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Category: Sports; Hindfoot Introduction/Purpose: Delays in diagnosis or treatment of acute Achilles tendon rupture are relatively frequent either due to the injury being misdiagnosed or the patient disregarding its severity. In the delayed presentation of Achilles tendon rupture, open repair is generally recommended for mobilization of the adherent and retracted tendons from the thickened paratenon layer repair although this introduces the risk of wound complications. Although a minimally invasive technique for acute Achilles tendon rupture has demonstrated lower infection rates, with functional results equivalent to those of open repair, their use in patients presenting in a delayed fashion has not been thoroughly investigated. The objective of this study is to compare the outcomes of percutaneous and open repair in cases of delayed presentation of acute Achilles tendon rupture. Methods: This was a retrospective study of prospectively collected data on consecutive patients who underwent either percutaneous or open repair for delayed presentation of Achilles tendon rupture and were followed up for at least one year. Delayed Achilles tendon rupture was defined as if patients underwent surgery 14 to 30 days after the injury and had received no treatment before surgery. The percutaneous repair was a modified Bunnell suture with an additional incision enough to permit mobilization of the tendon ends and core suture. An identical postoperative rehabilitation protocol was implemented in both groups: with below-knee cast in maximum plantarflexion, full weightbearing on the metatarsal heads was immediately allowed as tolerated. Postoperatively, the AT Resting Angle (ATRA), patient-reported functional outcomes using the AT Rupture Score (ATRS), and Calf circumference difference were evaluated. Postoperative complications, including re-rupture, wound infection, and sural nerve injury, were assessed. Results: There were no significant differences in demographic data between the percutaneous repair group (N =23) and the open repair group (N =23). The elapsed time from injury to surgical treatment and the gap between the proximal and distal stumps assessed on the MRI between the groups were similar. there were no statistically significant differences observed in ATRA (-2.9 ± 1.8 vs -2.1 ± 1.7, p = 0.687), ATRS (92.2 ± 2.5 vs 93.1 ± 2.6, p = 0.814), or calf circumference difference. Additionally, there were no cases of re-rupture in either group. A deep wound infection occurred in one patient in the open repair group. Symptoms related to sural nerve injury were observed in two patients in the percutaneous repair group, which resolved with conservative treatment. Conclusion: In cases of delayed presentation of Achilles tendon rupture, the percutaneous tendon repair technique is considered to yield comparable outcomes to the open tendon repair technique. [ABSTRACT FROM AUTHOR]

Category: Bunion; Other Introduction/Purpose: Hallux valgus is known to be more prevalent and present with greater severity in the elderly population compared to the younger age group. However, surgical treatment of hallux valgus in the elderly carries a risk of suboptimal results owing to porotic bone quality and multiple comorbidities typical of this age group. Although the third-generation minimally invasive Chevron and Akin osteotomy (MICA) technique, which features minimal soft tissue disruption and rigid internal fixation, may be an attractive option for surgical treatment of hallux valgus in the elderly, its outcomes have not been thoroughly investigated. This study sought to compare the outcomes of third-generation MICA procedures in patients aged 65 and older with those in the cohort under 65 years of age. Methods: In this retrospective cohort study, 76 patients (79 feet) who underwent the third generation MICA procedure for hallux valgus and were followed up for at least 1 year were stratified into 2 groups: ≥65 years old (Group 1: 36 feet) and < 65 years old (Group 2: 40 feet). Radiographic assessments included HV angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA). Clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score, pain visual analog scale (VAS), and patient satisfaction rating. Postoperative complications, including recurrence of the deformity, reduction loss and reoperation, were assessed. Results: The average age at the time of surgery in group 1 was 70.9 ± 5.8 (range 65~90) years, and in group 2, 50.2 ± 2.8 (range 21~ 63), respectively. In the elderly group, Bone Mineral Density (BMD) was measured -2.9. The mean HVA, IMA and DMAA significantly improved at the final follow-up in both groups, respectively (all P <.001). Both preoperative and postoperative HVA were significantly greater in group 1 (both, P <.001), and the change of this parameter after surgery was also lower in group 1 than in group 2 (P <.001). There were significantly higher rates of reduction loss (16% vs 2.5%) and recurrence (11.1% vs 0.5%). However, clinical scores and patient satisfaction rates did not differ significantly. Conclusion: The present study demonstrates that chronological age, specifically categorized as 65 years or older, exhibits no substantial influence on the clinical outcomes following third-generation MICA surgery. Nevertheless, it is imperative to adequately apprise patients of the potential for reduction loss and recurrence, possibly due to age-associated bone fragility. [ABSTRACT FROM AUTHOR]

Category: Ankle Arthritis; Sports Introduction/Purpose: Repetitive ankle sprains can cause various intra-articular pathologies, and there is a relatively clear consensus on the relationship between chronic ankle instability and osteoarthritis. However, information on the natural course in patients with chronic ankle instability and treatment options for preventing degenerative changes remain limited. This study aimed to compare the intermediate-term prognoses between patients with surgical and non-surgical treatment. Methods: This study included 44 patients who underwent lateral stabilization procedure (anatomical ligament repair or reconstruction) and 62 patients with conservative treatment for chronic ankle instability conjunction with early-stage arthritis of Takakura grade 2. Daily living and sport activities were evaluated using the Foot and Ankle Ability Measure (FAAM). Progression of osteoarthritis was evaluated through periodic weight-bearing radiographs. Additionally, the correlation between clinical evaluation score and the presence of progressive osteoarthritis was analyzed. Results: The FAAM score significantly improved from a mean of 48.8 points preoperatively to 83.6 points at final follow-up (p <.001) in the surgical group, while it also improved in the non-surgical group from a mean of 65.9 points to 74.1 points (p = 0.188). There was no significant difference in daily living ability of the FAAM score between the two groups at final follow-up (88.6 vs 81.4 points, p = 0.385), but the surgical group showed better results than the non-surgical group in sports ability (79.4 vs. 67.3 points, p <.001). The incidence of progression of osteoarthritis grade was not significantly different between surgery group (15.9%) and non-surgical group (17.7%) (p = 0.861). Conclusion: Patients with early medial osteoarthritis accompanied by chronic lateral ankle instability who underwent surgical and non-surgical treatment showed similar intermediate-term clinical outcomes. However, in terms of sports activity ability, the surgical group showed superior results compared to the non-surgical group. The radiological prognosis based on the Takakura grade of degenerative arthritis also showed similar results in both groups. There was a significant difference in clinical evaluation scores between patients with and without progressive osteoarthritis. [ABSTRACT FROM AUTHOR]

Category: Sports; Ankle Introduction/Purpose: Even after a considerable period following the modified Broström procedure, it is not uncommon for individuals to fail to fully regain their pre-injury sports activity capabilities. Return to sports activity can be influenced by various factors beyond the patient's determination (hope for sports activity), including residual pain or swelling, inadequate mechanical stability, deficits in postural control abilities or proprioception, among others. This study aimed to investigate the factors influencing the return to sports activity after anatomical ligament repair for chronic ankle instability. Methods: We conducted a study involving 62 patients under the age of 35 who underwent the modified Broström procedure for chronic ankle instability and were followed up for over 3 years. Among them, 51 patients (82.3%) were able to return to their pre-injury level of sports activity (return group), while 11 patients (17.7%) experienced some or significant limitations (non-return group). Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM). Mechanical stability was assessed through physical examination and stress radiography. peroneal strength was evaluated using Biodex isokinetic dynamometer to measure peak torque and total work during eversion movement. Postural control abilities were analyzed using the static and dynamic stability assessment modes of Biodex posturography. Results: There was a significant difference between the two groups in FAOS pain (94.7 points in return group vs 85.1 points in non-return group, p=0.004) and sports (91.2 points vs 78.8 points, p<.001) subscales. In FAAM assessment, there was a significant difference in the sports activity (90.5 points vs 77.4 points, p<.001). Recurrence of mechanical instability was confirmed in 2 patients (3.9%) in the return group and 4 patients (36.4%) in the non-return group. There were no significant differences between the groups in evertor peak torque and total work. Regarding posturography assessment, static postural control ability(overall stability index) did not show significant differences between the groups, but significant differences were observed in dynamic postural control ability (1.4 vs 2.3, p=0.002). Conclusion: It has been analyzed that residual pain, recurrence of mechanical instability, and inadequate recovery of dynamic postural control ability affect the return to pre-injury level of sports activity after the modified Broström procedure for chronic ankle instability. It is deemed necessary to develop effective treatment strategies considering these factors during the rehabilitation process aimed at returning to sports activity after surgery. [ABSTRACT FROM AUTHOR]