Spatial mechanisms for modelling the human ankle passive motion

Knowledge on how ligaments and articular surfaces guide passive motion at the human ankle joint complex is fundamental for the design of relevant surgical treatments. The dissertation presents a possible improvement of this knowledge by a new kinematic model of the tibiotalar articulation. In this dissertation two one-DOF spatial equivalent mechanisms are presented for the simulation of the passive motion of the human ankle joint: the 5-5 fully parallel mechanism and the fully parallel spherical wrist mechanism. These mechanisms are based on the main anatomical structures of the ankle joint, namely the talus/calcaneus and the tibio/fibula bones at their interface, and the TiCaL and CaFiL ligaments. In order to show the accuracy of the models and the efficiency of the proposed procedure, these mechanisms are synthesized from experimental data and the results are compared with those obtained both during experimental sessions and with data published in the literature. Experimental results proved the efficiency of the proposed new mechanisms to simulate the ankle passive motion and, at the same time, the potentiality of the mechanism to replicate the ankle’s main anatomical structures quite well. The new mechanisms represent a powerful tool for both pre-operation planning and new prosthesis design.

Sviluppo, implementazione e valutazione funzionale di un nuovo modello protesico di caviglia

Total ankle arthroplasty (TAA) is still not as satisfactory as total hip and total knee arthroplasty. For the TAA to be considered a valuable alternative to ankle arthrodesis, an effective range of ankle mobility must be recovered. The disappointing clinical results of the current generation of TAA are mostly related to poor understanding of the structures guiding ankle joint mobility. A new design (BOX Ankle) has been developed, uniquely able to restore physiologic ankle mobility and a natural relationship between the implanted components and the retained ligaments. For the first time the shapes of the tibial and talar components in the sagittal plane were designed to be compatible with the demonstrated ligament isometric rotation. This resulted in an unique motion at the replaced ankle where natural sliding as well as rolling motion occurs while at the same time full conformity is maintained between the three components throughout the flexion arc. According to prior research, the design features a spherical convex tibial component, a talar component with radius of curvature in the sagittal plane longer than that of the natural talus, and a fully conforming meniscal component. After computer-based modelling and preliminary observations in several trial implantation in specimens, 126 patients were implanted in the period July 2003 – December 2008. 75 patients with at least 6 months follow-up are here reported. Mean age was 62,6 years (range 22 – 80), mean follow-up 20,2 months. The AOFAS clinical score systems were used to assess patient outcome. Radiographs at maximal dorsiflexion and maximal plantar flexion confirmed the meniscalbearing component moves anteriorly during dorsiflexion and posteriorly during plantarflexion. Frontal and lateral radiographs in the patients, show good alignment of the components, and no signs of radiolucency or loosening. The mean AOFAS score was observed to go from 41 pre-op to 74,6 at 6 month follow-up, with further improvement at the following follow-up. These early results reveal satisfactory clinical scores, with good recovery of range of motion and reduction of pain. Radiographic assessment reveals good osteointegration. All these preliminary results confirm biomechanical studies and the validity of this novel ligamentcompatible prosthesis design. Surely it will be important to re-evaluate these patients later.

The ontogeny of bipedalism: insights from the study of talar growth

The development of bipedal locomotion was gradual during evolution, and with the increase in discoveries of fossils and, in particular, in discoveries of pedal bones, the attention to this problematic has grown in the last decades. Moreover, the discoveries of juveniles fossil foot bones has led the attention to the evolution and the development of bipedal locomotion. The study of the development of human gait in children may help in shedding light to the development of human locomotion. The human talus plays a pivotal role, linking the leg to the foot and receiving and distributing the weight, while permitting a wide range of foot movements. It is also present at birth, and this makes a perfect bone to study to disentangle how the bone structure acts to cope with the changes in locomotion and body weight. Here, I analyze the external and internal morphology of the human talus from the perinatal period to adolescence, to investigate how the different phases of the acquisition of bipedal gait affect talar morphology, and how the bone copes with the weight gain during growth. Results show that the talar internal and external morphologies change in line with the different activities and loading of the foot. Initially, at around birth, the talus has a very globular and immature external shape, with a very dense trabecular architecture, composed of thin, numerous, and densely packed trabeculae, with a rather isotropic structure. External and internal morphologies change in relation to the different loading patterns which follow during growth, showing a more specialized structure, both in the external and internal morphology, linked to the maturation of bipedal locomotion, until the adult-like pattern is reached, during adolescence.