Foot & ankle international最新文献

{"title":"Ligament Advanced Reinforcement System (LARS) Augmented Repair vs Autograft Reconstruction for Chronic Lateral Ankle Instability: A Retrospective Comparative Study.","authors":"Tong Wu, Zi Li, Jingjing Zhao, Cheng Hao, Wei Xie, Ke Fu, Shenghong Jia, Zhenhua Fang","doi":"10.1177/10711007261481801","DOIUrl":"https://doi.org/10.1177/10711007261481801","url":null,"abstract":"<p><strong>Background: </strong>Both autograft reconstruction and Ligament Advanced Reinforcement System (LARS) augmented repair are used for chronic ankle instability (CAI), but comparative evidence regarding postoperative recovery remains limited. This study compared recovery trajectories and functional outcomes between these techniques over 24 months.</p><p><strong>Methods: </strong>A total of 112 patients with CAI undergoing LARS augmented repair (n = 54) or autograft reconstruction (n = 58) were retrospectively analyzed. Primary outcomes were the Foot and Ankle Outcome Score Sport and Recreation subscale (FAOS-Sport) and Tegner activity score. Secondary outcomes included other FAOS subscales and visual analog scale (VAS) pain scores. Outcomes were assessed preoperatively and at 1, 3, 6, 12, and 24 months postoperatively; VAS was not assessed at 24 months. Longitudinal recovery trajectories were analyzed using generalized estimating equations, and an exploratory FAOS-based minimal clinically important difference (MCID) responder analysis was performed.</p><p><strong>Results: </strong>All outcomes improved significantly over time (all <i>P</i> < .001). Compared with the autograft group, the LARS group demonstrated higher FAOS-Sport and Tegner scores at 1, 3, and 6 months (all <i>P</i> < .001), indicating faster early functional recovery. Similar early advantages were observed in secondary outcomes, but between-group differences were no longer evident at 12 and 24 months. In the exploratory MCID analysis, a greater proportion of LARS patients achieved the FAOS MCID at 3 months, whereas all available patients in both groups reached the threshold by 6 months.</p><p><strong>Conclusion: </strong>Both LARS augmented repair and autograft reconstruction were associated with improved functional outcomes over time. LARS was associated with faster early recovery, whereas differences diminished over time and no significant between-group difference could be detected in the outcomes available by 24 months. LARS may be considered for patients prioritizing early functional recovery.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007261481801"},"PeriodicalIF":2.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978641","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":"Radiofrequency Ablation for Interdigital Neuroma: Moderate 2-Year Outcomes and Surgical Conversion Rate.","authors":"Rodrigo Díaz-Fernández, Paula Martín-de-Salvador, Rocío Valverde-Vázquez, Alejandro Oliver-Grosso","doi":"10.1177/10711007261473603","DOIUrl":"10.1177/10711007261473603","url":null,"abstract":"<p><strong>Background: </strong>Radiofrequency ablation (RFA) has emerged as a minimally invasive alternative for the treatment of interdigital neuroma; however, evidence regarding its midterm effectiveness remains limited. The aim of this study was to evaluate midterm clinical outcomes following RFA, focusing on pain relief, functional improvement, and the need for subsequent surgery.</p><p><strong>Methods: </strong>A retrospective observational study was conducted including patients with a single symptomatic interdigital neuroma treated with RFA between January 2019 and January 2024. Patients with multiple or bilateral neuromas were excluded. Clinical outcomes were assessed at a minimum follow-up of 2 years using the visual analog scale (VAS) and the Manchester-Oxford Foot Questionnaire (MOXFQ). A clinically meaningful improvement was defined as a reduction of ≥3 points in VAS.</p><p><strong>Results: </strong>Sixty-three patients were included. A clinically meaningful reduction in VAS was achieved in 65.2% of patients. MOXFQ scores improved (<i>P</i> < .001 for all domains) across all domains, exceeding the minimal clinically important change in pain and function subscales. However, 27.0% of patients ultimately required surgical treatment. No significant predictors of clinical response were identified.</p><p><strong>Conclusion: </strong>RFA was associated with moderate pain and functional improvement in selected patients with interdigital neuroma. Although approximately one-quarter of patients ultimately required surgical treatment, postoperative outcomes remained favorable, supporting RFA as a reasonable intermediate treatment option for appropriately selected patients. These findings highlight the need for careful patient selection, realistic preoperative counseling, and further comparative studies with alternative surgical techniques.</p><p><strong>Level of evidence: </strong>Level IV, therapeutic study.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007261473603"},"PeriodicalIF":2.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979043","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":"Functional Outcomes Following Hallux Sesamoidectomy in Athletic and Non-Athletic Populations at Two-Year Follow-Up.","authors":"Warren P Austin, Rachit Saggar, Joseph P Mullen, Abdulganeey O Olawin, Akeem Williams, Eva Heidinger, Lauren K Lewis, MaCalus V Hogan","doi":"10.1177/10711007261472906","DOIUrl":"https://doi.org/10.1177/10711007261472906","url":null,"abstract":"<p><strong>Background: </strong>The hallucal sesamoids are 2 small ovoid bones embedded within the flexor hallucis brevis tendon beneath the first metatarsophalangeal joint. Pathology of these structures can significantly impair foot function, resulting in pain, limited mobility, and reduced quality of life. When conservative treatment fails, surgical excision may be indicated. However, sesamoidectomy remains relatively uncommon, lacks standardized management guidelines, and has limited long-term outcome data. The purpose of the study was to evaluate postoperative functional outcomes following sesamoidectomy using validated patient-reported outcome measures in patients with persistent hallux sesamoid pathology refractory to conservative management, with emphasis on pain and functional improvement in athletes.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on patients who underwent sesamoidectomy between 2014 and 2024 at a single institution. Data were obtained from a secure database. Outcomes included visual analog scale (VAS) pain scores and Foot and Ankle Ability Measure activities of daily living (FAAM ADL) and Sports (FAAM Sp) scores. Patients with both preoperative and postoperative data were included. Descriptive statistics were calculated, and score differences were analyzed using 1-way analysis of variance with Tukey post hoc testing.</p><p><strong>Results: </strong>Forty-two patients met inclusion criteria, including 23 athletes. The mean age was 39.9 ± 19.8 years, and mean BMI was 28.9 ± 6.6. Average follow-up was 2.3 years. FAAM ADL scores improved from 61.2 ± 17.3 to 84.7 ± 16.7 (<i>P</i> < .001), with 78.6% achieving Minimal Clinically Important Difference and 57.1% exceeding Minimal Detectable Change thresholds. VAS pain decreased from 4.6 ± 2.5 to 2.7 ± 2.9 (<i>P</i> < .001). PROMIS Physical Health scores improved from 13.2 ± 2.0 to 15.8 ± 3.2, and PROMIS Mental Health scores improved from 13.9 ± 2.9 to 15.9 ± 3.2 (both <i>P</i> < .001). Athletes demonstrated significant improvement in FAAM Sports scores (39.7 ± 25.8 to 80.8 ± 26.1, <i>P</i> < .001).</p><p><strong>Conclusion: </strong>Sesamoidectomy was associated with meaningful pain relief and functional improvement in patients with refractory hallucal sesamoid pathology, particularly athletes. Although outcomes are encouraging, larger studies with longer follow-up are needed to define long-term durability.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007261472906"},"PeriodicalIF":2.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978406","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":"Outcomes of AO/OTA 43C Pilon Fractures Treated With Open Reduction Internal Fixation or Tibiotalocalcaneal Nailing.","authors":"Robin M Litten, M Turner Sankey, Chandler S Harris, Ryan N McIlwain, Clay A Spitler, Joey P Johnson, Michael D Johnson","doi":"10.1177/10711007261481165","DOIUrl":"10.1177/10711007261481165","url":null,"abstract":"<p><strong>Background: </strong>AO/OTA 43C pilon fractures are severe intra-articular distal tibia injuries associated with high complication rates. Although open reduction internal fixation (ORIF) remains the standard treatment, tibiotalocalcaneal (TTC) nailing has been used in select patients; this study compared characteristics and outcomes of patients treated with ORIF or TTC nailing.</p><p><strong>Methods: </strong>A retrospective cohort study was performed of adult patients (≥18 years) with AO/OTA 43C pilon fractures and ≥90 days of follow-up treated operatively at a single level 1 trauma center between 2020 and 2025. Patients treated with TTC nailing were matched 1:1 to patients treated with ORIF based on open vs closed fracture status, with open fractures further matched by Gustilo-Anderson classification. Primary outcomes included fracture-related infection (FRI), reoperation, fracture nonunion, amputation, and hospital length of stay (LOS).</p><p><strong>Results: </strong>In the unmatched cohort (n = 436), TTC patients had higher rates of open fractures (58.6% vs 38.8%, <i>P</i> = .002), higher Injury Severity Scores (ISSs) (15.8 vs 11.3, <i>P</i> = .001), and higher rates of polytrauma (42.9% vs 22.4%, <i>P</i> < .001). TTC nailing was associated with higher rates of FRI (25.7% vs 13.7%, <i>P</i> = .011), longer hospital LOS (13.0 vs 9.4 days, <i>P</i> = .004), and more frequent intensive care unit (ICU) admission (31.4% vs 20.2%, <i>P</i> = .038). After matching, the cohort included 70 TTC and 70 ORIF patients. TTC patients continued to have higher ISS (15.8 vs 11.4, <i>P</i> = .009), higher polytrauma rates (42.9% vs 20.0%, <i>P</i> = .004), more blood transfusions (48.6% vs 17.1%, <i>P</i> < .001), and more frequent ICU admission (31.4% vs 17.1%, <i>P</i> = .049). However, rates of FRI, reoperation, fracture nonunion, and amputation were similar between groups.</p><p><strong>Conclusion: </strong>With the numbers available, rates of postoperative complications showed no significant difference that could be detected between TTC nailing and ORIF after matching, supporting its use as a viable limb salvage strategy in patients with pilon fractures characterized by severe articular comminution, poor bone quality, or compromised soft tissues limiting conventional reconstruction.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007261481165"},"PeriodicalIF":2.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978883","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":"Distribution and Treatment Patterns of Symptomatic Tarsal Coalition in Japan: A Multicenter Retrospective Study.","authors":"Tomohiro Matsui, Kazuya Sugimoto, Kimio Miura, Shinji Isomoto, Norihiro Samoto, Tsukasa Kumai, Kenji Kawamura","doi":"10.1177/10711007261480705","DOIUrl":"https://doi.org/10.1177/10711007261480705","url":null,"abstract":"<p><strong>Background: </strong>Tarsal coalition is the congenital fusion of 2 or more tarsal bones, which can cause pain, restricted motion. Although calcaneonavicular (CN) coalitions have traditionally been reported to be the most common type of tarsal coalition in Western populations, recent East Asian studies have suggested the predominance of talocalcaneal (TC) and naviculocuneiform (NC) coalitions. We hypothesized that TC and NC coalitions are more prevalent than CN coalitions in symptomatic Japanese patients.</p><p><strong>Methods: </strong>This multicenter retrospective study included patients diagnosed with symptomatic tarsal coalition at 4 specialized foot and ankle centers between 1997 and 2025. Demographic data, laterality, coalition type, and treatment modalities were analyzed. Coalitions were categorized as TC, NC, CN, cubonavicular, or cuneometatarsal. Treatments were classified as conservative management, coalition resection, or arthrodesis.</p><p><strong>Results: </strong>A total of 127 coalitions were identified. TC coalitions were the most common type (56.7%), followed by NC (22.8%) and CN (16.5%) coalitions. Other coalitions, namely, cubonavicular (3.1%) and cuneometatarsal (0.8%), were less frequent. Among the TC coalitions, posterior facet involvement was the most frequent (73.6%), followed by combined middle-posterior involvement (22.2%), whereas isolated middle facet and panfacetal coalitions were rare. Bilateral involvement was observed in 18.9% of the patients. Conservative treatment was successful in 33.1% of the cases, whereas surgical treatment was performed in 66.9%, including coalition resection in 60.6%, and arthrodesis in 6.3%.</p><p><strong>Conclusion: </strong>In this symptomatic Japanese cohort, TC coalition was the most common type, followed by a relatively high proportion of NC and CN coalitions. Posterior facet involvement predominates among TC coalitions, whereas previous studies have reported a higher prevalence of middle facet involvement. Coalition resection was the most frequently performed surgical procedure in this cohort, whereas arthrodesis is rarely required. These findings highlight the importance of a computed tomography-based diagnosis for accurate characterization of coalition morphology in symptomatic tarsal coalitions.</p><p><strong>Level of evidence: </strong>Level IV, retrospective descriptive study.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007261480705"},"PeriodicalIF":2.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908132","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":"Perioperative Factors Associated With Postoperative Failure-Free Survival After Arthrodesis for Diabetic Charcot Neuroarthropathy of the Foot or Ankle.","authors":"Qiong Wang, Yan Zhang, Shen Shen, Jie Wang, Jun-Hu Wang, Hong-Mou Zhao","doi":"10.1177/10711007261473606","DOIUrl":"https://doi.org/10.1177/10711007261473606","url":null,"abstract":"<p><strong>Background: </strong>Evidence on perioperative factors associated with postoperative outcomes for diabetic Charcot neuroarthropathy (DCN) of the foot and ankle remains limited. We evaluated whether routinely available clinical, laboratory, and surgery-related variables were associated with postoperative failure-free survival (po-FFS) after arthrodesis.</p><p><strong>Methods: </strong>This single-center retrospective exploratory prognostic factor study screened consecutive surgically treated patients with DCN between June 2017 and October 2025. The final cohort included 83 patients with Eichenholtz stage III DCN of the foot or ankle treated with arthrodesis and follow-up sufficient for early endpoint ascertainment. The primary endpoint was early po-FFS. Kaplan-Meier analyses, Cox regression, sensitivity analyses, and supplementary analyses of anatomic variables and prior ulcer history were performed.</p><p><strong>Results: </strong>Thirty-five of 83 patients (42.2%) experienced postoperative failure, and 48 (57.8%) remained stable during follow-up. The estimated overall po-FFS was 96.0% (95% CI, 88.1%-98.7%) at 6 months and 45.3% (95% CI, 31.2%-58.5%) at 12 months. In the primary multivariable model, longer duration of diabetes (adjusted hazard ratio [HR] 1.091, 95% CI 1.034-1.150; <i>P</i> = .001) and smoking (adjusted HR 2.579, 95% CI 1.119-5.946; <i>P</i> = .026) were associated with worse po-FFS. Glycated hemoglobin (HbA1c) was not independently associated with po-FFS (adjusted HR 1.229, 95% CI 0.972-1.555; <i>P</i> = .085). In sensitivity analyses, duration of diabetes and smoking remained the most consistent factors. Fasting blood glucose was associated with worse po-FFS only in the alternative model replacing HbA1c. Brodsky classification and prior ulcer history were not independently associated with po-FFS after adjustment.</p><p><strong>Conclusion: </strong>Among patients with Eichenholtz stage III DCN of the foot or ankle treated with arthrodesis, diabetes duration and smoking showed the most consistent associations with early po-FFS. Glycemic markers may add information, but findings were marker-dependent. These exploratory findings require validation in larger prospective cohorts with longer follow-up.</p><p><strong>Level of evidence: </strong>Level III, retrospective prognostic cohort study.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007261473606"},"PeriodicalIF":2.2,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901875","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":"Outcomes of Ankle Fractures in Patients With Solid Organ Transplant.","authors":"Thomas R Yetter, Justin O Aflatooni, Roxanne R Miller, Karen L Hernandez, Jason S Ahuero","doi":"10.1177/10711007261473605","DOIUrl":"https://doi.org/10.1177/10711007261473605","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of solid organ transplant (SOT) patients is rising, and orthopaedic surgeons will treat these patients in elective and traumatic settings. Ankle fractures are common orthopaedic injuries often treated with surgery. Because of organ dysfunctions and effects from immunosuppressive regimens, SOT patients may have higher complication rates postoperatively compared with non-SOT patients. However, there is minimal literature reporting on these injuries or the surgical outcomes in this population.</p><p><strong>Methods: </strong>A retrospective case-control study was performed at a single institution to investigate postoperative outcomes of solid organ transplant (SOT) patients undergoing ankle procedures after injury. <i>Current Procedural Terminology</i> (<i>CPT</i>) codes were used to identify patients and their healthy, non-SOT matched controls. Charts were reviewed for infection, nonunion, wound dehiscence, readmission, discharge disposition, hospital length of stay (LOS), and operative time and compared between the 2groups. Generalized estimating equations (GEEs) accounted for the 3:1 matched design, analyzing continuous and categorical data via linear and logistic models, respectively.</p><p><strong>Results: </strong>In this study of 132 patients (33 SOT, 99 non-SOT matched controls), there were no differences in preoperative demographics (age, body mass index, Charlson Comorbidity Index), surgical characteristics (blood loss, procedure time), or postoperative characteristics (anticoagulation, antibiotics, LOS, discharge disposition) between groups. With the numbers available, no significant differences could be detected for 90-day emergency department (ED) visit (36.4% vs 38.4%, <i>P</i> = .846), readmission (30.3% vs 33.3%, <i>P</i> = .762), deep vein thrombosis (0% vs 1.0%, <i>P</i> = .562), pulmonary embolism (0% vs 0%, <i>P</i> = 1.000), or overall complications between groups (48.5% vs 27.3%, <i>P</i> = .137). SOT patients had a higher frequency of nonunion/delayed union (24.2% vs 3.0%, <i>P</i> < .001) and were more likely to undergo external fixation prior to definitive fixation (18.2% vs 5.1%, <i>P</i> = .018).</p><p><strong>Conclusion: </strong>Patients with a history of SOT undergoing ankle procedures after injury did not show a significant difference in readmissions, ED visits, or overall complication rate after surgery compared with non-SOT patients. However, SOT patients did show a higher rate of delayed/nonunion after surgery. Close monitoring for union in SOT patients and a lower threshold for bone healing adjuvant therapies may be advantageous.</p><p><strong>Level of evidence: </strong>Level III, retrospective case-control study.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007261473605"},"PeriodicalIF":2.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876176","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":"The Distal Fascicle of the Anterior Inferior Tibiofibular Ligament (AITFL-df) as a Reliable Landmark for Fibular Tunnel Positioning in Anterior Talofibular Ligament Reconstruction.","authors":"Chenyu Lian, Anhong Wang, Dong Jiang, Chen Jiao, Qinwei Guo","doi":"10.1177/10711007261461286","DOIUrl":"10.1177/10711007261461286","url":null,"abstract":"<p><strong>Background: </strong>Lateral ankle sprain commonly leads to chronic lateral ankle instability, often requiring ATFL reconstruction. Accurate fibular tunnel placement is essential but may be challenging when the fibular obscure tubercle (FOT) is unclear. The distal fascicle of the anterior inferior tibiofibular ligament (AITFL-df) may provide a reliable alternative landmark.</p><p><strong>Methods: </strong>In this retrospective radiographic cohort study, we reviewed patients with chronic lateral ankle instability who underwent anatomic ATFL reconstruction between January 2020 and December 2024. Patients were allocated to 2 groups according to the landmark used intraoperatively for fibular tunnel positioning: the AITFL-df-guided group (tunnel centered 7 mm distal to the AITFL-df) and the FOT-guided group (tunnel centered at the FOT). The evaluation metric was the accuracy and consistency of the fibular tunnel position, quantified as the fibular tunnel ratio on postoperative 3-dimensional computed tomography (3D-CT). Subgroup analysis was performed according to FOT visibility on preoperative 3D-CT.</p><p><strong>Results: </strong>A total of 124 patients were included (61 in the AITFL-df-guided group, 63 in the FOT-guided group). The intra- and interobserver reliability for measuring the fibular tunnel ratio was excellent (intraclass correlation coefficients > 0.87). The mean fibular tunnel ratio was comparable between the AITFL-df and FOT groups (0.45 ± 0.05 vs 0.46 ± 0.10, <i>P</i> = .207). However, the AITFL-df group showed significantly lower variance in tunnel position (<i>P</i> < .001). Subgroup analysis showed similar AITFL-df positioning irrespective of FOT visibility (<i>P</i> = .902 for variance), whereas FOT-guided positioning varied significantly when the FOT was unclear (<i>P</i> = .037 for mean, <i>P</i> = .022 for variance). In FOT- cases, AITFL-df-guided positioning was superior in both mean tunnel ratio and variance.</p><p><strong>Conclusion: </strong>The AITFL-df may serve as a reliable anatomical landmark for fibular tunnel positioning in graft-based ATFL reconstruction. Compared with the FOT, it was associated with greater positioning consistency, particularly when the FOT was unclear.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"1187-1200"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595174","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":"Quantitative Bone SPECT/CT in Varus-Type Ankle Osteoarthritis: Association With Radiographic Stage and Preoperative Pain.","authors":"Kanu Shimokawa, Hidenori Matsubara, Takayuki Shibutani, Daiki Kayano, Yusuke Nakazawa, Hiroto Yoneyama, Takahiro Konishi, Satoru Demura","doi":"10.1177/10711007261469177","DOIUrl":"10.1177/10711007261469177","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the potential clinical relevance of quantitative bone single-photon emission computed tomography combined with computed tomography (SPECT/CT) in patients with ankle osteoarthritis (AOA), focusing on the relationship between radiotracer uptake and disease severity, as well as its correlation with preoperative subjective pain levels.</p><p><strong>Methods: </strong>We retrospectively analyzed 44 patients with varus-type AOA who underwent preoperative bone SPECT/CT between July 2018 and October 2024. All patients were classified according to the Takakura-Tanaka classification: stage 2 (n = 5), stage 3a (n = 15), stage 3b (n = 13), and stage 4 (n = 11). Quantitative parameters included the maximum standardized uptake value (SUVmax), SUVpeak, and total bone uptake (TBU), calculated at thresholds of 20% and 40% of SUVmax. Pain severity was assessed using the visual analog scale (VAS) within 1 month of imaging. Group comparisons were performed using the Kruskal-Wallis test with Dunn post hoc analysis. Pearson correlation coefficient was used to assess associations between uptake values and VAS scores.</p><p><strong>Results: </strong>Both SUV and TBU values showed a general increase in accordance with advancing radiographic stage. In post hoc comparisons with Bonferroni correction, SUVmax and SUVpeak showed significant differences between stages 2 and 3b, stages 2 and 4, and stages 3a and 4 (all <i>P</i> < .0125), whereas 20%TBU and 40%TBU showed significant differences between stages 2 and 4 and stages 3a and 4 (all <i>P</i> < .0125). All 4 quantitative parameters demonstrated moderate correlations with preoperative VAS scores (<i>r</i> = 0.49-0.55, <i>P</i> < .0125), suggesting that both tracer uptake intensity and extent were associated with the patient's perceived pain levels.</p><p><strong>Conclusion: </strong>Quantitative bone SPECT/CT parameters were associated with radiographic severity in patients with varus-type ankle osteoarthritis. Exploratory analyses suggested moderate associations between radiotracer uptake parameters and preoperative pain, although these findings should be interpreted cautiously because VAS data were available only in a subset of patients. These results support further investigation of quantitative SPECT/CT as a complement to conventional radiographic evaluation in AOA.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"1170-1177"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815302","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":"Hybrid, Suture Button, and Screw Fixation for Syndesmotic Stabilization in Isolated Danis Weber Type B and C Fibular Fractures.","authors":"Numan Mercan, Tevfik Çatal","doi":"10.1177/10711007261462530","DOIUrl":"10.1177/10711007261462530","url":null,"abstract":"<p><strong>Background: </strong>Syndesmotic fixation in ankle fractures remains controversial. Hybrid fixation combines a suture button device and a syndesmotic screw, but comparative evidence remains limited. This study compared hybrid, suture button (SB), and screw fixation in isolated Danis Weber type B or C fibular fractures requiring syndesmotic stabilization.</p><p><strong>Methods: </strong>This single-center retrospective cohort study evaluated 90 patients. Groups were Hybrid (n = 28), SB (n = 31), and Screw (n = 31). The primary endpoint was 6-month Olerud Molander Ankle Score (OMAS). Secondary outcomes included visual analog scale (VAS) score, serial OMAS values, 12-month ankle range of motion (ROM), radiographic measurements, and complications.</p><p><strong>Results: </strong>Six-month OMAS did not differ significantly among groups (Hybrid 82.32 ± 7.51, SB 79.35 ± 9.29, Screw 77.10 ± 8.24, <i>P</i> = .091). Plain radiographic measurements were similar throughout follow-up. At 12 months, operated to intact ROM percentage was higher in the SB group than in the Screw group (82.69% ± 9.77% vs 79.54% ± 7.71%, adjusted <i>P</i> = .049). The difference was small, approximately 3.15 percentage points, corresponding to 2.68° of operated-side total ROM. Complication rates remained similar, including and excluding screw breakage (<i>P</i> = .495 and <i>P</i> = .361).</p><p><strong>Conclusion: </strong>Hybrid fixation was not associated with significantly higher 6-month OMAS compared with SB or screw fixation. Because this study was powered for a large effect and was not designed for noninferiority or equivalence, smaller group differences cannot be excluded. The proportion of patients achieving the OMAS MCID threshold was higher in the Hybrid group (85.7%) than in the SB and Screw groups (both 32.3%), reflecting larger within-group score improvement from 12 weeks to 6 months rather than differences in absolute 6-month scores; the clinical significance of this finding is uncertain. The small ROM percentage difference favoring SB over screw fixation was hypothesis generating and of uncertain clinical relevance. These findings suggest that hybrid fixation is a clinically usable option, but future prospective studies should clarify whether combined dynamic and static stabilization offers added value in selected fracture patterns, instability profiles, or patient subgroups.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"1148-1159"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595214","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}