Foot and Ankle Surgery最新文献

Introduction: The presence of a fracture of the posterior malleolus gives a poor prognosis for ankle fractures. This study aimed to analyze the anatomical structures at risk in the traditional postero-medial (TPM) approach.

Methods: Of a total of 21 cadaveric pieces, 11 were female and 10 were male; 9 ankles/right foot and 11 ankles/left foot. The age of the specimens ranged between 66 and 98 years. The following statistical tests were performed: Median, Mean, SD and Mann Whitney non-parametric test.

Results: The p values associated with the statistical tests were calculated, obtaining all p values lower than the level of significance. Therefore, there is statistically significant evidence to reject the null hypothesis, that is, there is a difference in the medians of men and women, with respect to the 3 measurements. The evaluation of the anatomical structures at risk allowed us to measure the distance of the Posterior Tibial nerve, thus demonstrating that the approach was 20 mm above could cause injury. The difference in the measurements obtained between men and women had statistical significance.

Conclusion: Using the TPM (traditional postero-medial) approach it is possible to identify a large portion of the posterior malleolus both laterally and medially. The evaluation of the anatomical structures at risk allowed us to measure the distance of the Posterior Tibial nerve, thus demonstrating that the approach was 20 mm. above could cause injury. The difference in the measurements obtained between men and women had statistical significance. We intend to quantify visualization percentages using computed tomography in our next study.

Introduction: The Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines were developed in 2017 in order to establish a standardized approach for reporting key characteristics in platelet rich plasma (PRP)-based studies. However, the adherence to the guidelines from authors publishing data on studies related to the use of PPR in the management of osteochondral lesions of the talus (OLTs) has not yet been determined. The purpose of this study was to analyze how well clinical trials on PRP interventions for OLTs adhered to the MIBO guidelines.

Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to perform a systematic review of the PubMed, Embase and Cochrane Library databases. Inclusion criteria clinical studies that assessed PRP interventions for OLTs. The original 23 MIBO checklist items were separated and modified into a 46-point checklist. Adherence was determined by calculating the total percentage of checklist items that each article adequately and clearly reported from the 46-point checklist.

Results: A total of 9 studies (356 patients) with a weighted mean age of 42.1 ± 6.1 years were included in this study. The weighted mean follow-up was 32.2 ± 8.7 months. Overall, only 42.8 % ± 5.2 % of the 46-point MIBO checklist items were reported per article with no articles displaying adherence rates of 100 %. No articles had adherence rates ≥ 50 %, 6 (66.7 %) had adherence rates between 40.0 % and 49.9 % and 3 (33.3 %) had adherence rates less than 39.9 %. There was no difference in mean adherence rates between studies published prior to publication of the MIBO guidelines in May 2017 (41.7 %) and after publication of the MIBO guidelines in May 2017 (44.0 %) (p = 0.6473). There was variation in adherence rates between categories with the "Postoperative Care" category having the highest adherence rate (83.3 %) while the "Activation" category and the "Whole Blood Processing" had the lowest adherence rates (5.6 %).

Conclusion: This systematic review demonstrated that clinical studies evaluating outcomes following the use of PRP in the setting of OLTs poorly adhered to MIBO guidelines. None of the included studies had adherence rates ≥ 50 % and only 1 of the 12 MIBO categories had adherence rates ≥ 80 %. Interestingly, there was no difference in the mean adherence rates in studies conducted before and after publication of the MIBO guidelines in May 2017. This study underscores the need for superior reporting of critical data related to PRP in studies evaluating outcomes in patients with OLTs augmented with PRP.

Background: In patients with lateral ankle instability (LAI) and attenuated ligament tissue quality, the stability of lateral ankle can be achieved through percutaneous inferior extensor retinaculum augmentation (PIERA). This study is aimed to compare the functional outcomes of PIERA with gold standard Modified Broström Procedure (MBP) for patients with LAI.

Methods: Twenty participants were allocated to PIERA and MBP treatment group according to the intraoperative arthroscopic assessment of lateral ankle ligament, with each group comprises 10 participants. Patients were assessed using American Orthopaedic Foot and Ankle Society score, Cumberland ankle instability tool, Foot and Ankle Ability Measure, star excursion balance test (SEBT), and a stair descent gait analysis, a day prior to surgery and one year postoperatively. Operative outcomes and variables during stair descent were documented and compared between the preoperative and postoperative patients, and between treatment groups.

Results: The PIERA procedure significantly promoted the clinical outcomes of the patients with LAI. The anterior reach of SEBT was increased from 79.1 ± 12.6 to 84.8 ± 12.9 (p = 0.034). The PIERA procedure significantly increased ankle flexion range of motion (p = 0.049), maximal ankle dorsiflexion (p = 0.009), and peroneal activation post-initial-contact (p = 0.002) and during the gait cycle (p = 0.015). The effects of PIERA and MBP on ankle function were not significantly different.

Conclusion: PIERA produces similar functional outcomes compared with MBP in promoting clinical outcomes, dynamic postural stability, peroneal activation, and ankle sagittal range of motion for patients with LAI.

Level of evidence: III, retrospective cohort study.

Background: Plantar fasciitis (PF) is one of the most common causes of heel pain. With its treatment being mainly conservative, a lot of controversy surrounds the choice of the best conservative management for this entity. The purpose of this meta-analysis was to compare the effectiveness of extracorporeal shock wave therapy (ESWT) to other conservative treatment options for the management of plantar fasciitis PF.

Methods: PubMed, Cochrane, and Google Scholar (Pages 1-20) were searched systematically for randomized control trials (RCTs) published after 2013 comparing ESWT to other treatment modalities. ESWT was compared against six other treatment modalities and a placebo.

Results: Fifteen studies involving 1123 patients were included in the meta-analysis. ESWT was found to perform significantly better than placebo (SMD: 7.53, CI: [5.84, 9.22]; p < 0.00001) for VAS pain score, and CSI for FFI (SMD: 1.07, CI: [0.08, 2.07], p = 0.03). PRP outperformed ESWT for post-intervention VAS scores (SMD: -1.05; CI: [-1.53, -0.57]; p < 0.0001) and FFI (SMD: -0.84; CI: [-1.38, -0.30]; p = 0.002), while custom orthotics improved FFI significantly over ESWT (SMD: -0.74; CI: [-1.19, -0.28; p = 0.001]. No other significant differences were found between ESWT and other treatment modalities for the three metrics included in this study.

Conclusion: ESWT has been proven to be a successful treatment for PF. However, PRP showed a statistically and clinically significant greater improvement in pain and FFI than ESWT. However, compared to ESWT, PRP is still a more technically challenging procedure.

Level of evidence: Level 1 Meta-Analysis.