Foot & Ankle Orthopaedics最新文献

Background: In this study, we provide a comprehensive description of the morphometrics of the distal tibiae and propose that the intact posterior malleolus (PM) exhibits clinically relevant morphologic variation. These differences may have implications for fracture classification, fixation strategy, and implant design.

Methods: Fifty-two isolated dry tibias were analyzed to determine the PM morphometric parameters. Five key morphometric points were identified, and the PM was defined as the posterior bony projection of the distal tibial epiphysis. The malleolar groove established the PM's medial limitation, the posterior portion of the fibular notch defined the lateral limit, and the anterior boundary was a line connecting these landmarks across the inferior articular surface. PM shapes were categorized based on consistent morphologic patterns. Cross-sections of the distal tibia were performed to assess trabecular bone morphology and density.

Results: We found the PM presenting 3 distinct morphologic types: rounded, triangular, and trapezoid. Triangular and trapezoid types exhibited larger dimensions and robust bone tissue, whereas tibias with a rounded PM displayed smaller dimensions and delicate bone architecture.

Conclusion: These novel findings reveal PM morphologic diversity, which may enhance our understanding of PM fracture patterns and optimize the development of surgical implants.

Background: Progressive collapsing flatfoot deformity (PCFD) is a complex condition characterized by hindfoot valgus, midfoot varus, and forefoot abduction, leading to functional impairment and pain. Surgical correction often includes lateral column lengthening (LCL), which addresses structural deformity and restores alignment. Autografts remain the gold standard as an osteotomy gap filler for LCL despite donor site morbidity. Allografts augmented with patient's own bone marrow aspirate concentrate (BMAC) offer a potential alternative because of their osteogenic properties. This study compares the clinical and radiologic outcomes of autografts vs allografts with BMAC in LCL for PCFD.

Methods: This retrospective study reviewed 38 patients who underwent LCL for PCFD at a tertiary institution from 2012 to 2022. Patients were divided into 2 groups: the 25 who received autografts (group A), and the 13 who received allografts (group B) mixed with BMAC. Clinical outcomes were assessed using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, and 36-Item Short Form Health Survey (SF-36) scores at 6 and 24 months postoperatively. Radiologic union was evaluated through serial weightbearing radiographs at regular interval post-surgery.

Results: Both groups A and B achieved radiologic union at an average of 5.64 ± 1.80 and 5.15 ± 2.58 months, respectively. There were no cases of delayed union or nonunion. Both groups demonstrated significant improvements in VAS, AOFAS, and SF-36 scores at 6 and 24 months, with no statistically significant differences in outcomes. Group A had 2 cases of peroneal tendinopathy, 1 case of peroneal tendon adhesion to the plate, 1 case of screw prominence, and 1 case of chronic pain attributed to plantar nerve irritation. Group B had no reported complications.

Conclusion: This study suggests that allografts augmented with BMAC may be a viable alternative to autografts for LCL in PCFD, offering comparable union rates and functional outcomes. However, as a retrospective cohort study with a small sample size, further prospective research is needed to confirm these findings.

Level of evidence: Level III, retrospective cohort studies.

Background: Arthroscopic ankle arthrodesis (AAA) is a standard procedure for end-stage osteoarthritis of the ankle. One of the main concerns after AAA remains the development of secondary osteoarthritis in the subtalar and tarsal joints in the long term. This development is thought to be due to a compensatory increased mobility and therefore increased load on the adjacent joints. Therefore, the aim of the study was to analyze the residual motion of the tarsal joints, the load distribution under the foot, and the influence of tarsal joint motion on load distribution and gait pattern after AAA.

Methods: 29 patients with arthroscopic AAA were analyzed in a retrospective case-control series by pedobarographic gait analysis and fluoroscopy. The variables examined by pedobarography included peak force, peak pressure, and contact time of 10 different zones of the foot during the roll-over process, comparing the operated with the contralateral healthy foot. The range of motion (ROM) of the subtalar and medial tarsal joints in dorsiflexion/plantarflexion were assessed radiologically.

Results: After AAA, peak forces of the ipsilateral foot were significantly reduced for the entire foot and especially the first metatarsal, great toe, and lesser toes during the roll-over process. Peak pressure decreased significantly under the lesser toes and increased under metatarsal 5, without significant load alterations under the mid- and hindfoot. The residual ROM of the subtalar and tarsal joints in dorsiflexion/plantarflexion was 23.5 degrees. The greater the ROM of the adjacent joints, the more the gait pattern normalized.

Conclusion: Load distribution during the stance phase is influenced by AAA; the ROM of the subtalar and midfoot joints is essential in normalizing gait pattern.

Level of evidence: IV, case series.

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Background: This study aimed to determine whether prophylactic celecoxib reduces the prevalence of radiographic heterotopic ossification (HO) following total ankle arthroplasty (TAA). Secondary aims included evaluating its effect on the severity of radiographic HO and its association with patient-reported outcome measures (PROMs).

Methods: This retrospective cohort study included all patients who underwent a primary TAA between April 2019 to May 2023 at a single academic institution. The intervention group was composed of patients prescribed 4 weeks of celecoxib postoperatively and was compared to controls who received no celecoxib. Radiographs at ≥8 months were reviewed and graded using the modified Brooker classification for severity of HO. Ankle Osteoarthritis Score pain and disability, 36-Item Short Form Health Survey physical function and mental health were assessed at follow-up.

Results: One hundred seventy-nine patients, 95 males (53.1%) and 84 females (46.9%), were included. The mean age was 65.8 ± 9.6 years. Ninety patients (50.3%) received celecoxib and 89 (49.7%) did not. The prevalence of HO at the time of follow-up (1.2 ± 0.4 years) was 53 (29.6%) with grade 0, 78 (43.6%) with grade 1, 21 (11.7%) with grade 2, 21 (11.7%) with grade 3, and 6 (3.4%) with grade 4. Patients who did not receive celecoxib were significantly more likely to develop HO and experience greater severity of HO, with odds ratios of 2.19 (95% CI 1.10-4.33, P < .05) and 2.51 (95% CI 1.43-4.44, P < .05), respectively. No significant differences in patient-reported outcomes were observed between groups.

Conclusion: Celecoxib for 4 weeks postoperatively may reduce the risk and severity of HO after TAA without affecting patient-reported outcomes. HO prophylaxis did not have a statistically significant impact on PROMs. Celecoxib for HO prophylaxis can be considered following primary TAA while balancing the risks of side effects.Level of Evidence: Level III, (retrospective cohort study).

Background: Extensor tendon injuries of the foot and ankle are common, and less literature is available regarding its outcome. Ours is an observational study that aims to evaluate the functional outcome of surgical repair of all extensor tendons of the foot and ankle.

Methods: The study was conducted over a period of 1½ years with extensor tendon injury that was repaired within 24 hours of injury. The patients were followed up for a minimum period of 6 months and the functional outcome was evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score.

Results: A total of 30 patients were enrolled, and that included 15 patients in a prospective study and another 15 patients in a retrospective study. A total of 22 cases were followed up. The major tendons involved were extensor digitorum longus (60%) followed by a combination of 2 or more tendons (30%). Extensor hallucis longus and tibialis anterior were involved in 6.7% and 3.35% of cases, respectively. The mean follow-up was 16 ± 7.8 months, and the mean AOFAS score was 99.36 ± 2.1, with a range of 90-100. The mean pain score was 39.2 ± 9, with a range of 30-40. The mean functional score was 49.36 ± 2.17, whereas the mean alignment score was 10.

Conclusion: Extensor tendon injuries of the foot and ankle are common injuries that require active surgical intervention. Early repair with a good physiotherapy protocol was associated with excellent AOFAS score and a pain-free limb without deformities in the 22 of 30 patients who were followed up.

Level of evidence: Level IV, ambispective observational study.