Foot & Ankle Orthopaedics最新文献

{"title":"Navicular Height by Weight-bearing Ultrasound: A Reliable and Valid Tool for Assessing the Medial Longitudinal Arch in Physically Active Adults.","authors":"Natasha Noel-Barker, Charles Hillman, Ellys Pollon, Elizabeth Connors, Cameron Christie, William Pettitt, Jack Gallagher, Kathryn Higgins, Molly Riley, Thomas Bestwick-Stevenson, Stefan Kluzek","doi":"10.1177/24730114261460463","DOIUrl":"10.1177/24730114261460463","url":null,"abstract":"<p><strong>Background: </strong>The medial longitudinal arch (MLA) height is an important clinical indicator of foot posture, linked to injury risk and rehabilitation targets. Assessment of navicular height (NH) in standing position is commonly used as a marker of MLA height. Methods such as palpation and imaging face limitations with operator variability, accessibility, and radiation exposure. Ultrasonography may be a practical alternative, but its reliability compared to established methods needs further evaluation. The research objective was to assess the reliability and validity of plantar ultrasonographic navicular height measures (US-NH) in standing position using a novel ultrasonography platform.</p><p><strong>Methods: </strong>A test-retest study design was adopted across 2 cohorts: cohort study 1 (CS1, 2023; n = 16) and cohort study 2 (CS2, 2024; n = 30), using the standing ultrasonography platform. Intra- and inter-rater intraclass correlation coefficients (ICCs) were assessed to evaluate method reliability. Validity was assessed using cadaveric dissection as a gold standard.</p><p><strong>Results: </strong>US-NH demonstrated excellent intra-rater reliability (ICC 0.956, 95% CI: 0.934-0.971), improving from good reliability in CS1 (ICC 0.827, 95% CI: 0.675-0.912) to excellent in CS2 (ICC 0.981, 95% CI: 0.969-0.989) after methodologic refinements. Inter-rater reliability also increased markedly, from poor in CS1 (ICC 0.459, 95% CI: 0.240-0.819) to excellent in CS2 (ICC 0.964, 95% CI: 0.940-0.978), indicating reduced operator-dependent variability. Dissection confirmed the bone visualised with weight-bearing ultrasonography corresponded accurately to the plantar navicular surface.</p><p><strong>Conclusion: </strong>Ultrasonography is a reliable, valid, and radiation-free method for measuring navicular height, in a physically active population. Dissections demonstrated the high validity of ultrasonographic assessment when compared to direct anatomical measurement.</p><p><strong>Level of evidence: </strong>Level V, mechanism-based reasoning.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261460463"},"PeriodicalIF":0.0,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629780","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":"Biomechanical Stability of Intramedullary Nailing vs Plate Fixation in Displaced Intra-articular Calcaneal Fractures Under Axial Loading: A Systematic Review.","authors":"Ivana Djurica, Martin Pompach, Tim Schepers","doi":"10.1177/24730114261461284","DOIUrl":"10.1177/24730114261461284","url":null,"abstract":"<p><strong>Background: </strong>From a biomechanical perspective, intramedullary fixation offers potential benefits, including a central load-sharing axis that may better withstand axial and bending forces, while preserving the periosteal blood supply and reducing soft tissue damage. This review aimed to determine whether intramedullary nailing in displaced intra-articular fractures provides comparable or superior biomechanical stability to plate fixation.</p><p><strong>Methods: </strong>A literature search identified studies comparing the biomechanical stability of intramedullary fixation with plate fixation, screw-only fixation, or combined constructs in calcaneal fractures. Eligible studies used human cadaveric specimens or computational models, examined biomechanical outcomes such as stiffness, load to failure, displacement, or stress distribution, and employed laboratory, cadaveric (n = 3), or finite element analyses (n = 4).</p><p><strong>Results: </strong>Experimental and numerical studies showed that intramedullary fixation consistently provides greater or comparable construct stiffness and load to failure than locking plates, with no implant failures observed. Plates produced higher stress concentrations at screw junctions, whereas intramedullary nails yielded a more uniform stress distribution in most models; however, 1 finite element analysis study reported higher calcaneal bone stress with intramedullary nail fixation.</p><p><strong>Conclusion: </strong>Intramedullary calcaneal fixation provides comparable or superior biomechanical stability to plate fixation, especially under cyclic axial loading. Construct durability appears more dependent on axial load sharing than on implant category alone. Whether these biomechanical findings translate to improved clinical outcomes remains to be demonstrated.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261461284"},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13400927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591141","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":"FAO Essential Reviews, Part IX: Optimizing the Surgical Patient.","authors":"Charles Saltzman","doi":"10.1177/24730114261461994","DOIUrl":"10.1177/24730114261461994","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261461994"},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548561","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":"Fear of Reinjury Is Associated With Worse Physical Function Measured by PROMIS Following Minimally Invasive Achilles Rupture Repair.","authors":"Steven M Hadley, John J Peabody, Rachel Bergman, Eric H Durudogan, Sarah J Westvold, Frederic Washburn, Muhammad Y Mutawakkil, Milap Patel, Anish R Kadakia","doi":"10.1177/24730114261462481","DOIUrl":"10.1177/24730114261462481","url":null,"abstract":"<p><strong>Background: </strong>Prior literature suggests that patients suffering from fear of reinjury (FORI) following Achilles rupture may fail to return to sport and report worse Achilles Tendon Total Rupture Scores (ATRS); however, this prior study included patients who underwent both surgical and non-surgical management. This study therefore aims to determine whether self-reported fear (srFORI) is associated with worse outcomes as measured by validated Patient-Reported Outcomes Measurement Information System (PROMIS) measures of physical function (PF) and pain interference (PI) and ATRS following operative Achilles repair specifically.</p><p><strong>Methods: </strong>This investigation was a retrospective review of all patients who underwent Achilles repair at a single institution (2018-2023). Tendinopathies, open injuries, concomitant fractures, tendon transfers, and gastrocnemius recessions were excluded. A total of 119 patients completed questionnaires containing PROMIS and ATRS, and additional surveys querying srFORI measured at the time of survey participation. Primary outcome was PROMIS. Secondary outcome was ATRS.</p><p><strong>Results: </strong>Mean follow-up duration was 30.3 ± 8.3 months. No significant differences existed in baseline characteristics (<i>P</i> > .05). Twenty-nine of 119 patients (24.4%) self-reported FORI. SrFORI was associated with significantly worse PF relative to those without srFORI (53.0 ± 6.1 vs 59.0 ± 8.1, mean difference (MD) -6.08, 97.5% CI -9.79, -2.36, <i>P</i> < .001). SrFORI was similarly associated with significantly worse ATRS (72.6 ± 17.8 vs 88.7 ± 12.3, MD -16.18, 97.5% CI: -22.89, -9.47, <i>P</i> < .001). There were no significant differences in PI (44.9 ± 7.0 vs 43.9 ± 6.1, MD 1.03, 97.5% CI: -2.04, 4.11, <i>P</i> = .48). Adjusted regression revealed that srFORI was associated with significantly worse PF (MD 6.2 points lower, <i>P</i> < .001) and ATRS (MD 16.5 points lower, <i>P</i> < .001). Both differences in PF and ATRS reached MCID. With the numbers available, no significant difference in overall complications could be detected between groups (7.8%, 7/90, vs 10.3%, 3/29, <i>P</i> = .70).</p><p><strong>Conclusion: </strong>Nearly 25% of patients self-reported FORI following minimally invasive Achilles tendon repair, which may be associated with clinically and statistically significant deficits in functional outcomes as measured by PROMIS and ATRS following repair.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261462481"},"PeriodicalIF":0.0,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13382103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148600970","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":"Randomized Prospective Study Comparing Wide-Awake Local Anesthesia No Tourniquet (WALANT) and Locoregional Anesthesia in Minimally Invasive Hallux Valgus Surgery: Preliminary Results.","authors":"Daniele Marcolli, Alice Montagna, Ivan Pichierri, Tommaso Forin Valvecchi, Mirko Colombo, Riccardo Chierichini, Federico Alberto Grassi, Alessio Bernasconi, Pietro S Randelli","doi":"10.1177/24730114261455303","DOIUrl":"10.1177/24730114261455303","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive techniques for hallux valgus correction, such as minimally invasive chevron Akin (MICA), are increasingly adopted and traditionally performed under locoregional anesthesia (LRA). The choice of anesthetic technique may influence perioperative outcomes, patient experience, and resource utilization. The Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique has recently been introduced in foot surgery as a potential alternative.</p><p><strong>Methods: </strong>A prospective, randomized, single-center study was conducted on 40 patients with mild to moderate hallux valgus undergoing correction with the MICA technique. Patients were randomized into 2 groups: LRA (n = 20) and WALANT (n = 20). The primary endpoint of this study was the assessment and comparison of intraoperative and postoperative pain at 24 hours between the WALANT and LRA groups. Secondary endpoint was the comparison of anesthetic time and recovery stay between the 2 techniques.</p><p><strong>Results: </strong>Mean intraoperative and postoperative NRS pain scores showed no statistically significant differences between the 2 groups. The anesthesia time and the recovery stay were significantly shorter in the WALANT group compared with the LRA group. All WALANT procedures were successfully completed without anesthetic conversion.</p><p><strong>Discussion: </strong>The application of WALANT in hallux valgus surgery meets the growing demand for efficient perioperative pathways, potentially improving operating room efficiency and reducing hospitalization time. In this preliminary study, no statistically significant difference in intraoperative or postoperative pain at 24 hours was detected between WALANT and LRA with the numbers available. These findings suggest that WALANT may represent a feasible anesthetic approach for MICA correction of hallux valgus.</p><p><strong>Conclusion: </strong>In this prospective randomized study, no statistically significant difference in intraoperative or postoperative pain was detected between WALANT and locoregional anesthesia with the numbers available. WALANT was associated with shorter anesthesia time and recovery stay, suggesting that it may represent a feasible anesthetic option for MICA hallux valgus surgery. Further studies with larger cohorts are required to confirm these findings.</p><p><strong>Level of evidence: </strong>Level II, prospective randomized trial.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261455303"},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497288","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":"A Simplified Percutaneous Single-Suture Technique for Chronic Lateral Ankle Instability.","authors":"Nicolás Raimondi, Gabriel Octavio Pérez Lloveras, Ignacio Díaz Peccinetti, Joaquín Insua, Juan Manuel Yañez Arauz, Sergio Massetti","doi":"10.1177/24730114261464618","DOIUrl":"10.1177/24730114261464618","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261464618"},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13376513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577606","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":"Stable Long-term PROMIS Outcomes After Deep Peroneal Nerve Neurectomy for Midfoot Arthritis: A Longitudinal Study.","authors":"Seif El Masry, Cesar A Ramirez, Gabrielle M Meli, Breana M Jenkins, Edward T Haupt, Glenn G Shi","doi":"10.1177/24730114261463247","DOIUrl":"10.1177/24730114261463247","url":null,"abstract":"<p><strong>Background: </strong>Midfoot arthritis can cause debilitating dorsal midfoot pain and functional limitation. Deep peroneal nerve (DPN) neurectomy is a minimally invasive surgical option that addresses pain through selective denervation. Although favorable midterm outcomes have been reported, long-term durability remains unclear. The purpose of this study was to evaluate changes in patient-reported physical function and pain interference between midterm and long-term follow-up after DPN neurectomy using validated Patient-Reported Outcomes Measurement Information System (PROMIS) instruments.</p><p><strong>Methods: </strong>A retrospective review identified patients who underwent isolated DPN neurectomy for midfoot arthritis between 2017 and 2021 and completed PROMIS Physical Function (PF) and Pain Interference (PI) questionnaires at midterm and long-term follow-up. Mean follow-up was 2.9 years (midterm) and 6.1 years (long-term). PROMIS scores were compared using paired <i>t</i> tests. Clinically meaningful improvement was defined using established minimal clinically important difference (MCID) thresholds (+5.88 for PF, -5.49 for PI).</p><p><strong>Results: </strong>The final cohort included 32 patients (81.2% female, mean age 68.4 ± 7.3 year). PF improved from 37.7 ± 6.2 to 39.0 ± 7.5 (Δ = +1.3, 95% CI [-0.7 to +3.4], <i>P</i> = .188), whereas PI decreased from 62.6 ± 8.8 to 59.2 ± 9.0 (Δ = -3.4, 95% CI [-6.3 to -0.5], <i>P</i> = .020). Clinically meaningful improvement was achieved by 7 of 32 (21.9%) for PF and 15 of 32 (46.9%) for PI. Five patients experienced clinically meaningful worsening, including patients with stroke, chronic pain syndrome, or contralateral foot and ankle pathology or surgery.</p><p><strong>Conclusion: </strong>DPN neurectomy was associated with stable longitudinal PROMIS outcomes through extended follow-up, with a nonsignificant mean PF change of +1.3 points and a statistically significant but sub-MCID mean PI decrease of -3.4 points over approximately 6 years. Outcomes were heterogeneous; fewer than half of patients achieved clinically meaningful improvement in pain interference, and a subset experienced worsening. These findings suggest that DPN neurectomy may provide durable symptom stability in appropriately selected patients with refractory dorsal midfoot pain, although clinically meaningful benefit at the individual level is not universal.</p><p><strong>Level of evidence: </strong>Level III, comparative series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261463247"},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13376449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577580","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":"Association of Dementia With Total Ankle Arthroplasty and Ankle Arthrodesis Outcomes: A Short Report.","authors":"Devon Nixon, Brook I Martin, Hyunkyu Ko","doi":"10.1177/24730114261461273","DOIUrl":"10.1177/24730114261461273","url":null,"abstract":"<p><strong>Background: </strong>Foot and ankle surgeons evaluate older patients with ankle arthritis and dementia. In this report, we analyzed postoperative complications following ankle arthrodesis (AA) and total ankle arthroplasty (TAA), hypothesizing greater risk in patients with dementia.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using Medicare claims from 2016 to 2021, including beneficiaries aged ≥65 years who underwent TAA or AA. The primary independent variable was dementia, defined using the Charlson Comorbidity Index (CCI) dementia component based on <i>International Classification of Diseases, Tenth Revision</i> (<i>ICD-10</i>) diagnosis codes within 90 days before the index procedure. Outcomes included postoperative complications, all-cause readmissions, and mortality within 90 days and 12 months. Multivariable logistic regression models estimated adjusted differences in complication rates by dementia status.</p><p><strong>Results: </strong>Dementia was present in 0.56% of TAA patients (73 of 13 134) and 3.6% of AA patients (308 of 8519). With the numbers available, no significant differences could be detected with dementia in TAA using adjusted multivariable analyses, although 12-month readmissions were higher (<i>P</i> = .046). In contrast, among AA patients, dementia was associated with increased 90-day readmissions (<i>P</i> = .041) and higher 12-month mortality (<i>P</i> = .001), whereas other outcomes were not statistically significant.</p><p><strong>Conclusion: </strong>We found differences in postoperative outcomes, particularly readmissions and mortality, in patients with dementia following AA. Conversely, we found limited differences in patients with and without dementia undergoing TAA, which may reflect limited power to detect modest differences given the smaller number of dementia patients in the TAA cohort. Further research should explore how the severity of cognitive impairment influences decision making in ankle arthritis treatment.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261461273"},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469930","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":"Displacement Following Minimally Invasive vs Open Lateralizing Calcaneal Osteotomy: A Direct Comparison in a Cadaveric Model.","authors":"Hirbod Abootalebi, William Mayer, Erin Bigney, Oreoluwa Alugo, Rowan Urquhart, Jacob Matz","doi":"10.1177/24730114261463248","DOIUrl":"10.1177/24730114261463248","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive (MIS) calcaneal osteotomy is increasingly used to decrease soft tissue morbidity, but whether MIS lateral displacement calcaneal osteotomy (LDCO) can achieve similar translation to the open calcaneal osteotomy technique remains unclear.</p><p><strong>Methods: </strong>In a paired cadaveric study, 16 feet from 8 donors were block-randomized so that each pair received 1 open LDCO and 1 MIS LDCO performed by a fellowship-trained foot and ankle surgeon. Lateral translation of the tuberosity was measured directly via a medial approach using a metric ruler by 2 independent observers; Wilcoxon signed-rank test (α = 0.05) compared the 2 techniques. We operationally defined ≥5 mm as a clinically meaningful threshold.</p><p><strong>Results: </strong>Median lateralization was 5.0 mm (range 3.0-8.0) for MIS and 7.5 mm (range 4.0-9.5) for open. The Hodges-Lehmann median difference was 2.41 mm (95% CI: 1.25-4.00 mm), with no statistically significant difference detectable with the numbers available between techniques (Z = -1.47, <i>P</i> = .14). Using a clinically relevant ≥5 mm threshold, 4 of 8 MIS specimens fell below this level compared with 2 of 8 open specimens.</p><p><strong>Conclusion: </strong>Both open and MIS LDCO were associated with similar lateral translation of the calcaneal tuberosity, with no significant difference detectable with the numbers available, though MIS was less consistent in reaching ≥5 mm of lateralization. Either approach may be used for mild-to-moderate hindfoot varus, with technique selection guided by soft tissue and infection risk considerations.</p><p><strong>Clinical relevance: </strong>For mild to moderate hindfoot varus correction, MIS LDCO provides deformity correction comparable to the open approach while potentially reducing soft tissue morbidity. Surgical approach selection should consider patient-specific risk factors.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261463248"},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13376445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577550","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":"Dual-Incision Achilles Tendon Repair Using Krackow Sutures With Over-the-Top Knot Placement for Early Rehabilitation Without Immobilization: A Retrospective Case Series.","authors":"Kaho Yasuda, Akifumi Fujita, Gantaro Minami, Hiromitsu Moriuchi","doi":"10.1177/24730114261461274","DOIUrl":"10.1177/24730114261461274","url":null,"abstract":"<p><strong>Background: </strong>Early functional rehabilitation after Achilles tendon repair has gained increasing attention; however, most protocols still incorporate postoperative immobilization. Sufficient initial fixation strength may allow safe early mobilization without external immobilization.</p><p><strong>Methods: </strong>This retrospective case series evaluated patients who underwent dual-incision Achilles tendon repair using a Krackow locking stitch with over-the-top knot placement. Thirty-eight patients were included, and functional outcomes were analyzed in 35 patients with at least 12 months of follow-up. The rehabilitation protocol permitted early mobilization without routine postoperative immobilization. Clinical outcomes, including return to activity, gait recovery, and complications, were assessed with a mean follow-up of 33.4 ± 20.6 months.</p><p><strong>Results: </strong>The cohort included 38 patients (24 males and 14 females) with a mean age of 51.8 ± 17.0 years. The mean time from injury to surgery was 5.5 ± 3.6 days. The median preinjury and postoperative Tegner Activity Scale scores were 7 and 6, respectively (range, 3-8). Among the 35 patients with at least 12 months of follow-up, 33 maintained their preinjury activity level, whereas 2 demonstrated a decrease of 1 point in TAS. Median time to step-to gait was 10 days, and median time to independent ambulation was 30 days. Postoperative complications occurred in 3 patients (7.9%), all of which were superficial surgical site infections. No reruptures or sural nerve injuries were observed (0/38; 95% CI, 0%-9.3%).</p><p><strong>Conclusion: </strong>Dual-incision Achilles tendon repair using a Krackow locking stitch with over-the-top knot placement was associated with early functional rehabilitation without routine postoperative immobilization in this case series. Preservation of the paratenon and relocation of the knot away from the repair interface may confer biological and mechanical advantages.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261461274"},"PeriodicalIF":0.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13338513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404217","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}