Foot & Ankle Orthopaedics最新文献

{"title":"Minimally Invasive Percutaneous Achilles Repair System (PARS) Repair With vs Without Bio-inductive Scaffold Augmentation for Acute Achilles Tendon Rupture: A Retrospective Comparative Cohort Study.","authors":"Gil Genuth, Peter Stavrou, Lukas D Iselin","doi":"10.1177/24730114261484133","DOIUrl":"10.1177/24730114261484133","url":null,"abstract":"<p><strong>Background: </strong>Acute Achilles tendon rupture is a common injury in active individuals, often requiring surgical repair to reduce re-rupture rates, restore appropriate tendon length and plantarflexion power, and optimize functional recovery and return to sport (RTS). Bio-inductive collagen scaffolds have been introduced to enhance tendon healing; however, their role in acute rupture remains unclear.</p><p><strong>Methods: </strong>A retrospective comparative cohort study was conducted including 30 patients (30 tendons) treated between 2021 and 2024 with minimally invasive percutaneous Achilles repair system (PARS) repair, with (n = 15) or without (n = 15) bio-inductive scaffold augmentation. All patients underwent surgery within 2 weeks of injury. The primary outcome was Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF). Secondary outcomes included PROMIS pain interference (PI), RTS, and complication rates. PROMIS PF and PI scores were collected using validated electronic computer-adaptive questionnaires preoperatively and at 3, 6, 12, and 18 months, postoperatively.</p><p><strong>Results: </strong>Baseline characteristics were comparable between groups. RTS was achieved in 87% of scaffold patients and 80% of controls (<i>P</i> = .64). Time to RTS was shorter in the scaffold group (8.4 ± 1.3 vs 10.1 ± 1.6 months; <i>P</i> = .002). PROMIS PF was higher in the scaffold group at 3 months (52.1 ± 5.6 vs 47.3 ± 6.1; <i>P</i> = .02) and 6 months (56.8 ± 5.2 vs 52.4 ± 5.9; <i>P</i> = .03), with similar findings for PROMIS PI (<i>P</i> < .05). Outcomes converged at 12 and 18 months (all <i>P</i> > .40). Complication rates were low and comparable (13% vs 20%; <i>P</i> > .99).</p><p><strong>Conclusion: </strong>Bio-inductive scaffold augmentation in minimally invasive Achilles tendon repair was associated with improved early functional outcomes and shorter time to return to sport, with no significant difference in complications between groups. These secondary outcomes were not independently powered and should be interpreted with caution. Further prospective randomized studies are warranted.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261484133"},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donor Site Morbidity After Talar Mosaicplasty: Arthroscopic Medial Femoral Condyle vs Mini-Open Lateral Femoral Condyle Harvesting.","authors":"Amir Sabaghzadeh, Saeed Vosughi, Meisam Jafari Kafiabadi, Saber Barazandeh Rad, Babak Toloue Ghamari, Mohammad Pourmahmoudian, Shobeir Rostami Abousaidi, Pedram Khalighinejad, Mehrdad Sadighi, Adel Ebrahimpour","doi":"10.1177/24730114261481805","DOIUrl":"10.1177/24730114261481805","url":null,"abstract":"<p><strong>Background: </strong>Osteochondral lesions of the talus (OLTs) are challenging injuries that may require osteochondral autograft transfer for large, cystic, or refractory defects. Although mosaicplasty can restore hyaline cartilage and subchondral bone, donor site morbidity remains a concern. This study compared knee donor site morbidity and ankle functional outcomes after 2 technique-donor site combinations used for talar mosaicplasty: arthroscopic medial femoral condyle harvesting and mini-open lateral femoral condyle harvesting.</p><p><strong>Methods: </strong>In this retrospective comparative cohort study, 40 patients with OLTs who underwent osteochondral autograft transfer were available for final analysis. Nineteen patients underwent arthroscopic harvesting from the medial femoral condyle, and 21 underwent mini-open harvesting from the lateral femoral condyle. The mean follow-up was 28.8 months. Baseline characteristics, lesion morphology, functional outcomes, pain scores, and postoperative complications were compared between groups. Donor site morbidity was assessed using the Lysholm score. Secondary outcomes included the Knee Injury and Osteoarthritis Outcome Score, Foot and Ankle Outcome Score, Foot and Ankle Ability Measure, visual analog scale pain score, and complication rates.</p><p><strong>Results: </strong>Baseline demographics, follow-up duration, and measured lesion characteristics were broadly similar between groups; however, the small sample size limits interpretation of baseline comparability. With the available numbers, no significant between-group differences were detected in Lysholm, Knee Injury and Osteoarthritis Outcome Score, Foot and Ankle Outcome Score, Foot and Ankle Ability Measure activities of daily living or sport subscales, or visual analog scale pain scores (all <i>P</i> > .05). Overall, complications occurred in 5 of 40 patients (12.5%): 2 of 19 patients in the arthroscopic medial femoral condyle group and 3 of 21 patients in the mini-open lateral femoral condyle group, with no statistically significant between-group difference in complication rates (Fisher exact test, <i>P</i> > .99).</p><p><strong>Conclusion: </strong>In this retrospective cohort, no statistically significant differences were detected between arthroscopic medial femoral condyle and mini-open lateral femoral condyle harvesting for talar mosaicplasty. However, because the surgical approach and donor condyle differed simultaneously, this study cannot isolate the independent effect of approach alone. The limited sample size and wide CIs preclude conclusions regarding equivalence, superiority, or noninferiority.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261481805"},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Accuracy, Questionable References: Large Language Models' Performance and Citation Reliability in Foot and Ankle Surgery Examinations.","authors":"Benjamin Nieves-Lopez, Andrea Fabregas, Gonzalo F Del Rio Montesinos, José A Rosario-González, Jean L Santos-Agrait, Edward T Haupt, Keith T Aziz","doi":"10.1177/24730114261484163","DOIUrl":"10.1177/24730114261484163","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence large language models (LLMs) are increasingly used for medical education and decision support in orthopaedics, yet their performance on foot and ankle surgery board-style questions remains underexplored. Additionally, the capability of LLMs to provide reliable references and source material for education has not been evaluated. Therefore, this study aimed to compare the accuracy and citation reliability of ChatGPT‑5.4, Gemini‑3, and Copilot on foot and ankle surgery Self-Assessment Examination (SAE) questions.</p><p><strong>Methods: </strong>A total of 192 multiple-choice questions (64 text-only, 128 image-based) from OrthoBullets Foot and Ankle SAE forms D and E were entered into ChatGPT‑5.4, Gemini‑3, and Copilot; video-based items were excluded because of Copilot limitations. Accuracy was compared overall and by question type and imaging modality. References volunteered or prompted were classified as real, partially fabricated, or completely fabricated and compared across models and by answer correctness. Statistical significance was set at a <i>P</i> value <.05.</p><p><strong>Results: </strong>ChatGPT‑5.4 achieved the highest overall accuracy (89.6%) vs Gemini‑3 (76.6%) and Copilot (74.0%). ChatGPT‑5.4 and Gemini‑3 showed accuracy that did not differ significantly on text-only vs image-based questions, whereas Copilot performed significantly worse on image-based items (<i>P</i> = .028). With the numbers available, no significant difference in accuracy could be detected by imaging modality for any model. ChatGPT‑5.4, Gemini‑3, and Copilot fabricated 22.9%, 16.1%, and 2.8% of all references, respectively; most ChatGPT‑5.4 and Gemini‑3 fabrications were partially fabricated, whereas all Copilot fabrications were completely fabricated. ChatGPT‑5.4 fabricated significantly more references when it answered incorrectly (<i>P</i> = .013).</p><p><strong>Conclusion: </strong>ChatGPT‑5.4 showed the highest accuracy on foot and ankle SAE questions, with diminished image-related performance gaps relative to prior generations, but also the highest rate of reference fabrication. All models produced fabricated citations, underscoring the need to verify AI-generated references and to use LLMs as adjunct rather than primary educational tools in foot and ankle surgery.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261484163"},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital Anomaly of the Peroneus Brevis Tendon With a Bifid Digastric Variant Lacking Insertion on the Fifth Metatarsal Base: A Case Report.","authors":"Sayi P Boddu, Alex C Chang, Brady K Huang, Ian M Foran","doi":"10.1177/24730114261485215","DOIUrl":"10.1177/24730114261485215","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261485215"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13558994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return to Sport After Excision of Os Trigonum of Talus in Athletes.","authors":"Alexis Watson, Gokul Kalyanasundaram, Alexander J Wahl, Wen Chao","doi":"10.1177/24730114261481811","DOIUrl":"10.1177/24730114261481811","url":null,"abstract":"<p><strong>Background: </strong>Os trigonum syndrome is a common cause of posterior ankle pain in athletes performing repetitive hyper‑plantarflexion of the ankle. An accessory bone posterior to the talus, the os trigonum, may remain unfused or form a Stieda process, leading to pain from overuse, trauma, or impingement. Failure of conservative management often requires surgical excision. The objectives of this study are to evaluate the sustainability of long‑term pain relief and return to sport outcomes following open excision for bony impingement in athletes with os trigonum syndrome.</p><p><strong>Methods: </strong>A retrospective chart review identified 33 athletes who underwent open posteromedial os trigonum excision after at least 3 months of failed conservative treatment for os trigonum syndrome between 2014 and 2024. Exclusions were concomitant procedures not related to os trigonum syndrome or lost to follow‑up. Demographics, return to sport status, complications, and patient‑reported pain scores were collected. Pain scores were recorded preoperatively and at <1 month, 6 weeks, 3 months, and >1 year and compared with preoperative values using paired <i>t</i> tests. All athletes were interviewed as their most recent follow‑up.</p><p><strong>Results: </strong>The analysis included 26 athletes (35 ankles). Mean follow‑up was 7.3 ± 3.0 years. The average age was 17.4 ± 4.5 years, and 85% were female. Most were ballet dancers (n = 23), with 12% of athletes from other sports. Twenty‑five of 26 athletes returned to their sport. There was 1 reoperation for postoperative hematoma and no nerve complications. The mean preoperative pain score was 3.3 ± 3.3, with significant improvement at each time interval (<i>P</i> ≤ .033 for all comparisons). All athletes reported no pain at >1 year of follow-up.</p><p><strong>Conclusion: </strong>In this cohort of athletes with symptomatic os trigonum syndrome due to bony impingement after failed conservative management, open posteromedial excision was associated with substantial pain improvement, no neurovascular complications, and a high rate of return to sport.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261481811"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13558935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-term Patient-Reported Outcomes Following Isolated Gastrocnemius Recession for Recalcitrant Plantar Fasciitis.","authors":"Matthew R Rohl, Joseph Long, Brent Whitehead, Sydney Rohl, Nicholas A Cheney, Patrick M O'Connor","doi":"10.1177/24730114261481833","DOIUrl":"10.1177/24730114261481833","url":null,"abstract":"<p><strong>Background: </strong>Most patients with plantar fasciitis experience symptom relief with nonoperative management. However, a subset remains refractory to conservative treatments and may benefit from surgical intervention. Prior studies support the use of isolated gastrocnemius recession, demonstrating favorable short-term outcomes and low complication rates. Herein we assessed the outcomes following an isolated gastrocnemius recession for recalcitrant plantar fasciitis extended to midterm outcomes (36-89 months).</p><p><strong>Methods: </strong>Eighty-eight patients who underwent isolated gastrocnemius recession for recalcitrant plantar fasciitis between September 2014 and June 2017 were identified through procedural codes. Patients were contacted by phone to complete the Foot and Ankle Ability Measure (FAAM) and American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle Outcomes Questionnaire, and to report satisfaction, willingness to repeat the procedure, and willingness to recommend it.</p><p><strong>Results: </strong>Of 88 eligible patients, 43 completed follow-up (33 females, 10 males) at a mean of 5.0 ± 1.3 years postoperatively. Mean FAAM scores were 92.0 ± 15.0 for activities of daily living and 86.2 ± 24.2 for sports; mean ADL daily function was 91.0% ± 19.8%, with 39 patients reporting normal or near-normal function. Mean AAOS standardized norm-based score was 93.9 ± 11.4, and mean shoe comfort score was 83.5 ± 25.8. Among the 23 patients who provided pain data, mean VAS was 1/10, with 87% rating pain ≤2/10. Overall satisfaction was high: 95% were satisfied, 93% would undergo the procedure again, and 91% would recommend it. One patient required revision gastrocnemius recession with subsequent symptom resolution.</p><p><strong>Conclusion: </strong>Isolated gastrocnemius recession for recalcitrant plantar fasciitis was associated with durable midterm outcomes with high patient satisfaction, substantial functional scores, and low complication rates. These findings support its use in patients who fail conservative management.</p><p><strong>Level of evidence: </strong>Level IV, therapeutic.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261481833"},"PeriodicalIF":0.0,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overcoming Space and System Limitations: A Novel Lamina Spreader Technique for Optimal Reduction via External Fixation.","authors":"Jourdan H Meltzer, Carol Lin","doi":"10.1177/24730114261481810","DOIUrl":"10.1177/24730114261481810","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261481810"},"PeriodicalIF":0.0,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Costs of Surgically Managed Ankle Fractures Treated in an Inpatient vs Outpatient Setting: A Systematic Review and Meta-analysis.","authors":"Omkar S Anaspure, Aryan S Anaspure, Matthew Conti, Jensen K Henry, Albert T Anastasio","doi":"10.1177/24730114261468352","DOIUrl":"10.1177/24730114261468352","url":null,"abstract":"<p><strong>Background: </strong>Ankle fractures are prevalent, with 21% to 40% of cases requiring surgical intervention. Treatment decisions regarding non-complex fractures, whether in an inpatient (IP) or outpatient (OP) setting, are often influenced by local resource availability. Although IP care is generally expected to be more expensive, the magnitude of this difference and its interpretation across heterogeneous cost definitions, health care systems, and operative settings remain unclear. This systematic review and meta-analysis evaluates the cost differences between IP and OP surgical management of isolated ankle fractures, offering evidence to guide surgeons in optimizing care pathways while minimizing health care expenditures.</p><p><strong>Methods: </strong>This PROSPERO-registered systematic review and meta-analysis (CRD420251134624) of comparative studies evaluated cost differences for OP and IP management of ankle fractures. We queried PubMed, EMBASE, and CINAHL from inception through August 17, 2025. Because of the inconsistent definition \"cost\" across the literature, we extracted and analyzed the cost construct as defined by each included study and performed a random effects meta-analysis of the unstandardized mean differences (standardized to a common price year/currency)and reported them with 95% CIs.</p><p><strong>Results: </strong>Seven articles were included, with a final sample size of 21,955 patients with an average age of 43.50 ± 2.87 years and a 2.5-month mean follow-up. Overall, 53.8% (n = 11 813) of patients were treated in the IP setting and 46.2% (n = 10 142) were treated in the OP setting. The mean hospital length of stay (LOS) for IPs was 2.27 ± 0.25 days across the 5 studies reporting this value (n = 5718 IP patients). The average study reported direct cost for IP management was significantly higher than OP management ($11 236.37 ± $2205.05 vs $6990.18 ± $1670.72; <i>P</i> = .011, CI: 1654.50, 6920.19). Qualitatively, the safety and complication profiles between IP and OP were not different among 3 studies that examined this metric.</p><p><strong>Conclusion: </strong>Outpatient ORIF for isolated ankle fractures is associated with lower study-reported economic burden than inpatient management in appropriately selected patients, without clear evidence of worse short-term safety outcomes in the available comparative literature. These findings support outpatient pathways for patients with acceptable reduction and immobilization, manageable soft tissues, limited comorbidity burden, safe non-weightbearing mobility, and reliable follow-up. Because included studies used heterogeneous economic definitions and were observational, future prospective studies should use standardized economic outcomes and longer follow-up to better define the value of outpatient vs inpatient care.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261468352"},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal 3D Shape and Alignment Analysis of Post-traumatic Osteoarthritis After Tibial Plafond Fractures.","authors":"Andrew C Peterson, Jordan S Langford, Jacob C Benna, Curran P Reddy, Maryam Soltanolkotabi, Donald D Anderson, Julie Agel, Conor P Kleweno, Justin M Haller, Amy L Lenz","doi":"10.1177/24730114261473611","DOIUrl":"10.1177/24730114261473611","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to characterize longitudinal 3-dimensional morphologic, alignment, and radiographic changes of the ankle and hindfoot following surgical fixation of tibial plafond fractures and to identify structural features associated with post-traumatic osteoarthritis (PTOA) severity.</p><p><strong>Methods: </strong>Thirty-two patients with surgically treated pilon fractures from 3 institutions underwent weightbearing computed tomography (WBCT) at 6, 12, and 18 months post-operatively. At 18 months, patients were grouped into low-grade and high-grade PTOA groups. Statistical shape modeling was used to quantify morphologic and alignment variation across the tibia, fibula, talus, and calcaneus. Joint distances at the talocrural and subtalar joints were calculated using correspondence-based metrics. Radiographic parameters were automatically derived from 3-dimensional bone models using a MATLAB toolbox. Cross-sectional and longitudinal statistical differences were assessed.</p><p><strong>Results: </strong>Patients who developed high-grade PTOA demonstrated progressive flattening of the calcaneal pitch, posterior and inferior translation of the tibia and fibula, and narrowing of the central tibiotalar joint. In contrast, the low-grade group exhibited greater valgus hindfoot alignment, mild widening of the medial and posterior tibiotalar joint, and greater alignment variation over time. Radiographically, the high-grade group displayed a significant increase in tibiocalcaneal angle over time (<i>P</i> = .03) and a trend toward a more varus hindfoot configuration.</p><p><strong>Conclusion: </strong>Distinct longitudinal alignment and morphologic trajectories differentiate low-grade and high-grade PTOA development following pilon fracture fixation. Preservation of coronal alignment and subtalar adaptability may provide a protective mechanism against rapid PTOA progression. These findings highlight the clinical potential of WBCT and shape-based 3-dimensional analysis for early detection of malalignment patterns associated with post-traumatic degeneration.</p><p><strong>Level of evidence: </strong>Level III, prognostic study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261473611"},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open vs Arthroscopic Tibiotalar Arthrodesis: A Comparative Cohort Study from an Asian Tertiary Center.","authors":"Jeremy Tze En Lim, Yen Chin Jeremy Tan, Ramesh Radhakrishnan, Selvaraj Vijayaragavan, Rui Xiang Toh, Kizher Shajahan Mohamed Buhary, Zongxian Li, Kae Sian Tay","doi":"10.1177/24730114261471823","DOIUrl":"10.1177/24730114261471823","url":null,"abstract":"<p><strong>Background: </strong>Tibiotalar arthrodesis remains the standard surgical treatment for end-stage ankle arthritis. Although arthroscopic techniques are increasingly used, differences in operative time, complication profiles, and union rates between arthroscopic and open techniques remain inconsistently reported. In Asian populations, degenerative ankle arthritis is frequently associated with varus coronal deformity, which may influence surgical approach selection and outcomes. This study compared perioperative outcomes, radiographic union, postoperative complications, and patient-reported outcomes between open and arthroscopic tibiotalar arthrodesis.</p><p><strong>Methods: </strong>This study included 83 adult patients who underwent isolated tibiotalar arthrodesis at a single tertiary institution between January 2004 and December 2024 using either an open (n = 30) or arthroscopic (n = 53) approach. Perioperative outcomes, radiographic time to union, postoperative complications, and 6-month patient-reported outcomes were compared.</p><p><strong>Results: </strong>With the numbers available, no significant difference could be detected in the primary outcome of time to radiographic union between the arthroscopic and open cohorts (120.0 ± 99.5 vs 113.1 ± 73.0 days, respectively; <i>P</i> = .734), and no significant difference could be detected in overall complication rates between groups (18.9% vs 23.3%, respectively; <i>P</i> = .778). Patients undergoing open arthrodesis demonstrated greater preoperative coronal deformity compared with those treated arthroscopically (15.6° ± 10.8 vs 8.2° ± 7.4; <i>P</i> = .002). Arthroscopic arthrodesis was associated with longer operative time (154.7 ± 44.0 vs 130.1 ± 49.5 minutes; <i>P</i> = .028), whereas fewer reoperations were observed during follow-up (3.8% vs 20.0%; <i>P</i> = .024).</p><p><strong>Conclusion: </strong>In this comparative cohort, with the numbers available, no significant differences were detected in radiographic union, early functional outcomes, or overall complication rates between arthroscopic and open tibiotalar arthrodesis. Fewer reoperations were observed in the arthroscopic cohort, which was generally composed of patients with less severe deformity. Both arthroscopic and open tibiotalar arthrodesis remain reasonable treatment options when selected according to patient characteristics, deformity severity, and surgical requirements.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261471823"},"PeriodicalIF":0.0,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}