Foot And Ankle Outcome Score Research Articles

Functional outcomes of tibiotalocalcaneal arthrodesis using a hindfoot arthrodesis nail in treating Charcot's arthropathy deformity.

Tibiotalocalcaneal arthrodesis or hindfoot fusion is a salvage surgical option used to treat symptomatic or severe deformity as a result of Charcot's arthropathy. It is an internal fixation that utilizes nails to stabilize the hindfoot after surgical correction of the deformity. This study intends to measure the change in functional outcomes of patients with Charcot's arthropathy using this technique and the time taken to achieve fusion. This study presents a series of 40 cases of Charcot's arthropathy where hindfoot fusion was done using a hindfoot arthrodesis nail. A retrospective analysis was done where these patients' functional scores had been evaluated preoperatively and postoperatively (serially) with the Short-Form Health Survey 36 (SF-36), American Orthopedic Foot and Ankle Society (AOFAS), Foot and Ankle Outcome Score (FAOS), and Foot Function Index (FFI). Along with its complication, the length of time required for the fusion is also reported. This study consists of 40 patients (13 men, 27 women; mean age 60.5 years; age range 52-68 years) with a mean follow-up of 64 months (range 24-108 months). The mean time taken for fusion was 5.1 months. All patients showed improvement in functional scoring (SF-36, AOFAS, FFI, and FAOS) postoperatively. We establish that the improvements were gradual over 2 years. Approximately 37.5% of patients had a minor complication and 2.5% had a major complication. Hindfoot fusion using a hindfoot arthrodesis nail results in improved functional outcome with an acceptable fusion time and acceptable complication rate. Level III.

The applications of wearable devices in the rehabilitation of ankle injuries: A systematic review and meta-analysis

Wearable devices have been used in the treatment and rehabilitation of ankle injuries. This article systematically reviewed the trials that summarize and evaluate the effectiveness of rehabilitation treatment after an ankle injury. Three databases, PubMed (1974–2021), Embase, and Web of Science (1950–2021), were searched. The intervention was any wearable device, and the outcome measures were Activities Scale for Kids performance (ASKp), Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot and Ankle Society (AOFAS), Olerud-Molander Ankle Score (OMAS), and Circumference as measured by any validated outcome measure. Two independent authors evaluated the studies with the Cochrane risk-of-bias tool. Four papers were included, involving 476 participants, with a mean age of 29.3 ​± ​6.7 years. The mean duration of wearable devices was 3.83 weeks, and the mean length of training was 3.75 weeks. Wearable devices achieved better results compared with control on the functional performance (standardized mean difference [SMD] 0.66; 95% confidence interval [CI] 0.29 to 1.04; I2 ​= ​76%; P ​< ​0.001), as well as ankle score (SMD 0.78; 95% CI 0.22 to 1.35; I2 ​= ​82%; P ​< ​0.001). The definitive judgment could not be made due to the variability in training, training duration, and outcomes measurement. Wearable devices are a promising approach that has positive effects on ankle injuries in terms of functional performance and reducing the extent of swelling. There is insufficient evidence from randomized controlled trials (RCTs) to support this for ankle injury patients using wearable devices. Therefore, there is an need for well-conducted randomized controlled trials investigating more adaptive orthoses to achieve more effective strategies for early functional rehabilitation. PROSPERO registration number: CRD42021246289.

Long-term Impact of Planovalgus Foot on Activities of Daily Living in Patients With Down Syndrome.

Planovalgus foot (PVF) is the most common orthopaedic abnormality in children with Down syndrome (DS), and as a result these patients rarely develop an adequate plantar arch in adulthood. The present study aims to evaluate the impact of PVF on activities of daily living and participation in sports among young adults with DS and determine whether this impact is related to the degree of foot deformity based on clinical and imaging studies. Observational analytical study examining a database of 649 patients with DS from a pediatric referral center, identifying those individuals over age 20 years at the time of the study with a childhood diagnosis of PVF. Finally, 51 patients (102 feet) were evaluated based on clinical and imaging studies, and function was assessed using the The Foot and Ankle Outcome Score (FAOS) and the Visual Analogue Scale (VAS) pain scale. A correlation analysis was performed to determine the clinical and radiographic variables associated with functional outcomes. Linear regression models were obtained to quantify the impact of these variables on function. Patients had a mean age of 26.14±3.88 years and body mass index of 24.51±4.57. Clinically, 63.65% presented grade 3 or 4 PVF, and most were flexible. Radiographically, midfoot flattening was mild-moderate in 92.16%, 58.82% had medial talo-navicular uncoverage, and 30.39% had an increased hallux valgus (HV) angle. Mean scores for all FAOS subscales were between 65 and 71% and the mean VAS score was 1.45±1.96. An association analysis revealed a tendency toward lower scores on all FAOS subscales and greater pain according to the VAS scale in more severe PVF and in cases of moderate HV with asymmetry between feet. Linear regression models showed that major contributors to functional scores were radiographic evidence of hindfoot valgus, midfoot abduction, and flattening, and HV. Young adults with DS who are diagnosed with PVF in childhood have acceptable functional scores and low pain. Alteration of radiographic parameters toward flatter, more valgus and abducted feet and greater and asymmetric HV tend to be associated with worse long-term functional scores in activities of daily living and sports participation and increased pain. Therefore, non-operative management of these patients is justified, although individualized treatment is recommended. Level IV, Case series.

Sustained clinical success at 7-year follow-up after arthroscopic Lift-Drill-Fill-Fix (LDFF) of primary osteochondral lesions of the talus

PurposeTo describe the long-term clinical results of arthroscopic fragment fixation for chronic primary osteochondral lesions of the talus (OLT), using the Lift-Drill-Fill-Fix (LDFF) technique.MethodsEighteen patients (20 ankles) underwent fixation for a primary OLT with an osteochondral fragment using arthroscopic LDFF and were evaluated at a minimum of 5-year follow-up. Pre- and postoperative clinical assessment was prospectively performed by measuring the Numeric Rating Scale (NRS) of pain at rest, during walking and when running. Additionally, the change in Foot and Ankle Outcome Score (FAOS) and the procedure survival (i.e., no reoperation for the OLT) at final follow-up was assessed.ResultsAt a mean follow-up of 7 years, the median NRS during walking significantly improved from 7 (IQR 5–8) pre-operatively to 0 (IQR 0–1.5) at final follow-up (p = < 0.001). This result was sustained from 1-year follow-up to final follow-up. The NRS during running significantly improved from 8 (IQR 6−10) to 2 (IQR 0–4.5) (p < 0.001) and the NRS in rest from 2.5 (IQR 1–3) to 0 (IQR 0–0) (p = < 0.001). The median FAOS at final follow-up was 94 out of 100 for pain, 71 for other symptoms, 99 for activities of daily living, 80 for sport and 56 for quality of life. The FOAS remained significantly improved post-operatively on all subscales, except for the symptoms subscale. The procedure survival rate is 87% at final follow-up.ConclusionArthroscopic LDFF for fixable chronic primary OLTs results in excellent pain reduction and improved patient-reported outcomes, with sustained results at long-term follow-up. These results indicate that surgeons may consider arthroscopic LDFF as treatment of choice for fragmentous OLT.Level of evidenceLevel IV, prospective case series.

Correlating the Patient Reported Outcomes Measurement Information System (PROMIS) to the Foot and Ankle Outcome Score and Patient Functional Testing in Total Ankle Arthroplasty Patients

Category: Ankle Arthritis; Other Introduction/ Purpose: The orthopaedic field, including foot and ankle surgery, continues to rely on patient reported outcome measures (PROMs) as the cornerstone of research studies. Various questionnaires exist, each with their advantages and disadvantages. The Patient-Reported Outcomes Measurement Information System (PROMIS) has become increasingly popular due to its reliability, validity, and efficiency. This system has been tested against the Foot and Ankle Outcome Score (FAOS) for foot and ankle conditions, however little is known about its validity for patients with ankle arthritis undergoing total ankle arthroplasty (TAA). Additionally, its relationship to functional tests is unknown, which could reveal whether it could be used in lieu of these resource-intensive assessments. Therefore, we aimed to validate PROMIS against the FAOS and functional tests in TAA patients. Methods: This prospective cohort study included 102 patients (mean age: 63.5 years) who were diagnosed with ankle arthritis and underwent subsequent TAA. Preoperative PROMIS scores, FAOS, and functional tests including the 4 square test (4SST), timed up and go (TUG), and sit-to-stand (STS) were gathered and analyzed preoperatively. PROMIS physical function and pain interference domains were tested for reliability using Rasch partial credit models. Convergent validity between PROMIS physical function and pain interference, and FAOS function, daily living was evaluated using Spearman’s correlation coefficient. In addition, the relationship between the functional tests and all 6 PROMIS domains were evaluated using Spearman’s correlation coefficient. Results: Infit and outfit mean squares (MSQs) for PROMIS physical function ranged from 0.61 – 0.78, indicating a good fit in the Rasch model. Similarly, infit and outfit MSQs for PROMIS pain interference ranged from 0.77 – 0.8, also indicating a good fit. Separation reliability was 0.89 for physical function and 0.85 for pain interference, indicating good reliability to actual patient function and pain levels. PROMIS physical function demonstrated a moderate positive correlation with FAOS function, daily living (r=0.52) while pain interference demonstrated a moderate negative correlation (r=-0.52). PROMIS physical function demonstrated statistically significant weak negative correlations for all 3 functional tests (r=-0.19 for 4SST, r=-0.27 for TUG, r=-0.2 for STS) [Figure 1]. Conclusion: Our study revealed good reliability of PROMIS physical function and pain interference domains, with a moderate correlation to FAOS function, daily living. Additionally, we found weak correlations between PROMIS physical function and functional tests and no significant correlations between pain interference and functional tests. This indicates acceptable convergent validity to the FAOS but not to functional tests. Therefore, while PROMIS provides reliable and valid measures, it does not replace the need for functional tests, which should be pursued in conjunction to deliver a complete assessment of TAA patients.

Do radiolucencies affect the outcomes of a 4th generation total ankle prosthesis? A 2-year follow-up

Category: Ankle Arthritis; Ankle Introduction/ Purpose: Fourth generation ankle replacements benefit from improved surgical technique, respect for bony preservation, and increased surgeon awareness of operative indications. The rate of radiolucencies around the tibial component observed in studies about 3rd generation total ankle replacements are reported at rates that range from 30% to 43%. To date, studies have not been shown to predict survivorship or patient reported outcomes (PROs) however. We hypothesize that radiolucenices do not affect PROs or survivorship. Methods: Patients presenting for a total ankle replacement at 9 institutions were prospectively enrolled in academic and private settings. Each patient received an INFINTY ankle prosthesis (Stryker, Memphis, TN, USA). Implants were assessed for subsidence and the presence of radiolucencies based on the analysis and comparison of all postoperative weightbearing ankle radiographs available. Subsidence was defined as a change of tibial component alignment greater than 5degrees or a change in the vertical position of the talar component of 5 mm or more. Subsidence and radiolucent lines were deemed nonprogressive when no change in position or size was noted with comparison of the last 2 radiographs. PROMs were recorded pre-operatively and at 6months, 12months, and 24month intervals. The following PROMs were collected: Ankle Osteoarthritis Score (AOS), PROMIS Global Physical Health, and Foot and Ankle Outcome Score (FAOS). The preoperative and latest follow-up scores for patients with two years of follow-up were analyzed. Results: 110 patients were enrolled in the study who had 2-year follow-up with twenty-one patients (19.1%) exhibiting a radiographic lucency. To date, our survivorship is 97.3%, of which 2 patients were revised for aseptic loosening; both reporting radiolucencies. The radiolucencies for one identified at 6months became progressive for both tibia and talus with cysts above 5mm requiring revision at 1.5years post op. The other requiring revision at 2years post-op reported progressive radiolucency. There was no difference in rates of survivorship with or without radiolucencies. One patient had subsidence which required revision. All patients with radiolucencies had significant improvements in all domains of the AOS, PROMIS, and FAOS Scores (p&lt; 0001). Radiolucency did not impact the PROs (AOA p=.741, PROMIS p=.964, FAOS p=.8937) in those with 2-year follow-up. Conclusion: Radiolucencies did not impact PROMs in patients undergoing implantation with a 4th generation total ankle replacement. In carefully selected patients, radiolucency did not correlate with an increased need for revision surgery nor had decreased survivorship.

Surgical Construct Associated with Time to Fusion in Double and Isolated Talonavicular Arthrodeses

Category: Hindfoot; Ankle Arthritis Introduction/ Purpose: Double arthrodesis of the subtalar (ST) and talonavicular (TN) joints, along with isolated TN arthrodesis, are commonly performed for hindfoot osteoarthritis and rigid hindfoot deformity. Few studies have examined the effects of the type of ST and TN fixation constructs on nonunion rate following double and isolated TN arthrodesis procedures. This study evaluates the effect of surgical construct on the union rate and time to fusion in patients undergoing double or isolated TN arthrodesis. Methods: Retrospective chart review identified 52 patients (52 feet) who underwent double or isolated TN arthrodesis between 2016 and 2021 by a fellowship-trained foot and ankle surgeon with at least six months of follow-up (mean=1.62 years, range=0.50- 4.39 years). Data collected included demographics, medical history, surgical indication, surgical constructs used, complications, reoperations, patient-reported outcome measures, and radiographic measures. ST constructs included one (n=4) or two (n=44; parallel=43, divergent=1) cannulated screws, while TN constructs included dorsal plate (n=2), dorsal plate and screw (n=10), isolated screws (n=3) screw and staple (n=29), or isolated staples (n=13). At the time of their surgery, the mean age was 60.39 (range, 17-80) years, mean body mass index (BMI) was 33.89 (range, 20.74-48.41) kg/m2, and most subjects were non-smokers (94.7%). Mean follow-up duration was 1.62 (range, 0.50-4.39) years. Results: Overall complication and reoperation rates were 26.3% and 12.3%, respectively. Among TN constructs, the time to ST (p=.026) and TN (p=.018) fusion was statistically significantly slower among patients receiving a plate and screw TN construct. Complication rate did not differ by construct, but reoperation rate was significantly higher for the plate and screw TN construct (p=.039). Postoperative Foot and Ankle Outcome Score (FAOS) Quality of Life (p=.028) and Total (p=.016) scores were significantly better among plate and screw TN constructs. Conclusion: The utilization of a screw and staple or isolated staple construct have a statistically significantly quicker time to fusion and lower reoperation rates than plate and screw constructs for the TN joint. These findings can be used to guide clinician decision-making while allowing physicians to take their personal construct preference into account, as well as serve as a useful starting point to other researchers interested in investigating the impact of surgical constructs on ST and TN fusions.

Validation of the Foot and Ankle Outcome Score for Use in Infracalcaneal Heel Pain

There is growing interest in adopting validated and reliable patient-reported outcome measures following surgery. While the Foot and Ankle Outcome Score (FAOS) has previously been validated for use in multiple foot/ankle conditions, it has not yet been validated in patients with infracalcaneal heel pain. In this study we aimed to validate the FAOS by looking at 4 psychometric properties of the survey: construct validity, content validity, reliability, and responsiveness, using patients in our practice with a clinical diagnosis of plantar fasciitis. A total of 150 patients (mean age 49.7 ± 12.1 years [36 men and 114 women]) were included in one or more of the 4 components of this study. All FAOS subscales demonstrated adequate construct validity when compared with the physical health component of the 12-Item Short Form Health Survey (SF-12), and 2 out of 5 subscales demonstrated moderate correlation with the mental health component of SF-12 (all Spearman rho >0.3, and p values <0.05). Most FAOS subscales demonstrated content validity and were found to contain relevant questions from the patient's perspective. All 5 subscales demonstrated good test-retest reliability with intraclass correlation coefficients ≥ 0.827. Finally, 4 out of the 5 subscales (all but other symptoms) were responsive to change at a mean follow up of 12.2 months after surgery (p < .05). We conclude that the FAOS is a responsive, reliable, and valid instrument for use in infracalcaneal heel pain. We believe that due to its ease of use and broad applicability, the FAOS could be more widely adopted in foot/ankle practices as patient-centered healthcare delivery and research becomes increasingly prioritized in the US and abroad.

Arthroscopic Broström-Gould repair has comparable radiological and clinical outcomes compared to traditional open Broström-Gould repair in high-demand patients.

This study sought to confirm whether traditional open Broström-Gould repair and arthroscopic Broström-Gould repair forchronic ankle instability (CAI) would produce comparable radiological and clinical outcomes in high-demand patients. This retrospective case-cohort study included high-demand patients, as determined by a pre-injury Tegner Activity Level ≥ 6, who underwent Broström-Gould repair and were followed up for ≥ 2years. Patients were divided into the arthroscopic Broström-Gould repair group (AS Group) and the open Broström-Gould repair group (Open Group). Perioperative radiological assessments were performed. The Tegner Activity Levels, Foot and Ankle Outcome Scores (FAOSs), Karlsson and Peterson (K-P) scores, and American Orthopaedic Foot and Ankle Society ankle-hindfoot (AOFAS) scores were evaluated clinically. A total of 65 patients (31 from the AS Group and 34 from the Open Group) were included in the study. There were no differences in age, sex, body mass index, preoperative anterior talar translation, talar tilt, signal-to-noise ratio, FAOS, K-P score, or AOFAS score between the two groups (n.s.). The preinjury median Tegner Activity Level was 7 and unchanged at the final follow-up in both groups. Postoperative stress radiographs showed improvement; however, the groups did not differ significantly. The FAOS, K-P scores, and AOFAS scores improved in each group (P < 0.001). However, the clinical scores did not differ between the groups (all n.s.). Traditional open and arthroscopic Broström-Gould repair for CAI in high-demand patients had comparable radiological and clinical outcomes. Clinically, arthroscopic Broström-Gould repair may represent a viable surgical alternative to open Broström-Gould repair in high-demand patients. Level III.

Lesion depth and marrow stimulation results

AimThe aim of this study was to study the importance Osteochondral lesion (OCL) depth as a singular factor for treatment outcomes using marrow stimulation. We hypothesized that the clinical outcomes of marrow stimulation would be inferior for lesions with depths of more than 5 mm compared to those less than 5 mm. Materials & methodsAn interventional prospective cohort study was conducted on 55 ankles in 55 patients who had been diagnosed with full-thickness osteochondral lesions of the talus; stage II, III, IV according to Anderson staging system based on magnetic resonance imaging; depth of 10 mm or less; and area of 150 mm2 or less measured by preoperative computed tomography. According to lesion depth, patients were divided into two groups: group (A) ≤ 5 mm, and group (B) ˃ 5 mm. The mean follow-up period for both groups was 30 months (range, 22–40). ResultsFor groups A and B the average preoperative Foot and Ankle Outcome Scores (FAOS) were 43.1 ± 8.8 (range, 25–52) and 46 ± 8.5 (range, 32–60), respectively, and improved to 90 ± 4.3 (range, 80–96) (P = 0.001) and 75 ± 6.4 (range, 65–88) (P = 0.001) at the final follow-up. The average time to full weight bearing was 12 weeks (range, 10–16) in group A and 16 weeks (range, 12–20) in group B. ConclusionsAlthough treatment of OCLs is still undergoing changes and there are many prognostic factors that affect outcomes during marrow stimulation treatment, depth of OCL was shown to be an independent factor affecting outcomes. OCLs of less than 5 mm in depth were more likely to have superior clinical outcomes compared to OCLs of more than 5 mm. Clinical significanceThe depth of OCL talus is an important factor as it affects the outcome of arthroscopic marrow stimulation inversely. Level of evidenceI

Early Clinical Outcomes and Complications of Transfibular Total Ankle Arthroplasty: The Australian Experience

We report the short-term outcomes of a retrospective cohort of Trabecular Metal total ankle arthroplasties (TAAs) via a transfibular approach from a single, nondesigner surgeon in Australia. This was a retrospective cohort study. Demographic, clinical, and patient-reported outcome measures (PROMs) were collected. The primary outcome was the Foot and Ankle Outcome Score (FAOS), and secondary outcomes included patient satisfaction, the EuroQol-5 Dimension (EQ5D), and complications including revision rates. Between 2016 and 2019, 84 trabecular metal prostheses were implanted in 84 patients. Mean age (SD) at time of surgery was 68 (7.8) years, and 46 (55%) were male. Mean follow-up (SD) was 26.1 (13) months. There were significant (P < .001) improvements in the FAOS in the subscales of pain (47.9 to 79.1), activities of daily living (59.5 to 83.7), and quality of life (25.5 to 60.2) and EQ-5D (0.55 to 0.75) (P < .001), and overall satisfaction was 69.6%. The commonest complications were wound infection or breakdown (11.9%, n=10), fibular nonunion (3.5%), plate irritation (3.5%), and tibial nerve neuropathy (3.5%). There were no thromboembolic complications. Implant survivorship was 100%, with Trabecular Metal components retained in all patients. Two patients developed deep infection, with 1 requiring debridement and polyethylene exchange. No patients experienced implant loosening. Our results demonstrate that the trabecular metal survival rates are comparable with other total ankle implants in the Australian Orthopaedic Association National Joint Replacement Registry and as published in other international literature. Overall patient satisfaction was high, as were PROMs. However, the data highlight potential complications uniquely associated with this implant. The authors believe that these figures support TAA via a transfibular approach as a viable option in the treatment of ankle arthritis. Level IV, retrospective cohort study.

Clinical Outcomes of the Lateral Trabecular Metal Total Ankle Replacement at a 5-Year Minimum Follow-up.

The Trabecular Metal (Zimmer Biomet, Warsaw, IN) total ankle arthroplasty (TAA) system uses a lateral approach with a fibular osteotomy to gain access to the tibiotalar joint and a sagittally curved tibial component. This is the first TAA system to laterally approach the ankle, and few studies have explored outcomes associated with this implant. This study aimed to report the 5-year clinical and radiographic outcomes as well as the survivorship of the implant. Over a 3-year period, 2 fellowship-trained foot and ankle surgeons used this implant system to treat 38 end-stage arthritic ankles. Reoperation and revision data were collected from all patients (100%) as part of the local prospective database. Patients completed the Foot and Ankle Outcome Score (FAOS) questionnaire preoperatively and at each annual follow-up visit; scores for a minimum of 5 years were available for 28 (73.7%) patients. A radiographic analysis compared postoperative coronal and sagittal alignment in weightbearing radiographs at a minimum of 5 years with that at 3 months postoperatively, as well as cyst or lucency formation, which was available for 21 patients (55.3%). At 5 years, there were 3 revisions (7.9%) and 9 reoperations (23.7%). Reoperations included 4 fibular hardware removal and 5 medial gutter debridement procedures. The FAOS significantly improved for all domains (P < .05). Implant positioning did not significantly change between 3 months and 5 years postoperatively. Our 5-year results in this small series using this unique prosthesis showed good overall survivorship (92.1%) and a reoperation rate of 23.7%, along with clinically significant improvement in patient-reported outcomes. Level IV: Retrospective case series.

Favorable long-term clinical and radiologic outcomes with high survivorship after autologous osteochondral transplantation of the talus

PurposeTo evaluate long-term clinical and radiologic outcomes of patients undergoing autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLT) and to perform a correlation analysis between clinical and radiologic outcomes.MethodsThirty-five patients with a mean age of 32.2 ± 8.9 years undergoing AOT for OLT between 1997 and 2003 were available for follow-up after an average of 19.1 ± 1.4 years. Demographic, surgical, and injury-related data were collected. After a minimum 18-year follow-up, patient-reported outcome scores (PROs) were collected, including the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Foot and Ankle Outcome Score (FAOS), Tegner Activity Scale, and Visual Analogue Scale (VAS) for pain of the ankle. The Lysholm Score and VAS for pain of the knee were collected to assess donor-site morbidity. Magnetic resonance imaging scans were obtained to conduct an assessment of the replaced cartilage using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 scoring system. Any revision surgery (except symptomatic hardware removal and arthroscopic debridement) was defined as clinical failure.ResultsFavorable clinical and radiologic (MOCART score, 73.7 ± 16.7 points) outcomes without any donor-site morbidities were observed. Twenty-three (65.7%) patients were satisfied or very satisfied with the surgical treatment. Fourteen (40.0%) and 25 (71.4%) patients had no or minor limitations in their athletic and working performance, respectively. A significant correlation between the MOCART and the FAOS Sport and Recreational activities subscale was found (rs, 0.491; p = 0.033). Six (17.1%) patients met the criteria for clinical failure an average of 12.2 ± 6.6 years after AOT. Survival analysis demonstrated a mean estimated time of survival of 21.3 years (95% CI [19.55, 22.96]) and a 20-year survival rate of 77.9%.ConclusionAutologous osteochondral transplantation to treat OLT achieves high patient satisfaction and favorable PROs with a 20-year survival rate of almost 80%. Given the high clinical efficacy of AOT, this procedure can be recommended as a safe and promising technique for the long-term therapy of OLT.Level of evidenceLevel IV.

Does additional extracorporeal shock wave therapy improve the effect of isolated percutaneous radiofrequency coblation in patients with insertional Achilles tendinopathy? Study protocol for a randomized controlled clinical trial

BackgroundNo conclusive evidence recommends a prior treatment for insertional Achilles tendinopathy (IAT). It is theorized that both percutaneous radiofrequency coblation and extracorporeal shockwave therapy (ESWT) relieve pain within the insertion. However, no clinical evidence shows that either treatment promotes the regeneration of the tendon or if the combination of these 2 interventions offers better function and less pain than one therapy.MethodsThe study is a randomized, controlled trial with patients allocated in a 1:1 ratio to one of two parallel groups. Patients with insertional Achilles tendinopathy who are not satisfied with the effect of conservative treatment will be screened. A minimum of 38 patients will be enrolled after deciding to participate in the trial on an informed basis. Then the intervention group and the control group perform radial ESWT and sham-ESWT respectively at 6 months after percutaneous radiofrequency coblation. The primary outcome will be the Victorian Institute of Sports Assessment Achilles (VISA-A) Score. Secondary outcome measures will be Foot and Ankle Outcome Score (FAOS) scale, visual analog scale (VAS), Tegner Score, and MRI ultra-short echo time (UTE) T2* value. The assessments will occur in 6 months, 1 year, and 2 years, post-operatively. The differences between the 2 groups will be conducted as intention-to-treat basis.DiscussionWe aim to investigate if radiofrequency coblation associated with ESWT can provide more encouraging imaging findings as well as functional and clinical outcomes regarding the treatment of the IAT comparing to the single radiofrequency coblation treatment.Trial registrationChiCTR1800017898; pre-results. Registered on 20 August 2018.

Comparing the effects of ankle integral and conventional physiotherapy on pain, range of motion, balance, disability, and treatment effectiveness in patients with chronic ankle instability: Randomized controlled trial

Objective To compare the effects of ankle integral and conventional physiotherapy on pain, range of motion, balance, disability, and treatment effectiveness in patients with chronic ankle instability (CAI). Design Two-arm, parallel-group, randomized, double-blind, controlled trial. Participants 60 patients with unilateral CAI. Intervention integral physiotherapy (n = 30) or conventional physiotherapy (n = 30). Outcomes Visual Analog Scale (VAS), dorsiflexion and plantarflexion range of motion, Star Excursion Balance Test (SEBT), Single Leg Hop (SLH) test, Foot and Ankle Outcome Score (FAOS), Lower Extremity Functional Score (LEFS), global rating of change, were gathered pre and post-intervention. Results The ANOVA results revealed statistically significant interaction for FAOS, and LEFS outcome measures (P < 0.05) and the mean change results showed there were a favorable clinical difference incline toward the integral group (meanintegral = 20.14 (14.95–25.37), meanConventional = 29.46 (24.09–34.83)). There were no interactions between group and time among other outcome measures (P > 0.05). The group main effect did not show any statistical significance (P > 0.05). Conclusion Hip strengthening and balance exercises added to ankle rehabilitation could be more favorable on improving the patients’ functional ability.

Clinical Features and Treatment of Intra-Tendinous Suture Reaction Following Achilles Tendon Repair Using Nonabsorbable Suture Material: A Retrospective Case Series Study.

We aimed to investigate the clinical manifestations, radiological findings, and therapeutic outcome of treatment for patients with surgically confirmed foreign body reaction following an Achilles tendon repair using non-absorbable suture material. Eight consecutive patients who were confirmed as having an intra-tendinous suture foreign body reaction in the histopathological report were enrolled in this study. Medical records of all patients in terms of clinical and radiological features were retrieved. Also, the outcome of treatment was evaluated at a follow-up of at least 12 months. All the patients complained of pain and a palpable mass around a previous surgical site at mean 25.1 months (range, 4–72 months) after the initial surgery. Magnetic resonance imaging (MRI) or ultrasound were used to detect the lesion. All the patients underwent surgical excision of foreign body reaction tissue and primary repair using absorbable suture material. After the treatment, the wounds were healed completely in all, and the average FAOS (foot and ankle outcome score) was 91.32 at mean follow-up for 22.4 months. In conclusion, intra-tendinous suture reaction is a rare complication following an Achilles tendon repair using nonabsorbable suture material, but it can be treated adequately with only surgical excision of foreign body reaction tissue and primary repair using absorbable suture material.

Kinetic Effects of 6 Weeks' Pilates or Balance Training in College Soccer Players with Chronic Ankle Instability.

Lateral ankle sprain (LAS) is a common sports injury that frequently occurs in active individuals. LAS is characterized by a high recurrence rate, with a large proportion of patients progressing to chronic ankle instability (CAI). Pilates exercises have provided positive results in health care and in rehabilitation. This study compared Pilates training (PT) with traditional balance training (BT) in patients with CAI. Fifty-one college football players with CAI, divided into PT (n = 26) and BT (n = 25) groups, were included in the study. The groups performed PT or BT training as assigned, three times per week for 6 weeks. Isokinetic ankle strength, one-leg hop tests, Y-balance test (YBT), and foot and ankle outcome score (FAOS) were evaluated before and after training. There were considerable improvements in both the PT and BT groups after training. Group and time comparisons revealed that the PT group achieved better triple hop test results than the BT group, whereas the BT group exhibited a greater improvement in YBT posteromedial and posterolateral reach distances. In athletes with CAI, both PT and BT effectively improved symptoms and function. These findings suggest that ankle strength, balance, and core stability should be comprehensively evaluated and targeted in CAI rehabilitation programs.

Validation of the Foot and Ankle Outcome Score (FAOS) for Ankle Osteochondral Lesions

Category: Sports; Ankle Introduction/Purpose: Subjective patient-reported outcome scores are routinely used to evaluate the efficacy of surgical interventions however to date none have been validated for ankle osteochondral lesions (OCL's). The foot and ankle outcome score (FAOS) is a 42 item subjective questionnaire consisting of 5 domains: pain, symptoms, function in daily activities, function in sports, and quality of life. It has been recently validated for flatfoot deformity and hallux valgus correction. The aim of this study was to validate the FAOS for ankle OCL's. Methods: Patients diagnosed with ankle OCL's from 2008 to 2013 were identified through the hospital foot and ankle registry. A retrospective analysis was performed to determine construct validity, where the FAOS subscales were compared with corresponding short form-12 (SF-12) subscales. Correlation was deemed moderate if the Spearman's correlation coefficient was .4 to .7. Preoperative and postoperative scores of 54 patients with OCL's were compared to determine responsiveness. Content validity was prospectively assessed in 20 patients by a separate questionnaire where patients rated the relevance of each FAOS question to their ankle OCL. A score of 2 or more was considered acceptable. Both retrospective analysis and prospective evaluation of 44 patients were used to assess test-retest reliability, which was measured using intraclass correlation coefficients (ICC's). Results: All of the FAOS subscales demonstrated moderate correlation with the physical health component of the SF-12. The FAOS symptoms subscale showed the least correlation, demonstrating the foot-specific nature of the questionnaire. Mental health related domains demonstrated poor correlation. All five FAOS domains are significantly responsive to change in postoperative patients (p&lt;0.01). All domains have acceptable content validity overall, with quality of life (QoL) and function in sports the highest. Test-retest reliability was very good for all domains with ICC's above 0.8. Conclusion: Patient-based assessments have become increasingly important in evaluating treatment effectiveness. This study has shown that the FAOS has very good construct and content validity, reliability, and responsiveness in patients with ankle OCL's. We support its use and consider it a useful patient-based instrument for the assessment of surgical intervention

Limited Open Achilles Repair without Instrument Guided Assistance: A Surgical Technique

Category: Sports Introduction/Purpose: The limited open Achilles tendon repair technique has recently gained popularity as a treatment option for acute Achilles tendon ruptures. This surgical technique video describes a limited open Achilles tendon repair without instrument guided assistance, demonstrating improved clinical outcomes for patients while also reducing reliance on operative equipment, cost, and the duration of surgery. Methods: The indications for this limited open Achilles tendon repair technique include an Achilles tendon rupture less than six weeks from injury occurring in the watershed area. The patient is prone and a two to three centimeter longitudinal incision is made over the Achilles tear. In the proximal stump, three non-absorbable sutures are passed horizontally from proximal to distal direction. In the distal stump, the same is done in a non-locking manner. The stumps are then reflected and the deep fascial compartment is released. The foot is plantarflexed to reduce tension on the repair site. The non-locking sutures are tied sequentially from distal-distal to proximal-proximal direction. A running box suture using a non-absorbable suture followed by 0- Vicryl around the rupture site is performed. Results: This technique has demonstrated, at a median follow-up of 3.7 years, restored preinjury function along with no wound complications, reruptures, or reoperations in 33 patients. The median time from injury to surgery was 10 (range, 1-45) days and the mean time for returning to preinjury level of activity was 5.6 (range, 1.7-22.1) months. After the procedure, patients demonstrated significant improvements in mean Foot and Ankle Disability Index (49.1 to 98.4), mean Visual Analog Scale pain score (4.8 to 0.2), and mean Foot and Ankle Outcome Score (FAOS) subscales such as FAOS pain (54.8 to 99.2), FAOS symptoms (84.6 to 97.0), FAOS activities of daily living (61.4 to 97.2), FAOS sports and recreational activity (39.5 to 98.5), and FAOS quality of life (39.7 to 88.7). Conclusion: Patients who underwent a limited open Achilles tendon repair without instrument guided assistance demonstrated significant improvements in outcome scores with minimal complications.

Is There a Psychiatric Diagnosis in Chronic Ankle Instability Patients?

Category: Ankle; Other Introduction/Purpose: Ankle instability is an extremely common clinical entity. Chronic ankle instability (CAI) can develop in some patients, leading to continued pain and dysfunction. However, there is very limited data to date on what impact common psychiatric pathology may have on patients' experience with CAI. This study aimed to investigate the association between psychiatric diagnosis and CAI, and whether having a diagnosed psychiatric illness impacts the outcome of CAI. We hypothesized that a concomitant diagnosis of psychiatric pathology with CAI would be significantly associated with lower postoperative patient- reported outcome measures (PROMs). Methods: A retrospective review was conducted of 276 patients (280 ankles) treated between 2005 and 2021 at an academic medical center by one of three fellowship-trained foot and ankle orthopaedic surgeons, of which 56 underwent surgery and 130 had a concomitant psychiatric diagnosis (i.e., anxiety=111, depression=105, post-traumatic stress disorder [PTSD]=19, obsessive- compulsive disorder [OCD]=6, bipolar disorder [BPD]=5). Data collected included demographics, conservative treatment history, and patient-reported outcome measures (PROMs), such as Visual Analogue Scale (VAS), Brief Resiliency Scale (BRS), 12-Item Short-Form Survey (SF-12), Somatic Symptom Scale (SSS-8), Pain Catastrophizing Scale (PCS), Pain Disability Index (PDI), Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM). Results: Preoperatively, patients with these concomitant psychiatric diagnoses had worse preoperative PROMs. However, the overall cohort improved postoperatively across all PROMs. In particular, the FAOS Total score relatively increased by 35.28% (preop=57.29%, postop=77.50%, p=.011) and the FAAM Total by 49.86% (preop=45.87%, postop=68.74%, p=.027). Both improvements were significant. Of note, the relative change of pre- to postoperative FAOS and FAAM scores was greater among the mental illness group in all scores but FAOS Sports and Recreation. (Table 1) However, no postoperative PROM among the mental illness group, aside from the FAOS Symptoms and Stiffness score, was as high as the postoperative score of those without mental illness. Although patients with these psychiatric illnesses more often failed conservative measures and subsequently received surgical treatment, this was not significant. Conclusion: CAI patients with a concomitant psychiatric diagnosis improved more following surgery than those without mental illness, as measured by FAOS and FAAM scores. However, the mental illness group did not report postoperative FAOS and FAAM scores as high as those without mental illness. Furthermore, CAI patients with a concomitant mental illness more often failed conservative treatment and went on to receive surgery. Physicians should be aware of this information when counseling CAI patients with a concomitant mental illness.