Endoscopic calcaneoplasty with adjunctive Topaz radiofrequency microtenotomy for Haglund's deformity: A comparative study.

Platelet rich plasma therapy versus other modalities for treatment of plantar fasciitis: A systematic review and meta-analysis

To analyze the effectiveness of endoscopic calcaneoplasty (ECP) for treating hindfoot pain in patients with Haglund's deformity by comparing with conservative treatment. According to the included standard, 64 hindfoot pain patients (77 feet) with Haglund's deformity treated between January 2007 and October 2013 were enrolled. Based on the patient's sports habit, 39 patients (49 feet) who had no requirement on sports were given conservative treatment (control group) and 25 patients (28 feet) who had stable sports habit were given ECP (ECP group). There was no significant difference in age, gender, disease duration, disease side, Fowler-Philip angle, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score between 2 groups (P > 0.05). The patients were followed up 16-44 months (mean, 33.7 months) in ECP group, and 12-40 months (mean, 37.5 months) in control group. In control group, the syndrome in 34 cases (43 feet) disappeared after 2 weeks; pain was improved in 5?cases (6 feet), and pain disappeared at 3 weeks after orthesis immobilization; hindfoot pain recurred in 24 cases (30 feet) during following-up, 11 cases (13 feet) underwent ECP after 1 year. In ECP group, all incisions healed by first intention without nerve injury; no edema or pain was observed during follow-up. AOFAS ankle-hindfoot score was significantly improved in 2 groups when compared with score at pre-treatment (P < 0.05). With time, AOFAS ankle-hindfoot score gradually decreased in control group, but it gradually increased in ECP group. The AOFAS ankle-hindfoot score of ECP group was significantly higher than that of control group after treatment (P < 0.05). According to Ogilvie-Harris score system at 12 months, the results were excellent in 9 cases, good in 12 cases, and poor in 4 cases, with the excellent and good rate of 84.00% in ECP group; and the results were excellent in 8 cases, good in 14 cases, and poor in 17 cases, with the excellent and good rate of 56.41% in control group. There was significant difference in the excellent and good rate between 2 groups (Z=-2.194, P=0.028). Under the premise of strict control of surgical indications, the ECP can bring satisfactory effectiveness for treatment of hindfoot pain in patients with Haglund's deformity.

Assessment of the functional capacity of the foot requires adequate tools depending on a specific nosology. Objective: to investigate the possibility of using evaluation scale of H. Kitaoka (American Orthopaedic Foot and Ankle Society (AOFAS)), Foot Function Index (FFI) (Italian version), Roles and Maudsley score, visual analog scale (VAS) in patients with flatfoot. Materials and methods. Clinical and X-ray examinations of 63 patients (78 feet) who had flatfoot were performed. Their average age was 42.5 ± 2.0 (9–72) years. X-ray and clinical indicators were used: horizontal and vertical talo-metatarsal angles (TMA), angle of valgus deviation of the calcaneus, body mass index. The assessment of the functional state of the foot was carried out according to the H. Kitaoka (AOFAS) scale, FFI (Italian version), Roles and Maudsley score, VAS. The strength of the relationship between indicators was studied ­using Pearson’s pairwise correlations; a correlation regression analysis was performed on models where the indicators of rating scales were the dependent variables. Results. There was an inverse correlation between the foot function score (AOFAS) and the age and TMA, a direct correlation between the FFI and the age and body mass index, a direct dependence of functional insufficiency (Roles and Maudsley score) and pain level (VAS) on age. A sufficient degree of correlation (0.5–0.75) was found between the applied scales. Conclusions. Sufficient criterial and construct validity of the AOFAS scale, FFI (Italian version), Roles and Maudsley score, VAS was found when used in patients with flatfoot. The use of selected scales is an adequate tool for assessing functional capacity in patients with flatfoot.

IntroductionThe American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score is among the most commonly used instruments for measuring the outcome of treatment in patients who sustained a complex ankle...

BackgroundThis study aimed to investigate the early-to-mid-term efficacy of supramalleolar osteotomy (SMO) for the management of post-traumatic ankle arthritis resulting from previous fractures.MethodsA retrospective analysis was conducted on the clinical data of 19 individuals with post-traumatic ankle arthritis secondary to old fractures treated with SMO between March 2018 and September 2022. The cohort included 6 males and 13 females, aged 15 to 59 years, with an average of 37.1 ± 15.8 years. Among these cases, 12 underwent surgical treatment for their initial fractures, while 7 received conservative management. Clinical efficacy was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Foot Function Index (FFI), and Visual Analog Score (VAS) for pain. Imaging analyses were conducted using the changes of tibial anterior surface angle (TAS), talar tilt (TT) angle, and modified Takakura stage. Evaluation of patient satisfaction after surgery was conducted during the final follow-up.ResultsAll patients were followed up for 12 to 47 months (mean follow-up: 21.9 ± 11.1 months). At the final follow-up, the AOFAS ankle-hindfoot score improved to 81.9 ± 9.8, the FFI decreased to 24.2 ± 22.8, and the VAS score decreased to 3.2 ± 3.0, all showing significant improvement compared with preoperative values (p < 0.05). The TAS angle increased significantly to 90.2° ± 5.1° postoperatively (p < 0.05), while the TT angle was 0.3° ± 2.5°, without a statistically significant change (p = 0.314). No significant progression was observed in the modified Takakura stage (p = 0.458). The overall patient satisfaction rate was 89.5% (17/19). Prognostic analysis revealed no correlation between fracture-to-surgery interval (1–27 years) and AOFAS improvement ( r = 0.233, p = 0.337). Excessive preoperative TT (> 7.3°) did not compromise outcomes after correction.ConclusionsSMO demonstrates favorable early-to-mid-term efficacy in the treatment of traumatic fracture-related ankle arthritis, with significant improvements in pain relief, functional scores, and patient satisfaction. Prognostic factors (time since fracture, severe talar tilt) did not adversely affect results, supporting SMO’s utility across diverse presentations.

Currently, there are a lot of different surgical treatments for hallux rigidus, such as cheilectomy; first metatarsal osteotomies, hemiarthroplasty, arthroplastry and arthrodesis of the first metatarsophalangeal joint (MTPJ), and all of them have both advantages and disadvantages. To date, there is no single approach to choosing a method of surgical treatment of hallux rigidus. The autologous matrix-induced chondrogenesis (AMIC) technique is known to be quite successfully used for the treatment of osteochondral defects in the knee, hip, and ankle joints. Objective : to study the immediate results of first MTPJ chondroplasty using the AMIC technique in patients with hallux rigidus. Subjects and methods. As of now, MTPJ chondroplasty using the AMIC technique has been performed at the Nasonova Research Institute of Rheumatology in the first 9 patients with hallux rigidus. The surgery was made on both sides in one patient; there were accordingly a total of 10 above operations. The patients' mean age was 42.2+19.5 (range 20—71) years. During the examination, the investigators determined the range of motion in the first MTPJ, the intensity of pain on a visual analogue scale (VAS); foot status according to the American Orthopedic Foot and Ankle Society (AOFAS) scale; as well as the foot function index (FFI) and the functional condition of the foot and ankle (FA) joints according to VAS-FA. Prior to surgery, all the patients experienced significantly restricted motions in the first MTPJ. The median range of motion in the first MTPJ was 20°; Pain intensity was 70 mm; the AOFAS score was 52; FFI — 6.4; the VAS-FA — 4.1. First MTPJ chondroplasty was performed according to the AMIC technique using the Chondro-Gide and Aesculap Novocart Basic collagen matrices. The results of surgical treatment were assessed at 3, 6, and 12 months postoperatively. Results and discussion. Just 3 months after surgery, there was a pronounced significant reduction in first MTPJ pain. Its median decreased from 70 to 27.5 mm. After 6 months, there were also positive changes; the median pain was 10 mm. It remained at a level of 10 mm by the end of the first year of the observation. The median AOFAS scores increased from 52 to 78.5 and 90 at 3 and 6 months after surgery, respectively, and remained at the same level at 12 months. The median FFI decreased from 6.4 to 2.3, 1.1, and 0.8 at 3, 6, and 12 months following chondroplasty, respectively. The median VAS-FA scores were 8.1, 9.3, and 9.6 at 3, 6, and 12 months after chondroplasty. At 3 months postoperatively, the range of first MTPJ motion also increased significantly: its median rose from 20° to 60°; it was 65° at 6 months and increased to 67.5° at 12 months. First MTPJ chondroplasty with the AMIC technique in these patients resulted in positive changes that were maximal at 3 months after the surgery: the median pain decreased by 42.5 mm; AOFAS, FFI, and VAS-FA scores increased by 26.5, 2.1, and 4.0, respectively. Of great importance is also the increase in first MTPJ motion range, the median of which rose by 40° at 3 moths. The positive changes also persisted 6 months postoperatively. During this period, there was a further decrease in the median pain by 17.5 mm and increases in the median AOFAS, FFI, and VAS-FA scores by 12.5, 1.2, and 1.2, respectively. At 12 months of the follow up, the achieved improvement remained; however, the number of observations at this stage does not allow for adequate statistical analysis. Conclusion. The immediate results of the performed operations showed that first MTPJ chondroplasty using a collagen matrix can be a rather effective surgical treatment that makes it possible to relieve pain and to significantly improve quality of life in patients with hallux rigidus. A more complete evaluation of the efficiency of first MTPJ chondroplasty using the AMIC technique will be provided by studying the medium-term and long-term outcomes of the surgery.

The use of clinical outcomes instruments is essential for the effective interpretation of individual patient progress as well as the comparison of treatment groups. An outcomes instrument must be reliable and valid to obtain any meaningful data. The purpose of the present study was to examine the reliability and validity of the American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating scale for the hallux metatarsophalangeal-interphalangeal and lesser toes metatarsophalangeal-interphalangeal joints. Eleven patients (one man, 10 women) with an average age of 54 (range 40 to 72) years and with classic rheumatoid arthritis not currently treated for foot complaints were enrolled in the present study. The average duration of rheumatoid arthritis was 14 years. Each patient completed a set of two outcomes instruments and had a physical examination by a single clinician at the initial visit and returned at 1 week for completion of the same scales and examination. The outcomes scales used were the AOFAS clinical rating scale for the hallux, the AOFAS clinical rating scale for the lesser toes, and the previously validated Foot Function Index (FFI). Test-retest reliability was evaluated using intraclass correlation coefficients between week 1 and week 2 for the summary scores as well as for the subscales of pain and activity. Consistency between the two instruments was evaluated with Pearson correlation coefficients. The AOFAS clinical rating scale for the hallux and lesser toes is repeatable between 1-week trials (ICC 0.95; p < 0.05; ICC 0.80; p < 0.05, respectively). Moderately strong correlations were found between the mean values for the AOFAS hallux and FFI (r = -0.81; p < 0.05). Weaker correlations were seen between the mean values for the AOFAS lesser toes and FFI scales (r = -0.69; p < 0.05). The hallux subscale for pain correlates strongly with the FFI subscale for pain, suggesting high content validity (r = -0.94; p < 0.001). Ceiling effects were seen with the AOFAS lesser toe subscale for activity, limiting its usefulness in a general patient population. The AOFAS lesser toe subscale for pain and the AOFAS hallux subscale for activity correlated weakly with the FFI values (r = -0.31; r = -0.37; p > 0.05, respectively). Although the AOFAS hallux and lesser toe scales were found to be reliable in a rheumatoid patient population, their validity remains in question. These findings must be confirmed with larger subject numbers, with the inclusion of symptomatic patients before recommended routine use of the hallux clinical rating and lesser toe clinical rating scales.

This study aims to compare the radiological, clinical and patient-reported outcomes of patients with intra-articular calcaneus fractures treated conservatively or surgically. Fifty-four patients (30 males, 24 females; mean age 41.0 years; range, 18 to 73 years) treated due to calcaneus fracture were included in the study. Twenty-nine patients underwent conservative treatment (group 1) and 25 patients underwent surgical treatment (group 2). The fractures were classified according to Sanders. At the final follow-up, patients' Bohler's angle, The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and Foot Function Index (FFI) were used to evaluate their radiological, clinical and patient-reported outcomes. Postoperative complications were also noted. The fracture was at the right foot in 28 patients and the left foot in 26 patients. The mean follow-up duration was 41.1±23.2 months (range, 24 to 126 months). No statistically significant differences were found between the groups in terms of gender, fracture side, mean age, or follow-up duration (p=0.951, p=0.571, p=0.326, and p=0.620, respectively). According to Sanders classification, 18 patients were type 2 and 11 patients were type 3 in group 1, while 11 patients were type 2 and 14 patients were type 3 in group 2. However, there was no statistically significant difference between the groups in terms of the type of the fracture (p=0.184). On the other hand, the outcomes were significantly better for group 2 compared to group 1 in terms of the Bohler's angle, AOFAS and FFI scores (p=0.004, p=0.003 and p=0.006, respectively). In group 1, subtalar arthritis developed in three patients. In group 2, wound healing problems and superficial infection developed in three patients, while subtalar arthritis developed in two patients. Surgical treatment is more effective in intra-articular calcaneus fractures compared to conservative treatment according to clinical, radiological and patient-reported outcomes. In addition, wound problems should be considered in surgical management.

The Lisfranc fracture dislocation of the tarsometatarsal joint (TMTJ) is a complex injury with a reported incidence of 9.2 to 14/100,000 person-years. Lisfranc fixation involves dorsal bridge plating, transarticular screws, combination or primary arthrodesis. We aimed to identify predictors of poor patient reported outcome measures at long term follow up after operative intervention.127 patients underwent Lisfranc fixation at our Level One Trauma Centre between November 2007 and July 2013. At mean follow-up of 10.7 years (8.0-13.9), 85 patients (66.92%) were successfully contacted. Epidemiological data including age, gender and mechanism of injury and fracture characteristics such as number of columns injured, direction of subluxation/dislocation and classification based on those proposed by Hardcastle and Lau were recorded. Descriptive analysis was performed to compare our primary outcomes (AOFAS and FFI scores). Univariate analysis and multivariate regression analysis was done adjusted for age and sex to compare the entirety of our data set. p&lt;0.05 was considered significant. The primary outcomes were the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score and the Foot Function Index (FFI).The number of columns involved in the injury best predicts functional outcomes (FFI, P &lt;0.05, AOFAS, p&lt;0.05) with more columns involved resulting in poorer outcomes. Functional outcomes were not significantly associated with any of the fixation groups (FFI, P = 0.21, AOFAS, P = 0.14). Injury type by Myerson classification systems (FFI, P = 0.17, AOFAS, P = 0.58) or open versus closed status (FFI, P = 0.29, AOFAS, P = 0.20) was also not significantly associated with any fixation group.We concluded that 10 years post-surgery, patients generally had a good functional outcome with minimal complications. Prognosis of functional outcomes is based on number of columns involved and injured. Sagittal plane disruption, mechanism and fracture type does not seem to make a difference in outcomes.

Treatment of Recurrent Peroneal Tendon Dislocation by Peroneal Retinaculum Reattachment Without Fibular Groove Deepening

The optimal treatment for distal tibial fractures remains a matter of debate. Nonetheless, plate osteosynthesis produces favorable results to intramedullary stabilization in aspects of alignment restoration. The aim of the study was to compare the radiologic and clinical outcomes of distal metadiaphyseal tibial fracture between a simple/wedge fracture (SWF) and a comminuted fracture (CF) using minimally invasive plate osteosynthesis (MIPO). This retrospective study analyzed patients with SWF or CF of the distal tibial metadiaphysis that was surgically treated with a locking compression plate. Postoperative radiographic assessments and the time to radiologic union were noted. Clinical assessments were evaluated using both the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the foot function index (FFI). Postoperative complications were documented. Seventy-one cases were analyzed over a mean follow-up period of 20.9 months. Thirty-six patients had SWF and 35 patients presented with CF. The mean time to radiologic union, amounts of postoperative coronal angulation, and incidence of malunion showed no statistical differences. Fibular fixation was more applied in the CF group (P < 0.001). Moreover, the clinical scores revealed no differences. Nonetheless, in the valgus union group, the AOFAS ankle-hindfoot score was 90.9 compared to 84.1 in the varus union group (P = 0.042) and the FFI was 9.2% compared to 20.2% in the varus union group (P = 0.017). Plate osteosynthesis for SWF or CF of the distal tibial metadiaphysis led to high union rates and good clinical outcomes. There was no significant difference in the radiologic and clinical results according to the presence of fracture comminution. Nonetheless, the valgus union group showed better clinical outcomes than the varus union group. Clinically, it would be preferred to avoid intraoperative varus reduction.

To evaluate the early effectiveness of a new minimally invasive plate in the treatment of varus-type ankle arthritis. A clinical data of 15 patients with varus-type ankle arthritis who met the selection criteria between March 2021 and October 2021 were retrospectively analyzed. All the patients were treated with medial open-wedge supramalleolar osteotomy and fibular osteotomy. The osteotomies were fixed with the new minimally invasive plate. There were 7 males and 8 females with an average age of 49.8 years (range, 16-71 years). The causes of ankle arthritis included post-fracture deformity in 1 case, sprain in 8 cases, and acquired clubfoot in 1 case; and 5 cases were without obvious factors. The disease duration ranged from 1 to 12 years, with an average of 4.1 years. Comparisons were made between pre-operation and the last follow-up in the Takakura staging, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, foot function index (FFI), visual analogue scale (VAS) score, tibial anterior surface angle (TAS), tibial lateral surface angle (TLS), and talar tilt (TT). All incisions healed by first intention. All patients were followed up 7-18 months (mean, 12.8 months). At last follow-up, the AOFAS ankle-hindfoot score, FFI, VAS score, and Takakura staging significantly improved when compared with the preoperative ones ( P<0.05). X-ray films showed that the osteotomy healed at 3 months after operation. At last follow-up, TAS significantly increased and TT decreased when compared with the preoperative ones ( P<0.05), and the difference in TLS between pre- and post-operation was not significant ( P>0.05). Complications included 1 case of intraoperative screw breakage and 2 cases of nerve injury of the affected foot. None of the patients complained of significant discomfort at the plate placement during follow-up, and no loosening of the internal fixator occurred. Eleven patients were very satisfied with the effeectiveness, while 4 were relatively satisfied. The new minimally invasive plate for the varus-type ankle arthritis has good early effectiveness in relieving ankle pain, correcting deformity, improving limb alignment and ankle function, and reducing the incidence of postoperative incisional complications.

Avulsion of the Lisfranc ligament, fleck sign, results in unstable Lisfranc injuries. This cross-sectional study was conducted to investigate the characteristics of Lisfranc injuries with fleck sign and the clinical and radiological outcomes following closed reduction and percutaneous screw fixation. All consecutive operatively managed Lisfranc injuries with fleck sign were reviewed from 2016 to 2018. The injury pattern and characteristics of Lisfranc fleck sign were reviewed based on the preoperative CT scan. Postoperative complications besides radiological and clinical outcomes were assessed using visual analog scale (VAS) pain, American orthopedic foot and ankle society (AOFAS) midfoot scale, and foot function index (FFI). Thirty patients (20 males; mean age, 36.9 ± 17.0; range, 12-69years) with mean follow-up 16.9 ± 7.4 (range, 6-31) months were enrolled. Among 12 cases with avulsed Lisfranc ligament from the second metatarsal base, only two cases had isolated second metatarsal base fracture in plantar medial part while others had concomitant avulsion fracture of plantar aspect of the adjacent third and/or fourth metatarsal base. Mean of postoperative VAS pain, AOFAS midfoot scale, and FFI were 1.03 ± 0.29, 91.43 ± 1.43, 24.43 ± 6.66, respectively. We had seven (23.3%) removal of screws, two (6.6%) broken screws, four (13.3%) pulled-out screws, and six (20%) lost reductions in the final follow-up with good clinical functions. Closed reduction and percutaneous fixation of the Lisfranc injuries with fleck sign by a single position screw could be a good surgical option with reliable and predictable outcomes without needing to remove the hardware, routinely.

Objective To study the technique, clinical effect and safety of endoscopic calcaneoplasty for Haglund disease. Methods Clinical data of 12 patients with Haglund disease having underwent endoscopic calcaneoplasty were collected and retrospectively reviewed. All the patients experienced conservative treatment for 3 to 6 months which was failed and then turned to endoscopic calcaneoplasty. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score before and after operation, patient's satisfaction and complication were recorded. Postoperative complications were also observed. Results All the patients underwent the operation successfully within 70 min, with 42 min on average, and no complications occurred. All the patients were followed up for 12.4 (8 -16) months, the AOFAS ankle-hindfoot score after operation was significantly higher than before operation: 94.6 (86 -100) scores vs. 58.6 (32 -72) scores, and there was statistical difference (P <0.05). After operation, 10 cases were excellent, and 2 cases were good. All patients were satisfied with the surgery, and no recurrence occurred during the follow-up period. Conclusions Endoscopic calcaneoplasty appears to be a safe, minimal invasive and effective surgical procedure for the treatment of Haglund disease. Key words: Achilles tendon; Arthroscopes; Retrospective studies; Haglund disease; Calcaneoplasty

Background: Avulsion fracture of the Achilles tendon is a less common but debilitating disorder. There is a paucity of literature on this problem. Purpose: To present a retrospective case series assessing the clinical outcomes of avulsion fracture of the Achilles tendon after a reattachment procedure and to identify potential factors predicting postoperative outcomes. Study Design: Case series; Level of evidence, 4. Methods: A consecutive case series of 35 patients with acute insertional rupture of the Achilles tendon who received a reattachment procedure between 2011 and 2017 were reviewed. All patients were measured and classified by magnetic resonance imaging (MRI) and surgical findings. Patient-reported outcomes were evaluated using the visual analog scale (VAS) for pain, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Foot Function Index (FFI), Tegner score, and Ankle Activity Score (AAS). The range of motion and single-legged heel raise test were also conducted for both ankles. Results: Thirty-one out of 35 (88.57%) patients were followed up for an average of 43.65 months. The VAS pain score and AOFAS Ankle-Hindfoot score improved from 4.87 ± 1.61 preoperatively to 2.07 ± 1.57 postoperatively and from 58.32 ± 18.66 preoperatively to 87.32 ± 7.53 postoperatively, respectively (both P < .001). The mean FFI, AAS, and Tegner scores after the operation were 11.84 ± 1.62, 5.71 ± 2.18, and 4.61 ± 1.31, respectively. Compared with the intact ankle, the mean deficit in dorsiflexion in the involved ankle was 9.54°± 6.25° (range, 0.59°-23.70°; P < .001) and the mean deficit in plantarflexion in the involved ankle was 6.31°± 4.02° (range, 0.24°-14.92°; P < .001). Thirty patients could perform the single-legged heel raise on the operative leg. A larger body mass index was associated with worse postoperative AOFAS and FFI outcomes. Longer follow-up predicted statistically significantly better FFI scores. Better postoperative dorsiflexion was associated with better postoperative FFI, AAS, and Tegner scores, and a statistically significant interaction was found between the VAS score and plantarflexion deficit. Age, preoperative insertional tenderness, Haglund deformity, and MRI classification showed little association with postoperative outcomes. Conclusion: This study demonstrated that the reattachment procedure for acute avulsion fracture of the Achilles tendon can achieve firm fixation and promising outcomes.