Foot & ankle specialist最新文献

BackgroundVarious techniques using different implants with or without bone grafts have been described in tibiotalocalcaneal arthrodesis (TTCA). However, which reconstructive method and fixation device results in better outcomes remains unclear. The purpose of this study was to compare the surgical outcomes of TTCA performed with ipsilateral distal fibular autograft as intramedullary strut and lateral plating (FAISP) or retrograde intramedullary nail (RIMN).MethodsWe retrospectively reviewed the records of patients who underwent TTCA between 2010 and 2021 performed by a single surgeon. The surgery was performed with FAISP prior to January 2017 and with RIMN from January 2017 onward. Outcome assessments included radiographic evaluation, functional evaluation with American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHFS) and visual analogue scale (VAS) for pain, and occurrence of complications.ResultsAmong 30 patients who underwent TTCA, 11 cases were performed with FAISP and 19 cases with RIMN. Mean follow-up was 51.0 and 44.4 months in the FAISP group and the RIMN group, respectively. In the FAISP group, union was successfully achieved in 9 (81.8%) ankle arthrodesis and 7 (63.6%) subtalar arthrodesis. In the RIMN group, union was successfully achieved in 15 (79.0%) ankles arthrodesis and 12 (63.2%) subtalar arthrodesis. No significant difference was found between groups in ankle and subtalar union rate or in time to union. Functional evaluation revealed that mean AOFAS-AHFS score and mean VAS pain score improved significantly after TTCA in both groups, but there was no significant between-group difference in mean AOFAS-AHFS score or mean VAS pain score both preoperatively and at last follow-up. The occurrence of complications was similar between groups.ConclusionsBoth FAISP and RIMN yielded favorable functional and radiographic outcomes for TTCA. FAISP may serve as a viable alternative in select clinical situations.Level of Clinical Evidence:Level III: Retrospective cohort study.

Background: Concentrated bone marrow aspirate (CBMA) has become increasingly popular in the management of osteochondral lesions of the talus (OLT) due to its rich content of mesenchymal stem cells (MSCs) and bioactive substances that promote chondrogenesis and articular cartilage repair. However, comprehensive evaluations of clinical outcomes regarding the use of CBMA in OLT have yet to be published. The purpose of this review is to provide an evidence-based overview of clinical outcomes following the utilization of CBMA in the surgical management of OLT.

Methods: Using the search terms: ([CBMA] OR [concentrated bone marrow aspirate] OR [bone marrow aspirate] OR [bone marrow-derived mesenchymal stem cells]) AND ([talus] OR [ankle] OR [osteochondral lesion]), we systematically reviewed PubMed/Medline, Scopus, and Cochrane databases in February 2025. Inclusion criteria consisted of clinical studies published in English within the past 10 years that examined ankle pain or functional outcomes after treating OLT in adults with CBMA. Animal studies and studies including patients aged <18 years were excluded, as were systematic reviews and meta-analyses.

Results: Fifteen articles met inclusion criteria. CBMA showed beneficial effects in functional and pain outcomes across different applications: as a standalone therapy, in conjunction with debridement, and alongside reparative or replacement techniques. However, results varied, with some studies noting superior outcomes with CBMA compared to controls, while others found no significant differences. Radiologic outcomes assessed by Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring and complications were also mixed, suggesting benefits in some reparative techniques but not in others.

Conclusions: CBMA shows promise in the management of OLT, particularly when used as an adjunct to surgical intervention. However, the evidence is limited by the predominance of non-randomized studies. The heterogeneity in study design, follow-up, and outcome measures across the literature highlights the need for more standardized research protocols to definitively assess CBMA's efficacy and optimize its clinical use.Level of Evidence: III.

ObjectiveTo compare patient-reported outcomes and reintervention rates after open vs arthroscopic fusion of the ankle (TT-tibiotalar) or subtalar (ST) joint over a 10-year period in a cohort of patients from a single center.MethodsIn total, 129 patients (142 joints) underwent surgery for isolated TT or ST osteoarthritis between 2010 and 2020: 40 TT fusions (11 arthroscopic, 29 open) and 102 ST fusions (25 arthroscopic, 77 open). The course of treatment was followed clinically using patient-reported outcome measures (PROMs) for ankle function: Foot and Ankle Outcome Score-FAOS, general quality of life (European Quality of Life in Five Dimensions 3-level time-trade-off-EQ-5D 3L-TTO) and activity level (Tegner Activity Scale-TAS), and by tracking revision procedures.ResultsThe median follow-up time was 8 (3-13) years. The mean age at the time of surgery was 52 (14) years. Most subjective scores showed significant improvement; cumulative FAOS improved from 41 to 57 in the TT group and from 41 to 67 in the ST group and EQ-5D from 0.40 to 0.55 (TT group) and from 0.38 to 0.60 (ST group), while TAS remained at 2. The ST fusion patients had better subjective outcomes than TT fusion patients. There were no significant differences in PROMs between arthroscopic and open procedures. Older age and preoperative FAOS pain were found to be negative predictors for the postoperative FAOS subscales. Overall, there was an 18% revision rate: 17 non-unions and 8 infections. In addition, 20 hardware removals were performed.ConclusionIsolated TT or ST fusions performed open or arthroscopically were safe and significantly improved function and quality of life and reduced joint-related pain but did not increase patients' activity levels. Patients with ST fusion had a better subjective outcome. Older age and lower preoperative FAOS pain were associated with a worse postoperative subjective outcome.Level of Evidence:Level III.

Background: Amputation level in diabetic foot osteomyelitis (DFO) is most determined based on surgeon visualization of macroscopic criteria, leading to subjective variability. Wide variance in methods of bone histological analysis and culture are utilized to determine the presence of residual infection. We therefore conducted a systematic, qualitative review to evaluate the current available data on objective measures to delineate the appropriate level of resection in diabetic toe and forefoot amputations, as well as the accuracy of different methods to assess for persistent infection.

Methods: We performed a systematic review of studies from 1990 to 2023 performed on methods to determine margins in toe and forefoot amputations for DFO following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were summarized to discuss the study main objectives, methods utilized to determine amputation level, and techniques used to assess margins for persistent deep infection.

Results: 568 articles were identified, and 18 articles met the final inclusion criteria after review. All studies used plain radiographs for preoperative assessment. 13 used magnetic resonance imaging (MRI) as part of their algorithm to determine general amputation level and 3 used MRI to determine exact depth of resection. 15 studies used microbiological cultures and 13 used histopathological margins intraoperatively to assess margins for deep infection. Of those, 7 studies found that those with positive margins had higher rates of treatment failure.

Conclusion: Overall, majority of studies used combination of plain radiographs of MRI to determine amputation level. Patients who ultimately had positive margins correlated with longer antibiotic duration and higher rates of continued infection, impaired wound healing, reoperation, or readmission. Elucidating the optimal method of evaluating clean surgical margins is critical to lessen the burden on health care systems and improve patient care.Level of Evidence: Level III: Qualitative Review.

Background: Chronic ankle instability (CAI) commonly follows ankle sprains and significantly affects walking patterns and daily activities. Two main surgical treatments exist: Broström repair and anatomic allograft reconstruction. It remains unclear which technique better restores normal ankle movement. This study compared how these 2 surgeries affect ankle function during walking.

Methods: We conducted a prospective study with 30 CAI patients. Fifteen received Broström repair and 15 received anatomic allograft reconstruction. We also included 16 healthy controls. We analyzed ankle joint kinematics (range of motion in dorsi/plantar flexion and inversion/eversion), and kinetics (joint moments, power, and ground reaction force [GRF]) during the gait cycle using 3D motion capture and force plate measurements. Assessments were performed before and 8 months after surgery.

Results: Both surgical techniques altered ankle biomechanics compared with controls. However, the Broström repair group demonstrated gait patterns more similar to healthy controls in most parameters. The reconstruction group showed greater deviation from normal, with increased plantarflexion and eversion throughout the gait cycle. Kinetic analysis revealed that Broström repair better preserved normal ankle moment patterns, while reconstruction resulted in significant alterations in ankle power generation.

Conclusion: Both surgical techniques alter ankle mechanics, but Broström repair more effectively restores normal ankle biomechanics compared with allograft reconstruction in CAI patients during walking. These findings can guide surgeons in selecting the most appropriate surgical technique for restoring natural gait patterns.

Level of evidence: II.

Checkrein deformity is a rare entity that results in alteration of the normal flexion and extension of the hallux, caused by a retraction or adhesion of the flexor hallucis longus (FHL) in its tendinous or muscular portion. It is usually caused by the sequelae of ankle and tibia fractures, such as adhesions and neuropathies, and often undiagnosed compartment syndromes. Its treatment is mainly surgical, and different techniques of release or lengthening of the FHL have been described. We present the clinical case of a 61-year-old patient treated by a simple arthroscopic tenotomy of the FHL at the retromalleolar level of the ankle, with complete functional recovery and absence of recurrence after 2 years of evolution. We recommend that this procedure should be considered for this pathology due to its technical simplicity, low iatrogenicity, early recovery, and theoretical absence of recurrence.Level of Evidence: Level V: Expert opinion, case report.

ObjectiveThe purpose of this study was to determine whether the number of cannulated screws used during ankle arthrodesis (AA) might influence the union and complication rate.MethodsIn this Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant PROSPERO-registered systematic review, multiple databases were searched including studies in which patients undergone AA using cannulated screws as exclusive fixation method were followed. Data were harvested regarding the cohort, the study design, the surgical technique, the nonunion, and complication rate at the longest follow-up. Risk of bias was assessed using the modified Coleman Methodology Score (mCMS). Two groups were built (arthrodeses fixed with 2 screws [group 1, G1] vs arthrodeses fixed with 3 screws [group 2 G2]) and compared.ResultsFifteen series of patients from 15 studies (667 ankles) were selected (G1 = 458 ankles and G2 = 209). The pooled proportion estimate revealed a similar nonunion rate in the 2-screw group as compared with the 3-screw group (4% vs 3%; P = .68). The pooled proportion of complications was higher in G1 (19%) than in G2 (8%), but it was not significantly different either (P = .45). After exclusion of "symptomatic hardware and screw removal," the difference was still not significant (P = .28) although it resulted lower in G1 than in G2 (4% vs 8%, respectively).ConclusionsUsing 3 cannulated screws during AA as compared with a 2-screw construct does not significantly reduce the risk of nonunion nor the risk of complications.Level of EvidenceLevel IV, Systematic review of level IV.

BackgroundThe purpose of this study is to define the effect of facility type (inpatient vs outpatient) for the use of supplemental regional anesthesia (SRA), and SRA's effect on complications, readmissions, operation time, and length of hospital stay after elective foot and ankle surgery.MethodsWe performed a retrospective review to identify a large cohort of adult patients who underwent elective foot and ankle surgery between 2006 and 2020 from the American College of Surgeons National Surgical Quality Improvement Program database. We fit log-binomial generalized linear models to estimate risk ratios for general anesthesia (GA) with SRA versus GA alone, and linear regression models to estimate the effect of GA with SRA on the average total hospital length of stay (in days) and operation time (in minutes); we also performed inverse propensity scores.ResultsWe found that there is no statistical difference in the rate of readmissions (P = .081) between patients under GA alone versus GA with SRA. In the propensity score analysis, patients who underwent midfoot/forefoot surgery had 3.85 times the risk of complications under GA with SRA compared with GA alone (P = .045). Also, patients who received GA with SRA had a longer unadjusted operative duration (102.22 minutes) when compared with patients who received GA alone (93.84 minutes) (P < .001). However, patients who received GA alone had a longer unadjusted hospital length of stay (0.88 days) when compared with patients who received GA with SRA (0.70 days) (P = .006).ConclusionThis study found that, when compared with GA alone, GA with SRA leads to a statistically significant increased operative time but a shorter hospital stay without significantly increasing readmissions and only increasing the risk of complications for midfoot/forefoot surgery within 30 days postoperatively for elective foot and ankle surgery.Level of Evidence:Level III.

IntroductionTotal ankle arthroplasty (TAA) through anterior approaches is a common treatment for end-stage tibiotalar arthritis. The occurrence of wound healing problems can lead to severe consequences. The aim of this systematic review is to summarize the available methods to minimize postoperative wound complications after TAA through standard anterior approaches.MethodsThree databases were searched for original articles concerning methods to reduce anterior wound complications after TAA. Eligible articles were examined to extract studies' characteristics, population data, type of intervention, and related wound complications. Study risk of bias assessment was conducted through the Newcastle-Ottawa Scale.ResultsThirteen articles were included for analysis, investigating 8 types of intervention, which were grouped into 3 classes: biological, mechanical, and pharmacological methods. A significant decrease in wound complications was reported for negative pressure wound therapy (3% vs 24%, P = .014), soft tissue expansion strips (2% vs 12%, P = .04), and tranexamic acid (TXA) administration (9% vs 22%, P = .002).ConclusionDespite the limitations of the included studies, this review showed encouraging results for TXA administration. Good results were found for mechanical methods, despite each intervention being supported by only 1 comparative study. Careful selection of patients is recommended to identify potential benefits or contraindications to such interventions. Further prospective randomized studies would be helpful to confirm these results.Levels of Evidence: 3.

Metal hypersensitivity following total ankle arthroplasty (TAA) is an underreported complication that can manifest as dermal, systematic, and orthopaedic-specific symptoms. It is critical to recognize that metal hypersensitivity is a diagnosis of exclusion; only after all other potential sources of failure, such as loosening or infection are ruled out, can this diagnosis be considered. Aside from imaging and common laboratory analysis, skin patch testing, leukocyte migration inhibition test (LMIT), and lymphocyte transformation test (LTT) are the testing options available for metal allergy. With regards to management of metal hypersensitivity, nonoperative modalities involving topical dermatological management are generally preferred. Severe cases of metal allergy may necessitate operative management consisting of explantation of the implant and either revision TAA with a custom hypoallergenic implant or conversion to an ankle fusion. We present 3 cases of presumed metal hypersensitivity following TAA. In all 3 cases, other forms of TAA failure were carefully ruled out. One patient underwent explantation and conversion to hypoallergenic implant, 1 patient underwent explantation and ankle arthrodesis with hypoallergenic hardware, and 1 patient elected for conservative care. In patients who underwent explantation and conversion to hypoallergenic hardware, no further symptoms associated with metal allergy were noted. Additional research is necessary to improve diagnostic accuracy of metal allergy and make treatment options more effective and accessible.Level of Evidence: Retrospective case series, IV.