{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T16:38:09Z","timestamp":1778776689922,"version":"3.51.4"},"reference-count":42,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T00:00:00Z","timestamp":1659484800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Haemophilia"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Haemophilic ankle arthropathy (HAA) causes major morbidity. When conservative treatment fails, major surgical interventions are indicated. An alternative treatment to maintain joint mobility and postpone these interventions is desired.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To gather prospective data on clinical\/structural changes after ankle joint distraction (AJD) in HAA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study includes patients with severe HAA insufficiently responding to conservative treatment. AJD was performed during 8\u201310\u00a0weeks by use of an external frame. Questionnaires, physical examination and radiology were used to evaluate pain, function and structural changes before and 6, 12, 24 and 36\u00a0months after distraction. Mixed effect models were used for analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study includes eight cases (21\u201353\u00a0years). The fixed effects estimates of the visual analogue score (0\u201310) improved from 7.5 at baseline to 3.4 (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.023) 3\u00a0years after distraction. The Haemophilia Activities List (HAL, 0\u2013100) for basic\/complex lower extremities functions improved from respectively 29.6 and 31.5 to 54.3 (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.015) and 50.7 (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.031). Joint mobility was maintained. Magnetic resonance imaging (MRI) showed thickened cartilage and reduced bone marrow oedema and subchondral cysts. Pin tract infections (<jats:italic>n<\/jats:italic>\u00a0=\u00a06) were effectively treated and no adverse bleeding events occurred. At 3\u2010year follow\u2010up, in none of the patients the originally indicated arthrodesis was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This first prospective study showed that AJD in HAA results in decreased pain, improved function and decreased arthropathy\u2010related MRI findings in the majority of patients for prolonged time. Although the study population is small and follow\u2010up is relatively short, AJD may be promising to postpone invalidating interventions and might be a breakthrough treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hae.14633","type":"journal-article","created":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T17:47:08Z","timestamp":1659548828000},"page":"1044-1053","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Ankle joint distraction is a promising alternative treatment for patients with severe haemophilic ankle arthropathy"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9706-4566","authenticated-orcid":false,"given":"Eline D. P.","family":"van Bergen","sequence":"first","affiliation":[{"name":"Center for Benign Haematology Thrombosis and Haemostasis University Medical Center Utrecht University Utrecht  Van Creveldkliniek Utrecht The Netherlands"},{"name":"Department of Rheumatology &amp; Clinical Immunology University Medical Center Utrecht University Utrecht  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon C.","family":"Mastbergen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology &amp; Clinical Immunology University Medical Center Utrecht University Utrecht  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. Charles","family":"Vogely","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery University Medical Center Utrecht University Utrecht  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanya N.","family":"Balani","sequence":"additional","affiliation":[{"name":"Department of Rheumatology &amp; Clinical Immunology University Medical Center Utrecht University Utrecht  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piet","family":"de Kleijn","sequence":"additional","affiliation":[{"name":"Center for Benign Haematology Thrombosis and Haemostasis University Medical Center Utrecht University Utrecht  Van Creveldkliniek Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4970-8555","authenticated-orcid":false,"given":"Wouter","family":"Foppen","sequence":"additional","affiliation":[{"name":"Department of Radiology University Medical Center Utrecht University Utrecht  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter M.","family":"van Roermund","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery University Medical Center Utrecht University Utrecht  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Floris P. 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