Effects of the Ankle Flexion Angle During Anterior Talofibular Ligament Reconstruction on Ankle Kinematics, Laxity, and In Situ Forces of the Reconstructed Graft

Background: This study aimed to evaluate the effects of the ankle flexion angle during anterior talofibular ligament (ATFL) reconstruction on ankle kinematics, laxity, and in situ force of a graft. Methods: Twelve cadaveric ankles were evaluated using a 6–degrees of freedom robotic system to apply passive plantar flexion and dorsiflexion motions and multidirectional loads. A repeated measures experiment was designed using the intact ATFL, transected ATFL, and reconstructed ATFL. During ATFL reconstruction (ATFLR), the graft was fixed at a neutral position (ATFLR 0 degrees), 15 degrees of plantar flexion (ATFLR PF15 degrees), and 30 degrees of plantar flexion (ATFLR PF30 degrees) with a constant initial tension of 10 N. The 3-dimensional path and reconstructed graft tension were simultaneously recorded, and the in situ force of the ATFL and reconstructed grafts were calculated using the principle of superposition. Results: The in situ forces of the reconstructed grafts in ATFLR 0 degrees and ATFLR PF 15 degrees were significantly higher than those of intact ankles. The ankle kinematics and laxity produced by ATFLR PF 30 degrees were not significantly different from those of intact ankles. The in situ force on the ATFL was 19.0 N at 30 degrees of plantar flexion. In situ forces of 41.0, 33.7, and 21.9 N were observed at 30 degrees of plantar flexion in ATFLR 0, 15, and 30 degrees, respectively. Conclusion: ATFL reconstruction with the peroneus longus (PL) tendon was performed with the graft at 30 degrees of plantar flexion resulted in ankle kinematics, laxity, and in situ forces similar to those of intact ankles. ATFL reconstructions performed with the graft fixed at 0 and 15 degrees of the plantar flexion resulted in higher in situ forces on the reconstructed graft. Clinical Relevance: Fixing the ATFL tendon graft at 30 degrees of plantar flexion results in an in situ force closest to that of an intact ankle and avoids the excessive tension on the reconstructed graft.

Association of Ankle Dorsiflexion and Landing Forces in Jumping Athletes

Background: Dorsiflexion range of motion restriction has been associated with patellar tendinopathy, but the mechanisms of how dorsiflexion restriction could contribute to knee overload remain unknown. Hypothesis: Peak ankle dorsiflexion and ankle dorsiflexion excursion are negatively associated with peak vertical ground-reaction force (vGRF) and loading rate, and with peak patellar tendon force and loading rate, and positively associated with peak ankle plantar flexor moment. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: Kinematic and kinetic data of 26 healthy recreational jumping athletes were measured during a single-leg drop vertical jump. Pearson’s correlation coefficients were calculated to establish the association between peak ankle dorsiflexion and ankle dorsiflexion excursion with peak vGRF and vGRF loading rate, with peak patellar tendon force and patellar tendon force loading rate, and with peak ankle plantar flexor moment. Results: Ankle dorsiflexion excursion negatively correlated with peak vGRF loading rate ( r = −0.49; P = 0.011) and positively correlated with peak ankle flexor plantar moment ( r = 0.52; P = 0.006). In addition, there was a positive correlation between peak ankle dorsiflexion and peak vGRF ( r = 0.39; P = 0.05). Conclusion: Ankle kinematics are associated with vGRF loading rate, ankle flexor plantar moment and peak vGRF influencing knee loads, but no association was observed between ankle kinematics and patellar tendon loads. Clinical Relevance: These results suggest that increasing ankle dorsiflexion excursion may be an important strategy to reduce lower limb loads during landings but should not be viewed as the main factor for reducing patellar tendon force.

The Turmell-Meter: In Vivo Ankle Kinematics by Using Draw-Wire and Inertial Sensors

Objective: To implement a prototype specific for human ankle kinematics studies in limited spaces, immobile, or lying down patients. Based on anatomy and anthropometry, using a screw theory model, draw-wire and inertial sensors were employed Methods: We included ankle injury studies to highlight the importance of measuring the in vivo range of motion; we studied the ankle anatomy, biomechanics, and anthropometry to estimate the size and movements of the device. We simulated the biaxial representation of ankle motion through the product of exponential mapping. Finally, we designed a structure based on trilateration by projecting tetrahedrons, an acquisition circuit with firmware and calibration software. Results: The prototype has two main parts: support and adjustable platform. We proposed a method to find the position by projecting three apexes on the base using draw-wire sensors, an acquisition board, a single-board computer, a display, Bluetooth, Wi-Fi, and two inertial measurement units. The power source had battery backup with boost and buck converters. Conclusion: We proposed an ankle model in the screw theory framework, a method for localization, and a novel device for in vivo measurements specific for lying patients on a bed, the ground, outdoors, or remote locations without complex setups. The double-battery management is robust and long lasting. Significance: The device is an alternative for measuring the range of motion in laying down patients. We will use it in modeling, diagnosis, and rehabilitation.<br>

The Turmell-Meter: In Vivo Ankle Kinematics by Using Draw-Wire and Inertial Sensors

Objective: To implement a prototype specific for human ankle kinematics studies in limited spaces, immobile, or lying down patients. Based on anatomy and anthropometry, using a screw theory model, draw-wire and inertial sensors were employed Methods: We included ankle injury studies to highlight the importance of measuring the in vivo range of motion; we studied the ankle anatomy, biomechanics, and anthropometry to estimate the size and movements of the device. We simulated the biaxial representation of ankle motion through the product of exponential mapping. Finally, we designed a structure based on trilateration by projecting tetrahedrons, an acquisition circuit with firmware and calibration software. Results: The prototype has two main parts: support and adjustable platform. We proposed a method to find the position by projecting three apexes on the base using draw-wire sensors, an acquisition board, a single-board computer, a display, Bluetooth, Wi-Fi, and two inertial measurement units. The power source had battery backup with boost and buck converters. Conclusion: We proposed an ankle model in the screw theory framework, a method for localization, and a novel device for in vivo measurements specific for lying patients on a bed, the ground, outdoors, or remote locations without complex setups. The double-battery management is robust and long lasting. Significance: The device is an alternative for measuring the range of motion in laying down patients. We will use it in modeling, diagnosis, and rehabilitation.<br>

Modeling toes contributes to realistic stance knee mechanics in three-dimensional predictive simulations of walking

Physics-based predictive simulations have been shown to capture many salient features of human walking. Yet they often fail to produce realistic stance knee mechanics and terminal stance ankle plantarflexion. While the influence of the performance criterion on the predicted walking pattern has been previously studied, the influence of the mechanics has been less explored. Here, we investigated the influence of two mechanical assumptions on the predicted walking pattern: the complexity of the foot segment and the stiffness of the Achilles tendon. We found, through three-dimensional muscle-driven predictive simulations of walking, that modeling the toes and metatarsophalangeal joints, and thus using two-segment instead of single-segment foot models, contributed to robustly eliciting physiological stance knee flexion angles, knee extension torques, and knee extensor activity. Yet modeling toe joints did not improve ankle kinematics, nor did decreasing the Achilles tendon stiffness. The lack of predicted terminal stance ankle plantarflexion thereby remains an open question. Overall, this simulation study shows that not only the performance criterion but also mechanical assumptions affect predictive simulations of walking. Improving the realism of predictive simulations is required for their application in clinical contexts. Here, we suggest that using complex models is needed to yield such realism.