Open Ankle Dislocation without Associated Malleolar Fracture on a Trampoline. A Case Report

Dislocation of the ankle without fracture is very uncommon. There are only few reports in the international literature. Up to now approximately 80 cases are published. The risk of hyperflexion and -inversion of the ankle seems high on a trampoline. A multiple of the jumperʼs body-weight projects delayed on the upper ankle joint while dipping in the trampoline-sheet. Reduction should be performed as fast as possible to ensure a good clinical outcome. Imaging via MRI and CT scan allows a detailed evaluation of the injury severity. The decision for further treatment should be based on the findings in the MRI and CT scans. Reconstructing the medial and lateral capsular ligaments can be necessary. With a consequent treatment algorithm a good functional outcome can be achieved. In our case we documented a post-traumatic AOFAS score of 87/100 six months after the injury without an instability of the upper or lower ankle joint. Propioreceptive reflex and pronator training as well as taping seem to be useful before and during trampoline sports.

Is Soleus Muscle-Tendon-Unit Behavior Related to Ground-Force Application During the Sprint Start?

Purpose:To describe the stretch-shortening behavior of ankle plantar-flexing muscle–tendon units (MTUs) during the push-off in a sprint start.Methods:Fifty-four male (100-m personal best: 9.58–12.07 s) and 34 female (100-m personal best: 11.05–14.00 s) sprinters were analyzed using an instrumented starting block and 2-dimensional high-speed video imaging. Analysis was performed separately for front and rear legs, while accounting for block obliquities and performance levels.Results:The results showed clear signs of a dorsiflexion in the upper ankle joint (front block 15.8° ± 7.4°, 95% CI 13.2–18.2°; rear block 8.0° ± 5.7°, 95% CI 6.4–9.7°) preceding plantar flexion. When observed in their natural block settings, the athletes’ block obliquity did not significantly affect push-off characteristics. It seems that the stretch-shortening-cycle-like motion of the soleus MTU has an enhancing influence on push-off force generation.Conclusion:This study provides the first systematic observation of ankle-joint stretch-shortening behavior for sprinters of a wide range of performance levels. The findings highlight the importance of reactive-type training for the improvement of starting performance. Nonetheless, future studies need to resolve the independent contributions of tendinous and muscle-fascicle structures to overall MTU performance.

Long-Term Clinical and MRI Results after Refixation of osteochondral Fractures with resorbable Implants

Aims and Objectives: Refixation with resorbable implants is a common surgical treatment in patients with an osteochondral fracture of the knee or the upper ankle joint. Up to date there are no studies, which outline long-term outcome of this procedure. As a consequence aim of this study was to evaluate the long-term clinical und MRI results. Materials and Methods: In this study 12 patients were examined 13,9 (#CHR: plusmn# 1,2) years after refixation of an osteochondral fragment of the knee (10) and the upper ankle joint (2) with a mean size of 3.16 cm² (#CHR: plusmn# 2,27) by resorbable implants (SmartNail, Conmed). We used eight established clinical scores (VASS, Tegner, Lysholm, McDermott, KSS, WOMAC, AOFAS, FADI+Sports). Furthermore we ascertained integration of bone and cartilage morpholgy by MRI (3 Tesla) using proton-weighted- and cartilage-sensitive double-echo-steady-state (DESS) sequences. To identify a possible osteonecrosis we used T1-weighted sequences with a contrast agent (Gadolinum). The morphologic results were objectified with a modified MRI-Score based on Henderson et al. (2003). Results: After 13,9 (#CHR: plusmn# 1,2) years the patients with an injury of the knee as well as of the upper ankle joint showed good to excellent results (Knee: VASS: 1,3 (#CHR: plusmn# 1,7); Tegener 4,4 (#CHR: plusmn# 1,3); Lysholm 85,7 (#CHR: plusmn# 12,2); McDermott 90,7 (#CHR: plusmn# 8,6); KSS 189 (#CHR: plusmn# 15,9); WOMAC (6,16% (#CHR: plusmn# 8,45)) (Upper Ankle joint: VASS: 2,5 (#CHR: plusmn# 2,5); Tegener 5,5 (#CHR: plusmn# 1,5); Lysholm 87 (#CHR: plusmn# 13), McDermott 88 (#CHR: plusmn# 12); WOMAC (8,54% (#CHR: plusmn# 8,54); AOFAS 75,5 (#CHR: plusmn# 24,5); FADI+Sports 118 (#CHR: plusmn# 18)). There was a good integration of the osteochondral fragment in all cases in the MRI. 5 patients showed moderate subchondral cysts. There were changes of the cartilage contour in all patients. The mean Henderson-Score was 14,4 (#CHR: plusmn# 2,0) (Best: 8, Worst: 32), which correlates with good results. Conclusion: Because of its good clinical and MRI results the refixation by resorbable implants can be recommended to treat osteochondral flakes.

Finite Element Analysis Of Large Deformation Of Articular Cartilage In Upper Ankle Joint Of Occupant In Military Vehicles During Explosion

The paper presents the analysis of the load of lower limbs of occupants in the armoured military vehicle, which has been destroyed by detonation of the Improvised Explosive Device (IED) charge under the vehicle. A simplified model of the human lower limb focused on upper ankle joint was developed in order to determine the reaction forces in joints and load in particular segments during the blast load. The model of upper ankle joint, include a tibia and an ankle bone with corresponding articular cartilage, has been developed. An analysis of the stress distribution under the influence of forces applied at different angles to the biomechanical axis of a limb has been performed. We analyzed the case of the lower limb of a sitting man leaning his feet on the floor. It has been shown that during a foot pronation induced by a knee outward deviation, the axial load on the foot causes significantly greater tension in the tibia. At the same time it has been shown that within the medial malleolus, tensile stresses occur on the surface of the bone which may lead to fracture of the medial malleolus. It is a common case of injuries caused by loads on foot of passengers in armored vehicles during a mine or IED load under the vehicle. It was shown that the outward deviation of the knee increases the risk of the foot injury within the ankle joint.

Upper ankle ligament rupture and long term problems in a patient with Ehlers Danlos Syndrome — a case report

Rupture of the upper ankle joint ligaments is a common injury. Therapy in patients with Ehlers Danlos Syndrome (EDS) is a challenge due to the autosomal-dominant collagenopathy. Therapeutic recommendations and long term results in treatment of patients with EDS are rare. Therefore uncertainty exists. We present a case of clinical and radiologic long term results after ligament rupture of the upper ankle joint in a patient with EDS. A literature review tries to reveal current therapeutic strategies in patients with EDS.

Behandlungsalgorithmus der hämophilen Arthropathie des oberen Sprunggelenkes

SummaryThe upper ankle joint is one of the targetjoints of the haemophilic patient. Therefore, the secondary arthritis of the upper ankle joint is one of the most frequent forms of haemophilic arthropathy. It is a secondary form of arthritis not only because of chronic synovitis and cartilage injury resulting from chronic recurrent intraarticular bleeds, but also due to the misalignment of the joint and abnormal joint stress. The consequences are manifest even in young patients and finally lead to upper ankle joint arthritis. In such clinical situations, the upper ankle joint-arthroplasty is a viable alternative to arthrodesis. After several years of bleeding of the upper ankle joint many patients with haemophilia suffer from symptomatic arthritis. Open joint cleansing considerably improves mobility in the upper ankle joint and alleviates the pain in the talonavicular joint. However, the recovered mobility of the arthritic upper ankle joint also activates arthritis, associated with severe pain. With no contraindication to upper ankle joint replacement, a cement-free prosthesis can be implanted. Three months after surgery, the patients are mobile, with good foot rolling properties without orthopaedic aids and without pain in the upper joint ankle. Concludion: In terms of biomechanics the upper ankle joint-arthroplasty is a superior alternative to arthrodesis in haemophilia patients. In order to minimize the complication rate, their treatment should be restricted to specially equipped interdisciplinary centers with adequately trained and experienced surgeons as well as haemostaseologists.