Foot & Ankle International最新文献

{"title":"Blade Plate With Autogenous Bone Grafting to Salvage Peri Ankle Nonunions.","authors":"Mees Paulus Emmelot,&nbsp;Robert Kaspar Wagner,&nbsp;Stein Jasper Janssen,&nbsp;Peter Kloen","doi":"10.1177/10711007231165303","DOIUrl":"https://doi.org/10.1177/10711007231165303","url":null,"abstract":"<p><strong>Background: </strong>Salvage surgery for a nonunion around the ankle is challenging. Poor bone stock, stiffness, scarring, previous (or persistent) infection, and a compromised soft tissue envelope are common in these patients. We describe 15 cases that underwent blade plate fixation as salvage for a nonunion around the ankle, including patient/nonunion characteristics, Nonunion Scoring System (NUSS), surgical technique, healing rate, complications, and long-term follow-up with 2 patient-reported outcome measures.</p><p><strong>Methods: </strong>This is a retrospective case series from a level 1 trauma referral center. We included all patients that underwent blade plate fixation for a long-standing nonunion of the distal tibia, talus, or failed subtalar fusion. All patients had autogenous bone grafting, including 14 with posterior iliac crest grafts and 2 with femoral reamer irrigator aspirator grafting. Median follow-up was 24.4 months (interquartile range [IQR], 7.7-40). Main outcome measures were (time to) union, and functional outcomes using the 36-item Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary (MCS), and the Foot and Ankle Outcome Score (FAOS).</p><p><strong>Results: </strong>We included 15 adults with a median age of 58 years (IQR, 54-62). The median NUSS score at the time of index surgery was 46 (IQR, 34-54). Union was achieved after the index procedure in 11 of 15 patients. Additional surgery was performed in 4 of 15 patients. Union was achieved in all patients at a median of 4.2 months (IQR, 2.9-11). The median score for the PCS was 38 (IQR, 34-48, range 17-58, <i>P</i> = .009), for the MCS 52 (IQR, 45-60, range 33-62, <i>P</i> = .701), and for the FAOS 73 (IQR, 48-83).</p><p><strong>Conclusion: </strong>In this series, our use of blade plate fixation with autogenous grafting was an effective method for managing a nonunion around the ankle allowing for alignment correction, stable compression and fixation, union, and fair patient-reported outcome scores.</p><p><strong>Level of evidence: </strong>Level IV, therapeutic.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 6","pages":"516-527"},"PeriodicalIF":2.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10248309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10472896","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":"Contemporary Review: An Overview of the Utility of Patient-Reported Outcome Measurement Information System (PROMIS) in Foot and Ankle Surgery.","authors":"Natalia Czerwonka,&nbsp;Sohil S Desai,&nbsp;Emily Arciero,&nbsp;Justin Greisberg,&nbsp;David P Trofa,&nbsp;Bonnie Y Chien","doi":"10.1177/10711007231165752","DOIUrl":"https://doi.org/10.1177/10711007231165752","url":null,"abstract":"<p><p>Patient-Reported Outcome Measurement Information System (PROMIS) has favorable psychometric and administrative properties in orthopaedic clinical research. It facilitates clinically meaningful data collection while minimizing administration time and survey fatigue and improving compliance. PROMIS is a critical component of patient-centered care and shared decision making, as it provides enhanced communication and engagement between patients and providers. As a validated instrument, it may also aid in measuring value-based health care quality. The goal of the current work is to provide an overview of PROMIS metrics used in orthopaedic foot and ankle, including advantages and disadvantages compared to legacy scales and PROMIS's applicability in specific foot and ankle conditions based on psychometric properties. We provide a review of the literature regarding the utilization of PROMIS as an outcome measure for specific foot and ankle procedures and conditions.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 6","pages":"554-564"},"PeriodicalIF":2.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10472897","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":"FAI/FAO Social Media Presence and Introduction to Visual Abstract Opportunities.","authors":"Glenn G Shi,&nbsp;Adam D Bitterman,&nbsp;Cesar de Cesar Netto,&nbsp;Lauren E Geaney,&nbsp;Jonathan R M Kaplan,&nbsp;Ettore Vulcano,&nbsp;Charles L Saltzman","doi":"10.1177/10711007231171824","DOIUrl":"10.1177/10711007231171824","url":null,"abstract":"Today, social media has become an essential part of our lives. Platforms like Facebook, Twitter, Instagram, and LinkedIn have opened up new avenues for communication, marketing, and promotion. Social media is not just a tool for personal use. It is a powerful tool for professionals to promote their products and services worldwide. Authors published in Foot & Ankle International and Foot & Ankle Orthopaedics have an opportunity to allow their research to reach beyond those who regularly read these journals. This letter will outline our reasons for how social media can promote your publication and provide a new opportunity for authors to create a visual representation of their research for use in the social media world. First, social media platforms have a massive user base. According to Statista, as of 2021, Facebook has over 2.8 billion monthly active users; Instagram has over 1 billion monthly active users; and Twitter has over 330 million monthly active users. By using social media to promote your publication, you can reach a vast audience. With such a large audience, you can draw attention from specific demographics such as practicing orthopaedic surgeons, residents, and students to ensure that the publication reaches greater visibility. Second, social media is a cost-effective way to promote your publication. Although traditional forms of advertising, such as print and TV, can be very expensive and slow, social media advertising is relatively cheaper and faster. With @ AOFAS_Journals, we can reach out to thousands of followers who are interested in our publications. Also, social media allows us to track performance in real time. Third, social media can help authors build a brand identity. By creating a social media presence for your publications, you can establish a brand identity that resonates with a key target audience—our colleagues. For example, by creating a consistent voice, visual style, and messaging, you can create a brand identity that represents your research group’s research interests, values, and mission. Over time, this brand identity can help your publication stand out. Last, social media can help you engage with your audience. Social media platforms offer many tools for engagement, such as comments, likes, shares, and direct messages. By responding to comments and messages, you can show the audience that you value their feedback and opinions. Moreover, social media allows for the creation of polls and surveys that can help you quickly connect with other colleagues. Platforms are a quick way to create a sense of community and encourage dialogue. Social media has become an integral part of our society regardless of our opinions of it. Promoting your publication through these platforms is a smart and effective way to reach a large audience, build a brand identity, and engage with your readers. By leveraging the power of social media, you can improve your publication’s visibility and awareness in this digital age. We invite futur","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 6","pages":"479-480"},"PeriodicalIF":2.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9949918","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":"Does Patient-Reported Outcome Measures Use at New Foot and Ankle Patient Clinic Visits Improve Patient Activation, Experience, and Satisfaction?","authors":"David N Bernstein,&nbsp;Courtney M C Jones,&nbsp;A Samuel Flemister,&nbsp;Benedict F DiGiovanni,&nbsp;Judith F Baumhauer","doi":"10.1177/10711007231163119","DOIUrl":"https://doi.org/10.1177/10711007231163119","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported outcome measures (PROMs) can help predict clinical outcomes and improve shared clinical decision-making discussions. There remains a paucity of research assessing how the use of PROMs may drive improved patient experience and patient activation.</p><p><strong>Methods: </strong>New foot and ankle patients completed PROMIS physical function (PF), pain interference (PI), and depression assessments. Patients were then randomized to viewing and discussing their PROMIS scores with their surgeon or not. Following the clinic visit, patients completed a series of Clinician & Group Survey-Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) questions and the Patient Activation Measure (PAM). Responses to the CG-CAHPS questions and PAM were compared between the 2 groups and after clustering on surgeon. Potential interaction effects by social deprivation were also explored.</p><p><strong>Results: </strong>After enrolling patients but removing those lost to follow-up or with missing data, 97 and 116 patients remained in the intervention control cohorts, respectively. No difference was found in CG-CAHPS responses nor PAM scores between the 2 groups (<i>P</i> > .05). All surgeons were highly rated by all patients. When clustered by surgeon, intervention subjects were less likely to indicate \"top box\" scores for the understanding domain of the CG-CAHPS question (OR 0.51, <i>P</i> < .001) and had decreased odds of high patient activation compared to control subjects (OR 0.67; <i>P</i> = .005). Among the most socially disadvantaged patients, there was no difference in control and intervention subjects in their likelihood of having high patient activation (<i>P</i> = .09).</p><p><strong>Conclusion: </strong>Highly rated foot and ankle surgeons who show and discuss PROM results may not improve patient experience or activation and may, in fact, decrease understanding or patient activation in select populations. Future work is needed to determine when PROM discussions are most beneficial and how best to present PROMs data, as we suspect that how the information was presented-and not the use of PROMs-resulted in our findings. Health literacy tools and/or communication training may better engage different patient groups regarding PROMs.</p><p><strong>Level of evidence: </strong>Level I, randomized controlled trial.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 6","pages":"481-487"},"PeriodicalIF":2.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10453525","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":"Outcomes Following Repair of Achilles Midsubstance Tears: Percutaneous Knotless Repair vs Open Repair.","authors":"Ingrid K Stake,&nbsp;Lauren M Matheny,&nbsp;Spencer M Comfort,&nbsp;Grant J Dornan,&nbsp;C Thomas Haytmanek,&nbsp;Thomas O Clanton","doi":"10.1177/10711007231160998","DOIUrl":"https://doi.org/10.1177/10711007231160998","url":null,"abstract":"<p><strong>Background: </strong>Optimum treatment for acute Achilles tendon rupture results in high mechanical strength, low risk of complications, and return to preinjury activity level. Percutaneous knotless repair is a minimally invasive technique with promising results in biomechanical studies, but few comparison clinical studies exist. Our study purpose was to compare functional outcomes and revision rates following acute Achilles tendon rupture treated between percutaneous knotless repair and open repair techniques.</p><p><strong>Methods: </strong>Patients 18 years or older with an acute Achilles tendon rupture, treated by a single surgeon with either open repair or percutaneous knotless repair, and more than 2 years after surgery were assessed for eligibility. Prospective clinical data were obtained from the data registry and standard electronic medical record. Additionally, the patients were contacted to obtain current follow-up questionnaires. Primary outcome measure was Foot and Ankle Ability Measure (FAAM) activities of daily living (ADL). Secondary outcome measures were FAAM sports, 12-Item Short Form Health Survey (SF-12), Tegner activity scale, patient satisfaction with outcome, complications, and revisions. Postoperative follow-up closest to 5 years was used in this study.</p><p><strong>Results: </strong>In total, 61 patients were included in the study. Twenty-four of 29 patients (83%) in the open repair group and 28 of 32 patients (88%) in the percutaneous knotless repair group completed the questionnaires with average follow-up of 5.8 years and 4.2 years, respectively. We found no significant differences in patient-reported outcomes or patient satisfaction between groups (FAAM ADL: 99 vs 99 points, <i>P</i> = .99). Operative time was slightly longer in the percutaneous knotless repair group (46 vs 52 minutes, <i>P</i> = .02). Two patients in the open group required revision surgery compared to no patients in the percutaneous group.</p><p><strong>Conclusion: </strong>In our study, we did not find significant differences in patient-reported outcomes or patient satisfaction by treating Achilles tendon midsubstance ruptures with percutaneous knotless vs open repair.</p><p><strong>Level of evidence: </strong>Level IlI, retrospective cohort study.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 6","pages":"499-507"},"PeriodicalIF":2.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10090895","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":"Factors Associated With Nonunion in Arthrodesis of the First Metatarsophalangeal Joint: A Multicenter Retrospective Cohort Study.","authors":"Wout Füssenich,&nbsp;Gesine H Seeber,&nbsp;Tom M van Raaij,&nbsp;Christiaan P van Lingen,&nbsp;Rutger G Zuurmond,&nbsp;Martin Stevens,&nbsp;Matthijs P Somford","doi":"10.1177/10711007231160754","DOIUrl":"https://doi.org/10.1177/10711007231160754","url":null,"abstract":"<p><strong>Background: </strong>Arthrodesis of the first metatarsophalangeal joint is the current treatment of choice for symptomatic advanced hallux rigidus and moderate-to-severe hallux valgus. There are different methods to perform arthrodesis, yet no consensus on the best approach. Therefore, this study aimed to determine the effects of preoperative and postoperative hallux valgus angle (HVA), joint preparation and fixation technique, and postoperative immobilization on the incidence of nonunion.</p><p><strong>Methods: </strong>A retrospective multicenter cohort study was performed that included 794 patients. Univariate and multiple logistic regression was conducted to determine associations between joint preparation, fixation techniques, postoperative immobilization, weightbearing, and pre- and postoperative HVA with nonunion.</p><p><strong>Results: </strong>Nonunion incidence was 15.2%, with 11.1% symptomatic and revised. Joint preparation using hand instruments (OR 3.75, CI 1.90-7.42) and convex/concave reamers (OR 2.80, CI 1.52-5.16) were associated with greater odds of a nonunion compared to planar cuts. Joint fixation with crossed screws was associated with greater odds of nonunion (OR 2.00, CI 1.11-3.42), as was greater preoperative HVA (OR 1.02, CI 1.00-1.03). However, the latter effect disappeared after inclusion of postoperative HVA in the model, with a small association identified between residual postoperative HVA and nonunion (OR 1.04, CI 1.01-1.08). Similarly, we found an association between odds of nonunion and higher body weight (OR 1.02, CI 1.01-1.04) but not of body mass index.</p><p><strong>Conclusion: </strong>Based on our results, first metatarsophalangeal joint arthrodesis with planar cuts and fixation with a plate and interfragmentary screw is associated with the lowest odds of resulting in a nonunion. Higher body weight and greater preoperative HVA were associated with slight increase in rates of nonunion. It is crucial to properly correct the hallux valgus deformity during surgery.</p><p><strong>Level of evidence: </strong>Level III, retrospective case control study.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 6","pages":"508-515"},"PeriodicalIF":2.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/64/0c/10.1177_10711007231160754.PMC10248293.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10089241","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":"Three-Dimensional Analysis of the Windlass Mechanism Using Weightbearing Computed Tomography in Healthy Volunteers.","authors":"Takumi Kihara,&nbsp;Tadashi Kimura,&nbsp;Mitsuru Saito,&nbsp;Naoki Suzuki,&nbsp;Asaki Hattori,&nbsp;Makoto Kubota","doi":"10.1177/10711007231161011","DOIUrl":"https://doi.org/10.1177/10711007231161011","url":null,"abstract":"<p><strong>Background: </strong>The windlass mechanism (WM) increases the longitudinal arch of the foot via tension of the plantar aponeurosis during dorsiflexion of the metatarsophalangeal (MTP) joint. The purpose of this study was to perform a 3-dimensional evaluation of the displacement of each joint and the height of the navicular during dorsiflexion of the first MTP joint by using weightbearing computed tomography (CT).</p><p><strong>Methods: </strong>Participants were 6 men and 8 women with 23 healthy feet. CT of the foot with a load equivalent to the participant's body weight was performed. The first MTP joint was in the neutral position and dorsiflexed 30 degrees. Between the conditions, we measured the (1) rotation of each bone, (2) rotation of the distal bone with respect to the proximal bone at each joint, and (3) height of the navicular.</p><p><strong>Results: </strong>With respect to the tibia, the calcaneus was at 0.8 ± 0.7 degrees dorsiflexion and 1.4 ± 0.9 degrees inversion, while the talus was at 2.0 ± 1.2 degrees dorsiflexion and 0.1 ± 0.8 degrees eversion. The navicular was at 1.3 ± 1.2 degrees dorsiflexion and 3.2 ± 2.1 degrees inversion, whereas the medial cuneiform was at 0.3 ± 0.6 degrees plantarflexion and 1.3 ± 1.1 degrees inversion. At the talonavicular joint, the navicular was at 0.7 ± 1.3 degrees plantarflexion, whereas at the cuneonavicular joint, the medial cuneiform bone was at 1.4 ± 1.4 degrees plantarflexion. The height of the navicular increased by 1.1 ± 0.6 mm.</p><p><strong>Conclusion: </strong>We 3-dimensionally confirmed the dynamics of WM and found that the calcaneus, navicular, and medial cuneiform moved in all 3 planes. The results suggest that the cuneonavicular joint has the greatest movement among the joints. We believe that these findings will help to elucidate the pathogenesis of WM-related diseases and lead to advances in treatments for pathologies involving the longitudinal arch.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 6","pages":"545-553"},"PeriodicalIF":2.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10472357","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":"Management of Anxiety for Ambulatory Hallux Valgus Surgery With a Virtual Reality Hypnosis Mask: Randomized Controlled Trial.","authors":"Grégoire Rougereau,&nbsp;Marie Hélène Sandiford,&nbsp;Robin Lévêque,&nbsp;Christophe Ménigaux,&nbsp;Thomas Bauer,&nbsp;Alexandre Hardy","doi":"10.1177/10711007231162816","DOIUrl":"https://doi.org/10.1177/10711007231162816","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to evaluate the impact of using virtual reality masks for the management of preoperative anxiety and its impact on postoperative and predischarge anxiety as well as postoperative analgesia during outpatient hallux valgus surgery.</p><p><strong>Methods: </strong>From June 2020 to September 2021, preoperative anxiety of patients scheduled for a percutaneous hallux valgus surgery were analyzed using the State Trait Anxiety Inventory (STAI) questionnaire completed during the consultation. All patients with major anxiety, defined as a STAI score above 40, were included in a randomized prospective comparative single-center study. Sixty patients were included in the study and randomized into 2 arms of 30 patients according to whether or not they underwent a preoperative hypnosis session with a virtual reality mask before surgery.</p><p><strong>Results: </strong>There was an improvement in the postoperative (42.5 vs 45.2, <i>P</i> < .04) and predischarge (25.3 vs 30.2 <i>P</i> < .03) anxiety scores in the group that used the mask before the procedure. There was a notable decrease in immediate higher-level postoperative analgesics such as morphine or ketamine (3.3% vs 26.6%, <i>P</i> < .03) in the arm using the mask.</p><p><strong>Conclusion: </strong>In this study cohort undergoing percutaneous hallux valgus surgery, we found that use of a virtual reality hypnosis mask before surgery modestly reduced postoperative and predischarge anxiety as well as early postoperative consumption of higher-level analgesics in adults with significant preoperative anxiety.</p><p><strong>Level of evidence: </strong>Level II, prospective cohort study.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 6","pages":"539-544"},"PeriodicalIF":2.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10099953","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":"Which Way Should We Treat an Osteochondral Lesion: Up or Down?","authors":"Richard D Ferkel","doi":"10.1177/10711007231170869","DOIUrl":"https://doi.org/10.1177/10711007231170869","url":null,"abstract":"The treatment of an osteochondral lesion of the talus (OLT) can be challenging and the results are not always predictable long-term. The literature can be confusing regarding the best treatment method, especially in an osteochondral lesion with an adjoining cyst.10 In this issue, Huber et al6 have described their results utilizing retrograde drilling, ossoscopy, and autologous bone grafting of osteochondral lesions of the talus. This technique was used in 24 patients, with the largest lesion 1.4-cm2 with a mean follow-up of 89 months. The American Orthopaedic Foot & Ankle Society (AOFAS) and pain value scores were significantly improved. The use of retrograde (also called transtalar) drilling and bone grafting is not a new procedure. It was described in detail in 1996.4 In addition, Guhl et al5 mentioned the procedure in their third edition of Foot and Ankle Arthroscopy. Technically, this is not an easy operation. There are a number of potential problems and pitfalls: (1) the guidepin can broach the articular cartilage or wander out of the correct zone of the OLT; (2) the drill can cause thermal damage to the surrounding bone and cartilage and be too aggressive; (3) insertion of the bone graft and excision of the cyst can be challenging and excess bone can end up in the subtalar joint; and (4) the procedure requires careful arthroscopic and fluoroscopic evaluation to do correctly. Kennedy et al7 injected a viscous calcium sulfate paste retrograde up into the talus, to improve cyst fill and hasten weight bearing. They reported a significant improvement in AOFAS scores and a 68% partial or complete resolution on magnetic resonance imaging. Anders et al1 described fluoroscopy-guided retrograde core drilling and insertion of bone graft in 41 patients with an osteochondral lesion of the talus. The results were better with intact cartilage. Huber et al6 have provided us with further evidence of the validity of retrograde drilling of cystic OLT and insertion of autologous bone graft. However, further questions remain in our struggle to treat these difficult lesions. In our experience of treating thousands of cases of osteochondral lesions of the talus, there is only a small percentage that are amenable to this specific treatment. Most osteochondral lesions that are encountered are unstable or have diseased cartilage covering the bone that needs to be removed and cannot be left intact. However, the pediatric patient with an osteochondral lesion is especially amenable to retrograde drilling treatment, even if no cyst exists, because frequently their osteochondral lesion has an intact cartilage that should not be violated.2,3 Also, CT/MRI stage 4 lesions can be treated with retrograde drilling to avoid injuring the cartilage with transmalleolar drilling. In addition, it is important to remember this technique should only be used in lesions sized approximately 1.0 to 1.4 cm2 or smaller.8 Huber et al6 have shown the technique and utility of retrograde drilli","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 6","pages":"497-498"},"PeriodicalIF":2.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10099207","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":"Education Calendar.","authors":"","doi":"10.1177/10711007231180255","DOIUrl":"https://doi.org/10.1177/10711007231180255","url":null,"abstract":"","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 6","pages":"574"},"PeriodicalIF":2.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9574259","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}