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Functional Outcome Following Bone Transport Reconstruction of Distal Tibial Defects
Konstantinos A. Giannikas, FRCS, DSM1; Constantinos N. Maganaris, PhD2; Michael T. Karski, MRCS3; Peter Twigg, PhD4; Richard A. Wilkes, FRCS3; John G. Buckley, PhD4
1 15, Makedonias Street, Ag Paraskevi, 15341, Athens, Greece. E-mail address: kostas.giannikas@lineone.net
2 Institute for Biophysical and Clinical Research into Human Movement, Manchester Metropolitan University, Hassall Road, Alsager, Stoke-on-Trent ST7 2HL, United Kingdom
3 Hope Hospital, Stott Lane, Salford M6 8HD United Kingdom
4 Department of Optometry, University of Bradford, Bradford BD7 1DP United Kingdom
View Disclosures and Other Information
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Smith and Nephew Healthcare. (Smith and Nephew Healthcare paid the traveling expenses of the volunteers who participated in this study.) None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Optometry, University of Bradford, Bradford, and the Institute for Biophysical and Clinical Research into Human Movement, Manchester Metropolitan University, Alsager, Stoke-on-Trent, United Kingdom

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Jan 01;87(1):145-152. doi: 10.2106/JBJS.C.01550
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Background: Little has been written about the functional outcome of patients treated with bone transport to reconstruct a distal tibial defect. The aim of this study was to investigate the functional capabilities of patients who had undergone reconstruction with distraction osteogenesis for the treatment of a distal tibial defect in one lower limb.

Methods: At least eighteen months after completion of treatment, eight patients who had no pain and were able to walk and climb stairs without difficulty performed isometric ankle plantar flexion maximum voluntary contractions while the electromyographic activity of the tibialis anterior and triceps surae muscles was simultaneously recorded. Seven of the patients also underwent gait analysis. Data for the involved limb were compared with those collected for the contralateral limb.

Results: During gait, stance time (p = 0.01), the plantar flexion angular displacement and peak moment developed during the second half of stance (p < 0.046), and the amount of ankle power generated (p = 0.02) were significantly decreased in the involved limb compared with the contralateral limb. Similar decreases were observed in the plantar flexion (p = 0.01) and dorsiflexion (p = 0.01) maximum voluntary contractions and the corresponding electromyographic activity (p = 0.01).

Conclusions: These results suggest that adaptive changes had occurred at the level of the transported muscles, which affected both routine and maximal effort capabilities. These findings contribute to our understanding of the functional limitations of patients who have undergone bone transport with its obligatory shortening of muscle length.

Level of Evidence: Therapeutic study, Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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