Foot & Ankle International最新文献

{"title":"Exposure of Tissue-Engineered Cartilage Analogs to Synovial Fluid Hematoma After Ankle Fracture Is Associated With Chondrocyte Death and Altered Cartilage Maintenance Gene Expression.","authors":"Nicholas B Allen,&nbsp;Alexandra Hunter Aitchison,&nbsp;Kian Bagheri,&nbsp;Nicholas J Guardino,&nbsp;Bijan Abar,&nbsp;Samuel B Adams","doi":"10.1177/10711007231178829","DOIUrl":"10.1177/10711007231178829","url":null,"abstract":"<p><strong>Background: </strong>The first stage of fracture healing consists of hematoma formation with recruitment of proinflammatory cytokines and matrix metalloproteinases. Unfortunately, when there is an intra-articular fracture, these inflammatory mediators are not retained at the fracture site, but instead, envelop the healthy cartilage of the entire joint via the synovial fluid fracture hematoma (SFFH). These inflammatory cytokines and matrix metalloproteinases are known factors in the progression of osteoarthritis and rheumatoid arthritis. Despite the known inflammatory contents of the SFFH, little research has been done on the effects of the SFFH on healthy cartilage with regard to cell death and alteration in gene expression that could lead to posttraumatic osteoarthritis (PTOA).</p><p><strong>Methods: </strong>SFFH was collected from 12 patients with intraarticular ankle fracture at the time of surgery. Separately, C20A4 immortalized human chondrocytes were 3-dimensionally cultured to create scaffold-free cartilage tissue analogs (CTAs) to simulate healthy cartilage. Experimental CTAs (n = 12) were exposed to 100% SFFH for 3 days, washed, and transferred to complete media for 3 days. Control CTAs (n = 12) were simultaneously cultured in complete medium without exposure to SFFH. Subsequently, CTAs were harvested and underwent biochemical, histological, and gene expression analysis.</p><p><strong>Results: </strong>Exposure of CTAs to ankle SFFH for 3 days significantly decreased chondrocyte viability by 34% (<i>P</i> = .027). Gene expression of both <i>COL2A1</i> and <i>SOX9</i> were significantly decreased after exposure to SFFH (<i>P</i> = .012 and <i>P</i> = .0013 respectively), while there was no difference in <i>COL1A1</i>, <i>RUNX2</i>, and <i>MMP13</i> gene expression. Quantitative analysis of Picrosirius red staining demonstrated increased collagen I deposition with poor ultrastructural organization in SFFH-exposed CTAs.</p><p><strong>Conclusion: </strong>Exposure of an organoid model of healthy cartilage tissue to SFFH after intraarticular ankle fracture resulted in decreased chondrocyte viability, decreased expression of genes regulating normal chondrocyte phenotype, and altered matrix ultrastructure indicating differentiation toward an osteoarthritis phenotype.</p><p><strong>Clinical relevance: </strong>The majority of ankle fracture open reduction and internal fixation does not occur immediately after fracture. In fact, typically these fractures are treated several days to weeks later in order to let the swelling subside. This means that the healthy innocent bystander cartilage not involved in the fracture is exposed to SFFH during this time. In this study, the SFFH caused decreased chondrocyte viability and specific altered gene expression that might have the potential to induce osteoarthritis. These data suggest that early intervention after intraarticular ankle fracture could possibly mitigate progression toward PTOA.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 9","pages":"922-930"},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10282149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Deltoid Injury in Ankle Fractures: A Biomechanical Analysis of Different Repair Constructs.","authors":"Emilio Wagner,&nbsp;Pablo Wagner,&nbsp;Mario I Escudero,&nbsp;Florencia Pacheco,&nbsp;David Salinas,&nbsp;Alexandre Leme Godoy-Santos,&nbsp;Felipe Palma,&nbsp;Rodrigo Guzmán-Venegas,&nbsp;Francisco Jose Berral-De la Rosa","doi":"10.1177/10711007231184844","DOIUrl":"10.1177/10711007231184844","url":null,"abstract":"<p><strong>Background: </strong>The importance of the deltoid ligament in the congruency and coupling of the tibiotalar joint is well known. The current trend is to repair it in cases of acute injuries in the context of ankle fractures; however, there is limited information on how it should be reconstructed. The objective of this study was to compare different deltoid ligament repair types in an ankle fracture cadaveric model.</p><p><strong>Methods: </strong>Sixteen cadaveric foot-ankle-distal tibia specimens were used. All samples were prepared as a supination external rotation ankle fracture model. Axial load and cyclic axial rotations were applied on every specimen using a specifically designed frame. This test was performed without deltoid injury, with deltoid injury, and after repair. The reconstruction was performed in 4 different ways (anterior, posterior, middle, and combined). Medial clear space (MCS) was measured for each condition on simulated weightbearing (WB) and gravity stress (GS) radiographs. Reflective markers were used in tibia and talus, registering the kinematics through a motion analysis system to record the tibiotalar uncoupling.</p><p><strong>Results: </strong>After deltoid damage, in all cases the MCS increased significantly on GS radiographs, but there was no increase in the MCS on WB radiographs. After repair, in all cases, the MCS was normalized. Kinematically, after deltoid damage, the tibiotalar uncoupling increased significantly. All isolated repairs achieved a similar tibiotalar uncoupling value as its baseline condition. The combined repair resulted in a significant decrease in tibiotalar uncoupling.</p><p><strong>Conclusion: </strong>Our results show that deltoid repair recovers the tibiotalar coupling mechanism in an ankle fracture model. Isolated deltoid repairs recovered baseline MCS and tibiotalar uncoupling values. Combined repairs may lead to overconstraint, which could lead to postoperative stiffness. Clinical studies are needed to prove these results and show clinically improved outcomes.</p><p><strong>Clinical relevance: </strong>This study helps in finding the optimum deltoid repair to use in an acute trauma setting.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 9","pages":"905-912"},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10576603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Predictors of Peroneal Tendon Instability Accompanying Calcaneal Fractures.","authors":"Amir Reza Vosoughi,&nbsp;Ehsan Afaridi,&nbsp;Saeed Solooki,&nbsp;Zahra Shayan,&nbsp;Stefan Rammelt","doi":"10.1177/10711007231175666","DOIUrl":"10.1177/10711007231175666","url":null,"abstract":"<p><strong>Background: </strong>We aimed to find the prevalence of peroneal tendon instability (PTI) accompanying different types of calcaneal fractures and to determine predictors of PTI based on preoperative CT scanning.</p><p><strong>Methods: </strong>In a retrospective cross-sectional study, preoperative CT scans of 400 consecutive calcaneal fractures undergoing surgery were reviewed for comminuted fragments in the lateral gutter of the ankle, fractures at the tip of the lateral malleolus, dislocated peroneal tendons, excessive displacement of the lateral calcaneal wall, calcaneal fracture-dislocation, superior peroneal retinaculum (SPR) avulsion fracture (fleck sign), and shape of the retromalleolar groove. The correlation of these variables with intraoperative SPR stress test, defined as the diagnostic criteria for PTI in calcaneal fractures, was evaluated.</p><p><strong>Results: </strong>In total, 369 patients (mean age, 39 ± 13; range, 11-72 years), with 321 (87.0%) of them male, were included. Among all calcaneal fractures, 67 cases (16.7%) had associated PTI as confirmed intraoperatively by an SPR stress test. A statistically significant association was found between PTI in calcaneal fractures and comminuted fragments in the lateral gutter of the ankle (<i>P</i> = .03), dislocated peroneal tendons (<i>P</i> < .001), calcaneal fracture-dislocation (<i>P</i> < .001), SPR avulsion fracture (<i>P</i> < .001), and Sanders type IV of calcaneal fracture (<i>P</i> = .02). There was no statistically significant relationship between PTI and the mechanism of injury (<i>P</i> = .98), side of fracture (<i>P</i> = .30), uni- or bilateral calcaneal fractures (<i>P</i> = .27), a fracture at the tip of lateral malleolus (<i>P</i> = .69), shape of the retromalleolar groove (<i>P</i> = .78), or excessive displacement of the lateral calcaneal wall (<i>P</i> = .06). The most specific CT finding to predict PTI accompanying calcaneal fractures was calcaneal fracture-dislocation (99.1%).</p><p><strong>Conclusion: </strong>Following calcaneal fracture fixation, PTI was confirmed with intraoperative SPR stress test in one-sixth of cases. With the exception of calcaneal fracture-dislocation, preoperative findings on CT scanning and calcaneal fracture pathoanatomy are insufficient to diagnose PTI accompanying calcaneal fractures.</p><p><strong>Level of evidence: </strong>Level III, retrospective case control study.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 9","pages":"825-833"},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10577686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-Year Clinical and Radiologic Outcomes Following Surgical Treatment of Insertional Achilles Tendinopathy Using a Central Tendon-Splitting Approach.","authors":"Adriel You Wei Tay,&nbsp;Graham S Goh,&nbsp;Zongxian Li,&nbsp;Nicholas Eng Meng Yeo,&nbsp;Kae Sian Tay","doi":"10.1177/10711007231173679","DOIUrl":"https://doi.org/10.1177/10711007231173679","url":null,"abstract":"<p><strong>Background: </strong>If conservative treatment of insertional Achilles tendinopathy (IAT) fails, surgery is often considered. Various surgical approaches have been used including the central Achilles tendon splitting approach. This study aimed to report the 2-year clinical and radiologic outcomes after surgical treatment of IAT with a central tendon-splitting approach.</p><p><strong>Methods: </strong>Seventy-five cases of IAT treated surgically via the open central tendon-splitting approach were analyzed. Clinical outcomes included the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, visual analog scale (VAS), 36-Item Short Form Health Survey (SF-36) physical (PCS) and mental (MCS) component summary scores, all measured at baseline and 6 and 24 months postoperatively. Radiologic parameters measured included the Fowler-Philip angle (FPA) and parallel pitch lines (PPL).</p><p><strong>Results: </strong>Three patients had clinically significant wound issues but healed completely by 3 weeks. Mean AOFAS score improved from 45.63 preoperatively to 94.71 at 24 months. Mean VAS score improved from 6.73 preoperatively to 0.55, mean SF-36 PCS from 35.98 to 48.74, and mean SF-36 MCS from 53.04 to 55.43 at 24 months. Satisfaction at 2 years was 94.3%. Mean FPA decreased from 62.0 degrees preoperatively to 34.0 degrees postoperatively. PPL was positive in 82.7% (62 of 75) of cases preoperatively, decreasing to 1.3% (1 of 75) postoperatively. Increasing age and higher preoperative VAS and SF-36 MCS scores were significantly associated with improvements in postoperative AOFAS, SF-36 PCS, and MCS scores.</p><p><strong>Conclusion: </strong>Surgical treatment of IAT via the central tendon-splitting approach achieved substantial improvements in all patient-reported outcome measures measured. These excellent clinical outcomes continued to show improvement 2 years postoperatively.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 8","pages":"702-709"},"PeriodicalIF":2.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10097181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From 2D to 3D: Understanding Hallux Valgus Deformity.","authors":"Cesar de Cesar Netto","doi":"10.1177/10711007231180573","DOIUrl":"https://doi.org/10.1177/10711007231180573","url":null,"abstract":"Hallux valgus deformity (HVD) is usually considered a “bread and butter” problem for orthopaedic foot and ankle surgeons. There is an overall understanding that “we’ve got it covered.” But do we really have it covered? Do we really understand this extremely complex multifactorial, multifocal, and multiplanar foot deformity, its risk factors, pathophysiology, deformity components, treatment goals, and expected outcomes? In recent systematic reviews of the literature, Barg et al1 reported that around 10% of HVD patients treated surgically are dissatisfied with the results of the surgical treatment, and Lalevee et al6 demonstrated that the postoperative recurrence rate of the deformity is as high as 64% after a minimum follow-up of 5 years. The truth is that we cannot really treat accurately things that we do not completely understand. Hallux valgus is a 3-dimensional (3D) multifaceted deformity that can involve multiple tarsal joints in the hindfoot, midfoot, and forefoot, as well as a multitude of soft tissue imbalances. Currently, the interpretation, staging, and surgical treatment planning of HVD for most foot and ankle surgeons are performed using physical examination findings and 2-dimensional (2D) conventional radiographic assessment. This traditional assessment limits the 3D interpretation of the deformity and the multiple involved factors, such as the rotational profile of the first ray, metatarsal-sesamoid interaction, and anatomical characteristics of bones and joints. The study by Ji et al4 in the current issue of FAI supports the critical transition from a 2D to a 3D assessment of HVD. The authors compared anatomical features of the first tarsometatarsal joint (1stTMTJ), particularly the shape of the articular surface of the proximal first metatarsal (M1), between HVD patients and controls using weightbearing CT (WBCT) imaging and 3D bone modeling. They identified 4 distinct anatomical features for the proximal M1 articular surface: continuous-flat, separated-flat, continuous-protruded, and separated-protruded. The continuous-flat morphology was significantly more prevalent in HVD patients than in controls (74.4% vs 16.5%). In comparison, the separated-protruded shape was significantly more prevalent in the control population when compared to HVD patients (48.1% vs 4.3%). They also found that patients with a flat proximal M1 configuration also demonstrated significantly increased hallux valgus and intermetatarsal angles. Even though their study cannot guarantee a cause-effect relationship, the interpretation of their findings supports the theory that some people could possibly be predisposed to develop HVD by having a flat and potentially more hypermobile and unstable 1stTMTJ. These concepts are not new and have been proposed before, primarily based on cadaveric, anatomical, and 2D conventional radiographic studies. Doty et al3 also demonstrated in cadaveric specimens with and without HVD that increased 2D radiographic 1stTMTJ angulatio","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 8","pages":"788-789"},"PeriodicalIF":2.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10100254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Broström Repair With and Without Augmentation: Comparison of Outcomes at Median Follow-up of 5 Years.","authors":"Spencer M Comfort,&nbsp;Daniel C Marchetti,&nbsp;Parker P Duncan,&nbsp;Grant J Dornan,&nbsp;C Thomas Haytmanek,&nbsp;Thomas O Clanton","doi":"10.1177/10711007231176806","DOIUrl":"https://doi.org/10.1177/10711007231176806","url":null,"abstract":"<p><strong>Background: </strong>An augmented Broström repair with nonabsorbable suture tape has demonstrated strength and stiffness more similar to the native anterior talofibular ligament (ATFL) compared to Broström repair alone at the time of repair in cadaveric models for the treatment of lateral ankle instability. The study purpose was to compare minimum 2-year patient-reported outcomes (PROs) following treatment of ATFL injuries with Broström repair with vs without suture tape augmentation.</p><p><strong>Methods: </strong>Between 2009 and 2018, patients >18 years old who underwent primary surgical treatment for an ATFL injury with either a Broström repair alone (BR Cohort) or Broström repair with suture tape augmentation (BR-ST Cohort) were identified. Demographic data and PROs, including Foot and Ankle Ability Measure (FAAM) with activities of daily living (ADL) and sport subscales, 12-Item Short Form Health Survey (SF-12), Tegner Activity Scale, and patient satisfaction with surgical outcome, were compared between groups, and proportional odds ordinal logistic regression was used.</p><p><strong>Results: </strong>Ninety-one of 102 eligible patients were available for follow-up at median 5 years. The BR cohort had 50 of 53 patients (94%) completed follow-up at a median of 7 years. The BR-ST cohort had 41 of 49 (84%) complete follow-up at a median of 5 years. There was no significant difference in median postoperative FAAM ADL (98% vs 98%, <i>P</i> = .67), FAAM sport (88% vs 91%, <i>P</i> = .43), SF-12 PCS (55 vs 54, <i>P</i> = .93), Tegner score (5 vs 5, <i>P</i> = .64), or patient satisfaction (9 vs 9, <i>P</i> = .82). There was significantly higher SF-12 MCS (55.7 vs 57.6, <i>P</i> = .02) in the BR-ST group. Eight patients underwent subsequent ipsilateral ankle surgery, of which one patient (BR-ST group) was revised for recurrent lateral ankle instability.</p><p><strong>Conclusion: </strong>At median 5 years, patients treated for ATFL injury of the lateral ankle with Broström repair with suture tape augmentation demonstrated similar patient-reported outcomes to those treated with Broström repair alone.</p><p><strong>Level of evidence: </strong>Level II, retrospective cohort study.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 8","pages":"691-701"},"PeriodicalIF":2.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10102390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Haglund Deformity Size and Insertional Achilles Tendinopathy.","authors":"Wonyong Lee,&nbsp;Margaret Elizabeth Giro,&nbsp;Colt Crymes","doi":"10.1177/10711007231168625","DOIUrl":"https://doi.org/10.1177/10711007231168625","url":null,"abstract":"<p><strong>Background: </strong>We aimed to investigate the effect of Haglund deformity size on insertional Achilles tendinopathy (IAT) using a new measurement system and identify independent risk factors of IAT with Haglund deformity.</p><p><strong>Methods: </strong>We reviewed medical records of patients with IAT and age/sex-matched patients with diagnoses other than Achilles tendinopathy. Radiographs were reviewed to identify posterior heel spur, plantar heel spur, and intra-Achilles tendon calcification, and to measure Fowler-Philip angle, calcaneal pitch angle, and Haglund deformity angle and height. We introduced a new measurement system for Haglund deformity angle and height and evaluated its intraobserver and interobserver reliability. Multivariate logistic regression analysis was performed to identify independent risk factors of IAT with Haglund deformity.</p><p><strong>Results: </strong>Fifty patients (55 feet) were enrolled in the study group, equaling the size of the age/sex-matched control group. The new Haglund deformity measurement system showed excellent intraobserver and interobserver reliability. No significant differences between the 2 groups were noted in Haglund deformity angle and height: 6.0 degrees in both groups, and 3.3 mm vs 3.2 mm in the study and control group, respectively. The study group had significantly higher calcaneal pitch angle, incidence of posterior heel spur, plantar heel spur, and intra-Achilles tendon calcification: 5.2 vs 23.1 degrees (<i>P</i> = .044), 81.8% vs 36.4% (<i>P</i> < .001), 76.4% vs 34.5% (<i>P</i> = .003), and 67.3% vs 5.5% (<i>P</i> < .001), respectively. Multivariate logistic regression analysis identified independent risk factors of IAT: posterior heel spur (OR = 3.650, 95% CI = 1.063, 12.532), intra-Achilles tendon calcification (OR = 55.671, 95% CI = 11.233, 275.905), and increased calcaneal pitch angle (OR = 6.317).</p><p><strong>Conclusion: </strong>Based on our results, the actual size of Haglund deformity as we have reliably measured was not associated with IAT, suggesting a routine Haglund deformity resection may be unnecessary in the surgical treatment of IAT. If patients with Haglund deformity have posterior heel spur, intra-Achilles tendon calcification, or increased calcaneal pitch angle, a higher chance of IAT can be predicted.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 8","pages":"719-726"},"PeriodicalIF":2.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10096701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open Reduction and Internal Fixation of the Posterior Malleolus Fragment in Ankle Fractures Improves the Patient-Rated Outcome: A Systematic Review.","authors":"Rainer Christoph Miksch,&nbsp;Viktoria Herterich,&nbsp;Alexej Barg,&nbsp;Wolfgang Böcker,&nbsp;Hans Polzer,&nbsp;Sebastian Felix Baumbach","doi":"10.1177/10711007231165771","DOIUrl":"https://doi.org/10.1177/10711007231165771","url":null,"abstract":"<p><strong>Background: </strong>The best treatment strategy for fractures to the posterior malleolus (PM) is still intensively debated. The aim of this systematic review was to compare the patient-rated outcome following open reduction and internal fixation (ORIF) for fractures of the PM to either closed reduction using AP screws (CRIF) or no treatment in bi- or trimalleolar ankle fractures.</p><p><strong>Methods: </strong>Systematic literature research (MEDLINE (PubMed), CINAHL, Scopus, Central and EMBASE) according to the PICOS and PRISMA guidelines. Eligible were studies comparing the outcome following ORIF to any other treatment strategy for fractures to the posterior malleolus in isolated bi- or trimalleolar ankle fractures.</p><p><strong>Results: </strong>Twelve studies were eligible for a qualitative analysis and 6 for a quantitative analysis. Overall, a considerable heterogeneity among the studies was observed. The most commonly used outcome score was the American Orthopaedic Foot & Ankle Society ankle-hindfoot score (AOFAS). The final follow-up ranged from 12 to 160 months. Four studies compared ORIF to CRIF of the PM. The quantitative analysis revealed significantly better AOFAS scores for ORIF (90.9 vs 83.4 points; <i>P</i> < .001; <i>I</i>² = 0%). Three studies compared ORIF to untreated PM fragment. The quantitative analysis again revealed superior AOFAS scores for ORIF (92.0 vs 82.5 points; <i>P</i> < .001; <i>I</i>² = 99%). A similar trend was observed for the Ankle Fracture Scoring System and American Academy of Orthopaedic Surgeons Foot and Ankle Questionnaire scores as well as the quality of reduction.</p><p><strong>Conclusion: </strong>Despite a considerable heterogeneity, the data available point to a superior outcome following ORIF for fractures to the PM when compared to CRIF or no treatment.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 8","pages":"727-737"},"PeriodicalIF":2.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c9/4b/10.1177_10711007231165771.PMC10394961.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10098698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concomitant Triceps Surae Lengthening in Total Ankle Arthroplasty Affects the Mechanical Work at the Ankle Joint.","authors":"Paul-André Deleu,&nbsp;Alexandre Naaim,&nbsp;Laurence Chèze,&nbsp;Raphaël Dumas,&nbsp;Bernhard Devos Bevernage,&nbsp;Ivan Birch,&nbsp;Thibaut Leemrijse,&nbsp;Jean-Luc Besse","doi":"10.1177/10711007231176819","DOIUrl":"https://doi.org/10.1177/10711007231176819","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have examined the effect of concomitant triceps surae lengthening on ankle dorsiflexion motion at the time of total ankle arthroplasty (TAA). As plantarflexor muscle-tendon structures are important for producing positive ankle work during the propulsive phase of gait, caution should be exercised when lengthening triceps surae, as it may decrease plantarflexion strength. In order to develop an understanding of the work of the anatomical structures crossing the ankle during propulsion, joint work must be measured. The aim of this explorative study was to assess the effect of concomitant triceps surae lengthening with TAA on the resultant ankle joint work.</p><p><strong>Methods: </strong>Thirty-three patients were recruited to the study and divided into 3 groups of 11. The first group underwent both triceps surae lengthening (Strayer and TendoAchilles) and TAA (Achilles group), the second group underwent only TAA (Non-Achilles group), and the third group underwent only TAA, but had a greater radiographic prosthesis range of motion (Control group) compared to the first 2 groups. The 3 groups were matched in terms of demographic variables and walking speed. All patients underwent a 3D gait analysis 1 year after surgery to measure intersegmental joint work using a 4-segmented kinetic foot model. An analysis of variance (ANOVA) or Kruskal-Wallis test was used to compare the 3 groups.</p><p><strong>Results: </strong>The ANOVA showed significant differences between the 3 groups. Post hoc analyses suggested that (1) the Achilles group had less positive work at the ankle joint than the Non-Achilles and Control groups; (2) the Achilles group produced less positive work performed by all foot and ankle joints than the Control group; and (3) the Achilles and Non-Achilles groups absorbed less energy across all foot and ankle joints during the stance phase than the Control group.</p><p><strong>Conclusion: </strong>Concomitant triceps surae lengthening in TAA may reduce the positive work at the ankle joint.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 8","pages":"754-762"},"PeriodicalIF":2.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10097196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biokinetic Evaluation of Hallux Valgus during Gait: A Systematic Review.","authors":"Dov Lagus Rosemberg,&nbsp;Jonathan A Gustafson,&nbsp;Glaucia Bordignon,&nbsp;Daniel D Bohl,&nbsp;Gustavo Leporace,&nbsp;Leonardo Metsavaht","doi":"10.1177/10711007231166667","DOIUrl":"https://doi.org/10.1177/10711007231166667","url":null,"abstract":"Background: Foot pathologies can affect the kinetic chain during gait, leading to altered loading at other joints that can lead to subsequent pathologies. Although hallux valgus is the most common foot disease, little has been discussed about the biokinetic effects of hallux valgus on the foot and lower limb. This systematic review evaluated the kinematic, kinetic, and pedobarographic changes of the hallux valgus foot compared to a healthy one. Methods: Several electronic databases were searched up to January 2022, including only cross-sectional studies with clearly defined isolated hallux valgus diseases and healthy groups. Two investigators independently rated studies for methodological quality using the NIH Study Quality Assessment Tool for cross-sectional studies. Kinetic data were extracted, including temporal data, kinematics of the foot joint, kinematics of the proximal lower limb, and pedobarography. We did meta-analyses tests with a random effects model using the metafor package in R. Results: Hallux valgus patients walk slower compared to a disease-free control group −0.16 m/s (95% CI −0.27, −0.05). Hallux valgus patients exhibited significantly reduced coronal plane motion of the hindfoot-shank during preswing 1.16 degrees (95% CI 0.31, 2.00). Hallux valgus patients generated less force in the hallux region 33.48 N (95% CI 8.62, 58.35) but similar peak pressures in the hallux compared to controls. Hallux valgus patients generated less peak pressure at the medial and lateral hindfoot as compared to controls: 8.28 kPa (95% CI 2.92, 13.64) and 8.54 kPa (95% CI 3.55, 13.52), respectively. Conclusion: Although hallux valgus is a deformity of the forefoot, the kinematic changes due to the pathology are associated with significant changes in the range of motion at other joints, underscoring its importance in the kinetic chain. This is demonstrated again with the changes of peak pressure. Nevertheless, more high-quality studies are still needed to develop a fuller understanding of this pathology.","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 8","pages":"763-777"},"PeriodicalIF":2.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10099501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}