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Background: Sesamoid pathology can lead to significant pain and disability both with activities of daily living and high-impact athletic movements. Sesamoidectomy is a widely used procedure for patients who fail conservative treatment measures. Traditional dorsal or plantar approaches for sesamoidectomy have shown to successfully alleviate pain, but complications were reported. A proposed alternative medial approach using a burr may provide many advantages compared with traditional approaches. This study presents patient outcomes and complications for this technique. Methods: This was a retrospective chart review of patients undergoing sesamoidectomy (tibial, peroneal, or both) using a burr through a medial approach to the sesamoid metatarsal articulation. Data collected included patient demographics, radiographic analysis, and outcomes: Veterans Rand 12 Item Health Survey (VR-12), Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS), patient satisfaction, and complications. Results: Twenty-seven patients (29 feet) were included. The mean age was 38.4 years followed up for a mean of 30.9 months. VR-12 physical component improved from 35.98 ± 7.86 to 51.34 ± 8.01 (P <.001), FAAM ADL and sport improved from 58.33 ± 16.61 to 83.27 ± 18.28 (P <.001) and 26.37 ± 20.31 to 63.75 ± 29.74 (P <.001), respectively. Patient satisfaction with the treatment was 80.59% ± 27.06%. The overall complication rate was 11 (37.9%) whereas the overall reoperation rate was 4 (13.7%) of 29 feet. Complications included 1 arthrofibrosis, 1 flexor hallucis longus subacute rupture, and 1 asymptomatic hallux valgus. There were no sesamoid excision revisions. Conclusion: Sesamoidectomy using a medial approach with a burr provided significantly improved short-term functional outcomes, 80% patient satisfaction rate, with a relatively acceptable complications rate including 20% persistent pain. The medial approach is familiar to orthopaedic foot and ankle surgeons, provides adequate exposure, and eliminates the possibility of a painful plantar scar while avoiding disruption of the plantar plate, flexor hallucis brevis tendon, and ligamentous structures attached to the sesamoids. Larger studies with long-term follow-up from other centers are needed. [ABSTRACT FROM AUTHOR]

Background: For the younger, more active patient with flexible symptomatic progressive collapsing foot deformity (PCFD), joint-sparing procedures may be preferred to preserve functional motion. Isolated talonavicular (TN) arthrodesis has been described for treatment of rigid and flexible PCFD for patients that are older and less active whose deformity is still correctable through the TN joint. The purpose of this study was to evaluate radiographic and clinical outcomes in patients with PCFD treated with isolated triplanar correction with a TN joint arthrodesis. Methods: Forty-nine patients (53 feet) with flexible PCFD underwent isolated TN arthrodesis. Weightbearing radiographs were performed pre- and postoperatively, and measurements included lateral talar-first metatarsal angle, calcaneal pitch, TN coverage angle, and the anteroposterior (AP) talar-first metatarsal angle. The Foot and Ankle Ability Measure (FAAM) and Veterans-Rand 12-Item Health Survey (VR-12) scores were also collected. Results: Thirty-five females and 14 males were evaluated with a mean age of 63 years, at an average follow-up of 41.3 months. Significant improvements were found radiographically. Lateral radiographs demonstrated improvements in lateral talar-first metatarsal angle from 25.2 degrees preoperatively to 9.5 degrees postoperatively (P < .001) and calcaneal pitch from 14.9 degrees preoperatively to 17.5 degrees postoperatively (P < .001). AP radiographs showed the TN coverage angle improving from 35.0 degrees to 4.9 degrees postoperatively (P < .001) and AP talar-first metatarsal angle improving from 17.3 degrees to 5.9 degrees postoperatively (P < .001). Clinical outcomes were improved in the FAAM pain score (48.6 to 39.2, P = .130), FAAM ADL score (53.8 to 69.2, P = .002), FAAM Sport score (29.5 to 40.7, P = .099), and the overall FAAM score (47.7 to 63.1, P = .006). Patient satisfaction with medical care was 85.2/100 postoperatively. Conclusion: Isolated TN arthrodesis is a viable surgical option for older, lower-demand patients with flexible PCFD. This study demonstrated significant improvements in radiographic alignment and FAAM scores. Comparative studies with other surgical procedures should be performed to determine which is the best technique for older, lower-demand patients with flexible PCFD. [ABSTRACT FROM AUTHOR]

Background: Low-energy stage II Lisfranc injuries are rare, and treatment can be operative or nonoperative based on a surgeon's assessment of midfoot stability. No previously published patient-reported outcome measures (PROMs) data for Lisfranc injuries isolates purely ligamentous stage II injuries. The purpose of this study was to analyze PROMs for patients who underwent operative management of stage II Lisfranc injuries. Methods: Thirty-nine patients (39 feet) with confirmed Nunley-Vertullo stage II Lisfranc injuries between May 2012 and February 2022 were identified through a retrospective chart review. PROMs that were analyzed were the visual analog scale (VAS) pain scale, Veterans RAND 12-Item Health Survey (VR-12), Foot and Ankle Ability Measure (FAAM), and patient satisfaction. Results: Thirty-two open reduction internal fixations (ORIFs) and 7 fusions were performed. The mean latest follow-up was 44.6 (range, 12-92) months. There were 2 complications (5%, 2/39) that required a revision procedure. Twenty-six patients (67%, 26/39) underwent secondary surgery to remove retained hardware. The mean time to hardware removal was 3.97 (range, 2.70-7.47) months. The overall mean patient satisfaction score with overall medical care including clinical visits and interactions with medical staff personnel was 93.6/100. All PROMs (VAS, VR-12, FAAM) demonstrated statistically significant improvement (P <.05) from preoperative (injury) values to latest follow-up postinjury values. Conclusion: Patients who were treated surgically with stage II purely ligamentous Lisfranc injuries via the methods used were found to mostly undergo hardware removal and have high levels of overall satisfaction with their process of medical care. Level of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

Category: Ankle; Trauma Introduction/Purpose: The indications of deltoid ligament repair in ankle injuries with widened medial clear space in the absence of medial malleolus fracture remain controversial. Many authors reported no difference in long-term functional outcomes, while others reported persistent medial clear space widening and higher malreduction when deltoid ligaments went without repair. This malreduction can lead to chronic ankle instability and pain. Talar shift as little as 1mm is reported to lead to a 49% increase in ankle joint pressure, a detrimental factor for developing post-traumatic ankle arthritis. The purpose of this study was to compare deltoid ligament repair to no repair in a homogenous group of surgically treated isolated Weber C fibula fractures exclusively. Methods: A retrospective chart review of prospectively collected data was carried out to identify consecutive surgically treated Weber C lateral malleolus fractures and syndesmosis stabilization with associated deltoid ligament injury between February 2013-December 2023. Associated posterior/medial malleolus fractures other than avulsions, Weber A/B fractures, fibula fixation constructs besides plate and screws, Charcot neuropathy, pes planovalgus with incompetent deltoid ligament, and revisions were excluded. Those meeting inclusion criteria were split into two groups: deltoid ligament suture repair vs. no repair. Collected data included demographics, smoking and diabetes status, surgical procedure and patient reported outcome measures (PROMs).. Primary outcomes were oblique medial clear space (MCS) and valgus talar tilt angle (TTA) on weightbearing radiographs. All radiographs were independently reviewed by a fellowship trained foot and ankle orthopedic surgeon. Secondary outcomes were fracture union, complications, reoperations, and PROMs: Foot and Ankle Ability Measure (FAAM), Veterans-Rand 12 (VR12) General Health Survey, visual analog pain scale (VAS). Results: Seventy-nine fractures were included; 49 underwent deltoid ligament repair while 30 did not. The mean follow-up was 18.5 months. There was a statistically significant post-op improvement in most study outcomes within the groups. The valgus TTA in the repair vs no repair groups were 0.1±0.9 vs. 1.2±2.1 degrees, respectively (p=0.007). The MCS in the repair vs. no repair groups was 3.5±0.6 vs. 3.9±1.4mm, respectively (p=0.107). There were no statistically significant differences between deltoid repair and no repair groups in post-operative VR12 MCS (p=0.194), VR12 PCS (p=0.077), VAS (p=0.231), FAAM ADL (p=0.109), FAAM sport (p=0.314), or patient satisfaction (p=0.33). The union rate was 100% in the repair vs. 96% in the no repair groups (p=0.163). There were no complications related to repairing the deltoid ligament. Conclusion: Deltoid ligament repair led to a superior ankle coronal alignment in comparison to no repair. There were no complications or revisions related to the medial approach and repairing the deltoid ligament. While there were trends toward better functional outcomes with deltoid ligament repair, this did not reach statistical significance. Long term studies may be required before recommending deltoid ligament repair as the gold standard in isolated Weber C fractures. Meanwhile, we recommend valgus stressing the ankle at the end of the procedure and decide whether deltoid repair is needed on individual basis. Outcomes of deltoid repair group vs no deltoid repair group. [ABSTRACT FROM AUTHOR]

Category: Midfoot/Forefoot; Other Introduction/Purpose: Nitinol technology has revolutionized foot and ankle orthopaedic surgery, offering a quick and low-profile means of achieving bone healing. One application of this technology has been in the development of a first metatarsophalangeal (MTP) joint staple, utilized in place of crossing screws or a plate and interlocking screws constructs to achieve fusion at the first MTP joint. The objectives of this study were to compare radiographically and subjective outcomes for patients who had a first MTP joint fusion treated with an Enovis Dynaclip Delta staple vs those treated with a plate and interlocking screws. The hypothesis is the staple provides a quicker surgical time and equivalent rate of union compared to patients who were treated with standard plate and screws. Methods: A single-surgeon, consecutive case series of prospectively collected data was reviewed retrospectively for patients who underwent primary first MTP arthrodesis using a staple. Patients were age and gender matched to those who underwent primary first MTP arthrodesis with a plate and associated interlocking screws. Dates of surgery were November 2017 - December 2023. Exclusions included revision surgeries, prior forefoot/midfoot fusions, and ancillary fusions at the time of the index surgery. Preoperative and postoperative patient-reported outcome measures (PROMs) [Foot and Ankle Ability Measure (FAAM), Veterans-Rand 12 (VR-12) General Health Survey, visual analog pain scale (VAS), and radiographs (hallux valgus angle, dorsiflexion angle) were evaluated to compare the two groups. Comorbidities, operative time, fusion rates, and a patient satisfaction survey were also collected. Statistical analysis was performed using sutdent's t-tests. Results: Twenty-two feet were included in both groups. Preoperative and postoperative PROMs between groups demonstrated no significant differences in all questionnaire categories assessed. The staple group demonstrated significant differences from preoperative to postoperative in FAAM ADL (p=0.004), FAAM sport (p=0.010), and VAS (p< 0.001) while plate and screws demonstrated significant differences in FAAM ADL (p=0.032) and VAS (p=0.033). The radiographic measurements revealed a significant difference in the postoperative dorsiflexion angle for staple vs plate and screws 21.81±5.72 vs 26.47±6.99, respectively (p=0.012) and there were no other significant differences noted (table). Operative time revealed a significant difference between staple vs plate and screws (30.0 minutes vs 35.73 minutes, respectively) (p=0.006). The fusion rate was 95% in both groups. Conclusion: This study reports early results for a comparison of first MTP joint fusion treated with an Enovis Dynaclip Delta staple vs those treated with the standard plate and interlocking screws. While there were statistical differences within each group between most of the preoperative and postoperative PROMs, comparing the two groups, there was none. The fusion rate was the same in both groups. The staple group had an average of 5.7 minutes less operative time. Staple fixation achieves similar union rates to plate and screw constructs with a shorter operative time. Further patients are needed to expand this cohort. [ABSTRACT FROM AUTHOR]

Background: Ice hockey players have a high rate of hip pathology, which can lead to hip arthroscopy. Previous studies have not utilized team-based advanced performance statistics in the setting of hip arthroscopy in National Hockey League (NHL) players., Purpose/hypothesis: The purpose of this study was to use team-based advanced performance statistics to evaluate postoperative performance after hip arthroscopy in NHL players in comparison with their preoperative performance and matched controls of uninjured skaters. It was hypothesized that there would be no significant difference between preoperative and postoperative performance after hip arthroscopy in NHL players, as well as no difference when compared with matched controls of uninjured players., Study Design: Descriptive epidemiology study., Methods: There were 56 eligible NHL players found through public records who underwent hip arthroscopy over 12 seasons. Team-based advanced performance statistics including icetime, Corsi, Fenwick, goal, and expected goal percentages were recorded for the preinjury season, index season, and first 2 years after return to play (RTP). Relative percentages of each statistic were collected to allow for intrateam comparisons. A control group of NHL players without injury was collected and matched 1:2 by age, years of play, and draft round., Results: The RTP rate after hip arthroscopy at the NHL level was 89% for 1 season and 70% for 2 seasons. There were no significant decreases in performance in any advanced statistics after RTP after hip arthroscopy in comparison with the preinjury season or versus a matched control group of uninjured players. There was a significant decrease in games played in the injury season and the first year after RTP versus the preinjury season and versus a matched control group without differences thereafter., Conclusion: The RTP rate after hip arthroscopy at the NHL level was 89% for 1 season and 70% for 2 seasons. There were no significant decreases in team-based advanced performance statistics after RTP from hip arthroscopy for NHL players versus their preinjury levels or versus a matched control group of uninjured players. This indicates that NHL players who RTP at the NHL level are likely able to return to their previous level of performance, albeit playing in fewer games the first season after surgery., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: R.F.L. is a consultant for Ossur and Smith+ Nephew; has received royalties from Ossur, Smith+Nephew, and Elsevier; has received research grants from the Arthroscopy Association of North America, the American Orthopaedic Society for Sports Medicine (AOSSM), Ossur, and Smith+Nephew; has served on committees for AOSSM and the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; and has served on the editorial board for the American Journal of Sports Medicine, Knee Surgery, Sports Traumatology, and Arthroscopy, the Journal of Experimental Orthopaedics, the Journal of Korean Studies, the Journal of Orthopaedic and Sports Physical Therapy, and Operative Techniques in Sports Medicine. C.M.Larson. is a consultant for Responsive Arthroscopy and Smith & Nephew; has received stock options for Responsive Arthroscopy; and has received hospitality payments from Synthes GmbH. C.M.LaPrade. has received education payments from Evolution Surgical, Inc, Foundation Medical, LLC, Arthrex, Inc, and Smith+Nephew. M.D.L. has received education payments from Great Lakes Orthopedics. H.E.S. has received education and hospitality payments from Arthrex, Inc, Medwest Associates, Stryker, and Smith+ Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2025.)

Purpose: Patients with carpometacarpal (CMC) osteoarthritis (OA) often present with metacarpophalangeal (MP) hyperextension and/or thenar atrophy. This study hypothesizes that MP fusion (MPF) performed at the time of CMC arthroplasty (CMCA) for patients who have moderate-to-severe thenar atrophy, MP hyperextension >30°, or MP arthritis will have greater long-term pinch strength and improvements in the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score from preoperative values when compared with the unoperated side or those who had CMCA only., Methods: This study involved a retrospective review of long-term results from patients who underwent either CMCA or CMCA/MPF. The QuickDASH score, the pain visual analog scale (VAS), and an average of three pinch readings from each thumb were measured on the Baseline pinch gauge and recorded with a correction for hand dominance in right-handed patients., Results: Fifty-three female patients with 70 operated thumbs were included in the study. The mean age was 67.2 years. There were 29 CMCAs and 41CMCA/MPFs. The mean follow-up was 6.3 years (range 2-16.9 years). At the latest follow-up, the mean CMCA/MPF pinch strength (11.3 lbs) was significantly stronger than that of CMCA (8.0 lbs) and carpometacarpal osteoarthritis thumbs (8.9 lbs). There was no significant difference in pinch strength between patients who underwent a CMCA and CMCOA thumbs (8.0 lbs vs 8.9 lbs, respectively). Preoperative QuickDASH demonstrated worse function in the CMCA/MPF group (55.8 vs 36.5). At the latest follow-up, QuickDASH and VAS revealed similar values in both the CMCA/MPF (10.5 and 0.66) and CMCA (18.5 and 0.52) groups., Conclusion: Long-term results demonstrate stronger pinch and greater improvement in QuickDASH scores in patients who underwent CMCA/MPF compared with those who underwent a CMCA or untreated carpometacarpal osteoarthritis thumbs., Type of Study/level of Evidence: Therapeutic IV., (Copyright © 2023 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)