Foot and Ankle Surgery最新文献

Background: This study aimed to report our experience with the combined use of hemiwedge supramalleolar osteotomy (SMO) procedure and open ankle arthrodesis (AA) for correcting end-stage ankle arthritis with large varus deformity in the same operative session.

Methods: This retrospective study prospectively followed 14 consecutive patients (15 ankles), consisting of 5 men and 9 women, with a mean age of 68.3 years, and underwent SMO/AA for treating end-stage ankle arthritis and varus deformity of the hindfoot of ≥ 15° from April 2019 to June 2023. The participants were followed up for a mean duration of 3.4 years.

Results: All patients experienced pain relief and walking ability improvement after SMO/AA. The mean osteotomy wedge height was 7.0 mm. The mean time to full-weight bearing and bone union time was 8.4 weeks and 11.7 weeks, respectively. The mean visual analog scale and the Japanese Society for Surgery of the Foot scale score significantly improved from 7.3 and 51.9 preoperatively to 1.4 and 82.2 postoperatively, respectively (p < 0.001). Further, the Self-Administered Foot Evaluation Questionnaire was significantly improved on all subscales (p < 0.001). The mean hindfoot alignment angle significantly decreased from 22.5° preoperatively to 1.8° postoperatively (p < 0.001). Complications included secondary subtalar joint arthritis in two, asymptomatic stress fracture of the calcaneus in one, and delayed union of the osteotomy site in one patient.

Conclusions: Combined SMO/AA is a potential option for preserving the subtalar joint in treating end-stage ankle arthritis with large varus deformity. This technique successfully corrects ankle/hindfoot varus deformity and preserves leg length and subtalar joint motion. Further, a single lateral incision minimizes the risk of impaired blood supply. One-stage surgical treatment reduces recovery time, hospitalization duration, and surgical cost. Rigid locking fixation with careful postoperative weightbearing is required to attain uneventful bone healing.

Level of evidence: IV.

Background: Needle arthroscopy (nanoscopy) is gaining recognition as a minimally invasive alternative to standard arthroscopy, offering improved visualization of intra-articular structures. This cadaveric study evaluates its feasibility, effectiveness, and learning curve in the ankle joint.

Methods: Twenty fresh-frozen cadaveric ankle specimens were examined using a 1.9 mm NanoScope™ (Arthrex, Naples FL, USA). Four orthopedic surgeons (two experienced - Group 1, two inexperienced - Group 2) performed the procedures. Visualization of five key anatomical structures was assessed using a 5-point Likert scale.

Results: Needle arthroscopy enabled complete visualization of all predefined structures. The tibiofibular syndesmosis had the highest visualization scores (Group 1: 4.8 ± 0.16; Group 2: 4.5 ± 0.26), while the visualization of the ankle joint was the most challenging (Group 1: 4.53 ± 0.36; Group 2: 3.53 ± 0.51; p < 0.05). Deltoid ligament visualization was significantly better in experienced surgeons (4.65 ± 0.23 vs. 3.75 ± 0.29; p = 0.048).

Conclusion: Needle arthroscopy enhances visualization of deep ankle structures while remaining minimally invasive. Despite a learning curve, visualization scores were comparable across experience levels. Further research is needed to assess clinical outcomes and optimize training.

Background: Achieving precise three-dimensional reconstruction during foot and ankle corrective surgeries is challenging. Intraoperative plantar pressure measurement (IPPM) can help assess foot morphology and detect abnormal pressure distributions. We developed an IPPM system using a navigation to align the floor reaction force with the femoral head's center. This study evaluates its accuracy in anesthetized patients.

Patients and methods: Fifteen patients undergoing lower limb surgery were enrolled. Plantar pressure was measured intraoperatively in the supine position and compared with preoperative standing measurements. Similarity was evaluated using normalized cross-correlation (NCC) and peak pressure site agreement across 12 predefined foot regions.

Results: The IPPM device replicated standing plantar pressure, with a mean NCC of 0.92 ± 0.1 and a peak pressure site agreement rate of 76.7 ± 37.2 %.

Conclusions: The newly developed intraoperative plantar pressure-measuring device accurately replicates standing plantar pressure in anesthetized patients, offering potential for improving intraoperative assessments and corrective procedures.

Background: Chronic lateral ankle instability (CLAI) is a common condition often requiring surgical reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). While autografts are traditionally used, allografts are gaining interest due to reduced donor site morbidity. This study aimed to compare graft maturation between autograft and allograft using a multimodal MRI evaluation at one year.

Methods: This prospective, monocentric cohort study included 36 patients who underwent anatomical reconstruction of the ATFL and CFL between December 2020 and December 2023, using either gracilis autograft (n = 18) or frozen, non-irradiated allograft (n = 18). MRI performed at 8-15 months postoperatively assessed graft integration using three parameters: Signal-to-Noise Quotient Ankle (SNQA), Howell maturity score, and graft-to-bone interface signal. Measurements were performed independently by two blinded observers. Statistical comparison between groups was conducted using Mann-Whitney tests, and interobserver reproducibility was assessed using intraclass correlation coefficients (ICC).

Results: Interobserver reliability was excellent for SNQA (ICC = 0.976 for ATFL, ICC = 0.895 for CFL). No statistically significant differences were observed between autografts and allografts for any parameter: SNQA (ATFL, p = 0.267; CFL, p = 0.494), Howell score (ATFL, p = 0.436; CFL, p = 0.083), or graft-to-bone interface (talus, p = 0.332; calcaneus, p = 0.752; fibula, p = 0.289).

Conclusion: At one year, MRI-based maturation of autografts and allografts in anatomical lateral ankle ligament reconstruction was equivalent across all evaluated criteria. These findings support the use of allograft as a reliable alternative to autograft, particularly in selected patients where autograft harvesting is undesirable. Further longitudinal and functional outcome studies are warranted.

Background: Tibial diaphysis fractures, accounting for 17 % of lower extremity fractures, are often associated with fibular fractures. This study compares intramedullary pinning and extramedullary plating for fibular fixation following tibial fracture fixation.

Methods: A retrospective analysis was performed on 215 patients treated between 2012 and 2022. Patients were grouped by fibular fixation: no fixation, intramedullary pin, or extramedullary plate. Logistic regression identified risk factors for postoperative tibial malalignment and soft tissue complications.

Results: Malalignment occurred in 14.9 % of patients, with higher rates in those without fibular fixation (28.6 %) versus pinning (10.8 %) or plating (7.4 %). Logistic regression showed pinning (OR = 0.263, p = 0.029) and plating (OR = 0.162, p < 0.001) reduced malalignment risk without significant differences between methods. Plate fixation increased soft tissue complications (OR = 3.955, p = 0.003), whereas pinning did not (OR = 1.924, p = 0.297).

Conclusion: Intramedullary pinning offers similar alignment benefits to plating without increasing soft tissue complications and may be preferable in comminuted fractures or compromised soft tissue conditions.

Levels of evidence: Level III.

Background: This study investigates the quality, accuracy, and readability of ChatGPT's responses to common patient inquiries regarding hallux rigidus.

Methods: Twenty-five patient questions were directed to ChatGPT and analyzed. The DISCERN criteria assessed information quality, while the method by Mika et al. evaluated response accuracy. Questions were classified per Rothwell classification, and readability was evaluated using Flesch-Kincaid, Gunning Fog, Coleman-Liau, and SMOG indices.

Results: The mean DISCERN score was 50.26 (fair), and the Mika et al. score was 2.04 (satisfactory requiring minimal clarification). According to the Rothwell classification, 72 % of the questions were in the Fact group. The mean readability corresponded to 11.3 years of education.

Conclusions: ChatGPT provides partially satisfactory information about hallux rigidus in general at a high reading level. More detailed content should include surgical classifications, biomechanical details, and level of evidence. With these aspects, ChatGPT might be considered a supportive tool in patient education.

Levels of evidence: None.

Background: The number of total ankle replacements (TAR) is increasing each year and with that an associated rise in the burden of revision ankle replacement (rTAR) (Ratnamsey et al.) [3]. When a TAR fails, two options emerge: Arthrodesis or rTAR (Goldberg et al.) [1]; (Egglestone et al.) [2]; (Hinterman et al.) [4]. The preferred option in our centre following network discussion, is to convert the failing TAR to a rTAR. There is uncertainty whether this is best done in a single staged approach or two stages. The aim of this review was to assess the outcomes of single-to-two-staged approaches in rTAR, and to ascertain if there was any increase in complications or impaired outcome in the single-staged approach.

Method: A review was carried out of the prospectively collected data of all rTAR performed in our centre between Nov 2016 and Jan 2023. We reviewed: preoperative micro-sampling, intra-op microbiology and histology results, infection rate, tourniquet time, length of hospital stay, wound complications and PROMS of all patients who had undergone a single-staged rTAR, compared to two stages.

Results: We identified 86 rTAR patients, with a mean age of 71.4 (38-88) with a minimum of 2-year follow-up, range 2-7 years. There were 44 Left and 42 Right failing total ankle replacements. 14 were two staged procedures and 74 were single staged. No preoperative microbiology sampling was performed in the single or in the staged group. Both groups who underwent intraoperative microbiology sampling showed no positive microbiology growth. There was a significant difference in tourniquet times but with no associated significant complication rate in the single staged group versus the staged group. There was one infection in the single-staged group that went on to have a successful DAIR. There was no difference in wound complications post-op. Both groups showed improvement in PROMS, with no difference between the groups or in increase in length of hospital stay.

Conclusion: In our series, which is the largest in the literature, we have found single-staged revision arthroplasty to be safe and effective compared to a two-stage procedure in patients where there is a low index of suspicion of infection.

Level of evidence: Level III, Retrospective Cohort.