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

Johnson, Lindsey G; Fletcher, Amanda N.; Wu, Christine J.; Vernick, Robert C; Easley, Mark E.; DeOrio, James K.; Adams, Samuel B.; Nunley, James A.

doi:10.1177/10711007221132284

Cited by 9 publications

(18 citation statements)

References 31 publications

(44 reference statements)

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“…However, most previous studies investigating ROM after TAA have looked at the effect of preoperative ROM or concomitant procedures while not specifically assessing changes to the joint level. 6,7,13,22,30 Recently, a radiographic measurement method of the joint line level in TAA was described. 18 The "joint line height ratio" (JLHR) identifies ankle-specific landmarks that remain constant following TAA.…”

Section: Introductionmentioning

confidence: 99%

Influence of Joint Line Level on Clinical Outcomes and Range of Motion in Total Ankle Arthroplasty

Palma,

Shaffrey,

Kim

et al. 2023

Foot Ankle Int.

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Background: Ankle arthritis leads to an elevated joint line compared to the nonarthritic ankle, as measured by the “joint line height ratio” (JLHR). Previous work has shown that the JLHR may remain elevated after total ankle arthroplasty (TAA). However, the clinical impact of this has yet to be determined. This study assessed the correlation between postoperative JLHR, post-TAA range of motion (ROM), and 1-year Patient-Reported Outcome Measurement Information System (PROMIS) scores. Methods: A retrospective review of 150 patients who underwent primary TAA was performed. Preoperative and postoperative JLHR, as well as postoperative dorsiflexion, plantarflexion, and total ROM, was calculated on weightbearing radiographs at a minimum of 1-year follow-up. Correlation between JLHR, post-TAA ROM, and 1-year PROMIS scores was investigated using Pearson correlation and multiple linear regression models. Interobserver reliability for the JLHR was also calculated. Results: Interobserver reliability for the JLHR was excellent ( r = 0.98). Mean (SD) JLHR changed from 1.66 (0.45) to 1.55 (0.26) after TAA ( P < .001), indicating that the joint line was lowered after TAA. An elevated joint line was correlated with decreased post-TAA dorsiflexion ( r = −0.26, P < .001), total ROM ( r = −0.18, P = .025), and worse 1-year PROMIS physical function ( r = −0.22, P = .046), pain intensity ( r = 0.22, P = .042), and pain interference ( r = 0.29, P = .007). There was no correlation between the JLHR and post-TAA plantarflexion ( r = −0.025, P = .76). Regression analysis identified a 0.5-degree reduction in post-TAA dorsiflexion with each 0.1-unit increase in JLHR (Coeff. = −5.13, P = .005). Conclusion: In this patient cohort, we found that an elevated joint line modestly correlated with decreased postoperative dorsiflexion, total ROM, and worse 1-year PROMIS scores. These data suggest that effort likely should be made toward restoring the native joint line at the time of TAA. In addition, future studies investigating the clinical outcomes after TAA may consider including a measure of joint line height, such as the JLHR, because we found it was associated with patient-reported outcomes. Level of evidence: Level III, retrospective review of prospectively collected data.

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Section: Introductionmentioning

confidence: 99%

Influence of Joint Line Level on Clinical Outcomes and Range of Motion in Total Ankle Arthroplasty

Palma,

Shaffrey,

Kim

et al. 2023

Foot Ankle Int.

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

“…4,22 At least 10 degrees of ankle dorsiflexion are necessary for optimal mechanics during the midstance phase of the gait cycle, 5,31 and patients undergoing TAA may therefore benefit from a concomitant triceps surae lengthening if the affected joint cannot be passively dorsiflexed to 10 degrees with the trial or real implants in place. 20,21,35 The effect of concomitant triceps surae lengthening with TAA on gait mechanics has not been widely investigated. Queen et al, 35 a study that used a 1-segment foot modeling approach, found that patients who had concomitant triceps surae lengthening at the time of TAA had greater peak ankle dorsiflexion during the second rocker of the stance phase than those with TAA alone.…”

Section: Introductionmentioning

confidence: 99%

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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“…We read with great interest the article entitled “Tibiopedal Motion Following Tendo-Achilles Lengthening or Gastrocnemius Recession in Total Ankle Replacement: A Comparative Cohort Study” by Johnson et al 4 We truly appreciate the work for revealing an interesting phenomenon that merits further reflection, but we also wish to raise several issues that need to be addressed.…”

mentioning

confidence: 99%

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

Gan¹,

Li²,

Zhang³

2023

Foot Ankle Int.

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

Cited by 9 publications

References 31 publications

Influence of Joint Line Level on Clinical Outcomes and Range of Motion in Total Ankle Arthroplasty

Influence of Joint Line Level on Clinical Outcomes and Range of Motion in Total Ankle Arthroplasty

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

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

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