Ankle Society Ankle-Hindfoot Scale Research Articles

Fusion Rates of Ankle Arthrodesis with Anterior Plate Fixation Based on Computerized Tomography and Clinical Outcomes

Category:Ankle; Ankle ArthritisIntroduction/Purpose:Ankle arthrodesis is a common treatment for tibiotalar joint arthritis and anterior plate fixation is often utilized. Prior series reporting on anterior plate fixation for ankle arthrodesis have been relatively small and none have exclusively used post-operative computerized tomography (CT) scans for confirmation of fusion. The purpose of this study was to determine radiographic and clinical outcomes of patients who underwent ankle arthrodesis with anterior plate fixation. The primary outcome of the study was whether or not successful arthrodesis was obtained based on a quantitation of the fusion mass on CT scan.Furthermore, correlation between ankle fusion and clinical outcomes along with complications were evaluated.Methods::Adult patients who underwent ankle arthrodesis with anterior plate fixation (including straight anterior and anterolateral plates) were eligible for this study. Charts were retrospectively reviewed and data was collected in a prospective fashion. In total, 102 patients were included in the study and obtained a CT scan at least 90 days after surgery. The primary outcome was tibiotalar fusion, defined as osseous bridging of 50% or more of the tibiotalar joint based on CT scan reviewed by a single musculoskeletal radiologist. Secondary outcomes included patient reported outcome measures (PROMs): the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Foot function index (FFI), Visual analog scale (VAS) pain score, and Coughlin satisfaction scale. Additional surgeries and complications including nonunion, painful hardware, tibial stress fractures, wound dehiscence, deep infection, superficial infection, and nerve injury/deficit were recorded.Results:Post-operative CT scans demonstrated tibiotalar fusion in 85 of 102 (83.3%) patients. Of the 17 (16.7%) patients who were classified as non-unions, only 8 (47.1%) of them were symptomatic. Five patients (3.9%) in the union group and 2 patients (7.1%) in the non-union group developed tibial stress fractures. In the union group, 13.3% of patients underwent at least one secondary procedure compared to 53.6% in the non-union group (p<0.001). FFI (p=0.04) and Coughlin (p=0.03) scores were statistically lower in patients who underwent secondary procedures. Eighty-six patients (84.3%) did not demonstrate fusion between the lateral talus and fibula by CT but PROM scores were not statistically different compared to patients who demonstrated talofibular fusion.Conclusion:Tibiotalar arthrodesis utilizing anterior plate fixation is a reliable procedure to achieve ankle fusion based on 50% osseous bridging on post-operative CT scan. However, our results utilizing the accuracy of CT scanning demonstrated a lower rate of ankle fusion than historically reports which are primarily based on plain film imaging. Rates of tibial stress fracture and post-operative wound complications are relatively low with anterior plating, supporting this ankle arthrodesis procedure. Post- operative evaluation of ankle fusions using CT scan should be highly consider regardless of technique.

Arthroscopic Bone Marrow Stimulation for the Treatment of Osteochondral Lesions of the Talus Shows Promising Clinical Outcomes Over 10 Years

Category:Arthroscopy; AnkleIntroduction/Purpose:Arthroscopic bone marrow stimulation (BMS) has been considered as the 1st-line treatment for osteochondral lesions of the talus (OLT) with its simplicity, cost-effectiveness, low complication rate and successful clinical results in numerous studies. However, there were few studies which had investigated long-term clinical outcomes about the arthroscopic BMS. The purpose of this study is to evaluate the long-term outcomes of arthroscopic BMS for OLT and to identify prognostic factors that affect the outcomes.Methods:A retrospective analysis was performed for 202 ankles (189 patients) who underwent arthroscopic BMS as a primary surgery for the OLT between January 2001 and December 2008 with more than 10 years of follow-up. Visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scales, Foot and Ankle Outcome Score (FAOS) were assessed as clinical outcomes and re-operation data were collected. The clinical scores were compared along the stream of time. Kaplan-Meier plot and log rank test showed survival outcomes of OLT in the long-term follow-up. Factors associated with revision surgery were evaluated with multivariate Cox proportional hazard regression model.Results:The VAS scales were improved from 7.11 +- 1.73 (preoperatively) to 1.51 +- 1.61 (3 to 6 years after BMS), and 2.00 +-1.67 (over 10 years after BMS) (P < 0.001). Also the AOFAS ankle-hindfoot scale were also improved from 58.39 +- 13.7373 (preoperatively) to 85.85 +- 10.31 (3 to 6 years after BMS), and 82.56 +- 11.62 (over 10 years after BMS) (P < 0.001). FAOS at final follow-up was compatible with those of other literatures with short- and mid-term follow-up. Re-operation rate was 5.94 % (12 / 202 ankles). According to multivariate regression analysis, significant factors associated with the revision surgery were large- size (greater than 150mm2) OLT (P = 0.009) and body mass index greater than 25 kg/m2 (P = 0.014).Conclusion::Arthroscopic bone marrow stimulation is an effective and reliable operative procedure for the primary treatment of osteochondral lesions of the talus with favorable long-term outcomes at a mean follow-up of 13.9 years. Therefore, we recommend this procedure for the 1st-line treatment of the OLT. Success of arthroscopic BMS depends on the size of the OLT and the body mass index of patients.

Modified Bunnell suture repair versus bundle-to-bundle suture repair for acute Achilles tendon rupture: a prospective comparative study of patients aged

BackgroundThis study aimed to compare the operative outcome of percutaneous repair (modified Bunnell suture technique) versus open repair (bundle-to-bundle suture technique) of acute Achilles tendon rupture.MethodsSeventy-two consecutive patients who underwent surgical treatment of Achilles tendon rupture were evaluated in this prospective study. Thirty-six patients were treated using the bundle-to-bundle suture technique (group A), and 36 patients were treated using the modified Bunnell suture technique (group B). All patients underwent functional examination comprising measurement of the calf muscle circumference and performance of the single-leg heel-rise test. The length and diameter of the Achilles tendon were compared between the injured and uninjured sides on magnetic resonance imaging. The number of single-leg heel rises (height > 5 cm) performed within 15 s was compared between the injured and uninjured sides. The ankle range of motion was also recorded. The Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale score, and visual analog scale (VAS) pain score were used to evaluate the clinical outcome at 12 months postoperatively.ResultsA total of 61 patients were followed up. The mean follow-up duration did not significantly differ between group A (23.73 ± 2.81 months) and group B (22.61 ± 3.96 months). However, there were significant differences between groups in the heel-rise test (group A, 1.74 ± 0.96; group B, 2.37 ± 1.42) and length of the Achilles tendon (group A, 11.98 ± 1.64 cm; group B, 11.11 ± 1.74 cm). The calf circumference of the injured side was significantly larger in group A than in group B (p = 0.043). The cross-sectional diameter of the Achilles tendon was significantly smaller in group A than group B. At final follow-up, there were no significant differences between the two groups in the ATRS, AOFAS score, or VAS score. One patient in group A had delayed wound healing, which resolved in 40 days.ConclusionsPatients with acute Achilles tendon rupture treated with open repair (bundle-to-bundle suture technique) achieved a better clinical outcome regarding the heel-rise test and calf circumference compared with those treated with percutaneous repair (modified Bunnell suture technique).Trial registrationChinese Clinical Trial Registry, ChiCTR2000035229, 8/4/2020, Retrospectively registered.

Comparison of suture-button and screw fixation in the treatment of ankle syndesmotic injuries: Cohort study protocol.

Background:Syndesmotic injuries account for a significant number of ankle injuries. There is no consensus regarding the recommended method of treatment. The purpose of this study was to evaluate:(1)functional outcomes,(2)implant survivorship,(3)complications, and(4)radiographic analysis in patients who underwent fixtion with either syndesmotic screw or suture-button technique by the same experienced surgeon.Methods:This study was performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. The records of 200 patients with ankle fractures who had undergone surgical treatment in our clinics between January 2014 and January 2018 were retrospectively investigated. This retrospective cohort study was approved by the institutional review board in the 2nd Hospital of Jilin University. The primary outcome measure was the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale and the Foot Function Index. Secondary outcome measures included visual analog scale score, complications, range of movement of ankle, reoperations, and radiologic outcomes. For statistical comparison of the clinical and radiologic findings between the 2 groups, we used SPSS, version 21.0 (SPSS, Chicago, IL), statistical software. P Values of < .05 were considered statistically significant.Conclusion:The hypothesis was that the SB technique would achieve better functional outcomes as compared to the syndesmotic screw technique after surgery.Trial registration:This study protocol was registered in Research Registry (researchregistry5793).

Medium-term results of calcaneus lengthening in idiopathic symptomatic flat foot in children and adolescents.

Purpose Calcaneus lengthening can be used in symptomatic flat foot in children, but few details on its medium-term results and complementary procedures are available.MethodsA total of 20 flexible, symptomatic, idiopathic valgus flat feet (in 15 children; mean age 13.9 years (10 to 17)) were operated on. Complementary procedures were based on preoperative and intraoperative analyses. Radiographic measurements were obtained preoperatively and with at least four years follow-up.ResultsAt a mean of 8.3 years (4 to 15) postoperatively, 13 feet had good clinical and radiological results, with significant improvement in American Orthopaedic Foot & Ankle Society Ankle-Hindfoot scale scores and radiological measurements. Seven feet had residual pain. Six of them had no osteotomy of the first cuneiform.ConclusionCalcaneus lengthening with adequate complementary musculo-tendinous and/or bone procedures according to preoperative and intraoperative foot deformation leads to good medium-term results. Forefoot supination is the most frequent residual defect. If present intraoperatively, first cuneiform pronation-flexion osteotomy is indicated.Level of evidenceIV

Surgical approach strategies for open reduction internal fixation of closed complex tibial Pilon fractures based on axial CT scans

BackgroundTo explore the application and clinical efficacy of surgical approach strategies in open reduction internal fixation of closed complex tibial Pilon fractures based on axial CT scans.MethodsThis retrospective cohort study included data of 25 patients with closed complex tibial Pilon fractures treated from October 2011 to March 2014, including 19 males and 6 females aged 18–54 years (average 39.5 years). According to classification criteria of the Association for Osteosynthesis/Orthopedic Trauma Association (AO/OTA), 4 patients were type 43C1, 10 type 43C2, and 11 type 43C3. Surgical approaches were selected based on fracture line distribution and bone displacement revealed by axial CT scans, and an open reduction method was adopted for internal fixation of the bone plates. Postoperatively, Burwell-Charnley radiographic criteria were used to determine fracture reduction quality. Functional evaluation was performed using the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. Complications, fracture union time, and the AOFAS scores at last follow-up were recorded.ResultsThe 25 included patients were followed for 22–60 months postoperatively (average follow-up 33.9 months). Of these, 19 patients achieved anatomical reduction of the articular surface, 5 achieved good reduction, and one achieved fair reduction. Two patients developed superficial infection on the anteromedial incision and delayed union but recovered well after local dressing change and oral administration of antibiotics. Another patient developed deep infection on the anterolateral incision, which was controlled by debridement, catheter irrigation, and intravenous antibiotic injection. All fractures healed well and average union time was 2.8 months (range, 2–3 months). No fracture malunion or internal fixation failures were found at last follow-up. All 25 patients had AOFAS scores ranging from 80 to 100 at last follow-up (average 88.4). Overall, 15 patients were excellent, 10 good, and 0 fair or poor, with excellent and good rates of 100%.ConclusionsSurgical approach strategies for complex tibial Pilon fractures based on axial CT scans accurately reconstruct the articular surface and achieve solid internal fixation of assembled locking plates, while early postoperative functional exercises contribute to the functional recovery of affected limbs and reduce related complications.

Combined Posteromedial and Posterolateral Approaches for 2-Part Posterior Malleolar Fracture Fixation.

This study investigated the clinical efficacy of combined posteromedial and posterolateral approaches for repair of 2-part posterior malleolar fractures associated with medial and lateral malleolar fractures. This case series report included 27 Weber B with Haraguchi type II patients with medial and lateral malleolar fractures combined with 2-part posterior malleolar fractures. Patients were treated with open reduction and internal fixation through a combination of posteromedial and posterolateral approaches from January 2015 to January 2018. There were 11 males and 16 females, with an average age of 61.5 years (range, 53-67 years). The procedures were performed on prone patients under spinal anesthesia. The medial, lateral, and posterior malleolar fractures were exposed through posteromedial and posterolateral approaches performed at the same time. The lateral malleolar fracture was fixed using a plate, the medial malleolar fracture was fixed using screws, and the posterior malleolar fracture was fixed using a plate or cannulated screws according to the size of the fragments. We performed follow-up on 22 patients for an average of 30 months (range, 18-48 months). Primary healing of the incisions was achieved in all cases, and no infection was found. The mean time of bone union was 12.5 weeks (range, 10-15 weeks). The mean time from the operation to full weightbearing was 13 weeks (range, 11-16 weeks). We used the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale to score patient outcomes; the mean score was 85.4 (range, 80-92) at the final follow-up. No significant pain was found at the final follow-up. This study showed that satisfactory outcomes were achieved with combined posteromedial and posterolateral approaches. Therefore, we believe this approach was a good alternative strategy to repair 2-part posterior malleolar fractures associated with medial and lateral malleolar fractures. Level IV, retrospective case series.

Achilles tendon-splitting approach and double-row suture anchor repair for Haglund syndrome

BackgroundHaglund syndrom is characterized as a painful posterosuperior deformity of the heel with possible causes as tight Achilles tendon, high-arched foot and tendency to walk on the outside of the heel. Surgical treatment may be recommended in cases where of insufficient response to nonoperative treatment. This study aims to evaluate the clinical and radiographic results of central Achilles tendon splitting and double-row suture anchor technique in the surgical treatment of patients with Haglund syndrome. Methods27 patients with Haglund syndrome who underwent central Achilles tendon splitting and double-row suture anchor were retrospectively evaluated. The results were evaluated by the pre- and post-operative American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and visual analogue scale (VAS). All patients were evaluated radiographically to assess lateral talus-first metatarsal angle (TMTA), Calcaneal pitch angle (CPA), and the Fowler-Philip angle (FPA) preoperatively and postoperatively. ResultsThe mean preoperative AOFAS score was 47 ± 7 points; at the end of the follow-up period, it increased to 92 ± 4 points (p < 0.001). The mean preoperative VAS score was 9 ± 0.9 points; at the end of the follow-up period, it was 2 ± 0.6 points (p < 0.001). The lateral TMTA (preoperative: 5° ± 2°; follow-up: 4° ± 2°; p < 0.001), CPA (preoperative: 21° ± 5°; follow-up: 20° ± 5°; p = 0.005) and FPA (preoperative: 55° ± 6°; follow-up: 32° ± 3°; p < 0.001) values decreased at the end of the follow-up period. ConclusionIn the absence of an improvement to nonoperative treatment methods, central Achilles tendon-splitting approach appears to be an effective and safe treatment option. Level of evidenceLevel IV, retrospective case series.

Silver acupuncture for myofascitis: A protocol for systematic review and meta-analysis.

Background:This systematic review aims to evaluate the effectiveness and safety of silver acupuncture in treatment of myofascitis.Methods:Electronic databases of all silver acupuncture for myofascitis will be searched at PubMed, Cochrane Library, Springer, Embase, China National Knowledge Infrastructure, Wanfang, and Chinese Biological Medical disc from inception to March 31, 2020, with language restricted in Chinese and English. The primary outcome is visual analog scale, a short pain scale with sensitivity and comparability. Secondary outcomes included Clinical Assessment Scale for Cervical Spondylosis, Japanese Orthopaedic Association Scores, Oswestry dysfunction index, American Orthopaedic Foot and Ankle Society-Ankle Hindfoot scale, Foot and Ankle Ability Measure, The Cumberland ankle instability tool, Pittsburgh sleep quality index, self-rating anxiety scale, self-depression rating scale, and follow-up relapse rate. The systematic review and searches for randomized controlled trials of this therapy for myofascitis. The Cochrane RevMan V5.3 bias assessment tool is implemented to assess bias risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). Mean difference, standard mean deviation, and binary data will be used to represent continuous results.Results:This study will provide a comprehensive review and evaluation of the available evidence for the treatment of myofascitis with this therapy.Conclusion:This study will provide new evidence to evaluate the effectiveness and side effects of silver acupuncture for myofascitis. Due to the data are not personalized, no formal ethical approval is required.Ethics and dissemination:There is no requirement of ethical approval and it will be in print or disseminated by electronic copies.PROSPERO registration number:CRD42020151476

Arthroscopic Ankle Arthrodesis Provides Similarly Satisfactory Surgical Outcomes in Ankles With Severe Deformity Compared With Mild Deformity in Elderly Patients

To evaluate the surgical outcome in terms of radiographic measurements, functional outcomes, and complications following arthroscopic ankle arthrodesis (AAA) in patients 60 years of age or older, and to compare the results of patients with mildly deformed ankle with those of patients with severely deformed ankle. We retrospectively reviewed patients who underwent AAA with 3 cannulated screws between January 2008 and December 2017 and followed postoperatively for at least 24 months. All included patients were 60 years of age or older. Demographic data and radiographic and functional outcomes were compared between patients with coronal deformity of less than 15° (group I) and those with a deformity equal to or greater than 15 degrees (group II). A total of 41 patients with a mean age of 70.6 years were included (group I, n= 26; group II, n= 15) and mean follow-up was 51.4 months. Group II had significantly more severe preoperative coronal deformity of tibiotalar angle than group I (20.1 ± 2.9 vs 6.6 ± 4.1°, P < .01). Near-normal tibiotalar alignment was achieved postoperatively in both groups (group I, 3.4 ± 3.3 vs group II, 4.7 ± 3.1°, P= .227). Union was achieved in 39 (95.1%) patients with 2 cases in group I experiencing non-union. Union rate, mean American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, and visual analog scale pain scores were not significantly different between the 2 groups at final follow-up. AAA is a reliable procedure for end-stage ankle arthritis in patients 60 years of age or older resulting in a high union rate, encouraging radiographic and functional outcomes, and a low complication rate, even in cases with severe preoperative deformity. In addition, arthroscopic intra-articular malleolar osteotomy was a useful technique for correcting severe coronal deformity in our series. Level III, retrospective comparative study.

Comparison of dorsal closing wedge calcaneal osteotomy versus posterosuperior prominence resection for the treatment of Haglund syndrome

BackgroundHaglund syndrome is a common disease that causes posterior heel pain. This study compared the clinical outcomes of dorsal closing wedge calcaneal osteotomy (DCWCO) and posterosuperior prominence resection (PPR) for the treatment of Haglund syndrome.MethodsThis retrospective study included 12 patients who underwent DCWCO and 32 patients who underwent PPR from January 2010 to August 2016. Patients were evaluated using the American Orthopedic Foot Ankle Society ankle-hindfoot scale (AOFAS), Victorian Institute of Sport Assessment Scale for Achilles tendinopathy (VISA-A), Fowler-Philip angle, Bohler’s angle, and calcaneal pitch angle preoperatively and postoperatively (at 3 months, 6 months, 1 year, and the latest follow-up).ResultsBoth groups exhibited a significant increase in their AOFAS and VISA-A scores after surgery. The DCWCO group had lower AOFAS scores than the PPR group at 6 months (77.6 ± 5.1 vs. 82.8 ± 7.8; P = 0.037) but had higher scores at the latest follow-up (98.2 ± 2.3 vs. 93.4 ± 6.1; P = 0.030). The DCWCO group had lower VISA-A scores at 3 months (56.9 ± 13.9 vs. 65.2 ± 11.0; P = 0.044) but higher scores at the latest follow-up (98.2 ± 2.6 vs. 94.3 ± 5.0; P = 0.010) than the PPR group. Both groups exhibited significant changes in the Fowler-Philip angle and Bohler’s angle after surgery. The postoperative Fowler-Philip angle of the DCWCO group was greater than that of the PPR group (35.9° ± 4.9° vs. 31.4° ± 6.2°; P = 0.026). However, there was no statistically significant difference in any other angle of the two groups postoperatively.ConclusionsCompared to the PPR group, the DCWCO group had poorer short-term clinical outcomes but provide better long-term function and symptom remission. This method can be a good option for those patients with higher functional expectations.

Insertional Achilles tendinopathy

Objective: Retrospectively analyze surgical procedures performed on patients with insertional Achilles (calcaneal tendon) tendinopathy, focusing on outcomes and the impact on the patients’ functional quality. Methods: A descriptive, retrospective, case series study drawn up by collecting data directly from the patients’ medical records. For the functional analysis of patients, we used the questionnaire of the adapted American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS). An assessment was carried out on each of the patients who underwent surgery at our hospital from 2010 to 2019, using the surgical technique described in this article, i.e., resection of the affected portion of the tendon with its subsequent reinsertion. Results: All surgical patients achieved an improvement in their AOFAS score and in pain levels, with good functional performance only three months into the postoperative period, from 50.1 to 83.75 (p&lt;0.001). Conclusion: The use of the technique proved very effective, particularly in terms of the maintenance of foot function and important improvement in pain levels, thus producing a relevant increase in function among patients. Level of Evidence IV; Therapeutic Study; Case Series.

Danish Language Version of the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) in Patients with Ankle-Related Fractures

The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) is, to date, the most widely used scale for evaluating foot and ankle disorders. We translated it into Danish and evaluated the reliability, validity and responsiveness of the Danish version of the AOFAS-AHS (AOFAS-DK) in patients aged >18 years with isolated ankle-related fractures. Forward-backward translation, cross-cultural adaption, and validation study were performed. In total, 125 patients completed the AOFAS-DK and the Self-reported Foot and Ankle Score (SEFAS) at 3 time points after the date of fracture. The evaluation was performed according to the Consensus-based Standards for the selection of health Measurement Instruments guidelines. The intra-class correlation coefficient level of the AOFAS-DK total score was 0.87 (95% confidence interval: 0.80-0.91). Cronbach's alpha (CA) for the AOFAS-DK function subscale was 0.62, whereas the floor and ceiling effect of the function subscale was 32% (T1) and 19% (T2), respectively. Construct validity was correlated with the SEFAS, and >75% of the predefined hypotheses could be confirmed. Responsiveness was analyzed using longitudinal data, and showed that the AOFAS-DK can detect changes in scores. The Danish version of the self-administered section of the AOFAS-AHS showed overall good reliability, validity, and responsiveness. The low CA values and the presence of the floor effect might be due to the low number of items and response options available in the scale. The AOFAS-DK can be used to evaluate physical function in patients with ankle-related fractures.

The Clinical Efficacy of Two Endoscopic Surgical Approaches for Intractable Plantar Fasciitis

In this randomized retrospective study, 2 different endoscopic approaches were used to treat intractable plantar fasciitis with the aim to reduce complications and improve therapeutic effects. The lateral double incisions group included 23 feet in 22 patients, and the medial and lateral incisions group included 21 feet in 19 patients. Both groups were treated with endoscopy through the suprafascial approach. Patients were evaluated using the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale (AOFAS-AHS) and visual analog scale (VAS) preoperatively and 3, 6, 12, and 24 months postoperatively. At the final follow-up, the Roles-Maudsley (R-M) score was used to determine patient satisfaction. The AOFAS-AHS scores of the lateral double incisions group were 54.54 ± 7.02 preoperatively and 97.71 ± 3.67 postoperatively. Similarly, AOFAS-AHS scores in the medial and lateral incisions group were 55.52 ± 6.41 preoperatively and 96.64 ± 3.18 postoperatively. There was no significant difference in AOFAS-AHS scores between groups before and after surgery. The time to full weightbearing after surgery and the time to return to full athletic activities in the 2 groups showed no significant difference. The postoperative VAS scores were significantly lower than the preoperative values for both groups. However, no differences were noted in VAS scores or R-M scores postoperatively between the 2 groups. In the medial and lateral incisions group, 3 cases of injury of the first branch of the lateral plantar nerve occurred postoperatively. In conclusion, both endoscopic approaches are effective in the treatment of intractable plantar fasciitis. The lateral double incisions approach showed a lower incidence of nerve injury.

Comparison of the therapeutic outcomes between open plantar fascia release and percutaneous radiofrequency ablation in the treatment of intractable plantar fasciitis

BackgroundHeel pain is one of the most common complaints in foot and ankle clinic, and one of the leading causes of heel pain is plantar fasciitis.MethodsA retrospective analysis was carried out in 31 cases (39 feet) of patients with intractable plantar fasciitis. In the enrolled 26 cases, 16 patients (19 feet) received open plantar fascia release, and the other 15 patients (20 feet) received percutaneous radiofrequency ablation. The surgical results were assessed by visual analog scale (VAS) and American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AH) before and after surgery in all patients.ResultsAll 31 patients were followed up successfully, with a mean follow-up time of 58.77 months. There were no differences of patient’s demographics and characteristics information between the two groups. The average operative time of the feet in the open plantar fascia release is longer than that in the percutaneous radiofrequency ablation. Furthermore, the percutaneous radiofrequency ablation group had a shorter recovery time to normal activity than the open plantar fascia release group. There were no differences of postoperative VAS scores and the AOFAS-AH scores between the two groups. All patients reported satisfaction after either operation.ConclusionThe symptoms of pain and limb function were significantly improved in patients both of the partial plantar fascia release treated group and the percutaneous radiofrequency ablation treated group. The two types of surgical procedures shared the same long-term curative effects. However, percutaneous radiofrequency ablation was a better technique from the point of shorter operative time and postoperative recovery time.Trial registrationRetrospectively registered.

A modified posterolateral approach for lateral and posterior malleolar fractures: a preliminary report

Objective To observe the clinical efficacy of internal fixation through a modified posterolateral approach in the treatment of lateral and posterior malleolar fractures. Methods From January 2015 to January 2018, 25 patients with fracture involving the lateral and posterior malleolus were treated at Department of Orthopedics, The Second Affiliated Hospital to Wenzhou Medical University. They were 13 males and 12 females, aged from 18 to 70 years (mean, 43.1 years). By the Lauge-Hansen classification for ankle injury, 9 cases belonged to supination-supination type of degree Ⅲ, 11 to supination-supination type of degree Ⅳ, and 5 to pronation-supination type of degree Ⅳ. By the Haraguchi classification, all the posterior malleolar fractures in this series belonged to type Ⅰ. Internal fixation through a modified posterolateral approach was performed for all the lateral and posterior malleolar fractures. Their operation time, fracture healing time and postoperative complications were observed. At the last follow-up, ankle joint function was assessed by the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale. Results In the 25 patients, the operation time ranged from 50 to 100 min (mean, 70 min). Of this group, 21 patients were followed up for 12 to 18 months (mean, 14 months). Bony union was achieved after 3 to 5 months after operation. Superficial wound infection was observed in 3 cases. No such complications occurred like postoperative adhesion, deep infection, contracture of flexor hallucis longus tendon, or loosening or breakage of implants. By the AOFAS ankle-hindfoot scale at the last follow-up, the ankle function was excellent in 13 cases, good in 6 and fair in 2. Conclusion The modified posterolateral approach is worth popularizing in clinic because it provides possibilities of fixating the lateral and posterior malleolar fractures by the same incision, not stripping the muscular origins of the flexor hallucis longus and reducing postoperative adhesion of the flexor hallucis longus. Key words: Fractures, bone; Ankle joint; Fracture fixation, internal; Approach

Hind-foot endoscopic decompression of the retrocalcaneal space as an appropriate treatment for refractory Haglund’s syndrome

Background The traditional operative management of Haglund deformity and retrocalcaneal bursitis consists of an open excision of the inflamed bursa, resection of the posterosuperior calcaneal tuberosity, and debridement of the Achilles tendinopathy. In an effort to reduce morbidity and recovery time, an endoscopic technique was used for the management of this condition. The purpose of the current study was to evaluate the results from our patient series through the use of endoscopic bony and soft-tissue decompression of the retrocalcaneal space, calcaneal tuberosity resection, and Achilles tendon debridement as an appropriate treatment for refractory Haglund’s syndrome. Patients and methods Between January 2014 and June 2015, endoscopic management of Haglund’s syndrome was performed on 26 feet in 22 patients. The study included six males (six heels) and 16 females (20 heels), with a mean age of 24.3 years (range, 18–35 years). All patients experienced symptoms for a mean duration of 12.9 months (range, 8–20 months) before the operation. Patients were evaluated preoperatively and postoperatively with the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale. Results The mean follow up period was 18 months. All patients (26 heels) were available for follow-up. The American Orthopaedic Foot and Ankle Society scores averaged 62 preoperatively and 97 postoperatively. There were 17 excellent results, seven good results, and two poor results. One major complication occurred was an Achilles tendon rupture 3 weeks after surgery and residual pain and swelling that required reoperation through an open procedure. There were no wound complications or postoperative infections. Conclusion An endoscopic procedure seemed to be a safe and efficacious option for surgical treatment of Haglund’s syndrome. Sufficient exposure of the Achilles tendon and removal of the calcaneal prominence and retrocalcaneal bursa can be done effectively using an endoscopic technique and has a low morbidity and high patient satisfaction. The time to return to normal activity level is short.

The relationship between changes in distal tibiofibular joint congruence and clinical and functional results in the short-term follow-up of patients operated on for ankle fracture.

The effects of changes in distal tibiofibular joint (DTFJ) congruence on clinical and functional outcomes are unclear in patients operated on for ankle fractures. The present study aims to evaluate the relationship between changes in DTFJ congruence and clinical and functional outcomes in the short-term follow-up of the patients operated on for ankle fractures. In this study, hospital records of patients who were operated on for ankle fractures were retrospectively analyzed. The data of patients who underwent bilateral ankle computed tomography scans at least 18 months after surgery were used. DTFJ congruence was evaluated using four methods. Method 1: the distance between the most prominent anterior points of the tibia and fibula (anterior incisura [AI]) and that between the most prominent posterior points of the tibia and fibula (posterior incisura [PI]) were measured. Method 2: the direct anterior (DA) and direct posterior (DP) distances were measured based on perpendicular lines drawn from the most prominent anterior and posterior points of the longitudinal axis of the fibula to the tibia, respectively, and a direct translation (DT) distance was measured based on a perpendicular line drawn to the DA from the most prominent anterior point of the tibia. Method 3: the angle between a line connecting the most anterior and posterior points of the tibia and a line connecting the most anterior and posterior points of the fibula (rotational angle [RA]) was measured. The differences in distances and angles (dAI, dPI, dDA, dDP, dDT, and dRA) between the injured and non-injured sides were calculated in the first three methods. Method 4: any rotational/translational incongruency on the injured side was subjectively reported. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Olerud-Molander Ankle Score (OMAS), and Visual Analog Scale (VAS) were used for clinical and functional evaluations. Thirty patients (18 males and 12 females; mean age, 43.3 [range, 20-78 years] years) were included in this study. The average follow-up was 37.6 (range, 18-54 months) months. Negative correlations were detected between dDA and the AOFAS-pain subscale (r=-0.37; p=0.04), between dDP and the OMAS (r=-0.57; p=0.01), and between dDT and the AOFAS-pain, AOFAS-function, and OMAS (r=-0.55 p=0.01; r=-0.40; p=0.03; r=-0.39; p=0.04, respectively). Changes in dDA, dDP, and dDT values affect the clinical and functional outcomes. These parameters should be provided in accordance with the anatomy of the patient during the reduction of the DTFJ to achieve better outcomes.

Arthroscopic Microfracture for Osteochondral Lesions of the Talus: Functional Outcomes at a Mean of 6.7 Years in 165 Consecutive Ankles

Background: Arthroscopic microfracture for osteochondral lesions of the talus (OLT) has shown good functional outcomes. However, some studies have reported that functional outcomes deteriorate over time after surgery. Purpose: To use various functional scoring systems to evaluate functional outcomes in a large sample of patients with OLT treated by arthroscopic microfracture. Study Design: Case series; Level of evidence, 4. Methods: The study cohort consisted of 165 ankles (156 patients) that underwent arthroscopic microfracture for small to mid-sized OLT. The mean lesion size was 73 mm2 (range, 17-146 mm2), and the mean follow-up period was 6.7 years (range, 2.0-13.6 years). The Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, visual analog scale (VAS) for pain, and 36-Item Short Form Health Survey (SF-36) were used to compare the functional outcomes between the preoperative and final follow-up assessments. Results: The mean FAOS significantly improved in regard to all subscores (P < .001). The AOFAS ankle-hindfoot scale showed an improvement from 71.0 points (range, 47.0-84.0) preoperatively to 89.5 points (range, 63.0-100) at the final follow-up (P < .001). The VAS score showed an improvement from 6.2 points (range, 4.0-9.0) preoperatively to 1.7 points (range, 0-6.0) at the final follow-up (P < .001). The mean SF-36 score improved from 62.4 points (range, 27.4-76.6) preoperatively to 76.2 points (range, 42.1-98.0) at the final follow-up (P < .001). Among 165 ankles, 22 ankles (13.3%) underwent repeat arthroscopic surgery for evaluation of repaired cartilage status. Conclusion: Arthroscopic microfracture showed good functional outcomes and improved quality of life with maintenance of satisfactory outcomes at a mean follow-up of 6.7 years. Therefore, arthroscopic microfracture seems to be reliable as a first-line treatment for OLT at an intermediate-term follow-up.

Endoscopic Plantar Fascia Release versus Cryosurgery for the Treatment of Chronic Plantar Fasciitis: A Prospective Randomized Study.

In a prospective randomized study, we compared two different surgical techniques used in plantar fasciitis surgery. Forty-eight patients diagnosed as having plantar fasciitis and treated for at least 6 months with no response to conservative modalities were included in this study. The patients were randomly assigned to receive endoscopic plantar fascia release (EPFR) or cryosurgery (CS). Patients were evaluated using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) as a primary outcome measurement at baseline and 3 weeks and 3, 6, and 12 months after surgery. At the final follow-up visit, the Roles-Maudsley score was used to determine patient satisfaction. Five patients did not complete the 1-year follow-up examination (one in the EPFR group and four in the CS group). Thus, the study group included 43 patients. Although both groups showed significant improvement at the final evaluation, the patients in the EPFR group had significantly better AOFAS-AHS scores at 3 months. The success rate (Roles-Maudsley scores of excellent and good) in the EPFR group at 12 months was 87% and in the CS group was 65%. Both EPFR and CS were associated with statistically significant improvements at 1-year follow-up. At 3-month follow-up, EPFR was associated with better results and a higher patient satisfaction rate compared with CS.