Foot & ankle international最新文献

{"title":"MRI Evaluation of Ligamentous Injury in Weightbearing-Stable Suprasyndesmotic Ankle Fractures: A Prospective Observational Study.","authors":"Ola Saatvedt, Håvard Furunes, Peter Franz Schubert, Øyvind Fidje, Marius Molund","doi":"10.1177/10711007251352549","DOIUrl":"https://doi.org/10.1177/10711007251352549","url":null,"abstract":"<p><strong>Background: </strong>Suprasyndesmotic ankle fractures (Weber C) account for approximately 10% of ankle fractures, and surgery is advised because of the assumed unstable nature of these injuries. Treatment of transsyndesmotic ankle fractures (Weber B) has evolved as weightbearing radiographs are employed as a modality to evaluate ankle joint stability. Joint congruency on weightbearing radiographs indicate sufficient ligamentous integrity to allow for nonoperative treatment. However, no studies have evaluated the ligamentous injury patterns in suprasyndesmotic ankle fractures with a congruent ankle joint on weightbearing radiographs. This study investigates the ligamentous injuries in patients with suprasyndesmotic fractures of uncertain stability that reduce on weightbearing radiographs, aiming to provide further insight into the ligamentous injury patterns of these injuries.</p><p><strong>Methods: </strong>A prospective cohort study was conducted from October 2023 to August 2024, involving patients with suprasyndesmotic ankle fractures. Eligible patients underwent weightbearing radiographs, and if no medial clear space widening was noted, magnetic resonance imaging (MRI) examination was conducted. MRI results were analyzed for the integrity of the deltoid and syndesmotic ligament complexes to describe ligament injury patterns rather than guide treatment decisions. Weightbearing radiographs at 2-week, 6-week, and 6-12-month follow-up were evaluated for joint congruency and fracture healing. No clinical outcomes were assessed.</p><p><strong>Results: </strong>Twenty patients were included in the final analysis. The majority of participants exhibited a complete rupture of the anterior inferior tibiofibular ligament and interosseous ligament. Low frequency of complete rupture of the posterior inferior syndesmotic ligament (PITFL) and the deep posterior tibiotalar ligament (dPTTL) of the deltoid complex was evident. The majority of patients demonstrated a congruent ankle joint on the 6-12-month follow-up weightbearing radiographs, with 14 of 15 showing joint congruency. One patient treated nonoperatively demonstrated widening of the medial clear space at the 6-12-month follow-up.</p><p><strong>Conclusion: </strong>In this small observational study, suprasyndesmotic ankle fractures that demonstrated congruency on weightbearing radiographs often exhibited an intact or partially ruptured PITFL and dPTTL, when evaluated with MRI. Clinical relevance of these findings remains uncertain without outcome data.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007251352549"},"PeriodicalIF":2.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implant Survivorship and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using a Modular Revision System.","authors":"Justin J Ray, William B Haynes, G Dillon Graham, Samuel E Ford, Carroll P Jones, Bruce E Cohen, W Hodges Davis, Robert B Anderson","doi":"10.1177/10711007251352529","DOIUrl":"https://doi.org/10.1177/10711007251352529","url":null,"abstract":"<p><strong>Background: </strong>With the growing popularity of total ankle arthroplasty (TAA), there is an expectation that revision surgeries will increase. However, limited data exist on revision TAA outcomes using a revision-specific implant. The INVISION Total Ankle Revision System is a modular revision implant (Wright Medical Group/Stryker). The purpose of this study was to report implant survivorship, complications, and radiographic and clinical outcomes of revision TAA using the INVISION system at a minimum 2-year follow-up.</p><p><strong>Methods: </strong>A retrospective review was conducted of 27 patients that underwent a revision TAA using the INVISION implant at a single institution with minimum 2-year follow-up between 2016 and 2020. Implant survivorship was the primary outcome. Demographics, complications, reoperation, and radiographic and clinical outcomes were recorded.</p><p><strong>Results: </strong>Implant survivorship was 81.5% (22/27) at a mean of 3.6 years following revision TAA using the INVISION implant. There was evidence of aseptic loosening in 3 patients and talar subsidence in 4 patients on final radiographs. Reoperation rate at final follow-up was 40.7%, most commonly for aseptic loosening (n = 3), septic TAA (n = 2), or gutter impingement (n = 2). The mean American Orthopaedic Foot & Ankle Society (AOFAS) total score was 54.5, Foot and Ankle Ability Measure (FAAM) activities of daily living (ADL) subscale score was 52.9, and FAAM Sports was 31.0.</p><p><strong>Conclusion: </strong>Revision TAA using the INVISION implant demonstrated 81.5% implant retention at a mean of 3.6 years in this complex cohort. Patient-reported outcomes were lower than those reported after primary TAA. Physicians and patients should recognize that revision TAA remains a challenging procedure with a high rate of complications and reoperations.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007251352529"},"PeriodicalIF":2.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Specific Instrumentation Does Not Improve Alignment Compared to the Extramedullary Foot Holder for the INBONE II Total Ankle Arthroplasty.","authors":"Charlotte H Jones, Allison Boden, Patricia Friedmann, Suzy Wang, Ricardo Villar, Constantine Demetracopoulos, Jonathan Deland, Elizabeth Cody, Matthew S Conti, Jensen K Henry, Scott J Ellis","doi":"10.1177/10711007251353787","DOIUrl":"https://doi.org/10.1177/10711007251353787","url":null,"abstract":"<p><strong>Background: </strong>Patient-specific instrumentation (PSI) was developed to improve accuracy and efficiency in implant placement for total ankle arthroplasty (TAA). This study represents the first to measure the accuracy of PSI regarding implant alignment and implant size in the INBONE II total ankle system (Stryker). A secondary goal was to compare radiographic and clinical outcomes between the PSI and that of a matched group of implants performed with standard instrumentation.</p><p><strong>Methods: </strong>This retrospective study of 92 patients (46 PSI and 46 non-PSI cases matched by age and sex) was performed at a single institution between 2006 and 2024, including TAA patients with INBONE II implants. Median age was 61 years (range 27-81). Median body mass index (BMI) was 29.6 (range 19.9-45.6). One surgeon performed 71% of PSI. A different surgeon performed 96% of non-PSI cases. PSI alignment (tibiotalar angle [TTA]), deformity correction (talar-tilt [TT]), radiation exposure, tourniquet, and operative time were compared to the standard jig method (non-PSI). Total fluoroscopy, tourniquet and procedure time, and preoperative and postoperative radiographs were analyzed.</p><p><strong>Results: </strong>PSI predicted the correct size in 67% (n = 31) of talus implants and 89% (n = 41) of tibial implants. Median absolute deviation in the mortise view was 1.3 (IQR 0.53-2.18) and 1.8 (IQR 1.35-3.5) in the lateral view. For both groups, postoperative median TTA deviation was less than 2 degrees and postoperative median TT was less than or equal to 1 degree. Median fluoroscopic time was 92.1 seconds for PSI and 104.3 seconds for non-PSI. PSI had a longer tourniquet (156.5 vs 134.5 minutes) and procedure time (188 vs 161 minutes) compared with non-PSI.</p><p><strong>Conclusion: </strong>In this study of stemmed TAA implants, surgeons achieved alignment generally consistent with PSI predictions. PSI adequately predicted implant size. For most cases, PSI achieved similar alignment and correction of deformity compared with standard instrumentation. PSI did not improve radiographic alignment compared with traditional instrumentation and was associated with longer operative times, possibly reflecting the primary surgeon's early experience with the technique. Each surgeon should select PSI or the standard jig based on their experience and preference.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007251353787"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Risk to Articular Cartilage and the Calcaneofibular Ligament During Fibular Nailing: A Cadaveric Study.","authors":"Hirbod Abootalebi, William Mayer, Erin Bigney, Siyum Mohiuddin, Xiuming Shi, Madeline Power, Jacob Matz","doi":"10.1177/10711007251351314","DOIUrl":"https://doi.org/10.1177/10711007251351314","url":null,"abstract":"<p><strong>Background: </strong>Traditional surgical fixation of ankle fractures with plates and screws carries risks such as wound complications, hardware prominence, and soft tissue irritation. Intramedullary (IM) fibular nailing provides a minimally invasive alternative with potentially lower complication rates. Although prior studies have examined the risk posed by fibular nailing to the peroneal tendons and nerves, data remained limited regarding its impact on other adjacent structures especially the calcaneofibular ligament (CFL) and the articular cartilage of the distal fibula, structures whose injury could contribute to joint instability, persistent pain, or degenerative change.</p><p><strong>Methods: </strong>This study assessed the risk and extent of damage to anatomical structures during IM nail fixation on 10 cadaveric lower extremities. Risks were categorized based on distances from the nail to the CFL, anterior talofibular ligament (ATFL), sural nerve (SN), superficial peroneal nerve (SPN), peroneus longus, peroneus brevis (PB), and articular cartilage: high-risk (0-5 mm), moderate-risk (5.1-10 mm), or low-risk (>10 mm).</p><p><strong>Results: </strong>Macroscopic evaluation identified the CFL, ATFL, and PB as high-risk structures. The CFL was damaged in 3 of 10 specimens, ranging from 14% to 64% of its width. The average distances to the CFL (1.20 mm), ATFL (3.43 mm), PB (3.19 mm), and articular cartilage (3.45 mm) fell in the high-risk range, although no significant damage was observed to the articular cartilage, ATFL, SN, or SPN.</p><p><strong>Conclusion: </strong>This study further confirms that IM fibular nailing is a generally safe and reliable option for treating ankle fractures. However, attention should be given to the potential for iatrogenic damage to high-risk soft-tissue structures, particularly the CFL and peroneal tendons. Although cartilage was always spared in this cadaveric study, its proximity warrants surgical caution.</p><p><strong>Clinical relevance: </strong>These findings clarify the soft tissue risks associated with IM nailing and may provide guidance for orthopaedic surgeons and patient discussions, emphasizing the importance of proper technique to preserve soft tissues.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007251351314"},"PeriodicalIF":0.0,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the Side Matter? Medial vs Lateral Ankle Dorsiflexion Measurements During the Silfverskiöld Test in Children.","authors":"Suki Liyanarachi, Cecilie Jansen Basma, Olav Andreas Foss, Christian Reidar Øye, Ketil Jarl Holen, Håkon Langvatn","doi":"10.1177/10711007251351317","DOIUrl":"https://doi.org/10.1177/10711007251351317","url":null,"abstract":"<p><strong>Background: </strong>Isolated gastrocnemius tightness is associated with several foot conditions. The Silfverskiöld test examines for such tightness, and when assessing passive ankle dorsiflexion it is important to perform the examination with the proper technique. Several studies have reported reproducible examination techniques, yet none, to our knowledge, have evaluated whether measurement side-medial or lateral-affects dorsiflexion values. Understanding measurement consistency is crucial for clinical practice and research standardization. We have undertaken a study investigating whether this is of importance and assessed the repeatability of ankle dorsiflexion measurements.</p><p><strong>Methods: </strong>We performed an exploratory cross-sectional examination of 145 pediatric patients (290 feet) with a 2-person 2-hand Silfverskiöld test. Masked, repeated goniometric measurements were undertaken along both the medial and lateral axis of the leg and foot.</p><p><strong>Results: </strong>There was a small systematic difference between medial and lateral measurements where lateral measurements were on average almost 2 degrees more in equinus. The repeatability coefficient for all repeated measurements ranged from 5.1 to 5.5 degrees. The intraclass correlation coefficient between medial and lateral measurements was excellent (ICC = 0.97).</p><p><strong>Conclusion: </strong>We found a small systematic difference of 2 degrees between medial and lateral measurements that was less than the repeatability coefficient. The repeatability coefficient was 5 degrees, meaning that for ankle dorsiflexion measurements it is unlikely that a second measurement will differ more than 5 degrees. We do not believe that the statistically significant small difference between medial and lateral measurements is clinically relevant; however, it makes sense to consistently measure ankle dorsiflexion on either the medial or lateral side.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007251351317"},"PeriodicalIF":0.0,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Porcine Pilon Fractures Result in Significant Chondrocyte Cell Death on Both Sides of the Tibiotalar Joint.","authors":"Graham J DeKeyser, Tyler J Thorne, Aaron Olsen, Justin M Haller","doi":"10.1177/10711007251341310","DOIUrl":"https://doi.org/10.1177/10711007251341310","url":null,"abstract":"<p><strong>Background: </strong>The development of posttraumatic osteoarthritis after intra-articular fracture (IAF) of the tibial plafond is multifactorial and complex. The purpose of this study was to evaluate chondrocyte cell death at various areas of the ankle plafond in a high-energy and low-energy porcine pilon fracture model.</p><p><strong>Methods: </strong>Fifteen pilon ankle fractures were created in porcine hindlimbs using a validated large-animal IAF model. Three groups were tested: control pigs (CP), low-energy fracture pigs (LEP), and high-energy fracture pigs (HEP). Chondral samples were taken from the plafond adjacent to fracture (Tib-F), plafond at 5 mm away from the fracture (Tib-C), talus near the fracture (Tal-F), and talus 5 mm away from the fracture (Tal-C). At 48 hours, the samples were stained for live and dead cell labeling and confocal microscopy-evaluated cell death.</p><p><strong>Results: </strong>Cell death was significantly greater for the HEP when compared to the LEP. HEP Tib-F fractional cell death was 41.92% (SD 3.5) compared with LEP Tib-F 28.8% (SD 4.32) (<i>P</i> < .0001) and HEP Tal-F fractional cell death was 40.41% (SD 4.1) compared with LEP Tal-F cell death of 25.91% (SD 4.28) (<i>P</i> = .0018). Similarly, the fractional cell death of chondral samples near the fracture was significantly greater than the cell death 5 mm away from the fracture in both the LEP and HEP (all <i>P</i> < .0001). Finally, despite no visible fractures of the talar dome, the chondrocyte cell death was not significantly different between the tibia and the talus (HEP Tib-F 41.92% vs HEP Tal-F 40.41%, <i>P</i> = .29; LEP Tib-F 28.80% vs LEP Tal-F 25.91%, <i>P</i> = .16).</p><p><strong>Conclusion: </strong>Chondrocyte cell death was greatest at the fracture margin and in high-energy fractures. Interestingly, across both high- and low-energy IAF models, the chondrocyte cell injury rate was similar for both the talar dome and tibial plafond. Future research should focus on mitigating chondrocyte demise after injury.</p><p><strong>Clinical relevance: </strong>The rate of posttraumatic osteoarthritis after tibial plafond injuries in humans is exceedingly high despite advances in operative treatment. This study uses a clinically relevant, large-animal pilon fracture model to evaluate rates of chondrocyte cell death after 48 hours. This study confirms that cartilage cell death is associated with proximity to the fracture lines, higher-energy injury, and that pilon injuries impact cartilage on both the tibia and talus.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007251341310"},"PeriodicalIF":0.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Can We Learn From Large Animal Models of Intraarticular Fracture?","authors":"J L Marsh","doi":"10.1177/10711007251351597","DOIUrl":"https://doi.org/10.1177/10711007251351597","url":null,"abstract":"","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007251351597"},"PeriodicalIF":0.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Functional Outcomes After Single-Stage Achilles Tendon Reconstruction Using Free Anterolateral Thigh Flap With Tubularized Fascia Lata.","authors":"Sami Ferdousian, Isabel A Snee, Rachel N Rohrich, Ryan P Lin, Karen R Li, Meghan E Currin, Jess Lee, Christopher E Attinger, Richard C Youn, Karen K Evans","doi":"10.1177/10711007251343556","DOIUrl":"https://doi.org/10.1177/10711007251343556","url":null,"abstract":"<p><strong>Background: </strong>Achilles tendon injury with extensive soft tissue loss presents challenges to lower extremity (LE) reconstruction with functionally favorable results. The use of a free anterolateral thigh (ALT) flap incorporating a tubularized fascia lata (FL) segment offers a reconstructive option for these complex cases. This study evaluates the early outcomes of microsurgical reconstruction for Achilles tendon and soft tissue defects.</p><p><strong>Methods: </strong>A retrospective review of patients requiring LE free tissue transfer (FTT) between 2012 and 2023 was performed. All patients included had Achilles tendon defects and underwent reconstruction using an ALT flap with tubularized FL. Demographics, comorbid conditions, baseline functionality, reconstructive details, and wound characteristics were collected. Primary outcomes were flap success, return to functional ambulation, and complication rate.</p><p><strong>Results: </strong>Twenty-two patients underwent single-stage FTT for both soft tissue coverage and Achilles tendon reconstruction. The average age was 46.9 ± 16.1 years, with a median Charlson Comorbidity Index of 0 (IQR: 2). Average wound size was 80.6 ± 40.1 cm². All patients (n = 22, 100.0%) were ambulatory preoperatively. Flap success rate was 95.5% (n = 21). Twelve patients (55%) had long-term physical therapy follow-up. At a median of 7.6 months (IQR: 5.2), median ankle active range of motion (AROM) was 15 degrees (IQR: 7) for dorsiflexion (DF) and 43.5 degrees (IQR: 10) for plantarflexion (PF). Eleven (50%) patients had normal DF AROM (91.7%), and 9 (81.8%) patients had normal PF AROM. At a median of 2.3 months (IQR: 2.8), all 22 patients (100.0%) returned to full weightbearing and ambulation. Median follow-up time was 6.9 months (IQR: 16.5). These findings reflect early functional outcomes, with a median follow-up period of less than 1 year.</p><p><strong>Conclusion: </strong>The ALT free flap with an attached FL is a functional reconstructive technique for Achilles tendon injury in the setting of large soft tissue defects. The composite free flap provides consistent operative success with robust early patient return to ambulation and weightbearing. Further evaluation into patient-reported outcomes can provide additional understanding of functionality.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007251343556"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Calcaneal Osteotomies on Gait Kinematics in Simulated Progressive Collapsing Foot Deformity: A Cadaveric Study.","authors":"Jensen K Henry, Jeffrey K Hoffman, Jaeyoung Kim, Kira Lu, Brett Steineman, Constantine Demetracopoulos, Jonathan Deland, Scott Ellis","doi":"10.1177/10711007251351308","DOIUrl":"https://doi.org/10.1177/10711007251351308","url":null,"abstract":"<p><strong>Background: </strong>Calcaneal osteotomies are often used to correct hindfoot valgus and forefoot abduction in patients with PCFD. Calcaneal osteotomies are commonly performed to address hindfoot valgus and forefoot abduction present with PCFD. This study compared the dynamic effects of medializing calcaneal osteotomy (MCO) and lateral column lengthening (LCL), after simulated PCFD (sPCFD), on joint kinematics and plantar pressure during simulated gait.</p><p><strong>Methods: </strong>Twelve cadaveric mid-tibia specimens were loaded on a 6-degree-of-freedom robotic gait simulator. Gait was simulated first in the intact and sPCFD conditions. After sPCFD testing, surgical reconstruction and testing was performed in stages with MCO and LCL (6- and 8-mm grafts). Ankle, subtalar, and talonavicular joint kinematics and plantar pressures were collected, and differences compared between the intact, sPCFD, and surgically corrected conditions.</p><p><strong>Results: </strong>The isolated MCO partially corrected foot kinematics, and notably increased talar dorsiflexion throughout the stance. The isolated LCL restored ankle kinematics, but subtalar eversion and talonavicular abduction were still uncorrected during stance. However, LCL and MCO together were able to restore talonavicular kinematics throughout stance to normal levels. Larger LCL graft size further improved foot kinematics, but resulted in overcorrection in the subtalar and ankle joints during portions of stance. All procedure combinations increased lateral plantar pressure relative to the sPCFD condition.</p><p><strong>Conclusion: </strong>Isolated MCO and LCL, and a combination of both, all partially restored ankle and hindfoot joint kinematics. However, overcorrection in certain planes of motion and increased lateral plantar pressure suggest a risk of lateral column overload as LCL graft size increases.</p><p><strong>Clinical relevance: </strong>The synergistic effect of MCO and LCL may be effective at restoring kinematics, but surgeons should be cautious in increasing osteotomy size at the lateral column to avoid overload. Gait simulation may help us learn how to titrate combinations of corrections that best restore kinematics-and ultimately, improve clinical outcomes.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007251351308"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate Postoperative Weightbearing Following Arthroscopic Bone Marrow Stimulation for Talar Osteochondral Lesions: A Matched Cohort Study.","authors":"Tristan M F Buck, Jari Dahmen, Quinten G H Rikken, Julian J Hollander, Sjoerd A S Stufkens, Gino M M J Kerkhoffs","doi":"10.1177/10711007251348196","DOIUrl":"https://doi.org/10.1177/10711007251348196","url":null,"abstract":"<p><strong>Background: </strong>Bone marrow stimulation (BMS) is the most frequently performed surgical procedure for osteochondral lesions of the talus (OLTs). After the surgical intervention, one of the first goals of rehabilitation is to resume weightbearing. This study aims to compare clinical and radiologic outcomes between immediate weightbearing and delayed weightbearing, which represent unrestricted weightbearing and weightbearing starting at 6 weeks postoperatively.</p><p><strong>Methods: </strong>All patients who underwent BMS for their OLT between July 2019 and September 2022 in our clinic were screened for eligibility. Patients were retrospectively included with prospective collected data and were matched into 2 groups, the immediate weightbearing group or the delayed weightbearing group. The following variables were used for matching: age, gender, side, lesion size (volume and surface measured on CT scans), primary or nonprimary lesion, body mass index (BMI) and the numeric rating scale (NRS) of pain during walking. The primary outcome of this study is the comparison of the change in NRS of pain during walking between baseline and 12 months postoperatively, between both groups. Secondary outcomes consist of change in the NRS of pain during running, NRS pain during stairclimbing, NRS pain during rest, 36-Item Short Form Health Survey, Foot and Ankle Outcome Score, return to work, return to sport, and radiologic outcomes between both groups at 12 months.</p><p><strong>Results: </strong>After matching, 13 patients per group were included. Both groups showed improvement in NRS pain during walking from baseline to 12 months postoperatively. The difference in change scores between immediate and delayed weightbearing was not statistically significant (<i>P</i> = .57, 95% CI -3.25 to 1.86). A higher proportion of patients in the immediate weightbearing group exceeded the minimal clinically important difference threshold of 2 points compared with the delayed group (OR = 1.9, 95% CI 0.30-11.7), although this was not statistically significant. No significant between-group differences were observed in secondary clinical or radiologic outcomes, nor in return-to-work or return-to-sport rates.</p><p><strong>Conclusion: </strong>This matched cohort study found no statistically significant difference in clinical or radiologic outcomes at 12 months between immediate and delayed weightbearing following arthroscopic BMS for talar osteochondral lesions. Although early weightbearing may be feasible and well tolerated, the small sample size and wide CIs limit the strength of conclusions. These findings should be considered hypothesis-generating and underscore the need for larger, prospective trials.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007251348196"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}