Foot & Ankle Orthopaedics最新文献

{"title":"Does Deltoid Ligament Repair Reduce Complications and Improve Functional Outcomes Measured by PROMIS Scores Following Ankle Fracture Surgery?","authors":"Steven M Hadley, Rachel Bergman, John J Peabody, Sarah J Westvold, Ryan Filler, Milap Patel, Anish R Kadakia","doi":"10.1177/24730114251330879","DOIUrl":"https://doi.org/10.1177/24730114251330879","url":null,"abstract":"<p><strong>Background: </strong>Deltoid repair (DR) in ankle fracture surgery remains controversial. This study aims to determine whether DR reduces complications and improves outcomes measured by Patient Reported Outcomes Measurement Information System (PROMIS) computerized adaptive tests (CATs) of physical function (PF) and pain interference (PI). We hypothesized that DR would reduce complications and improve PROMIS scores.</p><p><strong>Methods: </strong>This was a retrospective study of 782 patients at a single institution who underwent ankle fracture surgery between January 2016 and December 2021. Two fellowship-trained foot and ankle orthopaedic surgeons independently reviewed all radiographs and assessed reduction quality and complications at final follow-up. Multiple extremity injuries, open fractures, and pilon variants were excluded. A total of 345 patients with deltoid ruptures were sent PROMIS CATs. Of those, 265 patients with minimum 1-year follow-up were analyzed for complications. Finally, 112 patients who completed CATs were analyzed for PROMIS. Wilcoxon rank-sum test compared PROMIS between groups. Linear regression modeled DR effect on PROMIS adjusted for relevant covariates and propensity scores.</p><p><strong>Results: </strong>Fifty of the 265 patients (18.9%) underwent DR. The incidence of radiographic evident complications among 215 patients (81.1%) without repair (NDR) was 14.42%: 7 (3.26%) degenerative joint disease, 3 (1.40%) ankle joint malreduction, 4 (1.86%) syndesmotic malreduction, and 8 (3.72%) malleolar malunion. The DR group had no radiographic complications. Among patients who completed CATs (n = 112), DR (n = 21) was not significantly different for mean PF (54.31±9.83 vs 52.79±10.42, <i>P</i> = .71) or mean PI (47.21±7.82 vs 48.53±8.37, <i>P</i> = .59) than NDR (n=91). Adjusted regression models estimated a 1.89-point increase in PF and a 1.67-point decrease in PI for DR vs NDR. When adjusted for propensity scores, DR had PF 2.17 higher and PI 1.73 lower compared to NDR. Neither of these reach minimal clinically important difference criteria.</p><p><strong>Conclusion: </strong>DR was associated with reduced radiographically evident complications following ankle fracture surgery. This study was underpowered to detect small effect sizes in PROMIS, and we remain uncertain if DR meaningfully improved patient-reported outcomes.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251330879"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967230","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":"Outcomes of Bilateral Scandinavian Total Ankle Replacement: A Detailed Analysis of Implant Survivability and Patient-Reported Outcomes.","authors":"Alexandra Hunter Aitchison, Albert T Anastasio, Kevin A Wu, Emily Poehlein, Cynthia Green, Samuel B Adams, James K DeOrio, Mark E Easley, James A Nunley","doi":"10.1177/24730114251329349","DOIUrl":"https://doi.org/10.1177/24730114251329349","url":null,"abstract":"<p><strong>Background: </strong>Total ankle replacement (TAR) is an established treatment for end-stage ankle arthritis, offering pain relief and improved functionality. The Scandinavian Total Ankle Replacement (STAR) was first used in the United States in 1998 and although unilateral STAR has been extensively studied, there is limited documentation on the outcomes of simultaneous bilateral STAR procedures. This study aimed to evaluate the survivability and patient-reported outcomes of simultaneous bilateral STAR, focusing on implant survival rates and improvements in quality of life, function, and pain relief.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on all patients managed with primary TAR performed simultaneously with bilateral STAR prostheses at our institution from July 1998 to February 2008. Demographics and perioperative characteristics were collected. Poisson regression was used for analyzing implant survivability, and generalized linear mixed models were applied to assess patient-reported outcomes, including the visual analog scale (VAS), Short Musculoskeletal Function Assessment (SMFA), 36-Item Short Form Health Survey (SF-36), and American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot, at multiple follow-up time points.</p><p><strong>Results: </strong>Twenty-one patients were included for a total of 42 implants. The average length of follow up was 4.9 ± 2.7 years. The implant failure rate at 5 years was 12.0% (95% CI 4.5%-32.0%). The last recorded failure occurred at 8 years postimplant, with an implant failure rate of 19.2% (95% CI 17.2%-51.1%). Statistically significant improvements were observed in all patient-reported outcome measures from baseline to the 5-year follow-up (<i>P</i> < .05) except SMFA bother because of high variability and small sample size.</p><p><strong>Conclusion: </strong>At midterm follow-up, patients who underwent bilateral simultaneous TAR with the STAR prosthesis experienced a significant and durable improvement in patient-reported outcome scores across multiple functional indices. Failure rates were within range to those reported in previous studies evaluating unilateral STAR, with an estimated average survivorship of 80.8% at 8 years.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251329349"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996260","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":"Comparison of Clinical and Radiographic Outcomes of Supination External Rotation Type IV Equivalent Ankle Fractures With and Without Deltoid Repair.","authors":"Saanchi Kukadia, David Cho, Stephanie Eble, Prashanth Kumar, Alan Shamrock, Mark Drakos","doi":"10.1177/24730114251329333","DOIUrl":"10.1177/24730114251329333","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of consensus on how deltoid injuries should be addressed in the setting of acute ankle fractures. This study aims to evaluate whether deltoid repair during lateral malleolar fracture fixation leads to improved clinical outcomes compared to fixation without deltoid repair.</p><p><strong>Methods: </strong>This was a single-center retrospective study involving 13 surgeons. Inclusion criteria were patients aged 18 years or older who underwent open fixation for a supination external rotation type IV (SER IV) equivalent ankle fracture. SER IV fractures were confirmed with stress radiographs. Deltoid injury was confirmed with an intraoperative external rotation stress test. A total of 146 patients were included. Eighty patients received a deltoid repair (DR), and 66 patients did not receive a deltoid repair (NDR). Patient-reported outcomes via PROMIS scores were collected preoperatively and at least 1 year postoperatively for all patients. Preoperative and postoperative medial clear space (MCS) were reviewed for all patients.</p><p><strong>Results: </strong>There were no significant differences in preoperative and postoperative PROMIS domains between the 2 cohorts. There were also no significant differences in preoperative MCS and postoperative MCS between the 2 cohorts. There were no significant differences in the incidence of subsequent procedures for removal of painful hardware, revisions, infections, progression to arthritis, and persistent pain.</p><p><strong>Conclusion: </strong>This study compares short- to medium-term outcomes and complications of SER IV-equivalent ankle fractures with and without deltoid repair. No significant differences between PROMIS scores, postoperative MCS, and complication rates were observed between groups.</p><p><strong>Level of evidence: </strong>Level III, retrospective case control study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251329333"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001808","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 Adjunctive Procedures, Patient Demographics, or Intraoperative Factors and the Risk of Complications or Reoperation Following Total Ankle Arthroplasty or Ankle Arthrodesis.","authors":"Ramiro Lopez, Cole Herbel, Glenn G Shi, Edward T Haupt","doi":"10.1177/24730114251329051","DOIUrl":"https://doi.org/10.1177/24730114251329051","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;End-stage ankle arthritis is successfully treated with surgery with either ankle arthrodesis (AA) or total ankle arthroplasty (TAA). Much is described comparing the 2 treatments in tightly selected patient groups. Limited evidence attempts to examine specific elements of technical complexity that increase perioperative risk for the surgical treatment of ankle arthritis. There is suspicion that AA may be preferable in the setting of elevated patient complexity, or that procedures may require staging to diminish complication risk when there is also foot deformity present. The aim of this study is to evaluate the effect of adjunctive procedures on overall postoperative complication (POC) risk, for both TAA and AA. Primary outcome measures were to compare overall complication and reoperation risk for TAA and AA. Secondary outcome measures were to identify patient factors, intraoperative factors, and factors of procedural complexity via number of associated surgeries and the incidence of complications and reoperation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective chart review of AAs and TAAs performed at a single academic institution from the years 2008-2024 was performed using &lt;i&gt;Current Procedural Terminology&lt;/i&gt; (&lt;i&gt;CPT&lt;/i&gt;) codes identifying AA and TAA. Patient demographics, operative details, and postoperative data were abstracted to collect relevant information. Statistical analyses, including odds ratios and analysis of variance, were then performed to reveal specific risk factors and correlations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Four hundred ninety-one patients were identified in the initial database query. After exclusions, 246 remained, of which 110 underwent AA and 136 underwent TAA. The mean length of follow-up was 36.4 months for TAA patients and 46.1 months for AA patients in this study. Overall, patients who underwent TAA were older and had an increased number of preoperative comorbidities (5.74 ± 3.07) compared to AA (4.74 ± 2.76) (&lt;i&gt;P&lt;/i&gt; = .008). Additionally, TAA patients experienced a lower overall rate of POCs (20/136, 14.71%) and reoperation (14/136, 10.29%) compared with patients who underwent AA (21/110, 19.09%; 21/110, 19.09%) (&lt;i&gt;P&lt;/i&gt; = .36 and &lt;i&gt;P&lt;/i&gt; = .05, respectively). As the number of adjunctive procedures increased, so did the rate of POCs, but not reoperation, in patients who underwent TAA. The number of adjunctive procedures was not significantly associated with complication or reoperation risk in AA patients. There were no specific adjunctive procedures that demonstrated a significant correlation with increased risk of complications or reoperation in both groups. Osteoporosis and coagulopathies were identified as predisposing TAA patients to postoperative complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In our retrospective cohort study with relatively low statistical power, we found that patients who undergo TAA or AA plus adjunctive procedures did not experience an increased r","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251329051"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996707","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":"Medicaid Reimbursement for Common Orthopaedic Foot and Ankle Procedures Is Highly Inconsistent Among States, Ranging from 37% to 324% of Medicare Reimbursement.","authors":"Adam P Henderson, M Lane Moore, Nathan C Beckett, Paul R Van Schuyver, Jack M Haglin, Joseph C Brinkman, Karan A Patel","doi":"10.1177/24730114251330302","DOIUrl":"https://doi.org/10.1177/24730114251330302","url":null,"abstract":"<p><strong>Background: </strong>Medicaid reimbursement to physicians is often perceived to be lower than Medicare, but little is known about orthopaedic foot and ankle reimbursement. This study sought to compare Medicare and Medicaid reimbursement for the 20 most common foot and ankle procedures.</p><p><strong>Methods: </strong>Medicare reimbursement rates for common foot and ankle codes were obtained from the online Centers for Medicare & Medicaid fee schedule, while Medicaid rates were found from individual state fee schedule websites. Medicaid rates were compared by state and pooled to obtain national differences. The Medicare Wage Index was used to adjust Medicaid rates by state wages to ensure a more accurate comparison. Variability between states was measured using state percentages of Medicare and coefficient of variation values.</p><p><strong>Results: </strong>Medicaid reimbursed physicians higher than Medicare in 31 states overall, with average reimbursement ranging from 37% to 324% of Medicare. Nationally, Medicaid reimbursed 8.8% higher than Medicare, but Medicare reimbursed 3.7% higher when adjusted for the Medicare Wage Index. The <i>Current Procedural Terminology</i> (<i>CPT</i>) codes with the highest ratio of Medicaid to Medicare reimbursement were <i>CPT</i> 28002 for incision and drainage of the foot (176.6%) and <i>CPT</i> 28820 for toe amputation (167.6%). Five codes had lower relative Medicaid reimbursement on average: <i>CPT</i> 27687 for repair procedures on the leg and ankle joint, <i>CPT</i> 28810 for amputation procedures on the foot and toes, <i>CPT</i> 28010 for toe tenotomy, <i>CPT</i> 28005 for incision procedures on the foot and toes, and <i>CPT</i> 28470 for closed treatment of a metatarsal fracture. The coefficient of variation values ranged from 0.34 to 0.84 in the Medicaid group and 0.40 to 0.78 in the adjusted group, indicating high variability between states and between procedures.</p><p><strong>Conclusion: </strong>Medicaid reimbursement is highly inconsistent between states, ranging from 37% to 324% of Medicare. Medicaid reimbursed more than Medicare overall, which is in contrast with most published findings that tend to show higher reimbursement for Medicare when compared to Medicaid. When adjusting for wage differences between states, Medicare reimbursed slightly higher than Medicaid.</p><p><strong>Level of evidence: </strong>Level IV, economic analysis.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251330302"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975642","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":"Midterm Outcomes and Surgical Approaches for Osteochondral Lesions of the Talus.","authors":"Christoph Biehl, Carina Fritzsche, Nike Walter, Lotta Biehl, Thaqif El Khassawna, Christian Heiss, Markus Rupp","doi":"10.1177/24730114251329378","DOIUrl":"https://doi.org/10.1177/24730114251329378","url":null,"abstract":"<p><strong>Background: </strong>Osteochondral lesions (OCL) of the talus are a significant cause of chronic ankle pain and functional impairment, typically following trauma. Despite advancements in diagnostic imaging and surgical interventions, long-term outcomes vary, and no gold standard treatment has been established.</p><p><strong>Methods: </strong>This retrospective study evaluated the outcomes of n=64 patients undergoing OCL-related surgery. Inclusion criteria: an OCL of the talus, patients without OCL, with osteoarthritis, or infection were excluded. The cohort was categorized primarily based on the stage of OCL and the surgical technique used: bone marrow stimulation by retrograde or anterograde drilling and microfracturing, transplantation of autologous cancellous bone, and acellular cartilage replacement and other procedures. Postoperative outcomes were assessed using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) score, and the Foot and Ankle Outcome Score (FAOS). Statistical significance was determined using χ² tests, with <i>P</i> <.05 considered significant.</p><p><strong>Results: </strong>A total of 97 operations were performed on 64 patients. Fifty-six percent of patients reported complete resolution of symptoms, 25% experienced partial improvement, and 19% showed no improvement. Patients aged ≤30 years had a higher success rate (62.5%) compared with older patients (45.8%, <i>P</i> = .227). Success rates were significantly better for patients with stage II and III lesions (50% and 59%, respectively) than for those with stage IV lesions (<i>P</i> = .043). Material substitution had a success rate of 44.4%, bone marrow stimulation 37.8%, and other procedures 18.8%.</p><p><strong>Conclusion: </strong>Surgical techniques for treating OCL of the talus provide moderate success, but a significant proportion of patients, especially those with advanced lesions, remain symptomatic.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251329378"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010411","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":"Revision Surgery for Failed Polyvinyl Alcohol Hydrogel Implant in the First MTP Joint: A Case Report and Comprehensive Review.","authors":"Thelma R Jimenez Mosquea, Christopher A Colasanti, Hugo A Ubillus, Raymond J Walls","doi":"10.1177/24730114251330300","DOIUrl":"https://doi.org/10.1177/24730114251330300","url":null,"abstract":"<p><strong>Background: </strong>Hallux rigidus is a degenerative condition of the first metatarsophalangeal (MTP) joint that can significantly impair function and quality of life. The introduction of polyvinyl alcohol (PVA) hydrogel implants, such as Cartiva, offered an alternative to arthrodesis by preserving joint motion. However, failures of these implants, often resulting in bone loss and joint instability, present a challenge for revision surgery.</p><p><strong>Methods: </strong>We report the case of a 43-year-old woman with persistent pain and functional limitations after a failed PVA hydrogel implant in the first MTP joint. The revision surgery involved a biologic resurfacing using the Osteochondral Autograft Transfer System (OATS) with a graft harvested from the ipsilateral femoral condyle, complemented by interpositional arthroplasty with a dermal graft and a proximal phalanx closing wedge osteotomy to correct residual hallux valgus.</p><p><strong>Results: </strong>At the 3-year follow-up, the patient-reported complete resolution of pain and returned to full activity with improved range of motion (40 degrees dorsiflexion, 15 degrees plantarflexion). Radiographic evaluation demonstrated graft incorporation and restoration of joint space, confirming the success of the procedure.</p><p><strong>Conclusion: </strong>This case highlights the potential of OATS combined with interpositional arthroplasty as a viable option for revision surgery in complex cases of failed synthetic cartilage implants in hallux rigidus. By addressing bone loss and preserving joint function, this approach provides a patient-specific alternative to traditional arthrodesis. Further studies are warranted to establish the long-term efficacy of this technique in similar cases.</p><p><strong>Level of evidence: </strong>Level V, case report.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251330300"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002565","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 Cannabis and Tobacco Use With Postoperative Complications after Ankle and Hindfoot Arthrodesis.","authors":"Alejandro M Holle, Nathan C Beckett, Jose M Iturregui, Jack M Haglin, Todd A Kile","doi":"10.1177/24730114251328669","DOIUrl":"https://doi.org/10.1177/24730114251328669","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to investigate the association between cannabis use and postoperative complications following ankle and hindfoot arthrodesis.</p><p><strong>Methods: </strong>A retrospective cohort study using a large national insurance database from 2010 to 2022 was conducted. All patients who underwent ankle or hindfoot arthrodesis with at least 2 years' follow-up were included. Patients were divided into 4 groups: cannabis-only users, tobacco-only users, cannabis and tobacco users, and nonuser controls. Groups were matched 1:4 with nonuser controls based on demographic variables and comorbidities. Also, both cannabis and tobacco users were matched 1:4 with tobacco-only users based on demographics and comorbidities. Medical complications within 90 days of surgery and surgery-specific complications within 2 years were compared between groups with multivariable logistic regressions.</p><p><strong>Results: </strong>Compared with nonuser controls, cannabis users only were not at increased risk of 90-day medical complications or 2-year surgical complications. Tobacco use alone was associated with increased risk of postoperative admission (OR 1.32, 95% CI 1.21-1.43) and emergency department (ED) utilization (OR 1.57, 95% CI 1.48-1.66) within 90 days as well as infection (OR 1.24, 95% CI 1.18-1.30), hardware removal (OR 1.12, 95% CI 1.07-1.18), nonunion (OR 1.33, 95% CI 1.27-1.40), and wound dehiscence (OR 1.38, 95% CI 1.27-1.49) within 2 years of surgery compared with nonuser controls. Compared with tobacco-only use, combined cannabis and tobacco use was associated with increased risk of ED visits within 90 days (OR 1.45, 95% CI 1.30-1.62) and nonunion within 2 years of surgery (OR 1.19, 95% CI 1.05-1.35).</p><p><strong>Conclusion: </strong>These findings suggest that although cannabis use alone was not associated with a higher risk of postoperative complications, its concurrent use with tobacco was linked to greater rates of adverse outcomes.</p><p><strong>Level of evidence: </strong>Level III, retrospective case control study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251328669"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972427","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":"Endoscopic Flexor Hallucis Longus Transfer With Interference Screw and Additional Tension Slide Cortical Button for Chronic Achilles Tendon Rupture.","authors":"Ayla Claire Newton, Samuel Franklin, Thomas Lorchan Lewis, Sanjana Mehrotra, Siddhartha Murhekar, Vikramman Vignaraja, Robbie Ray","doi":"10.1177/24730114251325862","DOIUrl":"10.1177/24730114251325862","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic flexor hallucis longus (FHL) tendon transfer can be used in the management of acute or chronic Achilles tendon rupture (ATR), including in elite sportspeople. A recent cadaveric study demonstrated that an increased ultimate load could be applied using an FHL tendon transfer with interference screw and cortical button applied using a tension slide technique compared with interference screw alone. The aim of this study was to explore patient-reported functional outcomes following this modification to this operation.</p><p><strong>Methods: </strong>We reviewed the imaging, history, patient-related outcome measures (PROMs), and complications of 17 patients who underwent endoscopic FHL tendon transfer for chronic ATR using the modified FHL reconstruction technique. The primary outcome was the Manchester-Oxford Foot Questionnaire (MOxFQ), EuroQol-5 Dimensions (EQ-5D), and visual analog score for pain (VAS-Pain) with a mean follow up of 1.5 years.</p><p><strong>Results: </strong>Seventeen patients (11 male, 6 female) underwent endoscopic FHL tendon transfer for chronic ATR between September 2020 and May 2023. Mean (SD) age at the time of surgery was 58.3 (16.1) years, and mean (SD) BMI was 27.6 (4.8). A specific event in the history associated with the rupture was present in 13 of 17 patients (76.5%); the median (IQR) time between injury and surgery was 33 weeks (21-42). Sixteen surgeries were primary procedures for chronic ATR, and 1 surgery was a revision procedure after a failed open acute ATR repair. MOxFQ, EQ-5D, and VAS-pain scores all showed a statistically significant improvement postoperatively (minimum 10 months) when compared to preoperative scores. There was 1 symptomatic complication of tibial neuritis (5.9%).</p><p><strong>Conclusion: </strong>Endoscopic FHL tendon transfer for chronic ATR augmented using a cortical button as well as an interference screw seems to be a safe and effective procedure, with patients reporting a statistically significant improvement in health-related quality of life, pain, and specific foot and ankle outcome function.<b>Level of Evidence:</b> Level IV, case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251325862"},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763356","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":"Ligamentous Injuries in Stable Ankle Fractures: An MRI-Based Study.","authors":"Alex N Karanja, Albert Ho-Huynh, Tom Walsh, Simon R Platt","doi":"10.1177/24730114251328694","DOIUrl":"10.1177/24730114251328694","url":null,"abstract":"<p><strong>Background: </strong>Ankle fractures are common orthopaedic injuries, and their management is primarily determined by fracture stability. The Lauge-Hansen classification system categorizes fractures according to mechanism of injury and ligaments involved. Supination external rotation (SER) type 2 fractures correspond to stable weber B fractures and are traditionally treated nonoperatively, whereas SER 3 and SER 4 fractures, characterized by syndesmosis disruption, typically require surgical intervention. We hypothesize that some apparently stable injuries may involve additional structures, challenging the conventional treatment approach. This study aims to determine the prevalence of SER 3 and SER 4 ankle injuries among radiographically stable SER 2 fractures.</p><p><strong>Method: </strong>The study used baseline data from a longitudinal cohort conducted at Gold Coast Hospital and Health Service (GCHHS). Patients attending the GCHHS fracture clinic with radiographically stable SER 2 fractures were invited to participate. Those meeting the eligibility criteria underwent ankle magnetic resonance imaging (MRI) to evaluate the integrity of syndesmotic and ankle ligaments.</p><p><strong>Results: </strong>Fifty-six participants were recruited, 38 (68%) female and 18 (32%) male, with a mean age of 47.2 years. All had stable syndesmoses on radiographic assessment and diagnosed with stable SER 2 ankle fractures. MRI scans revealed that 71% (n = 40) met the criteria for SER 2 injuries, 25% (n = 14) for SER 3 injuries with complete ruptures of posterior inferior tibiofibular ligament (PITFL), and 4% (n = 2) for SER 4 injuries with PITFL and deltoid ligament (DL) ruptures. These results challenge the assumption that radiographically stable SER 2 fractures are consistently stable in terms of additional structures involved.</p><p><strong>Conclusion: </strong>The study highlights that a considerable proportion of seemingly stable ankle fractures involve more structures than previously thought. This suggests the management of SER 3 and SER 4 injuries could include nonoperative treatment.</p><p><strong>Level of evidence: </strong>Level III, cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251328694"},"PeriodicalIF":0.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751917","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}