American Orthopedic Foot And Ankle Score Score Research Articles

Long-term results and complication following Achilles tendon rupture repair

Introduction Currently,there is no consensus regarding optimal treatment options of Achilles tendon rupture. The purpose of this study was to evaluate long term results of Achilles tendon repair using different surgical techniques, assess complication rate and subjective satisfactionMethods The study included patients treated for Achilles tendon rupture using minimally invasive and open surgical repair. Complications including re-rupture, infection, deep vein thrombosis and neuropraxia were identified. In order to evaluate the factors influencing the risk of postoperative complications, logistic regression analysis was performed. The Achilles Tendon Rupture Score (ATRS) and the American Orthopedic Foot and Ankle Score (AOFAS) evaluated subjective outcomes.Results 130 patients with Achilles tendon tear were enrolled (123 primary and 7 revision cases). In primary repairs percutaneous technique was used in 60 % of cases (74/123), mini open technique – in 16 % (19/123), and open technique – in 24 % (30/123). Re-rupture occurred in 2.4 % of patients treated with minimally invasive techniques. There were no repeated ruptures following open repairs. Predominant number of infections was registered after open repairs and made 10 %, while minimally invasive techniques had 3.2 % of infections. Logistic regression analyses showed that steroid injection, open repair, application of tapes and autografts increased the risk of infectious complications. There were no significant differences in ATRS and AOFAS scores between different primary Achilles tendon repair techniques (p > 0.05).Discussion Results, obtained in the current study, are consistent with previously published data.Conclusions Open Achilles tendon repair showed a higher rate of infections, and lower rate of re-ruptures. The anamnesis of steroid injection, open repair, application of tapes and autografts increases the risk of infectious complications.

Çoklu Metatars Kırıklarında Retrograd Pinleme Güvenilir mi?

ABSTRACT
 
 Background: Fixation with K-wires is a commonly used method in the surgical treatment of metatarsal fractures. The application of K-wires can be antegrade and retrograde. There is a limited number of studies about the fixation of metatarsal fractures with retrograde K-wires in the literature. The present study aims to investigate the long-term results of retrograde pinning.
 Methods: 14 patients with at least a four-year follow-up were included in the study. The patients' union status, demographic data, duration of surgery, duration of fluoroscopy use, metacarpophalangeal (MP) range of motion, American Orthopedic Foot and Ankle Score (AOFAS) scores, and plantar keratosis formation were evaluated.
 Results: Complete union was observed in 13 of 14 patients. MP joint restriction was not found in any patient with a union. Symptomatic plantar keratosis was not observed in any patient. Good and perfect results were obtained in AOFAS scores.
 Conclusion: According to the literature, retrograde pinning in metatarsal fractures is thought to be a treatment that is difficult to apply, has high radiation exposure, and complications are observed frequently. However, in this study, we believe that retrograde pinning is a treatment method with satisfactory clinical results in long-term follow-up and fewer complications than mentioned.

Short-Term Outcomes of Jones-Specific Implant Versus Intramedullary Screw and Plate Fixation for Proximal Fifth Metatarsal Fractures

Although intramedullary screw fixation is commonly performed for proximal fifth metatarsal fractures, high rates of nonunion, refracture, and hardware prominence have been reported. The Jones Specific Implant (JSI) is a novel surgical implant which contours to the native curvature of the fifth metatarsal allowing for a more anatomic fixation. The purpose of this study was to compare short-term complication rates and outcomes of patients treated with the JSI to other fixation types such as plates and intramedullary screws. Electronic records were queried for adult patients with proximal fifth metatarsal fractures who underwent primary fixation from 2010 to 2021. All patients were treated by a foot and ankle fellowship-trained surgeon with intramedullary screws, plates, or JSI (Arthrex Inc., Naples, FL). Visual analog scale (VAS) and the American Orthopedic Foot and Ankle Score (AOFAS) were recorded and compared using univariate statistics. Eighty-five patients underwent fixation using intramedullary screw (n = 51, 60%), plate (n = 22, 25.9%), or JSI (n = 12, 14.1%) with a mean follow-up of 11.1 ± 14.6 months. The total cohort demonstrated a significant improvement in VAS pain (p < .0001) as well as AOFAS (p < .0001) scores. When comparing the cohort treated with JSI and the cohort treated with all other types of fixation, there were no significant differences in postoperative VAS or AOFAS scores. Only 3 complications, one with JSI (3.5%) required removal of the symptomatic hardware. The JSI is a novel treatment for proximal fifth metatarsal fractures, with similar early outcomes and complication rates when compared with intramedullary screw and plate fixation.

Treatment of Calcific Insertional Achilles Tendinopathy: Knotless Internal Brace versus Knot-Tying Suture Bridge.

This study aimed to compare the knotless internal brace technique and the knot-tying suture bridge technique via the medial approach in the treatment of calcific Achilles tendinopathy. The clinical data of 25 cases of calcific Achilles tendinopathy in which nonoperative treatments had failed were retrospectively collected. All the patients received Achilles tendon debridement and Haglund deformity excision through a medial approach, followed by repair using the knotless internal brace technique or the knot-tying suture bridge technique. Pain was evaluated by using the visual analog scale (VAS). The American Orthopedic Foot and Ankle Score (AOFAS) questionnaire was administered preoperatively and postoperatively. The mean follow-up time was 2.6 (range 2-3.5) years. There were no wound complications and no Achilles tendon ruptures. At 1 year postoperatively, the internal brace group was superior to the suture bridge group in terms of the VAS scores (p = 0.003). However, no differences were noticed between the two groups in either the VAS or the AOFAS scores at 2 years postoperatively. The medial approach in combination with the suture bridge technique was effective in treating calcific Achilles tendinopathy. The knotless internal brace technique involved less pain compared to the knot-tying suture bridge technique only at the early postoperative stage.

The role of corticosteroid injections in treating plantar fasciitis: A systematic review and meta-analysis

BackgroundPlantar fasciitis is a recurrent cause of heel pain and is often treated by corticosteroid infections (CSI). The current study reviewed and analysed the role of CSI with platelet rich plasma (PRP), and CSI with extracorporeal shock wave therapy (EWST) for plantar fasciitis treatment. MethodsPubMed, Medline, Web of Science, Embase, Cochrane, and Google Scholar databases were searched for relevant studies. Preferred Reporting in Systematic Review & Meta-Analysis (PRISMA) guidelines were used to search relevant studies published from infinity to April 2021. The risk of bias was performed using Cochrane Collaboration’s tool. GRADE assessment was used for quality of evidence. Data analysis was performed with the use of R software and P < 0.05 was considered statistically significant. CSI was compared with PRP and EWST. ResultsEighteen studies comprising 1180 patients were included in this meta-analysis. When compared to PRP, CSI with lignocaine/lidocaine had significantly higher mean difference on visual analogue scale (VAS) pain scores at 3 months (0.62 [0.13; 1.12], P = 0.01) and 6 months (MD = 1.49 [0.22; 2.76], P = 0.02). At 6 months, VAS scores were higher in the CSI group than the ESWT group (MD = 0.8 [0.38; 1.22], P = 0.1). At 6 months, a significant reduction in the American Orthopaedic Foot and Ankle Score (AOFAS) was observed in the CSI group compared to PRP (MD = − 11.53 [− 16.62; − 6.43], P < 0.0001). ConclusionPatients suffering from plantar fasciitis, PRP achieved better VAS scores compared to CSI at 3 and 6-month follow-up. In addition, ESWT had better VAS score outcomes at 6 months compared to CSI. Regarding AOFAS score, PRP was more efficacious than CSI at 6 months of follow-up. Only through the development of high-quality, large-scale longitudinal studies, will the findings and conclusions of this meta-analysis be strengthened and influence our clinical practice in the treatment of plantar fasciitis. Level of clinical evidenceII.

Use of Pro in Evaluating TAA and its Indications

Category: Ankle Introduction/Purpose: The indications for total ankle arthroplasty (TAA) have greatly expanded over the past decade. This rapid growth has been made possible with evidence-based medicine. Patient-reported outcomes (PROs) have been the primary outcome measure in many of these studies. To evaluate the quality of the evidence underlying expanded indications for TAA, we must first understand what PROs have been used in the evaluation of outcomes of TAA. Methods: The goal of this study was to conduct a systematic review of the literature from 2010 to 2021 capturing all studies of TAA to determine what PRO instruments were used, and what facets of TAA practice were studied. Studies reporting on outcomes and PROs following a TAA procedure were selected to review from the PubMed database between January 2010 and July 2021. Results from one hundred sixty-three studies were reviewed and pooled for analysis for this study. Results: After the evaluation of one hundred sixty-three studies, twenty-four separate PRO measures were identified in the literature. The PROs that were most reported in the literature from 2010 to 2021 were American Orthopedic Foot and Ankle Score (AOFAS) (49.1%), 36-Item Short Form Survey (SF-36) (40.5%), visual analog scale - pain (VAS) (35.6%), Ankle Osteoarthritis Scale (AOS) Questionnaire (17.8%), and Short Musculoskeletal Function Assessment (SMFA) (14.7%). The independent variables in these studies included a wide range of modifiable and unmodifiable patient factors such as age (27 studies), BMI (23 studies), smoking (8 studies), and preoperative coronal plane deformity (5 studies). A significant portion of the studies (41%) advocating for expanded indications did so based on the failure to find a difference in groups. Conclusion: The most commonly used PROs for TAA were AOFAS, SF-36, and VAS. The AOFAS score which had been the most commonly used PRO in 2009, is still today despite the determination in 2011 that it is not valid and there is a substantial risk for bias. Newer, validated PRO instruments, such as PROMIS, have not yet attained significant implementation in studies of TAA. The vast majority of the evidence supporting the expanded indications for TAA has come from studies with negative results. Caution should be exercised in interpreting these results and their study implications.

Is 2D SWE sufficient as clinical diagnosis in patients with plantar fasciitis?

The use of shear wave elastography (SWE) seems to be an important imaging method in the diagnosis of plantar fasciitis (PF). To compare patients diagnosed with PF with similar and young healthy control groups in terms of B-mode ultrasound (US) and SWE results and to evaluate the elasticity of the plantar fascia. A total of 140 feet of 70 participants were evaluated, including 30 patients and 40 healthy individuals as the control. Clinical, B-mode US, and SWE evaluations were performed for each patient. In addition, American Orthopedic Foot and Ankle Score (AOFAS) was calculated to evaluate pain and foot function in both groups. Of the patients in the PF group, 40 (88%) were women and the healthy control groups had similar sex distributions (P = 0.23). The AOFAS score was lower in feet with PF compared to the other groups (P < 0.001). Of 30 patients with PF, 15 (50%) had bilateral PF and 15 (50%) unilateral PF. In addition, ≥4 mm thickness measurement, which was used as a diagnostic criterion for PF as a US finding, could be shown in 11 (73.3%) patients with unilateral PF and 6 (40%) patients with bilateral PF. In conclusion, the evaluation of the diagnosis of PF with clinical findings and regular follow-up of measurements with SWE can provide measurement results with higher sensitivity in the diagnosis of PF.

Percutaneous Reduction and Fixation of Displaced Intra-Articular Calcaneal Fractures

Despite the relative prevalence of intra-articular calcaneal fractures, definitive management is controversial. The goal of this study is to evaluate the clinical and radiological outcome of percutaneous reduction and fixation of 20 patients with intraarticular calcaneal fractures Sanders type II, III or IV by k wires, Steinmann pins or cannulated screws subjectively and objectively over 8 months .Twenty-two (22) percutaneous fixation of calcaneal fractures in 20 patients were included in this study. This study included closed intra-articular calcaneal fractures type II , III and IV in adult patients and excluded open, extra-articular, type I fractures. The American Orthopaedic Foot and Ankle Score (AOFAS) was used for evaluation. The excellent and good results were considered satisfactory while the poor and fair results were considered unsatisfactory. The results at the end of this study were satisfactory in 86.3% of patients (AOFAS score more than 75 in 19 fractures) and unsatisfactory in 13.6% of patients (AOFAS score less than 75 in 3 fractures). All patients included in this study showed normal range of motion of the ankle joint (active dorsiflexion and planter flexion) with variable decrease in the subtalar range of motion (active inversion and eversion) when compared with the normal side. .Percutaneous reduction and fixation had been found to be satisfactory in reduction of Bohler’s angle, Gissane angle and Sarrafian angle with avoiding open reduction surgical and postoprtative complications and avoiding conservative management bad functional outcome.

Local injection of Platelet Rich Plasma for Plantar Fasciitis

Background: Plantar fasciitis can be defined as inflammation at the insertion of plantar fascia and is thought most commonly due to overuse injury. It usually presents as sharp shooting heel pain which is worse in the morning. The location of pain is usually plantar surface of the foot and pain may radiate proximally in long standing and severe cases. In mild cases of plantar fasciitis non steroidal anti-inflammatory drugs and activity modification may be sufficient. Severe cases may require interventions such as night splints and orthotic devices which works by reducing loading of plantar fascia. Recently local injection of autologous platelet rich plasma is used by many researchers with promising results.&#x0D; Aims and Objectives: This prospective cohort study was undertaken to analyze the functional and clinical outcome in patients with plantar fasciitis who were treated by autologous injection of platelet rich plasma.&#x0D; Materials and Methods: This was a prospective cohort study conducted in department of orthopedics of a tertiary care medical college located in an urban area. The patients diagnosed to be having plantar fasciitis were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were assessed for severity of pain by the Visual Analogue Score for pain and American orthopedic foot and ankle score (AOFAS). A VAS score of 0-3 was taken as pain relief and VAS score of 4-10 was considered as no pain relief. Whereas AOFAS scores of 90-100, 80-89, 60-79 and less than 60 were taken as excellent, good, fair and poor outcome respectively. All patients were treated by local injection of autologous platelet rich plasma. The patients were followed up at 4 weeks, 8 weeks and 12 weeks. During follow up visits the pain relief was assessed by VAS and AOFAS scores. For statistical purposed SSPS 21.0 software was used and p value less than 0.05 was taken as statistically significant.&#x0D; Results: A total of 60 patients were included in this study out of which there were 22 (36.67%) males and 38 (63.33%) females with a M:F ratio of 1:1.72. The most common affected age group was between the age of 41-50 years (35%) followed by 51-60 years (21.67%) and 31-40 years (20%). Twenty-seven (45%) patients were either overweight or obese. A statistically significant reduction in pain was documented at the time of follow up of 4 weeks. At the end of 12 weeks 58 (96.67%) patients experienced significant pain relief and only 2 (3.33%) patients had significant pain. Also, there was statistically significant difference between AOFAS scores at the time of presentation and at 4 weeks, 8 weeks and 12 weeks follow up visits.&#x0D; Conclusion: Injection of autologous platelet rich plasma for chronic plantar fasciitis is found to have promising results in terms of pain relief (reduced VAS score) and functional outcome (Improvement in AOFAS score).

Patient-specific instrument-assisted minimally invasive internal fixation of calcaneal fracture for rapid and accurate execution of a preoperative plan: A retrospective study

BackgroundTraditional methods for minimally invasive internal fixation (MIIF) of calcaneal fractures require extensive intraoperative fluoroscopy, and fracture recovery is usually not ideal. We developed a new surgical procedure using digital surgical simulation and constructed a patient-specific instrument (PSI) for calcaneal fracture that we used during the operation. This study investigated whether PSI-assisted MIIF of calcaneal fracture enables rapid and accurate execution of the preoperative plan.MethodsWe retrospectively analyzed patients with Sanders type III or IV fresh calcaneal fractures who had undergone PSI-assisted MIIF at our hospital from January 2016 to December 2018. We analyzed perioperative data including intraoperative fluoroscopy time, concurrence of internal fixation actual usage (IFAU) with the preoperative plan, surgery time, and complications. We also compared pre- and postoperative actual measurements from X-ray radiographs and computed tomography images including Böhler, Gissane, and calcaneus valgus angles; subtalar joint width; and calcaneal volume overlap ratio with the preoperative design. All patients had been followed up and their American Orthopedic Foot and Ankle Score (AOFAS) score was available.ResultsMean intraoperative fluoroscopy time was 3.95 ± 1.78 h; IFAU in 16 patients (16 ft) was the same as the preoperative plan; mean surgery time was 28.16 ± 10.70 min; and none of the patients developed complications. Böhler, Gissane, and calcaneus valgus angles and subtalar joint width did not differ between pre- and postoperative plans; however, the actual preoperative values of each of these parameters differed significantly from those measured postoperatively. The calcaneal volume overlap ratio with the preoperative design was 91.2% ± 2.3%. AOFAS scores increased with time, with significant differences in the score at each time point.ConclusionsThe newly developed PSI-assisted calcaneal fracture MIIF method can rapidly and accurately execute the preoperative plan.

Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients.

The aim of this study was to evaluate clinical and functional outcomes in diabetic patients undergoing tibiocalcaneal arthrodesis using a retrograde nail. A total of 12 diabetic patients [8 men and 4 women; mean age at intervention: 56.8 years (range: 27-76 years)] who underwent tibiocalcaneal arthrodesis by a retrograde nail were enrolled in this study. The indication for surgery was massive talar osteonecrosis in four patients, Charcot arthropathy in another four patients, and various severe ankle/hindfoot derangements in four patients. All surgeries were performed by the same surgeon. All patients were evaluated by their American Orthopedic Foot and Ankle Score (AOFAS) score, and radiographic follow-up was performed. The mean follow-up time was 59.5 months (range: 27-121 months). Ten patients (83.3%) healed and were able to walk with full weight bearing without crutches. Among them, nine patients (75%) achieved union with solid bone healing. The mean overall improvement in the AOFAS score was 72.5% (preoperatively: 40 points vs postoperatively: 69 points; p<0.001). We observe a complication in 50% of our patients. Minor complications included two cases of dehiscence of the surgical wound, one case of soft tissue irritation owing to hardware protrusion, and one cause of lymphedema. Two patients had deep infection and underwent surgical removal of hardware, debridement, and antibiotic treatment: one healed after the treatment but never recovered full weight bearing and the other one died from other complications. These two deep infections occurred after 23 months of follow-up. Tibiocalcaneal arthrodesis using retrograde nails is a salvage technique extremely effective in ankle and hindfoot disorders in a diabetic patient. This procedure allows good functional outcomes and pain relief. When correctly indicated, it is a safe procedure with good clinical outcomes and low risk of below-knee amputation. Level IV, Therapeutic study.

Percutaneous fixation of fractures of the calcaneus and its functional outcomes

Background: Closed fractures of the calcaneum are common fractures of the lower limb and which usually result from by high velocity axial loading of the calcaneum. Open reduction and internal fixation methods have formed the mainstay of their treatment. However the associated wound complications have made the management of such injuries more difficult. Percutaneous fixation techniques provide an effective method of closed treatment of these fractures and can help avoid wound related complications.Methods: Twenty- four patients with fractures of the calcaneum were treated with percutaneous reduction with Essex-Lopresti technique and fixation with Steinman pin and K-wires, followed by immobilization with a slab. The American orthopaedic foot and ankle score (AOFAS) was calculated at the final follow up. Also the heel width (with a vernier caliper) and the heel height (from lateral malleolus to the ground surface) were recorded at the final follow up.Results: Of the total patients 8 had excellent, 10 had good and 6 had fair results. None of the patients had heel widening or loss of calcaneal height of more than 1 cm as compared to the contralateral limb. Complications seen were superficial pin tract infections (3) which were treated with early implant removal and appropriate antibiotics. The Bohler’s angle at follow up was at a mean 30 degrees. Conclusion: The percutaneous reduction of closed fractures of the calcaneum provides good functional results as per AOFAS score. It also helps avoid wound related complication seen in open techniques. The Essex-Lopresti technique of reduction of such fractures has a short learning curve and can be reproduced at most operative setups. Long term follow up studies and bigger sample sizes can help support our conclusions.

Preliminary outcomes of anterior ankle arthrodesis

Objective: The objective of this study was to evaluate preliminary clinical and radiographic outcomes of a case series of patients with ankle osteoarthritis undergoing anterior tibiotalar arthrodesis using anterior plate and cannulated screws as a form of fixation. Methods: We retrospectively assessed the clinical and radiographic outcomes of eight cases treated with this technique in our service between 2014 and 2017, using the American Orthopedic Foot and Ankle Score (AOFAS) questionnaire and radiographic evaluation in two orthogonal views with ankle weight bearing, evaluated at one year after surgery. Results: We obtained AOFAS scores between 38 and 92 in the late postoperative period and a consolidation rate of 87.5% (seven cases). There was consolidation failure in one case, which resulted in plate loosening and the need for reoperation. Only one of the patients presented superficial surgical wound complication, treated only with serial dressings. There were no neurovascular complications. Conclusion: The present study obtained adequate preliminary outcomes with the use of the demonstrated technique, indicating a possible advantage of the same in relation to conventional techniques and the possibility of using lower-cost surgical materials. Level of Evidence IV; Therapeutic Studies; Cases Series.

Evaluation of Scarf Osteotomy for Management of Hallux Valgus Deformity

Hallux valgus is a complex progressive deformity affecting the forefoot. The main pathologic anatomy concerns the first metatarsophalangeal joint, including a varus or medial deviation of the first metatarsal and pronation deformity in the longitudinal axis. The goal of this study was to evaluate a series of consecutive patients over a 2-year period after a scarf osteotomy of the first metatarsal. A scarf osteotomy was performed on 31 consecutive patients with moderate to severe hallux valgus deformity (intermetatarsal angle, 13-22°; hallux valgus angle, 20-44°). Twenty-nine women and 2 men had an average age of 57 years (range, 21-71 years) at the time of surgery. Preoperative and postoperative evaluations included standing anteroposterior and lateral radiographs, American Orthopaedic Foot and Ankle Score (AOFAS) score, physical examination, and foot pressure analysis by weight-bearing ink prints. Patients were evaluated radiographically and clinically in the initial postoperative period (≤1 month), intermediate postoperative period (2-6 months), and final follow-up (12-36 months). Twenty-eight feet were available for analysis. Five of the 28 feet had concurrent surgeries on the lesser toes for hammer-toe correction or preoperative metatarsalgia. Paired Student t test on the 28 feet showed a statistically significant improvement (P<.0001) between pre- and postoperative intermetatarsal angle, hallux valgus angle, and AOFAS score. One foot had recurrence of the hallux valgus deformity. Paired analysis of variance of the 27 feet without recurrence showed a statistically significant improvement in the pre- and postoperative parameters (P<.0001). From this subset, the multiple-comparison Student-Newman-Keuis post hoc test showed a statistically significant (P<.0001) preservation of the correction in the intermediate follow-up period to final follow-up at an average 28 months.