Foot & ankle international最新文献

Background: To investigate the impact of decompressive chevron osteotomy on subchondral bone density at the first metatarsophalangeal (MTP) joint.

Methods: Sixteen feet (12 patients) with hallux rigidus underwent decompressive chevron osteotomy. Standing cone beam 3D computed tomography (3DCT) were assessed preoperatively and at 4-month follow-up, and clinical data were collected. Radiologic measurements, including bone density using Hounsfield units (HU), were conducted. Statistical analyses were performed to evaluate changes and correlations.

Results: Postoperative bone density significantly decreased in proximal (Pre, 650.9 ± 149.1; Post, 312.4 ± 115.9; P < .001) and distal (Pre, 910.4 ± 143.3; Post, 639.0 ± 167.1; P < .001) components of the first MTP joint and the first tarsometatarsal (TMT) (Pre, 762.9 ± 166.6; Post, 611.5 ± 165.9; P < .001) joint. No significant difference was measured at the tibiotalar joint (Pre, 497.5 ± 143.6; Post, 534.3 ± 130.7; P = .065). Length of the first metatarsal (Pre, 60.4 ± 3.4; Post, 54.3 ± 3.0; P < .001) and metatarsal protrusion index (MPI) (Pre, -0.9 ± 3.0; Post, -9.0 ± 3.6; P < .001) significantly decreased postoperatively. Clinical assessments showed significant improvements in pain on the visual analog scale (-5.3 ± 1.9).

Conclusion: Decompressive chevron osteotomy leads to a significant decrease in subchondral bone density of the first MTP joint. A decrease in bone density occurs also in the first TMT joint.

Level of evidence: Level IV, radiographic study.

Background: Postoperative osteolysis may be observed around poly-l-lactic acid (PLLA) pins in osteochondral fragments fixation for an osteochondral lesion of the talus (OLT). Hydroxyapatite (HA) improves biocompatibility, osteoconductivity, and mechanical strength when added to PLLA. This study aimed to compare the characteristics of osteolysis and clinical outcomes of fixation for OLT with PLLA pins vs PLLA/HA pins.

Methods: Thirty-one ankles undergoing fixation with bioabsorbable pins for OLT were included. Fourteen ankles were fixed with PLLA/HA pins and 17 ankles with PLLA pins. Magnetic resonance imaging (MRI) was taken pre- and postoperatively at 1 year. Osteolysis around pins, bone marrow edema (BME) in the talus, and pin insertion angle on MRI, the American Orthopaedic Foot & Ankle Society (AOFAS) score, and the visual analog scale (VAS) pain score were compared between the 2 groups pre- and postoperatively at 1 year. AOFAS score at the final follow-up was also compared between the 2 groups.

Results: The osteolysis area was significantly smaller in the PLLA/HA group in both coronal and sagittal planes on MRIs obtained 1 year postoperatively. There were no significant differences in osteolysis frequency, BME area, AOFAS score, and VAS pain score. Lower pin insertion angles measured on either sagittal or coronal planes were generally associated with greater amounts of osteolysis.

Conclusion: We did not find superiority using PLLA/HA pins compared with PLLA pins to fixate talar osteochondral fragments. However, PLLA/HA pin use was associated with less osteolysis around pins compared with PLLA pins.

Background: The paratenon has been shown to promote Achilles tendon healing, but the evidence supporting the role of paratenon protection technique in Achilles tendon repair is sparse. We retrospectively assessed the results of a paratenon-sparing repair technique vs an open giftbox repair of Achilles tendon ruptures.

Methods: Patients with Achilles tendon rupture who underwent surgical treatment at our hospital between January 2015 and August 2021 were retrospectively reviewed. Among them, 61 patients underwent surgical repair using the minimally invasive paratenon protection technique (MI group) and 67 patients using the open repair giftbox technique (OR group). The postoperative rehabilitation protocol was identical in both groups. The operation time, complication rate, length and cross-sectional area (CSA) of Achilles tendon, shear wave elastography (SWE), CSA of the calf triceps muscle, isokinetic strength, Achilles tendon Total Rupture Score (ATRS), and the Victorian Institute of Sports Assessment-Achilles (VISA-A) score were compared between the 2 groups.

Results: The average follow-up time was 40.0 ± 10.2 months. The operation time and complication rate in the MI group were significantly lower than in the OR group (P < .001, P = .031). The ATRS score (P = .015), VISA-A score (P = .002), isokinetic strength (60 degrees/second: P = .006; 180 degrees/second: P = .036), SWE values (P = .007), and CSA of Achilles tendon (P = .043) in the MI group were significantly higher than the OR group. SWE values were significantly positively correlated with the ATRS score (r = 0.294, P < .001) and the VISA-A score (r = 0.304, P < .001). And a significant negative correlation was found between Achilles tendon extension length and peak torque (60 degrees/second: r = -0.309, P < .001; 180 degrees/second: r = -0.218, P = .013).

Conclusion: Compared with the open repair giftbox technique, the minimally invasive paratenon protection technique was associated with likely marginally clinically significant improved clinical outcome scores, greater isokinetic strength, and better mechanical properties of the Achilles tendon.

Background: The most commonly used classification for proximal fifth metatarsal fractures has not shown good reproducibility. The aim of this study was to evaluate the intraobserver and interobserver agreement of a new classification system for such fractures.

Methods: The study involved the development of a novel classification system that categorized these fractures into 2 main types and 2 subtypes. This cross-sectional study included a total of 52 cases that were retrospectively collected to assess the reliability of this system. These cases were then evaluated by 3 independent foot and ankle surgeons who classified the fractures based on the newly established classification system. After 10 months, the same evaluators classified the fractures again. The level of agreement among the evaluators, both internally and externally, was assessed using the kappa coefficient, following the criteria established by Landis and Koch. This framework categorizes agreement levels as slight (0.00-0.20), fair (0.21-0.40), moderate (0.41-0.60), substantial (0.61-0.80), or almost perfect (0.81-1.00).

Results: Fifty-two fractures were detected, and 312 evaluations were carried out. The interobserver agreement was substantial when assessing the 2 main types, with a κ value of 0.73, and remained substantial even when considering the subtypes, with a κ value of 0.67. Similarly, the intraobserver agreement demonstrated substantial outcomes when evaluating the 2 main types, with a κ value 0.79. It maintained its significance when including the subtypes, with a κ value 0.77.

Conclusion: Lawrence and Botte's classification identifies 3 primary zones and exhibits moderate interobserver agreement. In contrast, the newly proposed system focuses on only 2 main zones and shows better interobserver agreement. The present study introduces a more precise and reproducible framework that reveals consistency among various observers, including the same observer. This framework may be beneficial for biomedical research as it enhances the ability to compare results across different studies.

Background: Addressing hindfoot varus via calcaneal osteotomy with simultaneous peroneal tendon repair from a single incision has not been thoroughly assessed. Some concerns with one incision are wound complications, nerve damage, and symptomatic hardware.

Methods: Patients operated on by one surgeon May 2012 to January 2022 were retrospectively reviewed with minimum 2-year follow-up via in-person visit, telephone, and chart review. Patients with peroneal tendon repair in conjunction with a modified Dwyer (with lateral shift) osteotomy fixated with a laterally applied locking plate were included. Those whose osteotomies were fixated with posteriorly applied screws were excluded.

Results: Fifteen patients were assessed, 13 males and 2 females, average age 56.9 ± 9.9 years. There were no wound complications or nerve injuries. One patient elected to have plate removal. There was 1 deep vein thrombosis. Return to activity including sports was 5.3 ± 1.3 months. On average, postoperative Roles and Maudsley and AOFAS hindfoot scores improved to "significant from pre-treatment" 11 with "excellent" results.

Conclusion: Peroneal tendon repair can be performed through the same incision as a modified Dwyer calcaneal osteotomy to address hindfoot varus deformity. In this series, there were no wound or nerve issues.

Background: Tibiotalar arthrodesis (TTA) is a common operation for end-stage ankle arthritis. Elevated body mass index (BMI) is believed to contribute to complications following TTA. Previous studies involved national registries or small, underpowered cohorts. This study aimed to determine the effects of elevated BMI on nonunion and complication rates following TTA with a large cohort from a single academic institution.

Methods: A retrospective study identified 514 patients (527 ankles) who underwent primary TTA from 2005-2017. Mean age was 60 years. Patients were stratified by BMI according to the World Health Organization classification. A reference group of 203 patients (208 ankles) included normal weight or mildly overweight patients (BMI 18.5 to <30). Ankle radiographs were evaluated to determine union or nonunion. Other outcomes included revision TTA, reoperations, subsequent adjacent joint arthrodesis, infection, and readmission. Data were analyzed using Pearson χ² and odds ratios for categorical variables. Analysis of variance and Kaplan-Meier estimation assessed continuous variables and time-to-event outcomes, respectively. Mean follow-up was 34.3 months.

Results: Obesity class III patients had elevated risk of complications compared with normal weight patients including nonunion (odds ratio [OR] 3.96, P = .002), revision (OR 3.69, P = .03), superficial infection (OR 9.36, P = .002), and readmission (OR 10.90, P = .01). Superficial infection rates were elevated in class I (OR 6.36, P = .007) and readmissions in class II (OR 9.98, P = .01). No differences were found in reoperation (P = .448), symptomatic implant removal (P = .805), adjacent joint arthrodesis (P = .353), or deep infection (P = .507) rates.

Discussion: In this retrospective review after TTA, increased rates of nonunion, revision, superficial infection, and readmission were found in obesity class III patients, compared with the reference group of normal weight or mildly overweight patients. Superficial infection rates were likewise relatively elevated in class I and readmission rates in class II patients.

Background: Operative management of chronic Achilles tendinopathy with large defects can be surgically challenging. Concerns exist regarding transosseous transfer of the flexor hallucis longus (FHL) tendon because of the shortened lever arm of flexion and weakening of the big toe. The aim of this study was to demonstrate the 2-year outcome of transosseous FHL transfer for the treatment of large Achilles tendon defects.

Methods: We retrospectively analyzed 28 patients who underwent FHL transfer. The extent of the defect was measured with magnetic resonance imaging. Outcome parameters were the German Foot Function Index (FFI-D) evaluated at baseline and 6, 12, and 24 months postoperatively, the University of California-Los Angeles (UCLA) activity scale, 2 questions about patient satisfaction, reports on complications, or plantar flexion weakness of the great toe.

Results: Mean FFI-D scores of pain and disability improved from 37.2 and 52.3, respectively, at baseline to 6.9 and 15.0, respectively, 24 months postsurgery. (P < .001). At 24 months, 57% of patients were very satisfied and 25% were satisfied with the current symptoms related to their Achilles tendon. All patients noted a relevant improvement at the 2 year follow-up; 1 patient noted weakness of big toe flexion without relevant functional limitation. Complications occurred in 3 patients in the initial postoperative course (2 with delayed wound healing, and 1 with severe perifocal wound necrosis); all resolved completely.

Conclusion: We found transosseous FHL transfer using the long, open harvest method and additional bridging of large Achilles defects to be a successful treatment. The majority of patients experienced a significant improvement in both function and pain level and were satisfied with the outcome. Flexion weakness of the big toe does not appear to be a clinically relevant issue after this treatment for chronic Achilles tendinopathy.

Background: This study aims to report the results of the patients with symptomatic accessory navicular (AN) who underwent endoscopic AN and partial navicular resection.

Methods: The medical records of patients with type 2 symptomatic AN who underwent the aforementioned surgery at our hospital from November 2019 to May 2022 with a follow-up of >2 years were reviewed. Data on clinical, radiographic, and patient-reported outcomes were obtained.

Results: The analysis included 29 patients (20 females; mean age, 19.6 years; mean body mass index, 21.5) with a mean follow-up duration of 39.5 months. Comparing the preoperative and postoperative scores, visual analog scale score improved from 74.6 to 5.4, and the Japanese Society for Surgery of the Foot score improved from 63.0 to 95.9. We had one wound dehiscence and no other recognized complications. Magnetic resonance and ultrasonographic imaging done 1 year postoperatively revealed that the empty space that remained after resection of the AN was filled with tendonlike tissue.

Conclusion: Endoscopic AN and partial navicular resection for treating symptomatic AN resulted in good outcomes and only one case with wound complications.