Total ankle arthroplasty: Strength, pain, and motion

DiLiberto, Frank E.; Haddad, Steven L.; Wilson, Walter Clark; Courtney, Carol A.; Sara, Lauren K.; Vora, Anand

doi:10.1016/j.clinbiomech.2021.105342

Cited by 6 publications

(7 citation statements)

References 40 publications

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“…13,42 This positive work is partly produced by the elastic recoil of the Achilles tendon (which releases energy stored by the tendon stretch resisting ankle [shank-calcaneus] dorsiflexion) 2,26,39,45 as well as the concentric muscle contraction. 45 The results of DiLiberto et al 14 seem to confirm the early concerns of Hintermann et al 19 —their isokinetic torque analyses also revealing a trend toward a decrease in peak plantarflexion torque in patients undergoing concomitant triceps surae lengthening with TAA (gastrocnemius recession or tendo-Achilles lengthening) compared to patients undergoing TAA alone. The findings of our study support these concerns as concomitant triceps surae lengthening in TAA seemed to lead to lesser positive mechanical work at the ankle joint in the Achilles group compared to the Non-Achilles group.…”

Section: Discussionsupporting

confidence: 59%

“…The best approach to improve plantarflexor muscle strength in patients who have had concomitant triceps surae lengthening with TAA is presently unclear. 14 Future studies should investigate whether specialized programs, such as fast high-intensity resistance training, known to enhance type II muscle fibers, or biofeedback training to stimulate the patient to maximize muscle contractions and develop strategies to improve activation during resistive exercises designed to increase muscle force production, would help to tackle this plantarflexor strength deficit. 28 In this study, the Achilles group was composed of 8 patients having undergone Strayer lengthening and 3 patients having undergone tendo-Achilles lengthening, which may have affected the outcome.…”

Section: Discussionmentioning

confidence: 99%

“…This is of clinical relevance as previous studies have shown that concomitant triceps surae lengthening can result in significant decreases in plantarflexion strength. 10,14,19,29 The study hypothesized that patients undergoing concomitant triceps surae lengthening at the time of TAA would exhibit lower positive mechanical ankle joint work than patients undergoing TAA alone, even with similar dorsi- and plantarflexion radiographic prosthesis range of motion (ROM). Delp et al 10 showed that concomitant triceps surae lengthening may restore normal passive ankle ROM but may at the same time substantially decrease the active force-generating capacity of the plantarflexor muscles.…”

Section: Introductionmentioning

confidence: 99%

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Concomitant Triceps Surae Lengthening in Total Ankle Arthroplasty Affects the Mechanical Work at the Ankle Joint

et al. 2023

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Background: Previous studies have examined the effect of concomitant triceps surae lengthening on ankle dorsiflexion motion at the time of total ankle arthroplasty (TAA). As plantarflexor muscle-tendon structures are important for producing positive ankle work during the propulsive phase of gait, caution should be exercised when lengthening triceps surae, as it may decrease plantarflexion strength. In order to develop an understanding of the work of the anatomical structures crossing the ankle during propulsion, joint work must be measured. The aim of this explorative study was to assess the effect of concomitant triceps surae lengthening with TAA on the resultant ankle joint work. Methods: Thirty-three patients were recruited to the study and divided into 3 groups of 11. The first group underwent both triceps surae lengthening (Strayer and TendoAchilles) and TAA (Achilles group), the second group underwent only TAA (Non-Achilles group), and the third group underwent only TAA, but had a greater radiographic prosthesis range of motion (Control group) compared to the first 2 groups. The 3 groups were matched in terms of demographic variables and walking speed. All patients underwent a 3D gait analysis 1 year after surgery to measure intersegmental joint work using a 4-segmented kinetic foot model. An analysis of variance (ANOVA) or Kruskal-Wallis test was used to compare the 3 groups. Results: The ANOVA showed significant differences between the 3 groups. Post hoc analyses suggested that (1) the Achilles group had less positive work at the ankle joint than the Non-Achilles and Control groups; (2) the Achilles group produced less positive work performed by all foot and ankle joints than the Control group; and (3) the Achilles and Non-Achilles groups absorbed less energy across all foot and ankle joints during the stance phase than the Control group. Conclusion: Concomitant triceps surae lengthening in TAA may reduce the positive work at the ankle joint. Level of Evidence: Level III, retrospective comparative study.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Concomitant Triceps Surae Lengthening in Total Ankle Arthroplasty Affects the Mechanical Work at the Ankle Joint

et al. 2023

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“…27 A final theory is offered in a recent study evaluating the interplay of pain, motion, and strength following TAR. DiLiberto et al 9 evaluated ankle PF strength in 38 patients before and after TAR and noted improvements in pain and motion at 6-month follow-up, with ankle PF torque remaining unchanged across time but lower than the control values postoperatively. The authors suggest that deficits in postoperative ankle plantar flexor torque are most likely due to the consequences of end-stage ankle arthritis and not necessarily due to the TAR procedure or postoperative protocol.…”

Section: Discussionmentioning

confidence: 99%

“…The authors suggest that deficits in postoperative ankle plantar flexor torque are most likely due to the consequences of end-stage ankle arthritis and not necessarily due to the TAR procedure or postoperative protocol. 9 Whether the cause of abnormal PF is due to the debilitating nature of end-stage ankle osteoarthritis or an inherent biomechanical outcome in TAR, it remains a critical component in analyzing outcomes following TAR.…”

Section: Discussionmentioning

confidence: 99%

Tibiopedal Motion Following Tendo-Achilles Lengthening or Gastrocnemius Recession in Total Ankle Replacement: A Comparative Cohort Study

Johnson

Fletcher

et al. 2022

Foot Ankle Int.

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Background: End-stage ankle arthritis is a debilitating condition often necessitating total ankle replacement (TAR). Tendo-Achilles lengthening (TAL) and gastrocnemius recession (GR) are commonly performed with TAR to improve ankle dorsiflexion (DF). No studies to date have radiographically analyzed tibiopedal motion to guide surgical management. The purpose of this study is to determine the effect of a TAL or GR during TAR on radiographic tibiopedal range of motion (ROM). Methods: A retrospective review of a prospectively maintained database was conducted followed by a propensity score–matched analysis of 110 patients who underwent TAL (n = 26), GR (n = 29), or no lengthening procedure (n = 55) with TAR. Minimum of 1-year ROM radiographic follow-up was required. Exclusion criteria included (1) calcaneal osteotomies, (2) simultaneous or previous hindfoot or midfoot arthrodesis, (3) prior ankle arthrodesis, or (4) revision TAR. Demographic data were extracted from the TAR database. Radiographic assessment included tibiopedal dorsiflexion (DF) and plantarflexion (PF). Results: DF improved by 2.8 degrees ( P = .0286) and by 6.0 degrees ( P < .0001) in the TAL and GR cohorts, respectively, with no difference in the control group (+0.7 degrees, P = .3764). PF was decreased by 4.5 degrees ( P = .0152) and by 7.2 degrees ( P = .0002) in the TAL and GR cohorts, respectively, with no difference in the control group (–0.2 degrees, P = .8546). Minimal differences were observed for total arc of motion for all 3 groups (control 0.5 degrees, GR –1.2 degrees, TAL –1.7 degrees), all of which were nonsignificant (all P > .05). There was no between-group difference in the change in overall arc of motion between the groups ( P = .3599). GR resulted in a greater increase in DF (6.0 vs 2.8 degrees; P = .1074), with a reciprocal greater decrease in PF (7.2 vs 4.5 degrees; P = .2416) compared with the TAL cohort. Conclusion: Both TAL and GR increased postoperative DF; however, this was accompanied by a reciprocal loss in PF. Minimal differences were observed for total arc of motion. Patients should be counseled that concomitant procedures performed to increase DF will do so at the expense of PF. Level of Evidence: Level III, retrospective review of prospectively collected data.

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Ankle plantar flexor muscle performance and patient reported outcomes in people following total ankle arthroplasty

DiLiberto

Vora

Wilson

et al. 2022

Clinical Biomechanics

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Total ankle arthroplasty: Strength, pain, and motion

Cited by 6 publications

References 40 publications

Concomitant Triceps Surae Lengthening in Total Ankle Arthroplasty Affects the Mechanical Work at the Ankle Joint

Concomitant Triceps Surae Lengthening in Total Ankle Arthroplasty Affects the Mechanical Work at the Ankle Joint

Tibiopedal Motion Following Tendo-Achilles Lengthening or Gastrocnemius Recession in Total Ankle Replacement: A Comparative Cohort Study

Ankle plantar flexor muscle performance and patient reported outcomes in people following total ankle arthroplasty

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