The biomechanical influence of tibio‐talar containment on stability of the ankle joint
Notice bibliographique
Résumé
Chronic ankle instability (CAI) is a frequent sport orthopaedic entity. Although many risk factors have been studied extensively, little is known how it is influenced by the osseous joint configuration. Based on lateral X-rays, the radius of the talar surface and the tibial coverage of the talus (sector alpha) were measured on a DICOM/PACS system in 52 patients with CAI and an age- and sex-matched control group. The talar radius was found to be larger in patients with CAI (21.2 +/- 2.4 mm) than in the control group (17.7 +/- 1.9 mm; P < 0.0001). The tibio-talar sector was smaller in patients with CAI (80 degrees +/- 5.1 degrees ) than in the control group (88.4 degrees +/- 7.2 degrees ; P < 0.0001). The aim of this study is to analyse the biomechanical influence of the clinical data on stability of the ankle joint. A two-dimensional model of the tibio-talar joint in the sagittal plane was developed. The joint configuration was described by the tibio-talar sector (alpha) and the radius (r) of the talus. The force (F = F (BW) tan alpha/2) and energy (E = F (BW) r [1 - cos alpha/2]) to dislocate the talus out of the tibial plafond were deduced. Ankle stability is a function of the tibio-talar sector: the force necessary to dislocate the joint is decreasing with a smaller sector. The clinical data show that the force needed to dislocate the ankle of CAI patients was 14% weaker than the one needed in the case of healthy subjects (P < 0.0001). The energy to dislocate the ankle depends both on the sector and the radius. The clinical data do not show a significant difference between the energy needed to dislocate the joint of CAI patients and the one of healthy subjects. This is because there is a correlation of a small sector and a large radius for CAI ankles. CAI is associated with an unstable osseous joint configuration, which is characterized by a larger radius of the talus and a smaller tibio-talar sector. The findings of the biomechanical model explain the clinical observations and demonstrate how stability of the ankle joint is influenced by the osseous configuration. Surgical ankle ligament stabilization might be more recommended in patients with an unstable osseous configuration as such patients have a disposition for recurrent sprains. Removing anterior osteophytes for anterior impingement should be done carefully in CAI patients because this would decrease the tibial coverage of the talus and thus dispose the talus to dislocate anteriorly. People who have an unstable ankle configuration and who nevertheless engage in activities with high risk of ankle sprains could be asked to wear ankle protecting sports equipment.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».