Foot & ankle international最新文献

{"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}

{"title":"Postoperative Sensory Nerve Complications Following Ankle Arthroscopy: Incidence, Risk Factors, and Clinical Course in 545 Consecutive Procedures.","authors":"David Roche, Ronny Lopes","doi":"10.1177/10711007261463237","DOIUrl":"10.1177/10711007261463237","url":null,"abstract":"<p><strong>Background: </strong>Neurologic complications are among the most frequent adverse events after ankle arthroscopy, yet their clinical course and prognostic factors remain incompletely defined. This study aimed to determine the incidence, risk factors, and natural history of postoperative neurologic complications following ankle arthroscopy.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted including 545 consecutive arthroscopic procedures of the ankle and hindfoot performed at a single referral center (October 2023-May 2025). Postoperative neurologic complications involving the superficial peroneal nerve or sural nerve were identified at routine follow-up. Patients presenting neurologic symptoms completed a structured electronic questionnaire assessing symptom onset, pain intensity, temporal evolution, neuropathic pain characteristics (DN4 and S-LANSS), and functional outcome using the Simple Ankle Value. Multivariable logistic regression analyses were performed to identify factors associated with neurologic injury and spontaneous symptom resolution.</p><p><strong>Results: </strong>Neurologic complications occurred in 46 procedures (8.4%). The superficial peroneal nerve was most frequently involved (65.2%), followed by the sural nerve (23.9%). Symptoms developed within 48 hours postoperatively in 64.4% of cases. At a mean follow-up of 13 months, complete symptom resolution was observed in 44.4% of patients, while 84.4% reported progressive improvement. Smoking and surgical approach were independently associated with neurologic complications. Higher residual pain intensity and neuropathic pain features (S-LANSS ≥12) were associated with a lower likelihood of spontaneous recovery.</p><p><strong>Conclusion: </strong>Postoperative sensory nerve complications after ankle arthroscopy occurred in 8.4% of procedures and predominantly involved the superficial peroneal nerve. Although most patients reported progressive improvement, complete symptom resolution occurred in fewer than half at a mean follow-up of 13 months, which is a longer course than traditionally assumed. Smoking and non-anterior surgical approaches were independently associated with complications, and neuropathic pain features predicted lower rates of spontaneous recovery. These findings support individualized preoperative counseling and early recognition of neuropathic symptoms.</p><p><strong>Level of evidence: </strong>Level IV, retrospective cohort study.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"1137-1147"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595219","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":"COFAS Grade is not Associated with Outcomes following Infinity Total Ankle Arthroplasty: A Multicenter Study with Minimum Five-Year Follow-Up.","authors":"David Townshend, Rebecca Martin, Andrew Bing, Chris Blundell, Tim Clough, James Davenport, Howard Davies, James Davis, Sunil Dhar, Steve Hepple, Rajesh Kakwani, Mike Karski, Nilesh Makwana, John McKinley, Aradhyula Murty, Martin Raglan, Hisham Shalaby, Ian Sharpe, Robert Smith, Heath Taylor, Andrew Goldberg","doi":"10.1177/10711007261463232","DOIUrl":"10.1177/10711007261463232","url":null,"abstract":"<p><strong>Background: </strong>Total ankle arthroplasty (TAA) is increasingly used for end-stage ankle arthritis, with modern fixed-bearing designs demonstrating improved survivorship. The Canadian Orthopaedic Foot and Ankle Society (COFAS) classification stratifies patients by intra-articular and extra-articular deformity and adjacent joint arthritis. However, limited evidence exists on the impact of COFAS grade on mid-term TAA outcomes. This study reports the minimum 5-year outcomes of the Infinity fixed-bearing TAA and examines whether COFAS grade influences survivorship (defined as freedom from revision), complications, reoperations, revisions, radiographic findings, or patient-reported outcomes (PROMs).</p><p><strong>Methods: </strong>A prospective, multi-center observational study included 502 ankles in 496 patients who underwent primary Infinity TAA across 11 UK centers. Patients were stratified by preoperative COFAS grade. Outcomes included implant survivorship, complications, reoperations, revisions, radiographic assessment of radiolucencies, and PROMs (the Manchester-Oxford Foot Questionnaire; the Ankle Osteoarthritis Scale [AOS]; and the EuroQol 5-dimension, 5-level index) collected preoperatively and at 2 and 5 years postoperatively. Patient-specific instrumentation (PSI) use was also recorded.</p><p><strong>Results: </strong>Five-year implant survivorship was 98.2%, and reoperation without revision was 5.8%. There was no significant association between COFAS grade and revision or reoperation rates. Radiographic analysis demonstrated 5.7% linear radiolucencies >2 mm and 10.9% cystic radiolucencies >5 mm, with no correlation to COFAS grade. PROMs improved significantly across all domains from baseline to 5 years, with no differences between COFAS grades. PSI, used in 20.1% of cases, was associated with improved AOS scores at 5 years, though PSI and site effects could not be fully disentangled, and did not influence complication, revision, or radiographic outcomes.</p><p><strong>Conclusion: </strong>In this large multicenter cohort, higher COFAS grades were not associated with inferior outcomes in patients undergoing Infinity fixed-bearing TAA. Survivorship, complications, reoperations, radiographic outcomes, and PROMs were not statistically different across all grades. In this cohort, Infinity TAA was associated with favorable outcomes across all COFAS grades, including those with complex deformity or adjacent joint disease.</p><p><strong>Level of evidence: </strong>Level II, prospective cohort study.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"1094-1104"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868611","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 Effect of Flexible Suture Button Fixation on the Reduction of the Syndesmosis: A Cadaver Study.","authors":"Lydia Roward, Zachary Reynolds, James Harris, Kyle Jeray, John D Jd Adams","doi":"10.1177/10711007261462519","DOIUrl":"10.1177/10711007261462519","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;To evaluate the reduction ability of a suture button device on the syndesmosis and determine whether quadricortical or tricortical placement of the cortical button affects syndesmotic reduction; prior studies have not quantified the degree of improvement or determined whether button position or drill hole aperture accounts for the reduction benefit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Seven cadaveric lower extremity specimens were used. Syndesmotic ligaments were sectioned. To evaluate the reduction ability, the fibula was intentionally malreduced either anterior or posterior. A 3.5-mm screw was placed followed by a TightRope (Arthrex Inc) placed quadricortical and tricortical, all placed through the same drill path and trajectory. Axial CT scans using a 3D fluoroscopic spin (Siemens Cios Spin; Simens Healthineers) were obtained after each implant: screw (S), quadricortical (Q) TightRope, and tricortical (T) TightRope. Translation and rotation were calculated. Reduction improvement from S was calculated for Q and T and analyzed using 1-sample &lt;i&gt;t&lt;/i&gt; tests. A paired &lt;i&gt;t&lt;/i&gt; test was used to compare the average improvement between Q and T.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The average intentional malreduction in S was 5.10 ± 2.8 mm. The average rotational difference from baseline was 12.7° ± 4.0°, with 5 of 7 having internal rotation. In comparison, the reduction improved by 2.50 ± 1.6 mm (&lt;i&gt;P&lt;/i&gt; = .005) in Q and 3.2 ± 1.5 mm in T (&lt;i&gt;P&lt;/i&gt; = .001). With the numbers available, no significant difference could be detected between Q and T (&lt;i&gt;P&lt;/i&gt; = .27). In both Q and T, 3 specimens returned to within 1 mm of baseline reduction. Q improved an average of 8.9° ± 6.1° (&lt;i&gt;P&lt;/i&gt; = .008) and within 3.9° ± 5.2° of baseline fibular rotation. T improved by an average of 11.6° ± 4.5° (&lt;i&gt;P&lt;/i&gt; = .0004) and within 1.3° ± 1.1° of baseline fibular rotation. With the numbers available, no significant difference in rotational improvement between Q and T could be detected (&lt;i&gt;P&lt;/i&gt; = .227).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Placement of a suture button device appears to aid in syndesmotic reduction at the time of fixation toward anatomic, with an average improvement of approximately 3 mm of translation and approximately 10° of rotation. Quadricortical and tricortical placement does not seem to play a major role in the improvement of reduction; the degree of correction appears related to the 3.7-mm drill aperture permitting suture movement rather than button position.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical relevance: &lt;/strong&gt;Surgeons can expect a flexible suture button device to improve a suboptimal provisional syndesmotic reduction at the time of fixation by approximately 3 mm of translation and 10° of rotation. This improvement does not appear to depend on whether the construct is quadricortical or tricortical, suggesting that button position need not drive device selection for this purpose. As new flexible fixation devices enter the market, surg","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"1201-1206"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763815","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":"Passive and Dynamic Stabilizers of First Ray Alignment After TMT-I Fusion: The C1-C2 Intercuneiform Ligament and Peroneus Longus in a Sequential Cadaveric Destabilization Model.","authors":"Alena Richter, Peter Savov, Sarah Ettinger, Leif Claassen, Daiwei Yao, Frederik Emanuel Mann, Anna Altemeier, Christian Plaass","doi":"10.1177/10711007261460458","DOIUrl":"10.1177/10711007261460458","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend first tarsometatarsal joint (TMT-I) fusion in case of symptomatic hallux valgus (HV) with TMT-I instability. Despite successful TMT-I fusion, recurrence rates of 1.7% to 2.9% have been reported suggesting that residual instability of surrounding structures may contribute to recurrent deformity. The aim of this study was to measure the effect of sequential sectioning of the surrounding ligamentous structures in a TMT-I fusion model with and without activation of the peroneus longus tendon.</p><p><strong>Methods: </strong>Crossed-screw TMT-I fusion was performed in 6 cadaveric feet, and an optical infrared marker camera system was installed to detect relative movements between the first and second metatarsal head. A transverse force of 10 N and a vertical force in the coronal plane of 15 N were applied on the first metatarsal head and sectioning of the M. abductor hallucis, the dorsal and plantar Lisfranc ligaments, and the medial-middle intercuneiform ligament (C1-C2) were performed. The influence of the peroneus longus tendon (PL) was additionally evaluated.</p><p><strong>Results: </strong>In the transverse plane, significant changes occurred after sectioning of dorsal and plantar Lisfranc ligaments and predominantly after cutting the medial-middle intercuneiform ligament (C1-C2) without PL force (mean difference: 2.3°, 95% CI: -4.16 to -0.4°, <i>P</i> = .0234). In coronal plane, the overall effect of ligament release was not significant (<i>P</i> = .132); post hoc analysis identified a significant increase in first metatarsal translation only after release of the M. abductor hallucis tendon without PL force (mean difference: 0.9°, 95% CI: -1.68 to -0.09°, <i>P</i> = .033). There was a significant influence of the PL force, especially in transverse plane (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>Sequential sectioning of the M. abductor hallucis, dorsal and plantar tarsometatarsal ligaments, and the medial-middle intercuneiform ligament was associated with progressive first ray instability in this cadaveric model. PL activation provided a significant dynamic stabilizing effect, particularly in the transverse plane, where it compensated for progressive ligamentous insufficiency; in the coronal plane, abductor hallucis release was the primary destabilizing event and PL compensation was significant only under full destabilization.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"1207-1216"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Internal Validation of a Predictive Model for Clinically Meaningful AOS Improvement After Primary Total Ankle Arthroplasty.","authors":"Carlos F Albarrán, Marianne Koolen, Tudor Trache, Sultan K Alharbi, Andrea Veljkovic, Oliver Gagne, Murray J Penner, Alastair Younger, Kevin Wing","doi":"10.1177/10711007261463241","DOIUrl":"10.1177/10711007261463241","url":null,"abstract":"<p><strong>Background: </strong>Ankle osteoarthritis is a condition that generates a level of disability comparable to that of heart failure, chronic kidney failure, and end-stage hip and knee arthritis. To date, no predictive model has been described to determine which patients will experience a more pronounced improvement in patient-reported disability following total ankle replacement.</p><p><strong>Methods: </strong>In this prospective cohort study, we included all patients between 2003 and 2023 who after joint decision making with their surgeon elected to undergo a total ankle replacement. Patients undergoing primary ankle fusion, revision total ankle replacement, with a history of previous ankle infection or Charcot neuroarthropathy, and those who declined to participate in the registry were excluded. A total ankle arthroplasty was considered to have a good response if patients showed a difference greater or equal than 28 points between the pre-operative and the 1-2-year AOS score. A multivariable logistic regression using a stepwise method was performed, adding or removing variables, and analyzing demographic variables (age at the time of surgery, smoking status, diabetes, inflammatory pathology, and body mass index), prosthesis type (Infinity, InBone II, InVision, Agility, Hintegra, Mobility, Zimmer, and STAR), etiology, and the AOS at the time of enrollment. As variables were added or removed, the model's Akaike information criterion was compared, ultimately keeping the most parsimonious version. After model selection, overfitting was evaluated using a bootstrapping method with 1000 replications, and finally, the goodness of fit was assessed with the Hosmer-Lemeshow test.</p><p><strong>Results: </strong>A total of 631 total ankle replacements were included. The average age at the time of surgery was 64.96 ± 9.7 years. The most frequently used total ankle replacement was Hintegra (n = 159), followed by Infinity (n = 151), Zimmer (n = 127), and Agility (n = 78). The variables included in the model were the AOS at the time of enrollment (OR 1.06, <i>P</i> < .01, 95% CI 1.05-1.08) and instability etiology (OR 5.1, <i>P</i> < .01, 95% CI 1.69-15.26). The AUC was 0.76, and when compared using the bootstrapping method, no differences were found, indicating that the model did not show overfitting. Finally, the Hosmer-Lemeshow test showed that calibration was satisfactory.</p><p><strong>Conclusion: </strong>Higher baseline disability and instability-related etiology were associated with increased likelihood of clinically meaningful improvement after TAR. This internally validated model may assist preoperative counseling and shared decision making. A baseline AOS score above 63 was associated with a high probability of clinically meaningful improvement.</p><p><strong>Level of evidence: </strong>Level II, prospective cohort study.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"1117-1125"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815146","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":"No Difference in Short-term Postoperative Complication Rates Between Non-chilled and Chilled Saline Irrigation in Percutaneous Foot and Ankle Surgery.","authors":"Paolo Ivan Fiore, Tyler A Gonzalez, Alice Montagna, Anne Holly Johnson, Ettore Vulcano","doi":"10.1177/10711007261460461","DOIUrl":"10.1177/10711007261460461","url":null,"abstract":"<p><strong>Background: </strong>The advent of minimally invasive percutaneous foot and ankle surgery techniques has helped to lower certain complication rates, including wound infection and nonunion. The percutaneous burr is the work horse to perform these procedures. One concern with burr usage is that heat generated from prolonged use may induce thermal injury to the bone and soft tissues, affecting healing and outcomes. It is in contention whether further chilling the irrigation fluid may affect postoperative complication rates. Thus, the objective of this study is to assess the impact of chilled vs non-chilled saline during burr use on percutaneous double osteotomy bunionectomy.</p><p><strong>Methods: </strong>Data were prospectively collected for 485 consecutive patients undergoing percutaneous double osteotomy bunionectomy at 2 separate facilities, treated with either non-chilled saline or chilled saline. Age, sex, complication rates, union rates and time to union data were collected. Categorical and numerical statistical analysis was performed.</p><p><strong>Results: </strong>A total of 442 patients (chilled = 220, non-chilled = 222) were included. The mean age (SD) for all patients was 50.93 (20.51). Median (IQR) time to union was 12 (2) weeks for the chilled saline group and 12 (1) weeks for the non-chilled saline group (<i>P</i> = .11). Union rates were 100% in the chilled saline group and 100% in the non-chilled saline group (<i>P</i> = 1). Complication rates were 1.36% (95% CI, 0.28%-3.93%) in the chilled saline group and 0.45% (95% CI, 0.01%-2.49%) in the non-chilled saline group (<i>P</i> = 0.30).The complications seen in the chilled saline group included 1 superficial wound dehiscence and 2 delayed unions. The non-chilled saline group saw 1 case of painful hardware removal.</p><p><strong>Conclusion: </strong>Based on our results, no significant difference could be detected between chilled saline and non-chilled saline groups during burr use for percutaneous double osteotomy bunionectomy when comparing union times, union rates, and complication rates (all <i>P</i> > 0.05).</p><p><strong>Level of evidence: </strong>Level II, prospective cohort study.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"1089-1093"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984348","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 Amount of Peroneus Longus Insertion Resection With Modified Lapidus Procedure for Severe Hallux Valgus: Comparative Radiographic Study of 2 Different Osteotomy Methods.","authors":"Satoru Sakurai, Tomoyuki Nakasa, Yasunari Ikuta, Saori Ishibashi, Dan Moriwaki, Taro Chujo, Nobuo Adachi","doi":"10.1177/10711007261457068","DOIUrl":"10.1177/10711007261457068","url":null,"abstract":"<p><strong>Background: </strong>Modified Lapidus procedure is well established for severe hallux valgus (HV). Nonetheless, postoperative recurrence remains a clinical concern. Peroneus longus (PL) functions as a dynamic stabilizer of the first ray, and its insertion at the base of the first metatarsal may be partially resected during osteotomy. Notably, PL dysfunction may contribute to recurrence by contributing to postoperative first ray instability. Nevertheless, extent of PL insertion resection during modified Lapidus procedure has not been quantified. This study aimed to evaluate the extent of resected PL insertion during modified Lapidus procedure.</p><p><strong>Methods: </strong>We retrospectively reviewed 80 feet from 74 patients with severe HV. We simulated 2 osteotomy methods: lateral wedge osteotomy at the base of the first metatarsal (M-method) and lateral wedge osteotomy at the distal medial cuneiform (C-method). On radiographs, resected lateral edge length of the first metatarsal (rM1-length) to correct intermetatarsal angle (IMA) to 0° was measured. Based on the rM1-length, 3-dimensional computed tomography models were used to measure whole PL insertion length, resected PL insertion length (rPL-length), and percentage of resected PL insertion (%-rPL). These parameters between the M-method and the C-method were compared. Cutoff value of the IMA for diagnosing feet with %-rPL greater than 50% using the M-method was evaluated.</p><p><strong>Results: </strong>rM1-length, rPL-length, and %-rPL were significantly greater with the M-method than with the C-method (all <i>P</i> < .001). Notably, the mean %-rPL with the M-method exceeded 50%. The IMA cutoff value was 21.4°; however, with the numbers available, no statistically significant difference was detected in the rPL-length and %-rPL with the C-method above and below this cutoff.</p><p><strong>Conclusion: </strong>Lateral wedge osteotomy at the first metatarsal may result in substantial PL insertion resection during the modified Lapidus procedure. Lateral wedge osteotomy of the medial cuneiform bone may better preserve PL insertion and potentially have implications for first ray stability.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"1126-1136"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393074","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}