Lateral ankle sprains are a common musculoskeletal injury. The anterior talofibular ligament (ATFL) is the primary ligament involved and is assessed via an anterior drawer test. Clinically assessing joint laxity has been a subjective task. Evaluating both magnitude of translation and quality of the endfeel has presented challenges. Until recently, a reliable and valid arthrometer to test joints other than the knee has not been available. The Mobil-Aider arthrometer has undergone bench testing for validity, reliability testing in healthy persons, and most recently the testing of participants for pathology. A summary of these studies is available in the Online Supplement . The goal of this study was to determine the ability of the arthrometer to objectively identify the anterior translation of the ankle and the relationship to the clinical diagnosis. The participant was evaluated by a physician and magnitude of ankle sprain was determined. An arthrometer was used to perform an anterior drawer test (uninjured before injured, 3 measures each) in the prone position. Both clinicians were blinded to the data of the other. There were 30 participants, 10 per group (uninjured, 1° sprain, 2° sprain). Mann-Whitney U testing found significant differences between the control and grade 1 ankle sprain groups ( P < .001), the control and grade 2 ankle sprain groups ( P < .001), and the grade 1 and grade 2 ankle sprain groups ( P = .004). There was ± 0.31 mm difference in anterior translation between healthy ankles, whereas there was 1.11 mm and 2.16 mm difference between ankles in grade 1 and grade 2 sprains, respectively. The anterior drawer test is the gold standard for clinical ATFL testing, but the subjective nature of this test poses challenges. Technology is available to assess ankle joint laxity and enhance the objectivity of patient assessment and throughout the recovery process. An arthrometer is a valuable tool in quantifying orthopaedic examination.
Lateral ankle sprains are a common musculoskeletal injury across a variety of activities. Researchers have sought to identify a method to objectively assess joint laxity with a device that is simple to use and affordable.
The purpose of this study was to assess the use of an ankle arthrometer on individuals with ankle sprains.
The participant was evaluated by the physician and the degree of ankle sprain was identified. In the prone position, the arthrometer was used to perform an anterior drawer test (uninjured before injured, 3 measures each). Both clinicians were blinded to the data of the other.
There were 30 participants, 10 in each group (uninjured, grade 1 sprain, grade 2 sprain). Mann-Whitney U testing found significant differences between the control and grade I ankle sprain groups (P < .001), the control and grade II ankle sprain groups (P < .001), and the grade I and grade II ankle sprain groups (P = .004). There was ±0.31-mm difference in anterior translation between healthy ankles, whereas there was 1.11- and 2.16-mm difference between ankles in grade 1 and grade 2 sprains, respectively.
Despite the manual anterior drawer test being convenient, the subjectivity makes it unreliable. This study is consistent with prior literature about the difference in translation (millimeters) between the uninjured and injured ankles corresponding to the magnitude of ankle laxity. This study also contributes to the evolving evidence to support the relationship of a ratio of measures (injured/uninjured) as an objective measure of laxity. These comparisons to the individual’s healthy ankle mitigate the variability of the normative values. The use of an arthrometer to assess ankle joint laxity enhances the objectivity of patient assessment throughout the recovery process.
Level III
- NSF-PAR ID:
- 10381982
- Publisher / Repository:
- SAGE Publications
- Date Published:
- Journal Name:
- Foot & Ankle Specialist
- ISSN:
- 1938-6400
- Page Range / eLocation ID:
- Article No. 193864002211258
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
More Like this
-
more » « less
-
more » « less
Background: Graft placement is a modifiable and often discussed surgical factor in anterior cruciate ligament (ACL) reconstruction (ACLR). However, the sensitivity of functional knee mechanics to variability in graft placement is not well understood.
Purpose: To (1) investigate the relationship of ACL graft tunnel location and graft angle with tibiofemoral kinematics in patients with ACLR, (2) compare experimentally measured relationships with those observed with a computational model to assess the predictive capabilities of the model, and (3) use the computational model to determine the effect of varying ACL graft tunnel placement on tibiofemoral joint mechanics during walking.
Study Design: Controlled laboratory study.
Methods: Eighteen participants who had undergone ACLR were tested. Bilateral ACL footprint location and graft angle were assessed using magnetic resonance imaging (MRI). Bilateral knee laxity was assessed at the completion of rehabilitation. Dynamic MRI was used to measure tibiofemoral kinematics and cartilage contact during active knee flexion-extension. Additionally, a total of 500 virtual ACLR models were created from a nominal computational knee model by varying ACL footprint locations, graft stiffness, and initial tension. Laxity tests, active knee extension, and walking were simulated with each virtual ACLR model. Linear regressions were performed between internal knee mechanics and ACL graft tunnel locations and angles for the patients with ACLR and the virtual ACLR models.
Results: Static and dynamic MRI revealed that a more vertical graft in the sagittal plane was significantly related ( P < .05) to a greater laxity compliance index ( R2= 0.40) and greater anterior tibial translation and internal tibial rotation during active knee extension ( R2= 0.22 and 0.23, respectively). Similarly, knee extension simulations with the virtual ACLR models revealed that a more vertical graft led to greater laxity compliance index, anterior translation, and internal rotation ( R2= 0.56, 0.26, and 0.13). These effects extended to simulations of walking, with a more vertical ACL graft inducing greater anterior tibial translation, ACL loading, and posterior migration of contact on the tibial plateaus.
Conclusion: This study provides clinical evidence from patients who underwent ACLR and from complementary modeling that functional postoperative knee mechanics are sensitive to graft tunnel locations and graft angle. Of the factors studied, the sagittal angle of the ACL was particularly influential on knee mechanics.
Clinical Relevance: Early-onset osteoarthritis from altered cartilage loading after ACLR is common. This study shows that postoperative cartilage loading is sensitive to graft angle. Therefore, variability in graft tunnel placement resulting in small deviations from the anatomic ACL angle might contribute to the elevated risk of osteoarthritis after ACLR.
-
INTRODUCTION: In practice, the use of a whip stitch versus a locking stitch in anterior cruciate ligament (ACL) graft preparation is based on surgeon preference. Those who prefer efficiency and shorter stitch time typically choose a whip stitch, while those who require improved biomechanical properties select a locking stitch, the gold standard of which is the Krackow method. The purpose of this study was to evaluate a novel suture needle design that can be used to perform two commonly used stitch methods, a whip stitch, and a locking stitch, by comparing the speed of graft preparation and biomechanical properties. It was hypothesized that adding a locking mechanism to the whip stitch would improve biomechanical performance but would also require more time to complete due to additional steps required for the locking technique. METHODS: Graft preparation was performed by four orthopaedic surgeons of different training levels where User 1 and User 2 were both attendings and User’s 3 and 4 were both fellows. A total of 24 matched pair cadaveric knees were dissected and a total of 48 semitendinosus tendons were harvested. All grafts were standardized to the same size. Tendons were randomly divided into 4 groups (12 tendons per group) such that each User performed analogous stitch on matched pair: Group 1, User 1 and User 3 performed whip stitches; Group 2, User 1 and User 3 performed locking stitches; Group 3, User 2 and User 4 performed whip stitches; Group 4, User 2 and User 4 performed locking stitches. For instrumentation, the two ends of tendon grafts were clamped to a preparation stand. A skin marker was used to mark five evenly spaced points, 0.5 cm apart, as a guide to create a 5-stitch series. The stitches were performed with EasyWhip, a novel two-part suture needle which allows one to do both a traditional whip stitch and a locking whip stitch, referred to as WhipLock (Figure 1). The speed for graft preparation was timed for each User. Biomechanical testing was performed using a servohydraulic testing machine (MTS Bionix) equipped with a 5kN load cell (Figure 2). A standardized length of tendon, 10 cm, was coupled to the MTS actuator by passing it through a cryoclamp cooled by dry ice to a temperature of -5°C. All testing samples were pre-conditioned to normalize viscoelastic effects and testing variability through application of cyclical loading to 25-100 N for three cycles. The samples were then held at 89 N for 15 minutes. Thereafter, the samples were loaded to 50-200 N for 500 cycles at 1 Hz. If samples survived, they were ramped to failure at 20 mm/min. Displacement and force data was collected throughout testing. Metrics of interest were peak-to-peak displacement (mm), stiffness (N/mm), ultimate failure load (N) and failure mode. Data are presented as averages and standard deviations. A Wilcoxon signed-rank test was used to evaluate the groups for time to complete stitch and biomechanical performance. Statistical significance was set at P = .05. RESULTS SECTION: In Group 1, the time to complete the whip stitch was not significantly different between User 1 and User 3, where the average completion time was 1 min 13 sec. Similarly, there were no differences between Users when performing the WhipLock (Group 2) with an average time of 1 min 49 sec. In Group 3 (whip stitch), User 2 took 1 min 48 sec to complete the whip stitch, whereas User 4 took 1 min 25 sec (p=.033). The time to complete the WhipLock stitch (Group 4) was significantly different, where User 2 took 3 min and 44 sec, while User 4 only took 2 min 3 sec (p=.002). Overall, the whip stitch took on average 1 min 25 sec whereas the WhipLock took 2 min 20 sec (p=.001). For whip stitch constructs, no differences were found between Users and all stitches were biomechanically equivalent. Correspondingly, for WhipLock stitches, no differences were found between Users and all suture constructs were likewise biomechanically equivalent. Averages for peak-to-peak displacement (mm), stiffness (N/mm), and ultimate failure load (N) are presented in Table 1. Moreover, when the two stitch methods were compared, the WhipLock constructs significantly increased stiffness by 25% (p <.001), increased ultimate failure load by 35% (p<.001) and reduced peak-to-peak displacement by 55% (p=.001). The common mode of failure for grafts with whip stitch failed by suture pullout from tendon (18/24), where a few instances occurred by suture breakage (6/24). Tendon grafts with WhipLock stitch commonly failed by suture breakage (22/24), where two instances of combined tendon tear and suture breakage were noted. DISCUSSION: The WhipLock stitch significantly increased average construct stiffness and ultimate failure load, while significantly reducing the peak-to- peak displacement compared to the whip stitch. These added strength benefits of the WhipLock stitch took 55 seconds more to complete than the whip stitch. No statistically significant difference in biomechanical performance was found between the Users. Data suggests equivalent stitch performance regardless of the time to complete stitch and surgeon training level. SIGNIFICANCE/CLINICAL RELEVANCE: Clinically, having a suture needle device available which can be used to easily perform different constructs including one with significant strength advantages regardless of level of experience is of benefit.more » « less
-
more » « less
Abstract Background The optimal duration of capecitabine combined with temozolomide (CapTem) for metastatic pancreatic neuroendocrine tumours (PanNETs) remains controversial. The present study aimed to assess the activity and safety of prolonged CapTem and Cap maintenance therapy in patients with metastatic PanNETs.
Methods Retrospective real‐world data of 94 patients with metastatic PanNETs were obtained from one cancer centre. Fifteen patients were treated with Cap maintenance therapy after fixed 12–13 cycles of CapTem (group I), 44 patients were treated with prolonged CapTem until disease progression (group II), and 35 patients were treated with fixed 12–13 cycles of CapTem (group III).
Results The mean ± SE follow‐up period was 41.79 ± 26.31 months. The median CapTem treatment duration was 12 months in group I and 14 months in group II. The median time to best partial response was 12 months both in groups I and group II. The objective response rates of groups I and II were significantly higher than those of group III (73.3%, 41.9%, and 20%, respectively,
p = .002). The median progression‐free survival (mPFS) of group I and group II was significantly higher than that of group III (35 months, 26 months vs. 19 months,p < .001). Safety analysis of the three groups indicated rare events of grade 3–4 toxicities, with nausea, vomiting, fatigue, and anaemia being the most common adverse effects.Conclusions Patients with PanNETs who responded well to CapTem treatment may benefit from prolonged CapTem and Cap maintenance therapy after fixed cycles. Prospective studies are encouraged to further explore the prolonged CapTem treatment and maintenance therapy.
-
more » « less
Autism spectrum disorder (ASD) is currently viewed as a disorder of cortical systems connectivity, with a heavy emphasis being on the structural integrity of white matter tracts. However, the majority of the literature to date has focused on children with ASD. Understanding the integrity of white matter tracts in adults may help reveal the nature of ASD pathology in adulthood and the potential contributors to cognitive impairment. This study examined white matter water diffusion using diffusion tensor imaging in relation to neuropsychological measures of cognition in a sample of 45 adults with ASD compared to 20 age, gender, and full‐scale‐IQ‐matched healthy volunteers. Tract‐based spatial statistics were used to assess differences in diffusion along white matter tracts between groups using permutation testing. The following neuropsychological measures of cognition were assessed: processing speed, attention vigilance, working memory, verbal learning, visual learning, reasoning and problem solving, and social cognition. Results indicated that fractional anisotropy (FA) was significantly reduced in adults with ASD in the anterior thalamic radiation (
P = 0.022) and the right cingulum (P = 0.008). All neuropsychological measures were worse in the ASD group, but none of the measures significantly correlated with reduced FA in either tract in the adults with ASD or in the healthy volunteers. Together, this indicates that the tracts that are the most impacted in autism may not be (at least directly) responsible for the behavioral deficits in ASD.Autism Res 2020, 13: 702–714Lay Summary White matter tracts are the data cables in the brain that efficiently transfer information, and damage to these tracts could be the cause for the abnormal behaviors that are associated with autism. We found that two long‐range tracts (the anterior thalamic radiation and the cingulum) were both impaired in autism but were not directly related to the impairments in behavior. This suggests that the abnormal tracts and behavior are the effects of another underlying mechanism.
