Effect of Peritalar Subluxation Correction for Progressive Collapsing Foot Deformity on Patient-Reported Outcomes.

IF 2.4 2区医学 Q2 ORTHOPEDICS

Foot & Ankle International Pub Date : 2023-11-01 Epub Date: 2023-09-12 DOI:10.1177/10711007231192479

Cesar de Cesar Netto, Nacime Salomao Barbachan Mansur, Matthieu Lalevee, Kepler Alencar Mendes de Carvalho, Alexandre Leme Godoy-Santos, Ki Chun Kim, Francois Lintz, Kevin Dibbern

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引用次数: 0

Abstract

Background: Peritalar subluxation (PTS) is part of progressive collapsing foot deformity (PCFD). This study aimed to evaluate initial deformity correction and PTS optimization in PCFD patients with flexible hindfoot deformity undergoing hindfoot joint-sparing surgical procedures and its relationship with improvements in patient-reported outcome measures (PROMs) at latest follow-up. We hypothesized that significant deformity/PTS correction would be observed postoperatively, positively correlating with improved PROMs.

Methods: A prospective comparative study was performed with 26 flexible PCFD patients undergoing hindfoot joint-sparing reconstructive procedures, mean age 47.1 years (range, 18-77). We assessed weightbearing computed tomography (WBCT) overall deformity (foot and ankle offset [FAO]) and PTS markers (distance and coverage maps) at 3 months, as well as PROMs at final follow-up. A multivariate regression model assessed the influence of initial deformity correction and PTS optimization in patient-reported outcomes.

Results: Mean follow-up was 19.9 months (6-39), and the average number of procedures performed was 4.8 (2-8). FAO improved from 9.4% (8.4-10.9) to 1.9% (1.1-3.6) postoperatively (P < .0001). Mean coverage improved by 69.6% (P = .012), 12.1% (P = .0343) and 5.2% (P = .0074) in, respectively, the anterior, middle, and posterior facets, whereas the sinus tarsi coverage decreased by an average 57.1% (P < .0001) postoperatively. Improvements in patient-reported outcomes were noted for all scores assessed (P < .03). The multivariate regression analysis demonstrated that improvement in both FAO and PTS measurements significantly influenced the assessed PROMs.

Conclusion: This study demonstrated significant improvements in the overall 3D deformity, PTS markers, and PROMs following hindfoot joint-sparing surgical treatment in patients with flexible PCFD. More importantly, initial 3D deformity correction and improvement in subtalar joint coverage and extraarticular impingement have been shown to influence PROMs significantly and positively. Addressing these variables should be considered as goals when treating PCFD.

Level of evidence: Level II, prospective cohort study.

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肱骨周围半脱位矫正进行性塌陷足畸形对患者报告结果的影响。

背景:椎体周围半脱位(PTS)是进行性塌陷足畸形(PCFD)的一部分。本研究旨在评估后足灵活畸形的PCFD患者接受后足关节保留手术的初始畸形矫正和PTS优化，以及其与最新随访中患者报告结果测量(PROMs)改善的关系。我们假设术后观察到明显的畸形/PTS矫正，与PROMs改善呈正相关。方法:对26例接受后足关节保留重建手术的柔性PCFD患者进行前瞻性比较研究，平均年龄47.1岁(范围18-77岁)。我们评估了负重计算机断层扫描(WBCT)在3个月时的整体畸形(足部和踝关节偏移[FAO])和PTS标记(距离和覆盖图)，以及在最后随访时的prom。多变量回归模型评估了初始畸形矫正和PTS优化对患者报告结果的影响。结果:平均随访19.9个月(6-39)，平均手术次数4.8次(2-8)。术后FAO分别从9.4%(8.4-10.9)改善到1.9% (1.1-3.6)(P = 0.012)， 12.1% (P = 0.043)和5.2% (P = 0.0074)，而跗骨窦覆盖率平均下降57.1% (P = 0.0074)。结论:本研究表明，柔性PCFD患者后足关节保留手术治疗后，整体3D畸形、PTS标记物和PROMs有显著改善。更重要的是，最初的三维畸形矫正和距下关节覆盖和关节外撞击的改善已被证明对PROMs有显著和积极的影响。在治疗PCFD时，应将解决这些变量视为目标。证据等级:II级，前瞻性队列研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Foot & Ankle International 医学-整形外科

CiteScore

5.60

自引率

22.20%

发文量

144

审稿时长

2 months

期刊介绍： Foot & Ankle International (FAI), in publication since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. This journal is an ideal resource for highly-trained orthopaedic foot and ankle specialists and allied health care providers. The journal’s Founding Editor, Melvin H. Jahss, MD (deceased), served from 1980-1988. He was followed by Kenneth A. Johnson, MD (deceased) from 1988-1993; Lowell D. Lutter, MD (deceased) from 1993-2004; and E. Greer Richardson, MD from 2005-2007. David B. Thordarson, MD, assumed the role of Editor-in-Chief in 2008. The journal focuses on the following areas of interest: • Surgery • Wound care • Bone healing • Pain management • In-office orthotic systems • Diabetes • Sports medicine