Ankle Activity Score Research Articles

All-Inside Endoscopic Classic Bröstrom-Gould Technique: Medium-term Results

Background: Short-term results after arthroscopic/endoscopic lateral ligament repair for chronic lateral ankle instability have been satisfactory, although medium- to longer-term results are lacking. Purpose/Hypothesis: The purpose of this study was to report the medium-term results of an all-inside endoscopic classic Bröstrom-Gould procedure where both the both lateral ligaments and the inferior extensor retinaculum can be approached directly, interchanging between arthroscopy for intracapsular structures and endoscopy for extracapsular structures. It was hypothesized that the all-inside endoscopic classic Bröstrom-Gould procedure would produce sustainable good outcomes at a medium term of 5 years. Study Design: Case series; Level of evidence, 4 Methods: A prospective database for 43 patients who underwent an all-inside endoscopic classic Bröstrom-Gould repair of the anterior talofibular ligament and calcaneofibular ligament with inferior extensor retinaculum augmentation was reviewed. Patient details, American Orthopaedic Foot & Ankle Society score, Karlsson score, ankle activity score (AAS), and patient satisfaction were collected and analyzed. Results: The study cohort of 43 patients with a mean age of 29.4 years (SD, 11.9 years) were reviewed at a mean follow-up of 63.1 months (SD, 8.5 months). The American Orthopaedic Foot & Ankle Society scores showed significant improvement from a mean of 69.6 (SD, 13.9) to 93.7 (SD, 10.7), while the Karlsson score improved from 59.7 (SD, 14.5) to 91.5 (SD, 14.5) at the final follow-up. The AAS showed that 32 (74.4%) patients maintained or had improvement in the AAS, from a mean of 5.38 (SD, 2.8) to 5.41 (SD, 2.8), with a mean satisfaction rate of 9.1 (SD, 1.3). Although the remaining 11 patients had a reduced AAS, at a mean of 4.6 (SD, 2.6), they reported a mean satisfaction rate of 7.4 (SD, 2.9). There were no surgical complications or reoperations reported in this cohort, although there were 3 patients with recurrent instability at their last follow-up, resulting in a failure rate of 7%. Conclusion: The current study is the first to report the medium-term outcomes of an all-inside endoscopic classic Bröstrom-Gould procedure. Overall, 93% of the patients had good functional outcomes, but approximately 25% of patients had decreased ankle activity levels at a mean of 5 years postoperatively, albeit with good satisfaction rates.

Prognosis of Nonconcurrent Bilateral Achilles Tendon Rupture Is Worse Than Unilateral Achilles Tendon Rupture: Patient-Reported Outcomes at Minimum 2-Year Follow-up.

Approximately 5%-7% of patients who have had Achilles tendon rupture (ATR) suffer from contralateral ATR. However, no studies have evaluated the clinical outcomes of contralateral ATR in patients with an existing ATR. Therefore, in this study, we aimed to investigate patient-reported ankle function and activity levels in patients with nonconcurrent bilateral ATR. We retrospectively reviewed the data of 222 patients with an acute ATR who presented at our 2 institutions between 2005 and 2017. All patients had a minimum 2-year follow-up period, with no other major injuries to the ankle joint. Of these patients, 17 patients had nonconcurrent bilateral ATR. Patient-reported outcomes were assessed by telephone interview, using the Achilles tendon Total Rupture Score (ATRS), the ankle activity score, and a patient satisfaction questionnaire. Telephonic interviews were conducted by 2 authors, using a prepared script to minimize bias owing to individual interviewers. The mean age of the patients was 45.1 ± 9.8 years, and 89% were men. Patients with nonconcurrent bilateral ATR had significantly lower values in terms of ATRS, ankle activity score, and satisfaction with current activity level, compared to patients who had unilateral ATR (p < 0.001, p = 0.027, and p = 0.012, respectively). Patients with nonconcurrent bilateral ATR had poorer ankle function, activity levels, and satisfaction than those with unilateral ATR in terms of patient-reported outcome measures with an intermediate-term result and a 2-year minimum follow-up period. These results emphasize the importance of the impact of contralateral injury on the prognosis of patients with ATR and the need for efforts to prevent contralateral rupture.

Surgical treatment for medium-sized cystic osteochondral lesions of the talus: Autologous osteoperiosteal transplantation provides better clinical outcomes than bone marrow stimulation when cysts are deeper than 6 mm.

To compare clinical outcomes of autologous osteoperiosteal transplantation versus bone marrow stimulation (BMS) for medium-sized (100-150 mm2) cystic osteochondral lesions of the talus (OLTs) and assess the correlation between patient demographics and outcomes. It was hypothesised that autologous osteoperiosteal transplantation would provide better clinical outcomes than BMS for medium-sized cystic OLTs. Patients who underwent autologous osteoperiosteal transplantation or BMS for medium-sized cystic OLTs between 2014 and 2019 were retrospectively evaluated. According to their characteristics, a 1:1 propensity-score matching was performed and 33 pairs of patients were matched. The visual analogue scale, American Orthopaedic Foot and Ankle Society (AOFAS) score, Foot Ankle Outcome Score (FAOS) and Ankle Activity Score were collected preoperatively and at the last follow-up. In addition, a general linear model analysis was performed between patient demographics and clinical outcomes in two groups separately to detect potential risk factors. Finally, 28 patients in the grafted group and 27 patients in the BMS group completed the follow-up and were enrolled with a mean follow-up period of 63.5 ± 13.9 months. Both groups showed significant improvement in all patient-reported outcomes (p < 0.01). At the final follow-up, no significant differences between groups were found in all postoperative scores except FAOS Pain (p = 0.02). Correlation analysis showed a moderate correlation between cyst depth and the postoperative AOFAS score in the BMS group (r = -0.48, p = 0.01). Based on the regression line, the patients in the BMS group with a cyst deeper than 6 mm showed a lower AOFAS score than the mean score (88.7 ± 9.5) of the grafted group. Autologous osteoperiosteal transplantation and BMS are both safe and effective for medium-sized cystic OLTs. However, autologous osteoperiosteal transplantation is expected to provide better clinical outcomes than BMS when the cysts are deeper than 6 mm. Level III.

Effects of Preoperative Abnormality of Posterior Tibial Tendon on the Surgical Outcomes of Medial Osteochondral Lesion of the Talus.

Although surgical treatment for osteochondral lesionof the talus (OLT) can obtain good clinical outcomes, the rate of return to sports is variable. It is reported that medial OLT unrelated to trauma has abnormal structures in the medial aspect, which may induce the medial OLT due to the medial instability. The posterior tibial tendon (PTT) plays an important role in the stabilization of the foot, and high mechanical stress may be added to the PTT to compensate for medial instability in medial OLT. We investigated whether abnormal PTT findings on preoperative magnetic resonance imaging (MRI) in patients with OLT affect clinical outcomes after surgery. Methods: Eighty-one ankles in 74 patients who were treated surgically for OLT were included in this study (41 men and 33 women; mean age, 26.0 years). Abnormalities of the PTT were evaluated using preoperative MRI. The Japanese Society for Surgery of the Foot (JSSF) scale, arch height, and ankle activity score (AAS) on standing plain radiogram were compared between patients with and those without preoperative PTT abnormalities. Twenty-five ankles (30.9%) had PTT abnormalities on preoperative MRI. All patients with preoperative PTT abnormalities were medial OLT. There were no significant differences in the preoperative JSSF scale in the procedures for OLT. The postoperative JSSF scale and arch height were significantly lower in patients with preoperative PTT abnormalities than those without them. AAS in patients with preoperative abnormalities significantly decreased at the final follow-up. Conclusion: PTT abnormalities on preoperative MRI may affect clinical outcomes even in preoperative asymptomatic patients in the medial OLT unrelated to trauma.

Low socioeconomic status is associated with worse treatment outcomes in patients with Achilles tendinopathy

ObjectiveTo assess whether there is a difference in symptom severity at baseline and 24 weeks follow-up between conservatively managed patients with Achilles tendinopathy (AT) with low socioeconomic status (SES) compared...

Return to Sports Activity After Microfracture for Osteochondral Lesion of the Talus in Skeletally Immature Children.

Osteochondral lesions of the talus (OLTs) are among the common sports-related injuries. However, there are few reports on the return to sports after OLT surgery in skeletally immature children. This study was performed to evaluate the return to sports after microfracture for OLTs in skeletally immature children. This study involved 17 ankles of 16 patients (mean age, 13.2 years; range, 10-16 years) with open tibial epiphyses on magnetic resonance imaging (MRI) who underwent microfracture for OLTs <10 mm in diameter and confirmation of lesion instability under arthroscopy. Nine of 17 ankles had additional lateral ankle ligament stabilization. All patients were participating in some form of sports. The Japanese Society for Surgery of the Foot (JSSF) score, Ankle Activity Score (AAS), return to sports rate, lesion size, grade of subchondral bone marrow edema, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score on MRI were evaluated after microfracture. The mean postoperative follow-up period was 53.5 months. The mean JSSF score significantly improved from 76.1 points preoperatively to 94.9 points at the final follow-up (P < .01). The mean AAS showed no change from preoperative state to final follow-up. The return to sports rate was 100%. The lesion size significantly decreased from 76.3 to 56.7 mm2 in area (P = .02) and from 283.2 to 185.6 mm3 in volume (P = .05). The bone marrow edema grade decreased in 8 of 17 ankles. The total MOCART score showed a significant improvement from 6 months to 1 year postoperatively (P = .05). All skeletally immature children who underwent microfracture for OLTs in this study were able to return to sports activity and showed improvements in clinical scores and MRI parameters. Microfracture may be considered an effective first-line treatment for OLTs <10 mm in diameter in skeletally immature athletes. Level IV, retrospective case-control study.

Risk Factors for the Recurrence of Instability After Lateral Ankle Ligament Repair.

Arthroscopic anterior talofibular ligament (ATFL) repair is widely performed for chronic lateral ankle instability (CLAI). Although many studies have reported excellent outcomes with this procedure, the recurrence of instability remains a common concern. Therefore, this study aimed to analyze the risk factors for the recurrence of instability after arthroscopic repair for CLAI. Fifty-six ankles of 53 patients with a mean age of 31.8 ± 14.7 years were retrospectively reviewed. All patients underwent arthroscopic ATFL repair. If instability remained immediately after ATFL repair, calcaneofibular ligament (CFL) repair was performed. The Ankle Activity Score (AAS) was assessed preoperatively, and clinical outcomes including the Japanese Society for Surgery of the Foot scale, Karlsson-Peterson scores, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were evaluated preoperatively and at the final follow-up. Talar tilt angle (TTA) was assessed preoperatively and 1 year postoperatively. Ankles were divided into 2 groups-nonrecurrence (postoperative TTA, <6 degrees) and recurrence (postoperative TTA, ≥6 degrees)-and clinical outcomes were compared. Sixteen ankles showed recurrent instability, whereas 40 did not. AAS, TTA, and social functioning in the SAFE-Q were significantly higher in the recurrence group than those in the nonrecurrence group preoperatively. In addition, the rate of poor ATFL remnant quality and the number of CFLs not repaired despite the preoperative injury diagnosis were significantly higher in the recurrence group than in the nonrecurrence group. Arthroscopic repair for ATFL and CFL deficiencies with preoperative high activity, poor remnant quality, and neglected CFL injury can result in the recurrence of instability. Appropriate surgical procedures to prevent the recurrence of instability should be selected for these ankles. Level IV, retrospective case series.

Characteristics of Chronic Ankle Instability Requiring Both Anterior Talofibular and Calcaneofibular Ligament Repair

Chronic ankle instability (CAI) leads to the ankle osteoarthritis (OA), and ligament repair is performed to restore ankle stability. However, anterior talofibular ligament (ATFL) repair alone is not sufficient to stabilize the ankle in some cases, which additionally require calcaneofibular ligament (CFL) repair. This study aimed to explore characteristics of CAI that necessitated the repair of both ATFL and CFL. Forty-three patients (44 ankles) with CAI treated operatively were retrospectively reviewed. After ATFL repair, patients with residual ankle instability revealed by the varus stress under fluoroscopy additionally underwent CFL repair. Preoperative condition and intraoperative findings of the combined ATFL and CFL repair (AC) (n = 24) and only ATFL repair (A) (n = 20) groups were compared. The ankle activity score of group AC was significantly higher (p < .05) than that of group A. OA changes at the medial gutter were observed in 62.5% (15/24) in the group AC and 20% (4/20) in group A. Chondral/osteochondral lesions were seen in 66.7% (16/24) in the group AC and 20% (4/20) in group A. The remnant quality in group AC was inferior to that of group A. CAI that necessitated both ATFL and CFL repair exhibited characteristic findings such as high ankle activity score, high rate of chondral/osteochondral lesions and/or OA changes, and poor quality of ATFL remnants compared to those in CAI that required only ATFL repair. The repair of both ATFL and CFL should be considered in CAI which exhibit these characteristics to ensure complete correction of the instability.

High-stress distribution in the lateral region of the subtalar joint in the patient with chronic lateral ankle instability.

Chronic lateral ankle instability (CLAI) is associated with osteoarthritis (OA). However, the characteristics of patients with CLAI who progress to OA are not clear. Measurement of Hounsfield Unit (HU) value on computed tomography (CT) is reported to be useful to evaluate the stress distribution. We aimed to evaluate the stress distribution in the ankle and subtalar joints and factors enhancing it in patients with CLAI. Thirty-three ankles with CLAI (CLAI group) and 26 ankles without CLAI (control group) were included. A mean age of CLAI was 35.2years and control was 30.3years. Color map was created in the ankle and subtalar joint according to the HU values using three-dimensional CT to identify the region with high HU values, and HU values in those regions were measured using two-dimensional CT and compared between control and CLAI groups. In CLAI group, the relationships between HU values and ankle activity score (AAS), OA, talar tilting angle (TTA), cartilage injury were assessed. The HU values in the anteromedial region of the talus and lateral region in the subtalar joint were higher than those in the control. In CLAI, patients with an AAS of ≧ 6, over 10° of TTA, cartilage injury, and OA changes in the medial gutter had significantly higher HU values in the lateral region of the subtalar joint than those with an AAS of ≦5, less than 10° of TTA without cartilage injury and OA change. CLAI patients, especially in the patients with high activity level, large TTA, cartilage injury, and OA changes at the medial gutter, have high HU values in the lateral region of the subtalar joint, which suggests that disruption of the subtalar compensation toward OA will occur. For these patients, instability should be completely eliminated to prevent ankle OA. Level III, comparative series.

Open Versus Endoscopic Osteotomy of Posterosuperior Calcaneal Tuberosity for Haglund Syndrome: A Retrospective Cohort Study.

Background:Although endoscopic calcaneoplasty and retrocalcaneal debridement have been extensively applied to treat Haglund syndrome, evidence of the value of the endoscopic procedure remains to be fully established.Purpose/Hypothesis:The purpose of this study was to compare the postoperative outcomes and the amount of osteotomy between open and endoscopic surgery for the treatment of Haglund syndrome. It was hypothesized that endoscopic calcaneoplasty would lead to higher patient satisfaction and lower complication rates compared with open surgical techniques.Study Design:Cohort study; Level of evidence, 3.Methods:The following postoperative outcomes were compared between the open surgery group (n = 20) and the endoscopic surgery group (n = 27): visual analog scale for pain, American Orthopaedic Foot & Ankle Society ankle-hindfoot scale, Foot Function Index, Tegner score, Ankle Activity Score, and 36-Item Short Form Health Survey; postoperative complications; and duration of surgery. To determine the extent of resection, the authors compared the calcaneal height ratio, calcaneal resection ratio, calcaneal resection angle, pitch line, and Haglund deformity height between groups. The learning curve for endoscopic calcaneoplasty was also calculated.Results:There were no significant differences between the open and endoscopic groups on any outcome score. Two patients in the open group reported temporary paresthesia around the incisional site, indicating sural nerve injuries; no complication was reported in the endoscopy group. None of the parameters for extent of resection were statistically significant between the groups. The duration of surgery was 44.90 ± 10.52 and 65.39 ± 11.12 minutes in the open and endoscopy groups, respectively (P = .001). Regarding the learning curve for endoscopic calcaneoplasty (6 surgeons; 27 follow-up patients; 9 patients lost to follow-up), the duration of surgery reached a steady point of 55.68 ± 4.19 minutes after the fourth operation.Conclusion:The results of this study indicated that the endoscopy procedure was as effective as the open procedure. The endoscopic procedure required significantly more time than the open procedure, and the duration of the endoscopic procedure was shortened only after the fourth operation, suggesting that it requires high technical skills and familiarity with the anatomic relationships.

All-inside endoscopic anatomic reconstruction leads to satisfactory functional outcomes in patients with chronic ankle instability.

Ankle sprain is a common injury that can be treated conservatively, though many injured patients do not seek treatment or are not adequately managed, both of which can lead to subsequent chronic ankle instability (CAI). The purpose of this study was to evaluate the functional scores and complication rates of an all-inside anatomic reconstruction technique to treat CAI at a minimum follow-up of 24months. The authors retrospectively collected the records of 41 patients that underwent all-inside endoscopic anatomic reconstruction of the ATFL and CFL including demographics, complications, satisfaction, American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson score, and ankle activity score (AAS), at a minimum follow-up of 24months. The study cohort, comprised 34 patients aged 35.6 ± 10.8years, were assessed at 48.7 ± 19.0months. AOFAS scores improved from 60.3 ± 11.9 to 94.3 ± 6.2 postoperatively. Karlsson scores improved from 49.0 ± 10.9 to 87.2 ± 10.1 postoperatively. Thirty-three (97%) patients returned to the same AAS (5.6 ± 3.1) and rated their overall satisfaction ≥ 7. One patient (3%) was reoperated to treat a hematoma, while five patients (15%) were reoperated to remove the cortical fixation device that caused discomfort. The novel all-inside endoscopic technique for anatomic reconstruction of the ATFL and CFL grants satisfactory functional outcomes at a minimum of 24months, and the improvements in AOFAS and Karlsson scores compared favourably to those reported for other techniques in the literature. IV.

Retrograde Drilling for Osteochondral Lesion of the Talus in Juvenile Patients.

Background:Retrograde drilling (RD) is generally used for treating osteochondral lesion of the talus (OLT) with a stable osteochondral fragment and nearly normal articular cartilage surface. Previous studies that included participants of various ages have reported good clinical results. This study aimed to clarify the clinical outcomes of RD for OLT in juvenile patients whose bone-forming ability and physical activity might affect the healing process.Methods:This retrospective study included 8 juvenile patients who underwent RD for OLT (5 boys and 3 girls, mean age 14.9 years, mean follow-up 2 years, 7 medial and 1 central lesion). American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and ankle activity score were evaluated, and arthroscopic findings were graded according to the International Cartilage Research Society (ICRS) classification system. The condition of the underlying bone was assessed on preoperative computed tomographic images. The stability, incorporation, and subsidence of the osteochondral fragment, articular surface congruity, and the area of the bone marrow lesion (BML) were evaluated using magnetic resonance imaging (MRI).Results:AOFAS ankle-hindfoot score and ankle activity score significantly improved postoperatively. Arthroscopically, the lesions were classified as ICRS grade 0 or 1. Bone sclerosis or multiple small cysts of the underlying bone were observed in all patients. MRI demonstrated no signs of osteochondral fragment instability or subsidence, good or fair fragment incorporation, good articular surface congruity, or slight irregularity. The postoperative BML was reduced; however, these BMLs were still detectable at 1 year after surgery.Conclusion:Our data suggested that RD is an option for treating juvenile patients with OLT refractory to nonoperative treatment at short-term follow-up. Although bone sclerosis or multiple small cysts were identified in the underlying bone preoperatively and the BML under the osteochondral fragment remained postoperatively, clinical status such as pain and physical activity level were improved by RD.Level of Evidence:Level IV, retrospective case series.

Calcaneoplasty coupled with an insertional Achilles tendon reattachment procedure for the prevention of secondary calcaneal impingement: a retrospective study.

Background:Posterior heel pain may occur after an Achilles insertional rupture reattachment procedure and could be attributed to an impingement between the calcaneal tuberosity and Achilles tendon, which could be observed using postoperative magnetic resonance imaging (MRI). Moreover, such impingement, which may be associated with postoperative pain symptoms, could be relieved by calcaneoplasty.Methods:Postoperative Visual Analog Pain Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score, Foot Function Index (FFI), Ankle Activity Score (AAS), and Tegner score were obtained and compared between 10 patients who underwent calcaneoplasty (calcaneoplasty group) and 11 patients who did not receive calcaneoplasty (non-calcaneoplasty group). Several signs of calcaneal tuberosity impingement identified in MRI were also compared between the two groups, which included retrocalcaneal bursitis, postoperative tendinopathy, tendon calcification, bone marrow edema, increased Achilles tendon diameter, and bony spurs.Results:The VAS score was 2.00 ± 1.41 and 2.18 ± 1.83 (p = 0.803), the AOFAS score was 90.60 ± 4.22 and 81.82 ± 7.77 (p = 0.005), the FFI was 5.00 ± 2.86 and 17.18 ± 15.92 (p = 0.028), the AAS was 5.50 ± 2.55 and 5.82 ± 2.04 (p = 0.750), and the Tegner score was 4.30 ± 1.49 and 4.45 ± 1.21 (p = 0.797) in the calcaneoplasty and non-calcaneoplasty groups, respectively. The AOFAS score and FFI were significantly different between the groups. MRI findings revealed that the non-calcaneoplasty group had significant signs of calcaneal impingement compared with the calcaneoplasty group.Conclusions:Secondary calcaneal impingement due to insertional tendon enlargement may occur, and prophylactic calcaneoplasty coupled with an insertional reattachment procedure could achieve promising postoperative outcomes for patients with insertional Achilles tendon rupture.

Return to Sport After Arthroscopic Autologous Matrix-Induced Chondrogenesis for Patients With Osteochondral Lesion of the Talus.

To determine the rate of return of patients to sport after arthroscopic autologous matrix-induced chondrogenesis (AT-AMIC) for outcomes 2 years after surgery. Retrospective observational cross-sectional study. C.A.S.C.O.-Foot and Ankle Unit, Istituto Ortopedico Galeazzi, Milan, Italy. Twenty-six consecutive patients, 65.4% male (mean ± SD age: 33.7 ± 11.0 years), that underwent AT-AMIC procedure between 2012 and 2015 were selected retrospectively. From this population, only sporting patients at amateur's level were included. Arthroscopic autologous matrix-induced chondrogenesis was proposed in patients with pain and persistent disability. All patients were assessed with the American Orthopaedic Foot and Ankle Score (AOFAS), physical component score of the 12-Item Short Form Health Survey (SF-12), Halasi ankle activity score, and University of California, Los Angeles (UCLA) activity scale preoperatively and at 24 months postoperatively. Overall, 80.8% of the patient group returned to the same preinjury sport. The mean follow-up was 42.6 ± 10.9 months (range from 25 to 62 months). Significant differences were observed with reference to AOFAS, SF-12, Halasi, and UCLA scores at the last follow-up in patients who had undergone AT-AMIC (all, P < 0.001). A high percentage of patients return to their preinjury sport after AT-AMIC surgery.

Platelet-Rich plasma Injection Management for Ankle osteoarthritis study (PRIMA): protocol of a Dutch multicentre, stratified, block-randomised, double-blind, placebo-controlled trial

IntroductionPlatelet-rich plasma (PRP) is a potentially efficacious treatment for ankle osteoarthritis (OA), but its use has not been examined in high-quality studies. Systematic reviews show that PRP injections significantly decrease...

Optimal Outcomes for Acute Avulsion Fracture of the Achilles Tendon Treated With the Insertional Reattachment Technique: A Case Series of 31 Cases With Over 2 Years of Follow-up

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.

Reattachment of the superior peroneal retinaculum versus the bone block procedure for the treatment of recurrent peroneal tendon dislocation: two safe and effective techniques.

Clinical outcomes between reattachment of the superior peroneal retinaculum (SPR) and the bone block procedure were compared in this study to elucidate which procedure was safer and more effective. From 2012 to 2016, 25 patients with recurrent peroneal tendon dislocation underwent the bone block procedure (group A), and another 22 patients underwent reattachment of the SPR (group B). American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Ankle Activity Score (AAS), time to return to sports activity, rate of return to sports level, range of motion (ROM) of the ankle, rate of recurrence, and overall patient satisfaction were collected to evaluate outcomes between the two groups. In group A, 24 patients followed up at a mean period of 42.5 ± 16.7 months. The mean postoperative AOFAS score was 92.9 ± 3.9. The median time to return to sports activity was 6.0 months (IQR 4.3-6.0 months) with 19 patients (79.2%) returning to their previous sports level. Two patients experienced recurrent dislocation, and 22 patients (91.7%) were satisfied with the procedure. In group B, 20 patients followed up at a mean period of 35.8 ± 15.3 months. The mean postoperative AOFAS score was 95.0 ± 4.2. The median time to return to sports activity was 5.0 months (IQR 4.0-5.0 months) with 18 patients (90.0%) returning to their previous sports level. No recurrence was reported, and 18 patients (90.0%) were satisfied with the procedure. The time to return to sports activity in group B was significantly shorter than that in group A. There was no significant difference in complications or clinical outcomes between the two procedures. Both procedures offered satisfactory results for recurrent peroneal tendon dislocation with low rates of recurrence and complications. However, the time to return to sports activity after the reattachment of the SPR was shorter than that after the bone block procedure. Retrospective Comparative Study, Level III.

Achilles tendinosis does not always precede Achilles tendon rupture.

Degenerative change is a typical histologic finding of Achilles tendinosis and is thought to be a factor associated with Achilles tendon rupture; however, this relationship remains controversial. Therefore, the aim of this study was to review the histological findings of ruptured Achilles tendons and analyze demographics and injury patterns. Retrospective analysis was performed for all patients who underwent Achilles tendon repair for acute Achilles tendon rupture at our institution between 2008 and 2015. The presence of Achilles tendinosis was determined by light microscopic histology of ruptured Achilles tendons. Patients were grouped according to the presence of Achilles tendinosis and patient demographics, sports activities, and clinical outcomes were compared. Ankle activity score was used to evaluate the level of sports activity and Achilles tendon total rupture score (ATRS) was used to evaluate clinical outcomes. A total of 152 Achilles tendon ruptures were included: 112 (77%) showed Achilles tendinosis at a ruptured Achilles tendon on histology and 40 (23%) did not. Patients who had no Achilles tendinosis prior to rupture had a lower ankle activity score (P < 0.05) and higher incidence of non-sports related injury (P < 0.05). ATRS was not significantly different between the groups at final follow-up (P = n.s.). In contrast to previous reports, Achilles tendon rupture can occur without prior Achilles tendinosis, especially in non-sports-related injuries and in patients with low sports activity. Although the direct clinical applications of these results are limited, the findings of this study can improve our understanding of the etiology of Achilles tendon rupture. Prognostic, Level III.

Sports and physical activity after osteochondral talar reconstruction with arthroscopic autologous matrix-induced chondrogenesis

Category: Sports Introduction/Purpose: Osteochondral talar lesions (OLTs) are common entities in active patients who practice sports. Degenerative changes and development of osteoarthritis can occur in up to 50% of non-treated patients, due to poor chondral tissue healing abilities. In recent years, autologous matrix-induced chondrogenesis (AMIC) repair has been introduced for OLTs with satisfactory results through medium-term follow-up. The aim of the study was to evaluate the return to sport and physical activities in patients underwent arthroscopic autologous matrix-induced chondrogenesis (AT-AMIC) 2 years after surgery. Methods: This is an observational cross-sectional study. Informed consent was obtained from all participants, and procedures were conducted according to the Declaration of Helsinki. Twenty-seven consecutive patients, 62.9% (17) male (mean ± SD age: 33.7±11.2 years), that underwent AT-AMIC were included in the study. All patients were assessed with the American Orthopaedic Foot &amp; Ankle Score (AOFAS), physical component score of the 12-Item Short Form Health Survey (PCS-SF-12), HALASI ankle activity score and University of California, Los Angeles (UCLA) activity scale preoperatively and at 24 months after surgery. Results: Overall, 81.48% of the patient group returned to the same preinjury sport. Mean follow-up was 42.7 ±11.1 months. A significant interaction with time (from pre-operative to the final follow-up) for the clinical parameters UCLA, Halasi, AOFAS and SF-12 was found, P&lt;0.001). In addition, there were significant differences between preoperative versus last follow-up (all, P &lt;0.001), Conclusion: A high percentage of patients return to their sport activity after osteochondral talar reconstruction with AT-AMIC technique; furthermore AT-AMIC improve quality of life in young and active patients, allowing return to sport.

Clinical Results Of Arthroscopic Anatomical Reconstruction Of The Lateral Ankle Ligaments

Arthroscopic technique for anatomical lateral ligament reconstruction using a gracilis tendon for chronic lateral ankle instability is good surgical procudure for the patients who have insufficient local tissue for a Broström-Gould reconstruction such as in revision cases. Lateral ankle sprain is very common injury and patients who injured are mainly successfully treated conservatively. However about 10% of them change over to chronic lateral ankle instability (CLAI). CLAI leads to repeated ankle sprains, articular cartilage injury and the development of degenerative arthritis of the ankle. Therefore, they need surgical intervention. There are many surgical techniques reported for the treatment of CLAI. One of the procedure of the anatomical reconstruction, Broström procedure, leads good clinical results in long time. However, some patients who had attenuated lateral ligaments or failed previous reconstruction of lateral ankle ligaments or high-level athletic activity or obesity or ankle laxity had poor results by Broström procedure. They need anatomical reconstruction using by some graft augmentation. We can find some reports about anatomical reconstruction of lateral ankle ligaments, however there are few reports performed by arthroscopy and we recently reported an all-arthroscopic technique for anatomical reconstruction of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) by gracilis graft. Therefore, the purpose of this study is to assess the clinical results of this technique for CLAI retrospectively. We retrospectively reviewed 34 ankles from 34 patients, followed up more than 2 years, who had been surgically treated for CLAI. Summary of the surgery is as follows: 1. Make the bone tunnels at fibular, talar and calcaneal attachments of the lateral ligaments. 2. Introduce the tendon graft to each bone tunnel. 3. Fixation of the tendon graft is with an endobutton in the fibular bone tunnel and interference screws in the talus and calcaneus. The results were assessed by the Karlsson-Peterson Ankle Score (Karlsson) and American Orthopedics Foot, Ankle Society Ankle Hindfoot Scale (AOFAS) and Ankle Activity Score. Of the patients, (67.6 %) played competitive or recreational sports before the injury (Ankle Activity Score: 5.5 ± 3.0). At a mean follow-up of 32.5 ± 5.1 months (range, 24-43 months), the Karlsson and AOFAS score improved significantly from 47.4 ± 11.5 and 57.8 ± 12.0 preoperatively to 88.3 ± 9.9 and 94.7 ± 6.3 points postoperatively (P<0.01). After operation, they recovered same sports activity level except 1 patients, who has ankle pain (Ankle Activity Score 5.2 ± 2.9) (N.S.). All-arthroscopic technique for anatomic reconstruction for CLAI leads to good clinical results. Further studies need to confirm the indication and superiority of this procedure.