FAOS Score Research Articles

CLINICAL OUTCOMES OF AUTOLOGOUS OSTEOCHONDRAL TRANSPLANTATION FOR OSTEOCHONDRAL LESIONS OF THE TALUS: AN AGE-BASED MULTIVARIABLE ANALYSIS

IntroductionThe purpose of this study was to examine trends in patient characteristics and clinical outcomes that occur with age as a statistical variable when performing autologous osteochondral transplantation (AOT) for the treatment of osteochondral lesions of the talus (OLT).MethodsA retrospective cohort study for AOT procedures on 78 patients from 2006 to 2019. was conducted Clinical outcomes were evaluated via FAOS scores. A multivariable linear regression was used to assess the independent factors predictive of the first post-operative FAOS after AOT. The independent variables included pre-operative FAOS, age, defect size, shoulder lesion, cystic lesion, prior traumatic injury, and history of microfracture surgery. A p-value <.05 was considered significant and 95% confidence limits (95% CL) for regression coefficient estimates (est.) were calculated.Results78 patients were included with a mean age of 35.5 ± 13.6years at a mean follow-up was 54.4 ± 18.9 months. The mean pre-operative FAOS was 54.3 ± 19.4 and the mean post-operative FAOS was 83.4 ± 13.6. The mean defect size was 109.3±62.4 mm2. The multivariable linear regression showed that the pre-operative FAOS was associated with a higher post-operative FAOS (est., 95% CL: 0.16, 0.012 – 0.307; p=0.034). Defect size (est., 95% CL: −0.05, −0.097 – −0.003; p=0.0358), having a shoulder lesion (est., 95% CL: −9.068, −15.448 – −2.688; p=0.006), or having a prior microfracture surgery (est., 95% CL: −7.07, −13.118 – −1.021; p=0.0226) were associated with a lower post-operative FAOS.ConclusionPatient age was not an independent risk factor for inferior clinical outcomes after AOT for OLT. Additionally, cystic lesions, or lesions with a traumatic aetiology were not significantly associated with post-operative FAOS. Having a shoulder lesion had the largest marginal effect on post-operative FAOS. These findings provide important information for providers when counseling and selecting patients for AOT procedure for treatment of OLT.

AUTOLOGOUS OSTEOCHONDRAL TRANSPLANTATION FOR LARGE OSTEOCHONDRAL LESIONS OF THE TALUS IS A VIABLE OPTION IN AN ATHLETIC POPULATION

Autologous osteochondral transplantation (AOT) is an effective treatment for large Osteochondral Lesions of the Talus (OLT), however little is reported on an athletic population, who are likely to place higher demands on the reconstruction. The aim is to report the outcomes of large OLT (>150mm2) within an athletic population. The study population was limited to professional or amateur athletes (Tegner score >6) with an OLT of size 150mm2 or greater. The surgical intervention was AOT with a donor site from the lateral femoral condyle. Clinical outcomes at a minimum of 24 months included Return to Sport, VAS and FAOS Scores. In addition, graft incorporation was evaluated by MRI using MOCART scores at 12 months post-surgery. 38 athletes including 11 professional athletes were assessed. Mean follow-up was 46 months. Mean lesion size was 249mm2. 33 patients returned to sport at their previous level and one did not return to sport (mean return to play 8.2 months). Visual analogue scores improved from 4.53 pre-operatively to 0.63 post-operatively (p=0.002). FAOS Scores improved significantly in all domains (p< 0.001). Two patients developed knee donor site pain, and both had three osteochondral plugs harvested. Univariant analysis demonstrated no association between pre-operative patient or lesion characteristics and ability to return to sport. However, there was a strong correlation between MOCART scores and ability to return to sport (AUC=0.89). Our study suggests that AOT is a viable option in the management of large osteochondral talar defects in an athletic population, with favourable return to sport levels, patient satisfaction, and FAOS/VAS scores. The ability to return to sport is predicated upon good graft incorporation and further research is required to optimise this technique. Our data also suggests that patients should be aware of the increased risk of developing knee donor site pain when three osteochondral plugs are harvested.

A MEDIUM-TERM REVIEW OF THE OUTCOMES OF TALAR OSTEOCHONDRAL LESIONS TREATED WITH MATRIX-ASSOCIATED STEM CELL TRANSPLANTATION

IntroductionOsteochondral lesions (OCLs) of the talus are a challenging and increasingly recognized problem in chronic ankle pain. Many novel techniques exist to attempt to treat this challenging entity. Difficulties associated with treating OCLs include lesion location, size, chronicity, and problems associated with potential graft harvest sites. Matrix associated stem cell transplantation (MAST) is one such treatment described for larger lesions >15mm2 or failed alternative therapies. This cohort study describes a medium-term review of the outcomes of talar lesions treated with MAST.MethodsA review of all patients treated with MAST by a single surgeon was conducted. Preoperative radiographs, MRIs and FAOS outcome questionnaire scores were conducted. Intraoperative classification was undertaken to correlate with imaging. Postoperative outcomes included FAOS scores, return to sport, revision surgery/failure of treatment and progression to arthritis/fusion surgery.Results58 MAST procedures in 57 patients were identified in this cohort. The mean follow up was 5 years. There were 20 females and37males, with a mean age of 37 years (SD 9.1). 22 patients had lateral OCLS were and 35 patients had medial OCLs. Of this cohort 32patients had previous surgery and 25 had this procedure as a primary event. 15 patients had one failed previous surgery, 9 patients had two, four patients had three previous surgeries and three patients had four previous surgeries. 12 patients had corrective or realignment procedures at the time of surgery. In terms of complications 3 patients of this cohort went on to have an ankle fusion and two of these had medial malleolar metal work taken out prior to this, 5 patients had additional procedures for arthrofibrotic debridements, 1 patient had a repeat MAST procedure, 1 additional patients had removal of medial malleolar osteotomy screws for pain at the osteotomy site, there were 2 wound complications one related to the ankle and one related to pain at the iliac crest donor site.ConclusionMAST has demonstrated positive results in lesions which prove challenging to treat, even in a “ failed microfracture” cohort.RCT still lacking in field of orthobiologics for MAST. Longer term follow up required to evaluate durability.

Minimally Invasive Treatment of Inversion Shortening Calcaneal Fractures in the "Out-In" Position.

Heel fractures need extensive surgical incisions and are challenging to successfully reposition using traditional prying. The goal of this study is to evaluate the clinical effectiveness of using a Kirschner pin-guided distractor to treat inversion shortening calcaneal fractures in the "out-in" position. A total of 40 data from 37 patients with inversion shortened calcaneal fractures from January 2018 to March 2020 were reviewed. Preoperative lateral and axial X-rays and 3D CT were taken to assess the fracture type, and minimally invasive internal fixation was performed in the "out-in" position with distractor repositioning, and intraoperative and postoperative images were taken to assess fracture repositioning and fixation. During the follow-up period, the postoperative functional recovery status was assessed using the VAS score, AOFAS score, and FAOS score. Paired-samples t-test was used for all data comparisons. All cases received a mean follow-up of 28.49 ± 3.25 months, and the mean fracture healing time was 7.84 ± 0.71 weeks. The postoperative images showed well-fixed fracture repositioning, and calcaneal height, length, width, and inversion angles were significantly improved. At the final follow-up, the calcaneal height, length, and width recovered from 39.35 ± 4.44mm, 79.35 ± 2.7mm, and 45.75 ± 2.87mm preoperatively to 50.93 ± 3.18mm, 82.23 ± 1.90mm, and 39.67 ± 1.58mm postoperatively (p < 0.001; p < 0.001; p < 0.001). The calcaneus inversion angle restored from 7.73° ± 2.26° to 3.80° ± 1.80° (p < 0.001). Böhler's angle and Gissane's angle improved from 13.13° ± 3.02° and 105.15° ± 8.94° to 27.95° ± 3.41° and 122.85° ± 5.54° (p < 0.001; p < 0.001). No non-healing fractures, osteomyelitis, or traumatic arthritis were observed. Minimally invasive internal fixation with distractor repositioning in the "out-in" position is effective in the treatment of inversion shortening calcaneal fractures while restoring the anatomy and protecting the soft tissue.

Mid Term Followup of Patient Reported Outcomes in Patients &lt;50 years with a Total Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: End stage arthritis is a debilitating condition that significantly affects patients’ quality of life. Ankle arthritis differs from arthritis of the hip and knee in that ankle arthritis is often posttraumatic in nature and affects a younger patient population. Historically, younger age was a contraindication to total ankle arthroplasty (TAA) and ankle arthrodesis was the mainstay of treatment. Advances in TAA implant design and revision implants has expanded indications and increased usage of TAA. Despite this, many surgeons remain hesitant due to the lack of long term data on patient outcomes and survivorship in these patients. The purpose of our study was to evaluate patient reported outcome measures and survivorship after primary TAA in patients &lt; 50 years of age at the time of surgery. Methods: A retrospective chart review was conducted of patients &lt; 50 years of age who underwent primary TAA at a single institution from 2010-2020. Patient demographics, outcome measures, and complications were recorded. All patients had a minimum clinical follow up of 5 years. Patient reported outcome (PRO) measures collected included FADI, VAS, SMFA SF-36, AOFAS hindfoot scores, and FAOS scores. Outcome measures were evaluated preoperative, 1 year postoperative, and at final clinical follow up. Paired t-tests were performed to compare individual patients’ changes in PRO from preoperative to postoperative timepoints. Multiple comparisons correction was performed using the Bonferroni method. Implant survivorship was evaluated based on need for revision of either the tibial or talar component. Results: A total of 59 patients were included in the study. The average age at time of surgery was 43.2 years. All patients had a minimum follow up of 5 years with a mean follow up time of 8.8 years. Mean FADI improved from 53.3 (sd:14.1) preoperatively to 16.1 (sd:11.4) (p &lt; 0.001) at 1-year postoperatively. Mean VAS and SMFA also improved from preoperative to 1-year postoperative timepoints [VAS: 68.2 (sd:27.0) to 10.3(sd:13.1) (p &lt; 0.001); SMFA: 36.1 (sd:12.2) to 14.8 (sd:13.7) (p &lt; 0.001)]. A total of 5 patients required revision of components during the follow up period. Three patients required complete revision of both tibial and talar components, 2 due to aseptic loosening and 1 due to deep infection requiring explant of components. Conclusion: Patients &lt; 50 years undergoing TAA for end stage ankle arthritis have improved patients reported outcomes greater than 5 years after surgery. Despite the increased demands of the younger population, survivorship of total ankle implants in our study was 85% at a mean of 8.8 years postoperative. We believe that TAA is a safe and reliable option for young patients with high patient satisfaction at mid term follow up.

InternalBrace for Anatomic AITFL Augmentation and Syndesmotic Stabilization: Results at Long-term Follow Up

Category: Ankle; Trauma Introduction/Purpose: In the light of recent randomized control trials, both suture-button and syndesmotic screw fixation are considered standard-of-care for syndesmotic fixation, but no gold standard currently exists. An alternative technique that has been described to stabilize the syndesmosis is with use of suture-tape (InternalBrace, Arthrex) to augment a torn AITFL. This method has been the subject of several biomechanical studies that show it better restores anatomic relationships and can provide a preinjury level of syndesmotic stability. Additionally, it is thought to allow for protected healing of native ligaments, which may be of benefit to patients in the long-term. With this study we sought to explore the long-term outcomes of anatomic augmentation of the AITFL with the InternalBrace for the treatment of syndesmotic injury. Methods: We identified 31 patients who had suffered an acute or subacute syndesmotic injury and were treated with the InternalBrace technique (with or without adjunctive syndesmotic fixation) over a 12-month period from 2019-2020 by a single surgeon. The primary outcome variable was the Olerud-Molander Ankle Score (OMAS) at long-term follow up (12-36 months). Other outcomes collected were FAOS scores, range of motion data, and complications. Additionally, radiographs at five timepoints were reviewed to determine maintenance of syndesmotic reduction. Results: At final follow-up, 15 patients completed the primary outcome with a mean OMAS of 78 (SD, 18). All 31 patients were determined to have a successful syndesmotic reduction at the time of the index procedure. No patients were noted to have a radiographic loss of reduction with a tibiofibular clear space &gt; 6mm at time of final radiographic follow up (mean follow-up 439 days). For those patients with ROM data collected at final follow up, 12/15 patients were limited in dorsiflexion (average deficit 6 degrees), and 7/15 in plantarflexion (average deficit 14 degrees). In total, 10/31 patients developed symptoms of anterolateral impingement, for which six underwent secondary arthroscopic debridement. Conclusion: We report the first mid-to-long term clinical results of a newer alternative method of syndesmotic stabilization. Functional results are comparable to current standards-of-care. AITFL augmentation provides consistent anatomic reduction of the syndesmosis with enough biomechanical strength to resist rotation and diastasis. However, in some patients the development of irregular thickening/scarring of the AITFL contributed to symptoms of anterolateral impingement and stiffness. To avoid this complication, alterations in technique, such as a more proximal application of the suture-tape or avoidance of overtightening, are possible and emphasize the importance of future research.

Effectiveness of Platelet-rich Plasma Injections for Plantar Fasciitis: A Patient Reported Outcomes Evaluation

Category: Other Introduction/Purpose: Steroid injection is a common treatment for Plantar fasciitis (PF) but has high recurrence rates. Platelet- rich plasma (PRP) injections have been used as an alternative treatment. Our aim was to review the effectiveness of PRP injection. Methods: All patients who underwent PRP injection for PF between 2015 and 2021 were included in this study. Clinical results and patient reported outcomes (MOX-FQ scores, EQ-5D and FAOS scores) were collected pre and post-operatively. Results: A total of 34 patients underwent PRP injection between 2015 and 2021 (mean age 34 years). There was a 71% PROMs response rate (80% female with, mean age 53). The mean duration of symptoms was 4 years and the median follow up time was 4.2 years. 77.1% were satisfied with overall outcomes of treatment with PRP injections (p &lt; 0.05). 68.1% of patients reported satisfaction with pain relief. 74.6% were satisfied with return to activities of daily living. 72.6% were satisfied with return to recreational activities. 59% reported improvement in quality-of-life post treatment. 64% were happy to receive the same treatment again; 13.6% would not have the procedure again. 2 patients had severe pain within 2 weeks following the injection but symptoms settled. No other complications. Conclusion: PF is considered to be a self-limiting condition but can be debilitating whilst awaiting resolution of symptoms which can take upwards of 12 months to fully resolve. PRP injection provides effective pain relief for PF at 4 years follow up.

Do Patients who Undergo Fixation for Pilon Fracture Develop Symptoms Comparable to Primary Ankle OA?

Category: Ankle Arthritis Introduction/Purpose: Pilon fractures are challenging to manage and have poor functional outcomes and high complication rates. A significant proportion of these patients go on to develop post-traumatic ankle arthritis. Our aim was to assess the long term patient reported outcomes following pilon fracture fixation and how this compares to patients with end stage ankle osteoarthritis requiring surgical intervention in the form of total ankle arthroplasty. Methods: We retrospectively identified all patients who underwent pilon fracture fixation between April 2012 and December 2015 (Group A). Group B consisted of patients with primary ankle osteoarthritis awaiting elective total ankle replacement between 2015 and 2017. Patients completed a Patient Reported Outcome Measures questionnaire (MOX-FQ, EQ-5D and FAOS scores) pre and post-operatively. The average follow up was 8 years. Results: There were 18 patients in Group A and 22 in Group B. Ankle arthritis patients reported significantly worse score for MOXFQ Pain (P vs. AA; 39.0 ±29.5 vs. 68.0 ±27.1; p=0.001), Difficulty with Walking/ Standing (38.3±26.0 vs. 56.4±26.5; p=0.037) and difficulty with social activities (24.0 ±25.6 vs. 49.4 ±31.3; p=0.007) and FAOS domains of symptoms (68.7 vs. 52.1; p=0.005), ability to do Activities of Daily Living (18.9 vs. 27.5; p= 0.003) and Quality of life (56.6 vs. 32.5; p=0.012). There was no difference between groups for EQ-5D general health scores (78.8 vs. 68.8; p=0.156). Ankle arthritis group patients reported worse scores for mobility, ability to self-care and performed activities of daily living (p=0.012) compared to the pilon fracture group. Conclusion: Our 8 year follow up demonstrate good long term outcomes for patients following pilon fracture fixation. Patients did not develop symptomatic arthritis comparable to end stage ankle arthritis requiring surgical intervention and we therefore recommend primary treatment with fixation, irrespective of fracture severity.

Functional and radiological outcome of subtalar arthroereisis for flexible pes planovalgus in children: A retrospective analysis

IntroductionPediatric idiopathic pes planovalgus can correct itself with growth. Otherwise, in the event of functional impairment and after failed conservative treatment, surgery can be considered. Based on a multicenter retrospective study, we report the functional and radiographic results obtained after subtalar arthroereisis. HypothesisWe hypothesized that this surgery improves functional and radiological parameters in childhood. Material and methodForty-eight medical records of children (78 feet) operated on between 2010 and 2019 were studied. Functional (FAOS score) and radiographic (Djian angle, calcaneal slope, lateral talocalcaneal divergence and calcaneus/M5 alignment, talonavicular coverage measurement, AP talocalcaneal divergence) results were studied. The analysis of these different criteria was carried out between the preoperative period and the last follow-up. ResultsThe functional outcome was satisfactory with an average FAOS questionnaire score of 95.5 out of 100 total points. All the radiographic parameters studied were significantly improved (p<0.001). The average age at the time of surgery was 11.3 years (range: 7 to 16) with a mean follow-up of 35 months (range: 18 months to 84). Spontaneous screw expulsion and subtalar pain were the main complications found. DiscussionThe results obtained are consistent with those in the literature. The age at the time of the surgery is an essential factor to consider with the goal of optimal correction. ConclusionThis technique is reliable and effective in the short term. It can be offered as first-line therapy in the management of symptomatic pes planovalgus in children. The follow-up is short, which necessitates longer term studies of this population. The ideal age for surgery remains to be determined. Level of evidenceIV.

Modified Brostrom-Gould surgical procedure for chronic lateral ankle instability compared with other operations: a systematic review and meta-analysis

BackgroundThis study performed a randomized trial data meta-analysis to assess The Modified Brostrom-Gould (MBG) for proven chronic lateral ankle instability (CLAI).MethodsAll published randomized clinical trials comparing MBG and other operations were found by searching the Cochrane Library, EMBASE, and PubMed databases. The Review Manager 5.4 software was used to compare the two groups regarding postoperative functional score, ankle stability, and complications. Risk Ratio (RR) and Mean Differences (MD) were used in meta-analyses.Results8 experiments are suitable for it, 426 patients were enrolled, and 222 patients underwent other operations surgery. Among the six outcome indicators, in terms of FAOS scores, the other operations group has an advantage, 6.53 points higher than MBG; others show no significant differences.ConclusionsBased on this meta-analysis, the authors believe that other surgical groups can achieve better outcomes than MBG in some aspects of CLAI treatment.

Clinical Outcomes of Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: An Age-Based Multivariable Analysis

Category: Sports; Ankle; Hindfoot; Other Introduction/Purpose: Osteochondral lesions of the talus (OLT) are common injuries that are often found in patients with chronic disabling pain after ankle sprains. While OLT is becoming increasingly prevalent in the younger active population, there is disagreement and a lack of strong evidence about the impact of age on outcomes. The purpose of this study is to perform an Age- Based multivariate analysis to evaluate the clinical outcomes of Autologous Osteochondral Transplantation (AOT) for the treatment of OLT. The goals of this study are to examine trends in patient characteristics and clinical outcomes that occur with age as a statistical variable when performing AOT for the treatment of OLT. Methods: All study protocols were approved by the Institutional Review Board at the senior author's institution. A retrospective cohort study using chart review for AOT procedures on approximately 80 patients from 2006 to 2019 performed by a single surgeon. Clinical outcomes of patients were evaluated via FAOS scores for Symptoms, Pain, Activities of Daily Living, Sports and Quality of Life. A multivariable linear regression was used to assess the independent factors predictive of the first post-operative FAOS after AOT. The independent variables included in the model were pre-operative FAOS, age, defect size, whether the lesion was a shoulder lesion, cystic lesion, or a result of a traumatic injury, and whether the patient had a prior microfracture surgery. A p-value &lt;.05 was considered significant and 95% confidence limits (95% CL) for regression coefficient estimates (est.) were calculated. Results: 78 patients were included in the analysis with an average age of 35.5 +- 13.6. The average follow-up was 54.4 months +- 18.9 months, average pre-operative FAOS was 54.3 +- 19.4 and the average post-operative FAOS was 83.4 +- 13.6. The average defect size was 109.3 mm2 (std. dev. = 62.4 mm). 56 patients had a shoulder lesion, 24 had a prior microfracture surgery, 42 had a cystic lesion, and 27 had a prior traumatic injury. The multivariable linear regression showed that the pre-operative FAOS was associated with a higher post-operative FAOS (est., 95% CL: 0.16, 0.012 - 0.307; p=0.034). Defect size (est., 95% CL: -0.05, -0.097 - -0.003; p=0.0358), having a shoulder lesion (est., 95% CL: -9.068, -15.448 - -2.688; p=0.006), or having a prior microfracture surgery (est., 95% CL: -7.07, -13.118 - -1.021; p=0.0226) were associated with a lower post-operative FAOS. Conclusion: The main finding of this study is patient age was not an independent risk factor for inferior clinical outcomes after AOT for OLT. Additionally, having a cystic lesion, or having a lesion because of a traumatic injury were not significantly associated with post-operative FAOS. Having a shoulder lesion had the largest marginal effect on post-operative FAOS. These findings provide important information for providers when counseling and selecting patients for AOT procedure for treatment of OLT.

Clinical and Radiological Results after Use of A Human Bone Graft (Shark Screw®) in TMT II/+II Arthrodesis

Category:Basic Sciences/Biologics; Midfoot/Forefoot; TraumaIntroduction/Purpose:The tarsometatarsal joints, also called Lisfranc-joints, are the joints between the midfoot bones and the tarsal bones. The continuous arthrotic destruction of the tarsometatarsal joints leads to pain and foot deformities. The therapy of choice after failure of conservative therapy is arthrodesis. For this operation there is the possibility of using a transplant screw made of allogenic human bone material (Shark Screw), instead of conventional metal implants. This study investigates the clinical significance and radiological integration of the allogenic bone screw for arthrodesis of the tarsometatarsal joints II/+III.Methods:This is a retrospective study involving 20 feet of 17 patients who received TMT II/+III arthrodesis with an allogenic bone screw (Shark Screw) at Speising Orthopedic Hospital in Vienna, Austria. VAS, FFI, FAOS, and AOFAS were used as measures to compare preoperative and postoperative results. Radiologic integration in the recipient bone was also evaluated.Results:Comparing preoperative with the postoperative score of 20 feet from 17 patients, a significant reduction of the VAS (pain) from 7,6 points to 1,4 points (p=<0,001)), as well as a decrease of the VAS (function) from 7,25 points to 1,8 points has been observed. Further, a significant reduction of the FFI from 62,3% to 16,7% (p=<0,001), and a significant increase from 29,7 points to 79,9 points of the AOFAS (p=<0,001) was detected. Analyzing the FAOS score, there was a significant (p=<0,001) increase of all subscales (Symptoms, Pain, Function and Quality of life). Moreover, in all cases a good radiological integration into the recieverbone was noticed. As a result the screw was, after a follow-up time from 12 months, no longer distinguishable from the original bone.Conclusion:These results demonstrated that the human bone screw used for TMT II/+III arthrodesis has a good outcome and reliable clinical significance. This study may be used for further investigations that should be performed to ensure this result.

Functional outcome of 103 fractures of the proximal fifth metatarsal bone

BackgroundMetatarsal fractures are common skeletal injuries of the lower extremity in adults. The majority involves the proximal fifth metatarsal bone. In the current literature, there still exists controversy regarding treatment recommendations for the different fracture entities.MethodsAll patients suffering from single fractures to the proximal fifth metatarsal bone between 2003 and 2015 were enrolled in this retrospective analysis. Only patients with a minimum follow-up of 12 months were included. The fractures were classified according to Lawrence and Botte (L&B). Data were collected via patient registry, radiographs and a standardized questionnaire (Foot and Ankle Outcome Score = FOAS). For outcome analysis, the nonparametric Mann–Whitney U test was performed and Spearman’s rank correlation coefficient calculated.ResultsIn total, the functional outcomes of 103 patients suffering from fractures to the proximal fifth metatarsal bone were analyzed. L&B type I fractures (n = 13) had a FAOS score of 91 ± 23, L&B type II (n = 67) presented a score of 91 ± 15 and L&B type III (n = 23) a score of 93 ± 11. Surgically treated patients with an L&B type II fracture had no statistically significant better functional outcome in comparison to conservative management (p = 0.89). Operatively treated L&B type III fractures tended to have a better functional score (p = 0.16). The follow-up time was 58 (min: 15; max: 164) months.ConclusionsOverall, the functional outcome following fractures to the proximal fifth metatarsal bone is satisfactory. Conservatively treated L&B type II fractures showed an equivalent functional outcome compared to surgical management. Patients with an L&B type III fracture mainly were treated surgically, but difference in FAOS score did not reach level of significance.

Patient reported outcome of 33 operatively treated talar fractures

BackgroundManagement of talar fractures remains to be one of the most challenging aspects in trauma surgery. Unfortunately, the evidence regarding the correct treatment of these fractures is mainly based on retrospective case series, while studies assessing the patient-reported outcome are rare. Therefore, the aim of this trial was to analyze the patient reported outcome in context of trauma mechanism and concomitant injuries following operative treatment of talar fractures.MethodsA retrospective outcome study of patients with operatively treated talar fractures between 2003 and 2015 was conducted. The fractures were classified according to AO-/Hawkins classification system and to the Marti-Weber classification. Data was collected via patient registry, radiographs and a validated patient-reported outcome measure (PROM) for foot and ankle pathologies (Foot and Ankle Outcome Score = FOAS). An analysis regarding the functional outcome, concomitant injury and timing of surgery using the nonparametric Mann-Whitney U test and Spearman`s rank correlation was performed.ResultsIn total the functional outcome of 32 patients suffering from fractures to the talus were analyzed. The median age of the study cohort was 35±12.2 years, including 9 female (28 %) and 23 male (72 %) patients. The median FAOS score was 72±22.7 (range 13–94). Patients with an isolated talar fracture had an FAOS of 87±20 and with concomitant injury a score of 60±23.4 (p = 0.016). Patients with a closed talar fracture without emergency operation due to dislocation or polytrauma, showed no correlation between timing of surgery and FAOS (r= -0.17, p = 0.43). 10 % of the patients developed an avascular necrosis and 25 % showed signs of a posttraumatic arthritis. The follow-up time was 41 months (range: 16–145).ConclusionsTalar fractures were typically caused by high-energy trauma often associated with additional injuries of the lower extremity. The majority of the patients showed a fair to poor functional long-term outcome. Concomitant injuries of the lower extremity led to a lower FAOS. In closed talar fractures without the necessity of an emergency surgical intervention, time to surgery did not influence the patient reported outcome. Relating to the presented data, delayed surgery after soft tissue consolidation was not associated with a higher risk of developing an avascular necrosis.

Patient-Reported Outcome Following Operative and Conservative Treatment of Calcaneal Fractures: A Retrospective Analysis of 79 Patients at Short- to Midterm Follow-Up.

Background: Fractures of the calcaneus are severe injuries of the hindfoot, mostly resulting from high-energy axial loads, which still present enormous challenges to modern trauma surgery. Possible variables influencing the outcome are the type of fracture, age, and quality of fracture reduction. These might also be factors affecting the self-reported patient outcome, but large studies are still lacking. Therefore, the aim of this study was to analyze the patient-reported outcome of calcaneal fractures following operative and conservative treatment.Methods: All patients suffering from calcaneal fractures between 2002 and 2015 were enrolled in this retrospective analysis. The calcaneal fractures were classified according to Sanders and the AO classification system. For further analysis, two groups were formed: group I involved complex intra-articular fractures defined by the involvement of the posterior calcaneal facet, while group II consisted of extra-articular and process calcaneal fractures. Data were collected via the patient registry, radiographs, and a standardized questionnaire (Foot and Ankle Outcome Score, FAOS). For outcome analysis, non-parametric Mann–Whitney U-test was performed, and Spearman's rank correlation coefficient was calculated.Results: In total, the functional outcome of 79 patients with calcaneal fractures was analyzed. In group 1 (n = 43), the mean FAOS score was 65.5 ± 18.9. The surgically treated patients with a Sanders type II calcaneal fracture had a mean FAOS score of 72.9 ± 17.2, type III fractures had 65.6 ± 20.8, and type IV had 61.1 ± 19 (p = 0.15). The reoperation rate was 22%, most frequently caused by wound complications (10%). The mean follow-up time was 64.5 ± 44 months. The mean FAOS score of group 2 (n = 36) was 75.2 ± 18.4, and 83% of the patients (=30) were managed conservatively. Only one out of six operatively managed patients had a reoperation due to regular implant removal. The mean follow-up time was 31 ± 25.9 months.Conclusion: Intra-articular calcaneal fractures are severe injuries of the hindfoot leading to a fair to poor functional outcome in the majority of the patients. Complications regarding wound healing are the most common causes for revisional surgery. Extra-articular calcaneal fractures are a heterogenous entity commonly managed non-operatively. Overall, they show a better functional outcome in comparison to intra-articular calcaneal fractures.

A prospective comparative study of arthroscopic Brostrom procedure alone vs. Brostrom-Gould procedure in the repair of isolated ATFL injury at follow-up in one year

Objectives:Arthroscopic Brostrom-Gould procedure is the reference technique in the treatment of isolated anterior talofibular ligament injury. Extensor retinaculum reinforcement uses the proximal part, without any mechanical function. The objective is to compare the isolated ATFL reinsertion technique with reinsertion + biological augmentation.Methods:This is a prospective study that compares the isolated ATFL reinsertion technique (Brostrom) vs. reinsertion + retinaculum reinforcement (Brostrom-Gould) at one year follow-up. 2 groups of 25 patients were selected. The two groups matched in terms of age, weight, and gender. All patients presented with isolated ATFL with stage 1 or 2 lesions according to the French arthroscopy society (SFA) classification. Patients were clinically evaluated preoperative and in one year with the FAAM and FAOS scores and the recurrence rate was assessed as well as passive joint amplitudes pre- and postoperatively. There was a single operator for the series and the surgical technique was chosen before surgery. Patients had the same postoperative rehabilitation protocol (ankle splint to be worn for 30 days with weight-bearing, no work in varus before 30 days, rehabilitation at D2).Results:Regarding clinical scores, in both groups there was a significant improvement in the sports FAAM and FAOS scores in the postoperative period. In the isolated Brostrom group, the FAAM score increased from 20 to 29 and the FAOS score from 75% to 95%. In the Brostrom-Gould group, the FAAM score increased from 19 to 30 and the FAOS score from 77% to 96%. There was no significant difference between the 2 groups. We identified no postoperative complications in either group. A sprain recurred in 2 patients in the Brostrom-Gould group and in 3 patients in the isolated Brostrom group. The sprain was mild in all cases and was controlled by ultrasound. The joint amplitudes in active plantar flexion were 36° in the isolated Brostrom group and 34° in the Brostrom-Gould group. There was no significant difference between the 2 groups.Conclusion:Our study shows that there is no difference between the isolated arthroscopic Brostrom technique and the Brostrom-Gould technique in the management of isolated ATFL grade 1 and 2 lesions in terms of recurrence and clinical scores and that the isolated Brostrom technique can be used to treat these lesions.

Six out of ten patients with sinus tarsi syndrome returned to pre-injury type of sport after subtalar arthroscopy

PurposeThe purpose of this study was to determine multiple return to sport rates, long-term clinical outcomes and safety for subtalar arthroscopy for sinus tarsi syndrome.MethodsSubtalar arthroscopies performed for sinus tarsi syndrome between 2013 and 2018 were analyzed. Twenty-two patients were assessed (median age: 28 (IQR 20–40), median follow-up 60 months (IQR 42–76). All patients were active in sports prior to the injury. The primary outcome was the return to pre-injury type of sport rate. Secondary outcomes were time and rate of return to any type of sports, return to performance and to improved performance. Clinical outcomes consisted of Numerous Rating Scale of pain, Foot and Ankle Outcome Score, 36-item Short Form Survey and complications and re-operations.ResultsFifty-five percent of the patients returned to their preoperative type of sport at a median time of 23 weeks post-operatively (IQR 9.0–49), 95% of the patients returned to any type and level sport at a median time of 12 weeks post-operatively (IQR 4.0–39), 18% returned to their preoperative performance level at a median time of 25 weeks post-operatively (IQR 8.0–46) and 5% returned to improved performance postoperatively at 28 weeks postoperatively (one patient). Median NRS in rest was 1.0 (IQR 0.0–4.0), 2.0 during walking (IQR 0.0–5.3) during walking, 3.0 during running (IQR 1.0–8.0) and 2.0 during stair-climbing (IQR 0.0–4.5). The summarized FAOS score was 62 (IQR 50–90). The median SF-36 PCSS and the MCSS were 46 (IQR 41–54) and 55 (IQR 49–58), respectively. No complications and one re-do subtalar arthroscopy were reported.ConclusionSix out of ten patients with sinus tarsi syndrome returned to their pre-injury type of sport after being treated with a subtalar arthroscopy. Subtalar arthroscopy yields effective outcomes at long-term follow-up concerning patient-reported outcome measures in athletic population, with favorable return to sport level, return to sport time, clinical outcomes and safety outcome measures.Level of evidenceIV.

One-year follow-up data from the German Cartilage Registry (KnorpelRegister DGOU) in the treatment of chondral and osteochondral defects of the talus.

Chondral and osteochondral lesions of the talus (OLTs) remain a challenging issue with numerous operative treatments proposed to date. The aim of this study was to evaluate 1-year follow-up data in the German Cartilage Registry (KnorpelRegister DGOU). Among 401 patients in the database, 114 patients with a complete 1-year Foot and Ankle Outcome (FAOS) score for subscale Pain as the primary variable were included. A total of 12 different surgical treatments were performed. However, 8 techniques were carried out in negligible numbers of patients (n = 1-3), leaving 89 patients treated with the following techniques: arthroscopic antegrade bone marrow stimulation (group A; n = 32), autologous chondrocyte implantation with autologous cancellous bone grafting (group B; n = 9), matrix-augmented bone marrow stimulation (group C; n = 22), and matrix-augmented bone marrow stimulation with autologous cancellous bone grafting (group D; n = 26). Group differences and possible influencing variables such as age and sex were evaluated. Level of significance was set at p < 0.05 for all statistical tests. All four treatment groups showed significant improvement of the FAOS scores at 1year postoperatively compared with their preoperative scores. No significant differences were found with respect to score changes among the groups. A positive correlation between FAOS subscale Pain improvement and defect size volume and negative correlations between increasing age and FAOS subscales Sports/Rec and QoL were found. Concomitant ankle stabilization led to greater improvement in FAOS subscales Symptoms and ADL than in patients with no stabilization. FAOS subscale Pain showed greater improvement in women than in men. All analyzed treatment options were effective for treatment of OLTs. In particular, large defects appeared to benefit from treatment. In the presence of concomitant ankle instability, a stabilizing procedure appeared to have a positive impact on the outcome.

Outcomes following Subchondroplasty in the First Metatarsal Head

Category:Midfoot/Forefoot; OtherIntroduction/Purpose:Patients with subchondral bone marrow lesions often present with arthritic symptoms causing severe discomfort. Recently, subchondroplasty has been offered to treat such patients who suffer from symptoms of bone marrow edema. Calcium phosphate is percutaneously injected into these edematous regions to stabilize damaged bone and aid in healing. Subchondroplasty has been used successfully in the knee for femoral and tibial plateau injuries. However, its use in foot and ankle orthopaedics is relatively limited. This procedure has shown short-term success in patients with painful edema of the talus, as well as patients with early stage avascular necrosis (AVN) in the second MTP joint and the cuboid. Here, we report outcomes of two patients who developed AVN as a result of subchondroplasty in foot and ankle surgery.Methods:A retrospective review of patients was performed in those patients who underwent subchondroplasty in their first metatarsal heads between January 2017 and April 2017. Exclusion criteria included patients lost to follow up. Following implementation of inclusion and exclusion criteria, two patient charts were reviewed. Patients were treated by a single surgeon at the same institution. Data collected included patient demographics (age, laterality, BMI, ASA class, comorbidities), preoperative and postoperative VAS scores, FAOS scores, and imaging. Patients were followed up in clinic for two years following the procedure. Data was then analyzed via mean, standard deviation, median, and range for continuous variables and counts with percentages for categorical data.Results:In both patients, VAS scores increased, and physical exam showed greater tenderness over the affected region. The corresponding MRIs showed development of avascular necrosis in the region of the first metatarsal joint where the subchondroplasty had occurred. Both patients consequently had to undergo revascularization procedures and required further operations to correct the condition.Conclusion:Ultimately, subchondroplasty over the first metatarsal head failed in our patients. Exposure to calcium phosphate exacerbated their condition, resulting in symptomatic AVN. Although literature for subchondroplasty in foot and ankle orthopaedics is limited, preliminary results are unfavorable for use in the first metatarsal joint. Therefore, more long term data needs to be gathered this area before implementing the procedure more widely in foot and ankle surgeries.

Clinical Safety and Outcomes of a Novel Ultrasound Assisted Bioabsorbable Suture Anchor in Foot and Ankle Surgeries

Category:SportsIntroduction/Purpose:Bioabsorbable suture anchors have been popularized due to potential for osseous integration, less interference with diagnostic imaging, and ease of use. Recently, ultrasound assisted suture anchor systems have been introduced with the benefits of obtaining interdigitation with cancellous bone while maintaining a minimal footprint. In a cadaveric study, ultrasound assisted suture anchors demonstrated a similar pullout strength and less system displacement when compared to a benchmark bioabsorbable anchor system. However, the failure and complication rates of ultrasound assisted bioabsorbable anchors has never been demonstrated in a clinical setting. We studied the Stryker SonicAnchor by examining complication rates in foot and ankle procedures and secondarily determined the efficacy by evaluating clinical outcomes of surgeries using this anchor system.Methods:A retrospective analysis was performed on all patients treated by the primary investigator using the Stryker SutureAnchor between the dates of May 2016 and February 2018. We included all patients for which the anchor was used during surgery with at least 2 year followup including VAS and FAOS scores. We recorded baseline demographic information as well as the type of surgery patients underwent. We recorded all intraoperative and postoperative complications for these surgeries. In addition, we compared preoperative and postoperative clinical scores.Results:57 patients met inclusion criteria. On average, patients were 53 years old at the time of surgery. Mean followup was 32.8 months. Mean BMI was 30.36. Three patients reported current tobacco use (5.3%), four patients (7.0%) had type II diabetes mellitus at the time of their surgery, and only one patient (1.8%) had osteoporosis. Common procedures were Achilles repair including Haglund’s resection, peroneal surgery, and lateral ligament reconstruction. There were two deep infections requiring reoperation, one medial malleolus stress fracture following total ankle replacement, one metatarsal stress fracture not involving the surgery site, and one DVT. No reports of anchor pullout or soft tissue repair failure. VAS and FAOS scores improved from 6.2 to 1.2 and 54.3 to 93.9.Conclusion:In our review of 57 patients operated on with the SonicAnchor with at least two year followup, there were zero cases of complications stemming from the anchor including anchor pullout or soft tissue repair failure. Overall, patients improved tremendously in their clinical outcome scores across a wide range of different procedures. Previous studies have demonstrated the biomechanical strength of the SonicAnchor and our review supports its clinical safety and efficacy in long-term clinical followup.