Correction of progressive collapsing foot deformity classes after isolated arthroscopic subtalar arthrodesis.

IF 1.9 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery Pub Date : 2024-07-07 DOI:10.1016/j.fas.2024.07.002

Alessio Bernasconi, Matthieu Lalevée, Céline Fernando, Antonio Izzo, Cesar de Cesar Netto, François Lintz

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引用次数: 0

Abstract

Introduction: Subtalar osteoarthritis in the context of flatfoot (recently renamed Progressive Collapsing Foot Deformity (PCFD)) may be treated through subtalar joint (SJ) arthrodesis with anticipated consequences on three-dimensional bony configuration. This study investigates the correction of PCFD-related deformities achieved after Anterolateral Arthroscopic Subtalar Arthrodesis (ALAPSTA).

Methods: In this retrospective study, we evaluated pre- and post-operative (at 6 months) weight bearing computed tomography (WBCT) images of patients diagnosed with PCFD with a degenerated SJ (2 A according to PCFD classification) and/or peritalar subluxation (2D) with or without associated flexible midfoot and/or forefoot deformities (1B, 1 C and 1E) which underwent ALAPSTA as a standalone procedure between 2017 and 2020. Multiple measurements were used to assess and compare pre and post-operative PCFD classes.

Results: Thirtythree PCFD (33 patients, median age 62) were included in the study. Preoperative medial facet subluxation was 28.3 % (IQR, 15.1 to 49.3 %). Overall PCFD 3D deformity improved with a reduction of the foot and ankle offset from 9.3 points (IQR, 7.8 to 12) to 4 (IQR, 0.9 to 7) (p < 0.001). Class A-hindfoot valgus (median tibiocalcaneal angle and median calcaneal moment arm improved by 9.4 degrees (p < 0.001) and 11 mm (p < 0.001), respectively), class B-midfoot abduction (median talonavicular coverage angle improved by 20.5 degrees, p < 0.001) and class C-forefoot varus (median sagittal talo-first metatarsal angle improved by 10.2 degrees (p < 0.001)) were significantly corrected after surgery. Class D was difficult to assess due to the fusion procedure. No patient had a pre-operative valgus deformity at the ankle (no class E), and no significant change of the talar tilt was observed (p = 0.12).

Conclusion: In this series, ALAPSTA performed as a standalone procedure to treat patients diagnosed with PCFD with a degenerated subtalar joint and/or peritalar subluxation was effective not only at correcting hindfoot alignment but also flexible midfoot abduction and flexible forefoot varus.

Level of evidence: Level IV, case series.

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孤立关节镜下足底关节置换术后进行性塌足畸形的矫正。

简介：扁平足（最近更名为渐进性塌足畸形（PCFD））患者的足底骨关节炎可通过足底关节（SJ）固定术进行治疗，但预计会对三维骨性结构造成影响。本研究探讨了前外侧关节镜下距骨关节置换术（ALAPSTA）对 PCFD 相关畸形的矫正效果：在这项回顾性研究中，我们评估了2017年至2020年间接受ALAPSTA作为独立手术的PCFD患者的术前、术后（6个月时）负重计算机断层扫描（WBCT）图像，这些患者被诊断为SJ退化（根据PCFD分类为2 A）和/或眶周脱位（2D），伴有或不伴有灵活的中足和/或前足畸形（1B、1 C和1E）。多重测量用于评估和比较术前和术后的PCFD等级：研究共纳入 33 例 PCFD（33 名患者，中位年龄 62 岁）。术前内侧切面半脱位率为 28.3%（IQR，15.1% 至 49.3%）。PCFD 3D 总体畸形有所改善，足踝偏移从 9.3 点（IQR，7.8 至 12）减少到 4 点（IQR，0.9 至 7）（P 结论：ALAPSTA 是一种有效的治疗方法：在这一系列病例中，ALAPSTA作为一种独立的手术，用于治疗被诊断为PCFD并伴有距下关节退变和/或眶周脱位的患者，不仅能有效矫正后足对齐，还能灵活矫正中足内收和灵活矫正前足外翻：证据等级：IV级，病例系列。

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 and Ankle Surgery ORTHOPEDICS-

CiteScore

4.60

自引率

16.00%

发文量

202

期刊介绍： Foot and Ankle Surgery is essential reading for everyone interested in the foot and ankle and its disorders. The approach is broad and includes all aspects of the subject from basic science to clinical management. Problems of both children and adults are included, as is trauma and chronic disease. Foot and Ankle Surgery is the official journal of European Foot and Ankle Society. The aims of this journal are to promote the art and science of ankle and foot surgery, to publish peer-reviewed research articles, to provide regular reviews by acknowledged experts on common problems, and to provide a forum for discussion with letters to the Editors. Reviews of books are also published. Papers are invited for possible publication in Foot and Ankle Surgery on the understanding that the material has not been published elsewhere or accepted for publication in another journal and does not infringe prior copyright.