Modelling of the ankle joint complex. Reflections with regards to ankle prostheses

doi:10.1016/j.fas.2004.06.003

Foot and Ankle Surgery

Volume 10, Issue 3, 2004, Pages 109-119

https://doi.org/10.1016/j.fas.2004.06.003 Get rights and content

Abstract

The goal of the present article is to provide a review and summary (2) of biomechanical research on the ankle joint, (3) ankle joint models, (4) ankle endoprostheses, and (5) reflections with respect to possible applications of ankle prosthesis design. Knowledge of the biomechanical function is essential for a successful design of a joint replacement for the ankle, which is highly complex. Presently, predictions of joint compressive forces are the primary basis for the design development of artificial total ankle replacements. Shear forces at the bone-to-implant interface, accountable for an increased loosening rate of the implant, are obviated with the so-called unconstrained design philosophy. However, the knowledge of transverse forces and shank torsional moments in conjunction with artificial ankle replacements and problems possibly related to these loads is rare. This review summarizes contributions of relevance with respect to the modelling of the ankle joints and a prosthetic replacement design and discusses some potentially important aspects for future ankle prostheses.

Introduction

The human ankle joint is a complex anatomical structure combining various mechanically coupled joints. Its motion results from an interplay of several articulating joint surfaces and restraining ligaments. In combination with the knee and hip joints it enables locomotion in various forms and transmits forces and moments during the foot-ground contact when the foot can be regarded as the interface of the human locomotor system with the environment. Malfunction or pain of the ankle joint leads to severe impairment of gait and consequently to a reduction of individual mobility. The clinical goal of replacing damaged ankles with artificial total joint replacements (arthroplasties) is to restore a fully functional locomotor system and to provide a recovering patient with the most possible and ideally unresented and painless mobility.

Biomechanical research on the ankle joint has a history which dates back almost 100 years, the most prominent investigators being Fick [1], Manter [2], Barnett and Napier [3], Hicks [4] and Isman and Inman [5], [6]. The work of all these authors concentrated on the general functional and anatomical description of the ankle. During the past decades, further work was also conducted on the human foot, as for example investigations that concentrated on some of the numerous joints within the foot, the load transmission from the shank to the heel and various parts of the forefoot, etc.

Besides biocompatibility issues and biological adaptation mechanisms of living tissues such as bone, ligaments and joint capsules, the development of a model that accurately describes the kinematics and predicts the kinetics of a joint involved in gait is very important for a proper design of a functional endoprosthesis (Andriacchi and Hurwitz [7]). Whereas the performance of artificial hip and knee joints may be regarded as satisfactory, this goal has not yet been attained to the same degree for the artificial ankle joint. The key role of the ankle being subjected to comparatively high loads during gait combined with its complexity legitimate an intensive research.

The goals of this article are to provide a review of the literature of ankle joint complex with a particular focus on:

1.
Summary of experimental biomechanical research on the ankle joint
2.
Summary of ankle joint models
3.
Summary of ankle endoprostheses
4.
Conclusions.

Section snippets

Historical Review (until 1976)

The list of anatomical and functional contributions on the human ankle joint is considerably large. This section summarizes early work until Inman's extensive investigations [6], which are frequently used as a reference. For the purpose of brevity, this part concentrates rather on functional than on descriptive publications, admitting that a distinction between the two is often not very simple.

Fick [1] (1911), one of the early authors of ankle biomechanics, considered the ankle to have one

Summary of ankle joint models

Next to the above discussed in vivo and in vitro experimental investigations of the ankle joint, a number of models to different degrees of complexity have been developed which also improved the understanding of ankle joint biomechanics. For a better understanding, this section is further divided into kinematic and kinetic modelling.

Summary of ankle endoprostheses

This chapter summarizes the current status of ankle endoprostheses design in the light of the previously discussed biomechanical research and model approaches of the ankle. It also addresses to clinical outcome studies and to the ongoing debate on the applicability of ankle replacements.

Komistek et al. [60] determined the ankle kinematics of 10 ankles after successful arthroplasties under weight bearing condition using dynamic video fluoroscopy and compared them with the unaffected ankles on

Conclusions

The summaries of chapter 1–3 show that the relevant question is whether ankle endoprostheses must be able to transmit torsional and/or transverse forces or not. However, the current state of the art does not answer this question.

•
If the answer to that question is yes (as it is the case in an unaffected ankle), the consequence of these transmitted forces would be an increased shear forces present at the implant-to-bone interface, with would increase the tendency of implant loosening. The coupling

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The findings suggested that ankle bones translate independently from each other, and in some cases in opposite directions. These findings help explain the distribution of osteochondral lesions of the talus which have previously been observed to be in medial and lateral regions of the talar dome in 90% of cases. They also provide a reason for the central region of talar dome being less susceptible to developing osteochondral lesions.
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With the rapid evolution of robotic technology and the rising demand for health care, robot-assisted rehabilitation research has gradually stepped into the high-precision stage. As the most complex weight-bearing joint of human [1–3], the ankle has a higher injury rate than others [4], and its robot-assisted precision rehabilitation is more valuable and challenging. Based on this background, the theoretical innovation of ankle rehabilitation robot has experienced three vital leaps, which extend from matching ankle degrees-of-freedom (DOF) [5–10] to adapting ankle motion center [11–17] and then to the latest matching ankle bone structure [18–22].
The latest rehabilitation robot based on generalized spherical parallel mechanism (GSPM) forces higher requirements for the accurate ankle motion description, but the talus, ankle core component, is hidden within soft tissue and difficult to be directly observed and described. For this problem, the accurate detection robot and robot-assisted instantaneous motion recognition method for ankle based on it are proposed. Firstly, a foot-talus coupled motion model based on ankle bone structure is established, functional requirements of the detection robot are clarified. Secondly, a type synthesis method of variable GSPM is proposed based on screw theory, and partially decoupled under-actuated GSPMs are constructed. This method can directly determine the actuators and sensors arrangement during the non-instantaneous limb synthesis to avoid complex judgment and screening. Then, the principle and method of robot-assisted ankle instantaneous motion recognition are revealed and summarized by clarifying kinematic mapping relationship of human-machine system. This method can accurately recognize talus orientation and drive repetitive foot motion to weaken subjects' fatigue factors. Finally, based on the established virtual prototype, the rationality and feasibility of the robot-assisted recognition method are verified.
An image-based kinematic model of the tibiotalar and subtalar joints and its application to gait analysis in children with Juvenile Idiopathic Arthritis
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This latter motion, despite its simplified appearance, is justified because the predominant motion occurs about a single axis of rotation (Scott and Winter, 1991). However, this DOF has been reported to be less accurately described with current musculoskeletal modelling approaches, mainly due to the difficulties in identifying the joint functional axis in vivo (Van den Bogert et al., 1994; Dettwyler et al., 2004; Parr et al., 2012). A high variability within- and between-subjects has been observed in the modelled joint axes, which is also related to the specific locomotion task (Leitch et al., 2010).
In vivo estimates of tibiotalar and the subtalar joint kinematics can unveil unique information about gait biomechanics, especially in the presence of musculoskeletal disorders affecting the foot and ankle complex. Previous literature investigated the ankle kinematics on ex vivo data sets, but little has been reported for natural walking, and even less for pathological and juvenile populations. This paper proposes an MRI-based morphological fitting methodology for the personalised definition of the tibiotalar and the subtalar joint axes during gait, and investigated its application to characterise the ankle kinematics in twenty patients affected by Juvenile Idiopathic Arthritis (JIA). The estimated joint axes were in line with in vivo and ex vivo literature data and joint kinematics variation subsequent to inter-operator variability was in the order of 1°. The model allowed to investigate, for the first time in patients with JIA, the functional response to joint impairment. The joint kinematics highlighted changes over time that were consistent with changes in the patient’s clinical pattern and notably varied from patient to patient. The heterogeneous and patient-specific nature of the effects of JIA was confirmed by the absence of a correlation between a semi-quantitative MRI-based impairment score and a variety of investigated joint kinematics indexes. In conclusion, this study showed the feasibility of using MRI and morphological fitting to identify the tibiotalar and subtalar joint axes in a non-invasive patient-specific manner. The proposed methodology represents an innovative and reliable approach to the analysis of the ankle joint kinematics in pathological juvenile populations.
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Kinematic models of lower limb joints have several potential applications in musculoskeletal modelling of the locomotion apparatus, including the reproduction of the natural joint motion. These models have recently revealed their value also for in vivo motion analysis experiments, where the soft-tissue artefact is a critical known problem. This arises at the interface between the skin markers and the underlying bone, and can be reduced by defining multibody kinematic models of the lower limb and by running optimization processes aimed at obtaining estimates of position and orientation of relevant bones. With respect to standard methods based on the separate optimization of each single body segment, this technique makes it also possible to respect joint kinematic constraints. Whereas the hip joint is traditionally assumed as a 3 degrees of freedom ball and socket articulation, many previous studies have proposed a number of different kinematic models for the knee and ankle joints. Some of these are rigid, while others have compliant elements. Some models have clear anatomical correspondences and include real joint constraints; other models are more kinematically oriented, these being mainly aimed at reproducing joint kinematics. This paper provides a critical review of the kinematic models reported in literature for the major lower limb joints and used for the reduction of soft-tissue artefact. Advantages and disadvantages of these models are discussed, considering their anatomical significance, accuracy of predictions, computational costs, feasibility of personalization, and other features. Their use in the optimization process is also addressed, both in normal and pathological subjects.
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While complex models are unsuitable for dynamic simulation, they also fail to provide forces along the ankle ligaments, which is important for the research on ankle joint rehabilitation. Kinematics of the ankle complex has been studied in the past (Barnett and Napier, 1952; Lundberg et al., 1989) and while some models describe its motion as purely rotational (Engsberg, 1987; Demarais et al., 2002; Ying and Kim, 2005; Leardini et al., 1999), others consider foot motions to be a consequence of rotations about two hinge/revolute joints (biaxial) in series (Dettwyler et al., 2004; Apkarian et al., 1989; Dul and Johnson, 1985; Wright et al., 2000a, b; Scott and Winter, 1993; Delp et al., 2007; van den Bogert et al., 1994; Inman, 1976). Ankle complex kinematics have also been modelled using four-bar linkages and spatial parallel mechanisms (Leardini et al., 1999; Gregorio et al., 2007).
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ReviewModelling of the ankle joint complex. Reflections with regards to ankle prostheses

Abstract

Introduction

Section snippets

Historical Review (until 1976)

Summary of ankle joint models

Summary of ankle endoprostheses

Conclusions

Gait Posture

Clin Biomech

J Biomech

J Biomech

J Biomech

Clin Biomech

J Biomech

J Biomed Eng

J Biomech

J Biomech

J Biomech

J Biomech

J Biomed Eng

Clin Biomech

J Biomech

Math Biosci

J Biomech

J Biomech

J Biomech

J Biomech

J Biomech

J Biomech

J Biomech

J Biomech

J Biomech

J Arthroplasty

Foot

Foot

Foot Ankle Clin N Am

FussSprungg

FussSprungg

FussSprungg

FussSprungg

FussSprungg

Foot Ankle Surg

Handbuch der Anatomie und Mechanik der Gelenke: III, Spezielle Gelenk-und Muskelmechanik

Movements of the subtalar and transverse tarsal joints

Anat Rec

The axis of rotation at the ankle joint in man. Its influence upon the form of the talus and the mobility of the fibula

J Anat

The mechanics of the foot: I, the joints

J Anat

Anthropometric studies of the human foot and ankle

Bull Pros Res

Inman's joints of the ankle

The evolution of the human foot with especial reference to the joints

J Anat

Kinesiology and mechanical anatomy to the tarsal joints

Clin Orthop

Action of the subtalar and ankle-joint complex during the stance phase of walking

J Bone Joint Surg Am

Mobility of the ankle joint

Acta Orthop Scand

The three-dimensional kinematics and flexibility characteristics of the human ankle and subtalar joints—part II: flexibility characteristics

J Biomech Eng

A kinematical analysis of the tarsal joints: an X-Ray photogrammetric study. Dissertation

Acta Orthop Scand, Copenhagen

The three-dimensional kinematics and flexibility characteristics of the human ankle and subtalar joints—part I: kinematics

J Biomech Eng

The axis of rotation of the ankle joint

J Bone Joint Surg Br

Kinematics of the ankle/foot complex: plantarflexion and dorsiflexion

Foot Ankle Int

Review
Modelling of the ankle joint complex. Reflections with regards to ankle prostheses