Kobayashi Takumi, Suzuki Eiichi, Yamazaki Naohito, Suzukawa Makoto, Akaike Atsushi, Shimizu Kuniaki, Gamada Kazuyoshi
Department of Physical Therapy, Hokkaido Chitose Institute of Rehabilitation Technology, Hokkaido, Japan (TK)Department of Orthopaedics, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (ES)Department of Medical Radiation, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (NY)Department of Rehabilitation, Yokohama Sports Medical Center, Kanagawa, Japan (MS)Department of Orthopaedics, Yokohama Sports Medical Center, Kanagawa, Japan (AA, KS)Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan (KG).
Department of Physical Therapy, Hokkaido Chitose Institute of Rehabilitation Technology, Hokkaido, Japan (TK)Department of Orthopaedics, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (ES)Department of Medical Radiation, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (NY)Department of Rehabilitation, Yokohama Sports Medical Center, Kanagawa, Japan (MS)Department of Orthopaedics, Yokohama Sports Medical Center, Kanagawa, Japan (AA, KS)Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan (KG)
Foot Ankle Spec. 2015 Dec;8(6):445-53. doi: 10.1177/1938640015585967. Epub 2015 May 8.
Functional ankle instability (FAI) may involve abnormal kinematics and contact mechanics during ankle internal rotation. Understanding of these abnormalities is important to prevent secondary problems in patients with FAI. However, there are no in vivo studies that have investigated talocrural joint contact mechanics during weightbearing ankle internal rotation. The objective of this study to determine talocrural contact mechanics during weightbearing ankle internal rotation in patients with FAI.
Twelve male subjects with unilateral FAI (age range, 18-26 years) were enrolled. Computed tomography and fluoroscopic imaging of both lower extremities were obtained during weightbearing passive ankle joint complex rotation. Three-dimensional bone models created from the computed tomographic images were matched to the fluoroscopic images to compute 6 degrees of freedom for talocrural joint kinematics. The closest contact area in the talocrural joint in ankle neutral rotation and maximum internal rotation during either dorsiflexion or plantar flexion was determined using geometric bone models and talocrural joint kinematics data.
The closest contact area in the talus shifted anteromedially during ankle dorsiflexion-internal rotation, whereas it shifted posteromedially during ankle plantar flexion-internal rotation. The closest contact area in FAI joints was significantly more medial than that in healthy joints during maximum ankle internal rotation and was associated with excessive talocrural internal rotation or inversion.
This study demonstrated abnormal talocrural kinematics and contact mechanics in FAI subjects. Such abnormal kinematics may contribute to abnormal contact mechanics and may increase cartilage stress in FAI joints.
Therapeutic, Level IV: cross-sectional case-control study.
功能性踝关节不稳（FAI）可能在踝关节内旋过程中涉及异常的运动学和接触力学。了解这些异常情况对于预防FAI患者的继发性问题很重要。然而，尚无体内研究调查负重状态下踝关节内旋时胫距关节的接触力学。本研究的目的是确定FAI患者在负重状态下踝关节内旋时的胫距关节接触力学。
招募了12名单侧FAI的男性受试者（年龄范围18 - 26岁）。在负重状态下被动进行踝关节复合旋转时，获取了双下肢的计算机断层扫描（CT）和荧光透视成像。从CT图像创建的三维骨骼模型与荧光透视图像匹配，以计算胫距关节运动学的6个自由度。使用几何骨骼模型和胫距关节运动学数据，确定踝关节中立旋转以及背屈或跖屈过程中最大内旋时胫距关节的最接近接触区域。
在踝关节背屈 - 内旋过程中，距骨的最接近接触区域向前内侧移动，而在踝关节跖屈 - 内旋过程中，它向后内侧移动。在最大踝关节内旋时，FAI关节的最接近接触区域比健康关节的更偏内侧，并且与胫距关节过度内旋或内翻有关。
本研究证明了FAI受试者存在异常的胫距关节运动学和接触力学。这种异常的运动学可能导致异常的接触力学，并可能增加FAI关节中的软骨应力。
治疗性，IV级：横断面病例对照研究。
