Journal of Foot & Ankle Surgery最新文献

Background: Treatment strategies for talar avascular necrosis range from nonsurgical management to surgical interventions, including joint-sparing and joint-sacrificing procedures. However, no consensus exists on the optimal treatment approach, particularly in cases requiring ankle arthrodesis.

Purpose: This study evaluated whether open ankle arthrodesis and arthroscopic ankle arthrodesis differ in complication rates when used for the treatment of talar avascular necrosis.

Study design: Patient outcomes following ankle arthrodesis procedures were analyzed retrospectively using a national healthcare database containing diagnosis and procedure codes.

Methods: Utilizing data from the TriNetX database, we identified patients with talar avascular necrosis who underwent open or arthroscopic ankle arthrodesis between January 29, 2004, and January 29, 2024. Propensity score matching controlled for age, sex, long-term steroid use, and comorbidities. Primary outcomes included one-year rates of nonunion and hardware removal. Risk differences were calculated, and significance was assessed with Z-tests.

Results: No significant differences in orthopaedic complications between the open-ankle and arthroscopic cohorts, including rates of nonunion (30.6% vs. 31.1%, p = 0.936) and hardware removal (19.0% vs. 12.1%, p = 0.147) were found.

Conclusion: This study found no significant differences in complication rates between open and arthroscopic ankle arthrodesis for talar avascular necrosis, including nonunion and hardware removal. These findings suggest that both open and arthroscopic approaches offer comparable complication profiles.

Background: With an aging U.S. population, demand for foot and ankle surgical services continues to increase. The purpose of this study was to evaluate 25-year trends in Medicare reimbursement for foot and ankle surgical procedures. We hypothesized that inflation-adjusted reimbursement has declined.

Methods: Medicare reimbursement data (facility pricing, locality 0431200 Oklahoma) for 81 commonly performed foot and ankle surgical CPT codes was extracted from the CMS Physician Fee Schedule Look-Up Tool for 2000-2024. Reimbursement was adjusted to 2000 dollars using both the Consumer Price Index (CPI) and Medicare Economic Index (MEI). Compound annual growth rates (CAGR) were calculated.

Results: From 2000 to 2024, inflation-adjusted reimbursement for foot and ankle surgical procedures declined 45.9% (CPI-adjusted) and 36.9% (MEI-adjusted), corresponding to CAGR values of -2.5% and -1.9%, respectively. This represents an average decline of $221 per procedure (CPI-adjusted) or $178 per procedure (MEI-adjusted) in 2000 dollars.

Conclusion: Medicare reimbursement for foot and ankle surgical procedures has declined substantially over the past 25 years when adjusted for inflation. These findings should alert surgeons, hospital administrators, and policymakers to the widening gap between operative costs and reimbursement, with potential downstream effects on access to care.

Purpose: To evaluate the clinical and functional outcomes of percutaneous correction of lesser toe deformities using extra-articular osteotomies, with a focus on patient-reported outcomes and postoperative complications.

Methods: A retrospective review was conducted on 98 percutaneous hammertoe correction procedures performed on 41 patients between April 2019 and April 2024. Inclusion criteria included age >18, minimum 12-month clinical follow-up, and pre- and post-operative radiographs. Procedures involving interphalangeal arthrodesis or isolated fifth toe corrections were excluded. Functional outcomes were assessed using the Foot Function Index (FFI) pre-operatively and at least one year post-operatively. Statistical analysis was performed using paired t-tests. Complications and concomitant procedures were also recorded.

Results: Patients had a significant improvement in overall FFI scores, from a pre-operative average of 86.3 to a post-operative average of 34.9 (p < 0.0001). Subscale improvements were also statistically significant for pain (p < 0.0001) and disability (p < 0.0001), but not for activity limitation (p = 0.06). Common concomitant procedures included percutaneous hallux valgus correction (46%) and distal metatarsal metaphyseal osteotomies (39%). The most frequent complications were recurrence requiring revision arthrodesis (7%) or capsular release (5%). No infections or wound complications were reported.

Conclusion: Percutaneous correction of lesser toe deformities using extra-articular osteotomies offers a safe and effective alternative to traditional open techniques. The procedure significantly improves patient-reported outcomes with a low complication rate and high patient satisfaction. Further research, including long-term follow-up and comparison with open techniques, is warranted.

Level of evidence: 3 - Therapeutic Study, Retrospective Comparative study.

Background: The Foot and Ankle Outcome Score (FAOS) assesses pain, function, sports activity, and quality of life in patients with foot and ankle disorders. Its use in Arabic-speaking populations is limited by the absence of a validated Arabic version.

Purpose: To translate, culturally adapt, and validate an Arabic version of the FAOS (FAOS-AR).

Study design: Prospective validation study.

Methods: The FAOS was translated and culturally adapted into Arabic using cross-cultural methodology, including forward translation, reconciliation, back-translation, review, and pilot testing. Adults aged ≥18 years with foot or ankle pain were recruited from two outpatient clinics and completed the FAOS-AR and the Arabic American Orthopaedic Foot and Ankle Society score (AOFAS-AR). A clinically stable subgroup repeated the FAOS-AR after 5-10 days. Psychometric evaluation included internal consistency, test-retest reliability, measurement error, and content, structural, and convergent validity.

Results: Score distributions showed acceptable floor and ceiling effects. Internal consistency was excellent for Function/Activities of Daily Living (α=0.97), Sports/Recreation (α=0.90), and Pain (α=0.89); acceptable for Quality of Life (α=0.73); satisfactory for Stiffness (α=0.75); and low for Symptoms (α=0.34). Test-retest reliability was excellent for the total score (ICC=0.978) and all subscales except Symptoms (ICC=0.778). The standard error of measurement was 3.16, yielding a minimal detectable change of 8.76 points. Principal component analysis supported unidimensionality for most subscales, whereas Symptoms demonstrated multidimensionality. Convergent validity was shown by correlations with AOFAS-AR domains (ρ=0.516-0.673).

Conclusion: The FAOS-AR is valid for assessing outcomes in patients with foot and ankle conditions.

Level of evidence: Level II.

Background: Clinical standards for diagnosing Charcot neuroarthropathy (CN) rely on two-dimensional (2D) radiographs, despite the complex three-dimensional (3D) deformities. This study utilized a 3D measurement method, previously applied to nonweightbearing imaging, for weightbearing imaging to quantify deformities in CN patients and compared these to 2D weightbearing radiographs (WBR).

Methods: This retrospective study included seven CN patients who underwent both 2D WBR and 3D weightbearing CT scans (WBCT). Five observers manually annotated 2D radiographs, and placed 3D fiducial markers on anatomic landmarks that were processed using a patient-specific coordinate system. Paired t-tests and Bonferroni adjustment (p_adj) compared 2D and 3D values.

Results: The 3D WBCT measurements revealed significantly greater anteroposterior talocalcaneal angles (153.59 degrees ± 2.49 vs. 19.98 degrees ± 1.74, p < 0.0001, p_adj< 0.0001) and talonavicular angles (10.61 degrees ± 2.16 vs. 1.75 degrees ± 0.25, p < 0.0001, p_adj<0.0001). Unadjusted medial and lateral column heights were significantly higher on WBCT (25.31 mm ± 3.70 vs. 14.09 mm ± 2.39, p = 0.001, p_adj=0.009; 15.60 mm ± 2.39 vs. 8.17 mm ± 2.29, p = 0.027, p_adj=0.243, respectively). Tibiotalar angles were significantly lower on WBCT (91.72 degrees ± 1.27 vs. 124.05 degrees ± 2.04, p < 0.0001, p_adj< 0.0001).

Discussion: Comparisons between the novel method of analyzing 3D WBCT and standard analysis of 2D WBR revealed significant differences in several angular and distance measurements of pathological deformities in CN. Measurements related to forefoot abduction, midfoot arch height, and hindfoot valgus alignment differ from 2D WBR compared to 3D WBCT.

Purpose: Traditional open approaches for matrix-induced chondrogenesis (AMIC®) carry significant morbidity risks. The purpose of this study is to evaluate the effectiveness of the as all-arthroscopic Autologous Matrix-Induced Chondrogenesis (AT-AMIC®) technique in treating osteochondral lesions of the talus (OLT), with a focus on mid-term functional outcomes and complications rates.

Methods: In this retrospective, multicentric case series, we analyzed 64 patients (39 men, 25 women; age range, 18-71 years) with symptomatic OLTs, confirmed by Magnetic Resonance Imaging (MRI), who were treated with the AT-AMIC technique. The intervention included lesion debridement, subchondral bone microfracture, autologous cancellous bone grafting when needed, and the implantation of a porcine collagen bilayer matrix (Chondro-Gide®). Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, with a mean follow-up of 44 months (range, 31-62 months). Statistical analysis was performed using the Wilcoxon test, with the significance level set at 5% (p < 0.05).

Results: The average size of the OLTs was 112 mm², with the most common location being Raikin zone 4 (54.68%). The average preoperative AOFAS score was 51.58, which significantly improved to 89.64 at the final follow-up (p < 0.0001). Seven patients (11%) experienced treatment failure due to complications such as membrane detachment, membrane hypertrophy, or recurrence of lesions. No significant correlation was found between lesion size or symptom duration and clinical outcomes.

Conclusion: The AT-AMIC® technique is a reproducible method of treatment for OLTs that resulted in a statistically strong clinical improvement in the mid-term. Further comparative studies are needed to confirm its long-term efficacy.

Background: Numerous calcaneal osteotomies exist for the correction of rearfoot varus; however, the preferred surgical option remains controversial. Limited data are available regarding radiographic union and complication rates associated with Malerba calcaneal osteotomy without lateralization of the calcaneal tuberosity.

Purpose: To report the incidence of union, complications, and revision surgeries associated with the Malerba calcaneal osteotomy performed without lateralization for the treatment of adults with rearfoot varus deformity.

Study design: Observation, retrospective case series METHODS: A retrospective review of clinical charts of consecutive adult patients were performed from 1/2018 through 3/2024 at a single hospital in the Midwest region. Patient demographics, clinical variables, and postoperative variables (radiographic union, postoperative complications, the need for surgical reoperation, and revision surgery) were obtained.

Results: A total of 46 cases were included, with a mean follow-up of 14.7 months. Three fixation methods were used, including single screw (37 cases, 80%), two screws (2 cases, 4%), and staple alone (7 cases, 15%). The union rate was 100% across all fixation methods used in this study. Three patients developed postoperative complications resulted in an overall complication rate of 7% (3/46 cases) with one case each of hardware removal, wound dehiscence, and superficial infection.

Conclusion: The Malerba calcaneal osteotomy performed without lateralization of the calcaneal tuberosity achieves a high union rate and a low complication profile across various fixation methods.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly utilized in managing type 2 diabetes mellitus (T2DM) and obesity. Emerging evidence suggests their role in enhancing bone metabolism, with potential implications for orthopedic outcomes.

Purpose: To evaluate the impact of perioperative GLP-1RA use on outcomes following midfoot arthrodesis.

Study design: This retrospective cohort study used the TriNetX U.S. Collaborative Network to evaluate outcomes following midfoot fusion in patients with versus without perioperative GLP-1RA use.

Methods: Patients were propensity score matched (1:1) for key demographic and clinical variables. Primary outcomes included 90-day and 1-year surgical complications, nonunion, and mechanical issues. Logistic regression models were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Among 1504 matched patients (752 per cohort), GLP-1RA use was associated with significantly reduced odds of nonunion at 1 year (OR = 0.712; 95% CI = 0.52-0.958). However, GLP-1RA users had higher 90-day rates of wound complications (OR = 1.713, 95% CI = 1.141-2.57), irrigation and debridement (OR = 1.873; 95% CI = 1.223-2.869), and elevated 1-year mechanical complications rates (OR = 2.446; 95% CI = 1.552-3.857). No significant differences were observed in infection rates or overall hospital admissions.

Conclusion: There is an observed association with perioperative GLP-1RA use and lower nonunion rates following midfoot arthrodesis, indicating a potential benefit for bone healing. However, increased mechanical and wound-related complications warrant further investigation into their surgical safety profile in foot and ankle procedures.

Background: Ankle fractures are a common orthopedic injury often requiring surgical fixation. Prior studies have found that inpatient treatment is associated with increased risk of 30-day complications versus outpatient treatment.

Purpose: As outpatient fixation becomes increasingly common, and as surgical and rehabilitation techniques continue to evolve, we aim to provide an updated analysis of short-term complications following inpatient and outpatient management of ankle fractures.

Study design: A retrospective cohort study was conducted.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients receiving surgery for ankle fracture from 2010-2021. Cohorts were divided by treatment setting and matched using the nearest neighbor method. A sub-analysis was performed to determine the most common fracture types treated for each cohort. Chi-square and independent t-tests were employed to evaluate for differences in 30-day complications. Regression analyses were employed to assess independent risk factors for adverse outcomes.

Results: 21,612 inpatient and 23,932 outpatient ankle fractures were identified, with 4,926 patients included per matched cohort. Inpatients had more bimalleolar and trimalleolar fractures, while outpatients had more lateral malleolus fractures. ASA class and prevalence of heart failure remained significantly higher in the inpatient cohort after matching. Rate of postoperative complications was greater for inpatients (6.1%) versus outpatients (2.6%). Greater age, ASA class, dependent functional status, preoperative blood transfusion, and various comorbidities were found to be independent risk factors for complications, regardless of surgical setting.

Conclusions: Inpatient management of ankle fractures resulted in more postoperative complications compared to outpatient treatment. Preoperative characteristics, including patient comorbidities, may contribute to this difference. Additionally, there are several risk factors for adverse postoperative outcomes that should be considered prior to any fixation, regardless of surgical setting. Understanding these relationships can help surgeons better optimize patients and mitigate costs of care.

Background: Routine deltoid ligament repair (DLR) during operative management of ankle fractures remains controversial.

Purpose: To compare patient-reported outcomes (PROs), complications, and radiographic outcomes in patients with bimalleolar equivalent ankle fractures treated with or without DLR.

Study design: Retrospective cohort study.

Methods: Adult patients who underwent operative fixation of bimalleolar equivalent ankle fractures at two level 1 trauma centers between 2010 and 2023 were retrospectively identified. The primary outcome was the Olerud-Molander Ankle Score (OMAS). Secondary outcomes included additional PROs, complications, and radiographic measurements. Multivariable logistic regression assessed the association between DLR and the odds of achieving an excellent (≥91) versus non-excellent OMAS.

Results: A total of 260 patients (median age 36.4 years, 38.4% female) were included. Thirty-one (12%) patients underwent DLR and 229 (88%) did not. PROs were obtained from 92 patients (18 DLR, 74 non-repair) at a median of 7.0 years postoperatively. Median OMAS was similar between cohorts (90 vs. 90, P = 0.79). DLR was not associated with increased odds of achieving an excellent OMAS (adjusted OR 1.89, 95% CI: 0.52-7.08, P = 0.335). Secondary PROs and complications were comparable between cohorts. Radiographic measurements in 111 patients (26 DLR, 85 non-repair) revealed a decreased median tibiofibular clear space in the DLR group (4.50 mm vs. 5.09 mm, P = 0.012). Medial clear space and tibiofibular overlap were similar between cohorts.

Conclusion: Patients with bimalleolar equivalent ankle fractures had comparable long-term PROs and complication rates regardless of DLR. Radiographic findings suggested adequate restoration of ankle joint congruity and medial stability in both cohorts.