Foot And Ankle Outcome Score Scores Research Articles

Modified Anatomic Hamstring Graft Reconstruction for Revision and Severe Cases of Lateral Ligament Instability

Category: Ankle Introduction/Purpose: Treatment for patients with severe ankle instability or failed previous ankle stabilization is not well defined. Results after ankle stabilization techniques involving non-anatomic reconstruction have historically been suboptimal, and newer techniques have limited presence in the literature. The purpose of this study is to report clinical and radiographic outcomes after modified anatomic lateral ligament reconstruction using hamstring auto- or allograft in patients with severe ankle instability or failed previous ankle stabilization. A novel technique for ligament reconstruction is also presented that is hypothesized to restore functional and radiographic ankle stability. Methods: A retrospective chart review was performed on all patients that had undergone modified anatomic lateral ligament reconstruction by a single surgeon between 2011 and 2015 with at least 6 months follow-up. Indications for modified anatomic reconstruction included failure of previous ankle stabilization or severe laxity with greater than 20 degrees of talar tilt or anterior drawer greater than 15 mm on stress radiographs. Patients completed routine pre- and post-operative functional outcome scores including Foot and Ankle Outcome Score (FAOS), Short Form 12 Health Survey (SF-12), and Visual Analog Scale (VAS). Patients underwent pre- and post-operative stress radiographs using the Telos Stress Device (Hungen, Germany). Thirty-four patients (35 ankles) were included with average follow-up of 26.7 months. Average age was 34.2 years, and there were 29 female patients and 5 male patients. Hamstring autograft was utilized in 31 ankles and hamstring allograft in 4 ankles. Results: Indications for surgery included failure of previous ankle stabilization in 13 patients and severe ankle instability in 22 patients. All functional outcome scores improved; VAS increased from 5.3 to 1.0 points (p < 0.0001), SF-12 increased from 64 to 89 points (p < 0.0001), and FAOS scores increased in all categories (p < 0.05). Radiographic measurements of instability also improved; anterior drawer decreased by 3 mm (p = 0.0002) and talar tilt decreased by 11 degrees (p < 0.0001) (see Table 1). One patient (3%) returned to the operating room for removal of hardware after over 2 years. There were 4 patients (12%) with delayed wound healing, 2 patients (6%) with neurologic complications, and 2 patients (6%) with venous thromboembolic events. Conclusion: Patients demonstrated significant improvement in functional outcome scores as well as radiographic measures of ankle stability following modified anatomic lateral ligament reconstruction in a population with severe or recurrent instability. This is the largest series to date of ankle ligament reconstruction using autograft, and it is associated with high patient satisfaction, reduced pain, improved objective stability, and low morbidity. Further study is warranted to develop well-defined guidelines on the management of patients with severe or recurrent instability.

Magnetic Resonance Imaging Evidence of Postoperative Cyst Formation Does Not Appear to Affect Clinical Outcomes After Autologous Osteochondral Transplantation of the Talus

To identify potential cysts using magnetic resonance imaging (MRI) after autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLTs) as well as to determine the effect of cysts on short-term clinical outcomes. Eighty-nine MRI scans of 37 patients who had AOT for an OLT were evaluated. Radiographic variables examined included cyst presence, cyst location, bone edema, and cartilage integrity. Patient clinical variables recorded and examined for association with the presence of a cyst included gender, age, preoperative lesion size, size and number of osteochondral graft used, symptoms reported, and pre- and postoperative Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) scores measured at final follow-up. Twenty-four patients (64.8%) had MRI evidence of cystic change after AOT for an OLT at a mean MRI follow-up time of 15months after surgery (range 2-54). Patients with presence of a cyst after surgery were older (mean age, 42.7years) than those without cysts (mean age, 32.7years) (P= .041), and among patients with a cyst, older patients more often had involvement of the subchondral plate (57.3 v 36.7years) (P < .001). No other variables associated with cyst formation had statistical significance. Mean patient FAOS scores increased from 50 (±19) preoperatively to 87 (±8) postoperatively. Mean SF-12 scores increased from 52 (±18) preoperatively to 85 (±6) postoperatively. Patients not identified as having a cyst had lower SF-12 (P=.028) and FAOS (P= .032) preoperative scores and more improvement in SF-12 (P= .006) and FAOS (P=.016) scores than patients with cysts. Postoperative cyst formation on MRI was found to be a common occurrence after AOT for OLT. Although increasing age was related to increased cyst prevalence, the clinical impact of cyst formation was not found to be significant at short-term follow-up. Continued long-term longitudinal follow-up of postoperative cysts is needed. Level IV, prognostic case series.

Validation of the Foot and Ankle Outcome Score for Hallux Rigidus.

There is a clear call for improved patient-centered outcomes. The Foot and Ankle Outcome Score (FAOS) is a region-specific patient-reported measure that has been validated for a number of foot and ankle diagnoses, but not hallux rigidus. The aim of this study was to validate the FAOS in patients with hallux rigidus. From 2007 to 2013, 211 patients with hallux rigidus (HR) were included in the study. For the construct validity portion of the study, 125 patients completed a Short-Form 12 (SF-12) and FAOS survey. Forty additional HR patients were prospectively given questionnaires to assess the relevance of each FAOS question as it pertained to their HR. Reliability was assessed in 36 HR patients via administration of a second FAOS an average 1month following the first. In 55 patients, preoperative and postoperative FAOS scores were compared to determine responsiveness. All FAOS subscales demonstrated moderate correlation coefficients with the physical functioning, role physical, bodily pain, and physical health component scores of the SF-12, with all subscales demonstrating poor correlation with the SF-12 mental health-related domains. Content validity was high for all FAOS scores, with the exception of the daily activities subscale. All subscales achieved acceptable test-retest reliability with correlation coefficients of ≥0.72. Furthermore, all subscales were rated as responsive to change in postoperative patients (p < 0.001). This study demonstrates the acceptable construct and content validity, reliability, and responsiveness of the FAOS for hallux rigidus. Due to its broad applicability and proven validation across multiple foot and ankle pathologies, the FAOS represents a patient-centered outcome measure that can be reliably used for the assessment of patients with hallux rigidus.

Validity and reliability of Thai version of the Foot and Ankle Outcome Score in patients with arthritis of the foot and ankle.

Although the Foot and Ankle Outcome Score (FAOS) is commonly used in several languages for a variety of foot disorders, it has not been validated specifically for foot and ankle arthritic conditions. The aims of the present study were to translate the original English FAOS into Thai and to evaluate the validity and reliability of the Thai version of the FAOS for the foot and ankle arthritic conditions. The original FAOS was translated into Thai using forward-backward translation. The Thai FAOS and validated Thai Short Form-36 (SF-36®) questionnaires were distributed to 44 Thai patients suffering from arthritis of the foot and ankle to complete. For validation, Thai FAOS scores were correlated with SF-36 scores. Test-retest reliability and internal consistency were also analyzed in this study. The Thai FAOS score demonstrated sufficient correlation with SF-36 total score in Pain (Pearson's correlation coefficient (r)=0.45, p=0.002), Symptoms (r=0.45, p=0.002), Activities of Daily Living (ADL) (r=0.47, p=0.001), and Quality of Life (QOL) (r=0.38, p=0.011) subscales. The Sports and Recreational Activities (Sports & Rec) subscale did not correlate significantly with the SF-36® (r=0.20, p=0.20). Cronbach's alpha, a measure of internal consistency, for the five subscales was as follows: Pain, 0.94 (p<0.001); Symptoms, 0.58 (p<0.001); ADL, 0.96 (p<0.001); Sports & Rec, 0.79 (p<0.001); and QOL, 0.93 (p<0.001). The intraclass correlation coefficient (ICC) of a major subscale of ADL, containing 17 items, was significant at 0.33 (p=0.013; 95% confidence interval, 0.04-0.57). The Thai FAOS demonstrated sufficient levels of construct and content validity for the evaluation of foot and ankle arthritis. Although reliability was satisfactory for the major subscale ADL, it was not sufficient for the minor subscales. Our findings suggest that it can be used as a disease-specific instrument to evaluate foot and ankle arthritis and can complement other reliable outcome surveys.

Results of Surgical Management of Osteochondritis Dissecans of the Ankle in the Pediatric and Adolescent Population.

There is a paucity of published literature on operative management of osteochondritis dissecans (OCD) in the ankle in adolescents. This study seeks to elucidate patient and lesion characteristics associated with surgical success and failure as well as reporting functional outcomes. Retrospective chart review identified all patients aged 18 years old or younger surgically treated for OCD of the ankle at our institution from 2001 to 2010. This included 109 ankles in 100 patients (75 female, 25 male), mean age 14.3 ± 2.3 years (range, 7 to 18 y), with a median follow-up of 3.3 years (range, 1 to 10.8 y). Patient and lesion data, surgical procedure, clinical results, and complications were recorded. Postoperative radiographs were reviewed in 80 ankles. A return to sport survey and a Foot and Ankle Outcome Score (FAOS) was sent to all patients. Multivariate statistical analysis evaluated predictors of reoperation rate, Berndt and Harty clinical grade, and FAOS scores. Kaplan-Meier analysis was applied to determine freedom from reoperation. The OCD lesion was most commonly found on the medial talus (80, 73%). The most common procedures performed included transarticular drilling (59, 54%), fixation (22, 20%), and excision microfracture (27, 26%). The overall rate of reoperation was 27% (29/109). Berndt and Harty clinical grade was poor (33, 30%), fair (23, 21%), and good (53, 49%). Reoperation rates were significantly higher for OCD lesions in which postoperative radiographs had no change or looked worse (10/16, 63%) (P = 0.002). Thirty-six of 44 survey respondents (82%) were satisfied and 37 (84%) returned to sports at a median time of 6 months. Average FAOS score was 77 ± 18. Multiple linear regression confirmed that female sex and elevated body mass index were significant negative predictors for FAOS score. The reoperation rate following surgical intervention for OCD of the ankle is high. Females and those with a higher body mass index may have worse subjective functional ankle outcomes.

Functional Outcome of Conservative Treatment of Isolated Anterior Talofibular Ligament Injury - A Prospective Analysis

Introduction: Ligamentous injuries of the ankle are very commonly encountered in orthopaedic practice and 40% of these injuries constitute the Anterior Talo-Fibuar ligament (ATFL) injuries. It is the weakest of the lateral ligaments. Unless there is significant joint instability, surgery is rarely indicated in the treatment of isolated ATFL injuries. Our study focused on the assessment of the long term outcome of isolated ATFL injuries treated by conservatively. Material and Methods: We included 20 patients who presented to us with isolated ATFL injury from January 2015 to march 2015 for this prospective study. The diagnosis was confirmed with an MRI. 12(60%) patients were grade II and 8 (40%) patients were grade III. All the patients were conservatively treated with the POLICE protocol and weight-bearing was advised as tolerated but strictly with a proper ankle support. Patients were followed up at the end of 1st week, 2nd week, 1 month,3rd month and at 6 months. Patients were evaluated with a Visual Analog Scale (VAS) and the Foot and Ankle Outcome score (FAOS). Results: There was statistically significant improvement in the VAS and FAOS scores. From the pre-treatment scores of 9.1 and 53, they improved to 1.4 and 91 respectively at the final follow-up. Conclusion: From our prospective study, we conclude that conservative management of isolated ATFL injuries is a safe and effective method of treatment. Key words: Anterior Talo-Fibular Ligament (ATFL); Lateral ligament Injuries of ankle; Conservative: POLICE

Clinical outcomes following ankle fracture: a cross-sectional observational study

The purpose of the current study was to examine objective and subjective differences between three severity groups of ankle fractures patients compared to healthy controls. This was a case-controlled study. 92 patients with an ankle fracture injury of which 41 patients were eligible to participate in the study. 72 healthy people served as controls. All patients underwent a computerized gait test, completed self-assessment questionnaires (The Foot and Ankle Outcome Score (FAOS) and the SF-36), evaluated with the American Foot and Ankle Score (AOFAS) form and completed the 6-min walk test. The control group performed a computerized gait test and completed the SF-36 health survey. All ankle fracture patients presented compromised gait patterns and limb symmetry compared to controls (p < 0.05). Ankle fracture patients also had lower SF-36 scores compared to controls (p < 0.05). Significant differences were found between the unimalleolar group compared to the bimalleolar and trimalleolar groups in most parameters, except for the FAOS scores. There were no significant differences between the bimalleolar fracture group and the trimalleolar fracture groups. Although all fracture severity classification groups presented a compromised gait pattern and worse clinical symptoms compared to controls, it seems that patients with a unimalleolar fracture is a different group compared to bimalleolar and trimalleolar fracture. Furthermore, it seems that bimalleolar fracture and trimalleolar fracture affect the gait pattern and clinical symptoms to an equal extent, at least in the short-term. NCT01127776 .

Clinical outcomes following ankle fracture: a cross-sectional observational study.

BackgroundThe purpose of the current study was to examine objective and subjective differences between three severity groups of ankle fractures patients compared to healthy controls.MethodsThis was a case-controlled study. 92 patients with an ankle fracture injury of which 41 patients were eligible to participate in the study. 72 healthy people served as controls. All patients underwent a computerized gait test, completed self-assessment questionnaires (The Foot and Ankle Outcome Score (FAOS) and the SF-36), evaluated with the American Foot and Ankle Score (AOFAS) form and completed the 6-min walk test. The control group performed a computerized gait test and completed the SF-36 health survey.ResultsAll ankle fracture patients presented compromised gait patterns and limb symmetry compared to controls (p < 0.05). Ankle fracture patients also had lower SF-36 scores compared to controls (p < 0.05). Significant differences were found between the unimalleolar group compared to the bimalleolar and trimalleolar groups in most parameters, except for the FAOS scores. There were no significant differences between the bimalleolar fracture group and the trimalleolar fracture groups.ConclusionsAlthough all fracture severity classification groups presented a compromised gait pattern and worse clinical symptoms compared to controls, it seems that patients with a unimalleolar fracture is a different group compared to bimalleolar and trimalleolar fracture. Furthermore, it seems that bimalleolar fracture and trimalleolar fracture affect the gait pattern and clinical symptoms to an equal extent, at least in the short-term.Trial registrationNCT01127776.

Lateral ankle instability in high-demand athletes: reconstruction with fibular periosteal flap

Fibular periosteal flaps have been used to address chronic lateral ankle instability, but there are no studies in the literature reporting functional outcomes after this particular procedure in high-demand athletes. We postulated that for chronic instability, nonanatomical reconstruction of the lateral ankle ligament with a fibular periosteal flap will return high-demand athletes to their previous levels of activity. Forty patients who had grade III ankle sprain and experienced no success after a course of supervised conservative management lasting at least six months and who had a preinjury Tegner score of ≥ 6 underwent a lateral compartment reconstruction with a fibular periosteal flap. Each patient was given the Tegner and Karlsson questionnaire and was evaluated by the Zwipp method, Foot and Ankle Outcome Score (FAOS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score at the six-month, one, two and three-year time points. Range of motion (ROM) of the affected ankle was assessed, and stress X-rays were performed. Mean patient age was 24.5 (range17-30) years, and no patient was lost to follow-up. Mean follow-up was 36 (minimum 18) months, mean Tegner scores at the one, two and three-year time points were 8.8, 8.9 and 8.9, respectively, and mean Karlsson scores were 93 ± 5.2, 95 ± 3.1 and 94.9, respectively. AOFAS and FAOS scores improved from a mean of 69.4 and 71.4, respectively, in the preoperative group to a mean of 97.2 and 94.4, respectively, at the last follow-up. The ROM was equal to the contralateral ankle in all but two patients at the two-year follow-up. No major complications were found. Nonanatomical ligament reconstruction with a fibular periosteal flap for chronic lateral ankle instability was effective in returning high-demand athletes to their preinjury functional levels.

Hindfoot Arthroscopy: A Systematic Surgical Approach for Identifying Anatomy and Hindfoot Pathology (SS-47)

Hindfoot arthroscopy has been recognized as a safe and valid technique for treating hindfoot pathology, while also facilitating an earlier return to sporting activities when compared to the traditional open approach. Standardized examinations for anterior ankle arthroscopy, such as Ferkel’s 21 point evaluation, have been described in the literature, however a systematic surgical approach for performing hindfoot arthroscopy has not yet been described. The objective of this study is to present a structured systematic surgical approach for identifying relevant anatomical structures and pathology during hindfoot arthroscopy. In addition, we report the clinical results of a case series of 22 patients whom had hindfoot arthroscopy performed for posterior ankle impingment. The systematic surgical approach divides the extra-articular structures of the hindfoot into quadrants as defined by the intermalleolar ligament. Twenty-two patients underwent hindfoot arthroscopy for the treatment of posterior ankle impingement syndrome. The mean follow-up time was 20 months (range, 7 – 35 months). Standard patient reported outcome questionnaires in the Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) general health survey were administered at standard time points after surgery. Return to sporting activities was also calculated as the time period from the date of surgery until the patient was able to participate at their previous level of activity. The mean FAOS score improved from 58.17 points (range 22.22 – 94.45) preoperatively to 86.06 points (range 47.22 – 100) postoperatively (p < 0.0001). The mean SF-12 scores showed similar improvement with a mean of 65.62 points (range 41.88 – 95.30) preoperatively to 86.88 points (range 55.94 – 95.55) postoperatively (p < 0.0001). 19 patients reported competing at some level of athletic sport prior to surgery. All patients returned to their previous level of competition after surgery. The mean time to return to sporting activities was 12 weeks (range 6 – 16 months). Two complications were reported post-operatively; one wound infection and one case of dysthesia of the deep peroneal nerve. Hindfoot arthroscopy is a safe and effective treatment strategy for posterior ankle impingement syndrome. In addition, it allows the patients a rapid return to sporting activities.

Hindfoot Arthroscopic Surgery for Posterior Ankle Impingement

Background: Hindfoot arthroscopic surgery has been described as a minimally invasive surgical treatment for posterior ankle impingement syndrome. The current article describes a systematic approach for identifying relevant hindfoot structures as well as the clinical results of a case series. Purpose: To present a structured systematic surgical approach for identifying relevant anatomic structures and abnormalities during hindfoot arthroscopic surgery. In addition, we report the clinical results of a case series. Study Design: Case series; Level of evidence, 4. Methods: The systematic surgical approach divides the extra-articular structures of the hindfoot into quadrants as defined by the intermalleolar ligament. Twenty-two patients underwent hindfoot arthroscopic surgery for the treatment of posterior ankle impingement syndrome. The mean follow-up time was 25 months (range, 14-35 months). Standard patient-reported outcome questionnaires of the Foot and Ankle Outcome Score (FAOS) and Short Form–12 (SF-12) general health survey were administered at standard time points after surgery. Return to sporting activities was also calculated as the time period from the date of surgery until the patient was able to participate at their previous level of activity. Results: The mean FAOS score improved from 59 (range, 22-94) preoperatively to 86 (range, 47-100) postoperatively (P < .01). The mean SF-12 score showed similar improvement with a mean of 66 (range, 42-96) preoperatively to 86 (range, 56-98) postoperatively (P < .01). Nineteen patients reported competing at some level of athletic sport before surgery. All patients returned to their previous level of competition after surgery. The mean time to return to sporting activities was 12 weeks (range, 6-16 weeks). Two complications were reported postoperatively: 1 wound infection and 1 case of dysesthesia of the deep peroneal nerve. Conclusion: Hindfoot arthroscopic surgery is a safe and effective treatment strategy for posterior ankle impingement syndrome. In addition, it allows the patients a rapid return to sporting activities.

Validation of the Foot and Ankle Outcome Score in Adult Acquired Flatfoot Deformity

The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score has been under recent scrutiny. The Foot and Ankle Outcome Score (FAOS) is an alternative subjective survey, assessing outcomes in 5 subscales. It is validated for lateral ankle instability and hallux valgus patients. The aim of our study was to validate the FAOS for assessing outcomes in flexible adult acquired flatfoot deformity (AAFD). Patients from the authors' institution diagnosed with flexible AAFD from 2006 to 2011 were eligible for the study. In all, 126 patients who completed the FAOS and the Short-Form 12 (SF-12) on the same visit were included in the construct validity component. Correlation was deemed moderate if the Spearman's correlation coefficient was .4 to .7. Content validity was assessed in 63 patients by a questionnaire that asked patients to rate the relevance of each FAOS question, with a score of 2 or greater considered acceptable. Reliability was measured using intraclass correlation coefficients (ICCs) in 41 patients who completed a second FAOS survey. In 49 patients, preoperative and postoperative FAOS scores were compared to determine responsiveness. All of the FAOS subscales demonstrated moderate correlation with 2 physical health related SF-12 domains. Mental health related domains showed poor correlation. Content validity was high for the Quality of Life (QoL; mean 2.26) and Sports/Recreation subscales (mean 2.12). All subscales exhibited very good test-retest reliability, with ICCs of .7 and above. Symptoms, QoL, pain, and daily activities (ADLs) were responsive to change in postoperative patients (P < .05). This study has validated the FAOS for AAFD with acceptable construct and content validity, reliability, and responsiveness. Given its previous validation for patients with ankle instability and hallux valgus, the additional findings in this study support its use as an alternative to less reliable outcome surveys. Level II, prospective comparative study.

Treatment Of Chronic Lateral Ankle Instability With ATLF And CFL Fibular Advancement: Surgical Technique And Clinical Outcome

Objectives:To report the 2 to 5 year outcome of ATFL and CFL fibular advancement for the treatment of lateral ligament instability of the ankle.Methods:Fifty-five patients presenting with chronic lateral ankle instability who had failed non-operative management (bracing, taping, physiotherapy) underwent a lateral ligament fibular advancement between 2005 and 2008. In each case the ATLF and CFL were released from the fibula and advanced using two double loaded metallic suture anchors (3.5mm). The senior author DJOH) performed all the cases. Patients were allowed to full weight bear in a walking boot for 6 weeks after surgery. Patients were assessed pre-operatively and post-operatively using the Foot and Ankle Outcome Score (FAOS). Data were prospectively collected and retrospectively reviewed by an independent author.Results:Six patients (11%) were lost at follow-up, leaving a study group of 49 patients (23 male and 26 female). The mean patient age at the time of surgery was 25 years old (range, 18-37 years old), with a mean duration of symptoms of 1.8 years (range, 6 months - 5 years). The mean follow-up was 42 months (range, 24 - 60 months). Significant improvement was seen in the FAOS score from a mean value of 36 pre-op to 75.4 post-op (p<0.001). Pain subscale improved from 35 to 75 (p<0.001); symptoms from 29 to 77 (p=0.01); function from 45 to 77 (p<0.001); function in sports and recreation from 38 to 70 (p<0.001); foot and ankle related quality of life from 35 to 78 (p<0.001). The failure rate was 6%, with three patients complaining of residual instability secondary to re-tear. Two cases of superficial infections were seen. One patient complained of temporary nerve irritation and numbness.Conclusion:This study demonstrates that ATFL and CFL advancement with suture anchor fixation and early, protected weight bearing is an effective procedure for the treatment of chronic lateral ankle instability.

Are Knee and Foot Orthopedic Problems More Disabling in the Superobese?

Aiming to ascertain whether frequency and severity of knee and foot problems were different between morbid obesity (MO) and superobesity (SO), a prospective clinical study was designed. Bariatric candidates (N = 81, body mass index 40-81.3kg/m(2), 43.2% with SO) were submitted to knee and foot radiologic assessment, baropodometric footprint measurement, and the questionnaires Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Foot and Ankle Outcome Score (FAOS). Main outcome measures were imaging diagnosis of knee osteoarthritis and flatfoot, along with functional impact on activities of daily living estimated by the questionnaires. Knee osteoarthritis was radiologically diagnosed in 74.1% (60/81), and the entire cohort suffered from flatfoot according to both footprint index and talar-first metatarsal radiographic angle; nevertheless, distribution was not different between SO and MO. However, WOMAC and FAOS scores were markedly worse in SO, affecting joint pain, stiffness, and general mobility. This is the first protocol of our knowledge to address foot and knee derangements in SO. Functional impairment was more severe in SO, despite a morphologic pattern similar to MO. Even though amelioration is probable with weight loss, long-term orthopedic assistance might be required in such circumstances.

The Treatment of Osteochondral Lesions of the Talus with Autologous Osteochondral Transplantation and Bone Marrow Aspirate Concentrate: Surgical Technique.

Objective:To present the functional results after autologous osteochondral transplantation with bone marrow aspirate concentrate in 72 patients, while placing an emphasis on the surgical technique.Methods:Between 2005 and 2009, 72 patients underwent autologous osteochondral transplantation under the care of the senior author. The mean patient age at the time of surgery was 34.19 years (range, 16-85 years). All patients were followed for a minimum of 1 year after surgery. The mean follow-up time was 28.02 months (range, 12-64 months). Patient-reported outcome measures were taken preoperatively and at final follow-up using the Foot and Ankle Outcome Score (FAOS) and Short Form–12 (SF-12) general health questionnaire. Identical questionnaires were used in all instances.Results:The mean FAOS scores improved from 52.67 points preoperatively to 86.19 points postoperatively (range, 71-100 points). The mean SF-12 scores also improved from 59.40 points preoperatively to 88.63 points postoperatively (range, 52-98 points). Three patients reported donor site knee pain after surgery, and one patient required the decompression of a cyst that developed beneath the graft site approximately 2 years after the index procedure.Conclusion:Autologous osteochondral transplantation is a reproducible and primary treatment strategy for large osteochondral lesions of the talus.

Posterior Malleolar Stabilization of Syndesmotic Injuries is Equivalent to Screw Fixation

Fixation of unstable ankle fractures, including fixation of posterior malleolus fracture fragments with the attached, intact posteroinferior tibiofibular ligament (PITFL), reportedly provides more stable fixation than transsyndesmotic screws. To confirm this observation we compared the Foot and Ankle Outcome Score (FAOS) and radiographic maintenance of fixation for fractures treated through direct posterior malleolar fixation versus syndesmotic screw fixation. We prospectively followed 31 one patients with unstable ankle fractures treated with (1) open posterior malleolus fixation whenever the posterior malleolus was fractured, regardless of fragment size (PM group; n = 9); (2) locked syndesmotic screws in the absence of a posterior malleolar fracture (S group; n = 14); or (3) combined fixation in fracture-dislocations and more severe soft tissue injury (C group; n = 8). All patients had preoperative MRI confirming syndesmotic injury and an intact PITFL; postoperative and followup radiographs were evaluated for syndesmotic congruence. The minimum followup was 12 months (mean, 15 months; range, 12-31 months). Postoperative and followup FAOS scores were similar in the three groups. The tibiofibular clear space was greater in the S versus the PM group, but we found no other differences in the postoperative versus followup measurements between the PM, S, and C groups. Syndesmotic fixation through the posterior malleolus and PITFL is maintained at followup, and these patients have functional outcomes at least equivalent to outcomes for patients having syndesmotic screw fixation. Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.