Ankle Society Score Research Articles

A novel alphanumeric classification system for ankle fractures: clinical applications and evaluation

PurposeThe purpose of this study was to introduce and evaluate the Descriptive Ankle Fracture Classification (DAFC) system, a novel alphanumeric method for categorizing ankle fractures and fracture dislocations, and to assess its reliability and prognostic value compared to traditional classification systems (AO/OTA, Weber, and Lauge-Hansen).Materials and methodsA retrospective review was conducted on 90 patients who underwent surgical treatment for ankle fractures. Four observers of varying experience levels classified the fractures using the DAFC, AO/OTA, Weber, and Lauge-Hansen classification systems. Interobserver and intraobserver reliability were evaluated using Fleiss’ Kappa coefficient. Functional outcomes were assessed with the American Orthopaedic Foot & Ankle Society (AOFAS) and Olerud Molander Ankle Score (OMAS) systems, and comparisons were made across classification systems to determine prognostic value.ResultsThe DAFC system demonstrated superior interobserver reliability, particularly for medial malleolus fractures (Kappa = 0.935–0.954) and syndesmotic injuries (Kappa = 0.873–0.891), compared to the other systems. Intraobserver reliability was consistently high across all categories in the DAFC system, with Kappa values ranging from 0.967 to 1.000. Functional outcomes revealed significant associations with the DAFC classification: patients with complete dislocation (D2) had significantly lower AOFAS and OMAS scores than those without dislocation (D0) (P = 0.011), and those with larger posterior malleolus fractures (P2) had poorer OMAS scores (P = 0.014). No statistically significant differences in AOFAS or OMAS scores were observed across AO/OTA, Weber, or Lauge-Hansen classifications.ConclusionsThe DAFC system offers a reliable and comprehensive framework for ankle fracture classification, with the added benefit of prognostic insights, particularly regarding dislocation and posterior malleolus involvement. Its high interobserver and intraobserver reliability, even among observers with varying experience, suggests that the DAFC system is valuable for clinical use. Future research should focus on validating these findings in larger cohorts and assessing the DAFC system’s impact on long-term patient outcomes.Level of evidenceLevel IV, Retrospective cohort.

Arthroscopic lateral ligament reconstruction for isolated chronic lateral ankle instability is associated with longer recovery compared to arthroscopic Broström repair and inferior extensor retinaculum augmentation.

Patients with chronic lateral ankle instability (CLAI) can be managed with arthroscopic Broström repair and inferior extensor retinaculum augmentation or arthroscopic assisted lateral ligament reconstruction using ipsilateral semitendinosus autograft, with good functional outcomes in patients. It is unclear whether one offers better outcome that the other. This retrospective analysis of prospectively collected data compared the outcomes of repair and reconstruction. Patient treated for CLAI by arthroscopic Broström repair and inferior extensor retinaculum augmentation (Repair/augmentation Group; n=39) and lateral ligament reconstruction (Reconstruction Group; n=23) procedures with a minimum follow-up of 24 months were enrolled. The operative time, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Functional Score (KAFS), Tegner score, Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the time of the patients return to sports activities were assessed. The operative time was longer in the Reconstruction Group. The patients in the Reconstruction Group experienced more pain. At 3 months after surgery, the patients in Repair/augmentation Group gained better AOFAS, KAFS, Tegner, and AJPS scores. At 6 months after surgery, better KAFS and AJPS were observed in Repair/augmentation Group. At 1 and 2 years, patients in the Reconstruction Group recorded better functional outcomes (AOFAS and KAFS) compared to the Repair/augmentation Group. The mean time of the patients return to sports activities was 10.42 ± 7.77 weeks (range, 8-56 weeks) in the Repair/augmentation Group, compared to 14.18± 5.34 weeks (range, 8-24 weeks) in the Reconstruction Group (p = 0.049). In CLAI patients, arthroscopic reconstruction yields better outcomes in terms of ATT, AOFAS, and KAFS in the mid-term; however, it is associated with a longer intraoperative time, delayed return to sports, and an extended duration to resume normal ankle function compared to the arthroscopic Broström repair and inferior extensor retinaculum augmentation procedure.

An alternative fixation for all mild and moderate hallux valgus cases enabling intraoperative readjustment

BackgroundThe development of a cost-effective and easily applicable fixation method to address all components of hallux valgus (HV) surgery is of great importance to the field. This study aims to assess the clinical efficacy of an alternative fixation method that combines the advantages aspects of commonly used distal osteotomy techniques and evaluate its level of applicability in the treatment of mild and moderate HV cases.MethodsThe retrospectively designed study was conducted at Adana City Training and Research Hospital, Adana, Türkiye. The inclusion criteria were as follows: having undergone distal metatarsal osteotomy, minimum duration of follow-up of twelve months, and the availability of dorsoplantar weight-bearing X-ray images of the foot performed preoperatively and at the follow-up visits. The analysis data included age, gender, Visual Analog Scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores, the values of the length of the 1st metatarsal, hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), rotation type of the first metatarsal (RTFM), and the position of the tibial sesamoid (TSP).ResultsA total of 82 files were available for analysis. The mean age of the patients was 40.5 ± 13.8 (Median = 43) years; 67 (81,7%) were female, and 15 (18.3%) were male. The mean operation duration was 33.2 ± 3.0 min. The mean follow-up period was 22.7 ± 7.0 months. There was a linear relationship between the average age of the patients and the shortness (mm) values (r = 0.466; p < 0.001). The HVA, IMA, DMAA, TSP, and VAS scores were lower in the patients after the operation compared to before values (p < 0.001). The preoperative assessment of RTFM identified 15 cases with an angular type, 38 cases with an intermediate type, and 29 cases with a round type. The postoperative mean AOFAS value was higher than the mean score before the operation (p < 0.001). A dramatic reduction was observed in postoperative IMA and DMAA values (p < 0.001).ConclusionThis study’s findings demonstrate the benefits of a new fixation method for treating HV that is applicable to all mild and moderate HV cases. This method enables intraoperative readjustment without compromising the fixation strength and has a short learning curve.

Clinical outcomes of arthroscopic modified suture augmentation versus InternalBrace™ reconstruction in the treatment of chronic ankle instability

BackgroundAt present, the modified suture augmentation (MSA) repair and the InternalBrace™ (IB) reconstruction techniques are commonly used for the treatment of chronic ankle instability (CAI). This study aimed to evaluate and compare the clinical efficacy of the MSA repair and IB reconstruction techniques, providing a reference for clinical practice.MethodsAfter propensity score matching, 50 patients with CAI between May 2021 and May 2022 were included in this retrospective study. Of these, 26 underwent IB reconstruction surgery and 24 underwent MSA repair surgery. The American Orthopedic Foot and Ankle Society (AOFAS) scores, visual analog scale (VAS) scores, anterior drawer tests, and patient satisfaction were used for clinical efficacy evaluation.ResultsThe postoperative AOFAS scores in the MSA group (88.8 ± 3.0) were significantly higher than those in the IB group (84.3 ± 5.4, P = 0.001). However, the patient satisfaction scores in the IB group (7.3 ± 0.8) were higher than those in the MSA group (6.7 ± 0.8, P = 0.02). There were no significant differences between the two groups in the anterior drawer test results and VAS scores (P < 0.05). In addition, regarding postoperative complications, only one patient (4.2%) in the MSA group had joint laxity.ConclusionsMSA repair was superior to IB reconstruction in terms of AOFAS scores. However, IB reconstruction was superior in terms of patient satisfaction. These findings highlight the potential of MSA repair and IB reconstruction techniques for the treatment of CAI.

Comparative study of arthroscopic autologous cancellous bone grafting and medial malleolar osteotomy combined with autologous periosteal iliac bone grafting for the treatment of osteochondral lesions of the talus

BackgroundSurgical management methods for Hepple IV-V osteochondral lesions of the talus (OLT) are diverse. This study aimed to compare the clinical efficacy of arthroscopic autologous cancellous bone grafting and medial malleolar osteotomy combined with autologous periosteal iliac bone grafting in the treatment of medial Hepple IV-V OLT.MethodsA retrospective analysis of clinical data from patients who underwent surgical treatment for Hepple IV-V OLT (2020–2023) was conducted. A total of 37 patients were included, with 17 receiving arthroscopic autologous cancellous bone grafting (Group A) and 20 receiving medial malleolar osteotomy combined with autologous periosteal iliac bone grafting (Group B). Compared the surgical time of the two groups; the visual analog scale (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and ankle joint mobility were used preoperatively, and at 3 months and 1 year postoperatively to assess clinical efficacy; the magnetic resonance observation of cartilage repair tissue (MOCART) 2.0 ankle scores were evaluated at early postoperatively and 1 year postoperatively to assess cartilage repair.ResultsThe surgical time for Group A was significantly shorter than Group B (P < 0.05). At 3 months and 1 year postoperatively, both groups showed a significant improvements in VAS scores, AOFAS scores, and ankle joint mobility compared to preoperative levels (P < 0.05). At 3 months postoperatively, Group A had significantly higher AOFAS scores and ankle joint mobility than Group B (P < 0.05), while there was no statistically significant difference in VAS scores between the two groups (P > 0.05). At 1 year postoperatively, no significant differences in any of the assessed parameters were found between the two groups (P > 0.05). The MOCART 2.0 ankle scores at 1 year postoperatively were significantly higher than early postoperatively for both groups (P < 0.05), with no significant differences between the two groups (P > 0.05).ConclusionArthroscopic autologous cancellous bone grafting showed superior early functional recovery at the 3-month follow-up compared to medial malleolar osteotomy combined with autologous periosteal iliac bone grafting, with shorter surgical time and avoiding osteotomy. Both surgical methods were able to relieve patients’ pain, restore function, and improve cartilage repair.Level of evidenceIII, retrospective comparative study.

Treatment of irreducible second metatarsophalangeal joint dislocation by double percutaneous osteotomy: Haspell and distal metatarsal mini-invasive osteotomy.

Subluxation or dislocation of the second metatarsophalangeal joint may be commonly associated with crossover toe, metatarsalgia, and painful calluses. This retrospective study aims to evaluate the clinical and functional results in patients with irreducible second metatarsophalangeal joint dislocation treated by double percutaneous osteotomy in one step: Haspell's osteotomy and Distal Metatarsal Mini-Invasive Osteotomy. A total of 39 patients were included in this study. 31 patients had a simultaneous procedure on the first ray for hallux valgus correction. The American Orthopaedic Foot and Ankle Society score (AOFAS), the degree of joint range of motion (ROM) and hyperkeratosis of the second ray were assessed as outcomes at the baseline (T0), at 6 months (T1), and at 1 year (T2) from surgery. The mean pre-operative AOFAS score was 62.76 ± 5.5, at 6 months after surgery it increased to a value of 78.81 ± 8.15 and at one year to a value of 88.78± 6.51. No differences in term of ROM were found between pre and postoperative values at 6 months. A significant improvement in ROM at 12 months was found. Hyperkeratosis, assessed with a nominal scale classification, decreased statistically significantly and, one year after surgery, in 88.88 % of cases they completely resolved. The double percutaneous osteotomy brings advantages in terms of pain reduction. In conclusion, DMMO associated with Haspell's osteotomy is a safe and effective and reproducible technique in the resolution of metatarsalgia in patient with irreducible instability of the second metatarsophalangeal joint. LEVEL OF CLINICAL EVIDENCE: 4.

First metatarsal osteotomy with an intramedullary locking plate is a good alternative for the reintervention of recurrent hallux valgus.

This study describes the results of first metatarsal (M1) distal osteotomy with an intramedullary locking plate in persistent/recurrent painful hallux valgus (HV) deformity (without advanced degenerative changes) after primary surgery. Outcomes included postoperative incidences of HV angle (HVA)<16°, intermetatarsal angle (IMA)<9°, proximal articular set angle (PASA)<10°, and the American Orthopedic Foot and Ankle Society (AOFAS) score. Data normality was assessed with the Shapiro-Wilk test, and preoperative vs. postoperative comparisons, as well as postoperative angles vs. preestablished thresholds, were performed with the Wilcoxon signed rank test or the paired Student's t-test, as applicable. Firth's penalized logistic regression analyzed the association between severe complications and undergoing surgery before 2017. Thirty-two patients were included, with a median (range) age of 62.5 (40.0 - 84.0) years; 31 (96.9 %) were females. The minimum follow-up was 24 months. Postoperative incidences (95 %CI) of HVA<16°, IMA<9°, and PASA<10° were, respectively, 75.0 % (57.9 - 86.8 %), 93.8 % (79.9 - 98.3 %), and 56.0 % (33.6 - 66.4 %). Median postoperative HVA, IMA, PASA, and AOFAS score values improved significantly (p < 0.001 for all). Postoperative HVA and IMA were significantly better than preestablished thresholds (p = 0.008 and p < 0.001, respectively), but the PASA was not (p = 0.507). Seven (21.9 %) patients experienced Clavien-Dindo ≥IIIa complications, all in the early implementation period (first 5 years), corresponding to the first 20 surgeries performed (p = 0.046). In conclusion, distal M1 osteotomy plus stabilization with an intramedullary plate offers a viable joint-preserving alternative for recurrent moderate to severe HV deformities in patients without severe arthritic changes or hypermobility of the first TMT joint. LEVEL OF EVIDENCE: IV.

The impact of mental health disorders on outcomes following total ankle arthroplasty: A systematic review.

The purpose of this systematic review was to evaluate the impact of mental health disorders (MHDs) on the clinical and functional outcomes following total ankle arthroplasty (TAA) for the treatment of end-stage ankle arthritis. A systematic review of the EMBASE, MEDLINE, and Cochrane Library databases was conducted in April 2024 following PRISMA guidelines. Data collected included patient demographics, clinical outcomes, complications, and failures. Six studies published between 2019 and 2023 were included, involving a total of 8772 patients who underwent TAA. Among these, 1076 patients (12.3 %) had a pre-operative MHD. The weighted mean age was 64.1 ± 4.9 years, and the mean postoperative follow-up was 4.6 ± 7.2 months. There were inferior subjective clinical outcomes in patients with an associated MHD, as demonstrated by lower scores in the Self-Administered Foot Evaluation Questionnaire (SAFE-Q), Visual Analogue Scale (VAS), and American Orthopaedic Foot and Ankle Society (AOFAS) scores compared to patients without a MHD. Additionally, patients with MHDs had high complication rates (23.7 %), including 76 prosthetic complications (6.1 %) and 15 cases (1.2 %) requiring revision procedures. However, no significant differences in objective outcomes such as joint mobility or implant failure rates were found between those with and without MHDs. MHDs adversely affect subjective outcomes and complications following TAA, highlighting the need for integrated mental health management in preoperative and postoperative care. Further research is needed to understand the precise role of mental health in TAA outcomes.

Comparative Retrospective Study of PLLA and PLLA/HA Pins for Osteochondral Fragment Fixation in Osteochondral Lesion of the Talus.

Postoperative osteolysis may be observed around poly-l-lactic acid (PLLA) pins in osteochondral fragments fixation for an osteochondral lesion of the talus (OLT). Hydroxyapatite (HA) improves biocompatibility, osteoconductivity, and mechanical strength when added to PLLA. This study aimed to compare the characteristics of osteolysis and clinical outcomes of fixation for OLT with PLLA pins vs PLLA/HA pins. Thirty-one ankles undergoing fixation with bioabsorbable pins for OLT were included. Fourteen ankles were fixed with PLLA/HA pins and 17 ankles with PLLA pins. Magnetic resonance imaging (MRI) was taken pre- and postoperatively at 1 year. Osteolysis around pins, bone marrow edema (BME) in the talus, and pin insertion angle on MRI, the American Orthopaedic Foot & Ankle Society (AOFAS) score, and the visual analog scale (VAS) pain score were compared between the 2 groups pre- and postoperatively at 1 year. AOFAS score at the final follow-up was also compared between the 2 groups. The osteolysis area was significantly smaller in the PLLA/HA group in both coronal and sagittal planes on MRIs obtained 1 year postoperatively. There were no significant differences in osteolysis frequency, BME area, AOFAS score, and VAS pain score. Lower pin insertion angles measured on either sagittal or coronal planes were generally associated with greater amounts of osteolysis. We did not find superiority using PLLA/HA pins compared with PLLA pins to fixate talar osteochondral fragments. However, PLLA/HA pin use was associated with less osteolysis around pins compared with PLLA pins.

Efficacy comparison of dorsal approach and medical approach in treating Lisfranc injury

Objective: To compare the efficacy of dorsal approach and medial approach in the treatment of Lisfranc injury. Methods: A retrospective cohort study was conducted to analyze the clinical data of 43 patients with closed Lisfranc injuries admitted to Tongji Hospital of Tongji University from January 2017 to December 2021. The surgical approach were open reduction and internal fixation or metatarsal cuneiform joint fusion, with 23 cases using the dorsal approach and 20 cases using the medial approach. The duration of surgery, incisional complications, loss of internal fixation, internal fixation removal rate, patient's clinical satisfaction, and American Orthopedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score of pain in the patients were reviewed based on the medical record system and follow-up records. Results: Of the patients, 33 were male and 10 were female, with a mean age of (45.2±13.4) years. All the patients were followed up for (17.9±6.7) months, and there was no statistically significant differences in the baseline data between the two groups. Preoperatively, the dorsal approach group and the medial approach group had a AOFAS score of (30.3±10.7) and (28.5±9.3), respectively, and a VAS score of (6.2±1.9) and (6.3±2.1), respectively (both P>0.05); the operation time was (112.2±25.0) min and (91.0±22.5) min, respectively in the two groups (P=0.006). Two patients in the dorsal approach group developed superficial infection in the incision, one patient experienced delayed healing in the medial approach group, while the remaining patients achieved primary healing. In the dorsal approach group, three patients suffered long-term numbness or pain on the dorsum of the foot during follow-up, which was alleviated with neurotrophic medications; in the medial approach group, one patient had abnormal sensations around the wound site, which gradually improved. During the follow-up period, a total of 10 patients underwent internal fixation removal, including 7 patients (30.4%) in the dorsal approach group and 3 patients (15.0%) in the medial approach group (P=0.294). The AOFAS score in the dorsal approach group and the medial approach group at the last follow-up was 83.8±7.7 and 86.7±6.9 (P=0.207), and the VAS scores was 2.1±1.0 and 1.3±0.5 (P=0.002), respectively, both showed improvement when compared with those before the surgery (both P<0.001). In both groups, the internal fixations were all in place, with no cases of lost implants. In the dorsal approach group, 3 patients (13.0%) were dissatisfied with the surgical outcome, while in the medial approach group, 1 patient (5%) was dissatisfied (P=0.848). Conclusions: Both surgical approaches resulted in a good prognosis, and there is no statistical difference between the two groups in terms of fixation effect, and the medial approach group is superior to the dorsal access in operative time, internal fixation removal rate, VAS score and patient clinical satisfaction.

Long-Term Results after Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A 10-Year Cohort Study.

A gold standard surgical treatment for osteochondral lesions (OCLs) of the talus still needs to be established. Still, autologous matrix-induced chondrogenesis (AMIC) is a commonly applied 1-stage procedure that has achieved good short- and mid-term results. The present cohort study aimed to assess whether the long-term, 10-year results can confirm the previous findings. All patients underwent an open AMIC procedure using a collagen type I/III bilayer matrix for a talar OCL. General demographic data, preoperative magnetic resonance imaging findings, intraoperative details, and German version of the Foot Function Index (FFI-D) scores preoperatively and at 1, 5, and 10 years as well as European Foot and Ankle Society (EFAS) and American Orthopedic Foot & Ankle Society (AOFAS) scores at 10 years after surgery were analyzed. The primary outcome variable was the procedure's longitudinal effect, and several variables' influence on the outcome was tested. Of 47 consecutive patients, 18 (38%) were included. Of the 18 patients, 6 (33%) were female, and 12 (67%) were male, with a mean age of 39 ± 15 (range = 15-62) and an average body mass index (BMI) of 26 ± 5 (range = 20-38) kg/m². The mean defect size was 1.4 ± 0.9 (range = 0.2-4) cm². The FFI-D total score showed a significant decrease from preoperatively to 1 year postoperatively (56 ± 19 to 34 ± 27; P = 0.001) with a further nonsignificant decrease to the 5-year (34 ± 27 to 21 ± 20; P = 0.16) and 10-year follow-up (21 ± 20 to 15 ± 13; P = 1.00). All the single items decreased significantly from preoperatively to the 5- and 10-year mark. Although not significant, most items improved from 5 to 10 years postoperatively. Age positively correlated with the preoperative, 5-year, and 10-year follow-up FFI-D total score. AMIC, as a single-step surgical intervention, is a viable long-term treatment option. Patient selection regarding symptoms and findings is vital to achieve satisfying results.

Surgical treatment of flexible flatfoot in adolescents: Sinotarsic endorthesis

Objectives: The surgical procedure of arthroereisis for flexible flatfoot involves placing a screw or spacer between the talus and calcaneus, limiting the excessive inclination of the calcaneus. This study aimed to evaluate the clinical results of patients treated using an endosenotarsal screw. Methods: Seventy-three patients were treated with arthroereisis (54 unilateral and 19 bilateral) using the Fit-As subtalar screw (Gemes®). A total of 92 screws were implanted. Pre- and post-operative clinical evaluations were performed before and 3 months after the operation. Results: The median follow-up period was 46 months (12–80 months). The average age at the time of surgery was 12 years (range 8–19 years). The mean pre-operative American Orthopedic Foot and Ankle Society (AOFAS) score was 63.7/100, while the mean post-operative AOFAS score was 98.6/100. The average pre-operative disability index Foot and Ankle Disability Index Questionnaire was 77.7/104, whereas the average post-operative index was 102.3/104. None of the treated patients required surgical screw removal at the time of the final follow-up. Conclusion: The results obtained in this series of patients with Fit-As titanium endorthesis are in accord with those reported in the literature and lead to good clinical results, the absence of complications, and the unnecessary removal of the device.

Outcomes of triple arthrodesis with IOFIX type fixation: A prospective study.

The aim of this study was to evaluate the patient reported outcome measures (PROMS), radiological outcome and complications when performing a triple arthrodesis using the IOFIX system for the talonavicular and calcaneocuboid joints. Data was collected prospectively. Twenty-nine consecutive patients were reviewed 1 year postoperative. Outcomes analysed were rate of fusion, American Orthopaedic Foot and Ankle Society (AOFAS) score, Visual Analogue Scale (VAS), patient satisfaction and complications. Complete fusion was achieved in 90 %. The mean preoperative AOFAS score improved from 42 (95 % confidence interval: 22-43) to 75 (95 % confidence interval 67-82) postoperative and the mean VAS improved from 6.5 (95 % confidence interval 4.9-8.6) to 4 (95 % confidence interval 3.1-4.9), p < 0.001. There was an early complication rate of 13 %. After 1 year 86 % were satisfied and there was a complication rate of 3 %. This study suggests that the IOFIX system offers a reliable and performant alternative technique for patients undergoing a triple arthrodesis. Level II, prospective cohort study.

Operative Treatment of Nonprimary Osteochondral Lesions of the Talus: A Systematic Review.

Nonprimary osteochondral lesions of the talus (OLT) pose a significant challenge in orthopaedics, with no definitive consensus on optimal surgical treatment. To consolidate the most recent evidence on operative treatments for nonprimary OLT by assessing patient-reported outcomes (PROs), postoperative complications, and clinical failures. Systematic review; Level of evidence, 4. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and PRISMA in Exercise, Rehabilitation, Sport medicine and Sports science guidelines. Searches were conducted in PubMed, Embase, and Cochrane Library databases through June 2023. Eligible studies evaluated operative outcomes in skeletally mature patients with nonprimary OLT after failed previous surgeries. Primary outcomes included clinical and functional PROs. Secondary outcomes included postoperative complications and clinical failures. Quantitative analyses involved weighted means, mean differences, minimal clinically important differences, success rates (95% binomial proportion confidence interval), and a pre-to-postoperative meta-analysis. Out of 3992 identified records, 50 studies involving 806 ankles from 794 patients were included. All operative treatments significantly improved PROs (P < .05), except osteochondral allograft transplantation (OCA) for American Orthopaedic Foot and Ankle Society and pain (visual analog scale/numeric rating scale [VAS/NRS]) scores and HemiCAP for pain (VAS/NRS) scores. Autologous chondrocyte implantation (ACI) and osteochondral autologous transplantation (OAT) demonstrated the greatest PRO success rates, exceeding 80%. Postoperative complications occurred in 4% of cases, most frequently with HemiCAP. Clinical failures affected 22% of cases, particularly with autologous matrix-induced chondrogenesis, OAT, OCA, and HemiCAP. Our systematic review demonstrated that ACI and OAT are promising treatments for nonprimary OLT, with ACI showing fewer clinical failures than OAT. Conversely, OCA and HemiCAP exhibited lower effectiveness and higher clinical failure rates, suggesting a need for reassessment.

Concomitant Chronic Lateral Ankle Instability Affects Postoperative Functional Outcomes in Patients With Osteochondral Lesions of the Talus but Does Not Affect Cartilage Repair After Restoration of Ankle Stability.

To investigate the effect of concomitant chronic lateral ankle instability (CLAI) on postoperative clinical outcomes in patients with osteochondral lesions of the talus (OLTs). Patients who underwent surgery for OLTs between January 2018 and May 2022 were retrospectively evaluated. OLT patients underwent debridement, microfracture, or bone grafting, whereas patients with concomitant CLAI underwent lateral ligament repair or reconstruction. Functional assessments included the visual analog scale score, American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), and Tegner score, with a minimum follow-up of 24 months. Cartilage repair was evaluated using Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 1 and MOCART 2.0 scores based on postoperative magnetic resonance imaging. Additionally, multiple linear regression analysis was performed to explore the effects of potential factors, and Spearman correlation coefficients (rs) were calculated to assess the relationship between these factors and outcome scores. A total of 85 patients were included, with 39 in the OLT group and 46 in the OLT-CLAI group. The mean follow-up times were 46.95 ± 17.00 months (range, 24-76 months) and 41.80 ± 15.10 months (range, 24-76 months), respectively (P= .347). Compared with the OLT group, the OLT-CLAI group showed lower postoperative AOFAS and FAOS scores, with a significantly smaller overall improvement in the AOFAS score (P < .05). There was no significant difference in the number of patients achieving the minimal clinically important difference in functional scores between the groups. Multiple linear regression analysis showed that CLAI surgery negatively affected postoperative AOFAS (standardized β= -0.344, P= .001) and FAOS (standardized β= -0.332, P= .001) scores, with Spearman analysis indicating a moderate correlation (rs= -0.442 [P < .001] and rs= -0.339 [P= .002], respectively). No significant differences were observed between the groups in terms of MOCART 1 (61.52 ± 12.38 vs 65.89 ± 14.47) or MOCART 2.0 (68.70 ± 16.53 vs 73.75 ± 14.76) scores (P > .05), and multiple linear regression as well as Spearman analysis did not yield positive results. OLT patients with concomitant CLAI had lower postoperative functional outcomes than those without CLAI. However, after surgical treatment of CLAI, cartilage repair in OLT patients was not affected. Level III, retrospective comparative study.

Arthroscopic repair is an effective treatment for dynamic medial ankle instability secondary to posttraumatic and partial injury of the deltoid ligament deep fascicle.

When the intermediate or collicular fascicle of the medial collateral ligament (MCL) is injured, the diagnosis of posttraumatic medial ankle instability (MAI) is supported. The aim of this study was to describe an arthroscopic all-inside MCL repair after posttraumatic MAI secondary to an isolated injury of the MCL deep fascicle with a knotless suture anchor technique. Seven patients (seven men, median age: 23 [19-28] years) with posttraumatic MAI were treated by arthroscopic means after failing nonoperative management. The median follow-up was 34 (13-75) months. The MCL was repaired with an arthroscopic all-inside technique. A tear affecting the deep and intermediate or collicular fascicle of the MCL was observed in all cases. In addition, five patients were diagnosed with an isolated fibular anterior talofibular ligament (ATFL) detachment, and in two patients, both the ATFL and calcaneofibular ligament were involved. All patients reported subjective improvement after the arthroscopic ligament repair. The median American Orthopedic Foot and Ankle Society score increased from 68 (range: 64-70) preoperatively to 100 (range: 90-100) at final follow-up. Posttraumatic MAI can be successfully treated by an arthroscopic all-inside repair of the MCL. The presence of an MCL tear affecting the tibiotalar ligament fibres attached to the area of the anterior colliculus should be considered a sign of posttraumatic MAI. This partial deltoid injury at the level of the intermediate or collicular fascicle will conduct to a dynamic MAI. Level IV.

The Mid- and Long-Term Consequences After Surgically Treated Lisfranc Injuries: A Case Series and Review of the Literature.

Background Long-term follow-up data are difficult to collect, especially in uncommon foot injuries. Therefore, it is rare to find publications that include patient-reported outcomes. Therefore, a case series and systematic review are provided to evaluate mid- and long-term outcomes. Methods Patients operated for a Lisfranc injury in our hospital, between 2010 and 2016, were included. Patients were invited to fill out a combined European Foot and Ankle Score (EFAS) and Short Form (SF-12) questionnaire and to undergo an x-ray of the operated foot. In addition, a systematic review of the literature was performed, and our results were compared with that review. Results Fourteen out of 29 patients (48%, four male, 10 female) were seen at a mean follow-up of 8.3 years. Initial Hardcastle & Myerson Classification was: two A (14%); one B1 (7%); 10 B2 (71%); and oneC2 (7%). Three patients underwent multiple surgeries: one external fixation followed by definitive stabilization, and two received fasciotomies (14%). The median EFAS score was 15.5, the EFAS sports score was 14, theSF-mental score was 55.73, and the SF-physical score was 48.25. There was substantial variability in outcomes between patients. 12 patients (86%) also underwent a follow-up X-ray exam, demonstrating a mean Kellgren-Lawrence score of 2.7. In the systematic review, 20 studies and 1052 feet with an average follow-up of 73 months met the inclusion criteria. Most cases underwent K-wire fixation (396 feet, 37.6%). Screw-only fixation was the next most common treatment (306 feet, 29.1%), followed by plate fixation (46 feet, 4.4%). Only three studies present primary arthrodesis in 68 (7.5%) cases. In 47 of the 686 patients (6.8%) with osteosynthesis (open reduction and internal fixation (ORIF)) a secondary definitive arthrodesis of the Lisfranc joint was required later. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 75. Conclusion Patients need to be informed about the possibility of limitations of activity, including sporting activity. Mid-term follow up studies are manly limited to ORIF. No operative technique shows an advantage in the mid-term.

Osteosynthesis with anatomic reduction after malleolar fractures improves ten years outcome: a single center trial

IntroductionMalleolar fractures are the most common ankle fractures and a major risk factor for ankle osteoarthritis in the long-term. Little is known about modifiable risk factors for a satisfactory outcome. This study aimed to assess the long-term clinical, functional and radiological outcomes in patients after osteosynthesis.MethodsIn this retrospective single center study, we assessed the difference in patients who underwent surgical intervention for malleolar fractures sustained between 2007 and 2014. The reduction was assessed on the first postoperative radiograph. At follow-up patients completed a questionnaire, including the European Foot and Ankle Society (EFAS) and Short Form-12 (SF-12) scores to evaluate patient-reported outcomes and quality of life. Ankle osteoarthritis was assessed using the Kellgren and Lawrence classification.ResultsOne hundred seventeen patients, 102 with anatomic reduction and 15 with malreduction, were reached at mean follow-up at 11.4 years and 10.9 years. The mean EFAS score was 18,0 for anatomic and 16,1 for nonanatomic reduction and 6.1 and 4.5 for the sport component. The rate of satisfaction with the result was 8.2 in anatomic reduction and 7.5 in the malreduction. There was no significant difference in the SF-12 group between the two groups. Anatomic reduction is a protective facture for a satisfactory outcome in the univariate model with the hazard ratio of 5.94.ConclusionAnatomic reduction is one of the strongest protective factors for satisfactory outcome after malleolar fractures in a follow-up of more than 10 years.

Kidner Procedure Without Implant Fixation in Accessory Navicular Patient, has a Good Outcome After 1-Year Evaluation at Prof. IGNG Ngoerah Hospital: A Case Report

Introduction: The accessory navicular bone (ANB) is a common developmental anomaly that may cause foot pain, morbidity, and even flatfoot deformity in symptomatic individuals. The Kidner procedure is a widely accepted surgical treatment for symptomatic ANB, typically involving removal of the ANB and reattachment of the posterior tibial tendon. This case report presents a successful 1-year follow-up outcome of an implantless Kidner procedure in a patient with type II ANB. Case Presentation: A 44-year-old female patient presented with a 3-month history of medial-sided left foot pain, aggravated by walking long distances. Physical examination revealed a bony prominence on the inner side of the left foot, with tenderness on palpation. Radiographs demonstrated a type II ANB. The patient underwent an implantless Kidner procedure under general anesthesia, which involved excision of the accessory navicular, osteotomy of the true navicular, and advancement of the tibialis posterior tendon using ethibond sutures. Postoperative follow-ups at 3, 6, and 12 months showed gradual improvement in the American Orthopedic Foot and Ankle Society (AOFAS) score from 75 to 85 and 90, respectively, with no complications or recurrence of symptoms. Discussion: The presence of ANB, particularly type II, can result in foot pain and associated complications, requiring surgical intervention if conservative measures fail. The implantless Kidner procedure presented in this case report demonstrates favorable outcomes in symptom resolution and functional improvement. The use of sutures instead of hardware materials for tendon fixation in this modified procedure appears to be safe and effective. Conclusion: The implantless Kidner procedure is a viable surgical option for the management of symptomatic type II ANB, providing satisfactory results and functional improvement at 1-year follow-up. Further research with larger sample sizes and longer follow-up periods is needed to validate the long-term efficacy of this modified technique.

Permissive weight bearing versus restrictive weight bearing in surgically treated trauma patients with displaced intra-articular calcaneal fractures (the PIONEER study): study protocol for a multicenter randomized controlled trial

BackgroundFollowing successful treatment, displaced intra-articular calcaneal fractures (DIACFs) necessitate an extensive rehabilitation regimen, significantly influencing functional and socio-economic outcomes. Apart from surgical intervention, the implementation of a comprehensive rehabilitation protocol is crucial to optimize foot stability and functional recovery. The objective of this study is to ascertain the optimal rehabilitation protocol for patients with surgically treated DIACFs, either permissive weight bearing (PWB) or Restricted Weight Bearing, focusing on functional outcomes, health-related quality of life (HRQoL), radiographic parameters, cost-effectiveness, and incidence of complications.MethodsStudy design: A prospective multicenter randomized controlled trial. Study population: Presence of surgically (extended lateral, sinus tarsi, or percutaneous approach) treated unilateral DIACFs (Sanders type II to IV), aged 18–67 years (labor force). Patients must be able to understand and follow weight bearing instructions. N = 115 patients with DIACFs will be included. Interventions: Patients with DIACFs will be randomly allocated to one of the rehabilitation protocols, either PWB or RWB. Primary outcome measure: Functional outcome, measured with the American Orthopaedic Foot & Ankle Society Score (AOFAS)). Secondary outcomes: Functional outcome (Maryland Foot Score, MFS), HRQoL (EuroQol-5D, EQ-5D), differences in radiographic parameters, cost-effectiveness, and complications. Nature and extent of burden: The PWB protocol is aimed to be non-inferior to the RWB protocol. Previous analysis of this protocol in other lower extremity fractures has shown a safe complication rate. Follow-up is standardized according to current trauma guidelines, namely at time points 2, 6, 12 weeks, and 6 months. The radiation exposure for both groups will differ from standard care (one extra CT scan of the foot will be made). Therefore, the burden for participants is considered minimal, with no significant health risks.DiscussionThis study will be the first study to define an optimal rehabilitation regime for surgically treated patients with DIACFs. The limitations of this study include the absence of patient blinding, as this is impossible in rehabilitation. Additionally, the primary outcome measure (AOFAS) has limited validity for DIACFs. However, it is the most commonly used questionnaire in the literature on DIACFs. There is an apparent need since current literature is lacking on this specific topic.Trial registrationClinicalTrials.gov NCT05721378, accepted on February 7, 2023.