Postural and kinematic alterations in the paediatric asymptomatic plano-valgus foot joints

INTRODUCTION: Plano-valgus (PV) is a common alteration of foot posture present in the paediatric population, characterized by valgus rearfoot, foot pronation and drop of the medial longitudinal arch (MLA). If misdiagnosed, this condition has the potential to cause pain and discomfort, and may hinder the lower limb kinematic chain. While a number of studies have investigated the kinematics of the paediatric PV foot, e.g. [1], no information is thus far available on postural and kinematic alterations of the major joints spanning the MLA - i.e. midtarsal and tarso-metatarsal. METHODS: 20 children (13 M, 7 F; 13 \ub1 1 years) with bilateral asymptomatic PV foot were recruited in the study. Radiological indicators of PV condition, such as the calcaneal pitch, lateral talo-first metatarsal angle, and talo-navicular coverage, were measured from weight bearing X-rays. Gait analysis was conducted on the childrens\u2019 feet with the Rizzoli Foot Model [2, 3]. This was applied to measuring double-leg support upright static posture and gait kinematics of the main foot joints, including midtarsal and tarso-metatarsal joints, along with MLA deformation. Range of motion and temporal profiles of joint rotations were compared to those from a control group of age-matched children with normally-developed (ND) feet (4 M, 6 F; age 13 \ub1 1 years). Mann-Whitney U test was used to assess differences in static posture and kinematic global parameters between PV and control. One-dimensional statistical parametric mapping was used to determine differences in stance-normalized foot joint rotations between PV and control. Acknowledgement of the Hospital\u2019s IRB was granted (protocol n\ub0 7/17) and parents\u2019 informed consent was obtained for all children recruited in the study. RESULTS: The PV midtarsal joint was more dorsiflexed, everted and abducted than that in the control group, but showed reduced median sagittal-plane ROM (PV= 15.9 [12.1 19.2] deg; ND = 22.2 [19.5 24.9] deg; p < 0.01). The tarso-metatarsal joint was more plantarflexed and adducted, and showed larger frontal-plane ROM. The MLA showed larger ROM (PV= 58 \ub1 18 deg; ND = 37 \ub1 9 deg; p < 0.05) and was more dropped throughout gait duration. A diagrammatic representation of sagittal-plane orientation of foot segments in static posture and at push-off in stance is shown in figure 1. DISCUSSION: Similar to what reported in previous studies, the PV hindfoot resulted significantly everted and plantarflexed with respect to the tibia, and the MLA was more collapsed throughout stance duration. In addition, the Rizzoli Foot Model allowed investigation of the postural and kinematic alterations at the midtarsal and tarso-metatarsal joints. It should be highlighted that children with PV foot walked more slowly and with a reduced stride length than control, and this might have\u2013 albeit marginally - affected the differences observed in the joint rotation profiles. SIGNIFICANCE/CLINICAL RELEVANCE: In the paediatric plano-valgus foot, a hindered windlass mechanism and/or insufficient activation of the intrinsic plantar muscles [4] may be responsible for larger dorsiflexion of midfoot joints and greater collapse of the MLA during gait. A better understanding of PV midfoot joints postural and kinematic alterations is necessary to improve diagnosis and treatment of PV condition. REFERENCES: 1. Hosl M, et al. Gait & Posture 2014; 39:23-8. 2. Leardini et al. Gait Posture 2007; 25(3):453-62 3. Portinaro et al. J Foot Ankle Res. 2014 20;7(1):754. 4. Angin S,et al. Gait & Posture, 2014; 40:48:52

Knee arthrodesis by the Ilizarov method in the treatment of total knee arthroplasty failure

Background Currently, the main indication for knee arthrodesis is septic failure of a total knee arthroplasty (TKA). The purpose of this study was to evaluate the results of knee arthrodesis by circular external fixation performed in the treatment of TKA failure in which revision arthroplasty was not indicated. Methods The study involved 19 patients who underwent knee arthrodesis by the Ilizarov method. Clinical and functional assessments were performed, including Knee Society Score (KSS). A postoperative clinical and radiographic evaluation was conducted every three months until the end of the treatment. Postoperative complications and eventual leg shortening were recorded. Results KSS results showed a significant improvement with respect to the preoperative condition. Of the 16 patients in the final follow-up, 15 patients (93.7%) achieved complete bone fusion. Major complications occurred in patients treated for septic failure of TKA and most occurred in patients over 75\ua0years of age; the mean final leg shortening was four centimeters. Conclusion In our experience, the Ilizarov method is effective for performing a knee arthrodesis in the case of extensive bone loss. At the same time, it is possible to correct the associated leg deformities or limb length difference. In addition, only the Ilizarov method provides a mechanical stimulus for bone formation and improves the quality of the bone and of the microcirculation, which enhances the host response against infection. Despite these attributes, knee arthrodesis by the Ilizarov method must be considered a \u2018salvage procedure\u2019 in cases of severe outcomes from knee surgery in which revision arthroplasty is not indicated

Prevalence of associated lesions in anterior cruciate ligament reconstruction

Background: Knee instability resulting from anterior cruciate ligament (ACL) rupture is an important risk factor for the onset of meniscal tears and cartilage injuries. A delay of the ligament reconstruction further increases this risk. There is currently no agreement on the right time for surgical ACL reconstruction. Purpose: To verify the correlation of time to ACL reconstruction, patient age, sex, and body mass index (BMI) with the prevalence of meniscal tears and cartilage injuries, as well as to identify the proper surgical timing to decrease the risk of developing associated injuries. Study Design: Cohort study; Level of evidence, 3. Methods: The medical records of 988 patients who underwent primary ACL reconstruction between January 2010 and May 2014 were analyzed to collect data on the prevalence of meniscal tears and cartilage injuries, surgical timing, and patient sex, age, and BMI. Logistic regression was performed to estimate the association between the prevalence of intra-articular lesions and the independent variables of surgical timing, sex, age, and BMI. Results: The risk of developing at least an associated lesion increased by an average of 0.6% for each month of delay of surgical reconstruction. The odds ratio (OR) for developing an intra-articular lesion was 1.989 (95% CI, 1.403-2.820) in those waiting more than 12 months for ACL reconstruction. A 12-month delay for the intervention nearly doubled the risk of developing a medial meniscal tear (OR, 1.806 [95% CI, 1.317-2.475]) but did not modify the risk for the lateral meniscus (OR, 1.183 [95% CI, 0.847-1.653]). Concerning cartilage lesions, the risk after a 12-month delay increased in the medial compartment (femoral condyle: OR, 2.347 [95% CI, 1.499-3.676]; tibial plateau: OR, 5.574 [95% CI, 1.911-16.258]). In the lateral femoral condyle, the risk became significant in patients who underwent surgery more than 60 months after ACL injury as compared with those treated in the first 3 months (OR, 5.949 [95% CI, 1.825-19.385]). Lateral tibial plateau lesions did not seem to increase significantly. Male sex was a risk factor for the onset of lateral meniscal tears (OR, 2.288 [95% CI, 1.596-3.280]) and medial tears (OR, 1.752 [95% CI, 1.280-2.399]). Older age (OR, 1.017 [95% CI, 1.006-1.029]) and increased BMI (OR, 1.120 [95% CI, 1.072-1.169]) were risk factors for the occurrence of at least 1 associated lesion. Conclusion: ACL reconstruction within 12 months of injury can significantly reduce the risk of meniscal tears and chondral lesions. The close association between BMI and prevalence of associated lesions suggests that attention be paid to patients with an elevated BMI when considering the timing of ACL reconstruction surgery