Foot & ankle international最新文献

Background: Patient-specific instrumentation (PSI) was developed to improve accuracy and efficiency in implant placement for total ankle arthroplasty (TAA). This study represents the first to measure the accuracy of PSI regarding implant alignment and implant size in the INBONE II total ankle system (Stryker). A secondary goal was to compare radiographic and clinical outcomes between the PSI and that of a matched group of implants performed with standard instrumentation.

Methods: This retrospective study of 92 patients (46 PSI and 46 non-PSI cases matched by age and sex) was performed at a single institution between 2006 and 2024, including TAA patients with INBONE II implants. Median age was 61 years (range 27-81). Median body mass index (BMI) was 29.6 (range 19.9-45.6). One surgeon performed 71% of PSI. A different surgeon performed 96% of non-PSI cases. PSI alignment (tibiotalar angle [TTA]), deformity correction (talar-tilt [TT]), radiation exposure, tourniquet, and operative time were compared to the standard jig method (non-PSI). Total fluoroscopy, tourniquet and procedure time, and preoperative and postoperative radiographs were analyzed.

Results: PSI predicted the correct size in 67% (n = 31) of talus implants and 89% (n = 41) of tibial implants. Median absolute deviation in the mortise view was 1.3 (IQR 0.53-2.18) and 1.8 (IQR 1.35-3.5) in the lateral view. For both groups, postoperative median TTA deviation was less than 2 degrees and postoperative median TT was less than or equal to 1 degree. Median fluoroscopic time was 92.1 seconds for PSI and 104.3 seconds for non-PSI. PSI had a longer tourniquet (156.5 vs 134.5 minutes) and procedure time (188 vs 161 minutes) compared with non-PSI.

Conclusion: In this study of stemmed TAA implants, surgeons achieved alignment generally consistent with PSI predictions. PSI adequately predicted implant size. For most cases, PSI achieved similar alignment and correction of deformity compared with standard instrumentation. PSI did not improve radiographic alignment compared with traditional instrumentation and was associated with longer operative times, possibly reflecting the primary surgeon's early experience with the technique. Each surgeon should select PSI or the standard jig based on their experience and preference.

Background: This study aimed to investigate the expression patterns of the neuropeptides, calcitonin gene-related peptide (CGRP), and substance P (SP), in the subchondral bone of patients with ankle osteoarthritis (OA) and examine their association with subchondral bone changes and cartilage degeneration. We hypothesized that neuropeptides were expressed in sclerotic subchondral bone and that this expression was associated with the progression of cartilage degeneration. This study investigated neuropeptide expression and its relationship with subchondral bone changes and cartilage degeneration in ankle OA.

Methods: Seventeen ankles of 16 patients who underwent total ankle arthroplasty for ankle OA were analyzed. Radiographic, histologic, and CT evaluations were conducted, including the measurement of Hounsfield unit (HU) values, subchondral bone plate thickness, trabecular bone area, and modified Mankin scores. Immunohistochemistry for CGRP; SP; collagen types I, II, and X; and TRAP staining for osteoclasts were performed.

Results: Subchondral bone sclerosis and cartilage degeneration progressed concurrently with increased thickness and trabecular area beneath the degenerated cartilage. CGRP and SP expression were significantly upregulated in the sclerotic subchondral bone, showing strong positive correlations with HU values, subchondral bone thickness, and Mankin scores. CGRP expression appeared earlier than SP expression in moderate degeneration stages. The number of TRAP-positive osteoclasts increased with degeneration and followed a distribution pattern similar to that of CGRP and SP.

Conclusion: CGRP and SP expression in the subchondral bone was closely linked to structural bone changes and cartilage degradation in ankle OA. Their early expression and association with osteoclast activity support a potential role in OA pathogenesis; however, causation cannot be inferred from this cross-sectional study.

Background: Ultrasound-guided percutaneous fasciotomy and debridement (USPFD) is a minimally invasive treatment for patients with plantar fasciopathy refractory to conservative management. Previous studies have shown clinical improvement with USPFD, but pain relief and patient satisfaction have not been demonstrated beyond 2 years.

Methods: This retrospective case series included patients who underwent USPFD at a quaternary academic medical center between April 2013 and January 2018, with refractory plantar fasciopathy and at least 4 years' follow-up. Patient outcomes were assessed through electronic surveys and telephone interviews. Primary outcome measures included mean changes in visual analog scale pain (VAS-Pain) scores and patient satisfaction via Likert scale. Secondary measures included VAS-Pain with the first 5 steps, VAS-Pain during daily weightbearing, and procedural complications.

Results: Seventy unique procedures were identified among 62 patients. Follow-up data were obtained from 51 of 62 patients (82%) who responded to surveys or phone calls. This corresponded to 58 of 70 procedures (83%) at a mean postprocedure follow-up of 6.6 ± 1.4 years. Patients had a mean duration of symptoms of 2.1 ± 3.0 years prior to the procedure. Baseline VAS-Pain was 6.8 ± 2.2 and final follow-up VAS-Pain was 0.7 ± 1.1. At the last follow-up, patient-reported VAS-Pain with first 5 steps was 0.9 ± 1.6 and VAS-Pain with weightbearing through the day was 1.3 ± 1.8. Overall, 91% (53/58) of the procedures were considered successful, where patients responded they were "satisfied" or "very satisfied" and 52 of 58 (90%) procedural responses indicated that based on the outcome, they would recommend the procedure to others. Final follow-up VAS-Pain, VAS-first 5 steps, and VAS-weightbearing, were all improved in the success vs failure groups (P ≤ .002). No complications were reported.

Conclusion: USPFD was associated with high patient satisfaction and durable pain relief for chronic plantar fasciopathy at an average follow-up of 6.6 ± 1.4 years.

Background: The peroneus longus (PL) tendon is increasingly used as an autograft for ligament and tendon reconstructions, particularly in populations where hamstring graft dimensions may be insufficient. However, donor-site ankle function and patient-reported outcomes measures (PROMs) after PL harvest remain underreported. This study aimed to evaluate changes in PROMs and range of motion (ROM) at the donor-site ankle 1 year after PL autograft harvest and the proportion exceeding minimal clinically important difference (MCID) thresholds.

Methods: Patients who underwent PL autograft harvest from January 2021 through April 2023 were retrospectively enrolled. PROMs-including the Single Assessment Numeric Evaluation (SANE), American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), and Cumberland Ankle Instability Tool (CAIT) score-were assessed preoperatively and at 1-year follow-up on the operated ankle. Ankle ROM was also measured. Donor-site morbidity was evaluated using MCID thresholds.

Results: Thirty-five patients (mean age: 43 ± 28 years) completed follow-up at a mean of 22.5 ± 10 months. Although ankle ROM was preserved with no statistically significant changes (P > .05), PROMs declined significantly compared with preoperative values (P < .05), with postoperative scores of SANE (92.3 ± 27.3), AOFAS (96.7 ± 10.7), FAOS (97.0 ± 23), and CAIT (27.4 ± 19.4). MCID thresholds were exceeded in 51.4% (SANE), 31.4% (AOFAS), 34.2% (FAOS), and 5.7% (CAIT) of patients. Two patients experienced transient sural nerve hypoesthesia, which resolved without long-term deficit.

Conclusion: PL tendon harvest was associated with preserved ankle ROM at 1 year but demonstrated statistically significant declines in PROMs compared with preoperative baselines. A subset of patients exceeded MCID thresholds, indicating clinically meaningful donor-site morbidity in some cases. These findings underscore the importance of informed graft selection and highlight the need for further long-term evaluation.

Background: The Lauge-Hansen classification is commonly used for ankle fractures but demonstrates poor interobserver reliability when based on radiographs alone. This study was conducted to determine whether the addition of computed tomography (CT) improves observer agreement and influences surgical planning.

Methods: A retrospective analysis was conducted on patients with operatively treated ankle fractures. Five masked observers (2 orthopaedic surgeons and 3 orthopaedic surgery residents) classified fractures using the Lauge-Hansen system in 2 sessions: first with radiographs alone and then with radiographs in combination with CT. Interobserver agreement was assessed using Cohen kappa and Fleiss kappa, whereas consistency of each observer's classifications between radiograph-only and CT-assisted sessions was also evaluated. Changes in fracture classification and treatment plans following CT evaluation were also recorded.

Results: A total of 145 patients were included. Interobserver agreement improved significantly with the addition of CT, increasing from κ = 0.464 (95% CI: 0.41-0.52) with radiographs alone to κ = 0.804 (95% CI: 0.76-0.85) with radiographs plus CT (P < .001). The use of CT led to a change in fracture classification in 73 to 80 cases across observers (50.3% to 55.2%), and treatment plans were revised in 69 to 75 cases (47.6% to 52.0%).Among these changes, decisions to fix the posterior malleolus increased from 41 to 64 cases after CT evaluation (Δ = 15.9%, 95% CI: 10.8%-22.7%, P = .008), and syndesmotic stabilization was newly planned in 36 to 59 cases (Δ = 15.9%, 95% CI: 10.8%-22.7%, P = .014), depending on the observer. These findings indicate that CT provided critical diagnostic details that influenced both classification and surgical decision making.

Conclusion: CT significantly improves the consistency of the Lauge-Hansen classification and can have a substantial impact on surgical decision making. CT imaging may be considered, especially when posterior malleolar or syndesmotic involvement is suspected; however, its impact on clinical outcomes remains uncertain.