Ankle Outcome Score Research Articles

The Influence of Pain and Resiliency on Foot and Ankle Surgery Outcomes.

Background:Resilience is the ability to recover after stressful events and has been shown to correlate with surgical outcomes. However, there has been minimal research on the impact of patient resiliency on foot and ankle surgical outcomes. This study aims to determine the predictive value of preoperative resiliency scores on surgical outcomes and investigate how this compares with the predictive value of pain scores.Methods:We conducted a retrospective review of adult patients who completed a preoperative Brief Resilience Scale (BRS) and underwent surgery between November 2019 and November 2020 with a fellowship-trained foot and ankle surgeon (N=184). Data included demographics, comorbidities, surgical details, complication and reoperation rates, pre- and postoperative opioid and benzodiazepine use, and additional patient-reported outcome measures (ie, visual analog scale [VAS], Pain Catastrophizing Scale [PCS], Pain Disability Index [PDI], Foot and Ankle Outcome Score [FAOS] pain subscale). Mean follow-up duration was 4.49 (range, 1.10-14.17) months.Results:BRS weakly correlated with decreased postoperative benzodiazepine use (P=.007). PCS magnification (P=.050) and helplessness (P=.047) subscales weakly correlated with increased follow-up duration. PDI total score and most subscores significantly correlated with an increase in at least 1 of the following: follow-up duration, or postoperative opioid or benzodiazepine use. Neither the VAS nor FAOS pain subscore correlated with any outcome. PDI total score was the strongest predictor of postoperative opioid (β=0.334) and benzodiazepine (β=0.315) use. Preoperative opioid users had significantly higher PDI total score (user=39.3, nonuser=24.9; P=.012) and subscores (ie, social activity, sexual behavior, self-care, life-support activities).Conclusion:BRS is an unreliable tool for predicting outcomes in foot and ankle surgery, as it only weakly correlated with decreased benzodiazepine use. Rather, given the PDI’s strong associations with postoperative measures in this study, physicians should consider the value of preoperative PDI completion when predicting how foot and ankle surgery recipients will fare postoperatively.Level of Evidence:Level III, retrospective cohort study.

High return to sports and return to work rates after anatomic lateral ankle ligament reconstruction with tendon autograft for isolated chronic lateral ankle instability

PurposeTo evaluate clinical outcomes as well as return to sports (RTS) and return to work (RTW) rates following anatomic lateral ankle ligament reconstruction with a tendon autograft for chronic lateral ankle instability (CLAI) in a high-risk population, and to compare these outcome parameters between patients having received a gracilis tendon autograft (GT) and free split peroneus brevis tendon (PBT) autograft.MethodsTwenty-eight consecutive patients, who were diagnosed with CLAI, presenting with ≥ 1 risk factor (ligamentous hyperlaxity, insufficient substance of native ligament and/or high-demand athlete), who underwent ankle ligament reconstruction with a tendon autograft between January 2011 and December 2018, were included in this retrospective study. At 63.7 ± 28.0 months (24–112), 23 patients with a mean age of 29.7 ± 10.9 years were available for follow-up. The Karlsson Score, the Foot and Ankle Outcome Score (FAOS), the Tegner Activity Scale and the visual analog scale (VAS) for pain were collected at a minimum follow-up of 24 months. RTS and RTW were evaluated by questionnaire. A subgroup analysis with regard to the graft used for ankle ligament reconstruction (GT versus PBT) was performed.ResultsPatients reported a Karlsson score of 82.1 ± 17.5 (37–100), a FAOS score of 87.8 ± 8.4 (73–99), a median Tegner activity scale of 5.0 (IQR 4–6) and a VAS for pain of 0.5 ± 0.9 (0–4) at rest and of 2.0 ± 2.1 (0–7) during activities at final follow-up. Postoperatively, 96% of patients had returned to sports after 8.3 ± 6.2 months. All patients (100%) had returned to work at 3.5 ± 5.7 (0–24) months, with 87% reporting an equal or improved working ability compared to that preoperatively. Postoperatively, exercise hours per week were significantly reduced compared to preoperatively in patients with a split PBT (n = 12; 13.0 ± 12.9 to 5.6 ± 6.4 h, p = 0.038) autograft as opposed to patients with a GT autograft (n = 11; 13.1 ± 8.7 to 12.4 ± 7.1 h, n.s.). No other group differences were observed.ConclusionGood patient-reported outcomes as well as excellent RTS and RTW rates can be achieved in high-risk patients undergoing ankle ligament reconstruction with a tendon autograft for CLAI. These results may be helpful in preoperatively managing patients’ expectations regarding sports- and work-related outcomes and provide tangible data on the expectable time frame of the individual return to sports and work trajectory.Level of evidenceIV.

Return-to-sports after minimally invasive stabilization of intra-articular calcaneal fractures.

Evaluation of different factors in patient quality of life after minimally invasive stabilization of intra-articular calcaneal fractures, including the return-to-sports rate. Patients with minimally invasive stabilization of intra-articular calcaneal fractures were collected from the database of a Level I trauma center and evaluated in a retrospective and explorative way. The clinical and radiological examination have been done immediately after the operation, after 2 and 6 weeks postoperative and after a minimum follow-up of 2 years. Clinical and radiological examination was performed by applying the American Orthopedic Foot and Ankle Society hindfoot scale score (AOFAS), 36-item Short Form Health Survey (SF-36), the Tegner Activity Scale, the Foot and Ankle Outcome Score (FAOS) and with a questionnaire about pre- and postoperative engagement in sport and recreational activities. Fourty-nine patients with an isolated uni-lateral fracture of the calcaneus who fulfilled all inclusion criteria were assessed. Fourty-two of them were male and 24 were under the age of 50 years. No statistically significant differences were noted between Sanders I/II and Sanders III/IV in terms of SF-36, AOFAS, FAOS or Tegner-scale. A less satisfying result was noticed in Sanders III/IV patients. General health, pain in FAOS, physical functioning and pain in SF-36 were strongly dependent on Tegner score values. Twenty-nine percent of our study population changed sport activities after injury, whereas 22 percent stopped all kinds of sports. Consequently, our overall return-to-sport rate was 78 percent. Clinical results including different scores and quality of life parameters in our study population were satisfying. About 80 percent of patients could return to sports, but there are still many patients that were not able to perform sports and physical activities on the same level as before.

Screw only versus screw plus plate in isolated talonavicular arthrodesis

BackgroundWe aimed to compare outcomes of treatment of isolated talonavicular arthrodesis (ITNA) with screw only or screw plus plate, respectively. MethodsWe retrospectively evaluated 40 consecutive cases of ITNA [two-screw fixation patients: Group 1 (23 cases); screw-plus-plate fixation patients: Group 2 (17 cases)]. Outcome measures included radiographic findings, Foot and Ankle Outcome Scores (FAOS), and visual analogue scale (VAS) scores. ResultsNonunion occurred more frequently in group 1 (21.7%) than in group 2 (5.9%), but there was no statistical significance (p = 0.216). Although the preoperative FAOS and VAS score showed similar results between both groups, there were significantly better clinical outcomes in two of five FAOS domains and VAS scores at 3 months postoperative and final follow-up (p < 0.05). ConclusionAlthough union rates were not significantly different, nonunion occurred more frequently in screw only group and we obtained more favorable clinical outcomes in screw plus plate group.

Effects of Mobile-Based Rehabilitation in Adolescent Football Players with Recurrent Lateral Ankle Sprains during the COVID-19 Pandemic.

Football is a sport involving dynamic movements, and ankle sprains are common sports injuries experienced by football players. Ankle sprains exhibit a high recurrence rate, and rehabilitation training is effective; however, expert-supervised rehabilitation (SVR) at training centers is difficult due to the recent COVID-19 pandemic. This study investigated the effects of mobile-based rehabilitation (MBR) performed at home by high school football players. Sixty players (SVR: 30 and MBR: 30) with recurrent ankle sprains were analyzed. The rehabilitation program consisted of strength and balance training, and the training intensity was gradually increased from week 1 to week 8. The SVR group underwent training at the center with experts, and the BMR group were provided with programs and feedback using mobile devices. Ankle muscle strength was evaluated by measuring isometric eversion, inversion, plantarflexion, and dorsiflexion contraction using a hand-held dynamometer, and dynamic balance was assessed using the Y-balance test (YBT; anterior, posteromedial, and posterolateral); the Foot and Ankle Outcome Score (FAOS) was used for the subjective evaluation. Measurements were conducted at weeks 1, 4, and 8. The patients visited the clinic within 1 week after the injury, and the first test was conducted after consent to participate in the research. Patients underwent the second test at an average of 3.2 weeks after the first test, and the last test at an average of 4.4 weeks after the second test. Although only the SVR group exhibited improvement in strength (eversion and dorsiflexion), YBT and subjective satisfaction at week 4, these measurements improved in both the SVR and MBR groups at week 8. Therefore, mobile–based rehabilitation could be a suitable alternative for high school athletes with ankle sprains who cannot undergo supervised rehabilitation.

Clinical Manifestations, Diagnosis and Management of Synovial Fistula Associated Lateral Ankle Sprain or Instability: A Retrospective Study of 19 Surgically Confirmed Patients.

We aimed to investigate the preoperative history, clinical manifestations, imaging findings, and postoperative clinical outcomes for patients with surgically confirmed synovial fistula around the ankle joint. 19 consecutive patients who were confirmed to have synovial fistula in the surgical field were enrolled in this study. Medical records of all patients in terms of preoperative details, operative findings, and postoperative outcomes at 1 year after the surgery were retrieved. As a diagnostic modality, the normal saline test or MRI was used. Intraoperatively, the synovial fistula was repaired with the capsuloligamentous repair or additional periosteal augmentation. All patients had a history of ankle sprain prior to symptoms and showed positive results in the saline load test. One patient had recurred symptom after the surgery, so needed a revisional periosteal augmentation. At 1 year follow-up period, the average Foot ankle outcome score was 87.65 and no surgery-related complication was detected. Synovial fistula of the ankle joint needs to be taken into consideration as a possible complication in patients with ankle sprain history and recurrent joint swelling. The saline load test would be useful for its diagnosis, and treatment should be focused on the complete closure of capsular opening along with restoration of its surrounding pathologic conditions.

Clinical efficacy of the Ankle Spacer for the treatment of multiple secondary osteochondral lesions of the talus.

BACKGROUNDThe Ankle Spacer was developed as a joint-sparing alternative to invasive end-stage surgeries. Currently, there are no clinical studies on the Ankle Spacer.AIMTo describe the operative technique and the clinical efficacy of the Ankle Spacer for the treatment of multiple, cystic osteochondral lesions of the talus in patients with failed prior operative treatment.METHODSThis is a prospective study during which patients were assessed preoperatively, at 2- and 6 wk, and at 3, 6, 12 and 24 mo postoperatively. Patients with multiple, cystic or large (≥ 15 mm) osteochondral lesions of the talus after failed prior surgery were included. The primary outcome measure was the numeric rating scale (NRS) for pain during walking at 2 years postoperatively. Secondary outcome measures included the NRS in rest and during stair climbing, the American Orthopaedic Foot and Ankle Society Hindfoot Score, the Foot and Ankle Outcome Score, the Short- Form 36 physical and mental component scale, and the Range of Motion (ROM). Radiographic evaluations were conducted to evaluate prosthetic loosening and subsidence. Revision rates and complications were also assessed.RESULTSTwo patients underwent an Ankle Spacer implantation on the talus. The NRS during walking improved from 6 and 7 preoperatively to 2 and 2 points postoperatively at 2 years, in patient 1 and 2, respectively. The other patient-reported outcome measures also improved substantially. There were no re-operations nor complications. Radiological imaging showed no loosening of the implant and no change of implant position.CONCLUSIONThe Ankle Spacer showed clinically relevant pain reduction during walking, improvement in clinical outcomes as assessed with PROMs, and no complications or re-operations. This treatment option may evolve as a joint-sparing alternative to invasive end-stage surgeries.

Patients with chronic Achilles tendon rupture have persistent limitations in patient-reported function and calf muscle function one year after surgical treatment \u2013 a case series

PurposeEvaluate the one-year postoperative outcomes in patients with Chronic Achilles tendon rupture.MethodsPatients surgically treated for Chronic Achilles tendon rupture (n = 22, 14 males and 8 females, mean age 61 ± 15) were evaluated by Achilles tendon Total Rupture Score, The Physical Activity Scale, The Foot and Ankle Outcome Score, Calf muscle endurance test, counter movement jump, Hopping, ultrasound measurement of tendon length, Achilles Tendon Resting Angle, dorsi flexion range of motion and calf muscle circumference. Muscle function and tendon length outcomes on the injured side were compared with the healthy side.ResultsThe patients scored a mean of 62 ± 26 on the Achilles tendon Total Rupture Score. Median scores on the injured compared with the healthy side were lower in heel-rise repetitions (20 vs 24 cm, p = 0.004), hel-rise height (8 vs 10 cm, p < 0.001), heel-rise total work (872 vs 1590 joule, p < 0.001) and hopping ratio (0.37 vs 0.48, p = 0.005). Median calf circumference was smaller (37 vs 38 cm, p = 0.001) and the mean tendon elongation greater on the injured side; Achilles tendon resting angle (55 vs 50°, p < 0.001) and ultrasound (22.4 vs 20.5 cm, p = 0.006).ConclusionsAt one year postoperatively, patients with chronic Achilles tendon rupture reported persistent limitations in subjective foot and ankle function. Heel-rise height and total work as well as hopping ratio were not recovered, and there was an elongation of the injured Achilles tendon compared with the healthy tendon.Level of evidence IV

Improved Clinical Outcomes and Patient Satisfaction of In-Office Needle Arthroscopy for the Treatment of Posterior Ankle Impingement

PurposeTo investigate the short-term clinical outcomes and satisfaction for the first set of patients at our institution receiving in-office needle arthroscopy (IONA) for the treatment of posterior ankle impingement syndrome (PAIS).MethodsA retrospective cohort study was conducted to evaluate patients who underwent IONA for PAIS between January 2019 and January 2021. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and Patient-Reported Outcomes Measurement Information System Pain Interference, and Pain Intensity scores. Patient satisfaction was measured at the final follow-up visit with a 5-point Likert scale. The Wilcoxon signed-rank test was performed to compare preoperative and postoperative outcome scores.ResultsTen patients (4 male and 6 female) with a mean age of 41.9 ± 15.5 years (range, 24-66 years) were included in the study. The mean follow-up time was 13.3 ± 2.9 months (range, 11-17 months). All mean preoperative FAOS scores demonstrated improvement after IONA, including FAOS symptoms (71.48 ± 10.3 to 80.3 ± 12.6), pain (69.3 ± 11.0 to 78.2 ± 13.9), activities of daily living (61.7 ± 8.8 to 77.93 ± 11.4), sports activities (55.6 ± 12.7 to 76.0 ± 13.6), and quality of life (46.6 ± 9.2 to 71.1 ± 12.1). There were 7 patients who participated in sports activities before the IONA procedure. Within this group, all patients returned to play at a median time of 4.1 weeks (range, 1-14 weeks). The median time to return to work was 3.4 ± 5.3 days. Patients reported an overall positive IONA experience with a mean rating scale of 9.5 ± 1.5 (range, 5-10).ConclusionsThe current study demonstrates that IONA treatment of PAIS results in significant pain reduction, a low complication rate, and excellent patient-reported outcomes. In addition, IONA for PAIS leads to high patient satisfaction with a significant willingness to undergo the same procedure again.Level of EvidenceIV, therapeutic case series.

Flexible Flat Foot, Short Tendo-Achilles, and Altered Gait.

BackgroundPediatric patients often present with vague complaints involving the anterolateral foot and ankle, the medial knee, the lower back, and the hip. In our experience, closer examination of these patients reveals a constellation of symptoms that involve pathology in the ankle, knee, back, and hip. This study aimed to detail the identification and treatment of patients with the triad of flexible flat feet, tight Achilles complex, and altered gait, and their clinical course over time.MethodsAll patients of age 18 years or younger who presented to our urban academic center outpatient clinic with foot, ankle, patellar, low back, or hip pain or pathology were included. Patients with identified tarsal coalitions, accessory naviculars, malalignment syndrome, bone cysts or tumors, soft tissue tumors, arthropathy, neuropathy, infection, limb length inequality, patellar subluxation or dislocation, or spinal pathology were excluded. For each patient, demographic information, symptom description, treatment, and clinical course, including the Foot and Ankle Outcome Score (FAOS) was recorded.ResultsA total of 62 patients were included in our study. Patients mostly presented with low back pain (n=24, 38.7%), medial patellar pain (n=36, 58.1%), anterolateral ankle pain (n=35, 56.5%), and vague foot pain (n=13, 21.0%). Overall, 53.8% of patients with back pain at the initial visit, 35.0% of patients with knee pain, 44.4% of patients with ankle pain and 80.0% of patients with foot pain improved at final follow up. While patient-reported sports and recreation subscale scores demonstrated a significant improvement at the final follow-up compared to baseline scores (p=0.02), all other scores did not significantly differ compared to baseline scores. At final follow-up, 12 of 26 (46.2%) patients reported being able to return to play in their desired sport.ConclusionComplaints of back, hip, knee, ankle, or foot pain in the pediatric population can be early markers for a constellation of conditions that include low back pain, flexible flat feet, Achilles contracture, and altered gait due to increased lateral subluxation of the patella and hip flexion.

Validation of Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) in individuals with chronic ankle instability: a cross-sectional observational study

BackgroundAnkle sprain is the most common lower limb injury in physically active individuals. Loss of function, decreased postural control (PC), strength deficit, and reduced range of motion (ROM) are common after acute lateral ankle sprains. Some patients experienced long lasting symptoms, with recurrent sprains, and episodes of giving-way: a condition known as chronic ankle instability (CAI). Evaluating the function in patients with CAI in the clinical environment is important to identify the severity of the condition, in addition to allowing to assess the effectiveness of a given treatment. The aim of this study was to investigate the validation of the Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) in terms of muscle strength, PC and ROM in adults with CAI.MethodsThis is a cross-sectional study. Individuals with CAI aged between 18 and 45 years were eligible. Individuals with CAI were identified using the Identification of Functional Ankle Instability (IdFAI). All patients filled in the FAAM and FAOS scores. Muscle strength was assessed by manual dynamometry, ROM by the Lunge test, PC by computerized posturography, modified Star Excursion Balance Test (mSEBT) and modified Balance Error Score System (mBESS).Results50 participants were enrolled in the present study. The mean age of the patients was 27.2 ± 6.3 years, and the mean body mass index was 26.4 ± 4.8 kg/m2. 58% (29 of 50) were men and 42% (21 of 50) women. 18 individuals had unilateral (36%) and 32 bilateral (64%) CAI. The results of FAAM were associated with MCT, mSEBT, invertor muscles strength, plantar flexor muscles strength, dorsiflexor muscles strength, and external hip rotator muscles strength (P < 0.05). The results of FAOS were associated with mSEBT, invertor muscles strength, plantar flexor muscles strength, dorsiflexor muscles strength, evertor muscles strength, and external hip rotator muscles strength, and mBEES (P < 0.05).ConclusionBoth the FAAM and FAOS demonstrated validity to evaluate postural control and muscle strength in patients with CAI, while no association was found in relation to ankle dorsiflexion.

Outcomes of bone marrow aspirate concentrate and matrix-induced chondrogenesis (BMIC) for treatment of osteochondral lesions of the talus

BackgroundTo analyze the outcomes of Bone marrow aspirate concentrate and Matrix-Induced Chondrogenesis (BMIC) in Osteochondral Lesions of the Talus (OLTs). MethodsPatients with OLTs treated with BMIC from June 2013 to July 2020 were included. Visual Analogue Scale (VAS), Foot Function Index (FFI), and Foot Ankle Outcome Score (FAOS) before treatment and at last follow-up were subjected to analysis. ResultsForty-five patients were included and mean follow-up was 39.1 months (range, 13–97 months). Mean lesion size and depth were 180.7 ± 110.4 mm2 and 9.6 ± 3.7 mm, respectively. BMIC was performed without malleolar osteotomy in 36 patients (80%) and bone graft was performed in 42 (93.3%). VAS, FFI, and FAOS improved significantly. No complication occurred and no revision was required. ConclusionsThe BMIC procedure is feasible and should be considered a viable treatment option for OLTs associated with large subchondral bone defects.

Medial malleolar osteotomy for the correction of tibiotalar varus deformity during total ankle arthroplasty: Results in 95 ankles

BackgroundThe importance of deformity correction before or during total ankle replacement (TAR) has been recognized for a long time. Our results of TAR, combined with medial malleolar lengthening osteotomy, for the reconstruction of osteoarthritic ankles with varus deformity are hereby reported. MethodsAll ankles in which a medial malleolar osteotomy was performed during implantation of an ankle prosthesis during the period 1998–2018 were filtered out of our database. Preoperative coronal talar alignment was evaluated by measuring the angle between the tibial shaft and talar dome on the weightbearing mortise ankle radiograph. Patient-reported outcomes were measured with the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM). A Kaplan-Meier survival curve was constructed and the number of revisions per 100 observed component years was calculated for interprosthetic comparison. ResultsA total of 95 TARs were included, consisting of the Alpha Ankle Arthroplasty (n = 22); Buechel-Pappas (n = 14) and the Ceramic Coated Implant Evolution (n = 59) prostheses. The preoperative average talar angle in these ankles was 12.4 degrees varus. In 33% (31/95) corrective procedures, in addition to the medial malleolar osteotomy, were performed. A reoperation rate of 44% (42/95) was found, including 28 revisions (revision rate 29% (4% septic; 25% aseptic) at an average follow-up of 5.9 years, resulting in a survival of 0.69 for the total cohort at 10 years of follow-up.At an average follow-up of 6.6 years the average FAOS scores were: FAOSsymptoms 66, FAOSpain 73, FAOSfunction 78, FAOSsport 45 and FAOSquality of life 56 respectively. The FAAMadl score averaged 64. ConclusionThis is the largest cohort of TAR combined with medial malleolar osteotomy to date. A 29% revision rate at 5.9 years of average follow-up compares unfavorably with regular cohort studies and with most other results in varus-deformed ankles. Scores on the FAOS and FAAM are comparable to those obtained in regular cohorts with similar length of follow-up. TAR in varus-deformed ankles necessitating medial malleolar osteotomy has an even higher failure rate than regular TAR. Obtaining a stable prosthesis with a neutrally-aligned hindfoot at the end of the procedure is of paramount importance. Level of evidenceIV.

Clinical Outcomes of Nano Arthroscopy in the Office Setting for the Treatment of Anterior Ankle Impingement

Category:Ankle; ArthroscopyIntroduction/Purpose:The hypothesis was that IONA would provide the patient with a unique experience of their pathology and facilitate their rapid recovery through an awareness of their own condition, and that using IONA would accelerate recovery to sports-specific activities compared to the literature using standard arthroscopic procedures.Methods:This was a retrospective cohort study investigating patients who underwent IONA for anterior ankle impingement between 2019 and 2020. Clinical outcomes were evaluated using the following methods preoperatively and at final follow-up: The Foot and Ankle Outcome Scores (FAOS) and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Pain Intensity domains. A five-point Likert scale regarding patient satisfaction was evaluated at final follow-up.Wilcoxon signed-rank test was performed to compare preoperative and postoperative outcome scores.Results:Thirty-one patients were included in this study, which included eighteen males and thirteen females with a mean age of 41.7 +- 15.5 years (range, 17-69 years) and a mean body mass index (BMI) of 27.3 +- 5.7 kg/m2 (range, 19.37-41.5). The mean follow-up time was 12. +- 1.9 months (range, 11-15 months). There were 27 patients who participated in sports activity prior to IONA-arthroscopy procedure. Of those, 26 patients (96%) returned to their sports activities. The median time to return to sports was 3.9 weeks (range, 1.5 to 12 weeks). Patients reported an overall positive experience with a mean rating scale of 9.71 +- .8 (range, 6 to 10). Twenty-seven patients (87%) reported the highest rating (10/10) for overall positive experience and felt that seeing their procedure in real-time aided in their understanding of their underlying pathology. Lastly, twenty-nine patients (94 %) expressed willingness to undergo the same procedure again.Conclusion:The current study demonstrates that IONA treatment of anterior ankle impingement results in significant pain reduction, a low complication rate, and excellent patient-reported outcomes with high rates of return to work/sport. Additionally, IONA for anterior ankle impingement leads to high patient satisfaction with a significant willingness to undergo the same procedure again.

Patient Reported and Functional Outcomes for Revision Lateral Ankle Ligament Reconstruction

Category:Sports; AnkleIntroduction/Purpose:Despite multiple surgical treatment options for revision lateral ankle ligament reconstruction surgery, few studies describe the functional or patient reported outcomes. The purpose of this study is to describe the patient reported and functional outcomes for patient who required revision lateral ankle ligament reconstruction.Methods:We present follow-up of 26 patients who underwent revision lateral ankle ligament reconstruction between January 2010 and December 2019 at a single institution. Clinical notes and operative reports were reviewed to determine surgical techniques. Patient reported outcomes were completed using the Foot and Ankle Outcome Score (FAOS), Visual Analog Scale Pain, Visual Analog Scale for Ankle Instability, and Visual Analog Scale for Satisfaction. Functional outcome was evaluated with the hop test. Ankle stability was evaluated on physical exam with anterior drawer and inversion stress test.Results:Initial ligament reconstruction consisted of Brostrom (n=15), Brostrom Evans (n=3), Allograft (n=2) and Unknown (n=6). Revision lateral ligament reconstruction consisted of Brostrom (n=15), Brostrom Evans (n=2) and Allograft (n=9). Median follow up time after revision was 22 months. At last follow up, 20 patients (76.9%) had grade 0 inversion stress and anterior drawer test indicating stability. Median FAOS ADL sub score was 97 and median FAOS Symptom sub score was 79. Median VAS Pain was 3, median VAS Instability was 3 and median VAS satisfaction was 9.5. The single-leg hop test (Limb Symmetry Index %) was completed by 18 patients, with median score of 86.4% compared to their non-operative extremity. Six patients had persistent pain, three of which required additional surgery.Conclusion:The high majority of patients that require revision lateral ankle ligament reconstruction maintain a stable ankle on exam and are satisfied with their surgical results. Functional outcomes are similar but not symmetrical to their non-operative extremity.

Benefits of Ankle Arthroscopic Debridement in Acute and Subacute in Ankle Fractures

Category:Ankle; Arthroscopy; TraumaIntroduction/Purpose:The purpose of this study was to evaluate the benefits of ankle arthroscopy at the time of ORIF or after six months in patients with residual symptoms. The hypothesis was that in patients treated arthroscopically at the time of ORIF, there were faster and better clinical results than those treated after or untreated with arthroscopy.Methods:In this retrospective study, we compared three homogeneous groups of selected patients with specific inclusion criteria (144in total, mean age 38.2 years). They have been surgically treated for an ankle fracture (bimalleolar or trimalleolar without frank syndesmotic injuries) with open technique (ORIF) or arthroscopic ORIF (AORIF), between 2016 and 2019. The AO classification system was used for each patient. The clinical assessment was based on the Foot and Ankle Outcome Score (FAOS).Results:At the final follow-up (mean 36 months), both patients treated with ankle arthroscopic debridement at the time of ORIF and patients treated with arthroscopic debridement after ORIF showed a significant improvement of the FAOS, which reported84 and 85 respectively at final follow-up.Conclusion:Through direct visualization of intra-articular structures, ankle arthroscopy can offer an essential option for patients both in acute and in sequelae after an ankle fracture. More studies are needed to understand the real effectiveness of the procedure, especially in acute at the same time of osteosynthesis.

Ten-Year Outcomes of MobilityTM Total Ankle Replacement Confirms Radiological Loosening is Not Conclusive or Reliable for Long Term Survival Analysis

Category:Ankle; Ankle ArthritisIntroduction/Purpose:Different designs of Ankle replacement are being performed nowadays, long-term outcome data is the better way to understand these implants behaviour and survival. We compared the differences in demographic data, clinical, Radiological, and patient-reported outcomes among patients who underwent total ankle replacement performed with use of the uncemented stemmed mobile bearing (MOBILITY) Total Ankle System with 10 year follow up.Methods:We analysed 156 (15 bilateral ankles (3 non-mobility) Mobility TAR (of which 41, 45, 22 for OA, PTOA, Inflammatory arthritis respectively). Mean age 61.7 (SD 11.4) (Range 33-90). 70 Ankles had 10 years of follow up, 115 had 5 years follow up,. 96 were males, with 30 patients deceased before 10 years follow up covering 33 ankles. All from our local registry looking at the patient's demographic data, and patient-reported outcomes as measured with use of WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), the Foot and Ankle Outcome Score (FAOS), the 36-item Short-Form (SF-36) Health Survey, clinical and radiological outcomes and patient-satisfaction scores, collected preoperatively and at 1,3,5 and 10 years postoperatively.Results:Of the 156 ankles18 had wound complications after surgery two only needed surgical debridement. 5 CRPS,16 stress fractures 2 only requiring surgical fixation,11 had subsequent STJ fusion.77 had no signs of radiolucency. The rest had some degree of radiolucency on x-ray (55% on the tibia side) only 11 where symptomatic to require further surgery (6 revised to another TAR, 2 fused, and3 required bone grafting). 11 needed osteotomies after surgery. Aseptic loosening and infection are the least common complications requiring revision. There was significant improvement in WOMAC for pain (35.9 to 67.9), function (40.6 to 66.9) and stiffness (39.4 to 62.5) from pre-op to 1 year (p<0.05), this was maintained for 10 years. Although improvement noted in the composite physical component of SF=36 (28.3 to 34.5) there was no significant increase for composite mental component score. 77.5% reported satisfaction from pain relief,72.4% with return to ADL, 40% were dissatisfied with return to recreational activities and15.5% reported dissatisfaction with overall results of surgery. Mobility TAR shown about 86% survival in our 10 years cohort.Conclusion:With improved PROMS at 1,3,5,10 years showing Patient satisfaction score at 10 years indicates that uncemented mobile bearing implants have good long-term results, osteolysis and aseptic loosening as the least common cause of revision. It is pertinent that reporting of radiological loosening in an uncemented ankle is not conclusive or reliable for long term survival analysis.

Outcomes of Bone Marrow Stimulation for Secondary Osteochondral Lesions of the Talus Equal Outcomes for Primary Lesions

Category:AnkleIntroduction/Purpose:To compare clinical, sports, work, and radiological outcomes between primary and secondary OLTs (<15mm) treated with arthroscopic BMS.Methods:Ethical approval was obtained before the start of the study. A power analysis was performed for the primary outcome measure, the Numeric Rating Scale (NRS) during activities. Secondary OLTs were matched to primary OLTs in a 1:2 ratio using lesion size, patient age, body mass index, and sex as prognostic covariates to control for confounding. Secondary outcomes included pre- and one-year postoperative clinical assessment of the NRS at rest, American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS) subscales, and the EQ-5D general health questionnaire. The rates and time to return to work and sports were collected. Radiological examinations were performed preoperatively and at final follow-up using computed tomography (CT). The postoperative outcomes were compared with a Wilcoxon rank-sum test; a univariate linear regression analysis was used to investigate the influence of covariates on clinical outcome scores.Results:After matching, 22 and 12 patients with smaller (<15 mm) OLTs were included in the primary and secondary group, respectively. The NRS during activities was not different between primary cases (median: 2, IQR: 1 - 4.5) and secondary cases (median: 3, IQR: 1 - 4), P= 0.5. Both groups showed a significant difference between all pre- and postoperative clinical outcome scores, except for the FAOS symptoms subscale in the primary group and NRS at rest in the secondary group. No significant differences in any clinical outcome scores were found between both groups at one-year follow-up, nor did any covariate significantly influence the clinical outcome scores. The return to sport rate was 90% for primary cases and 83% for secondary cases (P= 0.6). All patients returned to work. Lesion filling on CT was complete (67% - 100%) in 59% of primary cases and 67% of secondary cases (P= 0.6).Conclusion:No differences in outcomes were observed between arthroscopic bone marrow stimulation in primary and secondary OLT at one-year follow-up. Repeat BMS may therefore be a viable treatment option for failed OLTs in the short term.

Gender May Affect Mid-Term Outcomes Following Bone Marrow Stimulation for Osteochondral Lesions of the Talus

Category:AnkleIntroduction/Purpose:Bone marrow stimulation (BMS) is typically indicated as a surgical intervention for patients who have symptomatic osteochondral lesions of the talus (OLT). Despite differences in ankle biomechanics and cartilage morphology between male and female patients, there is scant evidence examining whether these differences affect outcomes following BMS. The purpose of this study was to compare the outcomes in female and male patients following BMS in the treatment of OLTs.Methods:A retrospective analysis comparing female and male patients treated with BMS for OLT between 2007 and 2015 was performed. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS) and Short-Form 12 (SF-12). Magnetic resonance imaging (MRI) at final follow-up was evaluated with the modified magnetic resonance observation of cartilage repair tissue (MOCART) score.Results:Thirty-one females and 38 males were included in this study. The mean patient age was 39.6+-16.9 for females and 36.5+-14.5 years for males. There was no significant difference in age, lesion size, follow-up time, and a number of concomitant procedures. Lateral lesions occurred more frequently in male patients (p=0.034). In female patients, the mean FAOS pain score improved from 60.2 +- 15.5 preoperatively to 84.0 +- 8.9 at 1-2 year follow-up (p<0.001), and then decreased to 80.0 +- 13.1 at final follow-up at 3-4 years, which was not statistically significant (p=0.191). In male patients, the mean FAOS pain score improved from 64.7 +- 17.0 preoperatively to 83.1 +- 9.2 at 1-2 year follow-up (p<0.001), and then decreased to 76.0 +- 14.6 at final follow- up at 3-4 years (p=0.023). The mean MOCART scores were 59.3 +- 24.0 in female patients and 67.3 +- 23.6 in male patients (p=0.278).Conclusion:Lateral lesions were more common in male patients possibly indicating an acute traumatic etiology. Medial lesions were more common in female patients indicating potentially a chronic pathology. This may have implications in reducing the incidence of OLT in female patients. The outcomes following BMS in both female and male patients were good with no significant differences in FAOS pain score and MOCART score at short-term follow-up. FAOS scores in male patients were more likely to decrease after 1-2 years post-surgery, implying a possibly faster decline than in female patients.

Arthroscopic Bone Marrow Stimulation or Non-Operative Treatment for Osteochondral Lesions of the Tibial Plafond

Category:Ankle; ArthroscopyIntroduction/Purpose:A paucity of clinical results from osteochondral lesion of the tibial plafond (OLTP) treatment exists in the literature. The primary purpose of this study was therefore to compare the patient reported outcomes of OLTPs treated with arthroscopic bone marrow stimulation (BMS) and non-operative treatment. The secondary purpose was to compare the reintervention- and complication rates.Methods:Patients treated either with BMS (BMS group) or any form of non-operative treatment (non-operative group) at a minimum follow-up of 12 months were selected from a retrospective database query of patients treated between 1990 and 2020. Eligible patients were contacted by phone and cross-sectionally included. The primary outcome was the Numeric Rating Scale (NRS) during weightbearing. Secondary outcomes included; the NRS in rest, the Foot and Ankle Outcome Score (FAOS), and the Short Form Health Survey (SF-36) general health questionnaire. Additionally, the reintervention- and complication rates were collected.Results:A total of 55 patients were included, which consisted of 15 patients for the non-operative group and 40 patients for the BMS group were analyzed at a mean 73.2 +- 62.9 and 100.5 +- 72.1 months respectively (Table 1). The median NRS during weightbearing was 2 (IQR: 1-5) for the non-operative group and 1.5 (IQR: 0-4) for the BMS group (P= 0.43). The NRS in rest was, similarly, not significantly different between groups. None of the FAOS subscales were found to be significantly different between treatment groups. No reoperations or major complications after follow-up treatment were recorded.Conclusion:Clinical outcomes following arthroscopic BMS and non-operative treatment yield moderate to good clinical results in this cross-sectional cohort OLTP patients. Although this study was the first to report outcomes of non-operative treatment of OLTPs and to compare these to BMS, prospective studies are highly needed for these understudied lesions.