Search

Background: During the modified Broström procedure for chronic ankle instability, surgeons often experience cases with insufficiently restored mechanical stability even after anatomical ligament repair. In these cases, longer postoperative immobilization and delayed rehabilitation can be required, and a risk for recurrence of instability may persist. This study aimed to evaluate the clinical usefulness of suture-tape augmentation based on intraoperative stress radiographs during anatomical ligament repair for chronic ankle instability. Methods: Twenty-four patients who underwent additional suture-tape reinforcement because of residual mechanical instability on intraoperative stress radiographs were followed up ≥3 years. Clinical assessment was performed using the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). Changes in mechanical stability were analyzed through periodic stress radiographs, and postural control ability was evaluated with the modified Romberg test. Results: FAOS and FAAM scores improved significantly from preoperative mean 55.1 and 52.4 points to 92.3 and 90.2 points at final follow-up, respectively (P <.001). Talar tilt angle and anterior talar translation improved significantly from preoperative mean 15.8 degrees and 13.6 mm to 2.9 degrees and 4.2 mm, respectively (P <.001). Balance retention time improved significantly from preoperative mean 3.6 to 6.4 seconds (P <.001). Although 9 patients experienced sprain injury after surgery, no patient showed recurrence of mechanical and subjective instability, and 21 patients (87.5%) were able to return to preinjury level of sports activity. Conclusion: Evaluation of residual mechanical instability through intraoperative stress view and additional suture-tape augmentation showed satisfactory clinical outcomes at midterm follow-up. Suture-tape augmentation based on intraoperative stress radiographs seems to be a useful surgical option for patients with insufficiently restored mechanical stability even after anatomical ligament repair. This combined procedure can provide a reliable mechanical stability that can be performed after recognition of residual instability during the index surgery. [ABSTRACT FROM AUTHOR]

Background: The conventional operative method to treat an osteochondral lesion of the talus (OLT) is through bone marrow stimulation (BMS). Autologous osteochondral transplantation (AOT) is being used as an alternative option in cases with a large OLT, accompanying subchondral cyst, and/or failed BMS. We aimed to compare the intermediate-term clinical and radiologic results between medial and lateral OLTs after an AOT procedure. Methods: Among the patients who underwent AOT, 45 cases with at least 3 years' follow-up were included in this retrospective study. We had 15 cases of lateral lesions and selected 30 cases of medial lesions matched for age and gender. Lateral lesions were resurfaced without an osteotomy; medial lesion resurfacing was combined with a medial malleolar osteotomy. Clinical assessment was performed using the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). Radiographic assessment included the irregularity of articular surface (subchondral plate), the progression of degenerative arthritis, and the change of the talar tilt. Results: The mean FAOS and FAAM scores significantly improved after surgery in both groups. Up to 1 year postoperatively, there was significant difference in FAAM scores between the both groups (mean 75.3 points in medial group and 87.2 points in lateral group, P <.001). Delayed union or malunion of the malleolar osteotomy was found in 4 cases (13%) in the medial group. In addition, the progression of joint degeneration was observed in 3 cases (10%) in the medial group. There were no significant differences in the irregularity of articular surface and the change of talar tilt between both groups. Conclusion: A comparison between medial and lateral OLTs treated with AOT demonstrated comparable intermediate-term clinical outcomes. However, patients with medial OLT required a longer period to restore ability for daily and sport activities. In addition, we found more complications and higher rate of progression in the radiologic arthritis grade after medial malleolar osteotomy. Level of Evidence: Level IV, retrospective comparative study. [ABSTRACT FROM AUTHOR]

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]

Background: We aimed to compare midterm radiological and clinical outcomes between closed reduction and internal fixation (CRIF) using the fibular intramedullary nail (IMN) and open reduction and internal fixation (ORIF) using the locking plate for the treatment of unstable ankle fractures in active young patients. Methods: In this retrospective cohort study, 204 patients treated with CRIF using the fibular IMN (94 patients) or ORIF using the locking plate (110 patients) were included after at least 3 years of follow-up. The mean patient age was 41.4 years. Radiographic evaluation included the quality of reduction assessed by plain radiography and 3-dimensional (3D)–reconstructed computed tomography as well as the development of posttraumatic osteoarthritis (PTOA) of the ankle assessed by weightbearing plain radiography. Clinical evaluation included the American Orthopaedic Foot & Ankle Society hindfoot score, Olerud and Molander Score, the Foot and Ankle Outcome Score, and visual analog scale pain score as well as complications. Results: At median follow-up greater than 4 years, we found no significant differences in measured clinical outcomes between the 2 groups. There were significantly fewer postoperative complications in the IMN group than in the ORIF group (9.5% vs 39%, P <.001). However, we did find a greater proportion of radiographically fair or poor reductions in the IMN group than in the ORIF group (P <.001). The poor reductions in the IMN group were primarily related to Weber type C, pronation-type injury, and comminuted fibular and trimalleolar fractures (P <.001). PTOA was also more frequently observed in the IMN group than in the ORIF group (21.3% vs 9.1%, P =.024). Conclusion: Given the current prevailing technologies for fracture fixation, this study suggests that surgeons should consider ORIF for unstable ankle fractures in active young patients with Weber type C, pronation-type injury, and comminuted fibular and trimalleolar fractures. Level of Evidence: Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

Background: Total ankle arthroplasty (TAA) is known to be a reliable operative option for end-stage rheumatoid arthritis. However, higher risk of postoperative complications related to chronic inflammation and immunosuppressive treatment is still a concern. With the use of a newer prosthesis and modification of anti-rheumatic medications, we compared clinical outcomes after TAA between patients with osteoarthritis and rheumatoid arthritis. Methods: Forty-five patients with end-stage osteoarthritis (OA group) and 19 with rheumatoid arthritis (RA group) were followed for more than 3 years after 3 component mobile-bearing TAA (ZenithTM). Perioperative anti-rheumatic medications were modified using an established guideline used in total hip and knee arthroplasty. Clinical evaluations consisted of American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM). Results: In the preoperative and postoperative evaluation at final follow-up, there were no significant differences in AOFAS, FAOS, and FAAM scores between 2 groups. Despite statistical similarity in total scores, the OA group showed significantly better scores in FAOS sports and leisure (mean, 57.4 ± 10.1) and FAAM sports activity (mean, 62.5 ± 13.6) subscales than those in the RA group (mean, 52.2 ± 9.8, P =.004; and 56.4 ± 13.2, P <.001, respectively). There were no significant differences in perioperative complication and revision rates between 2 groups. Conclusion: Patients with end-stage ankle RA had clinical outcomes comparable to the patients with OA, except for the ability related to sports activities. In addition, there were no significant differences in early postoperative complication rates, including wound problem and infection. Level of Evidence: Level III, prognostic, prospective comparative study. [ABSTRACT FROM AUTHOR]

Background: The first aim of this study was to evaluate the side-to-side difference of joint-position sense, peroneal strength, postural control, and functional performance ability in patients with chronic lateral ankle instability. The second aim was to identify the correlation between various components contributing to the functional ankle instability (FAI). Methods: Thirty-five patients to be scheduled for the modified Broström procedure for chronic ankle instability were analyzed. Joint-position sense and peroneal strength were measured with an isokinetic dynamometer. Postural control ability was evaluated using the modified Romberg test. The functional performance test consisted of the 1-leg hop test, 6-meter hop test, and cross 3-m hop test. Spearman's correlation coefficient (r) was calculated to determine the linear association between the individual components of the FAI. Results: Except for the 6-m and cross 3-m hop tests, most examination tools for the FAI demonstrated significant side-to-side differences compared with the unaffected ankle. Spearman's correlation analysis revealed that individual components (joint-position sense, peroneal strength, postural control, and functional performance ability) of the FAI were significantly associated with one another, except between peroneal strength and postural control ability (r = 0.21, P =.195). Conclusion: Joint-position sense, peroneal strength, postural control ability, and 1-leg hop test demonstrated significant side-to-side differences in patients with chronic lateral ankle instability. Individual components contributing to the FAI were significantly correlated with one another, except between peroneal strength and postural control ability. Postural control evaluation using the modified Romberg test could substitute for dynamometer testing, with convenience and economic advantage. Level of Evidence: Level IV, prospective case series. [ABSTRACT FROM AUTHOR]

Background: Although lateral ligament augmentation using suture-tape has been effective for restoration of mechanical ankle stability, few data are available regarding changes of peroneal strength, proprioception, and postural control. The aim of this study was to determine effects of suture-tape augmentation on functional ankle instability (FAI). Methods: Twenty-four patients who underwent suture-tape augmentation were eligible and were followed more than 2 years postoperatively. Functional outcomes were evaluated with the Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM). Changes of peroneal strength, proprioception and postural control were analyzed with an isokinetic dynamometer and a modified Romberg test. Results: CAIT and FAAM (average of daily and sports activity scores) significantly improved to average 27.2 points and 86.7 points, respectively, at final follow-up. Peak torque for eversion in 60 degrees/s angular velocity significantly improved to 10.6 Nm at final follow-up. Deficit ratio of peak torque for eversion significantly improved from mean 39.5% to 20.9%, and significant side-to-side difference was revealed (P < .001). There were no significant differences in joint position sense. A significant improvement in balance retention time was revealed at final follow-up, and the relative deficit ratio compared to the unaffected side was 30.9%. Conclusions: Patient-reported functional outcomes significantly improved after lateral ligament augmentation using suture-tape. Although this procedure demonstrated significant effects on FAI based on improvement of isokinetic peroneal strength and postural control, recovery rates compared to the unaffected side were not significant at the intermediate-term follow-up. In addition, there was no positive effect on proprioception of the ankle. Level of Evidence: Level IV, prospective case series. [ABSTRACT FROM AUTHOR]

Background: There is limited information regarding the outcomes of operative treatment for ankle instability with coexisting arthritic changes in the medial gutter. This study was performed to evaluate the intermediate-term clinical and radiological outcomes following a modified Broström procedure and arthroscopic debridement in middle-aged patients with combined medial gutter osteoarthritis and chronic ankle instability. Methods: Twenty-two patients with medial gutter osteoarthritis related to chronic lateral ankle instability were followed for more than 3 years after operative treatment. All patients showed medial joint space narrowing of Takakura stage II at the time of surgery. The clinical evaluation consisted of the American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS) for medial ankle pain during walking, and Foot and Ankle Ability Measure (FAAM). Results: Mean AOFAS and FAAM scores significantly improved from 51.2 and 45.7 points preoperatively to 80.3 and 78.4 points at final follow-up, respectively (P < .001). Although mean pain-VAS significantly improved from 6.8 points to 3.5 points (P < .001), 8 patients (36.4%) complained of gait discomfort with considerable pain of 4 or more points. There was only 1 patient (4.5%) with recurrent ankle instability, while 6 patients (27.3%) showed a progression of arthritis stage. Conclusions: Modified Broström procedure combined with arthroscopic debridement appears to be an effective operative option for medial gutter osteoarthritis secondary to chronic ankle instability. Despite the onset of arthritis, most patients were able to achieve significant improvement in reducing pain while eliminating instability. Level of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

Category: Sports; Ankle Introduction/Purpose: Because modified Broström procedure for chronic ankle instability provides a restoration of mechanical stability by reinforcing attenuated host tissue, poor quality of remnant ligamentous tissue can be considered as a prognostic factor for anatomic ligament repair surgery. The aim of this study was to evaluate the intermediate-term clinical outcomes after anatomic lateral ligaments repair augmented with suture-tape for chronic ankle instability with poor quality of ligament remnants. Methods: Thirty-six patients with the insufficient lateral ligament remnants confirmed by preoperative magnetic resonance image and intraoperative inspection were followed for more than 3 years after the augmented Broström repair. The clinical evaluation consisted of the Foot and Ankle Outcome Score(FAOS), Foot and Ankle Ability Measure(FAAM). Measurements on stress radiographs were performed to evaluate the changes of mechanical instability. To identify the changes of functional ankle instability, postural control ability was evaluated using single leg stance test with eyes closed. Results: FAOS and FAAM scores had significantly improved from preoperative average 56.3 and 51.8 points to 90.2 and 88.5 points at final follow-up, respectively (p <.001). Talar tilt angle and anterior talar translation had significantly improved from preoperative average 16.3° and 13.2 mm to 3.5° and 4.3 mm at final follow-up, respectively (p <.001). Balance retention time had significantly improved from preoperative average 3.8 seconds to 6.6 seconds at final follow-up (p <.001). Complications included two wound problems (one with superficial infection and one with marginal necrosis) and one superficial peroneal nerve injury with temporary paresthesia. Although 8 patients sustained an ankle sprain after operation, only 1 patient(2.8%) showed a recurrence of subjective and mechanical instability. Conclusion: Modified Broström procedure augmented with suture-tape appears to be an effective alternative for chronic ankle instability with poor quality of ligament remnants. Through the suture-tape augmentation and the direct repair of attenuated ligaments, this combined procedure can provide reliable stability and advantages of the anatomic ligament repair. [ABSTRACT FROM AUTHOR]

Category: Ankle Arthritis; Ankle Introduction/Purpose: Because nonunion is known to be a relatively common complication following ankle arthrodesis, various fixation techniques have been introduced to enhance the stability and to improve fusion rate. With the use of anterior plate supplementation, postoperative wound problems have been frequently reported despite better fusion rate. This study was performed to determine the effects of tibialis anterior(TA) tenotomy on wound complications and functional outcomes after anterior fusion plating for severe ankle arthritis. Methods: Forty-six patients who underwent ankle arthrodesis using anterior fusion plate were followed for more than 3 years. TA tenotomy was performed prior to wound closure in all patients. As a control group, thirty-eight patients who underwent arthrodesis without TA tenotomy were analysed. Clinical outcomes were evaluated with Ankle Osteoarthritis Scale(AOS) and Foot and Ankle Ability Measure(FAAM). Wound complication rate, time to fusion, fusion rate, time to pain relief below 3 points in visual analog scale were evaluated. Results: Mean AOS and FAAM scores significantly improved to 32.6 and 69.4 points at final followup, respectively. As compared to control group (33.8 and 67.7 points), there were no significant differences in clinical outcomes. As postoperative wound complications, there were 1 case of wound dehiscence and 1 case of superficial wound infection. TA tenotomy group showed lower wound complication rate (4.3%) than control group (21.1%). While there were no significant differences in fusion rate, time to fusion, and time to pain relief between both groups, control group needed higher rate of implant removal. Conclusion: Ankle arthrodesis using anterior fusion plate in conjuction with TA tenotomy appears to be an effective surgical option for end-stage ankle arthritis, with higher fusion rate and less wound complication rate. Although there was no specific functional deficit related to a loss of the TA tendon, further studies are needed to determine the long-term effects of the TA tenotomy in patients with a fused ankle. [ABSTRACT FROM AUTHOR]

Category: Midfoot/Forefoot; Midfoot/Forefoot Introduction/Purpose: The surgical treatment of severe hallux valgus (HV) deformity is challenging due to the difficulty in achieving sufficient reduction and the increased risk of complications such as recurrence, delayed or non-union. Minimally invasive surgery (MIS) has been increasingly used to treat HV deformity, with the third-generation minimally invasive Chevron and Akin osteotomies (MICA) technique being widely accepted. This retrospective cohort study aimed to compare the radiographic and clinical outcomes between the distal and proximal MICA techniques for severe hallux valgus deformity. It was hypothesized that the proximal MICA technique would provide better radiographic results due to the stronger deformity correction achieved by the proximal metatarsal osteotomy. Methods: Seventy-four feet with severe HV (defined as HVA [≥40 degrees] and/or IMA [≥20 degrees]) treated with distal MICA (40 feet) or proximal MICA (34 feet) were included in this study after at least one year of follow-up. Clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score, pain visual analog scale (VAS), patient satisfaction rating, and complications. Radiographic assessments included HV angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA). Results: There were no differences in the mean AOFAS score, pain VAS score, and patient satisfaction rate at the final follow-up between the two groups (all p >.05). The mean postoperative HVA, IMA, and DMAA significantly improved at the final follow-up in both groups (all p <.001). There was no significant difference in the improvement of radiographic values after surgery between the two groups (all p > 0.05). Although not statistically significant, there was a trend toward a higher recurrence and delayed or nonunion rate in the distal MICA group (7.5% vs. 2.9%, P =.218 and 10% vs. 2.9%, P =.072). Conclusion: Both types of minimally invasive techniques resulted in satisfactory outcomes in terms of significant improvement in clinical values, large deformity correction, and reasonable complication rates. However, the proximal MICA technique appears to provide more stable maintenance of deformity correction than the distal technique. [ABSTRACT FROM AUTHOR]

Background: This retrospective comparative study reports the practical function in daily and sports activities after tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy. Methods: Seventeen patients were followed for a minimum of 3 years after tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy. Matched controls were used to evaluate the level of functional restoration. Functional evaluations included American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM) scores, and isokinetic muscle strength test. Radiographic evaluation for the changes of postoperative foot alignment included Meary angle, calcaneal pitch angle, hindfoot alignment angle, and navicular height. Results: Mean AOFAS, FAOS, and FAAM scores significantly improved from 65.1 to 86.2, 55.6 to 87.8, and 45.7 to 84.4 points at final follow-up, respectively. However, all functional evaluation scores were significantly lower as compared to the control group (P < .001). Mean peak torque (60 degrees/sec) of ankle dorsiflexors, plantarflexors, invertors, and evertors at final follow-up were 7.1 (deficit ratio of 65.4%), 39.2, 9.8, and 7.3 Nm, respectively. These muscle strengths were significantly lower compared to the control group (P < .001). No significant differences in radiographic measurements were found, and no patients presented with a postoperative flat foot deformity. One patient (5.9%) needed an ankle-foot orthosis for occupational activity. Conclusions: Anterior transfer of the tibialis posterior tendon appears to be an effective surgical option for paralytic foot drop secondary to peroneal nerve palsy. Although restoration of dorsiflexion strength postoperatively was about 33% of the normal ankle, function in daily activities and gait ability were satisfactorily improved. In addition, tibialis posterior tendon transfer demonstrated no definitive radiographic or clinical progression to postoperative flat foot deformity at intermediate-term follow-up. Level of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

Background: Hallux rigidus can be treated using several different methods and the best treatment option depends on the severity of degenerative changes of the metatarsophalangeal (MTP) joint. However, the ideal operative option for advanced hallux rigidus remains debatable. This prospective study was performed to evaluate the intermediate-term clinical outcomes of distal metatarsal osteotomy used as a joint-preserving method for the treatment of advanced hallux rigidus. Methods: Forty-two cases (39 patients) were followed for more than 3 years after distal metatarsal dorsiflexion osteotomy for advanced hallux rigidus of grade III-IV. Clinical evaluations included the American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Ability Measure (FAAM) scores, and patient subjective satisfaction scores. Range of motion (ROM) of great toe, complications, reoperation rates, width of the MTP joint space, and times to union were evaluated. Results: Mean AOFAS hallux and mean FAAM scores significantly improved from 56.4 and 61.2 points preoperatively to 87.6 and 88.7 points at final follow-up, respectively (P < .001). Grade III and IV groups had significantly different AOFAS and FAAM scores at final follow-up. Mean dorsiflexion of great toe significantly improved from 14.8° preoperatively to 35.5° at final follow-up (P < .001). Mean patient satisfaction score at final follow-up was 92.8 points. There were 4 cases (9.5%) of subsequent fusion and 2 cases (4.8%) of transfer metatarsalgia. Conclusions: Distal metatarsal dorsiflexion osteotomy using bio-compression screws appears to be an effective operative option for grade III advanced hallux rigidus with viable cartilage on >50% of the first metatarsal articular surface, as it restored joint motion, provided reliable pain relief, and did not require implant removal. However, based on the unsatisfactory clinical results and the high rate of reoperation observed, the authors cannot recommend this operative method for the treatment of end-stage (grade IV) hallux rigidus. Level of Evidence: Level IV, prospective case series. [ABSTRACT FROM AUTHOR]

Background: Although a ball and socket ankle deformity is usually congenital and asymptomatic, abnormal inversion and eversion mobility can result in recurrent ankle sprain and osteoarthritis. This retrospective study was performed to evaluate the clinical and radiologic outcomes of ankle fusion combined with calcaneal sliding osteotomy for severe arthritic ball and socket ankle deformity. Methods: Fourteen patients with severe arthritic ball and socket ankle deformity were followed for more than 3 years after operation. The clinical evaluation consisted of American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS) for pain, and subjective satisfaction score. The period to fusion and union of osteotomy, the change of hindfoot alignment angle, and complications were evaluated radiologically. Results: AOFAS and FAAM scores were significantly improved from an average of 37.4 and 34.5 points to 74.6 and 78.5 points, respectively. VAS for pain with walking over 20 minutes was significantly improved from an average of 8.4 points to 1.9 points. The average satisfaction score of patients was 88.9 points. The difference in heel alignment angle (compared to contralateral side) was significantly improved from an average of 34.8 to 5.4 degrees. There were 2 cases of progressive arthritis in an adjacent joint and 1 case of failed fusion. Conclusions: Ankle fusion combined with calcaneal sliding osteotomy can be an effective operative option for ball and socket ankle deformity with advanced arthritis. In spite of increased complication rate, reliable pain relief, and restoration of gait ability through correcting hindfoot malalignment could improve the quality of life. Level of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

Background: Although the modified Brostrom procedure has had excellent clinical results, postoperative complications such as skin irritation by suture material and problematic scar formation occur. This prospective study was performed to evaluate the clinical outcomes of mini-open ligament augmentation (internal brace technique) using suture tape for chronic ankle instability in a select cohort of patients. Methods: Thirty-four young female patients with less than 70 kg of body weight were followed for more than 2 years after suture tape augmentation for lateral ankle instability. The clinical evaluation consisted of the Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM) score, Sefton grading system, and the period to return to various activities. Measurement of talar tilt angle and anterior talar translation was obtained from stress radiographs to evaluate the longevity of mechanical ankle stability. Results: FAOS and FAAM scores had significantly improved to 92.5 points at final follow-up (P < .001). According to the Sefton grading, 31 cases (91.2%) achieved satisfactory functional results. The period to return to exercise was on average 10.2 weeks for jogging and 9.6 weeks for walking on uneven ground. The average subjective satisfaction score of patients was 93.8 points, and satisfaction with the scar was 98.5 points. Talar tilt angle and anterior talar translation had significantly improved to an average of 4.5 degrees and 4.1 mm, respectively, at final follow-up (P < .001). There were no complications such as skin irritation and wound infection, except for 1 case of chronic inflammation. Conclusions: Minimally invasive suture tape augmentation seems to be an effective alternative for young women with chronic ankle instability. Because there is a possibility of progressive elongation over time, the longevity of mechanical ankle stability and the proper indication for using the internal brace technique should be addressed in future studies. Level of Evidence: Level IV, case series study. [ABSTRACT FROM AUTHOR]

The article presents a study that compared the functional outcomes of two different ligament reattachment techniques using suture anchors. Topics include ligament reattachment techniques for the modified Brostrom procedure, the cost-effectiveness of the suture bridge technique, and the need to address proper indication and clinical usefulness of suture bridge technique for chronic ankle instability.