Mean Foot And Ankle Ability Measure Research Articles

CARTIVA SYNTHETIC CARTILAGE IMPLANT HEMIARTHROPLASTY FOR TREATMENT OF HALLUX RIGIDUS

ObjectivesCartiva synthetic cartilage implant (SCI) is licenced for use in management of symptomatic hallux rigidus in several countries including the UK. As for now, there are no independent comparative series for treatment of hallux rigidus utilising polyvinyl alcohol implants.Study design and methodsPatients at a single centre with symptomatic hallux rigidus who underwent Cartiva SCI implant procedure were identified. First metatarsophalangeal joint arthritis was radiographically graded according to the Hattrup and Johnson (HJ) classification. Pre-operative and post-operative patient-reported outcomes were evaluated using the Foot and Ankle Ability Measure (FAAM) activities of daily living subscale and the Manchester-Oxford Foot Questionnaire (MOXFQ).Results66 patients (19M, 47F) (43R and 23L) were followed up for an average of 14 months (min=2, max=36). 17 patients suffered from HJ2/moderate arthritis and 49 patients with grade HJ3/severe arthritis. Post-operative mean FAAM scores showed statistically significant improvement (p< 0.0001). Patients reported a 40% increase in functionality during activities of daily living. All 3 MOXFQ Domain scores improved significantly (p< 0.02). The Index score improved by 28 points (p< 0.0001). There was no correlation between length of follow up or age and PROMs (r=0.129). No statistical difference was demonstrated between sexes. However clinically, males and older patients exhibit better outcomes. There was a 89.4% patient satisfaction with the use of Cartiva.ConclusionsOur study shows excellent results with statistically significant improvements in functional outcomes, and promising short-term follow-up with low early revision rates. Pain in particular was significantly reduced. One third of patients developed post-operative stiffness requiring a manipulation under anaesthesia. Patient selection is key. Additional imaging may be required to assess sesamoid osteoarthritis. At 3 years the implant has demonstrated to be safe and efficacious in the management of hallux rigidus. Durability and survivability of the implant will continue to be studied in this cohort.

The Effects of Tibialis Anterior Tenotomy on Wound Problems after Anterior Fusion Plating for Severe Ankle Arthritis

Category: Ankle Arthritis; Ankle Introduction/Purpose: Because nonunion is known to be a relatively common complication following ankle arthrodesis, various fixation techniques have been introduced to enhance the stability and to improve fusion rate. With the use of anterior plate supplementation, postoperative wound problems have been frequently reported despite better fusion rate. This study was performed to determine the effects of tibialis anterior(TA) tenotomy on wound complications and functional outcomes after anterior fusion plating for severe ankle arthritis. Methods: Forty-six patients who underwent ankle arthrodesis using anterior fusion plate were followed for more than 3 years. TA tenotomy was performed prior to wound closure in all patients. As a control group, thirty-eight patients who underwent arthrodesis without TA tenotomy were analysed. Clinical outcomes were evaluated with Ankle Osteoarthritis Scale(AOS) and Foot and Ankle Ability Measure(FAAM). Wound complication rate, time to fusion, fusion rate, time to pain relief below 3 points in visual analog scale were evaluated. Results: Mean AOS and FAAM scores significantly improved to 32.6 and 69.4 points at final followup, respectively. As compared to control group (33.8 and 67.7 points), there were no significant differences in clinical outcomes. As postoperative wound complications, there were 1 case of wound dehiscence and 1 case of superficial wound infection. TA tenotomy group showed lower wound complication rate (4.3%) than control group (21.1%). While there were no significant differences in fusion rate, time to fusion, and time to pain relief between both groups, control group needed higher rate of implant removal. Conclusion: Ankle arthrodesis using anterior fusion plate in conjuction with TA tenotomy appears to be an effective surgical option for end-stage ankle arthritis, with higher fusion rate and less wound complication rate. Although there was no specific functional deficit related to a loss of the TA tendon, further studies are needed to determine the long-term effects of the TA tenotomy in patients with a fused ankle.

Comparison of Intermediate-Term Clinical Outcomes Between Medial and Lateral Osteochondral Lesions of the Talus Treated With Autologous Osteochondral Transplantation.

The conventional operative method to treat an osteochondral lesion of the talus (OLT) is through bone marrow stimulation (BMS). Autologous osteochondral transplantation (AOT) is being used as an alternative option in cases with a large OLT, accompanying subchondral cyst, and/or failed BMS. We aimed to compare the intermediate-term clinical and radiologic results between medial and lateral OLTs after an AOT procedure. Among the patients who underwent AOT, 45 cases with at least 3 years' follow-up were included in this retrospective study. We had 15 cases of lateral lesions and selected 30 cases of medial lesions matched for age and gender. Lateral lesions were resurfaced without an osteotomy; medial lesion resurfacing was combined with a medial malleolar osteotomy. Clinical assessment was performed using the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). Radiographic assessment included the irregularity of articular surface (subchondral plate), the progression of degenerative arthritis, and the change of the talar tilt. The mean FAOS and FAAM scores significantly improved after surgery in both groups. Up to 1 year postoperatively, there was significant difference in FAAM scores between the both groups (mean 75.3 points in medial group and 87.2 points in lateral group, P < .001). Delayed union or malunion of the malleolar osteotomy was found in 4 cases (13%) in the medial group. In addition, the progression of joint degeneration was observed in 3 cases (10%) in the medial group. There were no significant differences in the irregularity of articular surface and the change of talar tilt between both groups. A comparison between medial and lateral OLTs treated with AOT demonstrated comparable intermediate-term clinical outcomes. However, patients with medial OLT required a longer period to restore ability for daily and sport activities. In addition, we found more complications and higher rate of progression in the radiologic arthritis grade after medial malleolar osteotomy. Level IV, retrospective comparative study.

Role of platelet rich plasma in the treatment of plantar fasciitis

Introduction: Plantar fasciitis is a commonly occurring foot complaint that seriously affects the patient’s daily activities and quality of life. Plantar fasciitis is characterised by pain in the heel, which is aggravated on weight bearing after prolonged rest. Conservative noninvasive lines of treatment are numerous, among which platelet-rich plasma (PRP) has recently been demonstrated to be helpful in managing plantar fasciitis. Aim: The aim of this study was to evaluate the effectiveness of platelet-rich plasma as a form of interventional pain management for plantar fasciitis. Materials and Methods: This prospective study was carried out on 40 patients suffering from chronic Plantar Fasciitis who did not respond to conservative therapies including physical therapy, NSAIDs and heel cushions for a longer period. The patients were selected from the outpatient department of the Orthopaedics SKIMS medical College, Bemina Srinagar. All enrolled patients were treated with single dose of local injection of 3 mL autologous PRP. Assessment was done using visual analogue scale (VAS) for pain intensity. Functionally, foot and ankle ability measure (FAAM) was used at baseline and after injection. Results: The mean VAS score before the procedure was 7.21± 2.33 and after procedure were 2.96 ± 0.54. The mean difference of 4.24 was statistically significant. There was a significant raise of mean FAAM score 29.37 after 24 weeks of treatment and the difference was statistically significant. Conclusion: The present study observed by follow-up of PRP treated plantar fasciitis patients at intervals, revealed that this procedure is safe, efficient and effective for long term pain reduction along with reduction in thickness of plantar fascia.

Functional Outcomes of Arthroscopic OS Trigonum Excision in Adolescents

Background:Outcomes of symptomatic os trigonum excision have been well described as a successful treatment in adults; however, the literature lacks information on standardized longer term functional outcomes in the pediatric population.Hypothesis/Purpose:This study intends to report functional outcomes of arthroscopic os trigonum excision in adolescents who failed conservative management, with the hypothesis that these younger patients would have similar, successful outcomes of adult patients.Methods:A retrospective study was performed on adolescents who underwent arthroscopic os trigonum excision at a single institution between 2011 and 2017. Patient demographic, clinical history, radiographic, and operative data were documented. Outcome measures included the Foot and Ankle Ability Measure (FAAM) score comprised of the Activities of Daily Living (ADL) and Sports subscales, Single Assessment Numeric Evaluation (SANE) score, ability to return to the same level of sport, and any additional foot/ankle surgery.Results:Ten patients (12 ankles) met criteria with a mean age at surgery of 15.4 years (range, 12 to 18 years) and a mean follow-up of 6.5 years (range, 2.8 to 9.1 years). Mean FAAM ADL subscale, Sports subscale, and SANE scores were 91.0 ± 15.5, 76.3 ± 29.1, and 88.6 ± 15.1 respectively. A chronic duration of symptoms prior to surgery was associated with a lower FAAM Sports current level of function score (p=0.032). Four patients (40%) discontinued their sport due to continued ankle issues and reported significantly lower FAAM ADL subscale (p=0.01), Sports subscale (p<0.001), and SANE scores (p = 0.002).Conclusion:Os trigonum syndrome in the adolescent population may not have the same rate of success as that seen in adult athletes over the long term. However, if proven to be refractory to conservative measures and surgical intervention is indicated, patients and their families should be counseled about the risk for persistent ankle symptoms and the possibility that they may not be able to return to their previous level of sport.

Chopart Fractures and Dislocations: Case Series and New Algorithm of Treatment

Category:TraumaIntroduction/Purpose:Chopart fractures and dislocations are one of the most commonly overlooked injuries of the foot. These injuries are still challenging in both diagnosis and treatment and result in a high degree of long-term disability. Recent studies have shown that around 30 to 40% of these injuries are not adequately diagnosed on first consultation, mainly because of their low incidence and high clinical variability/spectrum of injuries. Anatomical reduction of Chopart injuries seems to be the most important prognostic factor of functional outcomes. However, there is still no consensus or clear evidence-based guidelines on the management of these types of injuries. We report the result of our current management protocol and propose a new algorithm of management of Chopart Injuries.Methods:We present a case series of patients with Chopart fractures and fracture-dislocations admitted to a Level 1 Trauma center between March 2015 and April 2020. Demographic data, mechanism of injury, treatment and complications were obtained from clinical records. Classification of injuries according to Zwipp was performed. Standardized surgical management was performed in 1 or 2 stages, according to soft tissue status. Open reduction and internal fixation of associated fractures of the talus, navicular, calcaneus and cuboid was performed. In cases of severe articular comminution or presence of medial and/or lateral instability, transarticular bridge plating was indicated. Postoperative radiological assessment was performed with X-rays and CT scan. Outcomes were determined using the American Orthopaedic Foot & Ankle Society midfoot score (AOFAS), visual analogue scale (VAS), foot and ankle ability measure (FAAM) and the 12-item Short Form Survey (SF-12).Results:Thirty four patients (12 women) were included in this study with a mean age of 37 years. Mechanisms of injury were: motor vehicle accidents (n=12), low energy midfoot torsion (n=12), crushing injuries (n=7), fall from height (n=2) and firearm injury (n=1). Mean follow up was 39 months (ranging from 8 to 71 months). The mean AOFAS score 84.8 (SD 12.9), mean FAAM of 84.4% (SD 15.4) and mean VAS score was 3/10. In terms of quality of life, the SF-12 physical component score was 43.59 (SD 9.3), with a mental component score of 51.98 (SD 12.1). Secondary procedures included: hardware removal (n=23), midfoot fusion (n=3) and skin coverage procedures by plastic surgery (n=5).Conclusion:In this case series, a standardized strategy for the treatment of Chopart injuries including the use of external fixation, ORIF and transarticular plating is presented. Reestablishment of joint alignment of both columns (medial and lateral) is crucial to obtain acceptable functional outcomes. Transarticular fixation is a useful alternative to post-reduction residual instability and bridging of fractures with periarticular comminution. Functional and quality of life results on this series were acceptable and comparable to previous reports at minimum one year follow up. Long-term follow up is needed to further validate the proposed algorithm.

Functional Outcomes of Arthroscopic Os Trigonum Excision in Adolescents.

Outcomes of symptomatic os trigonum excision have been well described as a successful treatment in adults; however, the literature lacks information on standardized longer term functional outcomes in the pediatric population. This study intends to report functional outcomes of arthroscopic os trigonum excision in adolescents who failed conservative management, with the hypothesis that these younger patients would have similar, successful outcomes of adult patients. A retrospective study was performed on adolescents who underwent arthroscopic os trigonum excision at a single institution between 2011 and 2017. Patient demographic, clinical history, radiographic, and operative data were documented. Outcome measures included the Foot and Ankle Ability Measure (FAAM) score comprised of the Activities of Daily Living (ADL) and Sports subscales, Single Assessment Numeric Evaluation (SANE) score, ability to return to the same level of sport, and any additional foot/ankle surgery. Ten patients (12 ankles) met criteria with a mean age at surgery of 15.4 years (range, 12 to 18 y) and a mean follow-up of 6.5 years (range, 2.8 to 9.1 y). Mean FAAM ADL subscale, Sports subscale, and SANE scores were 91.0±15.5, 76.3±29.1, and 88.6±15.1, respectively. A chronic duration of symptoms before surgery was associated with a lower FAAM Sports current level of function score (P=0.032). Four patients (40%) discontinued their sport due to continued ankle issues and reported significantly lower FAAM ADL subscale (P=0.01), Sports subscale (P<0.001), and SANE scores (P=0.002). Os trigonum syndrome in the adolescent population may not have the same rate of success as that seen in adult athletes over the long-term. However, if proven to be refractory to conservative measures and surgical intervention is indicated, patients and their families should be counseled about the risk for persistent ankle symptoms and the possibility that they may not be able to return to their previous level of sport. Level IV-case series.

Suture-button Versus Screw Fixation in Adolescent Syndesmotic Injuries: Functional Outcomes and Maintenance of Reduction.

Fixation of the tibiofibular syndesmosis is often performed with a trans-syndesmotic screw (SS) or suture-button (SB). SB fixation has been shown to have lower rates of postoperative syndesmotic malreduction, late diastasis, and implant removal, though some studies have found complications related to infection and implant subsidence. The purpose of this study was to compare maintenance of reduction, complications, implant removal and functional outcomes of SB versus SS fixation in adolescents. A retrospective chart review identified patients who underwent syndesmotic fixation from 2010 to 2019 at a single institution. Loss of syndesmotic reduction (diastasis) was defined as either a >2 mm increase in tibiofibular clear space or >2 mm decrease in tibiofibular overlap, and corresponding incongruence of the ankle mortise (medial clear space 1 millimeter greater than superior clear space). Functional outcomes were collected at a minimum of 1 year postsurgery using the Foot and Ankle Ability Measure (FAAM). Seventy-seven adolescents (45 SS, 32 SB) were included (mean age: 16±1.5 y). Forty-five patients had Weber C fibula fractures, 27 Weber B fractures, and 5 had isolated syndesmotic injuries or small posterior malleolus fractures. Fifty-one patients (66%) had functional outcomes available. There was no significant difference in mean FAAM Sports score between the 2 groups (SB=94.8%, SS=89.8%) at mean follow-up of 4.0±2.1 years. Syndesmotic implant removal occurred in 36/45 patients (80%) in the SS group compared with 4/32 patients (13%) in the SB group. There was 1 case of syndesmotic malreduction requiring revision surgery in the SS group, and no cases of postoperative malreduction or diastasis in the SB group. Nine patients in the SB group and 8 in the SS group weighed over 100 kilograms, with no cases of diastasis in these larger patients. There were 4 superficial infections and 1 deep infection in the screw group, with 1 superficial infection in the SB group. While both SB and screw fixation maintained syndesmotic reduction, SB fixation led to lower rates of implant removal surgery. SB fixation was equally effective at preventing recurrent diastasis in adolescents weighing over 100 kilograms, and functional outcomes were at least equivalent to screw-fixation at mean follow-up of 4.0 years. Level III.

Long-Term Patient Reported Outcomes after Correction of Traumatic Foot Drop

Category:Trauma; AnkleIntroduction/Purpose:There is limited literature on patient reported outcomes after tendon transfer for traumatic foot drop. The purpose of this study was to determine long-term patient reported functional outcomes after posterior tibialis tendon (PTT) transfer in patients with foot drop resulting from a traumatic common peroneal nerve injury.Methods:Between August 2006 to January 2019, 31 patients underwent PTT transfer for foot drop secondary to a traumatic injury to their common peroneal nerve at our institution. The average follow-up was 14 months. A retrospective chart review was performed to document physical exam measures and to review postoperative radiographs for changes in foot alignment. There were 17 out of the initial 31 patients available at a mean follow-up of 5.9 years who responded to a phone questionnaire, including the Foot and Ankle Ability Measure (FAAM) questionnaire, and questions on brace and assistive device use, activity level, and satisfaction with surgery.Results:Preoperatively, all patients had an equinus contracture with no dorsiflexion strength, abnormal gait, and used an ankle- foot orthosis (AFO) or pneumatic boot for ambulation. Postoperatively, the average ankle dorsiflexion strength was 4/5 with 28/31 patients reporting a normal gait and 26/31 not using a brace for ambulation. Postoperative radiographs did not show changes in alignment or progression to flatfoot deformity. For the subset of 17 patients who responded to the phone questionnaire, the mean FAAM ADL subscale score was 68.1 and the Sport subscale score was 52.1 at an average of 5.9 years after surgery. The majority of patients (76%) were very or quite satisfied with the outcome of surgery and 15/17 (88%) patients reported they would undergo the PTT transfer procedure again.Conclusion:Posterior tibialis tendon transfer for patients with foot drop secondary to a traumatic injury to their common peroneal nerve showed a high satisfaction rate and improvement in function after surgery without the need for brace or assistive device use at long-term follow-up at an average of 6 years. Additionally, there was no progression to flatfoot deformity after posterior tibialis tendon transfer at 1 year postoperatively.

Early Outcomes of a Synthetic Cartilage Implant for Treatment of Hallux Rigidus: A Series of 87 Patients

Category:Midfoot/Forefoot; BunionIntroduction/Purpose:Arthritis of the first metatarsophalangeal joint (MTPJ), or hallux rigidus, is the most common arthritic condition of the foot, affecting 1 in 40 people over 50 years of age. One surgical option is the implantation of a synthetic polyvinyl alcohol hydrogel implant that has water content, tensile strength, and biomechanical properties similar to those of healthy human cartilage. This implant is supported by positive outcomes in a Level 1 clinical trial out to over 5 years follow-up. The objective of this case series was to determine if the positive results seen in the pivotal trial could be recreated in a ‘real world’ setting.Methods:All patients implanted with a synthetic cartilage implant by a single surgeon between September 2016 and December 2018 were retrospectively reviewed. Consecutive adult patients diagnosed with hallux rigidus that failed nonoperative treatment were included in the analysis. Patient demographics, complications, Foot and Ankle Ability Measures (FAAM), and a 10-point visual analog score (VAS) were collected from the chart review.Results:A total of 87 patients were available for review during the time interval of interest with a mean length of follow-up of 38.7 weeks (range, 2-125). The average patient age was 56.6 years (range, 21-80). Two (2.3%) patients were converted to fusion. The first at 71 weeks and the second at 73 weeks following the initial surgery. Six (6.9%) patients experienced some complications: 3 cases of synovitis treated with corticosteroid injection; 1 case of sesamoiditis; 1 case of neuritis; and 1 insufficiency fracture at the plantar aspect of the MTPJ with implant subsidence. Patients had mean FAAM ADL and VAS scores of 81.2 (range 21-100) and 0.6 (range, 0-3), respectively, at final follow-up.Conclusion:This retrospective review is one of the first presentations of outcomes for a synthetic cartilage implant in a ‘real world’ setting. Patients experienced excellent pain relief, good functional outcomes, and a satisfactory survival rate. This case series confirms the positive results seen in the original pivotal trial for this device.

Long-term evaluation of the distal transverse plantar approach for Morton's neuroma excision.

There is currently no consensus on the ideal approach for the operative treatment of Morton&rsquo;s neuroma. The distal transverse plantar approach aims at optimal exposure without the scar complications associated with the longitudinal plantar approach. Long-term evaluation based on validated outcome instruments is lacking. The main purpose of this retrospective study was to evaluate the long-term clinical outcome of this approach using validated function and scar evaluation scores. Forty-nine patients operated on at our institution were examined clinically by two independent observers using the Foot and Ankle Ability Measure (FAAM) and the Vancouver Scar Scale (VSS). Patients who underwent neurectomy alone and those who had additional foot surgery were compared. Assessment at a mean of 7.9 years (range 4&ndash;12) postoperatively revealed a mean FAAM score of 84.8 &plusmn; 25% and a mean VSS score of 1.57 &plusmn; 1.7. Patients who underwent neurectomy alone had higher FAAM scores at follow up. We observed no complication that required an additional procedure. The transverse plantar approach results in good objective outcome scores, including scar healing, in the long term. This is our preferred technique because, in our experience, it offers optimal visualisation of the nerve, does not require deep dissection and allows the exposure of two adjacent web spaces of the foot through a single incision.

Cartiva case series: The efficacy of the cartiva synthetic cartilage implant interpositional arthroplasty at one year

BackgroundThe Cartiva synthetic cartilage implant (SCI) is licenced for use in management of symptomatic hallux rigidus in several countries including the UK. As of now, there are no independent series for treatment of hallux rigidus utilising polyvinyl alcohol implants. MethodsPatients at a single centre with symptomatic hallux rigidus who underwent Cartiva implant interpositional arthroplasty were identified. First metatarsophalangeal joint arthritis was radiographically graded according to the Hattrup and Johnson (HJ) classification. Pre-operative and post-operative patient-reported outcomes (PROMs) were evaluated using the Foot and Ankle Ability Measure (FAAM) activities of daily living subscale and the Manchester-Oxford Foot Questionnaire (MOXFQ). Results55 patients (14M, 41F) (37R and 18L) were followed up for an average of 21 months (min = 12, max = 38). 14 patients suffered from HJ2/moderate arthritis and 41 patients with grade HJ3/severe arthritis.Post-operative mean FAAM scores showed statistically significant improvement (p < 0.0001). Patients reported a 40% increase in functionality during activities of daily living.All 3 MOXFQ Domain scores improved significantly (p < 0.02). The Index score improved by 34 points (p < 0.0001).There was no correlation between length of follow up or age and PROMs (r = 0.129). No statistical difference was demonstrated between sexes. Clinically, however, males and older patients exhibited better outcomes. ConclusionsOur study shows excellent results with statistically significant improvements in functional outcomes, and promising short-term follow-up with low early revision rates. Durability and survivability of the implant will continue to be studied in this cohort.

A comparative prospective study of platelet rich plasma vs. corticosteroid injection in plantar fasciitis

Objective: To compare the relative effectiveness of intralesional Steroid versus Platelet- Rich Plasma injection among 80 patients in plantar fasciitis.Methods: A total number of 80 patients with plantar fasciitis were divided into 2 groups (Group A and B). Group A with 30 patients received intralesional Platelet Rich Plasma (PRP) and Group B received intralesional methyl prednisolone acetate injection. Pre and post intervention Visual Analogue Score (VAS), Foot and Ankle Ability Measure (FAAM) score and PF (plantar fascia) thickness for assessment of pain relief in two groups were recorded at 6 months.Results: The mean VAS scores for heel pain measured after 6 months of treatment were 1.460+0.6911in PRP group and 3.024+0.9572in steroid group. The decrease in mean VAS score in both the groups was statistically significant when compared with pre-treatment values (8.38+0.6820in PRP group and 8.44+0.6021in steroid group). The mean FAAM score measured after 6 months of treatment increased in both the groups (83.43±5.661in PRP group and 69.12±5.795 in steroid group)when compared with pre-treatment value (29.97±5.997in PRP group and 31.68±6.297 in steroid group)and it was statistically significant.There was 35.90% reduction in mean plantar fascia thickness in PRP group and 28.67% reduction in Steroid groupas compared to baseline values after 6 month of injection.Conclusion: Intralesional injection of both the PRP and steroid are effective and safe modalities of treatment for plantar fasciitis. Steroid is better for short term treatment of plantar fasciitis but in long term follow up platelet rich plasma therapy is better than steroid. Both the treatment methods have caused significant reduction in PF(Plantar fascia) thickness.

Lateral Flexor Digitorum Longus Transfer for Peroneal Tendinopathy

Category:SportsIntroduction/Purpose:Flexor digitorum longus (FDL) transfer to the lateral foot for concomitant irreparable rupture of the peroneal tendons has been reported in few clinical series. The purpose of this study is to provide midterm outcomes including subjective outcome scores, clinical examination data, and objective power after single-stage FDL tendon transfer.Methods:Twenty-five consecutive patients over a 7 year period (2008-2015) underwent FDL to fifth metatarsal transfer for irreparable peroneal tendon tears. Fifteen patients with a mean follow-up of 53.7 months completed the pain visual analog score (VAS), Foot Function Index (FFI), Short Musculoskeletal Functional Assessment (SMFA), and Foot and Ankle Ability Measure (FAAM) scores and participated in range of motion, peak force, and peak power testing.Results:All 15 patients were satisfied with their surgery and reported a reduction in their pain level with the average decrease in VAS of 5.59 +/- 2.5 (range: 1 - 9). The mean FAAM was 86.4 +/- 9.7 (range: 52.4 - 100). The mean FFI was 12.8 +/- 9.2 (range: 0 - 21.4). The mean SMFA Function index was 12.4 +/- 8 and the mean SMFA Bothersome Index was 11.5 +/- 11. Patients had on average 58% less eversion and 28% less inversion compared to the nonoperative side. Both isometric peak torque and isotonic peak velocity were decreased by 38.4% and 28.8%, respectively. On average, power in the operative limb was diminished by 56% compared to the nonoperative limb.Conclusion:FDL transfer to the lateral foot for significant, non-reconstructable peroneal tendinopathy is an effective, and durable treatment option.

Outcomes Following a Modified Broström Procedure and Arthroscopic Debridement of Medial Gutter Osteoarthritis Combined With Chronic Lateral Ankle Instability

Category:Ankle ArthritisIntroduction/Purpose:There is limited information regarding the outcomes of operative treatment for ankle instability with coexisting arthritic changes in the medial gutter. This study was performed to evaluate the intermediate-term clinical and radiological outcomes following a modified Broström procedure and arthroscopic debridement in middle-aged patients with combined medial gutter osteoarthritis and chronic lateral ankle instability.Methods:Twenty-four patients with medial gutter osteoarthritis related to chronic lateral ankle instability were followed for more than 3 years after operative treatment. All patients showed medial joint space narrowing of Takakura stage II at the time of surgery. The clinical evaluation consisted of the American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS) for medial ankle pain during walking, and Foot and Ankle Ability Measure (FAAM).Results:Mean AOFAS and FAAM scores significantly improved from 51.2 and 45.7 points preoperatively to 80.3 and 78.4 points at final follow-up, respectively (P < .001). Although mean pain-VAS significantly improved from 6.8 points to 3.1 points (P < .001), 5 patients (20.8%) complained of gait discomfort with considerable pain of 4 or more points. There was only 1 patient (4.2%) with recurrent ankle instability, while 6 patients (25%) showed a progression of arthritis stage.Conclusion:Modified Broström procedure combined with arthroscopic debridement appears to be an effective operative option for medial gutter osteoarthritis secondary to chronic ankle instability. Despite the onset of arthritis, most patients were able to achieve significant improvement in reducing pain while eliminating instability.

Cartiva Synthetic Cartilage Implant Hemiarthroplasty for Treatment of Hallux Rigidus

Category:Midfoot/ForefootIntroduction/Purpose:The Cartiva synthetic cartilage implant (SCI) is licenced for use in management of symptomatic hallux rigidus in several countries including the UK. As of now, there are no independent comparative series for treatment of hallux rigidus utilising polyvinyl alcohol implants.Methods:Patients at a single centre with symptomatic hallux rigidus who underwent Cartiva SCI implant procedure were identified. First metatarsophalangeal joint arthritis was radiographically graded according to the Hattrup and Johnson (HJ) classification. Pre-operative and post-operative patient-reported outcomes were evaluated using the Foot and Ankle Ability Measure (FAAM) activities of daily living subscale and the Manchester-Oxford Foot Questionnaire (MOXFQ).Results:66 patients (19 M, 47F) (43 R and 23 L) were followed up for an average of 14 months (min=2, max=36). 17 patients suffered from HJ2/moderate arthritis and 49 patients with grade HJ3/severe arthritis.Post-operative mean FAAM scores showed statistically significant improvement (p< 0.0001). Patients reported a 40% increase in functionality during activities of daily living.All 3 MOXFQ Domain scores improved significantly (p< 0.02). The Index score improved by 28 points (p< 0.0001).There was no correlation between length of follow up or age and PROMs (r=0.129). No statistical difference was demonstrated between sexes. However clinically, males and older patients exhibit better outcomes.There was a 89.4% patient satisfaction with the use of Cartiva.Conclusion:Our study shows excellent results with statistically significant improvements in functional outcomes, and promising short-term follow-up with low early revision rates. Pain in particular was significantly reduced. One third of patients developed post-operative stiffness requiring a manipulation under anaesthesia. Patient selection is key. Additional imaging may be required to assess sesamoid osteoarthritis. At 3 years the implant has demonstrated to be safe and efficacious in the management of hallux rigidus. Durability and survivability of the implant will continue to be studied in this cohort.

Clinical Outcomes of Osteochondral Lesions of the Tibial Plafond Following Arthroscopic Microfracture

Category:Ankle, ArthroscopyIntroduction/Purpose:There is little data regarding osteochondral lesions of the tibial plafond with only a few studies reporting clinical outcomes after arthroscopic treatment. The purpose of this study is to evaluate the clinical outcomes and the level of sports activities following arthroscopic microfracture for osteochondral lesions of the tibial plafond.Methods:A retrospective review was conducted for all patients who underwent arthroscopic microfracture surgery for ankle osteochondral lesions from January 2014 to June 2017. For functional evaluation, the Visual Analog Scale (VAS) pain score, Foot and Ankle Ability Measure (FAAM) score, and Short Form-12 (SF-12) general health questionnaire were used. We also investigated the level of sports activity before and after the surgery.Results:16 patients were included in the study, and the mean follow-up period was 29.8 months. The mean FAAM score was significantly improved from 57.6 (range, 6.0-88.9) for the activities of daily living subscale and 34.5 (range, 3.1-92.6) for the sports subscale to 84.3 (range, 46.4-100.0) and 65.2 (range, 23.3-55.1) for each subscale respectively at the final follow-up. There were also significant improvements in SF-12 score, from 36.3 (range, 23.3- 55.1) to 46.0 (range, 18.9-56.6) for SF-12 PCS, and from 41.3 (range, 14.2-65.0) to 52.6 (range, 32.8-60.8) for SF-12 MCS at the final follow-up. Although 16 of 16 (100%) were able to return to their sports activity, the level of sports activity was lower than their level before the surgery.Conclusion:Arthroscopic microfracture provided satisfactory clinical outcomes for osteochondral lesions of the tibial plafond. Though one hundred percentage of patients were able to return to sports activity after the surgery, the level of sports activity was lower than their level before the surgery.

Correlation of Health Insurance Provider to Orthopedic Patient Reported Outcome Measures

Category:Insurance, OutcomesIntroduction/Purpose:Previous research has suggested that patient insurance type can influence health-related measures, including patient survival, quality of care, clinical outcomes after certain injuries, and likelihood of returning to work following orthopedic injury. Patient reported outcome measures (PROMs) are a way of evaluating patients’ self-perception of health and function. The aim of this study is to determine if insurance type is associated with trends in PROMs scores in a general population of orthopaedic foot and ankle patients.Methods:We retrospectively reviewed the electronic medical records of 14,447 adult foot and ankle patients who had completed PROMs questionnaires from 2015 to 2017. We evaluated the following validated PROMs: Foot and Ankle Ability Measure (FAAM), PROMIS Global Short Form (both Physical and Mental Sub-scores), and PROMIS Physical Function Short Form 10A. Descriptive analyses, ANOVA, and Tukey HSD post-hoc analyses were conducted to evaluate trends of PROMs scores relative to insurance type.Results:The mean age of patients was 54.6 years, with 64.8% of patients being female (Table 1). Patients with Workers Comp/Motor Vehicle insurance (n=61) had the lowest mean FAAM, PROMIS Global – Physical Score, and Physical Function Short Form 10A score. Medicaid patients (n=836) had the lowest mean PROMIS Global – Mental Scores. Patients with Commercial insurance (n=9088) consistently had the highest PROMs scores (Table 1). Statistical analyses showed the scores of patients with Commercial insurance to be statistically significantly higher than the pooled scores of all other patients (Table 2). Significantly poorer scores were also seen for Workers Comp/Motor Vehicle as compared to the rest of the cohort (Table 2).Conclusion:This analysis reveals differences in PROMs amongst patients with different health insurance providers. In general, patients with Workers Comp/Motor Vehicle and Medicaid had poorer outcomes scores than those with Medicare or Commercial insurance. These differences were statistically significant and exceed published MCIDs for FAAM and PROMIS PF 10A. While further research is required, as we did not control for different diagnoses, we believe this is useful information in characterizing how patient insurance type can impact patient reported outcomes.

Lateral Transfer of the Flexor Digitorum Longus for Peroneal Tendinopathy.

Few studies have reported midterm outcomes after single-stage flexor digitorum longus (FDL) tendon transfer to the lateral foot for irreparable rupture of the peroneal tendons. Over a 7-year period (2008-2015), 25 consecutive patients underwent transfer of the FDL to the fifth metatarsal for irreparable peroneal tendon tears. Of these, 15 patients were available for inclusion with a mean follow-up of 53.7 ± 23.3 months, mean age at surgery of 48.4 years, and mean body mass index (BMI) of 29.8 kg/m2. Patients completed the pain visual analog scale (VAS), Foot Function Index (FFI), Short Musculoskeletal Function Assessment (SMFA), and Foot and Ankle Ability Measure (FAAM) and participated in range of motion, peak force, and peak power testing. All 15 patients were satisfied with their surgery and reported a reduction in their pain level with a decreased VAS of 5.6 ± 2.5. The mean FFI was 12.8 ± 9.2, the SMFA Function Index was 12.4 ± 8, and the mean SMFA Bothersome Index was 11.5 ± 11. The mean FAAM was 86.4 ± 9.7. Patients had on average 58% less eversion and 28% less inversion compared with the nonoperative side. Isometric peak torque and isotonic peak velocity were 38.4% and 28.8% less compared with the contralateral side, respectively. The average power in the operative limb was diminished by 56% compared with the nonoperative limb. In this small case series with midterm follow-up, FDL transfer to the lateral foot for significant, irreparable peroneal tendinopathy was an effective and durable treatment option. Level IV, retrospective case series.

Clinical Outcomes of Osteochondral Lesions of the Tibial Plafond Following Arthroscopic Microfracture.

The purpose of this study was to evaluate the clinical outcomes and the level of sports activity following arthroscopic microfracture for osteochondral lesions of the tibial plafond. A retrospective review was conducted for patients who underwent arthroscopic microfracture surgery for osteochondral lesions of the tibial plafond from January 2014 to June 2017. For functional evaluation, the visual analog scale (VAS) pain score, Foot and Ankle Ability Measure (FAAM) score, and Short Form-12 (SF-12) general health questionnaire were used. We also investigated the level of sports activity before and after the surgery. Sixteen patients were included in this study, and the mean follow-up period was 29.8 months. The mean VAS score improved from 8.3 (range, 6-10) preoperatively to 1.8 (range, 0-4) postoperatively. The mean FAAM score was improved from 57.6 (range, 6.0-88.9) for the activities of daily living subscale and 34.5 (range, 3.1-92.6) for the sports subscale to 84.3 (range, 46.4-100.0) and 65.2 (range, 23.3-55.1) for each subscale, respectively, at the final follow-up. There were also improvements in the SF-12 score, from 36.3 (range, 23.3-55.1) preoperatively to 46.0 (range, 18.9-56.6) postoperatively for the SF-12 PCS, and from 41.3 (range, 14.2-65.0) preoperatively to 52.6 (range, 32.8-60.8) postoperatively for the SF-12 MCS. All functional scores showed significant differences clinically and statistically at the final follow-up. The level of sports activity after the surgery was significantly lower than their level before the surgery (P = .012). Arthroscopic microfracture provided satisfactory clinical outcomes for osteochondral lesions of the tibial plafond. Though all the patients in this study were able to return to sports activity after the surgery, the postoperative level of sports activity was significantly lower than their preoperative level. Level IV, retrospective case series.