Subtalar arthrodesis known as talocalcaneal fusion is an end-stage treatment for adult hind foot pathologies. The goal of the arthrodesis is to restrict the relative motion between bones of the subtalar joints, aiming to reduce pain and improve function for the patient. However, the change of the subtalar structures through the fusion is considered a disturbance to the joint biomechanics, which have been suggested to affect the biomechanics of the adjacent joints. However, no quantitative data are available to document this phenomenon. The purpose of the current study was to quantify the effects of subtalar arthrodesis on the laxity and stiffness of the talocrural joint in vitro using a robot-based joint testing system (RJTS) during anterioposterior (A/P) drawer test. Six fresh frozen ankle specimens were used in this study. The lateral tissues of the specimens were removed but the anterior and posterior talofibular ligaments and calcaneofibular ligament were kept intact. A/P drawer tests were performed on each of the specimens at neutral position, 5° and 10° of dorsiflexion, and 5?and 10?of plantarflexion using a robot-based joint testing system (RJTS), before and after subtalar arthrodesis. The RJTS enabled unconstrained A/P drawer testing at the prescribed ankle position while keeping the proximal/distal and lateral/medial forces, and varus/valgus and internal/external moments to be zero. This was achieved via a force-position hybrid control method with force and moment control, which has been shown to be more accurate than other existing force-position hybrid control methods. The target A/P force applied during the A/P drawer test was 100N in both anterior and posterior directions. The stiffness and laxity were calculated from the measured force and displacement data. The anterior and posterior stiffness of the talocrural joint were defined as the slope beyond 30% of the target A/P force, and the peak displacements quantified the laxity of the joint. Comparisons of laxity and stiffness between the intact and fusion ankle specimens were performed using Wilcoxon signed rank test (SPSS 19.0, IBM, USA) and a significance level of 0.05 was set. Subtalar arthrodesis did not lead to significant changes in the stiffness and laxity in both anterior and posterior directions (P>0.05). The mean anterior stiffness before arthrodesis was 9.54±1.17 N/mm and was 10.35±2.40 N/mm after arthrodesis. The mean anterior displacements before and after arthrodesis were 9.68±0.94 mm and 8.97±1.42 mm, respectively. Subtalar arthrodesis did not show significant effects on the A/P laxity and stiffness of the talocrural joint in both anterior and posterior directions. This may imply that the motion of the subtalar joints do not have significant effects on the A/P stability of the talocrural joint, which is the main joint of the ankle complex. This agrees with the anatomical roles of the subtalar joints which provide mainly the varus/valgus motions for the ankle complex. The current study provides a basis for further studies needed to evaluate the effects subtalar arthrodesis on the varus/valgus stability

This edition of the Cochrane Corner looks at the three reviews that were published in the second half of 2023: surgical versus non-surgical interventions for displaced intra-articular calcaneal fractures; cryotherapy following total knee arthroplasty; and physical activity and education about physical activity for chronic musculoskeletal pain in children and adolescents.

Objectives

To review the systemic impact of smoking on bone healing as evidenced within the orthopaedic literature.