Ankle Surgery Research Articles

Concomitant Factors Associated With Tillaux-Chaput Fractures in Adults: A Case-Control Study.

Tillaux-Chaput fractures (TCFs) consist of fractures of the anterolateral distal tibia. They rarely occur in isolation in adults. When TCFs are missed, there is a risk of chronic pain, instability, and ankle osteoarthritis. This study aimed to identify which factors are related to the presence of TCFs in ankle injuries. A retrospective review of 1134 ankle fractures evaluated between 2013 and 2023 at a level 1 trauma center was performed. Inclusion criteria were patients aged ≥18 years, ankle radiographs and computed tomographic (CT) scan evaluation, and the presence of a TCF confirmed by CT scan. Exclusion criteria were prior ankle surgery, pilon, or distal tibial fractures. A musculoskeletal radiologist and a foot and ankle-trained orthopaedic surgeon classified the TCFs into type 1, an extraarticular avulsion; type 2, a fracture involving the incisura fibularis; and type 3, a fracture with impaction of the anterolateral tibial plafond. A matching control group of ankle fractures without TCF was created with a 1:2 ratio. The following variables were collected: sex, age (<50 vs >50 years), ankle dislocation or subluxation, Weber classification, Maisonneuve fracture, type of medial and posterior malleolar fracture, Lauge-Hansen classification, malleoli involved, and osteochondral lesion of the talus. Multivariate logistic regression was performed to detect which variables had an association with the TCF and their subtypes. P value <.05 was considered significant. A total of 481 ankle fractures had radiographs and CT scans available for evaluation, of which 83 (17.3%) had a TCF. Of these, 44.6% were type 1, 44.6% type 2, and 9.6% type 3. The mean age was 52.2 years; 66.3% were women. Six patients (7.2%) had an isolated TCF. Fifty-eight (69.9%), 50 (60.2%), and 62 (74.7%) ankles had involvement of the lateral, medial, and posterior malleolus, respectively. Age ≥50 years (OR 2.73, 95% CI 1.45-5.14) and pronation external rotation injuries (OR 2.94, 95% CI 1.43-6.06) had a significant association with TCF. Moreover, ankle dislocation or subluxation (OR 3.16, 95% CI 1.11-8.96) and the absence of posterior malleolar fracture (OR 5.97, 95% CI 1.65-21.6) were significantly associated with TCF type 2 and 3. In this study, age ≥50 years and pronation external rotation injuries were the unique independent risk factors for TCF. Furthermore, ankle dislocation or subluxation and the absence of posterior malleolar fractures increased the odds of having a more severe TCF. This study provides insights into the factors associated with TCF and its subtypes during adulthood.

UK Foot and Ankle Thromboembolism (UK-FATE).

Venous thromboembolism (VTE) is a potential complication of foot and ankle surgery. There is a lack of agreement on contributing risk factors and chemical prophylaxis requirements. The primary outcome of this study was to analyze the 90-day incidence of symptomatic VTE and VTE-related mortality in patients undergoing foot and ankle surgery and Achilles tendon (TA) rupture. Secondary aims were to assess the variation in the provision of chemical prophylaxis and risk factors for VTE. This was a multicentre, prospective national collaborative audit with data collection over nine months for all patients undergoing foot and ankle surgery in an operating theatre or TA rupture treatment, within participating UK hospitals. The association between VTE and thromboprophylaxis was assessed with a univariable logistic regression model. A multivariable logistic regression model was used to identify key predictors for the risk of VTE. A total of 13,569 patients were included from 68 sites. Overall, 11,363 patients were available for analysis: 44.79% were elective (n = 5,090), 42.16% were trauma excluding TA ruptures (n = 4,791), 3.50% were acute diabetic procedures (n = 398), 2.44% were TA ruptures undergoing surgery (n = 277), and 7.10% were TA ruptures treated nonoperatively (n = 807). In total, 11 chemical anticoagulants were recorded, with the most common agent being low-molecular-weight heparin (n = 6,303; 56.79%). A total of 32.71% received no chemical prophylaxis. There were 99 cases of VTE (incidence 0.87% (95% CI 0.71 to 1.06)). VTE-related mortality was 0.03% (95% CI 0.005 to 0.080). Univariable analysis showed that increased age and American Society of Anesthesiologists (ASA) grade had higher odds of VTE, as did having previous cancer, stroke, or history of VTE. On multivariable analysis, the strongest predictors for VTE were the type of foot and ankle procedure and ASA grade. The 90-day incidence of symptomatic VTE and mortality related to VTE is low in foot and ankle surgery and TA management. There was notable variability in the chemical prophylaxis used. The significant risk factors associated with 90-day symptomatic VTE were TA rupture and high ASA grade.

Post-Operative Recovery and Preparation for Ambulation after Foot and Ankle Surgery

This is a review article that focuses on patient self-recovery, pain modulation without pain medication, edema control and preparation for ambulation after a foot or ankle surgery both elective and traumatic surgical procedures. The available evidence and literature review were limited due to the few studies that are devoted to this area of focus. This review article takes a comprehensive and prescriptive perspective into strategies of the aftermath of the physiological and psychological effects on the body, specifically the lower extremity after foot or ankle surgery. Some of these strategies include initial edema control, nutrition, scar massage and reduction of non-mobile skin from the surgical incision within the surgery. A review of the theory of prehabilitation and examples of therapeutic exercises are explained within the article which target important proximal gait muscles needed for ambulation which can be conditioned with the foot and ankle in a CAM boot or a cast.

Key-risk factors for fracture-related infection after ankle surgery: a retrospective study

Background: Fracture-related infection (FRI) is a serious complication following ankle fracture surgery, with significant implications for patient outcomes. This study aimed to identify the key risk factors associated with FRI in a cohort of patients undergoing surgical fixation of ankle fractures. Methods: A retrospective analysis was conducted on 261 patients who underwent open reduction and internal fixation (ORIF) for ankle fractures between 2019 and 2021. Patient demographics, comorbidities, and surgical details were extracted from medical records. The primary outcome was the development of FRI within one year postoperatively. Logistic regression analysis was used to identify independent predictors of infection. Results: The mean age of the patients was 61.8 years (SD=16.5), with 69.3% being female. The overall infection rate was 8%. Significant predictors of FRI included smoking (OR=13.643, p=0.002), peripheral vascular disease (OR=17.684, p&lt;0.001), and diabetes mellitus (OR=11.309, p=0.002). Gender, congestive heart failure, obesity, and age were not statistically significant predictors of infection. Conclusion: This study identifies smoking, peripheral vascular disease, and diabetes mellitus as significant risk factors for FRI following ankle fracture surgery. These findings underscore the importance of targeted interventions to manage these comorbidities in high-risk patients to reduce the incidence of postoperative infections. Further research is needed to explore the role of other potential factors and to develop effective prevention strategies.

Fiberglass cast application in immediate post-operative period after an ankle fracture surgery: review of safeguards

An ankle fracture after stabilization may normally need post-operative support immobilization in a cast in the early phase to allow for the associated soft tissue ligamentous injury to recover. The cast may allow for an early rehabilitation of the operated ankle fractures with protected weight bearing potential. A cast immobilization in the immediate post-operative period following an ankle surgery has used gypsum plasters with great caution and care. The concerns of poor wound healing, infection, pressure ulcer, skin maceration due to soakage, development of compartment syndrome and thrombosis may present in the immediate post-operative period for ankle fractures following a cast application. The technique for fiberglass cast application in the immediate post-operative period may provide an advantage. The cast application needs an emphasis to understand the safeguards, avoid any abnormal pressure and do monitoring of wound care to attain a favorable desired outcome. The aspects of cast application have been reviewed to present the necessary safeguards.

Low tourniquet pressure has less impact on lower extremity nerve innervation: comparison of different tourniquet pressures used with intraoperative neuromonitoring with a randomized controlled study

BackgroundWe aimed to investigate the compression and ischemic effects of two different tourniquet pressures on tissues during surgery show a clinical difference.MethodsPatients aged 18–65 years who underwent foot and ankle surgery and applied a tourniquet in a single center between September 2022 and November 2023 were included in this prospective randomized study. Accordingly, tourniquet pressures were applied as limb occlusion pressure (LOP) + 50 mmHg in group 1 (12 patients) and LOP + 100 mmHg in group 2 (12 patients). The time point at which the femoral nerve motor evoked potential (MEP) decreased by 50%, the time point at which the MEP decreased by 100% for all nerves (femoral, tibial, and deep peroneal), and the time point at which all responses returned after the tourniquet was deflated were identified as the time points for analysis.ResultsThere were no differences in demographic data (age, body mass index, and sex) between the two groups. The mean tourniquet pressure was 191 ± 16 mmHg in Group 1 and 247 ± 21 mmHg in Group 2 (p < 0.001). A 50% decrease in the femoral nerve MEP value was observed at an average of 47 min in Group 1 and 34 min in Group 2 (p < 0.001). A complete loss of MEP responses for all nerves was observed at an average of 69 min in Group 1 and 56 min in Group 2. After the tourniquet was deflated, all MEP responses returned to baseline values at an average of 8.5 min in Group 1 and 12.6 min in Group 2 (p = 0.007). The results showed that lower limb nerve innervation was affected later and returned to normal earlier after deflation of the tourniquet in Group 1 (low tourniquet pressure group).ConclusionsThe innervations of the lower extremity nerves were affected later in the group in which low tourniquet pressure was applied (average 191 mmHg). Again, in this group (LOP + 50 mmHg), nerve conduction recovered an average of 10 min after deflation and four minutes earlier than in the high tourniquet pressure group.Level of evidenceLevel I, diagnostic study.Trial registrationNCT05926154.

No difference in early outcomes comparing intramedullary versus extramedullary fibular fixation in operative ankle fractures

IntroductionThe purpose of this study was to compare postoperative complications and outcomes of minimally invasive intramedullary fixation (IMF) versus plate fixation (PF) in the treatment of distal fibular fractures. Materials and methodsA retrospective review was performed from identifying all consecutive ankle fracture patients aged ≥18-years-old surgically managed between August 2017 to September 2022 at a tertiary care center with minimum 6 months clinical follow-up. Patients were grouped into those receiving intramedullary versus extramedullary fibular fixation. The primary outcomes were relevant demographic factors (diabetes, osteoporosis, charlson comorbidity index [CCI]), surgical time, complication rates, reoperation rates. Secondary outcomes included time to definitive fracture fixation, fracture characteristics (AO/OTA and Lauge-Hansen classification), syndesmotic instability requiring fixation and discharge disposition. ResultsForty-one IMF patients (average age 55.3 ± 18.1yrs) and 162 PF patients (47.7 ± 17.4yrs) were identified and included in this study. Within the IMF group, 25 patients received IM nailing and 16 patients received percutaneous screw fixation. A greater proportion of IMF patients had diabetes (39 % vs 22 %, p < 0.001), osteoporosis (22 % vs 3 %, p < 0.001), and moderate or severe CCI (41 % vs 23 %, p = 0.017). Surgical time was significantly reduced when using IMF technique (80.4 ± 43.1 min vs 99.1 ± 43.1 min, p = 0.012). Overall complication rates or time to complication did not differ significantly between groups (p = 0.578 and p = 0.082, respectively); however, when sub-stratified, IMF patients trended towards experiencing fewer wound related complications versus PF patients (5 % vs 9 %, p = 0.291). No IMF patients experienced deep or superficial infections and only 2 (5 %) patients experienced wound dehiscence. Reoperation rates(15 % vs 10 %, p = 0.267) and time to fracture union (2.7 ± 2.2 mos vs 3.1 ± 2.0 mos, p = 0.301) did not differ significantly. At final follow-up (IMF: 15.0 ± 12.2 mos vs PF: 28.5 ± 19.5 mos), Olerud and Molander ankle score was significantly higher in IMF compared to PF (87.1 ± 14.2 vs 76.2 ± 22.6, p = 0.002). ConclusionPatients in the IMF group at baseline had several comorbid medical conditions that put them at high risk for wound related complications, however, postoperatively they demonstrated higher functional scores and similar complication rates compared to the PF group. It is important to note, however, while we expected a higher rate of wound issues with the PF group, there were no significant differences in infection rates. Either IMF and PF is reliable for fixation and outcomes, and thus with proper soft tissue, biologically friendly technique, either IMF or PF is a reliable choice in the fixation of fibula fractures. Level of evidenceIII, retrospective cohort comparison study.

Morphological Variability of the Sural Nerve and Its Clinical Significance.

The sural nerve provides sensory innervation to the skin on the distal posterolateral third of the lower extremity. The morphological variants are characterized by high variability. However, it most commonly arises from a union of the medial sural cutaneous nerve and the peroneal communicating branch of the common fibular nerve. This article overviews the anatomical and clinical significance of the sural nerve. Despite the remarkable development of genetic diagnostics, sural nerve biopsy is still a very important tool to diagnose peripheral neuropathies such as diabetic, vascular and inflammatory neuropathies. Furthermore, the sural nerve is also commonly transplanted due to its characteristics. Such a procedure is applicable in cases of segmental nerve loss, but it is also used to restore potency in patients after radical prostatectomy. The knowledge of anatomical variants of the sural nerve is also crucial as it allows to minimize its damage during surgical procedures. Furthermore, during an ankle surgery, a nerve block can be used to complement anesthesia. The major aim of this work is to review contributions of the sural nerve to physiological and pathophysiological processes.

Surgeon-administered ultrasound-guided combined popliteal sciatic nerve and adductor canal block in fixation of trimalleolar fracture

Introduction: Combined popliteal sciatic nerve and adductor canal block under ultrasound guidance has been described as a safe and effective mean of regional anesthesia for foot and ankle surgery. Limited studies have shown its effectiveness while performed by surgeons. This study aims to assess the effectiveness and safety for this mode of regional anesthesia while carried out by orthopedic surgeons. Method: Patients presented to our unit with trimalleolar fracture of ankle who underwent operation under surgeon-administered ultrasound-guided combined popliteal sciatic nerve and adductor canal block were evaluated in this study. A total of 13 patients with mean age of 57.8 were included. Data regarding the diagnosis, pattern of injuries, comorbidities in American Society of Anesthesiologists Classification, duration of operation, blood loss, intraoperative pain control in visual analog scale (VAS), degree of motor blockage, postoperative pain control and hospital length of stay were collected and evaluated. Result: All patients experienced complete anesthesia with VAS 0 and complete motor blockage throughout the operation. Average operative time was 179 min. Postoperative pain control was satisfactory. There was no regional anesthesia related complication arise. Conclusion: Surgeon-administered ultrasound-guided combined popliteal sciatic nerve and adductor canal block is a safe and effective mean to provide anesthesia for trimalleolar fracture fixation according to our experience.

Opioid Prescribing Trends Among Workers' Compensation Patients Undergoing Foot and Ankle Surgery.

The purpose of this study was to evaluate opioid usage and prescribing trends among workers' compensation (WC) patients who underwent foot or ankle operative procedures compared with a control group. A retrospective review was conducted for WC and non-WC patients who underwent foot or ankle procedures in a single academic orthopaedic surgery practice. Outcome measures were total morphine milligram equivalents (MME) and number of opioid prescriptions. A total of 118 patients were identified, including 51 patients in the WC group and 67 in the non-WC group. After index surgery, 67% (34 of 51) of WC patients had 2 or more additional opioid prescriptions compared to 39% (26 of 67) of non-WC patients (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.4-6.7; P = .003). Collectively, there were greater prescriptions of oxycodone MME (P = .002) and hydrocodone MME (P = .07) in the WC cohort. Workers' compensation patients seem to be prescribed and consume opioids at a higher rate postoperatively. It is important for treating physicians to be aware of these trends, and discussions with patients regarding expected opioid use when planning surgical intervention may be beneficial. Physicians may need to set expectations preoperatively and suggest there are limits on the amount of opioids that can safely be prescribed. Level III, Retrospective cohort study, Prognostic.

AI discernment in foot and ankle surgery research: A survey investigation

BackgroundThis study evaluated the ability to differentiate between AI-generated and human-authored abstracts in foot and ankle surgery. MethodsAn AI system (ChatGPT 3.0) was trained on 21 published abstracts to create six novel case abstracts. Nine foot and ankle surgeons participated in a blinded survey, tasked with distinguishing AI-generated from human-written abstracts, rating their confidence in their responses. Surveys were completed twice at two different time points to evaluate intra-/inter-observer reliability. ResultsThe overall accuracy rate for distinguishing AI-generated from human-written abstracts was 50.5 % (n = 109/216), indicating no better performance than random chance. Reviewer experience and AI familiarity did not significantly affect accuracy. Inter-rater reliability was moderate initially but decreased over time, and intra-rater reliability was poor. ConclusionsIn their current form, AI-generated abstracts are nearly indistinguishable from human-written ones, posing challenges for consistent identification in foot and ankle surgery. Level of evidenceIV

Foot &amp; Ankle

The October 2024 Foot &amp; Ankle Roundup360 looks at: Hemiarthroplasty for hallux rigidus; Fixed or mobile-bearing ankle arthroplasty? A meta-analysis; Bone grafting for periprosthetic bone cysts following total ankle arthroplasty; Diabetic foot ulcer after first-ray amputation; Early motion after ankle surgery: the path to faster recovery?; Are podiatrists and orthopaedic surgeons approaching zone 2 fifth metatarsal fractures in the same way?.

Comparison of the European Foot and Ankle Score (EFAS) and the Self-Reported Foot and Ankle Score (SEFAS) in patients with foot and ankle surgery.

The European Foot and Ankle Score EFAS and the Self-reported Foot and Ankle Score SEFAS are two Patient Reported Outcome Measures (PROMs) used in foot and ankle surgery. The EFAS has been published in recent years, while the SEFAS is a validated questionnaire based on the New Zealand total ankle questionnaire. We compared the EFAS to the SEFAS, Short Form 36 (SF-36) and Numeric Rating Scale (NRS) regarding reliability and validity based on the results of 126 patients undergoing foot and ankle surgery in a single center. Both the EFAS and SEFAS demonstrate good psychometric properties with comparable reliability and validity. The EFAS questionnaire portrays pain and physical function as well as those well-established tools of SEFAS, NRS and SF-36. In conclusion both the EFAS and SEFAS show good psychometric properties with comparable results for internal consistency, test-retest reliability, sensitivity to change and strong correlation for the corresponding domains describing pain and physical function. III.

The use of biologic disease-modifying anti-rheumatic drugs does not increase surgical site infection or delayed wound healing after orthopaedic surgeries for rheumatoid arthritis.

To investigate the effect of the use of biologic disease-modifying anti-rheumatic drugs (bDMARDs) on surgical site infection (SSI) and delayed wound healing (DWH) in rheumatoid arthritis (RA) patients undergoing orthopaedic surgery. We retrospectively reviewed the records of 965 elective orthopaedic procedures undertaken in RA patients. The incidences of SSI and DWH were compared between the bDMARDs user and non-user groups. Subsequently, univariate and multivariate logistic regression analyses were performed to evaluate risk factors for SSI and DWH after propensity score (PS) matching. The incidence of postoperative flare-up was also examined. In 965 procedures, SSI and DWH were identified in 12 and 28 cases, respectively. SSI and DWH were identified in 3 and 17 of 414 procedures treated with bDMARDs, respectively. Flare-up occurred in 21 cases. PS matching identified 315 cases in both groups, with no significant difference in incidence between the two groups. No risk factors for SSI were identified, whereas age, diabetes mellitus, foot and ankle surgery and a history of musculoskeletal-related infection were identified as risk factors for DWH. The use of bDMARDs was not associated with an increased incidence of SSI or DWH, with the incidence of flare-up being relatively low.

Good rate of satisfaction but suboptimal clinical outcome at long‐term follow‐up in a large series of patients who had operative stabilization of the deltoid ligament of the ankle

AbstractPurposeTo report results following deltoid ligament reconstruction in a large series of patients.MethodsFor consecutive patients who had a medial ankle ligament stabilization 2010–2018 information from their medical files was registered, and they were invited for follow‐up in 2021–2022. They answered questions about satisfaction with the treatment and current symptoms, and they completed the Foot and Ankle Measurement (FAAM) questionnaire.ResultsOf the 503 patients, 342 (68%) had a history of trauma to the ankle and 114 (23%) had previous ankle surgery. 67% had other procedures (besides synovectomy) simultaneous to medial ligament reconstruction. 269 patients (54%) responded to the invitation for follow‐up. For 182 (71%) of the responders, the operation solved their ankle problems. 163 (63%) were satisfied with the surgery. 192 (71%) would repeat the operation. 173 (67%) had pain in the ankle during the past week, and 86 (50%) of these were not able to run. FAAM ADL‐scores were significantly higher than in a mixed group of ankle/foot patients but not normal.ConclusionThe relatively high degree of satisfaction despite suboptimal clinical results may reflect the complex nature of the deltoid ligament insufficient ankle. It is concluded that repair or reconstruction of the deltoid ligament is only performed in patients reporting ankle instability and with peroperatively demonstrated medial instability and pathology to the ligament.Level of EvidenceLevel III.

Locally obtained autologous bone grafts are effective for achieving arthrodesis while managing foot and ankle charcot’s neuroarthropathy: short to mid-term results from a specialized north African foot and ankle surgery unit

PurposeWe aimed to report the union rate after only utilizing a locally obtained autologous bone graft while correcting the deformity and performing joint arthrodesis in patients with foot and ankle Charcot neuropathy (CN) and to report on the radiographic, functional, complications incidence outcomes at a minimum of two years of follow up.MethodsWe included 24 patients having a mean age of 55.4 ± 10.1 years diagnosed with CN of the foot, ankle, or both. Seven (29.2%) cases were classified as Brodsky type 1, 11 (45.8%) as type 3 A, and six (25%) were type 4. Hindfoot and Midfoot bi-columnar arthrodesis was performed in 70.8% and 29.2% of the patients, respectively. Eight (33.3%) cases had preoperative ulcers. Functional outcomes were evaluated using a modified AOFAS score. Arthrodesis site union was assessed clinically and radiographically. All patients were available for a mean follow up of 35.7 ± 9.5 (24–54) months.ResultsArthrodesis site union was achieved in 23 (95.8%) cases after a mean of 4 ± 1.7 (2-7.5) months. The mean modified AOFAS score was 72.4 ± 10.41 (46–83) points; 79.2% achieved excellent and good scores. Ulcers healed in 87.5% of the patients. Twenty-two (91.7%) patients were satisfied with their functional results. Infection incidence was 12.5%, and no patients required revision or amputation.ConclusionFoot and ankle Charcot neuroarthropathy deformity correction by arthrodesis of the affected joint as a salvage management option resulted in acceptable clinical and radiological outcomes. To enhance the local environment for arthrodesis consolidation, locally obtained autografts led to higher union rates and avoided the drawbacks of using other graft types.

Comparison of the Analgesic Duration Using Ultrasound-guided Popliteal Sciatic Nerve Block between Diabetics with Neuropathy and Nondiabetics without Neuropathy.

In India, the prevalence of diabetes mellitus neuropathy was reported to be as high as 30%. Eight percentage of the diabetic population suffer from foot ulceration and 1.8% have amputations. Popliteal nerve block can be potentially used for foot and ankle surgery with several advantages. To compare analgesic duration of an ultrasound (US)-guided popliteal sciatic nerve block between diabetics with neuropathy and nondiabetics without neuropathy. Participants were allocated into two groups for popliteal sciatic nerve blocks under US guidance. The primary outcome was the duration to onset of sensory and motor blockade. The secondary outcome was the duration to rescue analgesic and the visual analog scale scoring within 24 h. Hemodynamic outcomes were also monitored along with the above variables. It was observed that the onset of sensory blockade was faster in participants with diabetes mellitus with peripheral neuropathy as compared to the nondiabetic participants and the duration for onset of motor blockade in dorsiflexion was faster in diabetic patients as compared to the nondiabetic patients (17.48 ± 3.21 min). However, there was no significant changes when comparing the onset of duration to loss of plantar flexion, in diabetics (17.86 ± 2.29 min) versus in nondiabetics (18.51 ± 3.32 min). The duration for rescue analgesics was found to be longer in diabetic participants (13.19 ± 2.14 h) as compared to the nondiabetic participants (11.44 ± 1.86 h). No differences were observed in the hemodynamic changes and the complications associated with local anesthetics in either group. Diabetic patients with neuropathy have faster onset of blockade when compared to nondiabetic patients without neuropathy which may be due to the degenerative condition of the peripheral nerves in them. The hemodynamic parameters do not play a role in defining the outcome of the block.

Predictors of poor pre-operative patient reported outcome measures in elective foot and ankle surgery: Analysis of 1217 patients

AimsPatient reported outcome measures (PROMs) have become the de facto measure of success in orthopaedic publications. It has been established that preoperatively collected patient reported outcomes correlate with post-operative outcome. The aim of our research is to identify which factors predict poor pre-operative scores using the most commonly used PROMs. MethodsMOXFQ and EQ-5D scores were collected for all patients presenting for elective foot and ankle surgery over a four-year period from June 2018 to February 2022. Multivariate linear regression calculated associations between PROMs and demographics, diagnosis, pre-operative appointments and comorbidities. Results1217 patients had PROMs taken, 1102 of these underwent a surgical procedure. Ankle and hindfoot arthritis predicted worse pre-operative scores. Total comorbidity number, depression/anxiety, younger patients, female gender and preoperative appointments with orthotist predicted a worse outcome score. ConclusionUnderlying patient characteristics can influence pre-operative PROMs in foot and ankle surgery.

Relationship Between Ankle Ligamentous Injuries and Osteochondral Lesions in a Saudi Arabian Population: A Retrospective Cohort Study.

Objectives This study aimed to investigate the relationship between ankle ligamentous injuries and osteochondral defects (OCDs) and to determine the incidence of these conditions within the Saudi Arabian population. Methods This retrospective cohort study included 215 patients (110 males and 105 females) who sought medical advice for an ankle injury at our institute from January 2017 to August 2022. The patients were divided according to age, sex, presence and type of ligamentous injury, and status of OCDs. Patients' ages were categorized into three groups: younger than 30 years (48 patients), 30-60 years (145 patients), and older than 60 years (22 patients). The patients were assessed for ligamentous ankle sprains, tears, and OCDs by reviewing their magnetic resonance imaging reports from radiology records. The exclusion criteria included ankle fracture, ankle surgery, osteoarthritis of the ankle joint, inflammatory arthritis, and congenital deformity of the ankle. The data were collected using a simple questionnaire created via Google Forms. Results Of the 24 patients with OCD, 23 had OCD of the talus. Anterior talofibular ligament (ATFL) injury was the most common injury (75 patients), whereas posterior talofibular ligament (PTFL) injury was the least common. The only significant relationship between ligamentous injury and OCD was observed between PTFL injury and OCD of the talus (P = 0.041). Conclusions In patients with an ankle injury, the most common OCDs occur at the talus, whereas the most injured ligament is the ATFL. Nevertheless, a significant relationship was observed between PTFL injury and OCD of the talus. The findings underscore the importance of considering specific ligament injuries when diagnosing and managing OCDs, especially in patients with chronic ankle pain.

Nonoperative Management of High Ankle Sprains: A Case Series With ≥18-Year Follow-up

Background: High ankle sprains are common athletic injuries and can be associated with long-term sequelae. Regardless of operative or nonoperative treatment, there is a paucity of data in the literature about the long-term outcomes of high ankle sprains. Hypothesis: Nonoperative treatment of high ankle sprains utilizing a standardized protocol will result in good long-term outcomes. Study Design: Case series; Level of evidence, 4. Methods: Patients who experienced a high ankle sprain without radiographic diastasis of the syndesmosis were identified from a previous study database and contacted for long-term follow-up. All patients were high school or National Collegiate Athletic Association Division IA athletes at initial injury and were treated nonoperatively with the same standardized protocol. Patients completed a questionnaire that included documentation of any interim ankle injuries, 2 different patient-reported outcome scores, and ankle radiographs to conduct Kellgren-Lawrence scoring for ankle osteoarthritis. Results: In total, 76 cases in 74 patients were identified in the database. A total of 40 patients were successfully contacted, and 31 patients (24 collegiate and 7 high school athletes) with 33 high ankle sprains completed the survey (31/40; 77.5%). The mean age at follow-up was 45 years (range, 34-50 years), with a mean time from injury to follow-up of 25 years. Overall, 93.5% (n = 29) of the respondents were male, and 42% (n = 13) of the respondents reported an ipsilateral ankle injury since their initial injury, with 16% (n = 5) having ankle or Achilles surgery. The mean Patient-Reported Outcomes Measurement Information System-10 score was 53.4 (SD, 8.3; range, 37.4-67.7), PROMIS median (IQR), 54.1 (39.9, 68.3), and the mean Self-reported Foot and Ankle Score score was 42.7 (SD, 5.86). Follow-up ankle radiographs were obtained in 11 (35%) of the respondents; 27% had Kellgren-Lawrence grade >2 osteoarthritis, and 36% had signs of heterotopic ossification on imaging. The mean tibiofibular clear space was 4.5 mm, and the mean tibiofibular overlap was 7.15 mm, with 27% of patients demonstrating some tibiotalar narrowing. Conclusion: At long-term follow-up, nonoperative management of high ankle sprains without diastasis on imaging was associated with acceptable patient-reported functional outcomes and low rates of subsequent ankle injuries. There was a high incidence of arthritis, but most cases were not clinically significant. This case series shows the natural history of nonoperatively treated high ankle sprains and may serve as a comparison for different management techniques in the future.