Foot and Ankle Surgery最新文献

Background and purpose: Accurate quantification of bony malalignment within the ankle syndesmosis is crucial in diagnosing syndesmotic instability, especially when subtle. While three-dimensional (3D) measurement techniques using weight-bearing computed tomography (WBCT) have gained popularity, normative bilateral comparative data still need to be established. This study aimed to identify the side-to-side variations and gender differences in the syndesmotic area and volume among individuals without syndesmotic injury using WBCT.

Methods: Retrospective analysis was conducted on bilateral ankle WBCT imaging of 88 individuals who underwent imaging for non-ankle-related injury or pathology. Two-dimensional area (at 1, 3, and 5 cm proximal to the tibial plafond) and three-dimensional volumetric (from 0.5 mm proximal to the tibial plafond and up to 3 and 5 cm proximally) measurements were obtained for bilateral ankles. Mean ( ± SD) values, percentage right-to-left differences, and gender differences were analyzed.

Results: Although there were no significant differences between laterality in any of the measurements, the largest right-to-left difference was 8.9 at the syndesmotic area at 3 cm above the tibial plafond in general. Contrarily, significant gender differences were found in the areas and volumes, with the largest difference observed for the 0.5-5 cm volume (8.41 ± 0.87 vs 7.45 ± 1.47 in male vs female, respectively; P = 0.001).

Conclusion: The mean side-to-site variation in the syndesmotic area and volume among individuals without syndesmotic injury is less than 9 %, and a side-to-side volume difference greater than 19 % might be indicative of abnormality. Additionally, gender-specific differences highlight the importance of considering gender norms in ankle syndesmosis evaluation and the need to use the contralateral side as a comparison.

Background: Research on outcomes measures after foot and ankle surgery is limited and methodological quality is not always assessed. We aimed to evaluate the measurement properties of patient-related outcome measures used in patients after foot- and ankle surgery.

Methods: A Medline, Embase and Web of Sciences systematic review was performed including dates from 2000 up to April 2022. Inclusion criteria were foot and/or ankle surgery, described outcome(s) and it's assessed measurement properties. Methodological quality assessment was performed using the NOS-scale and the COSMIN-criteria.

Results: 143 studies (n = 18383) were included for final review, 82 about PROMs, 61 about clinical outcomes. A total of 23 different PROMs were evaluated, with a positive result in all measurement properties for the FAOS. There were positive results too for most measurement properties of the LEFS and the MOXFQ. Most clinical outcomes were radiological measures, with a high reliability for most measurements on plain radiographs and CT-scans.

Conclusions: To monitor foot and ankle outcome and evaluate treatment, we recommend the FAOS as the most suitable foot and ankle PROM.

Level of clinical evidence: 2.

Background: Lower limb alignment on plain radiographs is commonly examined in orthopedics. Measurement of the medial distal tibial angle (MDTA) requires determining the tibial axis. Traditionally, in orthopedic practice, anatomical or surgical axes have been used. Due to the increasing availability of stitching tools, assessing the mechanical axis of the tibia in a lower leg mortise view radiograph has arisen as a third option. This study evaluated the reliability of three approaches to determine the MDTA on whole lower leg radiographs and the magnitude of the disparities between the approaches.

Methods: Thirty-eight patients were assessed on weightbearing, anteroposterior radiographs. The images included an anterior-posterior image ('mortise view') of the ankle joint, including the entire tibia. The radiographs were captured twice in each patient to analyze the reliability of the technique. The MDTA was measured according to the three approaches by two independent examiners.

Results: The mean absolute difference between MDTAs across two images was 0.8° for the anatomical axis and 0.74° for the mechanical. It was distinctly larger for the surgical axis with 1°. The MDTA differed by more than 2° between the anatomical and mechanical axes in 22 % of the patients and between the mechanical and the surgical axis in 10 % of the patients.

Conclusion: Weightbearing, lower leg mortise view radiographs centered on the proximal tibia and ankle joint provide reproducible values for the MDTA based on the mechanical axis. This approach should be preferred over the anatomical axis in future. The tibial tuberosity should not be used as a reference to determine the MDTA. The choice of the axis can lead to differences in the MDTA of clinically relevant magnitude.

Level of evidence: Level II, Prospective Cohort Study.

Background: Developments in minimally invasive surgical techniques (MIS) have sparked debate over the optimal intervention for calcaneal fractures. This meta-analysis compares the extensile lateral approach (ELA) to two MIS techniques; the sinus tarsi approach and percutaneous approaches.

Methods: A systematic search was conducted across seven databases for randomised control trials (RCTs). The clinical outcomes were wound complications, functional scores (American Orthopaedic Foot & Ankle Society score, and Maryland Foot Score) and radiological measures (Böhler's and Gissane's angles).

Results: Fourteen RCTs (n = 1367; mean age: 36.3 years; 25.7 % female) were included. MIS significantly reduced wound complications compared to ELA (RR 6.48, 95 %CI 4.03-10.41, p < 0.00001, n = 1380, GRADE: High). Functional scores favoured MIS, and radiological outcomes were equivalent.

Conclusions: Both MIS techniques reduce wound complications, improve functional outcomes, and achieve comparable anatomical reduction, making them suitable alternatives to the extensile lateral approach, to significantly improve patient's outcomes.

Level of evidence: Level 1.

Background: The aim of the study was to assess 7-year-follow-up (7FU) after Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in chondral lesions at the ankle as part of a complex surgical approach.

Methods: In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral lesion at the ankle treated with AMIC+PBC from July 17, 2016 to May 31, 2017 were included. Size and location of the chondral lesions, the Visual-Analogue-Scale Foot and Ankle (VAS FA) and the EFAS Score before treatment and at 5FU were analysed and compared with previous 2-year-follow-up (2FU). Peripheral Blood Concentrate (PBC) was used to impregnate a collagen I/III matrix (Chondro-Gide, Wolhusen, Switzerland) that was fixed into the chondral lesion with fibrin glue.

Results: One hundred and twenty-nine patients with 136 chondral lesions were included in in the study. The chondral lesions were located as follows (n (%)), medial talar shoulder only, 62 (46); lateral talar shoulder only, 42 (31); medial and lateral talar shoulder, 7 (10); tibia, 18 (13). The average for lesion size was 1.8 cm², for VAS FA 45.7 and for EFAS Score 9.8. 2FU/5FU/7FU was completed in 105 (81 %)/104(81 %)/103(80 %) patients with 112/111/109 previous chondral lesions. VAS FA improved to 79.8/84.2/82.9 and EFAS Score to 20.3/21.5/20.8 (2FU/5FU). No parameter significantly differed 2FU/5FU/7FU.

Conclusions: AMIC+PBC combined with adjunctive procedures resulted in improved and high validated outcome scores, after 7 years, without deterioration in comparison to results after 2 and 5 years. No method related complications were recorded.

Background: Chronic lateral ankle instability (CAI) is a common condition that can be effectively treated with lateral ankle ligament reconstruction to restore ankle stability and function. The aim was to assess the functional outcomes of arthroscopic lateral ligament reconstruction using the Manchester-Oxford Foot Questionnaire (MOXFQ), Visual Analog Score (VAS) and Euroqol-5D-5L (EQ-5D) patient-reported outcome measures (PROMs).

Methods: This prospective series included 36 consecutive patients who underwent isolated arthroscopic lateral ligament reconstruction for CAI between November 2020 and November 2022 with minimum 12-month follow up. All patients completed the MOXFQ, VAS, and EQ5D PROMs preoperatively, and a minimum of 12 months postoperatively. The MOXFQ is a foot and ankle-specific PROM that assesses foot and ankle function, the VAS measures pain and the EQ5D evaluates general health-related quality of life.

Results: Patients were followed up for 12-25 months. In all patients, there was significant improvement in all postoperative PROMs (p < 0.05). The MOXFQ index decreased from 59.1 ± 19.2-13.5 ± 18.1 (p < 0.01), EQ-5D index increased from 0.607 ± 0.224-0.854 ± 0.175 (p < 0.01) and VAS pain decreased from 36.6 ± 22.3-13.6 ± 18.4 (p < 0.01).A total of 6 patients(16.3 %) were lost to follow up and mean follow-up time was 1.63 ± 0.54 years.

Conclusion: Arthroscopic lateral ankle ligament reconstruction is an effective treatment for chronic ankle instability, with significant improvements in clinical and health-related quality of life outcomes.

Level of evidence: IV.

Background: Peroneal tendon injuries, particularly of the peroneus longus, contribute to lateral ankle pain and instability. However, limited literature addresses the anatomical influence of the cuboid tunnel and the os peroneum on such injuries. This study investigates histological changes in the peroneus longus tendon and their relationship to cuboid tunnel dimensions, os peroneum presence, and age.

Methods: This cross-sectional study examined 60 peroneus longus tendons from 30 cadavers (ages 15-71). Tendons were sectioned and histologically analyzed for cellularity and collagen composition. Cuboid tunnel dimensions were measured, and the presence of os peroneum, an accessory ossicle located within the peroneus longus tendon, was recorded. Statistical correlations were performed.

Results: Increased type III collagen and cellularity were significantly associated with advanced age, reduced tunnel width, and increased tunnel height (p < 0.05). No significant association was found with tunnel length or os peroneum presence.

Conclusions: Age, reduced cuboid tunnel width, and increased tunnel height are associated with peroneus longus tendon degeneration, with collagen type I replacement by type III, predisposing factors for tendinosis.

Level of evidence: Level IV (Anatomical Study).

Background: Total talar replacement (TTR) using a personalized customized total talar prosthesis (TTP) is an emerging and promising surgical option for the treatment of ankle problems. However, how to solve ankle instability after total talar replacement, and the influence of related solutions on foot biomechanics has not been investigated.

Methods: Our preliminary studies have found that enlarging a personalized total talar prosthesis (TTP0) by 1.5 % along the coronal axis (TTP-FP1.5) and reconstructing the anterior talofibular ligament (ATFL) significantly can enhance ankle stability. However, there is a lack of insight into the effect of the two options on biomechanics. Consequently, this work constructed anatomically detailed finite element models of the foot, including an intact model and four surgical models, including replacement of TTP0, replacement of TTP-FP1.5, and two models of TTP-coupled ATFL reconstruction. Biomechanical differences were evaluated by numerical simulation of a balanced-standing and three characteristic instants of the stand phase.

Results: Changes in plantar pressure distribution, joint contact pressure and force transmission, von Mises stress on bone, and prosthesis stress were predicted and analyzed. It was found that significant changes in foot biomechanics occurred after TTP-FP1.5 replacement compared to TTP0 replacement. In contrast, no ligament reconstruction versus ATFL reconstruction exerts a minor effect on biomechanics.

Conclusion: The findings indicate that the shape of the prosthesis is the primary factor affecting foot biomechanics after total talar replacement. In contrast, reconstruction of the ATFL has only a minimal effect on the biomechanics of the foot. The above findings will provide a solid basis for the improvement of TTR surgical plans in clinical.

Introduction: The purpose of this study is to evaluate the influence of chronic opioid dependence on postoperative outcomes following primary total ankle arthroplasty (TAA).

Methods: The Nationwide Readmissions Database (NRD) was queried from 2016 to 2020 to identify 29,751 patients undergoing primary elective TAA with patients divided into cohorts based on the presence of preoperative opioid dependence (861 patients; 2.9 %).

Results: The overall cohort was majority male (54.2 %) with mean age of 64.15 (range 17-90) years, and Charlson-Deyo Comorbidity Index score of 0.65 (range 0-12). Preoperative opioid dependence was significantly predictive of increased risk of wound dehiscence (OR=5.365; p < .001), adverse discharge (OR=1.443; p < .001), extended stay greater than 4 days (OR= 1.438; p < .001), and more than a $1000 increase in the total cost of admission (β= 1052.27; p = .027).

Conclusion: Chronic preoperative opioid use was significantly predictive of higher rates of postoperative complications, LOS, and substantially higher cost of admission for TAA.

Level of evidence: Level III, Retrospective Cohort Study.

Background: The aim of the study was to assess the 7-year-follow-up (7FU) after Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in chondral defects at the first metatarsophalangeal joint (MTP1).

Material and methods: In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral lesion at MTP1 that were treated with AMIC+PBC from April 1, 2009 from July 17, 2016 to May 21, 2017 were included. Size and location of the chondral lesions, the Visual-Analogue-Scale Foot and Ankle (VAS FA) and the European Foot and Ankle Society Score (EFAS Score) before treatment and at 5FU were analysed and compared with previous 2- and 5-year-follow-up (2FU/5FU). Peripheral Blood Concentrate (PBC) was used to impregnate a collagen I/III matrix (Chondro-Gide, Wolhusen, Switzerland) that was fixed into the chondral lesion with fibrin glue.

Results: One hundred and ninety-eight patients with 228 chondral defects were included. In 21 % of patients no deformities in the forefoot were registered. The average degree of osteoarthritis was 2.2. The chondral defect size was 1.0 cm² on average. The most common location was metatarsal dorsal (22 %), and in most patients one defect was registered (74 %). Corrective osteotomy of the first metatarsal was performed in 79 %. 176 (89 %)/164 (82 %)/159 (80 %) patients completed 2FU/5FU/7FU VAS FA/EFAS Scores were preoperatively 46.8/11.9 and improved 74.1/17.1//75.0/17.2//72.8/17.5 at 2FU/5FU/7FU on average. No parameter significantly differed between 2FU/5FU/7FU (ANOVA, p > 0.05).

Conclusions: In conclusion, AMIC+PBC as treatment for chondral defects at MTP1 as part of joint preserving surgery led to improved and high validated outcome scores at 7FU. The lack of significant differences between 2-year (2FU), 5-year (5FU), and 7-year (7FU) outcomes suggests plateaued benefits.