Bakgrund: Fotleden används dagligen och en nedsatt fotledsrörlighet kan orsaka många problem för personer i vardagen. Knäböj är en rörelse som används både i vardagen samt i träningssammanhang och kräver en god dorsalflexion i fotleden. Det är därför värdefullt att som fysioterapeut veta vilken metod som ökar dorsalflexion inför ett rehabiliteringsprogram där knäböj ingår. Syfte: Sammanställa litteraturen gällande akuta effekter av dynamisk och statisk stretching samt posterior talocrural glide på dorsalflexion i talocruralleden hos friska individer, definierat som personer utan fysiologisk sjukdom eller trauma med eventuell påverkan på fotleden. Studien syftar även till att värdera graden av evidens för behandlingarna. Metod: Litteratursökning utfördes i databasen PubMed. Slutligen inkluderades åtta studier med sammanlagt 141 deltagare. Samtliga studier kvalitetsgranskades enligt PEDro scale, därefter användes SBU:s GRADE för evidensbedömning. Resultat: Statistisk signifikant ökning på dorsalflexion för samtliga metoder med liknande utslag på rörlighet, med liten fördel för statisk stretch. Kvalitetsgranskning enligt PEDro scale visar på att fem studier anses vara av måttlig till hög kvalitet och tre anses vara av låg kvalitet. Otillräckligt vetenskapligt underlag för posterior talocrural glide, statisk och dynamisk stretch på dorsalflexion. Konklusion: Statisk stretch, dynamisk stretch och posterior talocrural glide ökar dorsalflexionen efter minst två minuters behandling. Evidensen talar för att samtliga metoder ger liknande utfall på dorsalflexionen med en liten fördel för statisk stretch, men fler studier behövs för att bekräfta resultatet. / Background: Demands are put on the ankle daily. Limited ankle range of motion can present problems during daily activities. The squat is a movement performed both in everyday life as well as in the context of training and requires ample dorsiflexion of the ankle. Therefore, it is of value to physiotherapists to know which method should be used to increase dorsiflexion in a rehabilitation protocol where the squat is included. Objective: To provide an overview of the acute effects of static and dynamic stretching as well as posterior talocrural glide in healthy individuals without physiological diseases or trauma relating to the ankle. The study will also assess the level of evidence surrounding each of these methods. Method: The database PubMed was used to search for the included studies. A total of eight studies was included in this review, with a total of 141 participants. Study quality was judged using PEDro scale, after which SBU’s GRADE was used to determine the level of evidence for each method. Result: A statistically significant increases present for each of the methods, with similar outcomes on the dorsiflexion. Assessing the quality of the included studies with PEDro scale resulted in five studies of moderate to high quality and three of low quality. Evidence supporting posterior talocrural glide, static and dynamic stretching is deemed insufficient according to SBU’s GRADE. Conclusion: Dorsiflexion is increased after two minutes of static and dynamic stretching as well as posterior talocrural glide. The evidence suggests that similar increases are present with each method, with static stretch showing a slightly higher result. However further research is required to confirm the result.

Osteochondral lesions of the talus (OLTs) are the third most common type of osteochondral lesion and can cause pain and instability of the ankle joint. Episurf Medical AB is a medical technology company that develops individualized implants for patients who are suffering from focal cartilage lesions. Episurf have recently started a project that aims to implement their implantation technique in the treatment of OLTs. This master thesis was a part of Episurf’s talus project and the main goal of the thesis was to find the optimal implantation angle of the Episurf implant when treating OLTs. The optimal implantation angle was defined as the angle that minimized the maximum equivalent (von Mises) strain acting on the implant shaft during the stance phase of a normal gait cycle. It is desirable to minimize the strain acting on the implant shaft, since a reduction of the strain can improve the longevity of the implant. To find the optimal implantation angle a finite element model of an ankle joint treated with the Episurf implant was developed. In the model an implant with a diameter of 12 millimeters was placed in the middle part of the medial side of the talar dome. An optimization algorithm was designed to find the implantation angle, which minimized the maximum equivalent strain acting on the implant shaft. The optimal implantation angle was found to be a sagittal angle of 12.5 degrees and a coronal angle of 0 degrees. Both the magnitude and the direction of the force applied to the ankle joint in the simulated stance phase seemed to influence the maximum equivalent strain acting on the implant shaft. A number of simplifications have been done in the simulation of this project, which might affect the accuracy of the results. Therefore it is recommended that further, more detailed, simulations based on this project are performed in order to improve the result accuracy. / Fokala broskskador på talusbenet är den tredje vanligaste typen av fokala broskskador och kan ge upphov till smärta och instabilitet av fotleden. Episurf Medical AB är ett medicintekniskt företag som utvecklar individanpassade implantat för patienter med fokala broskskador. Episurf har nyligen påbörjat ett projekt där deras teknik ska användas i behandlingen av fokala broskskador på talusbenet. Den här masteruppsatsen var en del i Episurfs talusprojekt och dess huvudmål var att finna den optimala implantationsvinkeln av Episurfs implantat i behandlingen av fokala broskskador på talusbenet. Den optimala implanteringsvinkeln definierades som den vinkel som minimerade den effektiva von Mises-töjningen som verkade på implantatskaftet under stance-fasen i en normal gångcykel. Det är eftersträvansvärt att minimera belastningen på implantatskaftet eftersom en reducering av belastningen kan förbättra implantatets livslängd. En finita element-modell av en fotled behandlad med Episurfs implantat utvecklades för att för att finna den optimala implantationsvinkeln. I modellen placerades ett implantat med en diameter på 12 millimeter på mittendelen av talus mediala sida. En optimeringsalgoritm utformades för att finna implantationsvinkeln som minimerade den effektiva von Mises-töjningen på implantatskaftet. Den funna optimala implantationsvinkeln bestod av en vinkel på 12.5 grader i sagittalplan och en vinkel på 0 grader i koronalplan. Både storleken och riktningen på kraften som applicerats på fotleden under den simulerade stance-fasen av gångcykeln verkade påverka belastningen på implantatskaftet. Ett antal förenklingar har gjorts i projektets simuleringar, vilket kan påverka noggrannheten i resultatet. Därför rekommenderas att ytterligare, mer detaljerade simuleringar baserade på det här projektet görs för att förbättra resultatets noggrannhet.

Avaliou-se a tipificação das fibras musculares e determinou-se parâmetros morfoquantitativos dos efeitos da imobilização por 2 e 4 semanas. Após o período experimental, os músculos (mm.) foram corados por HE e Picro-sírius. Para a tipificação das fibras, utilizou-se as reações da ATPase e NADH-tr; a análise ultraestrutural procedeu-se com microscopia eletrônica de transmissão. Nos resultados, alguns mm. imobilizados (Im) exibiram núcleos centralizados e fibras tipo IIB com formas elusivas. O perimísio destes mm. se espessou, sendo constituído por fibras colágenas tipo III. Os fusos musculares apresentaram espessamento da cápsula. Houve alterações nas linhas Z e modificação de outras ultraestruturas como as mitocôndrias. A área de secção transversa dos mm. Im por 4 semanas foi menor. As fibras do tipo IIB reduziram a área de perfil e aumentaram a densidade, além disso, se ampliou a porcentagem das fibras do tipo IIA. Portanto, a imobilização promoveu alterações nos fusos e esqueleto fibroso muscular, assim como transformou fibras do tipo IIB em IIA. / The effects of muscle immobilization for 2 and 4 weeks were studied by determining morphoquantitative parameters and muscle fiber-typing. After the trial period the muscles (mm.) were subject to HE and Picrosirius stain. The reactions of ATPase and NADH-tr were used for muscles fiber-typing. The ultrastructural analyses were made by transmission electron microscopy. The results showed changes in some of immobilized (Im) mm., it exhibited centralized nuclei cells and type IIB fibers took indefinite forms. The perimisium of Im mm. thicker up, and consisted of type III collagen fibers. Also the muscle spindles capsule thickened. Changes in the Z lines and other ultrastructures such as mitochondria were noticed. The cross-section area of Im mm. for 4 weeks was lower. The type IIB fibers reduced the profile area and density increased. Also the percentage of type IIA fibers expanded. Therefore the immobilization promoted changes in muscle spindles, fibrous skeleton morphology and provide an interconversion of muscle fibers type IIB into IIA.

Avaliou-se a tipificação das fibras musculares e determinou-se parâmetros morfoquantitativos dos efeitos da imobilização por 2 e 4 semanas. Após o período experimental, os músculos (mm.) foram corados por HE e Picro-sírius. Para a tipificação das fibras, utilizou-se as reações da ATPase e NADH-tr; a análise ultraestrutural procedeu-se com microscopia eletrônica de transmissão. Nos resultados, alguns mm. imobilizados (Im) exibiram núcleos centralizados e fibras tipo IIB com formas elusivas. O perimísio destes mm. se espessou, sendo constituído por fibras colágenas tipo III. Os fusos musculares apresentaram espessamento da cápsula. Houve alterações nas linhas Z e modificação de outras ultraestruturas como as mitocôndrias. A área de secção transversa dos mm. Im por 4 semanas foi menor. As fibras do tipo IIB reduziram a área de perfil e aumentaram a densidade, além disso, se ampliou a porcentagem das fibras do tipo IIA. Portanto, a imobilização promoveu alterações nos fusos e esqueleto fibroso muscular, assim como transformou fibras do tipo IIB em IIA. / The effects of muscle immobilization for 2 and 4 weeks were studied by determining morphoquantitative parameters and muscle fiber-typing. After the trial period the muscles (mm.) were subject to HE and Picrosirius stain. The reactions of ATPase and NADH-tr were used for muscles fiber-typing. The ultrastructural analyses were made by transmission electron microscopy. The results showed changes in some of immobilized (Im) mm., it exhibited centralized nuclei cells and type IIB fibers took indefinite forms. The perimisium of Im mm. thicker up, and consisted of type III collagen fibers. Also the muscle spindles capsule thickened. Changes in the Z lines and other ultrastructures such as mitochondria were noticed. The cross-section area of Im mm. for 4 weeks was lower. The type IIB fibers reduced the profile area and density increased. Also the percentage of type IIA fibers expanded. Therefore the immobilization promoted changes in muscle spindles, fibrous skeleton morphology and provide an interconversion of muscle fibers type IIB into IIA.

No description available.