Ankle Surgery Research Articles

Applications and Effectiveness of 3D Printing in Various Ankle Surgeries: A Narrative Review

Applications and Effectiveness of 3D Printing in Various Ankle Surgeries: A Narrative Review

The Impact of Social Deprivation on Outcomes in Forefoot Surgery.

The impact of social deprivation (SD) on health outcomes is a topic of increasing interest in orthopaedics. There are limited studies and no clear consensus, though, on the impact of SD on outcomes in foot and ankle surgery. Area deprivation index (ADI) is a well-studied and validated surrogate metric for SD. We hypothesized that patients with greater SD would have worse patient-reported pain and physical function at baseline and at 6 weeks and 6 months following elective forefoot surgery. We retrospectively analyzed data from 477 forefoot surgeries between January 2015 and December 2022 to determine if SD was associated with patient-reported outcomes (PROs) related to pain and physical function. Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and pain interference (PI) assessments administered preoperatively and at 6 weeks and 6 months postoperatively. SD was quantified using the ADI. Patients were divided into high- and low-deprivation groups using the national median ADI of 50. At baseline before surgery, PROMIS-PF and PROMIS-PI scores were similar between high and low social deprivation groups. At 6 weeks and 6 months after surgery, there were no significant differences between high- and low-deprivation groups for either PROMIS-PF or PROMIS-PI. Both groups (high and low social deprivation) demonstrated similar improvements in pain and function at 6 months after surgery. The only variable associated with outcomes was employment status, with disabled and unemployed patients exhibiting greater pain and less function before surgery. Disabled patients also had greater pain after surgery. Based on our data, social deprivation did not appear to be associated with patient-reported pain or physical function prior to forefoot surgery or at 6 weeks or 6 months following surgery.

Subtalar joint arthroscopic-assisted reduction and cannulated screw fixation versus open reduction and internal fixation for treating displaced intra-articular calcaneal fractures

BackgroundThe treatment of calcaneal fractures is not uniform. This study aimed to compare the functional and imaging results of subtalar joint arthroscopic reduction combined with cannulated screw fixation (SJACF) and the extended lateral approach (ELA) for the treatment of Sanders type II and III displaced intra-articular calcaneal fractures (DIACFs).MethodsFrom January 2020 to January 2023, 60 patients with calcaneal fractures were treated with SJACF or ELA for foot and ankle surgery at the Second Affiliated Hospital of Anhui Medical University. Changes in calcaneal Böhler’s angle, the Gissane angle, and calcaneal length, height, and width were recorded before, after, and at the 1-, 3-, 6-, 12-month, and last follow-up. The preoperative waiting time, operation time, length of hospital stay, and other data of each patient were analyzed. The visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores were used to evaluate clinical effects.ResultsAll 60 patients were followed up for at least 12 months. There was no statistical difference in baseline data (age, sex, fracture side, mechanism of injury, and classification) between groups (P > 0.05). The preoperative waiting time, length of hospital stay, and intraoperative fluoroscopy times were shorter in the SJACF group than in the ELA group; however, the operative time was greater in the SJACF group (P < 0.05). There were no significant differences in Böhler’s angle, the Gissane angle, or calcaneal length, height, or width between the two groups at any time point (P > 0.05). These imaging values were significantly improved after surgery and at the last follow-up (P < 0.05). The VAS scores of the patients in the SJACF group were significantly different from those in the ELA group at the last follow-up (P < 0.05). The final AOFAS score and incidence of postoperative complications were better in the SJACF group; however, the difference was not significant (P > 0.05). Simultaneously, patients were able to return to work and achieve full weight-bearing earlier in the SJACF group (P < 0.05).ConclusionBoth SJACF and ELA improved the clinical outcomes of patients with DIACFs. SJACF reduces surgical wounds and maintains effective reduction and strong internal fixation. It has the advantages of a reduced preoperative waiting time, shortened hospital stay, reduced intraoperative fluoroscopy time, alleviated postoperative pain, and accelerated patient recovery.

Effects of semaglutide in patients with chronic ankle instability: evidence from a prospective cohort.

Whether patients with chronic ankle instability (CAI) can benefit from weight loss yielded by using glucagon-like peptide-1 receptor agonists (GLP1-RAs) has remained unclear. In this observational study, we recruited more than 2000 adults with CAI according to the selection criteria proposed by International Ankle Consortium with at least two-year follow up from three medical centers. The primary endpoint was the change from baseline of the Foot and Ankle Ability Measure (FAAM) sports subscale at the last follow up. Secondary endpoints included the change from baseline of Foot and Ankle Outcome Score (FAOS)/ Cumberland Ankle Instability Tool (CAIT)/ FAAM activities of daily living (ADL) subscale, number of ankle sprains during study period, incident ankle surgery in treatment of CAI. In this study, 71 out of 2018 patients who received semaglutide in purpose of treating type 2 diabetes (T2DM) and/or weight loss during the study period. After controlling baseline characteristics, the adjusted mean difference in change from baseline was 16.3 for FAAM sports subscale and 9.3 for FAAM ADL subscale. Likewise, the adjusted analysis of five subscales of FAOS showed similar results, all consistently favoring semaglutide group. For CAIT, patients in the semaglutide group had achieved statistically significant improvement compared with control group. The association of semaglutide exposure with improvement in FAAM sports and ADL subscales was mediated by the weight loss measured by BMI (mediation proportion: FAAM sports subscale, 31.2% [22.2-41.2%]; FHSQ ADL subscale, 34.1% [24.4-44.8%]). We also observed statistically significant decreases in number of recurrent ankle sprains during study period. For incident ankle surgery, 1 out of 71 patients (1.4%) and 151 out of 1947 patients (7.8%) received ankle surgeries in semaglutide and control groups, respectively (P = 0.047). Semaglutide may show potential benefits as a supplementary intervention in treatment of CAI by improving patient-reported outcomes and preventing recurrent ankle sprains. Further randomized trial is warranted by the current study to further confirm our findings. researchregistry10716.

Long-term follow-up of the medial arch correction with calcaneal medialization osteotomy in progressive collapsing foot deformity.

Medializing displacement calcaneal osteotomies are part of conservative surgical treatments and represent a reliable option in valgus flatfoot deformities. Favorable short-term results of this procedure is well-known. However, there are few series with follow-up beyond five years. This study reports the clinical outcomes of calcaneal medialization osteotomy with a minimum follow-up of five years. The primary objective was to compare functional scores and radiographic measurements at the preoperative stage, immediately post operative, and at the final follow-up. This was a retrospective, single-centre, multi-operator study of 32 patients, who underwent a medialization calcaneal osteotomy for type II flatfoot. Clinical evaluation of the patients was conducted using the American Orthopaedic Foot and Ankle Surgery (AOFAS) score and the European Foot and Ankle Society (EFAS) score. Radiographic evaluation used the plantar arch angle angle, the talus-first metatarsal axis (T-M1) on lateral weight-bearing radiographs, and calcaneal valgus on Meary's angle in a hindfoot alignment view. Mean follow-up was seven years. AOFAS score improved from 46 to 87 and EFAS score from 11 to 20 (p < 0.05). Each radiographic parameter was significantly modified between the preoperative and immediate postoperative periods. We observed a significant and lasting improvement in functional scores at a mean follow-up of seven years. The correction of the evaluated radiographic parameters was significant and remained stable over time.

Advances in foot and ankle surgery : a review of recent innovations.

The last five years have seen notable advancements in foot and ankle surgery as a result of technical innovations and more consistent reporting of results. Much progress has been made in improving patient-reported outcome measures, in the development of basic research in this area, and in the development of personalized approaches which optimize outcomes for specific groups of patients. This review focuses on five main areas of development within foot and ankle surgery: ankle arthroplasty, osteomyelitis and the diabetic foot, sports injuries, minimally invasive surgery, and orthobiologics. The aim of this annotation is to discuss the progress made in these fields during recent years and propose avenues for further development.

RETRACTION: Prevalence of Surgical Site Infection and Risk Factors in Patients after Foot and Ankle Surgery: A Systematic Review and Meta-Analysis.

J. Cheng, L. Zhang, J. Zhang, K. Asadi, and R. Farzan, "Prevalence of Surgical Site Infection and Risk Factors in Patients after Foot and Ankle Surgery: A Systematic Review and Meta-Analysis," International Wound Journal 21, no. 1 (2024): e14350, https://doi.org/10.1111/iwj.14350. The above article, published online on 22 August 2023, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the journal Editor in Chief, Professor Keith Harding; and John Wiley & Sons Ltd. Following an investigation by the publisher, all parties have concluded that this article was accepted solely on the basis of a compromised peer review process. In addition, the investigation found significant textual overlap between the methods and discussions sections of this article and another article by some of the same authors [Asadi etal. 2023 [https://doi.org/10.1111/iwj.14300]). The editors have therefore decided to retract the article. The authors disagree with the retraction.

Incidence of venous thromboembolism following achilles tendon rupture. Data from the UK foot and ankle thrombo-embolism (UK-FATE) audit.

Incidence of venous thromboembolism following achilles tendon rupture. Data from the UK foot and ankle thrombo-embolism (UK-FATE) audit.

"Case report" and "Technical tip" article types cancelled and "Letter to the editor" format maintained in Foot and Ankle Surgery

"Case report" and "Technical tip" article types cancelled and "Letter to the editor" format maintained in Foot and Ankle Surgery

Achilles Tendon Trephination Versus Peroneus Brevis Tendon Transfer in Total Avulsion Injuries in a Tertiary Hospital

Introduction: Complete avulsion of Achilles tendon is common and treatment is challenging which can be trephination with suturing anchoring technique or peroneus brevis tendon transfer. The aim of the study was to evaluate the functional outcomes of ankles following Achilles tendon repair by comparing trephination with peroneus brevis tendon transfer in total avulsion injury. Methods: A single center prospective randomized study that consisted of 31 patients with Achilles tendon injuries who presented between April, 2019 and December, 2021 on account of complete avulsion injury of the Achilles tendon. Thirty-one (31) patients were randomized into two groups: Group A consisted of 16 patients who had trephination with suture anchoring technique while group B, consisted of 15 patients who had peroneus brevis tendon transfer. Achilles tendon injuries transected at least 10 mm above the calcaneus were excluded and repaired with conventional techniques. The inclusion criteria involved those patients that had complete avulsion injury. The socio-demographic data such as sex, age, occupation, mechanism of injury was documented. The outcome parameters were Endurance test and Proprioceptive evaluation. Results: Eighteen patients (58.1%) had right heel injuries while 13 patients (41.9%) had left leg injuries. About 16[51.6%] patients had trephination while 15[48.4%] patients had peroneus brevis tendon transfer. The age range was 3.2 and 8 years, with a mean age of 5.7years and a follow-up period of 10.4 and 14.8 months. All patients had open wounds. Seventeen males [63.6%] and fourteen females [36.4%] paediatric age group were studied. Complications were re-rupture in 1 patient with tendon transfer (3.2%), superficial surgical site infection in 3 patients (9.7%) and two sural nerve damage in peroneus brevis transfer (6.5%), stiff ankle joint 2 patients (6.2%) and post operative ankle pains up to 2 years was (1) 3.2%. The probability of damaging sural nerve was higher in peroneus brevis transfer as shown in Table 2, Achilles tendon rupture 1(3.2%) and stiff ankle joint in trephination 1 (3.2%). There was no significant statistical difference between the groups with p-value ≥ 0.06. Endurance test and proprioceptive evaluations were satisfactory at 8-10 weeks post- surgery.

Outcome measures after foot and ankle surgery: A Systematic Review.

Outcome measures after foot and ankle surgery: A Systematic Review.

ChatGPT Achieves Only Fair Agreement with ACFAS Expert Panelist Clinical Consensus Statements.

As artificial intelligence (AI) becomes increasingly integrated into medicine and surgery, its applications are expanding rapidly-from aiding clinical documentation to providing patient information. However, its role in medical decision-making remains uncertain. This study evaluates an AI language model's alignment with clinical consensus statements in foot and ankle surgery. Clinical consensus statements from the American College of Foot and Ankle Surgeons (ACFAS; 2015-2022) were collected and rated by ChatGPT-o1 as being inappropriate, neither appropriate nor inappropriate, and appropriate. Ten repetitions of the statements were entered into ChatGPT-o1 in a random order, and the model was prompted to assign a corresponding rating. The AI-generated scores were compared to the expert panel's ratings, and intra-rater analysis was performed. The analysis of 9 clinical consensus documents and 129 statements revealed an overall Cohen's kappa of 0.29 (95% CI: 0.12, 0.46), indicating fair alignment between expert panelists and ChatGPT. Overall, ankle arthritis and heel pain showed the highest concordance at 100%, while flatfoot exhibited the lowest agreement at 25%, reflecting variability between ChatGPT and expert panelists. Among the ChatGPT ratings, Cohen's kappa values ranged from 0.41 to 0.92, highlighting variability in internal reliability across topics. ChatGPT achieved overall fair agreement and demonstrated variable consistency when repetitively rating ACFAS expert panel clinical practice guidelines representing a variety of topics. These data reflect the need for further study of the causes, impacts, and solutions for this disparity between intelligence and human intelligence. Level IV: Retrospective cohort study.

Surgically treated ankle fractures in Sweden: a 15-year population-based study of 96 015 surgeries

BackgroundAnkle fractures are the third most common fractures, often requiring surgical intervention to restore function and mobility. Understanding trends in ankle fracture surgeries is essential for optimizing treatment strategies and improving patient outcomes. The aim of this study is to provide a comprehensive analysis of ankle fracture surgeries in Sweden in order to highlight changes in demography and trends in surgical procedures.MethodsUtilizing data from the National Patient Register, we conducted an observational population-based study of ankle fracture surgeries performed in Sweden between 2008 and 2022. Patients aged 15 years and above who underwent ankle fracture surgery were included in the analysis. Surgical procedures were identified using NOMESCO codes specific to ankle fractures. Demographic trends, surgical procedures and incidence rates were analyzed using descriptive statistics, incidence calculations and regression analyses.ResultsWomen accounted for 55% of surgeries (p = 0.022), with a significant proportion (47%) occurring in individuals aged 65 and above. Although the overall incidence of ankle surgeries decreased by 6% (p = 0.008), notable age-specific trends emerged, including a decrease in surgeries among younger adults and an increase among the elderly. Plate and screw fixation remained the most commonly employed surgical technique, with a 21% increase in usage (p < 0.001), while the use of external fixation and intramedullary nailing increased significantly by 123% and 69%, respectively (both p < 0.001). Conversely, the use of cerclage and/or pin fixation decreased by 74% (p < 0.001) over the study period.ConclusionsOur study of open source data shows current trends in surgically treated ankle fractures in Sweden, highlighting a decreased incidence overall, notable shifts between age groups and several trends in surgical procedures. Despite limitations inherent to retrospective observational studies, such as the inability to establish causal relationships, our findings contribute to the understanding of ankle fracture management trends, highlighting areas for further investigation and improvement in orthopedic care.

A NATIONAL SURVEY OF BOFAS MEMBERS ON THE TREATMENT OF PRIMARY OSTEOCHONDRAL DEFECTS OF THE TALUS

IntroductionOsteochondral defects (OCDs) of the talus were identified as a “TOP 10” research priority in foot and ankle surgery by the James Lund Alliance in partnership with BOFAS, BOA and NIHR. To develop a research strategy, the views of BOFAS members regarding OCDs of the talus were surveyed. The results are reported here.MethodsA questionnaire concerning the presentation, investigation and management of OCDs was formulated with input from the BOFAS National Clinical Study Group and ratified by the Scientific Committee. It concerned primary OCDs of the talus that had failed non-surgical management. It was distributed to BOFAS members via email using _Microsoft Forms_.ResultsThere were 90 responses. Data on presenting symptoms, investigations, initial management and decision making was collected. Surgical treatment was grouped according to defect size: small or large and shallow or deep. This gave 4 categories. For the purposes of the study a large defect had a width &gt;15mm and a deep defect had a depth &gt;5mm. For small, shallow lesions 85 respondents chose microfracture as the first line surgical treatment. For large shallow lesions 59 respondents chose microfracture, 18 chose bone marrow stimulation plus scaffold e.g. AMIC or ACIC and 6 chose bone marrow stimulation plus a biological agent e.g. cBMA or PRP. For small deep lesions microfracture was again most popular (69 respondents). For large deep lesions microfracture was chosen by 43 respondents, AMIC/ACIC by 23 and OATs by 7. Further data was collected on post op rehabilitation.DiscussionThe study demonstrates that microfracture is the most popular first line treatment for primary OCDs of the talus of any size. That said, a wide range of treatments are in practice. This information will facilitate the development of high-quality studies to identify the most appropriate evidence-based treatment for OCDs of the talus.

CUSTOM 3D-PRINTED IMPLANTS FOR CRITICAL-SIZED BONE DEFECTS IN FOOT AND ANKLE SURGERY: A MULTICENTRE COLLABORATIVE STUDY

IntroductionThe treatment of critical-sized bone defects in foot and ankle surgery remains challenging. Traditional methods, such as bone transport, bulk allograft, vascularized bone graft, and Masquelet procedures carry risks including multiple surgeries, donor site morbidity, infection, and non-union. Recently, custom 3D-printed implants have emerged, offering improved anatomical compatibility, eliminating the need for tissue harvesting, and often requiring only a single operation. This study aims to present the largest UK series of custom 3D-printed implants in foot and ankle surgery.MethodsA retrospective multicentre collaborative study was conducted in 10 NHS Trusts. Demographic, surgical and radiographic variables were recorded including: age; sex; side; type of operation; complications; and postop imaging at 6 weeks, 3 months, 6 months and 12 months. Baseline characteristics were described for demographic variables. Categorical variables were expressed as frequencies and percentages.ResultsData was collected on a total of 34 patients. The mean age of patients was 54 years (range 29 to 83). 68% of patients were men. Avascular necrosis was the most common indication for surgery (35%) followed by trauma (21%), total ankle replacement failure (21%), infection (12%), Charcot arthropathy (6%) and AVN and infection (3%). The most common operation performed was a fusion augmented with a truss (44%) and 91% of patients had a combination of regional and general anaesthetic. All patients had an ASA grade of less than 4. Of the patients that had follow-up imaging, the implants were reported intact by 94% at 6 weeks, 78% at 3 months, 68% at 6 months and 67% at 12 months.DiscussionThis is the largest case series of custom-made foot and ankle implants in the UK to date. The clinical and radiographic outcomes at one year Follow-up are satisfactory. Further work is required to assess long term implant survivorship.

Validity and reliability of the Manchester Oxford Foot Questionnaire (MOXFQ) in one-year postoperative ankle fracture patients—a validation study

BackgroundAnkle fracture patients are a heterogenous group with differences in age, sex, fracture morphology, and treatment provided. With the increased focus on patient-centered treatment, patient-reported outcome measures (PROMs) are increasingly adopted by clinicians to facilitate best clinical practice. The Manchester Oxford Foot Questionnaire (MOXFQ) has demonstrated good measurement properties when used in patients with foot or ankle disease. The PROM has three domains: (1) Pain; (2) Walking/Standing; and (3) Social Interaction. One study found sufficient content validity for the Pain and Walking/Standing domains when used in the evaluation of ankle fracture patients. Another validation study demonstrated acceptable structural validity and reliability for the MOXFQ in ankle fracture patients 12 weeks after injury. The aim of this study is to assess the structural validity and reliability of the Norwegian version of the MOXFQ in the context of an ankle fracture patients one year after surgery and provide patient acceptable symptom state (PASS) estimates.MethodsA pragmatic cross-sectional study design was used to collect the one-year MOXFQ follow-up data from patients surgically treated for an ankle fracture in the period 2017 to 2020 at (Stavanger University Hospital). The structural validity and internal consistency were assessed using confirmatory factor analysis. A separate test-retest study including patients at least one year since ankle surgery was used in the assessment of reliability and measurement error.ResultsA confirmatory factor analysis of the three-factor model of the MOXFQ had a good model fit (TLI 0.94; CFI 0.95; RMSEA 0.094; SRMR 0.039). However, the measurement model demonstrated poor discriminant validity of the three factors. A unidimensional model of the 16 items had worse model fit, while a second-order factor model demonstrated strong factor loadings for a second-order factor. A bi-factor model also revealed a strong general factor but also unique variance in the Pain and Social Interaction domain. The domains had good internal consistency (McDonald’s omega 0.80 to 0.95) and test-retest reliability (ICC 0.80 to 0.92). The standard errors of measurements for the three domains were between 6.5 and 7.5, and 5.5 for the MOXFQ-Index (scale 0 to 100). PASS estimates for the (sub)scales were: Pain 45; Walking/Standing 39; Social Interaction 19; and MOXFQ-Index 34.ConclusionThe MOXFQ with three domains demonstrated sufficient structural validity and reliability when used in the evaluation of a one-year postoperative ankle fracture population. Reporting the scores of the Pain and Walking/Standing domains was best supported.

Preoperative Optimization of Patients Undergoing Orthopedic Foot and Ankle Surgery: A Single Institution Cohort.

Careful preoperative patient preparation for orthopedic foot and ankle surgery can help manage postoperative expectations and avoid suboptimal outcomes. Our quality improvement initiative aimed to reduce emergency department (ED) visits within 30 days postsurgery by enhancing preoperative education. We focused on four outcomes associated with receipt of written preoperative information: (1) related ED visits within 30 days of surgery, (2) average number of patient portal messages, (3) phone calls initiated by patients, and (4) staff team experience survey results. All patients undergoing foot and ankle surgery by two surgeons at one institution from July 2023 to January 2024 were included. Through a series of six plan, do, study, act (PDSA) cycles lasting 1month each, we evaluated 431 patients (55.9% female, 61.4% White, 92.4% English speakers). Patients who received written preoperative information were significantly less likely to present to the ED for related concerns within 30 days of surgery compared with those receiving no written preoperative information ( p = .0068). In addition, we observed fewer portal messages and phone calls from patients receiving written preoperative information ( p = .3644, p = .0541). An increase in the use of standardized written preoperative information yields decreased ED visits and frequency of inquiries from patients through portal messages and phone calls.

Postoperative Imaging of the Ankle: Ligament and Tendon Reconstruction.

Tendon and ligament disorders are common indications for ankle surgery. Numerous surgeries and related modifications, ranging from simple repairs and debridement to complex reconstructions with tendon transfers or graft, are available. Knowledge of postoperative imaging appearances of common ankle surgeries is critical to identify complications and aid assessment of clinical treatment failure. This comprehensive review article discusses the surgical indications, techniques, imaging appearances, and complications-specifically those related to minimally invasive or arthroscopic surgery-for various ankle and foot conditions. It includes anatomical (Brostrom type) and nonanatomical lateral ligament repairs for ankle instability. Medial compartment procedures are described, such as peroneal tendon and retinacular repairs, as well as treatments for progressive collapsing flatfoot deformity, formerly known as posterior tibial tendon dysfunction or acquired flatfoot deformity. We also examine posterior compartment procedures, focusing on Achilles tendon repairs. Primary imaging modalities covered are magnetic resonance imaging, ultrasound, computed tomography, and radiographs, including expected postoperative appearances and the usefulness of each modality.

Readability of foot and ankle patient-reported outcomes: Alignment with National institutes of health and american medical association standards.

Readability of foot and ankle patient-reported outcomes: Alignment with National institutes of health and american medical association standards.

Three-Dimensional Navigation Assisted Pediatric Foot and Ankle Surgery: Operative Technique and Safety Profile

Three-Dimensional Navigation Assisted Pediatric Foot and Ankle Surgery: Operative Technique and Safety Profile