46% of the TARs implanted were AES ® , 38% Salto ® and 9% Hintegra ® . Gait analysis following TAR This study included two series of patients (15 in Brussels and six in Paris) with laboratory gait analysis preoperatively and at 6 months’ and 1 year's FU. Following TAR, speed, cadence and strides increased and mean total work approximated normal values. These two independent studies quantified the advantages of TAR over arthrodesis. Multicenter study This retrospective study had a minimum follow-up of 1 year. Results were not distinguished between the four types of prosthesis (approved by the French Healthcare Agency [HAS]) involved. Inclusion criteria for operators were: AFCP membership, and experience of more than 20 prostheses of a given type. Twelve out of 15 centers responded and undertook to include continuous series. Data were centralized on a dedicated anonymous online site. Five hundred and ninety-two TARs (388 Salto ® , 173 AES ® , 22 Hintegra ® , nine Star ® ) in 555 patients (mean age, 56.4 years; range 17–84 yrs) were included. Indications were post-traumatic arthritis (48%), arthritis associated with laxity (15%), inflammatory arthropathy (20%), primitive arthritis (9%), prosthetic revision (2%), and miscellaneous (5%). Sixty-one percent of operations included associated procedures: 208 Achilles lengthenings, 45 subtalar arthrodeses, nine calcaneal osteotomies and 45 lateral ligament reconstructions. Complications comprised 53 malleolar fractures, and 39 cutaneous and seven infections (9%). At a mean 37 months’ FU, 87.5% of patients were satisfied or very satisfied; mean functional score was 82.1/100; radiographic mobility, 23.2°; and total SF 36 score (on the Short Form Health Survey), 66. X-ray found stable anchorage in 98% of cases, cysts in 15%, and calcification in 4%. Revision for failure Overall cumulated survivorship was 88% at 71 months: 22 patients underwent arthrodesis (61% satisfied), and 10 implant replacement (50% satisfied). Conclusion This multioperator, multi-implant series of 592 patients confirmed literature data. Prospective follow-up of the cohorts managed in these expert centers is essential, in order to make available long-term data.

Objective This study was designed to compare the effects of different ankle taping methods on lower leg EMG and subtalar kinematics. Methods Twelve healthy volunteers were tested on an inversion platform in one of three taping conditions: non-elastic basketweave, elastic adhesive bandage wrap and non-taped control. Muscle activation and range of motion data were collected during an inversion of 35 degrees using a Biometrics® datalogger. Testing was done before and after 30 minutes of treadmill running. Results Significant differences were noted in total inversion, time to peak inversion and rate of inversion. While total inversion did not differ between tape conditions, the rate of inversion in the non-elastic condition was lower than the elastic adhesive condition, which was lower than the control. There was no effect of ankle taping style on latency of the peroneus longus. Conclusions The choice of ankle taping style can have significant effects on ankle biomechanics and the use of non-elastic tape reduces the rate of inversion. While the rate increased after 30 minutes of running, it was still lower than the other conditions.