Foot and Ankle Surgery最新文献

Objective: This study aimed to identify specific risk factors for sagittal plane malpositioning following primary ankle arthrodesis in patients with end-stage ankle joint diseases.

Methods: A retrospective cohort analysis was conducted on 166 patients who underwent primary ankle arthrodesis between January 2010 and December 2019. Sagittal plane malpositioning was defined as postoperative talar anterior translation > 5 mm or sagittal plane angulation > 10° on lateral radiographs. Potential risk factors analyzed included age, gender, affected side, primary disease, preoperative alignment, surgical approach combined with fixation system, concomitant procedures, and surgeon experience. Binary logistic regression was used to evaluate associations with postoperative malpositioning.

Results: The incidence of sagittal plane malpositioning was 16.3 % (27/166). Preoperative pes equinus and/or anterior talar subluxation (OR = 6.887, 95 % CI: 1.375-34.50, p = 0.019) and surgery performed by mid-senior surgeons (vs. senior surgeons; OR = 3.210, 95 % CI: 1.039-9.919, p = 0.043) were significant risk factors. Compared with the anterior approach + cannulated screws, the lateral approach + lateral plate plus cannulated screws was associated with a lower risk (OR = 0.105, 95 % CI: 0.012-0.953, p = 0.045). No significant associations were found with gender, age, affected side, primary disease, preoperative anteroposterior alignment, or concomitant subtalar arthrodesis.

Conclusion: Preoperative sagittal deformities, use of the anterior approach with cannulated screws alone, and less experienced surgeons increase the risk of sagittal malpositioning after primary ankle arthrodesis. The lateral approach with lateral plate fixation may reduce this risk. Thorough preoperative planning, appropriate surgical technique selection, and surgeon training are crucial to improving outcomes.

Level of evidence: Ⅲ, Retrospective Comparative Study.

Introduction: Arthroscopically assisted Reduction and Internal Fixation (ARIF) to fix talar neck fractures is progressively gaining popularity. Our aim was to determine if ARIF in this setting might increase the healing rate and reduce the number of complications as compared to percutaneous fixation (PF) alone.

Methods: As per PRISMA guidelines, multiple databases (Scopus, Pubmed, Web of Science and Cochrane) were used to retrieve studies reporting on patients diagnosed with a fracture of the talar neck undergone minimally invasive surgery using screws as exclusive fixation method. Data were recorded regarding the design of the study, the cohort, the surgical technique and the outcome achieved (clinical scores and complication rate) with the longest possible follow-up. The methodological quality of studies was evaluated using the MINORS (methodological items for non-randomized studies). Results after ARIF and PF were compared.

Results: Six studies were selected (ARIF=11 cases, 2 studies; PF=51 cases, 4 studies). In the two groups, the mean sample size (p = 0.88) and the mean age of patients (p = 0.24) were comparable. Patients were mostly males in the percutaneous fixation group (M/F: 36/15) and mostly females in the ARIF group (M/F: 4/7). The mean follow-up in the ARIF group was 16 months (range, 12-18) and 31 months in the percutaneous fixation group (range, 20-48), but the difference was not significant (p = 0.09). In both groups radiographic healing was achieved in all patients. The pooled complication rate was significantly different in the ARIF group (1 %) as compared to the PF group (19 %; p = 0.04). The incidence of early (before 48 months) peri-talar osteoarthritis was significantly lower in ARIF (0 %) as compared to PF (11 %; p = 0.04). The quality of studies was poor in the ARIF group and moderate in the PF group.

Conclusions: In this review based on small-sample studies, we found a similar radiographic healing rate in talar neck fractures treated percutaneously using screws with or without arthroscopy. Arthroscopic assistance allowed to reduce the incidence of complications, and specifically of early (before 48 months) peri-talar osteoarthritis. Larger studies are needed to confirm or disprove these findings.

Level of evidence: level IV, systematic review of level I to IV studies.

Background: This study aims to investigate the course, branching, and variations of the tibial nerve from the level of the ankle.

Methods: A total of 116 feet from 58 fetal cadavers were dissected and examined.

Results: It was observed that the bifurcation of the tibial nerve was located within the tarsal tunnel in all cases. Examination of the tibial nerve bifurcations revealed that the bifurcation was most frequently located proximal to the medial malleolus-calcaneal axis. The medial calcaneal nerve was classified into six distinct types, with Type 2 representing the most prevalent pattern, observed in 39.7 % of the specimens. The anastomosis between the medial and lateral plantar nerves was categorized into four types, among which Type 1 was the most common, occurring in 81.89 % of the cases.

Conclusions: This study will provide significant information for anatomists and clinicians regarding the course and branching pattern of the tibial nerve.

Level of evidence: Level IV (case series).

Background: Insertional Achilles tendinopathy (IAT) often necessitates surgery when conservative measures fail. In recent years, minimally invasive (MIS) Zadek osteotomy has emerged as a favourable alternative to open surgeries such as calcaneoplasty and tendon reattachment. This study evaluates our experience with MIS Zadek osteotomy and compares its clinical outcomes with those of open calcaneoplasty and Achilles tendon reattachment in the treatment of recalcitrant IAT.

Methods: A retrospective comparative study was conducted on thirty patients treated surgically for IAT between January 2023 and December 2024. Patients were divided into two groups: Open calcaneoplasty with Achilles tendon reattachment (n = 15), and MIS Zadek osteotomy (n = 15). Inclusion criteria comprised of patients with symptomatic IAT refractory to nonoperative treatment while patients with concomitant foot deformity or inflammatory conditions, and those who have undergone prior surgery to the same ankle were excluded. All patients had a minimum follow-up of twelve months. Primary clinical outcomes analysed include time taken to unrestricted independent ambulation, Visual Analogue Scale (VAS) scores, European Foot and Ankle Society (EFAS) scores, ability to perform unassisted single-legged heel raise (SLHR), satisfaction, and post-operative complications.

Results: Time to unrestricted independent ambulation and ability was significantly shorter in the MIS group (mean=7.1 weeks) versus the open group (mean=13.2 weeks; p < 0.001). More patients who underwent MIS Zadek were able to perform unassisted SLHR at 3 months (46.67 % in the open group vs 86.7 % in the MIS group; p = 0.019). Both groups had significant pain reduction at 12 months (VAS 0.67 vs. 0.20; p = 0.176). EFAS scores improved in both groups, with no significant intergroup differences at six or twelve months. Wound complications occurred in 26.7 % (n = 4) of patients in the open group, including one deep infection requiring readmission and multiple debridement. No wound-related complications were reported in the MIS group (p = 0.032).

Conclusion: MIS Zadek osteotomy is a viable surgical alternative for IAT, offering comparable pain relief and functional improvement while significantly shortening the time to independent ambulation and risk of wound complications. Comparative studies with larger sample sizes and longer term follow-up are warranted to validate these findings.

Level of evidence: III.

Purpose: Tarsal tunnel neurovascular vulnerability lacks robust anatomical classification. We established an MRI-based retromalleolar canal classification to assess its clinical utility for surgical approach guidance and pathology diagnosis.

Methods: This retrospective study analyzed normal ankle 3 T MRIs from 250 consecutive patients (2018-2023). Three musculoskeletal radiologists independently classified retromalleolar canal morphology using axial T2-weighted turbo spin-echo sequences (Siemens Skyra 3 T) acquired at a standardized plane 4 mm superior to the talar dome.

Results: Three radiologists demonstrated excellent interobserver reliability in all measurements (ICC >0.85, P < 0.001). Based on morphological parameters including shape, dimensions, and angular relationships, we classified retromalleolar canals into four distinct types: R (predominant, 60.4 %), V (18 %), K (16.8 %), and L (4.8 %). Morphometric analysis revealed significant differences across all classification groups (P < 0.001), particularly in groove depth and medial malleolar angle measurements.

Conclusions: The novel morphological classification may complement existing methods, potentially improving posterior ankle arthroscopy safety and aiding in the understanding of pathologies such as posterior tibial tendon dislocation and tarsal tunnel syndrome.