Ankle Osteoarthritis: Biomechanical and Orthopaedic Aspects

Ankle arthritis has reached a level of significant epidemiological and health-care importance. It is assumed that ankle arthritis will increase in the next decades due to an increase of its post-traumatic etiology group. The main purposes of this investigation were (a) to provide clinical information about ankle arthritis and total ankle replacement (TAR), (b) to provide in vivo biomechanical data in order to quantify the lower leg muscle atrophy in ankle OA, (c) to quantify the muscle rehabilitation after TAR (d) and to quantify gait characteristics of subjects with ankle OA before and after TAR.

Post-traumatic ankle OA featured preferentially a varus ankle alignment. TAR improved the clinical, daily and sports function of ankle OA patients. In normal subjects, a lower leg muscle asymmetry was found for EMG and torque measurements. Ankle OA was associated with atrophy of the lower leg muscles, characterized by a torque decrease and a reduction of EMG intensity and frequency. Further, ankle OA patients showed a pathological gait pattern that was different from normal healthy subjects. Three months after TAR surgery, torque, EMG and gait results reached the highest difference to the results of normal healthy subjects. One year after surgery, TAR patients showed joint torques and EMG intensities for the affected leg that were closer to the results of normal healthy subjects. However, the preoperatively lowered EMG frequency did not change during rehabilitation. The gait characteristics of TAR patients were one year after surgery closer to normal than preoperatively.

Year	Entry
1990	Ekstrand J, Tropp H. The incidence of ankle sprains in soccer. Foot Ankle Int. August 1990;11(1):41-44.
1983	Brown TD, Shaw DT. In vitro contact stress distributions in the natural human hip. J Biomech. 1983;16(6):373-384.
1994	Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. July 1994;15(7):349-353.
1989	Lundberg A, Svensson OK, Bylund C, Goldie I, Selvik G. Kinematics of the ankle/foot complex, II: pronation and supination. Foot Ankle Int. April 1989;9(5):248-253.
2000	Stacoff A, Nigg BM, Reinschmidt C, van den Bogert AJ, Lundberg A, Stüssi E, Denoth J. Movement coupling at the ankle during the stance phase of running. Foot Ankle Int. 2000;21(3):232-239.
2002	Vertullo CJ, Nunley JA. Participation in sports after arthrodesis of the foot or ankle. Foot Ankle Int. July 2002;23(7):625-628.
1987	Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly: the Framingham Osteoarthritis Study. Arthritis Rheum. August 1987;30(8):914-918.
1994	Yeung MS, Chan K-M, So CH, Yuan WY. An epidemiological survey on ankle sprain. Br J Sports Med. June 1994;28(2):112-116.
2002	Hurwitz DE, Ryals AB, Case JP, Block JA, Andriacchi TP. The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain. J Orthop Res. January 2002;20(1):101-107.
1995	Baumhauer JF, Alosa DM, Renström PAFH, Trevino S, Beynnon B. A prospective study of ankle injury risk factors. Am J Sports Med. September–October 1995;23(5):564-570.
1980	McCullough CJ, Burge PD. Rotatory stability of the load-bearing ankle: an experimental study. J Bone Joint Surg. November 1980;62B(4):460-464.
2000	Treppo S, Koepp H, Quan EC, Cole AA, Kuettner KE, Grodzinsky AJ. Comparison of biomechanical and biochemical properties of cartilage from human knee and ankle pairs. J Orthop Res. September 2000;18(5):739-748.
1999	Shepherd DET, Seedhom BB. Thickness of human articular cartilage in joints of the lower limb. Ann Rheum Dis. January 1999;58(1):27-34.
2000	von Tscharner V. Intensity analysis in time-frequency space of surface myoelectric signals by wavelets of specified resolution. J Electromyogr Kinesiol. December 2000;10(6):433-445.
1985	Stormont DM, Morrey BF, An K-N, Cass JR. Stability of the loaded ankle: relation between articular restraint and primary and secondary static restraints. Am J Sports Med. 1985;13(5):295-300.
1978	James SL, Bates BT, Osternig LR. Injuries to runners. Am J Sports Med. 1978;6(2):40-50.
2000	Myerson MS, ed. Foot and Ankle Disorders. Philadelphia, PA: W.B. Saunders Company; 2000.
2001	van Staa TP, Dennison EM, Leufkens HGM, Cooper C. Epidemiology of fractures in England and Wales. Bone. January 2001;29(6):517-522.
2004	Hintermann B, Valderrabano V, Boss A, Trouillier HH, Dick W. Medial ankle instability: an exploratory, prospective study of fifty-two cases. Am J Sports Med. January 2004;32(1):183-190.
1982	Mack RP. Ankle injuries in athletics. Clin Sports Med. March 1982;1(1):71-84.
1977	Garrick JG. The frequency of injury, mechanism of injury, and epidemiology of ankle sprains. Am J Sports Med. December 1977;5(6):241-242.
1976	Inman VT. The Joints of the Ankle. Baltimore, MD: Williams & Wilkins; 1976.
1981	Clement DB, Taunton JE, Smart GW, McNicol KL. A survey of overuse running injuries. Phys Sportsmed. May 1981;9(5):47-58.
2000	Gelber AC, Hochberg MC, Mead LA, Wang N-Y, Wigley FM, Klag MJ. Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann Intern Med. September 5, 2000;133(5):321-328.
1989	Lundberg A, Svensson OK, Bylund C, Selvik G. Kinematics of the ankle/foot complex, III: influence of leg rotation. Foot Ankle Int. June 1989;9(6):304-309.
1989	Lundberg A, Goldie I, Kalin B, Selvik G. Kinematics of the ankle/foot complex: plantarflexion and dorsiflexion. Foot Ankle Int. February 1989;9(4):194-200.
1985	Phillips WA, Schwartz HS, Keller CS, Woodward HR, Rudd WS, Spiegel PG, Laros GS. A prospective, randomized study of the management of severe ankle fractures. J Bone Joint Surg. January 1985;67A(1):67-78.
1994	Calhoun JH, Li F, Ledbetter BR, Viegas SF. A comprehensive study of pressure distribution in the ankle joint with inversion and eversion. Foot Ankle Int. March 1994;15(3):125-133.
1973	Johnson MA, Polgar J, Weightman D, Appleton D. Data on the distribution of fibre types in thirty-six human muscles: an autopsy study. J Neurol Sci. January 1973;18(1):111-129.
2004	Brown KW, Morrison WB, Schweitzer ME, Parellada JA, Nothnagel H. MRI findings associated with distal tibiofibular syndesmosis injury. Am J Roentgen. January 2004;182(1):131-136.
1990	Kadaba MP, Ramakrishnan HK, Wootten ME. Measurement of lower extremity kinematics during level walking. J Orthop Res. May 1990;8(3):383-392.

Year

Entry

1990

Ekstrand J, Tropp H. The incidence of ankle sprains in soccer. Foot Ankle Int. August 1990;11(1):41-44.

1983

Brown TD, Shaw DT. In vitro contact stress distributions in the natural human hip. J Biomech. 1983;16(6):373-384.

1994

Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. July 1994;15(7):349-353.

1989

Lundberg A, Svensson OK, Bylund C, Goldie I, Selvik G. Kinematics of the ankle/foot complex, II: pronation and supination. Foot Ankle Int. April 1989;9(5):248-253.

2000

Stacoff A, Nigg BM, Reinschmidt C, van den Bogert AJ, Lundberg A, Stüssi E, Denoth J. Movement coupling at the ankle during the stance phase of running. Foot Ankle Int. 2000;21(3):232-239.