Weber Score Research Articles

Cerrahi olarak tedavi edilen yetişkin ayak bileği kırıklarında üç farklı hasta bazlı değerlendirme ölçek sonuçlarının karşılaştırılması

Amaç: Bu çalışmda ayak bileği kırıklarının ameliyat sonrası klinik ve radyolojik sonuçlarının üç farklı hasta bazlı değerlendirme ölçeği kullanılarak değerlendirilmesi ve ölçeklerinin sonuçlarının ve birbirleri ile uyumlarının karşılaştırılması amaçlanmıştır. 
 Gereç ve Yöntem: Yaşları 18 ile 77 arasında değişen toplam 77 hasta prospektif olarak takip edildi. Tüm hastaların yaş, cinsiyet, kırık taraf, travma mekanizmaları, kırık tipleri, ameliyat sonrası atel uygulanma süreleri, tam yük vermeye başlama zamanları ve komplikasyonları kaydedildi. Hastaların 1. yıl kontrollerinde tüm hastalar, AOFAS, Ayak Bileği-Arka Ayak Değerlendirme Ölçeği, Weber Skorlaması ve Freiburg Skalası protokollerine göre incelendi. 
 Bulgular: AOFAS Değerlendirme Ölçeğine göre 57 hastada (%74) iyi ve 20 hastada (%26) kötü sonuç; Weber Skorlamasında 51 hastada (%66,2) mükemmel, 12 hastada (%15,6) iyi ve 14 hastada (%18,2) kötü sonuç ve Freiburg Skalasında 50 hastada (%64,9) mükemmel, 12 hastada (%15,6) iyi ve 15 hastada (%19,5) kötü sonuç elde edilmiştir. AOFAS-Weber, Ölçek sonuçları birbirleri ile uyumlu bulunmuştur. Komplikasyon gelişimi ile AOFAS Değerlendirme Ölçeği ve Weber Skorlaması arasında ve ileri yaş ile Weber Skorlaması arasında anlamlı ilişki saptanmıştır.
 Sonuç: AOFAS Ölçeği, Weber Skorlaması ve Freiburg Skalalarının sonuçları birbirleri ile uyumlu olup, yetişkin ayak bileği kırıklarının cerrahi tedavisi sonrası değerlendirilmesinde güvenle kullanılabilir. Komplikasyon gelişimi ve ileri yaş, ayak bileği kırıklarında kötü klinik sonuç ile ilişkilendirilebilir.

Comparison of K-wire versus screw fixation after open reduction of transitional (Tillaux and triplane) distal tibia fractures.

Our study aimed to compare the clinical and radiographic outcomes of transitional distal tibia fractures treated with K-wire fixation versus screw fixation after open reduction. A retrospective study was performed on all displaced transitional distal tibia fractures that underwent operative fixation. Following open reduction, surgical fixation was performed using either percutaneously inserted 2.0 mm K-wires, or 4.0 mm partially-threaded cannulated cancellous screws. Clinical and radiographic outcomes between the two groups were assessed using the modified Weber score. Other outcome measures assessed were surgical time, casting duration, follow-up duration and duration before return-to-sports. We recruited 49 patients with transitional distal tibia fractures requiring open reduction and surgical fixation. There were 18 patients in the K-wiring group (KWG), and 31 patients in the screw fixation group (SFG). All patients in both groups had excellent clinical and radiographic outcome based on the modified Weber's scoring, full radiological healing, and no residual displacement upon final follow up. The KWG had significantly shorter surgical time (41.0 min versus 75.1 min, P < 0.0001) and shorter follow-up duration needed before discharge (5.4 months versus 8.7 months, P = 0.024). However, they required a longer post-operative casting duration (7.3 weeks versus 5.3 weeks, P = 0.006). No significant difference was found for the duration before return to sports between both groups. Complications were few in this study group. Superficial pin site infection was noted in one patient in the KWG, and valgus deformity of the ankle was noted in one patient in the SFG. In our study, surgical treatment of transitional distal tibia fractures demonstrated equally excellent outcomes when treated by open reduction with either K-wire or cannulated screw fixation. Level of evidence: III.

Minimally invasive treatment of AO B ankle fractures: Surgical technique and long-term outcomes

BackgroundAnkle fractures are the most common traumatic bone injuries of the lower limb. Over 50% of ankle fractures occur at the syndesmosis level (type AO B). The goal of treatment is to achieve an anatomical reduction and appropriate stabilization. The present study aimed to evaluate the clinical-functional and radiological results, and complications of minimally invasive reduction and fixation technique for ankle fractures type AO B. The surgical technique also is detailed. Material and methodsA prospective analysis of 451 patients undergoing surgery for type AO B displaced ankle fracture was performed. All patients were treated with minimally invasive surgery. The following times were recorded: time between trauma and osteosynthesis, hospitalization length, surgical time, and exposure time to fluoroscopy. Age and gender, mechanism of injury, and characteristics of fractures were recorded. For functional outcome, AOFAS score, VAS, and Weber score were used. Radiographic analysis was performed. The average follow-up was 112 months. ResultsMean age was 48.2 years old. Average length of stay in hospital was 5.72 h. Mean duration of the surgery was 32.8 min. Average fluoroscopic exposure time during surgery was 9.25 s. Mean bone union time was 38.2 days. Weber’s score was on average 1.5/24 points and the long-term follow-up AOFAS score was on average 97.5/100. Postoperative complications incidence was 2.7%. ConclusionsDistal fibula fixation with the MIPO technique presented good functional outcomes and could be helpful in the avoidance of the complications associated with conventional open reduction and internal fixation. However, it needs more exposition to intraoperative fluoroscopy. Level of evidence: II.

Long-term results following intra-articular fractures of the medial malleolus in children and adolescents with special emphasis on MRI.

Presently, there is no publication combining clinical follow-up with magnetic resonance imaging (MRI) to determine possible post-traumatic alterations following paediatric intra-articular fractures of the medial malleolus. Therefore, the aims of this study were to retrospectively analyze a cohort of patients with Salter-Harris (SH) III and IV fractures of the medial malleolus and to evaluate their long-term outcome. MRI was used to assess possible changes of the articular surface that cannot be diagnosed on native radiographs. Fifty-four patients with SH III ( n = 38) or IV fractures ( n = 17) of the medial malleolus treated between 2001 and 2011 were invited for a follow-up examination. Clinical outcome was assessed with the Weber score and osteoarthritis with the Kellgren and Lawrence classification. MRI was rated by the Outerbridge classification. Correlations between the clinical and radiological outcomes were calculated. Seventeen patients were recruited for long-term follow-up at a mean of 112 (range, 65-184) months. The Weber score was very good for 5 patients, good for 10 patients and poor for 2 patients; the Kellgren and Lawrence score revealed a favourable grade 0 in 15 patients and grade 1 in 2 patients. The MRI-based Outerbridge classification yielded grade 0 for 12 patients, grade 1 for 1 patient, grade 2 for 2 patients and grade 3 for 1 patient. The Outerbridge score significantly ( p < 0.05) correlated with the Weber score. This study shows excellent and good outcome of SH III and IV fractures of the medial malleolus. Worse clinical outcome correlated with post-traumatic changes of the articular cartilage seen on MRI.

ANTIGLIDE PLATING IN D ISTAL FIBU LAR FRACTURE FIXATION IN OSTEOPOROTIC PATIENT

Background: Oblique spiral fractures of the distal third of the fibula are commonly encountered in any orthopedics practice. Controversy persists over various fixation methods, and their corresponding risks and benefits. Posterior antiglide plates have been introduced as a method of fixation for the distal part of the fibula. Objectives: The present study was targeting at the evaluation of radiographic and functional outcome after antiglide plating of distal fibular fracture in osteoportic patient. Functional results were assessed with Weber score system. Patients and Methods: A prospective study was on 15 patients with distal fibula fracture treated with ORIF. Results: Posterior plating report increased biomechanical strength, less lateral skin irritation, infrequent need for hardware removal, and ability to use bicortical fixation in the distal fragment. Conclusion: There was an insufficient evidence to support either posterior or lateral fibular plating as a gold standard. Choice of approach and surgical technique should be individually based on fracture pattern, patient characteristics and surgeon experience.

Treatment strategies for partial chronic instability of the distal syndesmosis: an arthroscopic grading scale and operative staging concept.

The aim of this study was to evaluate three different anatomical reconstruction techniques for the partial chronic isolated instability of the syndesmosis based on own arthroscopic classification criteria. A retrospective study was conducted to review 32 patients (15 female, 17 male; average age 41; range 18-71) with isolated partial chronic instability of the syndesmosis. During the arthroscopic examination of the patient, the instability of the syndesmosis was assessed by inserting a dissector of defined size into the distal tibiofibular joint. The lateralization of the fibula in the distal tibiofibular joint was then semi-quantitatively evaluated and classified. In all cases, open reconstructive surgery was carried out at the same time. Depending on the grading of the instability assessed arthroscopically (Grades I-III), one of three different anatomical reconstruction techniques was performed: suture of the anterior inferior tibiofibular ligament (AITFL), ligament repair using periosteal flaps, or autogenous plantaris tendon graft. Patients in all three groups were treated with a screw and an additional preassembled suture-button device. At 8 weeks after surgery, the screw was removed and full weight bearing was allowed. Clinical and radiological follow up were obtained at an average time of 17 months after surgery. Clinical evaluation of the reconstruction techniques was assessed using the American Orthopaedic Foot and Ankle Score (AOFAS) and the Weber Score. The median AOFAS score was significantly higher than before surgery for all three groups. In addition, the Weber score was significantly lower in all three groups than before surgery, indicating substantial improvement. There were no complications after the arthroscopies and the reconstructive surgeries. But in two cases, suture granuloma occurred within the 17-month window, which was treated with a revision operation and removal of the suture-button device. Depending on the arthroscopic classification of the partial chronic instability of the syndesmosis, the three different anatomical reconstruction techniques potentially provide appropriate treatment options based on the grade of injury.

Free and Pedicled Flaps for Reconstruction of the Weightbearing Sole of the Foot: A Comparative Analysis of Functional Results

Reconstruction of the weightbearing sole of the foot is complex and requires soft tissue that is resistant to weight, pressure, and shear stress. Despite a variety of flap types and techniques, it is still challenging to meet these demands. The present retrospective study included 21 patients after reconstruction of plantar tissue defects from 2001 to 2011. The outcome was evaluated using the lower extremity functional scale, Weber score, pedobarography, assessment of shifting, and sensory recovery. The patients' quality of life was documented using the SF-36 questionnaire. Plantar reconstruction was performed using 12 free and 9 pedicled flaps. No differences in functional results were observed between the flap types, despite a better sense of temperature in the adipocutaneous flaps. The extent of flap shifting was independent of the flap type and did not correlate with the functional results. Pedobarography showed a tendency for increased peak pressure and prolonged contact time in the reconstructed weightbearing plantar areas compared with the sound feet and a control group. The present study found no relevant differences in the functional results between different flap types and free or pedicled techniques. Flap selection should be based on the individual requirements and availability of donor sites.

Autologous Chondrocyte Implantation of the Ankle

Background: The treatment of osteochondral lesions of the talus after failed surgery is challenging, with no clear solution. Short-term results using autologous chondrocyte implantation have been promising. Purpose: To report the long-term outcomes of patients who underwent autologous chondrocyte implantation (ACI) of the talus after failed marrow stimulation techniques for osteochondral lesions of the talus (OLTs). Study Design: Case series; Level of evidence, 4. Methods: Thirty-two consecutive patients underwent ACI of the talus, and 29 patients (15 male, 14 female; mean age, 34 years [range, 16-54 years]) were available for follow-up. There were 23 medial and 6 lateral lesions, with a mean size of 18 × 11 mm (198 mm2; range, 80-500 mm2). Twenty patients underwent ACI of the talus alone; 9 underwent ACI with bone grafting of underlying cysts. Follow-up was performed at a mean of 70 months (range, 24-129 months). Patient outcomes were evaluated using the simplified symptomatology score, Tegner activity score, Finsen score, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Twenty-five patients (86%) underwent second-look arthroscopic surgery at the time of hardware removal and were assessed with the International Cartilage Repair Society (ICRS) score. Postoperative magnetic resonance imaging (MRI) was performed on 24 patients (83%) and compared with preoperative MRI scans. Results: Preoperatively, 26 patients rated their ankles as poor and 3 as fair using the simplified symptomatology score. At last follow-up, 9 were classified as excellent, 14 as good, 5 as fair, and 1 as poor using the same score. The mean AOFAS score improved from 50.1 to 85.9 (range, 65-100). The mean Tegner activity score improved from 1.6 to 4.3 (P < .0001). The mean Finsen score (modified Weber score) showed significant improvement from 13.7 to 5.1 (P < .0001). Conclusion: Autologous chondrocyte implantation of the talus yields improvement in all parameters tested with enduring long-term results in patients who have failed previous surgery for OLTs.

The “LIFT” Lesion: Lateral Inverted Osteochondral Fracture of the Talus

The purpose of this study was to assess a series of lateral inverted osteochondral fractures of the talus. Over a 17-year period, 10 patients with an acute lateral inverted osteochondral fracture of the talus after an inversion injury to the ankle were identified. Diagnosis was made by physical examination, radiographs, magnetic resonance imaging, and/or computed tomography scan. Arthroscopy was initially performed on all patients. All patients had an inverted osteochondral fragment. In 8 of 10 patients the fragment was reattached in an open manner in conjunction with lateral ligament reefing. The fragment was excised in 2 patients. The mean age of the patients was 17.2 years. They were evaluated with the Single Assessment Numeric Evaluation, American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, modified Weber score, Berndt and Harty score, and Short Form 36 version 2 score. Physical and radiographic examination was also performed. The mean time to follow-up was 112.3 months (9.3 years). The mean American Orthopaedic Foot and Ankle Society score improved from 18.9 preoperatively to 86.9 postoperatively (P ≤ .0001). The mean Single Assessment Numeric Evaluation and modified Weber scores were 81.6 and 81.5, respectively. On the Berndt and Harty scale, 6 patients had a good to excellent rating; 3, fair; and 1, poor. The mean Short Form 36 version 2 scores corresponded to national averages for healthy populations. Mean loss of motion for dorsiflexion and plantarflexion was 6.8° and 3.0°, respectively, when compared with the contralateral side. All patients showed some osteophyte formation on follow-up radiographs. An inverted osteochondral fracture of the lateral talus (lateral, inverted, fracture, talus [LIFT lesion]) can occur after a twisting injury to the ankle. Clinical suspicion should be high, especially in the younger athlete. This injury can be successfully managed with a combined arthroscopic and open approach. Level IV, therapeutic case series.

Évaluation fonctionnelle après lambeau homodactyle en îlot antérograde pour perte de substance pulpaire des doigts longs. À propos de 15 cas

ObjectivesFingertip amputations are very common. The aim of the treatment is to restore the sensibility of the finger pulp, with adequate pulp padding. The homodigital pedicle island flaps are used in zone 2 or 3 of Allen's classification. This study evaluates the functional results of this type of flap. MethodsFifteen patients were reviewed. The clinical evaluation noted complications, satisfaction level, use of the finger, cold intolerance and increased sensibility signs. The Weber test and the Semmes monofilaments were used for sensory evaluation. The joint mobility was measured and the Quick-DASH score calculated. ResultsThe mean time between surgery and the revision was 21 months. The average flap advancement was 12mm. Six of the patients were very satisfied. The finger use was normal in seven cases, and excluded in only one. The average Quick-DASH was 18.18. Sixty percent of the nails were deformed, 20% were hooked. Eight patients experienced cold intolerance, and five had increased local sensibility. The average Weber score was 7mm and the monofilaments were at 3.61. The flexion of the joint was limited in six cases. ConclusionFor specific indications in finger-pulp amputation, the homodigital pedicle island flaps give satisfying aesthetic and functional results, allowing considerable advancement. Nevertheless, they are often a source of cold intolerance, finger joint stiffness and require long healing periods.

Treatment of the Unstable Ankle with an Osteochondral Lesion

Background Few reports have studied the treatment of osteochondral lesions of the talus (OLTs) in the setting of lateral ankle instability. Hypothesis Arthroscopic treatment of an OLT and lateral ankle stabilization in the same sitting is safe and leads to reliable improvement of symptoms. Study Design Case series; Level of evidence, 4. Methods Of 37 patients who underwent concomitant treatment of an OLT and lateral ankle stabilization, 31 (84%) were evaluated at a mean of 7.3 years postoperatively. Patients were evaluated by physical examination, the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, the modified Weber Scale, the Single Assessment Numeric Evaluation, the Berndt and Harty Scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey. Results The average postoperative ankle-hindfoot score was 89, the mean modified Weber score was 85, and the mean Single Assessment Numeric Evaluation was 86. In sum, 74% of patients had a good result on the Berndt and Harty Scale, 23% had a fair result, and 3% had a poor result. Of the short-form survey, the mean physical function score was 86.5, and the mean summary physical component score was 52.3. For the 13 patients for whom prospective ankle-hindfoot scores were available, a statistically significant improvement was seen, from 75 points preoperatively to 91 points postoperatively (P < .001). Conclusion Simultaneous arthroscopic treatment of an OLT and open lateral ankle stabilization is a safe and effective procedure. The presence of an osteochondral lesion had a negative effect on the overall result when compared to that of patients who underwent lateral ankle stabilization as an isolated procedure.

Autologous Chondrocyte Implantation of the Ankle

Background Treatment of full-thickness talar cartilage defects that have failed previous surgery is problematic without a definitive solution. Purpose To report the first US prospective study of autologous chondrocyte implantation of the talus. Study Design Case series; Level of evidence, 4. Methods Eleven patients (6 women and 5 men; mean age, 33 years) underwent autologous chondrocyte implantation of the talus after previous failed surgical management. There were 9 medial and 2 lateral lesions, with a mean size of 21 × 13 mm (273 mm2). Five patients underwent autologous chondrocyte implantation of the talus alone; 6 had it with a “sandwich procedure.” Ten patients underwent a second-look arthroscopy with screw removal. Results Mean follow-up was 38 months. Preoperatively, 10 patients rated their ankles as poor and 1 as fair, using the simplified symptomatology evaluation. At latest follow-up, 3 patients were classified as excellent, 6 as good, and 2 as fair. Tegner activity level improved from 1.3 ± 1.0 (mean ± SE) preoperatively to 4.0 ± 1.6 (P <. 002) postoperatively. The Finsen score (modified Weber score) showed significant improvement in the total score (P <. 001). There was also overall agreement between the Finsen score and the American Orthopaedic Foot and Ankle Society ankle hindfoot score, with significant improvement from 47.4 ± 17.4 preoperatively to 84.3 ± 8.1 postoperatively (P <. 001). At repeat arthroscopy, complete coverage of the defect was seen in all patients. Conclusion Autologous chondrocyte implantation of the talus yields significant functional improvement; however, further investigation is necessary to determine the long-term structural and biomechanical properties of the repair tissue.

Chronic Lateral Instability: Arthroscopic Findings and Long-Term Results

A wide variety of procedures have been described to treat chronic lateral ankle instability. Nonanatomic procedures sacrifice normal tissue and can restrict motion. Anatomic reconstruction of the anterior talofibular and calcaneofibular ligaments, supplemented by reefing of the exstensor retinaculum (modified Broström procedure) provides good long-term stability with minimal drawbacks. Twenty-one patients had arthroscopic evaluation followed by the Gould modification of the Broström procedure. All patients filled out a detailed questionnaire, including the American Orthopaedic Foot and Ankle Society Ankle/Hindfoot Score, Modified Weber Score, and Hamilton Score at an average of 60 months after surgery. All patients were re-examined, and 14 had stress radiographs for comparison with the preoperative films. Ninety-five percent of the patients (20 of 21) had associated intra-articular problems. The mean score for the Modified Weber Score was 96; for the Ankle/Hindfoot Score, 97; and for the Hamilton score, 100% good and excellent results. All 14 patients recorded a side-to-side difference of less than 3 degrees on their postoperative stress radiographs. A high percentage of patients with lateral ankle instability have intra-articular pathology. Excellent results can be expected in patients with ankle instability who undergo arthroscopic treatment of associated intra-articular pathology and the modified Broström procedure.

Treatment of talar neck fractures: Clinical results of 50 patients

Fractures of the neck and body of the talus present as one of the most challenging and rare injuries. These fractures are often associated with other ankle, foot, and skeletal injuries, which complicate their treatment. The clinical course of 50 patients with a mean age of 29 years with a severe talus fracture between 1992 and 1997 is presented. According to the Hawkins classification there were 16 (32%) of type I, 14 (28%) of type II, 9 (18%) of type III, and 11 (22%) of type IV. Forty-three patients (86%) underwent operative treatment: 27 (63%) by open reduction and internal fixation with screws, seven (16%) by external fixation, five (12%) with percutaneous screws, and four (9%) by closed reduction with K-wire fixation. Mild osteoarthritis of the talocrural joint was seen in 14 patients (28%) and severe osteoarthritis in 10 patients (20%), five of whom required subsequent arthrodesis of the ankle joint. Arthrodesis of the subtalar joint was observed in 4 cases. Avascular necrosis with collapse of the talar body was seen in four patients (8%). The function of the ankle joint was evaluated according to the Weber score. Patients with talus fractures of Hawkins' type I and II had considerably better outcomes (with 95% being excellent or good) than individuals suffering dislocated fractures with involvement of the articulating surface with 70% good results in Hawkins' type III and 10% good results in Hawkins' type IV fractures. For the evaluation of the vitality of the talus body in cases with titanium implants, the authors used magnetic resonance imaging and intraosseous phlebography in cases with stainless steel implants. The displaced talus fractures must be treated by closed and, if necessary, open reduction with internal fixation. The initial postoperative management should consist of ambulation without weightbearing until radiographic appearance of trabecular bone in the fracture zone, indicating revascularization, can be manifested.

Massive intraosseous ganglion of the talus: Reconstruction of the articular surface of the ankle joint

Summary: We report on the outcome after autologous chondrocyte and spongiosal bone transplantation in a case of a massive intraosseous ganglion of the talus in a young patient. A 24-year-old man suffered from decreased ankle joint motion, recurrent swelling, and pain. Diagnostic evaluation by plain radiographs, computed tomography, and magnetic resonance imaging revealed cystic lesions in the head and the body of the talus with additional involvement of the cartilage surface. Operative treatment consisted primarily of an initial diagnostic arthroscopy, which established grade VI articular damage according to the arthroscopic classification of Bauer and Jackson. Pathological examination of intralesional biopsy tissue revealed the existence of an intraosseous ganglion. Additionally, healthy cartilage biopsy specimens were obtained and sent for chondrocyte extraction and cultivation with 60 mL of autologous serum. To retain the function of the ankle joint and to minimize the number of necessary operative interventions, 3 weeks after the initial arthroscopic operation, we performed a simultaneous curettage of the cystic lesion followed by autologous spongiosal bone and cultivated chondrocytes transplantation of the talus. Continuous passive motion was applied postoperatively and full weight bearing was allowed after 8 weeks. There were no complications. The clinical result after 18 months was excellent, with a fully functional, pain-free, and weight-bearing ankle joint. The postoperative evaluation score of Finsen (modified Weber score) of 2/6 = 0.3 showed an improvement comparison with the preoperative value of of 21/6 = 3.5 (0 = normal, 4 = pathologic).We encountered no complications postoperatively. Clinical success was achieved by this method of treatment on a patient too young to be treated through arthrodesis.Arthroscopy: The Journal of Arthroscopic and Related surgery, Vol 16, No 7 (October), 2000: pp 14e–14e

Treatment of the rupture of the distal tibiofibular syndesmosis with "Engelbrechts syndesmosis hook"

After completing the osteosynthesis of the lateral malleolus, the hook is positioned 3–5 cm cranial of the syndesmosis and fixed to the tibia with a screw. It is expected to allow undisturbed ligament healing of the syndesmosis with early formation or fibres under limited motion. No immobilisation is necessary and no early removing of the implant. Results: Of 62 patients questioned, 53 were examined, after an average of 50 months (2–6 years p. o.). Using the Weber score, 51 had excellent or good results. Twelve patients reported discomfort while jumping, in five cases the ROM concerned dorsal extension, and in three cases plantar flection was reduced. Four patients showed distinct radiologic signs of osteoarthrosis, and two patients slight signs.

Treatment of the rupture of the distal tibiofibular syndesmosis with "Engelbrecht's syndesmosis hook"

After completing the osteosynthesis of the lateral malleolus, the hook is positioned 3-5 cm cranial of the syndesmosis and fixed to the tibia with a screw. It is expected to allow undisturbed ligament healing of the syndesmosis with early formation or fibres under limited motion. No immobilisation is necessary and no early removing of the implant. Of 62 patients questioned, 53 were examined, after an average of 50 months (2-6 years p. o.). Using the Weber score, 51 had excellent or good results. Twelve patients reported discomfort while jumping, in five cases the ROM concerned dorsal extension, and in three cases plantar flexion was reduced. Four patients showed distinct radiologic signs of osteoarthrosis, and two patients slight signs.