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(Purpose) The aim of this study was to examine the factors involved and status of return to sports after Achilles tendon repair. (Subjects and Methods) The subjects were 118 patients (mean age 39.6 ± 12.2 years) who underwent unilateral Achilles tendon repair for the first time between 2017 and 2019. Subjects had participated in regular sports activities before the surgery. Post-surgery follow-up was possible for up to 9 months. Besides age and body mass index (BMI), various factors like post-operative single-leg heel-rise height index (HRHI), Achilles tendon resting angle (ATRA), the ratio of the presence or absence of pain in each group and the start time of obtaining movement (Movement) were examined. The factors affecting return to sports were examined by multiple logistic regression analysis, and their cutoff values were obtained. (Results) The results showed that the return to sports rate was 79.7%. Other items than age, including Movement, all showed significant differences between the two groups. Factors that affected return to sport were BMI and HRHI. For BMI, the odds ratio was 0.85 and the cutoff value was 24.5 kg/m². For HRHI, the odds ratio was 1.05, and the cutoff value was 86.7%. (Conclusion) The ratio of return to sports after Achilles tendon repair at our hospital was approximately 80%, which is a good result. To return to sports it is necessary to have adequate HRHI and to perform rehabilitation in consideration of BMI, pain generation, and ATRA. [ABSTRACT FROM AUTHOR]

Background: There are few reports on the intra- and interobserver agreement and parameters for the diagnostic accuracy of ultrasound (US) imaging for chronic lateral ankle instability (LAI). The purpose of this study was to investigate the reliability and validity of US imaging for identifying anterior talofibular ligament (ATFL) remnants in patients with LAI., Methods: A total of 547 ankles from 406 patients underwent surgery for LAI between 2019 and 2022. If ligament fibers remained in US images, they were evaluated as positive. If the ligament was not visualized, it was evaluated as negative. Two observers performed repeated measurements. Arthroscopic findings were considered the "gold standard" for validity and diagnostic test accuracy purposes. The intra- and interobserver agreements and parameters for diagnostic accuracy, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of preoperative US imaging as intraoperative arthroscopic findings were used as reference standards., Results: The intraobserver agreement was substantial, with an agreement of 98.54% and a kappa coefficient of 0.76. The interobserver agreement was also substantial, with an agreement of 98.72% and a kappa coefficient of 0.75. The sensitivity, specificity, and accuracy of preoperative US imaging were 98.7%, 100%, and 98.7%, respectively. The PPV and NPV of US imaging were 100% and 61.1%, respectively. In the arthroscopic evaluation of the 7 cases in which US imaging showed false negative results, the ATFL ruptured at the fibular attachment and ran in contact with the talus., Conclusion: A US examination finding of an intact ATFL is highly likely to be correct. An US examination finding of a ruptured ATFL can be false and may require arthroscopic confirmation., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Disclosure forms for all authors are available online.

Purpose: Post-operative meniscal cyst formation occurs following all-inside device meniscal repair. This study aimed to compare the incidence of cysts in patients who underwent meniscal repair with and without all-inside suture devices., Methods: This retrospective study included 227 knees that underwent meniscal repair between 2021 and 2022. The incidence of post-operative meniscal cysts was compared between patients who underwent repair using an all-inside suture anchor device (Group SA) and those who did not use an anchor (Group NA), based on post-operative magnetic resonance imaging (MRI) findings. Risk factors, such as the number of anchors used, were investigated. Using a subgroup analysis, the incidence of meniscal cysts based on the type of device used was investigated., Results: Groups SA and NA comprised 125 and 102 knees, respectively. Group SA had 11 cases of cysts (9% incidence), whereas Group NA had 7 cases (7% incidence), and no statistically significant difference was observed ( p  = 0.63). Symptomatic cysts were observed in two patients (1.6%) in Group SA, whereas none was observed in Group NA (0%); the difference was not significant ( p  = 0.50). Factors such as the number of anchors and sutures used and MRI timing were not identified as risk factors. Cyst incidence varied according to anchor type: Stryker AIR+ (4 out of 55, 7%), Smith & Nephew Fast-Fix 360 (7 out of 56, 13%) and Arthrex Fiber Stitch (0 out of 26, 0%), with no significant difference found ( p  = 0.14)., Conclusion: The incidence of cysts in patients undergoing meniscal repair with an all-inside suture anchor device was 9%, showing no significant difference compared with Group NA. Cyst incidence was not affected by device type., Level of Evidence: Level III, retrospective comparative study., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). Journal of Experimental Orthopaedics published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Background: Posterior ankle impingement syndrome (PAIS) is sometimes complicated by bilateral cases and lateral ankle ligament injuries. Reports on bilateral surgery for PAIS and simultaneous surgery for lateral ankle ligament injury are scarce in the literature., Methods: We present a 2-year follow-up of 76 athletic patients who underwent endoscopic hindfoot surgery for PAIS. Patients were divided into those who underwent unilateral or simultaneous bilateral surgery and PAIS surgery alone or simultaneous bilateral PAIS surgery without arthroscopic ankle lateral ligament repair., Results: All patients returned to full athletic activities postoperatively. There was no difference in all subscales of the SAFE-Q score between groups except for mean days after surgery for full return to athletic activities., Conclusion: Simultaneous bilateral surgery and simultaneous arthroscopic lateral ankle ligament repair had no negative effect on subjective clinical evaluation 2 years after surgery in hindfoot endoscopic surgery for PAIS., Level of Evidence: III, retrospective case-control study., (Copyright © 2024 European Foot and Ankle Society. All rights reserved.)

Purpose: The association of peroneal tendon dislocation with peroneal bone morphology and postoperative redislocation rates remains unknown. This study compared the fibula morphology in patients with peroneal tendon dislocation with that in a control population., Methods: The study enrolled 48 patients who underwent surgery for peroneal tendon dislocation at our institution during between 2018 and 2023. Thirty-five patients with preoperative magnetic resonance imaging of the ankle were defined as Group D and 35 with magnetic resonance imaging of the ankle for other reasons and with similar background data were selected as the control group (Group C). The posterior tilting angle of the fibula, posterolateral angle and posterolateral edge angle were evaluated at the plafond level. The posterior tilting angle, posterolateral angle and retromalleolar bone shape according to the Rosenberg classification (flat, convex, concave) were evaluated at the midpoint between the plafond and the tip., Results: At the plafond level, the posterior tilting, posterolateral and posterolateral edge angles were 57.7 ± 11.1°, 123.8 ± 12.3° and 90.8 ± 13.7°, respectively, in Group D and 64.1 ± 15.4°, 121.1 ± 12.3° and 88.7 ± 12.2°, respectively, in Group C, with no significant differences. No significant between-group differences existed in the posterior tilting and posterolateral angles at the midpoint level. Moreover, no significant differences existed in distribution of the bone geometry according to the Rosenberg classification., Conclusion: There were no differences in morphology between patients with peroneal tendon dislocation and controls. This study provides useful information on the indications for primary surgery and whether bony approach is useful for peroneal tendon dislocation., Level of Evidence: Level IV., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Lateral meniscal repair of the popliteal hiatus is technically demanding. The inside-out technique requires an additional incision and carries the risk of posterolateral soft tissue damage to the knee joint. In addition, the presence of the popliteal tendon limits the route of the suture thread. Within the current trend of the all-inside suture technique, meniscal suture-based all-inside repair demonstrates biomechanical advantages over anchor-based all-inside repair. We introduce a meniscal suture-based all-inside meniscal repair technique for longitudinal lateral meniscal tears., (© 2024 The Authors.)

Background: In recent years, arthroscopic lateral ankle ligament repair has become increasingly popular. However, reports on the clinical outcomes of arthroscopic ankle stabilization for skeletally immature patients remain scarce. This study investigated the clinical outcomes of arthroscopic lateral ankle ligaments repair in skeletally immature patients compared to skeletally mature patients., Methods: Our retrospective analysis compared skeletally immature patients and skeletally mature adults who underwent arthroscopic repair of the ankle lateral ligaments with a modified lasso-loop stitch using a suture anchor. Skeletal immaturity was defined as patients whose epiphyseal line of the distal fibula remained open on plain radiography. Clinical outcomes were evaluated using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) at 2 years after surgery. The time to postoperative walking, jogging, and return to full sports activities were also evaluated., Results: Sixty-four skeletally immature patients (IM group) and 103 skeletally mature adults (M group) were included. No significant differences were observed during both walking and jogging after surgery between the groups; however, return to full athletic activities was significantly earlier in IM group ( P  = .05). The mean scores in all SAFE-Q subscales significantly improved in both groups after surgery ( P  < .001). There were also no statistically significant differences between the groups in the mean postoperative SAFE-Q scores for all subscales. All patients in the IM group returned to playing sports at their preinjury levels postoperatively., Conclusion: We found that skeletally immature patients with chronic lateral ankle instability had generally similar responses to arthroscopic lateral ankle as skeletally mature adult patients at minimally 2 years' follow-up with a high rate of successful return to sport., Level of Evidence: Level III, retrospective case control study., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Disclosure forms for all authors are available online.

Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

Introduction: Although intramedullary screw fixation likely leads to successful union of Jones fractures compared to that of nonoperative treatments, bony union disorder after surgical treatment remains to be elucidated., Methods: Intramedullary screw fixation was performed for the surgical treatment of proximal fifth metatarsal stress fractures in this series. Between January 2008 and December 2019, the feet of 222 patients were investigated regarding the effective factors for postoperative bony union between the normal union group and the bony union disorder group according to the patients' physical status, radiological assessment, and screw size. The mean postoperative follow-up period was 11.1 months. Bone union disorder was defined as delayed union, nonunion, or a re-fracture recognized through a radiographic image., Results: The prevalence rate of union disorders occurred in 14% (31/222) of the patients. The risk of bone union disorder significantly increased when using a small-diameter screw (odds ratio 4.81, 95% confidence interval [CI] 1.62-14.2, p = 0.004) and non-bone graft procedures (odds ratio 3.13, 95% CI 1.22-8.02, p = 0.02). Screw length, preoperative Torg's classification, or patients' physical status did not affect postoperative bony union., Conclusions: Approximately 14.0% of the patients in our study had postoperative bone union disorder. Small-diameter screws and non-bone graft procedures increased the risk of bone union disorder in the intramedullary screw fixation technique of fifth metatarsal bone stress fractures., Level of Evidence: Level 4, case series., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The purpose of this study was to use the food intake level scale (FILS) to clarify whether calf circumference (CC) and stroke contribute to an improvement of inpatient dysphagia., Methods: We used the Japanese sarcopenic dysphagia database (n = 467) to analyze FILS data recorded at admission and after follow-up in 322 cases. A multivariate analysis was performed to determine whether CC and stroke improved the FILS by two points or more., Results: The patient characteristics were as follows: 177 (55%) men; median age, 81 years; median body mass index, 20.3 kg/m 2 ; median CC, 28.2 cm; presence of sarcopenic dysphagia, 183 (56.8%); history of stroke, 103 (32%); median FILS on admission (interquartile range (IQR)), 6 (2-7); and median FILS at the end of the observation (IQR), 7 (7-8). Comparison of FILS at admission and discharge showed that 137 patients had an improvement in the scale of two points or more, whereas 185 patients had no improvement. Multivariate logistic regression analysis showed the factors that were associated independently with an improvement in dysphagia were: age < 80 years (odds ratio (OR) 2.20, 95% confidence interval (CI) 1.36-3.54, p = 0.001); CC ≥ 29.4 cm (OR 2.19, 95% CI 1.33-3.61, p = 0.002); sex (OR 1.67, 95% CI 1.03-2.71, p = 0.037); and stroke (OR 1.85, 95% CI 1.09-3.16, p = 0.023)., Conclusions: Our results suggest that a CC ≥ 29.4 cm and history of stroke contributed to an improvement of inpatient dysphagia at discharge. The contribution of the easy-to-measure CC to predict an improvement in swallowing function may be very useful in daily clinical practice., (© 2022. The Author(s), under exclusive licence to European Geriatric Medicine Society.)

Purpose: To evaluate the femoral and tibial tunnel positions via a modified anatomic transtibial double-bundle anterior cruciate ligament (ACL) reconstruction., Methods: Patients who underwent double-bundle ACL reconstruction using the transtibial tunnel creation technique were identified. Double-bundle ACL reconstruction was performed for 94 knees using the transtibial tunnel creation technique. Tunnel aperture configurations and center positions of the anteromedial (AM) and posterolateral (PL) tunnels via postoperative 3-dimensional computed tomography were evaluated., Results: There were 94 knees included. Regarding the intra-articular tunnel aperture configurations, the AM and PL tunnels overlapped at the femoral and tibial aperture in 66.0% and 94.7% cases, respectively. The mean femoral bone tunnel center was located at 23.0 ± 3.9% in the posterior-to-anterior ratio and 28.7 ± 6.0% in the proximal-to-distal ratio for the AM tunnels and at 32.8 ± 4.7% and 51.2 ± 5.2% for the PL tunnels, respectively. In the tibial tunnels, the mean AM tunnel center was located at 31.4 ± 3.6% in the anterior-to-posterior ratio and 44.3 ± 1.8% in the medial-to-lateral ratio and at 47.5 ± 3.8% and 44.3 ± 1.9% in the PL tunnel center, respectively. The femoral tunnels of outliers, both those created in nonanatomic positions as well as the posterior wall blowouts, were revealed in 7.4% cases. The nonanatomical bone tunnel group had significant heavier weight patients, lower tibial posterior slope, and were anterior in the AM and PL tunnel position. Posterior wall blowouts were related to posterior and proximal PL bone tunnel positions., Conclusions: Modified transtibial double-bundle ACL reconstruction is a reliable tunnel creation technique with anatomic placement in 92.6% of the cases. The modification required that partially superimposing configuration of the 2 tibial tunnel apertures. The nonanatomic tunnels were related to patients of heavier weight and lower tibial posterior sloped knees, whereas the posterior wall blowouts were related to the posterior and proximal PL bone tunnel positions., Level of Evidence: Level IV, therapeutic case series., (© 2021 The Authors.)

Background: Intramedullary screw fixation is considered the standard treatment for proximal fifth metatarsal stress fractures. Low-intensity pulsed ultrasound (LIPUS) is a well-known bone-healing enhancement device. However, to the best of our knowledge, no clinical study has focused on the effect of LIPUS for postoperative bone union in proximal fifth metatarsal stress fractures. This study aimed to investigate the effect of LIPUS treatment after intramedullary screw fixation for proximal fifth metatarsal stress fractures., Methods: Between January 2015 and March 2020, patients who underwent intramedullary screw fixation for proximal fifth metatarsal stress fractures were investigated retrospectively. All patients underwent intramedullary screw fixation using a headless compression screw with autologous bone grafts from the base of the fifth metatarsal. The time to restart running and return to sports, as well as that for radiographic bone union, were compared between groups with or without LIPUS treatment. LIPUS treatment was initiated within 3 weeks of surgery in all cases., Results: Of the 101 ft analyzed, 57 ft were assigned to the LIPUS treatment group, and 44 ft were assigned to the non-LIPUS treatment group. The mean time to restart running and return to sports was 6.8 and 13.7 weeks in the LIPUS treatment group and was 6.2 and 13.2 weeks in the non-LIPUS treatment group, respectively. There were no significant differences in these parameters between groups. In addition, the mean time to radiographic bone union was not significantly different between the LIPUS treatment group (11.9 weeks) and the non-LIPUS treatment group (12.0 weeks). The rate of postoperative nonunion in the LIPUS treatment group was 0% (0/57), while that in the non-LIPUS treatment group was 4.5% (2/44). However, this difference was not statistically significant., Conclusions: There were no statistically significant differences regarding the time to start running, return to sports, and radiographic bone union in patients with or without LIPUS treatment after intramedullary screw fixation for proximal fifth metatarsal stress fractures. Therefore, we cannot recommend the routine use of LIPUS to shorten the time to bone union after intramedullary screw fixation for proximal fifth metatarsal stress fractures., (© 2021. The Author(s).)

Arthroscopic suture repair for a radial tear at the posterior horn of the lateral meniscus poses a technical procedure for surgeons. We describe an all-inside repair technique using all-inside meniscal repair devices without adding any accessory portals. This simple technique provides precise reduction and stabilization of the meniscus by pinching 2 all-inside vertical sutures consecutively across the tear site., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier.)

Background and Objectives: It is important to evaluate the swallowing function of patients with acute cerebral infarction. The effects of nutritional intervention after an early assessment by a flexible endoscopic evaluation of swallowing (FEES) were evaluated., Methods and Study Design: This retrospective study included 274 patients who were hospitalized for acute cerebral infarction and underwent a FEES between 2016 and 2018. The effects of early nutritional intervention after an assessment by a FEES within 48 h from admission were evaluated. The patients were divided into a shorter hospital stay group (<30 days) and a longer group (≥30 days). A multivariate analysis was performed to identify the predictive factors for a shorter hospital stay., Results: The overall patient characteristics were as follows: 166 men; median age, 81 years old; and median body mass index (BMI), 21.1 kg/m2. No significant differences in the age, sex, or BMI were found between the shorter and longer hospital stay groups. A FEES within 48 h of admission (odds ratio [OR], 2.040; 95% confidence interval [CI], 1.120-3.700; p=0.019), FILS level ≥6 at admission (OR, 2.300; 95% CI, 1.190-4.440; p=0.013), and an administered energy dose of ≥18.5 kcal/kg on hospital day 3 (OR, 2.360; 95% CI, 1.180-4.690; p=0.015) were independently associated with a hospital stay <30 days., Conclusions: Patients with acute cerebral infarction are more likely to have a shorter hospital stay (<30 days) if they undergo a FEES early after admission and receive optimal nutritional intervention.

Purpose: To assess the clinical outcomes comparing rectangular bone-tendon-bone (BTB) grafts and double-bundle hamstring tendon (HM) grafts used for anatomic anterior cruciate ligament (ACL) reconstruction in young female athletes., Methods: From January 2014 to November 2017, young female athletes 20 years or younger who underwent primary ACL reconstructions by a single surgeon were identified. Patients with concomitant injuries, not being a regular sports participant, the existence of contralateral ACL reconstruction, and who did not have a minimum of 1-year follow-up were excluded. We searched the rate and time for return-to-play, clinical outcomes including chronological instrumental side-to-side tibial translation difference, and muscle strength. Second ACL injury rates between the 2 groups during follow-up period were evaluated., Results: Twenty-seven BTB ACL reconstructions and 29 HM ACL reconstructions were performed. The mean follow-up periods were 35.2 months in the BTB group and 33.8 months in the HM group. The BTB group showed better knee stability in mean side-to-side translational difference via arthrometric testing of 0.6 mm in the BTB versus 1.7 mm in the HM group at 5 months ( P  = .01) and 1.1 mm and 2.0 mm at 12 months, respectively ( P  = .02). There was no significant side-by-side difference in quadriceps muscle strength ratio, but the hamstring muscle strength was significantly better in the BTB group. The graft reinjury rate in the BTB group and the HM group was 0% (0/27) and 10.3% (3/29) ( P  = .09), respectively. In contrast, contralateral ACL injuries occurred in 17.3% (4/27) of the BTB group and 3.5% (1/29) of the HM group ( P  = .12)., Conclusions: For young female athletes aged 20 years or younger, the BTB group had better knee instrumental stability than the HM group without range of motion loss or knee extensor muscle strength deficit. Although there was no statistical significance in terms of second ACL injury, we observed fewer graft rerupture and an increasing rate of contralateral ACL injuries in the BTB group., Level of Evidence: Level III, retrospective comparative study., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier Inc.)