Foot & Ankle Orthopaedics最新文献

{"title":"A CT-Validated Comparative Analysis of Fixation Constructs for Hindfoot Arthrodesis: Fusion and Complication Rates.","authors":"John Dalloul, Abhinav R Balu, Peter C Shen, Rachel Bergman, Ryan Filler, Armen S Kelikian, Muhammad Mutawakkil, Milap Patel, Anish R Kadakia","doi":"10.1177/24730114251328660","DOIUrl":"10.1177/24730114251328660","url":null,"abstract":"<p><strong>Background: </strong>Hindfoot arthrodesis is a procedure commonly performed to address degenerative changes and/or malalignment of the hindfoot, yet robust literature comparing traditional and modern constructs is sparse. The purpose of this study is to evaluate the efficacy of nitinol staples in hindfoot arthrodesis as compared to isolated screws and combined staple and screw constructs.</p><p><strong>Methods: </strong>A 10-year retrospective review of all patients undergoing hindfoot arthrodesis at our institution was performed. Hindfoot arthrodesis was defined as either a triple (subtalar, talonavicular, and calcaneocuboid), double (subtalar + talonavicular), or isolated arthrodesis. Outcomes included fusion success rate and reoperation rate. A postoperative CT confirming the presence or absence of osseous bridging was required for inclusion in the fusion outcome analysis.</p><p><strong>Results: </strong>We assessed 113 patients who underwent arthrodesis procedures across 128 joints in the hindfoot. There was no significant difference in functional outcomes between screws, staples, or the combination screw and staple constructs used in hindfoot arthrodesis. However, screws alone were associated with a significantly higher complication rate than staple-only fixation (<i>P</i> = .028).</p><p><strong>Conclusion: </strong>Nitinol staples are effective in hindfoot arthrodesis with respect to fusion success rate and may be associated with decreased revision rates compared with traditional screws only or staple plus screw constructs. Larger studies will be necessary to validate these findings and contribute to an assessment of the usage of these nascent constructs in hindfoot arthrodesis.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251328660"},"PeriodicalIF":0.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751859","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":"ChatGPT-4 Effectively Responds to Common Patient Questions on Total Ankle Arthroplasty: A Surgeon-Based Assessment of AI in Patient Education.","authors":"Heidi C Ventresca, Harley T Davis, Chase W Gauthier, Justin Kung, Joseph S Park, Nicholas L Strasser, Tyler A Gonzalez, J Benjamin Jackson","doi":"10.1177/24730114251322784","DOIUrl":"10.1177/24730114251322784","url":null,"abstract":"<p><strong>Background: </strong>Patient reliance on internet resources for clinical information has steadily increased. The recent widespread accessibility of artificial intelligence (AI) tools like ChatGPT has increased patient reliance on these resources while also raising concerns about the accuracy, reliability, and appropriateness of the information they provide. Previous studies have evaluated ChatGPT and found it could accurately respond to questions on common surgeries, such as total hip arthroplasty, but is untested for uncommon procedures like total ankle arthroplasty (TAA). This study evaluates ChatGPT-4's performance in answering patient questions on TAA and further explores the opportunity for physician involvement in guiding the implementation of this technology.</p><p><strong>Methods: </strong>Twelve commonly asked patient questions regarding TAA were collated from established sources and posed to ChatGPT-4 without additional input. Four fellowship-trained surgeons independently rated the responses using a 1-4 scale, assessing accuracy and need for clarification. Interrater reliability, divergence, and trends in response content were analyzed to evaluate consistency across responses.</p><p><strong>Results: </strong>The mean score across all responses was 1.8, indicating an overall satisfactory performance by ChatGPT-4. Ratings were consistently good on factual questions, such as infection risk and success rates, whereas questions requiring nuanced information, such as postoperative protocols and prognosis, received poorer ratings. Significant variability was observed among surgeons' ratings and between questions, reflecting differences in interpretation and expectations.</p><p><strong>Conclusion: </strong>ChatGPT-4 demonstrates its potential to reliably provide discrete information for uncommon procedures such as TAA, but it lacks the capability to effectively respond to questions requiring patient- or surgeon-specific insight. This limitation, paired with the growing reliance on AI, highlights the need for AI tools tailored to specific clinical practices to enhance accuracy and relevance in patient education.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251322784"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751913","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":"Diagnosis and Management of Deltoid Ligament Injuries in Chronic Ankle Instability: A Systematic Review.","authors":"Amanda Anderson, Maddison McLellan, Ryan Kim, Naudereh Noori","doi":"10.1177/24730114251323903","DOIUrl":"10.1177/24730114251323903","url":null,"abstract":"<p><strong>Background: </strong>The treatment of chronic ankle sprains has largely focused on lateral ankle instability in the literature. There is a scarcity of data regarding the diagnosis and management of chronic medial ankle instability secondary to deltoid ligament injury.</p><p><strong>Methods: </strong>A literature search was performed using the National Center for Biotechnology Information (NCBI) database for studies evaluating chronic ankle instability (CAI) involving deltoid ligament pathology. Studies were evaluated for workup including clinical presentation, imaging, treatment algorithm and operative techniques. Descriptive statistical analysis was conducted across the pooled data set.</p><p><strong>Results: </strong>Nine studies representing 516 patients with CAI were included in our analysis. Plain radiographs assessed talar-tilt angle in 440 patients (85%) and anterior displacement in 296 patients (57%). A total of 465 patients underwent magnetic resonance imaging, with deltoid injuries identified in 289 (62%) of patients. Of these 289 patients, superficial deltoid involvement was specified in 61 patients and deep deltoid in 146 patients. Surgical treatment most commonly included arthroscopy in 255 patients with open deltoid ligament repair in 199 patients. Repair method included suture anchors in 173 patients (87%), bone tunnels in 23 patients (12%), and unspecified technique in 3 patients (1.5%). Thirteen patients (6.5%) had suture anchor repairs augmented with an internal brace. Three patients underwent deltoid reconstruction with plantaris tendon autograft.</p><p><strong>Conclusion: </strong>Deltoid ligament injuries are common in patients with CAI. These data improve our understanding of chronic deltoid injuries and can help patients and surgeons better comprehend the pathoanatomy of chronic ankle instability.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251323903"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718159","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":"The Association of Body Mass Index and Achilles Tendon Rupture: A Retrospective Case-Control Study.","authors":"W Chad Elliott, Alvin Ouseph, Alexander Abraham, Jarrod Martinez, Jerry S Grimes","doi":"10.1177/24730114251327212","DOIUrl":"10.1177/24730114251327212","url":null,"abstract":"<p><strong>Background: </strong>Achilles tendon rupture (ATR) is a common injury with an estimated incidence of about 7 to 40 per 100,000 person-years. Identifying risk factors for ATR is an important step toward injury prevention. Modifiable factors, such as body mass index (BMI), are of particular interest because of the potential for intervention, and recent studies have shown mixed results for BMI as a risk factor for ATR. This case-control study aims to compare the BMI of patients diagnosed with a primary ATR to age and sex-matched controls diagnosed with an ankle sprain.</p><p><strong>Methods: </strong>A retrospective chart review of 168 patients was performed, which included 56 patients with ATR age- and sex-matched with 112 ankle sprain controls. Demographics and BMI data were collected and compared across the 2 groups. Mann-Whitney <i>U</i> tests and Fisher exact tests were used to determine differences between groups. Multivariate logistic regression models were used to further analyze significant variables.</p><p><strong>Results: </strong>The mean BMI for ATR was 33.4 and ankle sprain was 31.9, which was not statistically significant (<i>P</i> = .162). When BMI was divided into subclasses, there were significantly fewer patients who sustained ATR compared to ankle sprain controls in the class 1 (BMI 18-25; <i>P</i> = .020). Participating in sports (<i>P</i> < .001) and African American race (<i>P</i> < .001) were the only other statistically significant risk factors. Multivariate logistic regression showed increased likelihood of ATR for patients who were African American (<i>P</i> = .006), participated in athletics (<i>P</i> < .001), and had a BMI higher than 25 (<i>P</i> = .018).</p><p><strong>Conclusion: </strong>This study found that a BMI between 18 and 25 was associated with lower rates of ATR when compared to BMI classes greater than 25. Our data suggests that BMI may be an independent factor associated with ATR, even in patients engaging in sporting activity.</p><p><strong>Level of evidence: </strong>Level III, case-control study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251327212"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718200","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":"Applicant Factors for Matching Into an Orthopaedic Foot and Ankle Fellowship.","authors":"Zachary C Lum, Kyle Astleford, Christopher Kreulen, Eric Giza","doi":"10.1177/24730114251327208","DOIUrl":"10.1177/24730114251327208","url":null,"abstract":"<p><strong>Background: </strong>Over the past 2 decades, various initiatives have aimed to enhance diversity in orthopaedic surgery, promoting greater racial, ethnic, and gender equity. Building on this progress, demographic data on orthopaedic fellowship matches has been collected over the last 3 years. This study seeks to analyze trends in applicants to foot and ankle fellowships, characterize the applicant pool, and identify traits associated with successful matches.</p><p><strong>Methods: </strong>All applicant information from a fellowship application service site was obtained for match years 2022-2024. Applicants were selected only if they applied to the specific subspecialty fellowship. Gender, race, and ethnicity were recorded. Applicant factors such as Alpha Omega Alpha (AOA) status, Gold Humanitarian status, United States Medical Licensing Examination (USMLE) Step 2 score, number of applications, and number of interview invitations were used. Applicant medical school status, including allopathic, osteopathic, Canadian, and foreign medical graduate (FMG) were analyzed. χ² test was performed between US and FMG applicants. Univariate and multivariate binomial logistic regression was performed for FMGs.</p><p><strong>Results: </strong>There were 286 applicants, 82.8% males, 16.5% females, 133 US- and Canadian-trained graduates, and 153 FMGs. The match rate for US- and Canadian-trained graduates was 99.2% compared with FMGs, which was 43.7% and associated with lower matching rates (<i>P</i> < .00001). When performing analysis in US and FMG groups independently because of multicollinearity, no factors could be associated with matching. Only when the applicant had FMG status, then the number of interview invitations were associated with matching. When the number of interviews approached 6, the likelihood of matching was >95%.All except 1 US F&A applicant matched into an F&A fellowship. During the match period, US-trained applicants were 28%-32% female, 4%-8% Black/African American, 8%-17% Asian, 65%-73% White, 2%-4% American Indian, and 2%-8% Hispanic, with no Native Hawaiian and Pacific Islanders applying. Female applicants were above representation compared to Accreditation Council for Graduate Medical Education (ACGME) numbers, but the remaining race and ethnicity applicants were within the range of current ACGME standings, which is still lower than US Census results.</p><p><strong>Conclusion: </strong>Nearly all US-trained foot and ankle applicants matched, whereas FMG applicants matched 43% of the time.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251327208"},"PeriodicalIF":0.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718128","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":"Preoperative Expectations for Elective vs Nonelective Foot and Ankle Patients.","authors":"Lily Upp, Sahil Sethi, Jason Strelzow, Kelly Hynes","doi":"10.1177/24730114251322431","DOIUrl":"10.1177/24730114251322431","url":null,"abstract":"<p><strong>Background: </strong>Orthopaedic patients' expectations for surgical treatment are often disparate compared with those of their surgeon. There is increasing interest in assessing and understanding patient preoperative expectations and their potential association with postoperative satisfaction. Previous literature has found several predictors of patient-provider discrepancies in expectations for elective orthopaedic surgery, although no studies have included patients undergoing surgery for traumatic injuries. The aim of this study was to determine if there are differences in expectations between patients undergoing elective vs nonelective foot and ankle surgeries.</p><p><strong>Methods: </strong>A prospective study of adult foot and ankle patients was performed over 6 months (October 2023-March 2024). At the time of preoperative evaluation, patients and their surgeon each independently completed a validated Foot and Ankle Surgery Expectations Survey, developed by the Hospital for Special Surgery. For each survey, the total number of expectations for which a respondent anticipated at least \"a little improvement\" were counted, giving the Number of Expected Areas of Improvement (NEAI); and a validated Aggregate Score (AS), capturing the overall magnitude of expectations, was calculated. Average NEAI and AS for each patient group were calculated and analyzed in regression models that included several demographic covariates.</p><p><strong>Results: </strong>Sixty-nine patients were prospectively enrolled, 53 (76%) elective and 16 (24%) nonelective. The groups were demographically similar except for race. Patient expectations did not differ significantly between groups in NEAI or AS (<i>P</i> = .988, <i>P</i> = .462). Surgeon expectations were significantly lower both in NEAI and AS than those of patients in both groups (<i>P</i> < .001). Of the covariates tested in this study, increasing patient body mass index was the only significant predictor of increased patient-surgeon discrepancy (<i>P</i> = .005).</p><p><strong>Conclusion: </strong>This study confirms previous findings that surgeons have lower preoperative expectations than patients who undergo orthopaedic foot and ankle surgery. This exploratory study suggests that neither patients' nor providers' overall expectations differ between elective and nonelective foot and ankle surgeries.</p><p><strong>Level of evidence: </strong>Level III, prospective observational study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251322431"},"PeriodicalIF":0.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718197","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":"Fifteen-Year Follow-up of the Modified Oblique Keller Capsular Interposition Arthroplasty Compared to Arthrodesis for Treatment of Advanced First Metatarsophalangeal Joint Arthritis.","authors":"Jeffrey E Johnson, Andrea R Phinney, Mary K Hastings, Hyo-Jung Jeong, Ling Chen, Andrew P Thome, Jeremy J McCormick, Jonathon D Backus","doi":"10.1177/24730114251322766","DOIUrl":"10.1177/24730114251322766","url":null,"abstract":"<p><strong>Background: </strong>Although metatarsophalangeal joint (MTPJ) arthrodesis is considered the \"gold standard\" for treatment of advanced MTPJ arthritis, a modified oblique Keller capsular interposition arthroplasty (MOKCIA) is an alternative treatment for hallux rigidus that retains MTPJ motion. We aim to retrospectively compare long-term patient-reported outcomes, radiographic alignment, MTPJ walking kinematics, and plantar pressure between the MOKCIA and MTPJ arthrodesis for advanced hallux rigidus.</p><p><strong>Methods: </strong>Thirty-five patients were recruited from a retrospective chart review (MOKCIA [n = 15, average 15 years from surgery] or an arthrodesis [n = 20, average 13 years from surgery]). We measured visual analog scale (VAS) pain and satisfaction, Foot and Ankle Ability Measure (FAAM), Patient-Reported Outcomes Measurement Information System (PROMIS) physical function scores, radiographs, walking MTPJ sagittal plane kinematics, forefoot, and first toe peak plantar pressure during walking, MTPJ goniometer range of motion, and need for additional surgery. Two-sample <i>t</i> tests or χ² were used to compare groups. A Spearman correlation was used to examine the relationships between measured variables.</p><p><strong>Results: </strong>Groups did not differ on demographic characteristics, FAAM activities of daily living scale (MOKCIA = 94 ± 8, arthrodesis = 94 ± 7, <i>P</i> = .93), PROMIS physical function T-score (MOKCIA = 50 ± 6, arthrodesis = 48 ± 6, <i>P</i> = .41), forefoot, and first-toe walking peak plantar pressure. The MOKCIA had small but significantly lower VAS pain (MOKCIA = 0.1 ± 0.3, arthrodesis = 1.0 ± 1.6, <i>P</i> = .02) and higher satisfaction scores (MOKCIA = 9.5 ± 0.9, arthrodesis = 8.4 ± 1.8, <i>P</i> = .03). MTPJ passive arc of excursion in the MOKCIA group was 44 ± 15 degrees, and greater goniometric measured flexion of the first MTPJ correlated with greater patient satisfaction in the MOKCIA group (ρ = 0.70, <i>P</i> < .01). No MOKCIA patient in our study group required additional surgery.</p><p><strong>Conclusion: </strong>Patients in both the MOKCIA and arthrodesis groups reported high function with little limitation due to their toe surgery. Patients in the MOKCIA group had similar pain and satisfaction compared with the arthrodesis group. These results suggest MOKCIA is a joint range of motion-preserving alternative to MTPJ arthrodesis for long-term treatment of hallux rigidus.</p><p><strong>Level of evidence: </strong>Level III, retrospective, cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251322766"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669543","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":"Early Patient-Reported Outcomes Following Calcaneal Lengthening Osteotomy for Symptomatic Flexible Flatfoot.","authors":"Rohit Siddabattula, Matthew William, Daniel E Pereira, Jason L Cummings, Pooya Hosseinzadeh","doi":"10.1177/24730114251318733","DOIUrl":"10.1177/24730114251318733","url":null,"abstract":"<p><strong>Background: </strong>Calcaneal lengthening osteotomy (CLO) is frequently utilized to treat painful flexible flatfoot (FF) in children. The purpose of this investigation is to analyze the impact of CLO on patient reported pain and mobility using Patient Reported Outcome Measurement Information System (PROMIS) scores in a cohort of pediatric patients treated for painful FF.</p><p><strong>Methods: </strong>Children aged 8-18 who underwent CLO for painful FF correction were included. Retrospective chart review for PROMIS scores of pain and mobility were collected. Preoperative PROMIS scores were compared to PROMIS scores collected within 6-12 months postoperatively. Five PROMIS points was determined to be a minimal clinically significant difference, as this is half of the SD of the PROMIS metric. Preoperative and postoperative AP/lateral talo-first metatarsal angles were collected and compared. The patients with residual pain (PROMIS >55) after CLO were evaluated, and the effect of potential factors on residual postoperative pain was assessed.</p><p><strong>Results: </strong>Twenty-one patients with 31 feet were included in the study, with an average age of 12.2 (range, 9-15) years at the time of surgery. Mean preoperative pain and mobility PROMIS scores were 53.6 (range, 32.2-69.6) and 42.5 (range, 25.5-56.4), respectively. Mean postoperative pain and mobility PROMIS scores were 47.1 (range, 32.0-59.0) and 48.3 (range, 31.6-61.7), respectively. Patients who received CLO had significant improvement in both pain (<i>P</i> = .005) and mobility (<i>P</i> = .017). Average pain and mobility decreased by 6.51 points and increased by 5.81 points, respectively, after CLO, both clinically significant improvements.</p><p><strong>Conclusion: </strong>In early follow-up, we found the use of calcaneal lengthening osteotomy used to treat children for painful idiopathic flexible flatfoot to be associated with significant improvements in pain and mobility PROMIS scores.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251318733"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691544","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":"Minimally Invasive Cartilage Resection of the Subtalar Joint: An Anatomical Study.","authors":"Sebastian Schilde, Dariusch Arbab, Maria Felsberg, Heike Kielstein, Karl-Stefan Delank, Natalia Gutteck","doi":"10.1177/24730114251315666","DOIUrl":"10.1177/24730114251315666","url":null,"abstract":"<p><strong>Background: </strong>Subtalar arthrodesis is a commonly performed procedure for the treatment of posttraumatic or primary osteoarthritis and several hindfoot deformities. The primary objective of this study is to evaluate the efficacy and safety of a minimally invasive technique for cartilage removal of the subtalar joint using a modified sinus tarsi approach.</p><p><strong>Methods: </strong>An anatomical study was performed on 8 pairs of fresh frozen cadaveric feet. A modified 2.5-cm sinus tarsi approach was used to access the subtalar joint. Cartilage removal was performed in 2 groups using either a 13-mm Shannon burr (GB) or a curette (GC) with subsequent systematic dissection. Standardized scaled photographs of the resected articular surfaces were analyzed in ImageJ software to quantify cartilage removal. Nearby vulnerable anatomical structures such as the intermediate and lateral dorsal cutaneous nerves, peroneal, tibialis posterior, flexor digitorum longus, and flexor hallucis longus tendons were assessed for injury.</p><p><strong>Results: </strong>The area of completely removed cartilage in GC was median 79.7% talar and 76.6% calcaneal. In GB, median 67.8% of the talar cartilage and 76.8% of the calcaneal cartilage was removed. The overall mean of cartilage resection was 73% (±7.7). There was no statistically significant difference between the groups. Anatomical structures at risk were not inadvertently injured.</p><p><strong>Conclusion: </strong>Subtalar cartilage resection can be performed safely using a minimally invasive modified sinus tarsi approach and either a Shannon burr or curettes. The amount of cartilage resection is less than that reported in the literature for open cartilage resection, but may be beneficial in select patient populations at increased risk for wound healing compromise and infection.</p><p><strong>Level of evidence: </strong>Level III, comparative cadaver study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251315666"},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669642","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":"Complications and Early-Term Radiographic Analysis of a Novel Active Compression Tibiotalocalcaneal Arthrodesis Nail With a Proximal Flexible Coil.","authors":"Albert T Anastasio, Kevin A Wu, Emily J Luo, Cesar De Cesar Netto, Mark E Easley","doi":"10.1177/24730114251323895","DOIUrl":"10.1177/24730114251323895","url":null,"abstract":"<p><strong>Background: </strong>Tibiotalocalcaneal (TTC) arthrodesis is used among other methods as a salvage procedure for complex foot/ankle deformity. Fixation is usually achieved through plate/screw constructs or intramedullary (IM) nailing. Although IM nailing uses smaller incisions, fusion rates are variable and complications rates ranging from 25% to 55.7% have been reported. The Phantom ActivCore (AC) nail could serve as a viable alternative to traditional IM nailing by allowing for increased compression capacity and a potentially lower risk of stress fracture. However, no studies have described the early outcomes of TTC arthrodesis using the AC nail. The primary objective of this study was to determine the rates of early-term complications and radiographic union of the AC nail.</p><p><strong>Methods: </strong>Inclusion criteria consisted of patients who had undergone a tibiocalcaneal or TTC arthrodesis using the Phantom Hindfoot TTC Nail System with at least 6 months of follow-up. Radiographic analysis evaluated for successful union and flexibility of the flex coil. Patients were monitored for postoperative complications and additional secondary procedures.</p><p><strong>Results: </strong>Twenty-one patients were included and had an average follow-up of 9.4 ±4.7 months (range, 4.3-19 months). No intraoperative complications were reported. Seven patients experienced at least 1 adverse event, which included device migration, asymptomatic nonunion, symptomatic nonunion, bone stress reaction, device prominence, and screw breakage. There were no events of perioperative fractures or device breakage. Two patients required secondary surgical interventions. The 5 remaining patients were managed conservatively. An average nail coil flexion angle of 2.6 ± 3.1 degrees and 0.8 ± 1.59 degrees was found on lateral and anteroposterior radiographs, respectively. The overall union rate at a mean follow-up of 9.4 months was 90.4% (95% CI 69.6%, 98.8%).</p><p><strong>Conclusion: </strong>TTC arthrodesis via the AC nail demonstrated similar union rates and outcomes at short-term follow-up compared with rates generally reported in the literature for other IM nail constructs. The AC nail was able to function as designed and allow for motion at the proximal bone-implant interface.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251323895"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656690","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}